Letters to the Editor
New Size and Improved Format
Thank you, thank you, thank you! I really appreciate the new size, which makes it easier to store issues. I love your magazine and have benefited from its many informative articles. I also like to keep each issue for future reference. The old, larger size made it quite difficult to store my back issues, and I wrote to you many months ago to request that you consider changing the size. I'm pleased to know that you listen to your readers. Many thanks again!
Thousand Oaks, California
Thanks for the Article
I enjoyed the article that your editor wrote on Eva Saxl ("Eva's Insulin," January, p. 50), especially as I am a person who has had type 1 diabetes for 34 years and am also a Jewish person of Eastern European descent.
Thank you for the wonderful article and your editor's contribution to Diabetes Health.
St. Louis, Missouri
Some Healthcare Professionals Don't Look at Medical IDs
I have worn a MedicAlert bracelet for diabetes since 1980, when I was diagnosed. Having been in the hospital and emergency room many times for surgeries and other problems, I can count on one hand the professionals who have looked at the bracelet to see what was written on it. Most of the time they paid attention only when it had to be taken off for a procedure. I will continue to wear it for my own safety, but I wonder if medical personnel look for the bracelet or necklace.
Thank you for such a wonderful magazine. I learn a lot from it.
Ivy D. Randel
Concern About Bad Advice From Doctors
One doctor I saw said my addiction to endurance exercise was no different from being addicted to drugs, alcohol or tobacco. Another doctor said not to worry about hospital emergencies because "they happen to my patients all the time."
This shows there are too many health professionals without diabetes trying to treat people with diabetes. I guess that is why medicine is 25 percent science and 75 percent guesswork.
Whatever happened to prevention through diet and endurance exercise? The human body works the exact opposite of a machine. Work a machine hard and it eventually breaks down and wears out; work the human body hard and it only gets stronger.
San Jose, California
Spell Out Abbreviations
In the article "The Many Benefits of the Glycemic Index" (September 2001, p. 51), the authors spell out "Glycemic Index" before using the abbreviation "GI." Why not follow this good example in other articles? Elsewhere, Diabetes Health is full of abbreviations that should be preceded by the terms themselves.
A Low-Carb Diet Is Not the Answer
As a person with type 2 diabetes, I am disturbed by the recent trend among people with type 2 diabetes (mentioned in the "Letters to the Editor" section of your January issue) and diabetes educators toward limiting carbohydrate and counting carbohydrate grams rather than controlling fat and total calorie intake. Limiting carbohydrate grams means that the amount of protein or fat or both must be increased in order to maintain adequate caloric intake.
Protein can be used for energy only by converting the constituent amino acids to glucose and excreting nitrogen. Increased demand for nitrogen excretion can be detrimental to people with diabetes who have kidney damage, either from longstanding high blood pressure or from diabetic nephropathy. Before embarking on a high-protein diet, it would be prudent for people with diabetes to ask their physicians if they should have a thorough evaluation of kidney function and to have periodic rechecks thereafter.
People with diabetes often have disturbed lipid profiles; those who do have increased risks of stroke, heart disease and/or peripheral vascular disease. A diet high in fats is likely to lead to increases in blood levels of total cholesterol, triglycerides, and low- and very low-density lipoproteins. It seems unwise to advocate a diet that potentially adversely affects risk factors for developing vascular disease.
A healthy overall approach for people with type 2 diabetes encompasses lifestyle changes, including weight loss if needed; moderate exercise; and consumption of a healthy diet, with moderate amounts of protein, low fat, and complex carbohydrates high in fiber.
Lela K. Criswell, MS
Fort Collins, Colorado
Editor's note: We asked Joy Pape, RN, BSN, CDE, one of our food & nutrition advisers, to reply.
With all the media hype, I can understand your concern. As a professional, I too had those concerns about a low-carbohydrate diet. But I also found that these programs were beneficial for some people.
New research is emerging showing that there are benefits to these programs. We all know there is more to diabetes care and management than just looking at blood glucose—we need to look at each person as an individual and individualize care. Since 1994, the American Diabetes Association (ADA) no longer recommends a standardized diabetes diet.
The ADA Goals of Medical Nutrition Therapy (published in the January 2002 issue of Diabetes Care, Supplement 1) include the following points:
1. Attain and maintain optimal metabolic outcomes including
a) Blood-glucose levels in the normal range or as close to normal as is safely possible to prevent or reduce the risk for complications of diabetes.
b) A lipid and lipoprotein profile that reduces the risk for macrovascular disease
c) Blood pressure levels that reduce the risk for vascular disease.
2. Prevent and treat the chronic complications of diabetes. Modify nutrient intake and lifestyle as appropriate for the prevention and treatment of obesity, dyslipidemia, cardiovascular disease, hypertension and nephropathy.
3. Improve health through healthy food choices and physical activity.
The gentleman who told his story in our January issue reports that he has been on a low-carbohydrate diet since February 2000. His total cholesterol dropped from 270 to 165; his LDL dropped to 90; triglycerides went down to 125; and his blood-glucose levels are in control (84-120), with an A1C of 4.9%. One can hardly argue with these numbers. He did not mention his HDL, but we do usually see HDL rise in a lower-carbohydrate program.
We must remember that the protein/kidney issue is also highly controversial. The proponents of the lower-carbohydrate plans agree that if someone has advanced kidney disease it is more difficult for their kidneys to handle the protein, but this is not the cause of kidney disease. The fat issue was also mentioned.
Please also note that all "lower-carbohydrate" diets are not the same. Different amounts and types of proteins and fats are mentioned. Most of these diets do teach about avoiding trans fats and using monounsaturated fats. Many people speak of the long-term detrimental effect of these lower-carbohydrate plans. I am not, however, aware of any studies that prove this. As I've asked in the past, if you know of any, I would be happy to hear about them.
If we are truly able to individualize diabetes care, we will see that all people do not respond the same. Lower-carbohydrate plans work for some, and with today's technology we can closely monitor how someone is doing and detect problems if they should arise.
Marion Franz, MS, RD, CDE, one of our food & nutrition advisers, made these additional comments:
It is important to also note the following major points in the ADA guidelines:
- Address individual nutritional needs taking into consideration personal and cultural preferences and life-style while respecting the individual's wishes and willingness to change.
- Food containing carbohydrate from whole grains, fruits, vegetables and low-fat milk should be included in a healthy diet.
- The expert consensus is that the long-term effects of a diet high in protein and low in carbohydrates are unknown. Although such diets may produce short-term weight loss and improved glycemia, it has not been established that weight loss is maintained long-term. The long-term effect of such diets on plasma LDL (bad) cholesterol is also a concern.
It would seem reasonable that people with diabetes, as is the case with the general public, "deserve" the right to eat healthfully. There are better ways to correct metabolic abnormalities (such as medications) than the low carbohydrate diet.
The Correct Use of Lantus
Thank you for printing the recent correction about Lantus (insulin glargine [rDNA origin] injection), the first and only insulin analog that offers 24-hour, once-a-day treatment for diabetes.
To clarify, Lantus is indicated once daily for subcutaneous administration at bedtime. One injection of Lantus at bedtime lasts through the night and the entire next day, delivering 24-hour "basal" coverage. "Basal" refers to the slow, steady release of insulin needed to control blood glucose and to keep cells supplied with energy when no food is being digested. Lantus can be taken with oral diabetes medications, including sulfonylureas, metformin, and acarbose, and/or short-acting insulin. Lantus is not meant to replace short-acting insulins, which provide a "bolus" at mealtime. Therefore, some patients may need to augment Lantus treatment with additional injections of short-acting insulin. For patients who do not need short-acting insulin at mealtime, Lantus alone is sufficient.
Lantus is proven to lower basal glucose levels for a full 24 hours with no pronounced peak and works almost twice as long as neutral protamine Hagedorn (NPH), the most commonly used intermediate-acting insulin available. In order to provide full basal insulin coverage, two NPH injections are required to cover a full 24-hour period.
In addition, Lantus is a good choice for those whose glucose levels are too high in spite of efforts to control their diabetes with diet, exercise or oral diabetes medications.
Michael Pfeifer, MD
Medical Product Leader
Bridgewater, New Jersey
Diabetes Health Should Create an Index of Past Articles
As a subscriber who reads each issue from cover to cover, I often recall articles I have read but have trouble finding them when they are needed.
It would be great if Diabetes Health could create an index of past articles on your Web site so that your dedicated subscribers can locate information from your incredible resources when we most need it. Although I have a number of books published by the American Diabetes Association, magazine articles are more current and—in most cases—more informative.
I was diagnosed with type 1 at the age of 49 in March 2000. My blood-glucose level was 681 mg/dl when I was admitted to the hospital. My A1C was 15.8%; it's now at 5%. I am on the MiniMed 508 pump and am signed up to get the Paradigm later this year.
My A1C was already between 4.9% and 5.6% prior to receiving the pump. I am still on a "diabetes honeymoon," having only minimally depleted my insulin production (even though I have a high antibody count) over the past year. Of course, going to the gym five days a week and watching my diet and blood-glucose levels are definitely paying off.
I am continually trying to learn more about diabetes and help myself, friends and acquaintances with diabetes.
Thank you for all the information I continually receive from Diabetes Health. I consider all of you good friends who care.
Suffern, New York
Editor's note: Great idea about the index of articles! We are working on it!
Correction: The address for the National Certification Board for Diabetes Educators mentioned in the January issue (p. 11) is 330 E. Algonquin Road, Suite #4, Arlington Heights, Illinois 60005. The Web site address is www.ncbde.org.Click Here To View Or Post Comments