Letters to the Editor
In Defense of Non-Western Medicine. I was disappointed with Ron Zacker's editorial in the December 2002 issue ("Keep Your Eyes on the Prize," p. 46). It seemed that Zacker lost sight of the prize with his statement, "Too much information and too many options can distract us from what's really important."
I disagree with Zacker's contention that non-Western treatments cannot comprise the basics of diabetes care and define "what's really important." Because he is not an expert in non-Western medicine or a practicing clinician in "alternative" forms of treatment, Zacker is simply not in a position to make such a statement, regardless of minimal references to some of the research on "alternative" care.
The real issue in the area of non-Western medicine is assisting patients in finding competent practitioners of non-Western health care with extensive knowledge about diabetes, who can help them discern which treatments are appropriate for each particular body. Patients may consider this a challenge. However, in my experience, finding a competent endocrinologist who has extensive knowledge about type 1 diabetes and can work with a patient's idiosyncratic issues is also like finding a needle in a haystack—so we might as well broaden our haystacks.
Medical Journal Letter Still Causing Confusion
I was quite interested in the letter in the December 2002 issue of Diabetes Health ("Scare Tactics," p. 15) in which James Petty criticizes your coverage of the article from Diabetes Care about potential problems with lancet reuse ("A Sticky Situation," Sept-ember 2002, p. 22).
I, too, had similar feelings about your report, which led me to seek out the original article in Diabetes Care. Though you correctly state in your response to Mr. Petty that these two women were in "poor control," it must be emphasized that "poor control" in this case is about as complimentary a comment as could be made. For example, one of the women had existing kidney damage, chronic neuropathy, foot ulcers, elevated blood lipids, hypertension, an A1C of 14% and, perhaps not surprising, major clinical depression despite intensive drug therapy.
With all these complications, the doctors see an abscess on the tip of the third finger and blame it on reusing a lancet about six times. Something doesn't seem right here. The important question is, given the women's substantial medical problems, whether reusing a lancet a few times caused infected fingers or, more likely, whether any wound on their fingers, even from a sterile lancet, might have caused similar problems.
I'm still not clear why Diabetes Health chose to highlight this article or whom it might benefit. It is known that people with well-controlled diabetes consistently reuse lancets with no problems, and those with grossly uncontrolled diabetes surely have more serious problems to worry about.
In general, Diabetes Health does a terrific job and is, in fact, my favorite of the diabetes magazines. But in this case, I think you were not wise in covering this study. I'm sure the lancet manufacturers loved it, and perhaps that is partly why Diabetes Care chose to publish it.
Finally, I must admit to being tremendously impressed with Mr. Petty's ability to reuse a lancet for three years (approximately 1,500 pokes!). In my effort to keep BD solvent, I generally discard mine after only about a month (approximately 150 pokes).
Clinical adviser's note: In both our original report and our response to Mr. Petty, we emphasized that these were case reports from a letter written by two doctors to the medical journal Diabetes Care—not a medical study. Scott King, our editor-in-chief, believed it was potentially important to share these reports with our readers, who can then consider them along with other information from various sources and advice from their own diabetes care team. Compared to other aspects of diabetes management, the cost of lancets is minor. In some specific cases (individuals with an immune-suppressed state and/or those with poor glycemic control), an ounce of prevention may well be worth a pound of cure.
Reaction to "Diabetes in the Movies" Article
I just picked up my issue of Diabetes Health from a bookstore shelf the other day and was thrilled to get it. I had been meaning to resubscribe for quite a while and am sending in a card today.
Thanks for your November 2002 article on diabetes in the movies ("Diabetes in the Movies," p. 36). Most people go to the movies for entertainment rather than education. But they do retain some of what they see. So while I don't expect a movie to give me the amount of detail contained in the video I got with my insulin pump, I do feel it should make an accurate, verbal connection between symptoms, the emergency at hand and the appropriate treatment.
I can imagine a "good Samaritan," unfamiliar with diabetes, who stumbles upon a person in need of assistance. They see the person's medical alert ID and deduce from the symptoms that the person is hypoglycemic. Which response would you prefer if you were the movie's writer and the patient was your child or spouse? "Hey, I remember this from ‘Panic Room'—they gave the little girl insulin." Or, "Hey, I remember this from ‘Steel Magnolias'—they gave Julia Roberts something to eat."
I am intentionally avoiding getting too medically detailed in this scenario because the layperson unfamiliar with diabetes (and there are a few) may not know to use a meter to check blood glucose or how to calculate the carbs needed to raise it. He or she may also not know about glucagon kits. My point is, a movie does not have to advocate for a condition or give in-depth detail in order to educate the viewer that symptom X = emergency Y = treatment Z.
The article "Diabetes in the Movies" is just another excuse to blame ignorance on something other than the person being ignorant. "Panic Room" was just a movie, and it's not even based on a true story. Who sits watching a fictional movie and believes every single detail? People, please use common sense.
I saw "Panic Room," and my concern while watching was not whether they used the correct term for the shot given to the girl or whether it was type 1 or type 2. All I was concerned with was whether the mother was going to make it from the room to the girl's medicine without getting killed. Better yet, how were they going to get out of the room with the three men there?
Both my parents live with type 1 diabetes.
Movies are made for entertainment. We should not read too much into fictional characters