Dear Ann Landers

| Jan 1, 1999

On this issue's front page we begin the story of Ann Landers' comment that people with diabetes who test and inject at restaurant tables exhibit "gross insensitivity and very poor manners."

After this ran, I got lots of letters, emails and phone calls, including one from Sharon Palmer of Salisbury, Maryland, who implored me to tell our story as people with diabetes. Here is my letter, the story of why I disagree and why I cannot hide.

Dear Ann Landers,

Your disapproval of people who test their blood and inject insulin in public raised quite a stir among the readers of Diabetes Health, the only independent monthly publication about diabetes news and research. More than 140 readers responded. Although 25 percent agreed with you, the majority consider your answer way off. As Diabetes Health's editor-in-chief and publisher, and an insulin-dependent diabetic for 23 years, I would like to tell you why.

Diabetes care has improved dramatically in the past two decades. In the old days, we typically took one or two injections of long-acting insulin once or twice a day. Blood sugar was tested only at doctor visits, maybe once or twice a year. This low-maintenance routine was convenient, but our diabetes was not in control.

Poor control leads to painful diabetes complications like blindness, extremity amputations, kidney disease and heart disease.

These days, diabetes is treated aggressively, to help us avoid these complications. We have rapid-acting insulins and convenient, portable blood testing equipment. Insulin-dependent diabetics often take four or more insulin injections a day, before each meal and at bedtime. By testing our blood before each injection, and knowing what we are going to eat at a meal, we can gauge the exact amount of insulin we need at the moment. And, since modern insulins begin to work as soon as they are injected, the very best time to take the injection is when the plate is front of us. So many of us choose to inject at the table.

Insulin injections do not have to attract attention. There is no need to even pull up our shirts to expose skin. We can inject right through our clothing and, often, nobody realizes what's happening. Blood tests are more obvious, but, I must stress, they are a necessary part of our basic health care.

Sometimes we need to do eight or ten tests a day. Who wants to spend that much time in the bathroom, especially a public rest room? Even the best are unsanitary.

I used to test and inject in public rest rooms. One time, as I was about to draw up an insulin shot, my insulin bottle fell on the floor and shattered into bits of broken glass. I stood there, stunned, holding my empty syringe, as my life-giving fluid spilled across the tiles. For a moment I considered actually drawing from the insulin puddle on the floor, but I stopped. That was the last time I tried to inject in a rest room.

Hiding the facts of our everyday health care suggests that we're doing something shameful. People with diabetes are just like you, but with broken pancreases.

We need insulin to survive. We struggle to keep ourselves healthy and maintain self-esteem. By banishing us to the bathroom, you are undoing the efforts of thousands of health care workers, parents, spouses and friends who have worked hard to help us accept our diabetes in a positive, healthy manner.

The new Miss America, Nicole Johnson, is insulin dependent and wears an insulin pump. Would you really find it offensive to see this beautiful young woman doing a blood test that will help keep her alive and healthy? And she sometimes does test at restaurant tables. She told us.

I hope this gives you a better idea of the concerns and cares of over 8 million Americans with diabetes, many of whom take insulin.

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Categories: Blood Sugar, Diabetes, Insulin, Insulin Pumps, My Own Injection, Syringes

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