Letters to the Editor

Aug 1, 1999

Job Stress Leads to Complications

Editor's note: In the May issue, Ron Morris of Auburn Hills, Michigan, asked for help from other readers during his recovery from losing his job. Morris believes his employer harassed him because he has diabetes. Here, one reader identifies with his struggles.

When Ron Morris asked for moral support regarding harassment on the job because of his diabetes, my heart went out to him. You heard from me four years ago when I was harassed because of my diabetes on my job in the Utah Diabetes Control Program. If a state health department can allow this, I guess it could happen anywhere. The irony and disappointment still infuriate me.

After reviewing my case, the Equal Employment Opportunity Commission granted me the right to sue. However, by then my money had run out from legal fees, and I had become a pariah for rocking the boat at the local ADA chapter where I volunteered.

I have the sympathy of the health professionals with whom I've worked in the diabetes community, but I lack the support I need from others with diabetes.

My advice to anyone who faces this sort of discrimination is to put your diabetes care before your choice of professions. In the years since I resigned from my job, I had to resign from another job because my health had deteriorated. Part of the reason for this is my 51 years with diabetes, but I am sure stress played a part. Before my troubles on the job, I had no complications. When the troubles first began, I developed high blood pressure and an ulcer. Since then, I have developed coronary artery disease, had bypass surgery, had repeated vitreous hemorrhages and a vitrectomy, developed gall bladder disease, and had a cholestectomy.

No job is worth the risk of becoming disabled. My primary care physician has convinced me the fight would have killed me, had I continued it.

Take a hard look at your life and your diabetes, Ron. Hopefully, you are much younger and stronger than I was.

Anne White
Salt Lake City

Does Anyone Care About Y2K?

Editor's note: This reader appeared in our May 1999 story, "Advocates Lobby for One-Time Exception to Help Chronically Ill Survive Y2K," as both an advocate and a person who needs assistance getting an extra month's supply of medications in case of Y2K problems.

The moment I saw the cover of the June issue, my soul jumped. The heartache, courage and perseverance of these youngsters with diabetes, and their parents, sends a powerful message.

Here's an update on the Y2K and chronic illness story. Health care, in general, is still way behind on Y2K compliance. Overall, I am dismayed at the apathy in this nation over this issue.

Bob Levine
Concord, California

Power Bars Work Best For Me

I have a tip for your readers. When my blood sugars go really low, a Power Bar brings them back faster than anything else, even orange juice. Power Bars have 45 grams of carbohydrates each, so I only have to eat a few bites, or half a bar.

Leslie Stillman
Newark, Delaware

A Refrigerator Magnet Cools the Burning In My Feet

I have a tip for other people with diabetes. Recently, I read an article which says that the American Medical Association (AMA) has approved magnets for healing purposes. I am 67 years young, and have type 1 diabetes. I take extensive care of myself, and my HbA1c levels are between 5.8 and 6.1% each quarter of the year.

I have nerve damage in my left heel, which results in a continuous burning sensation, 24 hours a day. I had found no products that would eliminate the burning, but after reading the AMA article, I took one of those flexible refrigerator magnets, and placed it in my left shoe at the heel area. I kid you not, within a couple of minutes, the burning sensation totally left my left heel. It sounds astonishing, but it did not come back for the entire day I wore that magnet in my shoe.

I thought it was just a fluke, so the next day, I deliberately took the magnet out of the shoe heel, and within an hour, the burning returned. It remained until I replaced the magnet in the heel.

It's been about two weeks, and I have not had any more burning sensation in my left heel, thanks to that refrigerator magnet.

I deeply appreciate your publication. It's the best one regarding this terrible disease we have. Thank you.

John Boal
Carefree, Arizona

Aloe Vera Gel With Pump Tape

I was reading about people who have problems with their insulin pump tape. They said that the tape does not stick, and that it rolls up. I have had an insulin pump for four years now, and I use aloe vera gel. The gel is a little bit sticky and also has a healing quality. I apply it to the area around the injection site, making it slightly damp. Then, I stick the tape down tight and rub it all over, like you're supposed to. The aloe vera gel keeps the tape sticking to me and also makes sure I don't break out.

Debbi Tally
Bath, New York

Where Can I Learn Massage Techniques?

In the June issue of Diabetes Health, a research update on massaging children with diabetes ["Massage Can Drop Kids' BGs by 40 Points"] indicated that the massage technique takes approximately one hour to learn and a few hours to master. How and where do you learn it?

If it's good for children, wouldn't it be good for adults?

Betty Brewster
San Diego

Editor's note: We called the researchers who conducted this study at the Touch Research Institutes of the University of Miami. They cannot say for sure if massage works on adults with diabetes, because they have not tested it on adults.

To find a licensed massage therapist in your area, call the American Massage Therapy Association (AMTA), at (847) 864-0123. According to the Touch Research Institutes, if you find a massage therapist through other means, you can also call the AMTA to check on that person's reputation and credentials.

A Type 2 Prescription Does Not Mean Failure

In the May issue of Diabetes Health, the article on type 2 medications ["Following the Twists and Turns of Type 2 Medications"] fits in with Scott King's editorial a few months back on noncompliance. Specifically, it is important for people with diabetes to recognize that only part of their disease is controllable by lifestyle modification. After several years with diabetes, virtually all individuals with type 2 diabetes require some form of medication therapy. It is important not to see the progression to requiring medication therapy as a failure on anyone's part. It is part of the natural progression of diabetes.

Furthermore, after another five years or so, it is very common to take more than one medication to treat diabetes. In fact, it is now recognized that the window for diet and exercise may be only a few years, and the subsequent window for single-agent therapy may also be a few years. For the most part, individuals with type 2 diabetes require two or more agents [i.e., sulfonylureas, Glucophage, Rezulin] to maintain the degree of control recommended by the American Diabetes Association and the American Association of Clinical Endocrinologists (AACE).

For this reason, discussions about which agent to use first are becoming less important than what agents are best used together. A recent survey of AACE members revealed that the vast majority of endocrinologists are using combinations of all the oral agents, picking what is needed specifically for each individual's circumstance. Decisions are based upon high blood glucose levels, potential side effects, contraindications, convenience, cost and other factors. Every person is unique.

In the coming months, we hope to develop a number of algorithms that will help people sort through how to pick medications and how to use them in combination. I know that for many people and physicians, it seems like a very complicated maze of options. Thank you for trying to clarify issues for our readers.

Daniel Einhorn, MD, FACP, FACE
Diabetes Health Advisory Board Member
Diabetes Treatment and Research Center
San Diego

Love the New Layout

I have been a subscriber to Diabetes Health for a couple of years, and I enjoy the interesting and educational articles that you print. Your magazine seems to be the most comprehensive of any that I've read.

I just want to let you know that I appreciate the new layout of the stories and articles in the latest issue. I much prefer being able to read an article without having to start at the front of the magazine, and then jump to the back of the magazine for the end of the article. It now seems to flow better and read more easily. I would love it if you continue this layout method.

L. Moore
Shreveport, Louisiana

Should I Carry Around a Box of Corn Flakes?

Your article on the glycemic index in the May issue was very interesting. It raised some important questions for me.

Usually, when I have a low blood sugar, I use orange juice or Coke as a fast carb. The Coke isn't shown in your listing, but does the list imply that corn flakes (GI of 83) or white bread (GI 72) would do a faster job than orange juice (GI 49)? I believe orange juice is what most hospitals use and many doctors recommend.

Also, in bolusing Humalog with my insulin pump, I was told that fast carbs raise the BGs sooner and slow carbs raise them later, but both have the same total effect. Does the glycemic index mean that a serving of pasta (20 g. carbohydrates and GI 44-46) would have less total effect on BGs than a serving of mashed potatoes (13 g. carbohydrates and GI 72)? If so, it would certainly complicate meal planning for people like me.

Jessie L. Derenthal
Cherry Hill, New Jersey

Your first question seems to be, is orange juice effective for low blood sugars? You mention that many hospitals and doctors recommend orange juice. Before we answer, let's look at the history of orange juice and hypoglycemia. In the 1920s, research was first conducted on rabbits with diabetes, many of whom died from seizures caused by massive insulin overdoses. Due to these experiences, Dr. F. G. Banting (one of the discoverers of insulin) and his team kept orange juice available at Toronto General Hospital during the first human experiments to prevent the undesired seizures and death.

Even though orange juice was used this early for treating lows and has a sweet taste, your perception, that it is not the best choice, is correct. Most of the carbohydrates in orange juice come from fructose, which must be converted to glucose before it can raise blood glucose levels. It has a relatively low glycemic index (49 on a scale of 1 to 100), in part, because it is acidic, which slows down digestion. Its perceived benefit may be due somewhat to a placebo effect, where drinking fluid makes a person feel better during an insulin reaction, even though the juice is slow to correct the low blood sugar.

Unfortunately, using orange juice sets up a bad habit that can be dangerous. In most circumstances, a slowly rising blood sugar is not a problem, unless it is a situation where a rapid rise is essential, such as driving. Using orange juice or other juices (none of which are above 50 on the glycemic index), could prove disastrous in these circumstances.

We recommend setting up a habit of using the same product to treat all lows, so that deciding what you need comes automatically during the impaired thinking that is common in severe lows. The very best way to raise a low blood sugar is with glucose tablets, which have one of the highest readings (100) on the glycemic index. They work much faster and also come premeasured (4 or 5 grams of carbohydrate per tablet), so you don't overdo it. Even sugar or Coke, with an index of 65, is not as fast. Corn flakes, at 83, would be a good choice, but it is not always readily available, and is also prone to being overdosed.

Regarding your second question about whether the GI can be used to estimate insulin boluses, it is clear that the total carbohydrate content of a meal is the primary factor that determines the size of the bolus. As you size up the impact a meal will have, always focus first on its carb content. Once you know how many carbs each unit of insulin covers you can predict how many units you need for the carbs in a meal. For this purpose, all carbohydrates are essentially considered equal, especially when using Humalog insulin, or the soon-to-be-released Novolog. Forty grams of pasta and 40 grams of mashed potatoes would both be covered with the same number of units.

After you've counted the carbs and calculated your insulin coverage, you can factor in the smaller effect of a meal's glycemic index. The glycemic index tells you how fast your blood sugar will rise with a certain food. For improved control, it helps to eat carbs with a lower glycemic index because they don't spike the post-meal blood sugar so far. If a meal has lots of low-GI foods, you may want to reduce your normal bolus to compensate. For instance, if you eat a plate of lentils or a waffle with equal numbers of carbohydrate grams, the lentils (GI 27) would likely require a smaller bolus than the waffle (GI 76). With the lentils you might also split the bolus, giving part of the bolus before the meal, and the rest an hour after the meal, to spread the bolus out for the low-GI meal. The square wave bolus would also work well in this situation.

A new book on the glycemic index, "The Glucose Revolution," will be available in August. The authors explain the benefits of low-GI foods by saying, "The body is able to restore normal blood sugar levels more quickly after a slowly digested meal than a quickly digested one." Using the analogy of a bucket, they explain, "...turn on a tap full force above a bucket, with a small hole in the bottom,. The bucket will fill up quickly and empty slowly. In contrast, the same amount of water, delivered as a slow trickle, will empty with minimal accumulation..."

We recommend that you count carbs to estimate boluses, but keep in mind that modifications may be needed for some foods with a low glycemic index. For better blood sugar control, choose foods that have a lower GI, such as whole-wheat spaghetti (GI 37) rather than a microwaved white potato (GI 82). To handle a low blood sugar, choose a high glycemic index food that is measured, like glucose tablets.

For a clear explanation of the benefits of lower glycemic index foods, together with the glycemic indices of 372 foods, plus recipes and meal plans, see "The Glucose Revolution," available in August from The Diabetes Mall at (800) 988-4772 or www.diabetesnet.com/gi.html.

Ruth Roberts, MA, and John Walsh, PA, CDE
The Diabetes Mall and Torrey Pines Press
San Diego

Diabetes Health Propaga Buenas Noticias en España

Diabetes Health has been in the waiting room at my clinic for many years. All the clinic team members read Diabetes Health to see what is new in diabetes treatment.

I personally like the articles about pumping insulin. Many times, I get some useful tips for treating my patients.

We both play on the same team, and we are aiming for the same thing: to give people with diabetes the power to control their condition, and to fight against ignorance.


Ramiro A. de Alaiz, MD
Gijon, Spain

Desperate for Animal Insulin

I have received Diabetes Health for many many years now, and I absolutely love it! Now, comes the problem. Neither you nor I have access to beef insulin.

What should we do?

Doris Zimmermann
Mexico City, Mexico

Please see answer in the July issue on page 9, and see page 18 of this issue.

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Aug 1, 1999

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