Letters to the Editor
Heated Insulin Hazard
Trying to save some money, I ordered my Humalog through my insurance's mail-order pharmacy. Three vials arrived in my mailbox in a plain plastic bag, no ice pack and hot to the touch. The package was shipped from Texas to my Florida address and was four days in transit. It was 98 degrees on the day it arrived!
I called the pharmacist, who said that that is the way they ship all their insulin. She assured me it would be fine as long as it wasn't placed on a hot stove. I disagreed and called Eli Lilly, who said that at temperatures greater than 86 degrees the insulin would not remain stable for long
Most mail-order companies are very careful and securely pack their insulin with ice. If yours does not arrive in an ice pack, be careful. It could be the reason your control is not what it should be.
Shirley Vining, RN CDE
Winter Park, Florida
Medical Identification Ignored
The issue of medical identification has been discussed for as many years as I have been a diabetes educator. Prior to several personal experiences, I had encouraged everyone with a medical condition to wear visible ID. Now I don't bother and here is why.
One day in October 1996, I passed out on a sidewalk in Orlando and was taken to Sand Lake Hospital. Although checking for a medical ID bracelet should be the standard emergency treatment procedure, mine was never considered. Neither the paramedics, nor emergency room staff, nor intensive care staff ever regarded my medical ID bracelet. I know this because I was awake during my entire treatment time.
Two days later, I again needed medical emergency treatment and was taken to St. Anthony's Hospital in St. Petersburg. Again, when the paramedics arrived, they never looked for my medical ID, neither did the hospital emergency staff nor the intensive care nursing staff.
The big question now is, do I continue to wear my medical ID? After all, it didn't serve any purpose the two times I needed it most.
Betty Wedman, PhD, RD, LD
St. Petersburg, Florida
Success with Supplements
This letter is in response to Edward Marsh's question and the answer given by Beth Beller, CDE, RD, in the Q & A section of your June issue.
Mr. Marsh asked for "additional information on vitamins that help lower blood glucose levels." Ms. Beller's answer was basically just to take a good multiple.
As a type 1 diabetic for 27 years, this is the very question I have been struggling with and have used many different approaches. Within the last year, I have achieved much better blood glucose control and my insulin requirements have dropped dramatically. Here's what happened.
I read Dr. Bernstein's Diabetes Solution and I have been on the regimen prescribed in the book for a year, including the high-protein, low-carb diet. This is what brought my blood glucose within a normal range much more consistently.
I also started body building. Bill Phillips, a well-known expert in the field of natural body building, recommends alpha-lipoic acid (a co-enzyme), vanadyl sulfate (a biologically active form of the mineral vanadium) and chromium picolinate (a mineral) to increase insulin sensitivity. Through the use of alpha-lipoic acid and chromium picolinate alone, my insulin requirements have dropped from a total of 24 units daily to around 15, while still maintaining excellent blood glucose control.
I also read another invaluable book Dr. Atkin's Vita-Nutrient Solution: Nature's Answer to Drugs. Dr. Atkins lists several vitamins, herbs, and other nutrients that are helpful for type 1 and type 2 diabetics. He suggests supplements for virtually all diabetic complications-neuropathy, retinopathy, heart problems, even joint and tendon problems, which are so often absent from mainstream discussions of diabetes.
All of Dr. Atkins's suggestions are backed up by solid scientific research. As Dr. Atkins said in his book, "We are at the crest of an information explosion about vita-nutrients as treatments for illness."
I do plan to go further with my efforts at reducing my need for injected insulin through use of vita-nutrients and exercise, but I have approached this endeavor with extreme caution, as I would advise anyone to do as well.
Editor: We invited Beth Beller to respond to your letter.
I am glad that you have found a system that helps you keep your blood sugars in good control. Following a dietary plan and exercise is the basis of all diabetes care. In diabetes care we know that treatment must be individualized to meet the daily life requirements of the individual.
Some believe that it is in the blending of modalities that we achieve optimum health. When herbs, vitamins or minerals exert specific effects in the body then they are acting like a drug. Like drugs, these substances can have side effects; as well, they may interact with other medications. Hence, it is important, when one is adding these substances to one's daily care plan, that one enlists the help of a diabetes educator and/or a physician.
Bill Gates Wins
As usual, Melissa Sattley created an excellent article on the promise and issues of islet xenotransplantation ("The Xenotransplantation Debate" July 1998).
I just have one (small and petty) comment: Did I really say, "I know as much about biomedicine now as Bill Gates knows about Microsoft"? The truth is, I do not! Bill wins hands down. If I made this comment, I should have checked my blood glucose before speaking to Melissa.
Keep up the great work!
Alastair T. Gordon, president
The Islet Foundation
Ed: We confirm it was an accurate quote.
Plasma Meter Warnings
In reference to your Business Update, "On the Fast Track with FastTake" (July 1998, p.10), I would like to point out that the FastTake meter measures plasma, not whole blood. Plasma systems usually gives higher blood sugar readings. These differences could lead to taking the wrong dose.
One of the Accu-Chek meters measures plasma as well, and could lead to the same problem if one isn't careful. These companies haven't been making any mention of these differences unless you call the customer service lines and ask about it specifically. Your readers should make sure they are buying a meter that measures their blood glucose the way they are used to.
Manhattan Beach, Calif.
I'd like to alert fellow diabetics to a potentially serious problem with the new LifeScan FastTake blood glucose meter. It measures the glucose in plasma and is not comparable to other monitors like the LifeScan OneTouch Profile.
For instance, a test with the FastTake reads 194, so I adjusted my pump with one unit of Humalog to bring my glucose down to 100. Fortunately, I compared the FastTake reading with the Profile meter and discovered a big difference. My reading was 140 on the Profile. Without food to compensate or my own awareness, my blood glucose could have gone very low.
I contacted LifeScan immediately to discuss this issue and was told that they have rewritten the instruction manual as a result of many phone calls. The new manual, which comes with the new meters, will call attention to this situation. I was encouraged to call the company any time I experience a problem with their products. I believe that this solution could easily be too little too late for a lot of people.
I am returning my FastTake meter to the company and am being reimbursed. I probably don't have any other recourse. I do believe it's a good company, and I really like my OneTouch Profile.
Kathleen K. Wander
Editor: We invited LifeScan to respond to your concern.
First of all, because of variations between different meters and test strips, we don't encourage meter-to-meter comparisons. If you want to do a comparison, we encourage you to compare your results, whether you are using a whole-blood calibrated or plasma calibrated meter, to a lab result. If you are concerned about accuracy, you should perform the control solution test, which will indicate if the meter is operating accurately.
One of the reasons we put out a plasma calibrated meter is so users can compare the results directly with lab results, which are also plasma calibrated. Sometimes people take a whole-blood test and compare it to a lab result, which is confusing. The fact that FastTake is calibrated to plasma makes the comparison easier.
Those accustomed to whole-blood tests should do a control test, and compare it to a lab test to determine if their meter is operating correctly. If it is accurate, then the meter should operate within the sphere of its results. Comparing one meter to another meter only results in confusion.
However, it is good to know that plasma results are about 12 percent higher than whole blood. If you want to compare a lab result to a whole blood meter, divide by 1.12 and that should give the approximate whole blood meter result. Keep in mind, though, that meters are considered clinically accurate within 20 percent, plus or minus, of a lab result.
There's a notice in the FastTake packaging that states these differences. It is important to note that several other meters are plasma calibrated as well.
Communications Manager, LifeScan