Letters to the Editor
One Possible Road to the Cure
My daughter has diabetes. I am stunned that the last significant treatment advance was the development of self-monitoring blood glucose tests in 1980, 18 years ago. Why is it that a disease that costs America over $90 billion a year and accounts for 15 percent of its health care costs should see so little progress in developing a cure or dramatic treatment advances?
I believe the answer lies in the structure of the health care industry. Companies have no interest in investing funds in this research because it could reduce or eliminate their revenues from diabetes and its complications.
It is time to develop a funding mechanism for diabetes research that will produce a much higher level of investment. One possibility is that every time we purchase a diabetes product, we pay a user fee to a government agency. That government agency then funds an independent research group with no financial interest in keeping diabetes around. At the end of the year, we can deduct these user fees from our taxes. This is just one possibility; many others need to be explored.
We must fund the cure. Your help is needed now.
Hospital Food Does a Sick Body Good
In Judith Jones Ambrosini's October recipe column, "Adventures in Hospital Food," she addressed what to do if you get "stuck" with hospital food. She encouraged readers to ask the doctor to write an order for permission to bring in their own food.
I am a registered dietician, diabetes educator, type 1 diabetic, pump wearer and the director of food service at a small rural hospital. While I agree with the author that patients should be able to choose their own food, I feel this is appropriate only for those who have demonstrated the ability to monitor and manage their blood sugars effectively.
Most people are admitted to the hospital when they are sick or recovering from surgery. Blood sugar levels are often higher in these situations, as a result of the stress response. In many cases, high blood sugars have a negative impact on healing or recovery. Physicians order restrictive diets during hospital stays to help people control their blood sugar levels and to stimulate the healing process.
Becky Sulik, RD
More Reactions to Beef-Pork Insulin's Departure
I am another person having abnormal reactions to the human insulins who wants to go back to the beef-pork insulin. I am 47 years old and have had diabetes for 37 years. For 32 years I injected myself with beef-pork insulin one or two times per day. For the past five years, I have been on human insulin, injecting it four or five times per day. I feel terrible and have never had so many hypoglycemic reactions and sleepless nights. I had much better control and felt much better on beef-pork insulin. I am not the energetic person I used to be.
At times I am so upset and depressed that I fear leaving the house because I might have a low blood sugar without warning. Once I experience a low, the rest of my day is shot to pieces.
Something smells fishy. Somebody is benefiting from this change of insulins but it's not the person with diabetes. We need a spokesperson to speak to the insulin companies on behalf of those people who desperately need to go back on the beef-pork insulin. Time is of the essence.
Chevy K. Norman
I've been reading about some patients' troubles with hypoglycemia in Diabetes Health. I'd like to remind you, in case you weren't paying attention to John Walsh's July 1998 article, "Bringing your background insulin to the foreground," that the first thing to do if you want good control is establish a true basal regimen. That should be just under half the total dose and spread over two or more shots, such that you can fast all day long without BGs rising or falling.
It is true that human NPH and Lente, even human Ultralente, don't quite give the length of action that beef does, but establishing a basal dose with them is still possible.
From your readers' letters, and similar anecdotes from other sources, it seems to me that most hypoglycemia comes from a basal dose that is too high. If not, it comes from the worst of all insulin regimens, split/mixed, where a basal insulin, NPH, is actually used to cover a meal and overnight basal needs. It can't do both well, and while it can do the basal task, taking it at supper time in the split/mixed regimen is a prescription for a 3 a.m. hypo, just as taking it at breakfast is a prescription for a prelunch hypo.
You could do all your type 1 readers a favor by encouraging them to establish a true basal regimen with two or three shots of NPH or Lente per day, verified by actually fasting. John Walsh's book is a good start. When the basal dose is low enough that BGs don't fall even while fasting, it can't cause hypoglycemia. Then, the only thing that can get you in trouble is taking too much Regular or Lispro for a meal. You can look out for that by testing two hours after eating. If BGs aren't higher after the meal, you'll know to eat more, or at least to be alert for hypoglycemia signs, and to test yet an hour or two later.
David R. L. Worthington
Editor's note: For more information about John Walsh's book, Stop the Rollercoaster, call (800) 988-4772.
A Lesson on Recognizing Lows
I enjoy the information in your publication. I get information from the pages of Diabetes Health before I hear diabetes "news" anywhere else. I especially related to Pat Shermer's description of her hypoglycemic unawareness in your October issue. Pat has stopped driving alone and her husband is urging her to quit working. Pat, it doesn't have to be this way.
Now in my 15th year of type 1 diabetes, my HbA1c is now steady at 6.2%, but I spent several years experiencing frequent and severe hypos. I used to average at least two life-threatening, rush-to-the-hospital hypos a year. I did not get any signs of an impending low. Suddenly, I would lose control of myself, or, I would measure a reading in the 30s while feeling sharp.
First, I consulted an endocrinologist and implemented an intensive management plan, which has worked extremely well. I have had only one severe low in five years now. Secondly, I began to monitor my blood sugar before and two hours after every meal. I also tested before, during and after any kind of exercise, and once in the middle of the night, about five hours after my bedtime NPH.
A third key element in recognizing my lows and improving my uncontrollable behavior was mental training. Before I leave the house, get in my car, take a nap or go somewhere, I ask myself, "How do I feel?" Then, I test to verify it. If I have been doing the same activity for some time, like doing paperwork, reading a book or watching TV, I stop and ask myself again, "How do I feel?" then test to verify. My husband and I play this game to train ourselves. He can now guess my blood sugar based on my actions. Any time I feel overwhelmed, grumpy, tired, emotional, depressed or mentally foggy, I test.
Most importantly, low blood sugar has not stopped me from living the very active, productive life I want. I urge Pat and others to not stop doing what makes you you.
Scott Hammered One Home
In response to Scott King's column in the October issue, "Do You Buy It?" I would just like to say that truer words were never spoken. Mr. King hit the nail right on the head.
HMOs Pay for Seniors to Exercise
Some of us are lucky enough to have our HMO pay for our gym memberships. Silver Sneakers, a program for seniors, is open to many groups across this country. By swimming a kilometer every day and doing water aerobics, I regulate my diabetes without meds.
Keep the Laughs Coming
Thank you. I just wanted to write and thank you for publishing such a great magazine. I was diagnosed in October 1996. When I learned I had diabetes many thoughts rushed through my mind. All the information overwhelmed me. I thought for sure my life was over. But after reading and learning more about this disease, I soon discovered I could lead a "normal" life. Your magazine has helped me through so many things like my diet, gaining better control of my blood sugars and keeping me informed of the progress to finding a cure.
Even though I know diabetes is not a laughing matter, I look forward to your cartoons entitled Sugarless Humor. I enjoy them so much I keep them in a scrapbook. When I get depressed about having the disease, I flip through the scrapbook and realize that things do have a lighter side. Thank you again and keep the laughs coming.
Eileen M. Mogan
Vaculance Manufacturer Reacts to Story
I am writing regarding your recent article entitled, "Japanese Doctors Warn of Dangers of Blood Sampling from Fingers," which describes a letter to the editor originally published in the August 1998 Diabetes Care. The letter describes the possibility of performing skin punctures in sites other than the finger using the Bayer Corporation Microlet Vaculance Lancing Device.
Your article omits important information from the original letter in Diabetes Care. This omission will unnecessarily alarm persons who are currently performing finger punctures to obtain blood for self monitoring. The following items from the original letter should be pointed out to your readers:
The doctors who wrote the original letter stated that "although finger infection is relatively rare, it is reasonable to assume that open wounds on the finger increase the likelihood of infection."
The original article states,"The most important methods of preventing such an occurrence [infection of the finger] are routine hygiene [hand washing] and education."
The woman who had the finger infection had no pain sensation in the affected finger. She was shown to have decreased touch sensitivity and impaired pain sensation of the extremities, and had poor glycemic control (HbA1c 12.1%).
Neither the authors of the Diabetes Care letter nor Bayer Corporation mention or recommend use of lancing devices on toes. Many people with diabetes have circulatory problems in the feet, so your suggestion of toe use is dangerously inappropriate. To further clarify, should your readers decide to use the Microlet Vaculance device, the recommended sites are the fleshy portion of the palm between the wrist and little finger, the underside of the forearm, the abdomen and the outer thigh.
The Microlet Vaculance is a new alternative for skin puncture that allows persons with diabetes to use sites that are less sensitive and may be easier to keep clean than the fingertips. Persons who are satisfied with their finger puncture blood collection devices, however, need not be alarmed or abandon this procedure.
Ann Tideman, Senior Clinical Research Scientist
Donald R. Parker, PhD, Director of Clinical Trials Department
Bayer Group Diagnostics