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Thanks for Your Great Articles
I really enjoyed reading the article "The Islet Transplant Versus the Artificial Pancreas: Who Will Win the Race to Market?" (March 2002, p. 32). I'd like to suggest a follow-up article on research on islet encapsulation using porcine and/or human islets as an alternative to the Edmonton protocol (and the necessity of anti-rejection drugs).
Radha McLean has done a superb job of gathering all known and relevant facts into her interesting article on diabetes and left-handedness ("Taking the Upper Hand," February 2002, p. 32). There seems to be no question that there is a correlation between the two factors. I would like to know who can tell us why this connection exists. The need to understand the cause of type 1 diabetes is so great that we can leave no stone unturned.
Younger researchers may not know that, for children growing up in the '30s and '40s and earlier, left-handedness was considered an unacceptable affliction. Those of the older generation will remember the teacher patrolling the classroom during writing exercises, removing pencils from left hands and placing them into right hands. No child was to remain left-handed. It was considered unnatural.
That affects this inquiry because many older people with type 2 diabetes who are left-handed may no longer identify themselves as such.
I also love the new, smaller format of the magazine. Congratulations for making the good decision to change the size.
Thanks, Diabetes Health. Continue to lead us into the light!
Patient Advocate Adviser
Chevy Chase, Maryland
I am a registered dietitian in a rural Northern Michigan hospital. I coordinate our diabetes support group at our hospital. I just wanted you all to know how much I enjoy your publication. Scott King's editorial in the March issue reminded me again to not give up the good fight. We often discuss articles from your magazine at our monthly meetings.
Just wanted you to know we appreciate your publication!
Connie Farrier, RD
Director of Support Services
Kalkaska Memorial Health Center
After reading the February 2002 issue, I had the following thoughts:
In your article about blood-glucose meters ("It's Not Just About Quick Readings and Smaller Sample Sizes Anymore," p. 36), the importance of meter accuracy was emphasized. The comparison chart that reviewed meters (p. 39) did not, however, include a column indicating how each meter's readings relate to empirical lab tests (for example, ± 10 mg/dl).
I empathize with those who write to you to complain about this wretched disease, but we people with diabetes must stop to acknowledge that, in some respects, we are fortunate. I have the ability to work diligently to control this disease to delay or avoid the onset of complications. As Scott King so pointedly wrote in his column "My Own Injection" (p. 8), we do not have to let our tissues become the equivalent of beef jerky.
For the first time in history, it appears that a cure may become a reality in the near future—a closed-loop mechanical glucose monitoring and insulin pump system, and then perhaps a biological cure in the form of an islet, beta, or stem cell transplant, or other form of engineered cells that will also address the immunosuppression problem.
David J. Winkler
Whittier Institute for Diabetes
San Diego, California
Editor's note: We asked Cindy Onufer, RN, MA, CDE, Diabetes Health's clinical adviser, to reply to this reader's comments about blood-glucose meters.
The blood-glucose meters that we reported on are all approved by the U.S. Food and Drug Administration (FDA) for use in the United States. To obtain this approval, the manufacturers sponsored clinical trials to show the accuracy (validity) and precision (reliability from test to test) of the meters. The results were compared to results from laboratory standard instruments. One method of analyzing these results is a graph called Clarke's Error Grid Analysis. You can view these graphs on the Web sites of many of the meter manufacturers or on package inserts included with the meters and test strips, or you can obtain a copy by calling the toll-free customer service number.
An important factor in the accuracy of blood-glucose test results is user technique. In addition, the article mentioned the need to choose a meter that operates accurately in the hematocrit range of the user.
Sometimes interfering substances are a source of error. For example, certain drugs or ascorbic acid (vitamin C) levels may interfere with the chemical process of readings in the meter systems that require oxidation to test glucose. Each manufacturer can provide information on this in the ways mentioned above.
When comparing self-test capillary blood-glucose results to a laboratory venous sample, one must remember that, in the fasting state, plasma-calibrated meters will give results very close to lab results.
The results provided by whole-blood-calibrated meters are expected to be 12 to 15 percent lower than fasting lab results. But, in the after-meal state, capillary blood levels of glucose are expected to be about 20 to 70 mg/dl higher than venous (lab sample) blood. That is normal, not meter inaccuracy. The article by Richard Gadsden, PhD, "Sources of Variation in Blood Glucose Testing," in Challenges in Diabetes Management/
Milestone in Monitoring, sums up this topic by revealing that variability of up to +/-19 percent can be seen from laboratory to laboratory when testing identical serum samples. Obviously, quality control procedures help minimize that variability.
In its 1994 consensus statement about self-monitoring of blood glucose, the American Diabetes Association concluded that user technique is the main source of erroneous results. People with diabetes need to learn quality control procedures to use with their meter systems and practice the correct technique in self-testing.
Not Happy With the New Format
Your new, smaller format is not as easy to read. The print is too small and difficult on the eyes. There are many people with diabetes with poor vision. You should reconsider this change.
Editor's reply: Thank for your comments. We are working on improving the legibility of the type.
Problem With a Photo
As a nurse and diabetes educator, I have enjoyed your magazine. The material you feature suggests the editorial board is not afraid of making waves or rocking the boat.
I was disappointed by the photo used in the Research Update "A Question of Length: Research Finds Link Between Leg Length and Diabetes" (February 2002, p. 18). The study compared leg length of middle-aged men and subsequent risk of developing type 2 diabetes. The accompanying photo you selected was of women's legs! Women are already discriminated against in health care and research. I can think of no reason to exclude women from the study. To use a woman's body only for photographs is an affront to women and not in keeping with your magazine's track record or mission statement to help all people with diabetes. Keep rocking the boat, baby!
Katie Morales, RN
More on the "Fat and Lazy?" Debate
I just finished reading Rebecca Wiseman's response (February 2002, p. 10) to the editorial by Jan Chait ("Fat and Lazy?" November 2001, p. 11). Ms. Wiseman's letter was disparaging toward people with type 2 diabetes, and I feel compelled to respond.
I have survived for 37 years with type 1 diabetes. I, too, used to feel that type 1 was more dreaded and difficult than type 2 and that people with type 2 had an easier time with a disease that they caused.
But I've grown up and learned that it is just not so. It is not only unfair, it is totally wrong to say that difficulties do not occur with people who have type 2.
Ms. Wiseman appears to be unaware of many of the problems that are shared by both types. She also seems unaware that a great number of type 2s will eventually end up having to inject or infuse insulin and that many type 1s will develop insulin insensitivity.
She states, "I am well aware of the fact that type 1s have no choice but to take insulin. They do not have the option of simply changing their diet or exercise program to lower their blood glucose."
I know many type 2s who are beginning to gain some control, and I hope they will have as much as I do over time. They are testing 10 times a day and wearing an insulin pump 24/7, just like many type 1s, including myself. I would like to invite all type 1s to spend just one day living as a type 2, and then maybe they'll understand. Diabetes, no matter what type it is, is not easy! And Ms. Wiseman needs to realize that Jan Chait is a pumper herself.
Also, Ms. Wiseman is apparently unaware of how type 1s managed to stay alive before the discovery of insulin. I understand that Ms. Wiseman is upset with the prospects and difficulties that she and her daughter face, but please realize that quite a few type 2s face those same prospects. Why insist on the differences? Why can't we join together to defeat this "Dia-beastie"? Why can't we all just "get along" and fight our common enemy? Then both of us will thrive when that magic word becomes a reality: a cure!
The Exercise Debate
In the March 2002 issue of your grand publication, I was astounded to read the letter from Phyllis Matalis ("What's Wrong With Exercise," p. 14).
I have never noted such a negative reaction from the people at a gym called Healthquest in Napa Valley, California, where my wife and I are members. My wife has lost 45 pounds in the past three to four years and has had to buy a whole new wardrobe because of the weight loss.
We have exercise machines, treadmills, etc., and the overweight folks use those too. I have made friends with a man who used to weigh around 325 pounds. He has lost 40 pounds since last summer!
I get tired of hearing it when overweight people justify their obesity and try to get the public to accept them for how they look. I really don't care about their looks, but I do care that they are asking for health problems as time goes on, such as diabetes, failing knees and hip joints.
Richard E. Panzer, PhD
Napa Valley, California
Correction: The Business Brief on the InnoLet insulin delivery system in the March 2002 issue (p. 30) incorrectly stated that the product is now available. Although the InnoLet was approved by the U.S. Food and Drug Administration in December 2001, it is not yet available to physicians or patients. The InnoLet is a prefilled, disposable insulin delivery device that will be available with Novolin 70/30 insulin and Novolin N insulin.