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Roll With the Insulin Changes
For "Parting Causes Great Sorrow," thank you, for bringing into focus the effects of human versus animal insulin, and for shedding light on the need for fine tuning the specific type of insulin appropriate for each person with diabetes.
The October issue of Diabetes Health alerted me to animal insulin's being removed from the U.S. market, and I feel concern for others. I can understand that people with diabetes are worried about changing from one type to another. I believe that, where possible, most insulins should be available.
Perhaps we have forgotten that change is inevitable, and not always bad? There is the possibility that the difficulty described may be due to misunderstanding the new insulins and how they should be used.
I am not a medical person, just a long-time diabetic. I have had more than 20 doctors helping me for over 40 years. I have lived in other parts of the Western world and had two healthy babies. No, it was not all luck.
The new human insulin is wonderful for me and it might be for many others who now have difficulty with it. My current physician told me that human insulin may not be for everyone, but he thought it was just what I needed to really control my diabetes. It was. It takes time with our health teams and self-education to understand new kinds of medication.
Let's not get in a panic about this insulin change. Since the discovery of insulin many great changes have come along. Thank goodness they did. Each of us must work hard with our health team. If the team does not work to help us understand, then we must find a team that will (with HMOs this is not always easy).
If we test our blood as often as we should, even more often when we are ill or on a new insulin type, we may find control easier.
Most of us do not like change in any form. We become comfortable with what we know. The wonderful and positive aspect is that someone out there is always finding better help for us. Nothing is easy about a chronic illness. It takes effort on our part. It is good to read and self-educate, but talking with your health team really helps.
I would like to congratulate Diabetes Health and Robin Harrison on the article about the loss of beef-pork insulin, although I felt it was written with sadness and acceptance rather than justifiable anger. I wonder if controlled anger is not a more realistic and effective reaction to Iletin I's withdrawal. In the U.K., we have been using our anger since 1985, when animal insulin's availability was first threatened. The British Diabetic Association received 3,000 complaint letters. Our anger resulted in the formation of Insulin Dependent Diabetes Trust (IDDT) and we are fighting to maintain consumer choice of insulins.
There is a reality hidden in this article, and that is that the insulins we receive are controlled by the two major pharmaceutical companies who produce insulin. Treatment is no longer based on patient need, nor on the advice of the medical profession.
Your article states that "Over the past decade, the demand for animal insulin has decreased due to availability of human insulin." The reality is that the demand has been reduced because of a systematic withdrawal of animal insulins in countries around the world.
It also says, "Patients should speak to their physicians about transferring to human insulin." Why human insulin? Pork is still available, and is clearly the nearest in structure to beef-pork. This makes one wonder about the future of pork insulin.
We should not simply accept the drug companies' dictation of our choices of treatment. We should resist it, and, dare I say, fight it. As Scott King's October column pointed out, diabetes is a very lucrative business. The least the industry can do it to leave us with a choice of insulins. I recommend that every one of the 300,000 people who use beef-pork write to every authority in the land. Show the anger which is quite justified.
After 4 1/2 years of correspondence with our regulatory body in the U.K., IDDT recently received this statement:
"The Committee on Safety of Medicines has concluded that some patients did experience problems with human insulins, particularly when transferred from animal insulins, and were better suited to continuing their treatment with animal insulins."
If the industry does withdraw animal insulin after this evidence from a well-respected regulatory body, it is proof that it is looking after its own profits and ignoring the needs of people with diabetes and the regulatory authorities set up to protect them.
Jenny Hirst, parent and Chairperson of the IDDT
Northampton, United Kingdom
Don't Test with Your Toes
The information in the October article, "Japanese Doctors Warn of Dangers of Blood Sampling from Fingers," is incorrect and dangerous. You said that the Microlet Vaculance lancing device can be used on sites like the ear lobe or the toe. I recently instructed a patient on using the Vaculance, and nowhere in the information enclosed with the device does it state that ear lobes or toes should be used. Instead, it recommends testing at the forearm, abdomen and thigh.
Lancing the toe is very dangerous. People with diabetes have poor circulation in their toes. If an infection occurred in the toes, neuropathy would make it very hard for the person with diabetes to feel that infection. They are also hard to see, as feet are hidden in shoes all day. Please correct this information clearly to prevent anyone with diabetes from trying it.
Karen LaVine, RN, CDE
Albequerque, New Mexico
On Scott's Column
I read with interest Scott King's column regarding a wish list for new products. I also sensed a message between the lines, hinting on how diabetes product manufacturers envision their long-term survival. Their survival depends upon the never-ending and growing supply of persons with diabetes (and their insurance providers). We necessitate these products.
I don't want to be misunderstood. There have been wondrous developments over the past 20 years. Can any of us imagine trying to maintain tight control by testing our urine? On the other hand, where would we be today if the money, or even a percentage, that is spent on products were directed toward the research for a cure?
I tend to be very skeptical of publicly held corporations, which must show a return for their shareholders. Test strips cost us 50 cents to one dollar each while the meters that use them cost next to nothing.
There are people working on new technologies to monitor our blood glucose, and when those products go on the market, things will get a little easier for us. Yet, what have we seen lately from all the money that has been made? Have meters improved dramatically over the past five years?
I enjoyed your column, "Do You Buy It?" in the October issue. You make several good points and insightful observations regarding the costs associated with the intensive management necessary to avoid long-term complications of diabetes.
My interest was piqued because I work for Chronimed, a manufacturer of blood glucose test strips, and I am wrestling with a paradox. People are reluctant to purchase a blood glucose meter and test strips if they are not familiar with the brand name, yet creating brand awareness and name recognition requires substantial amounts of time and energy. Unfortunately, those expenditures are passed through to the consumer in the price of the product.
Chronimed is a reputable, publicly traded (NASDAQ, CHMD) health care manufacturer recently cited for the second consecutive year in Fortune magazine's "America's Top 100 Fastest-Growing Companies." We achieved this success because our mission is, "To manage costs, improve outcomes and enhance the quality of life for individuals with chronic health conditions."
Chronimed has the Select GT and the Assure blood glucose monitoring systems in the market. The meters are priced comparably to brand name products but the strips are priced 25 percent lower. We can afford this because we allocate an unusually small percentage of revenue toward product marketing and pass the savings through to our consumers. Therein lies the conundrum. How do we create widespread awareness and demand of lower-priced test strips without spending money? If we advertise sufficiently to become better known, we will then be forced to increase the price of test strips.
The bottom line is that suppliers behave the way they do because they are rewarded with sales. Perhaps if people chose lower-cost, value-priced blood glucose monitoring products like the Select GT and Assure, then other manufacturers would get the message. The alternative is supporting aggressive advertising and raised prices.
Robert W. Cramer
Director of Marketing, Chronimed
On Meter Accuracy
I rely on my glucose meter for my life. It infuriates me that glucose meters have little accuracy. Tested at the same time, two different meters, even of the same brand, can be different by as much as 30 points. I find it incredulous, with the amount of money that companies charge for the strips, that in this day and age they cannot come up with a truly accurate meter.
I test frequently and go through a lot of meters. I usually have three or four on hand. Recently my meter gave me a reading of 596. I took insulin immediately. A few minutes later I realized that the meter probably was wrong, so I tested with another meter. I was right. The original meter was wrong. It scared me to death.
I'm getting older, and I can't dance around all these things. I am severely affected by the flaws in these meters. This morning I tested with three different meters. One read 130; another read 157; a third read 160.
Another problem is that it costs a fortune to double check, but you have to. The prices of test strips are so high. Sometimes I need to check 12 times a day. Why do these strips cost so much?
In the past I have called the companies that manufacture the meters with my concerns and questions. When you call them, they give you the same old spiel, asking if you have you used your control. I think the control is ridiculous because it has such a wide spread. It's ludicrous when they tell me things like that.
With the technology they have today, it's unbelievable that they can't come up with an accurate meter.
Pomona, New Jersey
Editor's note: Jeff Christensen is LifeScan's representative who responded to readers' complaints about the FastTake glucose meter, which reads plasma glucose rather than blood glucose.
I am writing about Jeff Christensen's reply about the FastTake meter. It's not reasonable for users to "compare the results directly with lab results." You only get a couple of lab results per year. Since physicians pass on the numbers to patients, it seems more appropriate for physicians to convert the plasma number to whole blood, rather than have the meter second-guess the reverse operation for the user.
Why don't you ask LifeScan how the FastTake meter calculates a "plasma-calibrated" glucose value without knowing the patient's actual hematocrit level? Sounds like a rough "guesstimate" to me.
David R. L. Worthington
Again, Jeff Christensen answered this reader's question.
Judging from Mr. Worthington's letter, it seems that I may not have been as clear as I could have in my explanation.
All blood glucose meters use a whole-blood sample to calculate a blood glucose result. Some models, however, are programmed or calibrated to provide a result expressed as a whole-blood value, while others are calibrated to express a result as a plasma equivalent. While plasma blood glucose results are generally about 12 percent higher than their whole blood glucose equivalents, it is important to understand that neither is more accurate than the other. They are simply different methods for measuring the same thing, blood glucose.
One of the main reasons manufacturers have developed plasma-calibrated meters in recent years is that physicians and clinical chemists have repeatedly asked for them. When patients submit blood samples for laboratory tests, the results are expressed in plasma values. The results of whole blood-calibrated meters can be compared to lab results but they must first be converted mathematically, since they are 12 percent lower than plasma results. (To convert, multiple the whole-blood results by 1.12.) With plasma-calibrated meters, physicians can compare meter results directly to lab results without having to convert.
Cleared by the U.S. Food and Drug Administration, LifeScan's FastTake Meter provides accurate plasma-equivalent blood glucose results, when operated within the limits of its operating humidity, temperature and hematocrit ranges. All meters have designated performance ranges, and the FastTake's are sufficiently broad to meet most people's needs. If you have chronically high or low hematocrit values, though, you should consult with your physician before relying on your glucose meter's results, regardless of the make or model.
Associate Marketing Communications Manager, LifeScan, Inc.
As an avid consumer advocate for more accurate meters, I read with interest Jeff Christensen's diatribe in the September issue. I have used many different meters in attempting to get an HbA1c and fasting level that come close to laboratory results. I understand the differences between plasma-calibrated and whole-blood meters. I know the formulas to go between the two, and between BG readings and HbA1c readings.
In my experience, when using several plasma-calibrated meters simultaneously and comparing them to lab results, they have been from 40 to 167 points different. In comparing the meters themselves, they have been from 12 to 142 points different.
Can anyone explain why using two or three plasma-calibrated meters simultaneously is frowned on? I understand the 20 percent accuracy stipulation, but shouldn't the meters fall somewhat close?
Williamsville, New York
In your Letters to the Editor section in the October issue, you wrote that my research team at the University of California, San Diego has been able to get human islets to divide but that the National Institutes of Health was not funding our work. This is not correct. Both the NIH and the JDF are funding our work very generously. My point to you during our telephone conversation was that it is more difficult to get funding for preclinical or clinical trials than it is for basic research.
Alberto Hayek, MD
Professor of Pediatrics
Stop Covering Type 2 Diabetes
I am a 31-year-old type 1, and I have no cure. Many type 2s can cure or control their diabetes with diet and exercise. I need a pancreas transplant to cure me. I want more information about terminal type 1s.
I'm in great health. I'm thin. I exercise and eat well. I don't want to hear about diet and exercise.
My brother has had type 1 for 19 years. My mother is very overweight and has type 2. All the research money goes to help people like my mother, who hold the cure in their own hands. How much money can you spend telling people to lose weight?
Wood River, Illinois
Diabetes and Driving
Your article, "Hypo Hazards," brought into focus the need to test before you go behind the wheel. The responsible person with diabetes realizes that if he drives with a blood glucose below 60 then he is no better than a drunk. If we wait for the signs it may be too late. Thinking becomes confused, and the obvious is overlooked.
The solution is to test before the key is turned to drive. If you are low, act appropriately, then drive. Driving is a privilege, not a right.
Speak Out With Miss America
In light of the Miss America pageant, I think that the diabetes population should rally and take full advantage of the emerging awareness. Like Miss America 1999, I am an insulin pump wearer. It is astounding that the media is picking up on all this. I say we take the opportunity to speak out now.
I speak out frequently, educating whomever will listen to me. The response from even a handful of people is great, and that's how it all begins. I'm also organizing a local support group in my community. I plan to speak for diabetes awareness and increased federal funding for research. I hope that others will do the same. We have needed the spotlight and now we have it. Let's not lose it.
Man Without Health Insurance Seeks Help
A letter of thanks to the people who called me after I wrote to Diabetes Health about losing my 25-year profession to diabetes neuropathy and retinopathy. I was desperate, as Social Security did not seem to feel that my diabetes complications were very disabling.
My update is that I did finally receive approval for Social Security disability income because I wrote to the president's office and The Los Angeles Times. Although I will get SSDI, they tell me I have to wait two years for Medicare, so I presently have no health care.
I have charcot foot, about which Diabetes Health wrote in the July 1998 issue. It is very crippling and extremely painful. I have total numbness in my toes and front halves of my feet, and the bones hurt all the time.
The nerves in my feet have shown complete loss of feeling. My toes are numb all the time. The bones in the sides of my feet hurt unless I keep my feet elevated. I am ready to have my feet amputated just to stop the pain, which has made me an invalid. It's just too painful to walk on them.
I also have blurry vision. Will laser treatments help this?
I have no medical insurance and no ability to pay for health care. I am open to suggestions. Thank you for being there, Diabetes Health.
Rick Green, the Big Rig driver
Simi Valley, California
Nov 1, 1998