Letters to the Editor

Jan 1, 2003

Insulin Errors

The article on page 75 of the November 2002 issue ("Could U Be in Danger?") is one of the best I have read, and I have been following you since your days on the radio. I want to suggest an article for a future issue on how to say no to doctors and how to take control of your own testing and shots when you are in the hospital.

About four years ago, I was admitted to the hospital and the doctor asked if I wanted to take care of my testing and giving myself my own shots. I said yes. Since then, I take care of myself when I am hospitalized and do not leave it in the hands of people who really do not know what they are doing. This has been such a blessing, because every person with diabetes is different.

One example: After I had bypass surgery in 1996, a doctor who was in the process of learning to do heart bypass got all upset that I had a blood glucose of 210 at 11 p.m. I had just taken my NPH, and he wanted to give me 12 units of Regular. I said no. (People do not know that they can say no to a doctor, but I learned a long time ago that you have to learn to take care of yourself or you are in trouble.) The next morning, I was down in the low hundreds. The doctor knew about the heart, but he did not know about insulin and how it peaks.

Jack Isaacson
Chattanooga, Tennessee

Toeing the Line

I just finished reading your article on eating habits during the holiday season ("Toeing the Line or Taking a Holiday?" November 2002, p. 88). I was a bit surprised to read about so many people with diabetes who keep away from "forbidden foods" or deprive themselves. Why can't they enjoy any meal they would like?

I am the mother of a 6-year-old boy with Type 1 diabetes. I allow him to eat anything he wants and as much as he would like during meals—I just follow it up with a specific amount of Humalog according to how many carbs he consumed. Are we the only ones using the insulin-to-carbs ratio protocol? It works well for my son. He never feels deprived, and his blood-glucose values are within range. He even got to enjoy Halloween, his favorite holiday!

Tricia Ruby
San Jose, California

Editor's note: This article was written for all people with diabetes, whether or not they take insulin and can apply an insulin-to-carbohydrate ratio. Many people with Type 2 diabetes control with diet and exercise or with oral medications and cannot be as flexible as those who take insulin. Other reasons people may choose not to "indulge" during the holidays include weight concerns, other medical conditions, and personal dietary preferences.

Big Surprise!

I read with great interest your article entitled "No Surprise" (October 2002, p. 67) regarding obstacles to testing that people with diabetes encounter. I experienced an unexpected deterrent in a recent visit to my doctor.

While asking for prescription re-fills, I requested that my doctor write an order for a 60-day supply of 300 strips so that I would have enough to encourage frequent testing and, therefore, better control. Imagine my surprise when my doctor responded, "You shouldn't need to test that many times a day to achieve good control."

I was shocked. Although he deals almost exclusively with people who have diabetes and is good, he still has the misconception that diabetes control is relatively simple to achieve.

I fully intend to show him the "No Surprise" article and discuss the matter with him.

Thank you for giving a voice to the concerns of people with diabetes. Some of these are issues that even medical practitioners don't quite understand!

Mark Gang
Glendale, California

Supplementing the Supplements Feature

My congratulations to you on the feature about supplements for diabetes ("Herbs, Supplements & Vitamins," October 2002, p. 49). I particularly appreciate the positive nature of the article. The natural products industry appreciates your support.

I was, however, surprised by the noticeable absence of fundamentally important natural ingredients. Am-playa (bitter melon/Mormordica charantia), bilberry, gurmar (gymnema sylvestre), jambul, onion, prickly pear, Pterocarpus marsupium, reishi mushroom, sacred basil, salt bush and many others deserve some mention. The growing battery of clinical research surrounding many of these ingredients, coupled with increased attention and funding from the National Institutes of Health/National Center for Complementary and Alternative Medicine, lends further reason for more editorial attention. Maybe a continuing series is in order?

David Goldberg
President, Informulab
Omaha, Nebraska

Which Antibiotics Are Bad for the Kidneys?

I have had diabetes for 34 years and have developed some kidney complications in the last three years. I've had high potassium and creatinine levels.

In the September 2002 issue, I read an article by Betty Wedman-St Louis ("Diabetes and Kidney Disease: What Are the Four Stages?" p. 48) in which she wrote that "anti-inflammatory drugs seem to be major culprits for kidney disregulation, followed closely by antibiotics."

Could you please ask the author which "antibiotics" she was referring to? Is there maybe a list of antibiotics that should be avoided by people with kidney disease? My doctors have been of no help in this regard.

Diane Howland
San Jose, California

We asked Dr. Wedman-St Louis to reply to this reader's concern.

Space does not permit me to list all of the antibiotic and anti-inflammatory medications that can have kidney complications. I have chosen one of each to illustrate my point of why each person needs to check with his or her doctor and the Physicians Desk Reference (PDR) be-fore taking any medication.

Naprosyn (naproxen) is a popular non-steroidal anti-inflammatory drug used in the treatment of rheumatoid arthritis, osteoarthritis, tendonitis and acute gout. The kidney effects outlined in the PDR describe this drug's toxicity because of the accumulation of metabolites in the kidneys.

Nebcin (tobramycin) is an antibiotic derived from the mold Streptomyces tenebrarius and is used for the treatment of bacterial infections. Nephrotoxicity as discussed in the PDR includes elevated BUN, serum creatinine, and elevated pro-teinuria.

I hope these examples help to remind you and others that drugs have side effects in addition to their ability to help the body heal. Medications need to be customized to the patient, taking into account all the clinical side effects that may have an impact on other disorders occurring within the body.

Betty Wedman-St Louis, PhD, RD
St. Petersburg, Florida

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