Letters to the Editor

Dec 1, 1999

Diabetes Health a Hit in the Midwest

I have just received my first issue of Diabetes Health and I am very impressed. Before I subscribed, I was unsure whether your publication would have anything to offer me. Now, I will be watching for it in the mail every month.

Diabetes Health offers a lot of informative articles about many different aspects of diabetes. It is also nice to hear from other people with diabetes about how the disease affects their lives.

I was recently diagnosed with diabetes and have had no family history of the disease. I was overwhelmed in the beginning with all the information and responsibilities, and thought I would never understand it all. After one year, I feel I have achieved good control. I believe that this is largely due to my physician and the information I have received from magazines like Diabetes Health.

Ignorance is bliss, except when it comes to your health. I look forward to reading all my future issues of Diabetes Health.

Anna Matthen
Clinton, Iowa

I want to thank you for the September issue of Diabetes Health. I had never seen it before and found it to be everything you said it would be.

We held a Diabetes Health Fair in our community that was very well attended. Diabetes Health was given to all those who stopped at our booth and everybody loved it. We will offer them again at our next educational meeting this month.

Linda Shaw
Fayette County Chapter of the Central Ohio Diabetes Association
Washington Court House, Ohio

Vitamin E Finally Getting its Due Recognition

The article on the benefits of vitamin E in the October issue of Diabetes Health was wonderful ("Vitamin E Beneficial to People With Diabetes" p. 28). The diabetes community should be ashamed to acknowledge this so very late. Over 30 years ago, the Shute brothers, based on clinical evidence, declared that vitamin E reduced complications, insulin requirements and circulatory disease in people with diabetes.

I shudder to think of how many lives and limbs have been lost prematurely, as well as how much vision and nerve function have been lost, which might have been prevented with this simple, harmless and cheap nutrient.

Alan Lewis
Ann Arbor, Michigan

Alond Certainly Helped Me

I read with interest your article on Alond in the October issue of Diabetes Health ("Pfizer Finds Neuropathy Drug Ineffective," pg. 14). I was part of the stage-three trials for this drug for more than two years. When I read that Pfizer "recently announced that in clinical trials Alond did little more than a placebo for nerve pain in people with diabetes," I was stunned. This just wasn't the case in the clinical trials. When nerve conduction tests were performed on me throughout the study, both the doctor performing the test and I were overjoyed at the results I was showing with Alond.

Marston Thompson
Garden Grove, California

The Former Miss America Encourages Readers to Keep in Touch

I have a new Web site, www.nicolejohnson.com, that is equipped with email. This is the best place for fan mail or appearance requests.

Thank you so much.

Nicole Johnson
Miss America 1999

Halloween is a Different Kind of Treat For Kid With Diabetes

The other day my son told me that he was glad he has diabetes. I asked him why. He said because he gets presents on Halloween. I then asked him if that was better than candy. He replied with an enthusiastic yes.

Marilyn Savitt-Kring
Albuquerque, New Mexico

Halloween Article Missed the Point on Diabetes Control

The article "Halloween—Make It A Learning, Experience, Not A Horror," in the October issue of Diabetes Health, was more of a trick than a treat. It missed the point almost completely. I hope you know that the point of diabetes treatment is to keep blood sugar levels in the normal range. Taxpayers paid millions so the Diabetes Control and Complications Trial (DCCT) could prove this.

So, faced with lots of candy, what is the solution for a type 1 diabetic like me? The appropriate amount of insulin, of course. Jean Betschart knows the solution, saying "make an adjustment to the Humalog," but the article was very short on information on how to adjust Humalog. In my opinion, "adjustment" is the wrong word. The point is to balance the food with insulin, or cover the food with insulin. There was no mention of carbohydrate counting, however, and no mention of keeping records so people know how much insulin to take for what they eat.

If food, insulin and exercise are properly balanced, BGs stay in the normal range and we don't have complications nor die prematurely.

Why did Diabetes Health miss this point?

William Burton
DCCT volunteer
Riverside, California

Editor's reply: Thanks for your letter. The question of how to adjust insulin to cover food is a good one, and one which we have addressed in past issues of Diabetes Health.

With this article, we sought to provide a variety of tips for parents of kids at Halloween, like trading stickers or money for candy. We did provide carbohydrate exchanges for some common Halloween candies, but it looks like you wanted more information on how much insulin to take for these Halloween candies. This is a challenging question. In my personal experience, I generally need 1 extra unit of insulin for every 12 grams of carbohydrate that I consume, but I am a 185-pound male. Smaller individuals will need much less insulin.

There are many other variables that affect insulin needs. Any advice would have to take into account several other factors, including whether a person is on a pump, whether a person had exercised recently, and so on. Also, more insulin is usually required in the morning.

We recommend John Walsh and Ruth Robert's book, "Stop the Roller Coaster" (available from The Diabetes Mall at www.diabetesnet.com) for more information.

We will present an article in the future on how to calculate insulin requirements.

Scott King, Publisher

Story Exposed Reality of Poor HbA1c Testing

I read the story in the October issue of Diabetes Health about how most people with diabetes don't have their HbA1c checked. I would like to add some thoughts.

I am a physician who works in the hospital emergency room of a midsized Midwestern community. We have patients from a cross section of many different socioeconomic groups. I would venture to say that less than one in 20 patients with diabetes I see knows his or her HbA1c and, most truthfully, doesn't have any idea what the test is. People have never heard of it and those who have don't know what it means. I know several people who do know their HbA1cs, but are running around 9 and 10% or even higher. I talk to these people and find out they do not understand the significance of these numbers.

As the article reiterates, the DCCT and other studies have shown the very clear-cut connection between good control and lowered complication rates.

Keep up your wonderful work, with articles such as this one. Diabetes Health is part of the solution.

Maurice Sonnenwirth, MD
Saint Louis

Eye Article Did Not "See" The Truth About Optometrist Training

As a physician whose specialty is ophthalmology, I was surprised that the September issue of Diabetes Health printed such a misleading statement attributed to Michael Duenas in the article, "Eye Exams Available Through Cyber Space May Help Prevent Blindness."

Duenas correctly warns that the Inoveon system cannot "discover glaucoma and cataracts," but then the erroneous sentence follows: "While optometrists are trained to screen for these diseases, physicians are not."

Perhaps Duenas is not aware that medical schools teach their students about common ocular conditions and how to use a direct ophthalmoscope to evaluate the fundus. I often receive referrals from my internal medicine and family medicine colleagues for lenticular opacities and increased cup-to-disc ratios.

Carlos A. Rosende, MD, FACS
Texas Diabetes Institute
San Antonio, Texas

Reader Raves About Energy Bar

Scott, I just read your October column about your low blood sugar while changing a tire ("Lights, Lug Nuts and a Low," p. 7). I must tell you about a product that I've been using to raise my blood sugars, and it's one that I prefer over glucose tablets. The product is PowerGel made by PowerBar (www.powerbar.com). It's mainly marketed to cyclists and often cycling stores are the only place I can find it.

While not made from glucose (the first three ingredients are maltodextrin, water and fructose), PowerGel works incredibly fast and is really easy to ingest. What I like about them is they work better than other products in a few situations.

If I get low while exercising, they absorb very well and work quickly. I usually don't have to stop what I'm doing, and soon I am full of energy again. They don't give any feeling of fullness or the discomfort I get from digesting other bar products.

The worst low blood sugar for me is when I've taken too much insulin for a large meal. My stomach becomes full and eating anything more to compensate for a low is both uncomfortable and relatively ineffective due to slow stomach emptying brought on by a large meal (gastroparesis). The gel can be easily eaten and absorbed, despite a heavy load on the stomach. Sometimes I will even hold the gel in my mouth to let it absorb right into the lining of the mouth.

As with your tire-changing experience, sometimes we are faced with going from a sedentary situation to unplanned exercise. Here is where the gels are great, as a dose will effectively prevent lows. Similarly, as I wear an insulin pump, I try to reduce my basal two hours before exercise. But with the gels, I can usually pick up and exercise without having previously reduced my basal rate, as long as it's not too soon after a meal bolus.

The gels come in a variety of flavors, some with added caffeine, and are in convenient, 1.4-ounce disposable pouches which contain 110 calories, 28 grams of carbohydrate and 0 grams of fat. They also offer a refillable "flask" that holds about 6 ounces, allowing you to take smaller servings. This is convenient on a run, as I can take small "hits" every 20 minutes or so to keep me from going low.

A word of warning though: taking the full, 28-gram dose will raise blood sugars too much when not exercising. In these situations, I try to take a smaller dose or, if I take the whole 28 grams, I supplement with a small dose of insulin, about .5 to .7 units. I know it's scary to take insulin when low, but, when not exercising, I find that it will prevent a rebound experience.

It's really been a godsend for me. All people with diabetes should give it a try.

Christian Mastor
Colorado Springs, Colorado

Kudos For the Kids Article

Thank you for Diabetes Health June article about the Yale School of Nursing study on how diabetes management changes for children in the summer ("School's Out—and Diabetes Control is Down—For the Summer," p. 14). It was a good illustration of the need to test, rather than to trust conventional wisdom on how various factors affect the health of children living with diabetes.

However, I want to clarify the research team's recommendations. The degree of parental involvement we suggest would vary with patient age. For every patient, we strongly recommend planning for the changes that come with summer. These include diet, activity levels and sleep patterns, all of which can affect diabetes control. We see this planning as a cornerstone of good diabetes control throughout the calendar year.

Margaret Grey, DrPH, PNP, FAAN
Associate Dean for Research Affairs
Yale School of Nursing

Persistence Paid Off For Patient Seeking Insurance Coverage

I want to thank Diabetes Health for informing me that I am entitled to insurance coverage for my test strips.

I was about to give up, thinking I would never get coverage, but through a little persistence with my insurance provider, I got covered. I found out that my strips are covered under what is known as Durable Medical Care.

This hasn't been an easy thing for me, and I want to thank Diabetes Health for letting me know that I have these rights. You did a real good thing for me.

Mike Fisher
Highland Park, Illinois

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Dec 1, 1999

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