Letters to the Editor
Hail to the Elders
I want to express my appreciation for your feature article on long-term survivors of type 1 diabetes ("Wisdom of the Elders," July, p. 31). Now that I have reached the 44-year mark of having diabetes with minimal complications, I can identify with the commonalties noted in the article: self-discipline, optimism and an overall healthy outlook on life. Education has been a key part of my control as well. Although I have had some excellent endocrinologists over the years, they each held the belief that I was the only one who could control my condition.
Within my family, we conducted a miniature DCCT study. My brother and I have had type 1 for approximately the same period of time. I am healthy with few problems (one laser treatment) while my brother has virtually every complication. Level of control appears to be the major difference between us.
Long Beach, California
I want to compliment you on a very well done and extremely meaningful article ("Wisdom of the Elders," July, p. 31). I am a 42-year-old who has had diabetes for 33 years. What you conveyed in your article is that people with diabetes can live a long, productive and minimally disrupted life. This article should be submitted for an award. It has always been a hidden fear of mine that I will not see the golden years and, as time has passed, I worry less and less about this. Diabetes gives one a better reason to take care of oneself.
I strongly believe that exercise has kept me problem-free for all these years. I have worked out at the gym with weights for the past 25 years. I also run and have been studying martial arts for almost two years. I have been on a MiniMed pump for over one year with A1c levels all in the 5% range—the last being 5.9%. I am a local Juvenile Diabetes Research Foundation board member and recently attended its convention in Chicago. I am proud to say I met a "cured" person with diabetes there. The young lady received an Edmonton Protocol islet-cell transplant and had nothing but very positive results to report. She brought tears to my eyes, as I hope that we will all be joining her someday soon.
New Haven, Connecticut
I just had to write and say that I am a survivor! I have lived with diabetes for the past 46 years, since the age of 5. I was diagnosed in June 1955.
I was very interested in reading your article "Wisdom of the Elders." When I was a child, I used needles that hurt me and left bruises when I injected insulin, but I survived. Testing my blood sugar about eight times a day is no big deal since I have better control (my HbA1c is 6%). I do aerobic exercise every day, even though I hate to exercise. I now weigh five pounds more than I did in high school.
I made the best of my life with diabetes by publishing cookbooks. One of them is called "The Diabetic Goodie Book." I am currently working on another cookbook, which will include recipes for everything from breakfast to dessert prepared the healthy way. I do not use artificial sweeteners in my recipes.
I am very fortunate to have a fantastic husband of 30 years who gives me so much support. My two adult sons have also been very supportive and love to sample my new recipes.
I have never kept my diabetes a secret. I am proud of the fact that I have lived with this disease for so long with no complications. I am not just lucky—I have worked very hard to stay healthy and hope to continue to do so.
I want to be alive for my grandchildren so that I can dance at their weddings.
Keep up the good work of keeping us informed. I thoroughly enjoy reading Diabetes Health and learn something new each month.
Mendham, New Jersey
Finland Takes Wrong Approach to Prevention
With regard to your research update on Finland's Diabetes Prediction and Prevention Project ("Stop Right Where You Are!" July, p. 13) that determined which newborns are at risk for eventually developing diabetes, the Finns have it backwards.
Firstly, they need to develop a successful means of preventing and/or curing diabetes, then they need to find out who is at risk. Neither the World Health Organization nor Finland (nor, for that matter, America, with its unsuccessful DPT-1), know how to prevent diabetes.
To tell parents that their young children are at risk for developing a serious, chronic and possibly fatal disease, and that they can do nothing about it, is to cruelly inflict pain and anguish. It serves no purpose. You might as well tell them their children are tied to the railroad track and the train is coming, but you don't know when.
I'm sure the enthusiastic participating parents cited in the article were only responding to the (false) use of the term "prevention." We must continue to remember medicine's obligation to do no harm. Bringing unrelieved pain and anguish to parents of young children is definitely "doing harm."
Joan Williams Hoover
Chevy Chase, Maryland
Questions about HbA1c Testing
Regarding the topic of standardizing the A1c test in the July issue ("Letters to the Editor," p. 10), the comments provided by Arthur G. Williams, BS, were quite informative. I would also like to know the names of the three top laboratories performing the bulk of the HbA1c tests and the names of the labs certified by the NGSP.
Carl J. Johnson
Burlington, North Carolina
Editor's reply: We asked Dr. Williams to respond. For more information on A1c testing, see our feature article on page 24:
In regards to the three top laboratories that perform HbA1c tests, Quest Diagnostics and SmithKline Beecham Clinical Laboratories are together considered the largest. LabCorp of America is considered the second largest. Several clinical reference laboratories share rank among the third largest. All of these laboratories have locations around the country, so check the yellow pages for a location in your area.
As for the four laboratories that are certified by the NGSP, they are Premier Laboratories Inc. in Kansas City, Missouri; Mullin Pathology Laboratory Services in August, Georgia; FlexSite Diagnostics, Inc. in Palm City, Florida and Choice Point Health Systems Inc. in Olathe, Kansas.
Arthur G. Williams, BS
Diabetes Technologies Inc.
Is the Diabetic Walker Discontinued?
In your May 2001 issue you have a business brief called "Now Enter: Diabetic Walker Helps Avoid Development of Foot Complications" by AliMed. The article gives a number to call for more information. I called AliMed and they told me the product has been discontinued.
Editor's reply: We checked with AliMed Inc. of Dedham, Massachusetts, the manufacturer of the Diabetic Walker, and it has not been discontinued. To order one or to get more information, contact AliMed at (800) 225-2610.
Are There Body Builders with Diabetes?
I have been taking insulin for 37 years, seven months and five days. I was wondering if you could find any body builders that are insulin dependent, and perhaps find out how they deal with off days and keeping mass on, and whether they use a pump or take insulin by injection. I have a hard time keeping muscle mass on even though I go to the gym daily, where I either lift weights or do cardiovascular exercise. Any information would help. I enjoy your magazine tremendously.
Editor's reply: We asked Sheri Colberg, PhD, assistant professor of exercise science at Old Dominion University in Norfolk, Virginia, to respond.
Without knowing your exact regimen and degree of control, it is hard for me to precisely diagnose where your problem may lie.
There are several factors that come into play with muscle mass, though. For one, your level of glucose control could have a huge effect on muscle mass. If your blood sugars are not well controlled, your body may break down some of your stored protein (particularly in muscle) as an alternate fuel source. You need to achieve the best control possible to maintain your muscle mass.
Secondly, insulin is an anabolic (muscle building) hormone. You need to have sufficient insulin in your system during the period when you are recovering from a workout. A good portion of muscle glycogen storage and amino acid (building blocks of protein) uptake is dependent on insulin. Try to replenish soon after workouts and keep up blood-sugar levels at those times. Keep in mind, however, that you may need less insulin than usual to cover your food intake shortly after workouts.
Also, make sure that you take in adequate calories to replace those that you used in your weight training session, plus a small amount more. In order to gain muscle mass, you have to be in "positive nitrogen balance," that is, taking in more calories and protein than what your body is using as a fuel. (Be careful though; extra calories not used to build muscle mass go into fat storage!)
Finally, individuals with diabetes who lift weights use a variety of different insulin regimens. Most find that weight training may cause their blood sugars to rise or stay the same during the activity, but drop several hours afterwards. If you are maintaining good blood sugar control, there is probably not one insulin regimen that has substantial benefits over any other to gain muscle mass.
Sheri Colberg, PhD
Assistant Professor of Exercise Science
Old Dominion University
Is Diabetisweet Safe for People with Diabetes?
I have subscribed to your magazine for three years and thoroughly enjoy each edition, which I eventually read cover to cover. In the April 2001 issue there was a full-page ad for Diabetisweet sugar substitute. It seemed like a good product so I bought some. Much to my surprise the "nutrition facts" indicate that one teaspoon has 4.4 grams of carbohydrates, all from sugar alcohol. This value is somewhat higher than granulated sugar. This information is not given in the advertisement.
I called the 800 number given in the ad and was referred to another 800 number—(800) 262-9010. I was told that the product has a conversion factor of 2 from carbs to calories, which is not mentioned in the ad either and which I doubt is true. They sent me some literature. The label indicates the product is a mixture of Isomalt and Acesulfate but fails to mention the proportion. The literature indicates the components of Isomalt are glucose, sortbitol and mannitol (no proportions given), that is, it's a mixture of sugar and two sugar alcohols—all of which have four calories per carb. The literature also states on the same page that the calorie utilization of Isomalt is only 50 percent. How can that be so?
It would appear to me that the ad for Diabetisweet constitutes false advertising and is, at the very least, misleading to your readers with diabetes. Perhaps the Glycemic Index is lower than sugar, but certainly not the carbohydrates. As a long-time type 2 on NPH and Humalog, I monitor my carbohydrate intake very closely.
Please provide an explanation. I rely on the information in your magazine and assume that the information is correct unless clearly identified as opinion.
Nicholas De Marco
Editor's note: We asked Irene Ralske, senior chemist at Hi Tech Pharmaceuticals, the manufacturer of Diabetisweet, to respond.
Your statement that Diabetisweet has more grams of carbohydrates than sugar is incorrect. Sugar and Diabetisweet have the same amount of carbs before considering calorie content. Since sugar has twice as many calories as Diabetisweet, the total amount of carbs in sugar is higher. The formula to calculate grams of carbohydrates per tablespoon is as follows:
Diabetisweet: 4.8 grams of carbs per teaspoon x 2 calories per teaspoon = 8.5 grams of carbs
Sugar: 4.8 grams of carbs per teaspoon x 4 calories per teaspoon = 18 grams of carbs
Isomalt, the ingredient in Diabetisweet, begins with a sugar, but it is reproduced by a two-stage process and treated with enzymes so that it is no longer a sugar. Studies have shown that it is safe for people with diabetes. In fact, Diabetisweet has maintained a twenty-five year study on the use of Isomalt verifying its safety. It is one of the safest sugar substitutes because the body does not metabolize it and excretes it rapidly, unchanged, via urine.
Senior R & D Manager
Hi Tech Pharmaceuticals
Amityville, New York