Letters to the Editor
Readers Sweet On Aspartame Article but ADA Sour
Kudos on the March issue. The research and factual information in this issue are the best I have seen in any diabetes literature to date. Thank you for all the effort that goes into this publication, especially the March issue.
Williamsville, New York
Your March article on the so-called "debate" about aspartame was a disservice to people with diabetes.
When a publication claims that a controversy exists about a medical topic important to its readers, there is a reasonable expectation that the debate is between groups of well-informed researchers and health professionals, each drawing on the evidence of comparably well-designed studies. The debate that Sharon Kellaher describes, however, is mainly journalistic invention, not scientific reality. It is largely one between informed researchers and health professionals on the one hand, and a group of book authors peddling sensationalistic but unsubstantiated theories on the other. Using this low standard of debate, one might as well claim that controversy exists over the safety of fluoridation of water or the existence of the Holocaust. Even a cursory scan of Medline shows that none of these aspartame critics has published studies backing their claims.
Ms. Kellaher does make a stab at going beyond the bestseller shelves and tries to decipher the actual medical literature, but apparently without much effect. She claims that "for every study saying aspartame is harmful, another says it is not." This is simply false. The overwhelming number of large, well-designed studies available on Medline shows that aspartame is generally safe. Many of the studies showing negative effects for aspartame are in the form of anecdotes and case studies. For example, Ms. Kellaher cites a 1993 study from Biological Psychiatry that involved only 13 individuals. The 1994 study from Neurology that she cites involved only 25 individuals.
The overall paucity of evidence for negative effects of aspartame does not mean that people shouldn't report possible adverse effects like headaches to their doctors. But it is irresponsible to leave readers with the impression that no one really knows whether aspartame is safe or not. We know for certain that being overweight and uncontrolled blood glucose levels are dangerous; to cast general doubt on a product that might help readers better manage weight or blood glucose serves no one.
Publisher, American Diabetes Association
The sweetener debate in your March issue was timely. Lots of clients picked up the blast of aspartame on the Net and had concerns. Thanks for the balance of reporting.
Due to the aspartame cloud, I have been recommending the use of Sweet One as an alternative. Recently, from our registered dietitian, I received an article [from the Nutrition Action Healthletter, March 1999] that labels Acesulfame K [not aspartame, but a different sweetener] as unsafe or poorly tested.
Thanks for a terrific resource publication for clients and health care providers alike.
Faith Heitzer, RN, CDE
I want to respond to the March article, "The Web Brings Back Sweetener Debate" about aspartame. In 1988, I was diagnosed with both fibromyalgia/myofacial pain syndrome (FM/MPS) and diabetes at age 42. At the time, I was consuming large amounts of both hot and cold drinks containing aspartame, and continued to do so for the next several years.
Within two years, I went from controlling the diabetes with oral medication and diet, to using insulin in increasing amounts. I was also on three prescription medications for the FM/MPS. As the fatigue and pain increased, they kept me from doing the things I enjoyed. I saw all of my normal activities being decreased.
In 1994, I read Betty Martini's [of the organization Mission Possible, organized to outlaw aspartame] information on the dangers of aspartame and decided to test the validity of her claims. Within a week of stopping all use of aspartame, I was able to decrease the use of amitrypaline for the FM/MPS by half. My BG readings stabilized, and I was no longer craving carbohydrates to the extent I was before.
Over time, I was able to completely eliminate the use of all three prescription medications for the FM/MPS. I did this by using valerian root and over-the-counter pain medications. Yes, I still have pain and fatigue, and if I overdo anything, I pay for it the next three days. But overall I feel a lot better than I did when consuming products with aspartame, and my diabetes control is much better.
What do I use instead? I use fructose in small amounts or Sweet-n-Low on rare occasions. The fructose is low on the glycemic scale so it doesn't hit my blood stream as fast as regular sugar.
On a couple of occasions, I inadvertantly ate some yogurt with aspartame, not knowing it at the time. Later, when I was hit with pain and fatigue greater than normal, I read the carton and realized what happened.
In my opinion, the evidence I've seen in my own case, plus the warning on aspartame for people with PKU to avoid it, as well as the research that indicates that it does aggravate certain physical and mental conditions, are enough for me to warn everyone I know to stay away from it. There are too many unknowns about aspartame and the long-range effects it may have on people for me to consider it safe.
Don't Call Us Noncompliant
I agree completely with Scott King's April column. "Noncompliant" is a worthless, counterproductive term.
As a physician treating diabetes, it is my job to help each patient adopt the most appropriate measures possible to control blood sugar and prevent complications. If a patient cannot do our mutually agreed regimen, then it is up to me to suggest another approach.
Yes, diabetes is a matter of self-care, and the patient must basically follow the treatment plan. But, if a person does not substantially follow the treatment plan, I, the physician, must try to understand the barriers and help the patient overcome them.
By no means do we always succeed, but my patients and I, as well as the CDE and RD who are part of our team, keep trying.
Jan Ulbrecht, MD
Associate Professor of Biobehavioral Health and Clinical Medicine
Pennsylvania State University
Two years ago I went in to see my physician. I had spent the previous two years working on a weight loss program and lifestyle changes, and I lost over 60 pounds. When I went in to see my doctor, a general practitioner, instead of praising me for taking off the weight, she accused me of being in ketoacidosis and denying my diabetes. She had yet to get back any lab results, and she judged only by my thinning appearance and dark circles under my eyes because of recent fatigue.
From that day forward I have not seen her. I have been seeing an endocrinologist who encourages my lifestyle change. I have lost an additional 40 pounds and have just 20 more to go to reach my and my doctor's goal. I am off insulin injections and on an oral medication.
If I had stayed with the other physician, I truly believe that I would still be fighting the problem of too much insulin causing weight gain.
There is so much more to taking care of diabetes than just medication. There are personal changes, family life needs, exercise, eating habits, self-assurance and a doctor who really cares and is willing to work with you.
I agree with Scott. Under no circumstance should a diabetic be labeled "noncompliant." I understand there is a basic way to treat diabetes, but we are all individuals.
Life Insurance Company Rejects Girl With Diabetes-Mom Urges Boycott
I love your news magazine. Keep up the good work. Your continued efforts on behalf of persons with diabetes are greatly appreciated.
My daughter, Stephanie, was diagnosed with type 1 diabetes in 1993 at age 4. I recently answered a mail solicitation from National Benefit Life Insurance Company of New York. The company was offering a $10,000 life insurance policy for school children (age 5 to 24) for a $25 initial premium and $35 per year thereafter. I applied for this policy for both of my children. My other child does not have diabetes. I received the policy for my nondiabetic child almost immediately. I did not receive a policy for Stephanie, but rather, a denial letter.
The company wrote, "Based on responses to the medical questions in the application, we regret that we must decline this policy. However, this does not mean that your child would not be eligible for other insurance which is evaluated with complete medical underwriting."
I will boycott this company and I did send a response, but I know that it will not change anything.
This denial, I'm sure, is the first of many for Stephanie, and I will have to continue to explain this to a 9-year-old.
Jo Ann Sapp
More Information on LifeScan Meters and Altitude-FastTake Accurate Up to 10,000 Feet
Editor's note: All information regarding operating temperature and altitudes of strips and meters in the March meter update came from each company's customer service department. We called each company twice to make sure that we had the correct information that the customer service representatives are giving out.
In the March issue, the story on glucose meters, altitude and temperature ["Your Meter Doesn't Like to Go Outside; How to Protect It When You Do,"] reported that all of LifeScan's glucose meters have been tested and accurately function up to 5,280'. We have more information to add. Our meters have been tested and have performed accurately as follows:
One Touch meters up to 7200'
SureStep up to 9300'
FastTake up to 10,000'
Skier Says his One Touch Profile Survives to 12,000 Feet
I ski in the Rocky Mountains, and have used my One Touch Profile meter at altitudes in excess of 12,000 feet. I've never had any blood work done by a lab at these altitudes, but my meter has always seemed to work. Each week, hundreds of thousands of people invade these slopes. I'm sure that many of them have type 1 diabetes.
I wear jeans under a pair of insulated pants, and keep the test strips in the jeans. As for the meter, I keep it in an inside pocket of my jacket, where it is protected from the cold by the insulation layer of the jacket. I have used my meter at Killington, Vermont, after skiing all day at temperatures below zero. As long as there is a warming hut or a restaurant, you can use your meter to check your blood.
Skiing is a wonderful sport that burns lots of calories. Diabetes need not be a deterrent to taking up this sport.
New City, New York
Meters Not Suitable For Coastal Climate
I noticed on page 12 of the March issue that the operating temperature of all Roche Diagnostics' AccuChek meters is from 50 to 100 degrees Fahrenheit. Since the manual that came with my AccuChek Advantage states that the operating temperatures range from 57 to 104 degrees Fahrenheit, I called Roche and asked about the operating temperature range. Both phone reps with whom I spoke stuck with the manual.
Although the area where I live, the California coastal area from Marin County southward, has a relatively mild temperature even in winter, I, like many other diabetics in this area, do not heat my house at night. And since the house is unheated for at least two of the five blood glucose tests I do each day at home, and I often travel to places where it hits 95 degrees, I would certainly like to see blood glucose meter manufacturers stretch the operating range.
Instructions for all of the seven or eight meters I have used caution the user not to artificially warm the meter up before use. This leads one to believe that he should either keep the house within the operating range all the time, or move to a milder climate to do blood glucose tests. I ignore instructions, and use a small heater and my skin to warm both meter and strips.
One of the main reasons I use the AccuChek Advantage is that it gives the user a warning if the ambient temperature is too cold or hot. When that happens, I disregard the manual's instructions and artificially warm the meter against my skin in front of a small space heater. The readings I get this way seem to be within the ballpark.
I suppose it's too much to ask the manufacturers to consider the vast majority of humanity who cannot afford to control the temperature of their houses. I imagine that the meter makers see no reason to try to help such people, since those who have trouble heating their homes are not likely to be able to afford to test their blood glucose strips at 60 cents a pop.
Los Gatos, California
My Company Used My Diabetes To Harass Me
I'm really not sure what anyone can do for me. I was harassed about my diabetes on my job.
I used to drive a concrete truck. Michigan does not allow insulin-dependent drivers on highways, but I was grandfathered in and carried a medical card stating this. Now, I've been fired from this job [for cashing my paycheck on company time] and have lost my grandfather waiver, so I can no longer work in this field.
I think the owners have always tried to use my diabetes as a way to control my union activities. They would always remind me that they did not have to keep me as an employee and if they pushed it, I'd be out. Every day I felt humiliated, like I had to beg to take my shot or eat a snack without interfering with production. Also, if I had a sugar count that made me feel uncomfortable about driving, I felt pressured to keep driving, because they would use it as an excuse to discharge me. Usually, when this happened, I would return to the plant with high sugars, headaches, and feeling generally sick, which would last all night and sometimes affected me into the next day.
I liked my job. The work was challenging, but I enjoyed it, and the money was good. I built my life depending on it for my future. It was my chosen career. Now my wife and I have a pretty dark future.
In writing to you, I am searching for moral support. This world is full of good people, but, unfortunately, I worked for the worst. If anyone has ever gone through this type of situation, it would be great to talk about our experiences.
Auburn Hills, Michigan
Glucophage Comes From Guanidine in Goat's Rue
I'm responding to your story that said that Glucophage comes from goat's rue, an herb.
According to "Traditional Plant Medicines as Treatments for Diabetes," in a 1989 Diabetes Care (vol. 12, no. 8, p. 553), "The traditional use of Galega officinalis (goat's rue or French lilac) in medieval Europe is explained by its rich content of the hypoglycemic substance guanidine. Although guanidine proved too toxic for clinical use, the alkyl diguanides synthalin A and synthalin B were introduced as oral antidiabetic agents in Europe in the 1920s but were discontinued when insulin became available."
My point comes from the comment that guanidine from goat's rue "proved too toxic for clinical use." It's possible that the concentrations in the plant are low enough that the toxicity is lower, but people should use goat's rue with caution, I think. Metformin does not come from goat's rue. It is related to guanidine, which comes from goat's rue.
I recommend this Diabetes Care article for anyone interested in plant remedies as it has references to many primary sources.
CDE Has Prescribed High-Protein Diet To Only 2 People
I have a different opinion from Dr. Bernstein's recommendation of his low-carbohydrate diet in the March issue's Question & Answer section. People need to realize that very-high-protein diets can be harmful to their kidneys. High-carbohydrate diets, if used correctly with appropriate changes in insulin doses and exercise regimes, can get them in good control.
I have had diabetes for over 34 years, and my HbA1cs have been normal for the last two years. My last A1c was 5.7%. A high-carbohydrate diet has worked for me.
It's important that people realize the effects of fats and proteins on their renal systems, and that this can be one of the causes of renal damage. Therefore, in 17 years of taking care of people with diabetes, I have recommended the high-protein diet to only two people.
Patricia K., RN, CDE
San Antonio, Texas
Diabetes Health Gives Information to Great White North
I have just introduced your news magazine to our library in the resource center here at the Canadian Diabetes Association in Manitoba. I am impressed with the variety of information, plus how current it is. It seems that it requires more time for these pearls of wisdom to get filtered north.
Canadian Diabetes Association, Manitoba