Letters to the Editor

May 2005

May 1, 2005

A1C Author Did Not Prepare or Endorse A1C Chart

I am the author of the article “What Is A1C and What Does It Measure?” which appeared in the March 2005 issue of Diabetes Health.

I would like to make it clear to Diabetes Health readers that the editors of Diabetes Health added the chart that followed the article and the article’s reference to it. I do not endorse the products listed in that chart, and most of them were incorrectly listed as being certified by the National Glycohemoglobin Standardization Program (NGSP). None of these products are currently NGSP certified.

A complete and accurate listing of NGSP-certified methods and laboratories can be found on the NGSP Web site (www.ngsp.org).

Randie R. Little, PhD
NGSP Network Coordinator
Director, Diabetes Diagnostic Laboratory
University of Missouri School of Medicine
Columbia, Missouri

Editor’s note: We apologize for neglecting to mention that neither Dr. Little nor anyone at the NGSP prepared the chart that followed Dr. Little’s article. The manufacturers of the A1C monitoring products mentioned provided all information in the chart.

Reader Astonished by RD’s Comments

I was astonished by the comment made by Robin Edelman, MS, RD, CDE, in the March 2005 issue (“Readers Chime In On Diabetes Busts Article”), where she says, “For type 2 diabetes, it’s not the carbs but the total calories that are most important, anyway.”

Both are equally important, and individuals with type 2 diabetes must take both calories and carbs into consideration for good blood glucose control. You can eat no-carb or trace-carb foods (for example, a steak) and really overdo it on calories if you don’t consider portion size. And you also can eat fruits, which are low in calories, but higher in carbs. A 1-cup serving of most fresh fruits, while low in calories, has 25 grams of carbs, almost half of the recommended carb consumption per main meal on a diabetic diet (diet meaning food consumption, not weight loss.)

In contrast, a 1-cup serving of a vegetable such as green beans has only 6 carbs. People with type 2 diabetes need to know this and plan their meals accordingly, which requires counting carbs.

I personally found the ADA exchange system burdensome and confusing to use. With nutritional information available on packaging (and with so many new food items now available in low-carb versions), it’s easy to balance portion size, calories and carb counting.

You can make good choices at the grocery store by simply checking the nutritional information on the package. It’s up to the individual to educate him- or herself and put in place a program that works.

I also recommend “The Complete Food Counter” by Annette Natow and Jo-Ann Heslin (Pocket Books, 2003), which gives the nutritional information for many foods; it includes information for national chain restaurants and for foods that don’t list the nutritional information on the packaging.

Nancy Stacy
Milwaukee, Wisconsin

Reaction to Faustman Q & A

I read the interview with Denise Faustman, MD, with great personal interest (“A Q & A With Denise Faustman”, March 2005).

Over a decade ago, when I learned that my daughter had about a 50 percent risk of developing diabetes, I began to search for safe methods to protect her immune system.

Fortunately, articles by Naim Shehadeh, MD, et al, published in the March 19, 1994, issue of Lancet, as well as other studies were available. I was excited to learn of their success using bacillus Calmette- Guerin (BCG) vaccine, the agent Dr. Faustman is studying. Based on their work, my daughter was given an “off label” treatment of BCG.

Additional evidence supportive of BCG was published in the May 1997 issue of Diabetes Care, but the researcher observed only a delay. I wondered if this could be because the effects of BCG do not last. Dr. Shehadeh was kind enough to respond to my inquiries, and based upon his observations that NOD mice with “boosters” were more likely to remain free of type 1 diabetes, my daughter eventually received an additional BCG “booster.”

Your article doesn’t mention the negative results of studies, published in the October 1998 and October 1999 issues of Diabetes Care that showed that if BCG is given to people already diagnosed with type 1 diabetes, it is not effective.

However, BCG is certainly widely available, and study of the effects of BCG on T-cell responses will be interesting. Because previous studies in diagnosed patients did not yield positive results, perhaps timing and dosage, and even a possible need for repeat dosing, will be of interest.

Prior to giving my daughter the BCG and prior to the booster, we ensured that she was autoantibody negative. Additionally, we provided her with nutritional anti-inflammatory and antioxidant agents. She is 11 and still autoantibody negative—so no regrets. This “cocktail” approach of trying more than one agent at a time would surely be criticized as “unscientific,” but it wasn’t until the “cocktail” approach was deemed warranted that the rate of survival began to increase in cancer and AIDS patients.

Perhaps when we include type 1 diabetes as a disease that also has devastating consequences, the “unscientific” approach of trying multiple safe interventions will become acceptable.

Sonia Cooper
Children With Diabetes Foundation

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Categories: A1c Test, Blood Glucose, Diabetes, Diabetes, Food, Letters to the Editor, Type 1 Issues, Type 2 Issues

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May 1, 2005

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