Letters to the Editor
I would like to comment on the article "Perfect Control: Is It Possible? Is It Worth It?" (September 2002, p. 34). I was very disappointed with this article. It was very defeating and made perfect control seem so out of reach. While Ms. Abbott is doing a wonderful job with her care, I don't believe most people have that kind of time or dedication. I agree with Dr. Bernstein that tight control is possible and necessary, but what about nutrition? The foods left out of the diet he recommends are the ones that contain the most vitamins, minerals and fiber. What good is an A1C of 4% if you are not eating a balanced diet for your overall health?
Then there was Mr. Nairn: His schedule more closely resembles a normal lifestyle, but his A1C is 7.3%.
While I'm not saying an A1C of 7.3% isn't a great achievement, better control while living a normal lifestyle is possible. My daughter, Danielle, is 5 years old and has had diabetes for a little more than three years. She uses an insulin pump and tests about 10 times a day.
We use a paper logbook to record her blood-glucose readings and her insulin doses. We watch for trends and make adjustments to her regimen when necessary. She eats whatever she wants pretty much whenever she wants. We encourage a healthy diet, but nothing out of the ordinary.
Danielle's A1C levels run between 5.8% and 6.2%. Considering her age, we are very happy with this. Diabetes is always at the back of our minds, but we control it—not the other way around.
As the lead subject for your September cover story on "Perfect Control," I need to make a few corrections and additions.
First, I follow a moderate-carb diet, not a low-carb diet. I eat about 100 grams of carbohydrate per day, which might be considered low-carb only by somebody who eats 500 grams of carbohydrate per day.
Another comment has to do with the phrase, "Her goal is perfect blood glucose." My goal is not "perfect blood glucose." That's impossible. My goal is to avoid future diabetes-related complications by keeping my blood glucose as close to normal ranges as possible.
After five years of this kind of control, I don't find it restrictive or frustrating in the least. I spend less than half an hour per day doing diabetes-related calculations, weighing and measuring. Further, I eat out fairly frequently and, while I mostly avoid bread, pasta, grain products and root vegetables, I eat pretty much whatever else I want.
I would also like to explain the statement, "She has almost the same thing for breakfast and lunch every day." This needs to be interpreted broadly. I have three basic breakfasts that I rotate. (How many different breakfasts do people without diabetes eat?) While I do generally have soup and a low-carb tortilla rollup and a small part of a piece of fruit for lunch, I eat a variety of soups, tortilla fillings and fruits.
Eating monotonous meals is a sure way to get diet burn-out. The foods I rotate have all been tested and, basically, I know how much insulin I'll need to cover each, based on my pre-meal blood-glucose levels. This is where my logs come in very handy.
There's a lot going on in my life besides diabetes. I hold a full-time job, do volunteer activities, hike and quilt. And I have plenty of energy. Five years post-diagnosis, I have no complications, so this "800-pound gorilla" hasn't gotten me yet. If I have anything to do with it, it won't ever.
Finally, I think this is a fairly well-balanced article. Obviously I don't agree with all the experts quoted, especially Dr. Marcus, who considers an A1C of 7% acceptable. According to my research, complications will eventually accrue at that level.
I consider good diabetes control a challenge—sort of a game I play with myself, and this works for me. I would encourage others to follow this path.
I just wanted to thank you for printing "Creative Places to Wear Your Insulin Pump" (September 2002, p. 67). As a pump user, it is always nice to learn about alternative places to wear a pump.
I have a few creative places of my own. In the summer, when I wear a one-piece cotton dress, I prefer to place my pump on a pair of men's boxer briefs. The waistband is strong enough to hold the pump up, and if you turn it around with the clip in the front, no one knows you have it on.
Also, this little necessity can be discreetly placed in a pair of western boots. Place the clip on the outside, with the pump on the inside, and pull your jeans down over your boots (works best with the long infusion set).
Thanks again for giving us pump users some alternative ways to wear our pumps, as we are always looking for new ideas.
No Need to Pay for RX Lists
I have some information related to the article on page 28 in Diabetes Health's August 2002 issue ("RX Costs Too High? Coalition Offers Information to Help"). The article offers a publication for $5 containing lists of pharmaceutical manufacturers' patient assistance programs.
I take issue with the statement made by Chris Pongsak that "these programs are rarely, if ever, publicized." Many physicians' waiting rooms have brochures available about the Merck, Pfizer, Novartis and Together Rx patient assistance programs, among others. Information on these programs is also available for free—complete with up-to-date details and the actual application form for each of about 50 companies—on the Pharma Web site at www.phrma.org.
RxAssist (www.rxassist.org), supported by the Robert Wood Johnson Foundation is another useful site. Information can be sorted by brand name, generic name, company or drug class. Also of interest may be the link to drug discount cards for seniors and state and federal programs.
Rx Hope (www.rxhope.com), supported by Pharma, provides information for physicians and office staff as well as patient advocates and consumers.
There are income-level requirements and some paperwork to fill out, but I know that my company alone assists thousands of patients each year with free medication. Some programs require a small co-pay of $10 or $15 per drug.
I hope this information is helpful to your readers who do not have any other way to get the medications they need.
I enjoy your publication very much and look forward to each issue.
Editor's note: Thank you very much for taking the time to send us additional valuable information to share with our readers.
I read with interest your reporting of the Diabetes Care study connecting reuse of lancets and amputation ("A Sticky Situation," September 2002, p. 22).
I've used the same lancet four to five times a day for three years without it dulling and without getting an infection from it. Since the lancet is made of steel and I'm made of soft skin, how can usage dull it? I believe I've never gotten an infection because I squeeze a bit more blood out after testing and wipe with a clean tissue. (Blood has some salt in it and may not support infection.)
Sounds like scare tactics to me—both in the research and in your publishing it.
James S. Petty
Black Mountain, North Carolina
Clinical adviser's note: Please take a second look at that report of potential risks with lancet reuse. The article does not state that this is a research study result, but rather indicates that doctors in Florence, Italy, sent a letter to the editor of the medical journal Diabetes Care sharing case reports of two women with poorly controlled diabetes who required partial finger amputations after each reused a lancet for several weeks.
Key information in that report is that those women were in poor control of their diabetes. Two of the chief risk factors for infection are poor glycemic control and/or an immune-suppressed state, which can be created, for example, by the anti-rejection drugs required after organ transplant or by steroid therapy such as prednisone. In either of those conditions, the body is compromised in mounting the normal defenses against infection.
The 2002 Clinical Practice Recommendations of the American Diabetes Association (Diabetes Care, vol. 25, supplement 1, S113) give this caution about needle reuse: ".syringe/needle reuse may carry an increased risk of infection for some individuals. Patients with poor personal hygiene, an acute concurrent illness, open wounds on the hands, or decreased resistance to infection for any reason should not reuse a syringe or pen needle." It would seem that lancet reuse would fall under these same guidelines.Click Here To View Or Post Comments