Letters to the Editor
Learning From Experience
After reading the article "Identity Crisis" in the January 1998 issue, I want to help encourage all diabetics, and anyone with a serious medical condition, to get some form of identification. I know from first-hand experience that it works! If it weren't for my bracelet, I may not be here today nor would my healthy four-year-old daughter.
During my first trimester of pregnancy my blood sugar level fell hard and fast to 18 while driving home from work in rush hour traffic. Somehow I crossed traffic and parked my car on the side of a busy road. Someone called for help, and the paramedics quickly saw my medical ID bracelet. The police called my husband using the information I had in the front of my wallet.
Just months before this incident, my family gave me a beautiful bracelet. It has the red medical ID symbol on it soldered to a 14K gold ID bracelet. The front has my name engraved on it, and the back reads "Diabetic-Insulin." I get many compliments on it, and two people that have asked about it now have bracelets very similar to mine.
Port St. Lucie, Fla.
"A Few Words of Encouragement"
I am a medical representative at MediSense, and I just finished Scott King's February column, "My Story," and would like to add a few words of encouragement.
First, let me say how much your words touched my heart. I have a brother who is 15 years younger than me who has hemophilia. Like diabetes, it is chronic and has serious consequences. I remember taking him to a prayer meeting 25 years ago, hoping that God would free him from his disease. I too, believe that prayer is the first line of defense. However, like you, he has been through all of the emotional struggles that go with a chronic illness and still must continue to live with his disease. In addition he has had to deal with HIV because of a contaminated blood supply.
My brother has taught me more about true bravery than any other person in my life. I think that what I have learned from him about the daily struggles of living with a disease that never gives you a break has helped me to identify with the kids' frustrations and victories whom I work with at our Lake Tahoe Diabetes Kids' Camp.
Thank you for your contribution to all who work and live with diabetes.
Annie Munn, MS
Time To Make Some Noise
I read with great interest your story "Consumers Frustrated with HMOs," in the December 1997 issue.
As a pharmacist practicing in the retail environment, I can sympathize with patients who sign up for certain plans and then find that either their plan does not pay for something, they have a limited day supply or they must either use mail order or a certain pharmacy.
I am strongly urging all patients who have had problems with their HMO plans to write not only to their legislators, but to the HMO as well. The people of America will never have better health coverage unless they speak up.
Kathy Karas, RPh
That Terrible Year on Humulin
I am a 26 year-old diabetic who has had diabetes for 22 years, and I am very upset about the prospect of Eli Lilly pulling Iletin I insulin.
I have been taking Iletin I for 21 years. For one year I was put on Humulin and was later found to be extremely allergic to it. I became very sick with severe headaches, lost my hair and swelled up to the point of not being able to walk.
The doctors couldn't understand what was causing my extremely high BGs and ketones. They continued to raise my Humulin dose to almost 200 units a day and I continued to get worse. I couldn't even go to school. I was 15 and had made up in my mind that I couldn't live that way anymore and would rather die.
Finally a diabetic specialist took me off of Humulin and put me back on Lilly's Iletin I. In a matter of weeks I started feeling good and back to my old self again.
I will never forget that terrible year. That's why I want to do everything I can to keep Iletin I on the market. I, and a lot of other diabetics (including my mother), cannot take anything else but Iletin I.
Editors' Reply: Lilly stops production of Iletin I this month. Unfortunately, the only thing you can do is to report your experience to the FDA at (800) 332-1088. You might also want to try contacting Cheryl Smith, RN,MSN, at (413) 369-4339.
D.I. Misses the Point
A recent study of ours is described in your February 1998 issue. The study, a year-long study of low-fat diets, was published in the Journal of the American Medical Association in November. The study was complex and the most important messages were not reported in your article clearly. The illustration (several pounds of hot dogs, hamburger patties, steaks and a whole chicken) would be misleading to readers.
We compared four low-fat diets in men with high blood cholesterol. These diets ranged from 18 percent to 30 percent of calories from fat. All the diets were lower in fat than those the men followed before the study (37 percent fat). We found that all four diets were successful in lowering the men's LDL cholesterol.
The most successful diet had a goal of 26 percent fat. What does a diet like that look like? Very much like the "food pyramid," with up to five ounces a day of seafood, poultry or very lean meat; some nonfat and very low-fat dairy products; a little oil or soft margarine; lots of grains, especially those high in fiber; and lots of vegetables and fruits.
In our study, this food pattern worked as well to lower LDL cholesterol as two more restrictive diets and led to an overall better profile when all the cholesterol-related blood components were measured.
Barbara M. Retzlaff, MPH, RD
Head Research Dietitian
Co-Investigator, Dietary Alternatives Study
Northwest Lipid Research Clinic
Editors' Reply: We sincerely regret over-simplifying your work. In addition, as Anne Sumida of Newhall, Calif. brought to our attention last month, running the aforementioned photo was misleading. We apologize for the oversights.
A Vote for Vegetables
In the February Q&A section, reader Tom Hennessey asks about a vegan diet alleviating neuropathy. Your responder, Dana Arnold, MS, RD, CDE, must have been unaware of the following research when she expressed skepticism that "a totally vegetarian diet can help treat diabetic neuropathy."
The article "Regression of Diabetic Neuropathy with Total Vegetarian (Vegan) Diet" was published in the Journal of Nutritional Medicine (4:431, 1994). In the study, Milton Cranse, MD, of the Weimar Institute in Weimar, Calif., took 21 consecutive patients with diabetic neuropathy and put them on a low-fat (10 to 15 percent of daily calories), high-complex-carbohydrate, high-fiber vegan diet devoid of refined foods. Pain disappeared in 17 of the 21 patients in four to 17 days. Blood sugars improved by 35 percent and triglycerides fell by 25 percent.
Researchers from Georgetown University report that diabetics on this kind of regimen, consuming 60 to 70 grams of fiber from foods high in complex carbohydrates, decreased their fasting blood sugars 59 percent more than those put on the ADA diet recommendations. (Nutrition Report, May 2, 1997 27:17:7)
On February 12, 1997, the Journal of the American Medical Association showed that the opposite of this therapeutic diet, i.e., eating high glycemic index foods deficient in cereal fiber, is a powerful risk factor for the development of diabetes. This fact gives added credence to the possibility that the high-fiber, unrefined diet might be therapeutic.
The vegan diet involved in alleviating neuropathy is similar to that promoted by John McDougall, MD, in his books and his article in the Journal of the American College of Nutrition (14:491, October, 1995).
Anu de Monterice, MD
Dana Arnold's reply: It is difficult to take such a small study and extrapolate its findings to all persons with diabetic neuropathy. True, neuropathic pain disappeared in a majority of subjects but whether it was due to vegetarianism or simply better blood glucose control is unknown. Following this decrease in blood sugars, triglycerides would be expected to fall also.
Second, regarding the benefits of diets such as those included in the Georgetown study and the McDougall diet, I fully agree that a diet containing 60 to 70 grams of fiber per day would be therapeutic for many disease states including diabetes. Such a strict vegan diet, devoid of refined foods and incredibly high in fiber would likely be difficult if not impossible for most people to maintain as a lifelong diet.
This type of diet will lower blood sugars by displacing much of the digestible carbohydrate in the diet with fiber, thereby decreasing postprandial blood sugars. Most vegetarian diets, however, are not composed of unrefined carbohydrates but rather contain a generous amount of refined carbohydrates like pasta or rice. These high glycemic index foods are known to dramatically raise blood sugars and are the foods I was referring to in my answer.
Dana Arnold, MS, RD, CDE
Daly City, Calif.