Letters to the Editor
Diabetes Prevention Trial Not a Waste
In your editorial in the August 2001 issue ("My Own Injection," p. 8), you commented on the preliminary results from the Diabetes Prevention Trial (DPT-1), saying that it's too bad that the results were negative. Although I agree that it is disappointing that the results were negative, I don't agree that it's a bad thing. It is just as important to find out that a certain procedure or treatment (or medication) will not help as to find out that it will. Otherwise, we could be doing unnecessary things, and spending money and time without getting any results. Suppose that we went ahead and assumed that this treatment (small amounts of injected insulin) would work when it actually does not. That would be a big waste of time and money, wouldn't it? Now that we know it will not help, we can move on to find something else that will.
Des Moines, Iowa
The DPT-1 Trial Is Too Costly
Regarding the article on the Diabetes Prevention Trial (DPT-1) in your September 2001 issue ("Multi-Million Dollar Trial Shows Insulin Shots Do Not Prevent Diabetes," p. 40), I can't imagine spending that amount of money on such a stupid trial when there is so little money to be spent on finding a real cure. Could not these researchers have done it on a smaller scale and come up with a conclusion more quickly? The whole thing sounds so far-fetched that, surely, intelligent people would not go on such a wild goose chase based on suggestions from previous studies. And to still be recruiting participants for a trial on oral insulin surely is just as stupid. Surely the National Institutes of Health (NIH), which funded the trial, read this article and realized that the money they are spending on diabetes is wasted on stupidity. No wonder we are so far from a cure.
Oak Ridge, Tennessee
All in the Family
Your magazine gets better and better. I sent the article "Getting Better With Age" (July 2001, p. 31) to my brother, who has had type 1 for over 50 years and is in excellent health.
I gave the June issue to my daughter-in-law to pass on to her sister-in-law, who has a recently diagnosed six-year-old. That issue is filled with helpful information for parents. Keep up the good work.
I would like to see more information on type 2s. I was diagnosed four and a half years ago, have never been obese, always exercise and had four children weighing between five and six pounds at birth. I do have a brother with type 1 and an overweight sister who has type 2. My grandmother had type 2.
Thanks for all the ways in which you keep us informed. The article on Lantus ("One-Shot-a-Day Insulin Is Here," July 2001, p. 41) is very good. My endocrinologist gave me one of his first bottles and it's super.
East Setauket, New York
Thanks for the Type 1 Coverage
I went to our local library tonight and found two issues of Diabetes Health. What a pleasant surprise! I've been a type 1 diabetic for 35 years. I thought there was something drastically wrong with me because I still have low readings. What a treat to read about other peoples' experiences and learn that I am a "normal" person with type 1 diabetes. I will be subscribing to Diabetes Health soon.
Michael P. Soloski
Are My BG Readings Too Low?
My A1c doesn't correlate with the average BG readings given in the chart by Dr. Lodewick in the July 2001 issue of Diabetes Health (p. 11). My A1c is usually between 5.0 and 5.3 on a scale of normal < 6.0, the same as the DCCT guidelines. According to the chart, my average BGs should be between 90 and 100, and this just isn't the case. My BG average is usually 120-150, and I test before and two and four hours after meals. My BGs are usually around 90-120 fasting and 80-120 after meals. I have repeatedly verified my reading from my meter (the AccuChek Complete) against laboratory results, with control solutions, and it comes out correct. I am not having hypoglycemic episodes as far as I can tell. I test whenever I feel even remotely low and I'm usually not. My meter generally reports one to two percent of my BGs as low (under 70), as opposed to 35 percent high (over 140). I also test randomly at night, and don't get low at that time.
So my question is, in terms of control, which result should I believe? Should I be trying to achieve lower BGs after meals, or should I assume that my A1c is fine?
Natalie A. Sera
Editor's Note: We asked Dr. Lodewick to respond.
You are doing just fine! Most of your blood sugars are running in the normal range. Congratulations! You are doing better than the DCCT. I do not believe you have to do anything better; your A1c level is fine.
Peter Lodewick, MD
Diabetes Care Center
Low-carb Diet Works for Me
I really enjoyed reading the article by Joy Pape, RN, CDE, in the September 2000 issue ("Low-Carbohydrate Diets Can Work for Diabetes," p. 42). She discusses the benefits of using the dietary guidelines from the book "Sugarbusters!" to regulate blood-sugar levels. I was diagnosed with type 2 one year ago. Fortunately, I purchased the book right away and have subscribed to the low-carbohydrate approach ever since. My diabetes is under control (A1c of 6.8% down from 8.1% and my lipids are moving in the right direction). But I continue to find that doctors, dietitians and nurse practitioners are still wedded to the food-pyramid paradigm. It sounds like this article would be great for me to give to them. I wish the medical establishment could be more open-minded. How could they possible think that they know it all—the practice of medicine has always been 25 percent science and 75 percent guesswork!
Slim Fast Scare
I just had a frightening experience. A severe hypoglycemic, I took my regular 5 units of R Humulin 30 minutes before lunch. Instead of my normal sandwich and milk at lunch, I drank a glass of Slim Fast with milk. I carefully read the label and figured out that it was almost identical to the sandwich in calories, carbs and sugars.
Later that afternoon I laid down for a nap and, after a couple of hours, my wife was unable to wake me. She knew it was a low, but was unable to force anything down me, as I was virtually comatose. The paramedics arrived shortly and measured my blood sugar at 22 mg/dl. They are not allowed to give an injection, so they could not administer Glucagon, but rushed me to a nearby hospital where they started me on an IV of glucose. Even then, it was over an hour before they could wake me.
I am a constant reader of your magazine and have never read anything that would have warned me of such an experience. My doctor thinks that Slim Fast acted very rapidly, and was gone before the insulin wore off—leaving me extremely low.
I write this as a warning to others who might not know to consider the rapidity of absorption of sugars. I am 69 years old and have been a type 1 for 30 years.
Editor's Note: We asked nutritionist Marion Franz, MS, RD, CDE, to comment on this reader's experience.
Your letter raises some very interesting questions. There could be several factors that may have contributed to your severe hypoglycemic episode. Although there are some differences in how rapidly blood glucose levels increase after consuming different foods or beverages, the peak responses tend to be within minutes regardless of the carbohydrate eaten. However, the duration of the glucose response also differs and may well have been less for your lunch of Slim Fast versus your usual lunch. Therefore, the peak insulin response from your Regular insulin would occur as your blood-glucose levels were dropping. This is one of the main advantages of using rapid-acting insulin, such as lispro or aspart, in place of Regular insulin. The peak insulin response correlates better with the peak glucose response and it can be taken immediately before eating.
However, other factors may have contributed to the hypoglycemia. Did you do any additional physical activity that morning? Hypoglycemia is more likely to occur after exercise than during, and especially after exercise that is sporadic. Have you had frequent episodes of hypoglycemia? People who have frequent episodes of hypoglycemia are also more susceptible to hypoglycemia in the future. You may have heard "hypoglycemia begets hypoglycemia." Individuals need to make adjustments in their insulin regimens and glucose goals to try and reduce the frequency of hypoglycemia.
It may also be that the carbohydrate content of the Slim Fast lunch was less than your usual lunch. However, even if it were less you would not expect such a severe hypoglycemic event from the difference. Of course, there is always the possibility of taking the wrong insulin dose as well. However, it sounds from your letter as if it is more likely that there was not enough glucose from the carbohydrate you ate when the Regular insulin was at its peak activity.
As you well know, it is often frustrating trying to determine exactly what is the cause of hypoglycemia (and hyperglycemia) in persons who take insulin. Good luck in the future and check with your doctor in regard to changing your insulin regimen.
Marion Franz, MS, RD, CDE
Nutrition Concepts by Franz, Inc.
Thanks for Helping to Educate
I am a certified diabetes educator (CDE) with type 2 diabetes, currently controlled with diet and exercise. I have been a CDE for 19 years, and have served the diabetes community in many capacities—I have worked on various boards, as a program and fundraising volunteer and have worked extensively with diabetes program presentations. I love your publication because I can find some supportive point of reference in Diabetes Health to back up whatever type of treatment for diabetes I advocate.
I travel teaching how to use an insulin pump for the three top pump companies and a variety of physicians. The amount of important information that people are not aware of frustrates and angers me. I live in a rural area where access to diabetes care is a big concern. I pass out Diabetes Health subscription cards and encourage my patients to subscribe to your invaluable, practical publication.
Thank you for offering free copies of your magazine. I appreciate your initiative in the diabetes community and respect your publication as a professional tool to help people with diabetes, in every aspect of the disease.
Patricia A. Wagner RN, BSN, CDE
Another Mother Says "Thanks"
In the "Letters to the Editor" section of the August, 2001 issue of Diabetes Health (p. 11), the mother of a "beautiful nine-year-old daughter who has type 1 diabetes" wrote to tell you how much she loves your magazine. Ditto!
I, too, have a daughter with type 1 and feel the same way about your publication. As a nurse, parent of a type 1 child and an aspiring diabetes educator, I promote your magazine every chance I get. I learned about it at my first family support group meeting, after my daughter was diagnosed last fall, and subscribed right away.
The format of your articles and the useful content you cover is truly a Godsend! My daughter usually reads every issue cover to cover as well, and learns something new every time.
You are doing a great service. Thank you!
Elna S. Narula
Keep Up the Humor
Your publication fascinates me and I read it with sheer delight. Its balance overwhelms me. Its levity amuses me, and the serious articles educate me. Thank you!
The Diabetes Pipeline
East Greenbush, New York