

VOICE OF THE DIABETIC

A Support and Information Network

The Diabetes Action Network of the National Federation of
the Blind

Volume 12, No. 2, Spring Edition 1997

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     VOICE OF THE DIABETIC, published quarterly, is the
national newsmagazine of the Diabetes Action Network of the
National Federation of the Blind.  It is read by those
interested in all aspects of blindness  and diabetes.  We
show diabetics that they have options  regardless of the
ramifications they may have had.  We have a positive
philosophy and know that positive attitudes are contagious. 

     News items, change of address notices, and other
magazine correspondence should be sent to:  Ed Bryant,
Editor, VOICE OF THE DIABETIC, 811 Cherry Street, Suite 309,
Columbia, Missouri 65201; Phone:  (573) 875-8911; Fax: 
(573) 875-8902.

     Find us on the World Wide Web at:  http://www.nfb.org
and follow the links for "diabetes."

     Copyright 1997 Diabetes Action Network, National
Federation of the Blind.  ISSN 1041-8490

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FREE!  FREE!


     VOICE OF THE DIABETIC is offered absolutely free to any
interested person upon request.  Readers may receive the
publication in standard print, on audio cassette for the
blind, or in both formats.  To begin receiving the VOICE,
please complete the subscription form (or a facsimile),
found at the end, and mail it to the editorial office.

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INSIDE THIS ISSUE


MY TRANSFORMATION
   by Betty Walker

ORGAN DONORS

TAKE CARE OF YOURSELF
   by Leona Timbo

PREVENTING, MINIMIZING, OR DELAYING KIDNEY FAILURE

NEW DIABETES DRUG APPROVED

1997 NATIONAL CONVENTION

KIDNEY FAILURE, DIALYSIS, AND TRANSPLANTATION
   by Ed Bryant

LETTERS TO THE EDITOR

ADVISING THE ADVISORS:  THE NEED FOR SPECIALISTS
   by Peter J. Nebergall, PhD

DIABETES:  THE SPACE CONNECTION

SPOTLIGHT--ROBERT KRAMER

SOCIAL SECURTIY, SSI AND MEDICARE FACTS FOR 1997
   by James Gashel

DIALYSIS AT NATIONAL CONVENTION
   by Ed Bryant

LESS PROTEIN MAY REDUCE DIALYSIS DEATHS

TRAVEL, VACATIONS, AND DIABETES
   by Celia Henderson

ASK THE DOCTOR
   by Wesley W. Wilson, MD

CAN I EAT SUGAR?

TACTILE INSULIN VIALS -- PROGRESS REPORT
   by Ed Bryant

RECIPE CORNER

WHAT YOU ALWAYS WANTED TO KNOW BUT DIDN'T KNOW WHERE TO ASK 
(Resource Column)

FOOD FOR THOUGHT



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MY TRANSFORMATION

by Betty Walker


Photo:  portrait of Betty Walker

     I was born in 1953 in Dover Plains, New York.  In spite
of the fact that I was diagnosed with diabetes at age five,
my childhood was more or less "normal."  I graduated from
high school in 1971, and earned an A.A.S. degree in Nursery
Education from Duchess Community College in Poughkeepsie,
New York.  My problems began at that time.

     Glaucoma and diabetic retinopathy took my sight before
the end of 1974.  In January of 1978, I was confronted with
renal failure as well.  After coping with losing my sight,
which I did by daily thanking God for each day, I felt this
new development was just another of life's hurdles that I
had to jump over.  If I could not jump, I would climb; no
matter how slowly I would have to climb.

     When I went on hemodialysis, most of the time I felt
very ill.  I was so nauseated that I could not eat.  My
social life was nonexistent, and I no longer enjoyed any
hobbies.  I was so tired that most of the time between
dialysis sessions I spent in bed.  Life went on like that
for about six and one half months.  When I decided to have a
kidney transplant, I figured I had nothing to lose. 
Dialysis was always there to fall back on.

     On July 13, 1978, I was "born again."  My mother, Fran
Bator, gave me life when I was born and gave it to me again
when she became my kidney donor.  The transplant was done at
Yale-New Haven Hospital. It should be called a
"transformation," because that is what it was for me.

     I could hardly believe it, but, the day after the
transplant, I wanted to eat!  I was told that I had to wait
one more day.  Given Jello and ginger ale the next day, I
told the doctors I wanted "real" food.  The following day,
request granted, I ate like a horse, devouring every bit of
food on my tray.  I felt like running or doing something to
release my energy.  My hematocrit rose from 12 to 40.  All
of my blood chemistries were now normal.  The only problem
was with my blood sugar, which had risen because of the
steroid I was prescribed as postoperative medication.

     The most frustrating thing for me was that I could not
take a shower or a bath until my stitches were removed. 
Wouldn't you know it--they left them in for 16 days!  As
soon as the doctor removed the stitches and was out the
door, I was in the shower.  

     Since I became blind I have had this philosophy:  I
never say something CAN'T be done unless first I try it and
know that I can't do it.  So far the only thing I've found I
can't do is drive a car.  I lead a fairly active life since
my transplant.  My favorite leisure activity is horseback
riding.  Yes, it can be done by a totally blind person.  I
also enjoy swimming, hiking, sailing, ice-skating, arts and
crafts, cooking, baking, and writing poetry.  Included here
is one of my poems, "Natural High," expressing my outlook on
life.  

     In closing, I would just like to say:  "Never give up,
and don't let anything get you down."

     If anyone would like to write or call me, my address
and phone number are:  Betty Walker, 1826 Mississippi,
Jefferson City, MO  65101; telephone:  (573) 634-7969.

Natural High

     Whenever I am feeling high,
     I find it very hard to lie.
     My face will have a big bright smile,
     And when I talk, I talk a while.
     My high is not from any drug;
     I may be "up" from just a hug.
     Its cause is just a love of life
     That I hold on to with great strife.

Author's Postscript

     My original article was written in February 1980, for
the "Danbury Hospital Dialysis Newsletter," to encourage
dialysis patients to choose transplantation.

     I have now had my kidney transplant for 18 1/2 years. 
I have had no major problems in those years, and my blood
chemistries continue right in the middle of the normal
range.  I continue to do all of the things that I enjoy, and
I work actively in the National Federation of the Blind.

     David Walker, of Michigan, and I were married in 1982
in Minneapolis, Minnesota, at the National Federation of the
Blind Convention.  Shortly after our marriage, a new job for
Dave brought us to Jefferson City, Missouri, where we reside
today.

     I have been president of my local chapter of the
National Federation of the Blind, and have served on the
national board of our NFB Diabetes Action Network.  I
encourage anyone who is undecided about transplantation to
"go for it."

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ORGAN DONORS


     New Federal legislation directs the Secretary of the
Treasury to place an organ donor card and pamphlet in every
envelope containing an income tax refund check in 1997.  As
up to 70 million Americans receive such checks, this should
really help spread the message that organ donation saves
lives.  

     Think about it.  If something sudden were to happen to
you, your posthumous gift could bring life and independence
to others.  The wait is long for donated organs, and the
supply is limited.  You can make a difference!  

     You don't have to wait for a refund check from Uncle
Sam, to indicate your willingness to participate.  Many
states have a simple form on the back of their driver's
license.  Or you can talk to your doctor, or to family
members.  Tell your family what you want to do!  There is
great need, and organ donation is a precious gift you can
give.


Below are some questions you might have, and the answers:

1.   Will it cost my estate anything?  Organ donation is
free of charge.

2.   Will it delay the funeral?  No.  The process is
completed within hours of death.

3.   Will it alter my appearance?  Not in any way.  Any
"viewing" can take place in the normal manner.

4.   Can I change my mind?  You can alter or revoke this
decision in the same manner as you can your Last Will.

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TAKE CARE OF YOURSELF

by Leona Timbo


Photo:  portrait of Leona Timbo

     Finding out that yes, you DO have diabetes, can take
unusual forms.  It was my ophthalmologist who suspected it
and sent me for a blood sugar test.  Sure enough, I was, but
it was April 1, 1986, and i thought it was an April Fool's
joke--but it was not.

     My doctor put me on the oral medication diabeta.  I
could not get it through my head to watch what I ate or did. 
I was very depressed and antisocial, full of "Why did this
happen to me?"  I was always tired, my eyes were blurry, and
I made frequent trips to the bathroom.  

     But things settled down.  About 4 1/2 years later, I
had a heart attack.  That, and the double bypass surgery
that followed, changed my outlook.  After my operation, the
heart doctor told me my oral meds were not enough, and
switched me to insulin.  It took that much to make me aware,
to start taking care of myself properly.  

     Because of my diabetes, I have needed laser surgery on
my eyes, to stop the bleeding.  My kidney tests are a little
high.  But, can you imagine living 100 years ago, when there
was no treatment?  I'm glad there has been so much research
to help us.  I came to my senses:  This is my destiny; the
doctors' tests and my meters' results are all telling me to
keep these numbers DOWN.

     All of you out there, try your best!  Watch your diet,
listen to your doctor, and take care of yourself!  If in
doubt about what's good for you, and what you should be
doing to control your diabetes (it really is up to you),
talk to your doctor, your dietitian and your diabetes
educator.  Read books and articles, and subscribe to
diabetes magazines.  Learn, and keep positive.

     I have found my frame of mind has a lot of effect on my
diabetes control and on my general health.  Being in a good
humor helps too.  What I am saying is don't make a bad thing
worse by closing your eyes to it.  Putting it out of your
mind does not help.  Take care of yourself; life is good.

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PREVENTING, MINIMIZING, OR DELAYING KIDNEY FAILURE


Art:  Article printed over blown up silhouette of kidney

     "I'm sorry, but your kidneys are beginning to fail..." 
If you hear those words, what do you do next?  Knowing that
nephropathy, kidney failure, is a frequent complication of
diabetes, do you sit and wait to get worse, or do you act? 
What can YOU do to prevent, minimize, or slow kidney
failure?

     Before we relate specifics, a review of the kidney, and
why it fails.  Your kidneys are your body's blood-cleansing
devices, millions of tiny tubes (the glomeruli) designed to
filter wastes, products of normal cell metabolization, from
the blood into the urinary system.  Extended periods of high
blood sugar, as follow untreated or poorly-managed diabetes,
can inflame, scar, or obstruct the filters, leading to
permanent loss of function.  If enough of the kidney's
blood-cleansing function is lost (measurements of kidney
function remaining are described in the accompanying article
"Kidney failure, dialysis, and transplantation"), dialysis
or kidney transplantation become necessary to sustain life.

     The traditional test for protein spillage into the
urine (clear sign of kidney disease) has been the
proteinuria "dipstick test."  Although still widely used, it
has been made obsolescent by the much more sensitive
microalbuminuria "24-hour urine test," which is capable of
detecting kidney disease at much earlier stages.  Some
doctors have suggested that approximately ten years after
diagnosis (and sooner where indicated) every diabetic should
have a microalbuminuria test, to check for the early stages
of kidney disease. 

     The Diabetes Control and Complications Trial (DCCT), a
large, long-term, federally-funded study of the relationship
between diabetes control and the onset of complications,
found that there was a tight statistical link between
quality of diabetes control and ramifications such as heart
and blood vessel disease, diabetic eye disease, and
diabetogenic kidney failure.  The tighter your control, the
less chance you will experience the complications.  (Note
the linkage is not absolute; you can do your best and still
face these ramifications.)  

     The DCCT's findings are not mysterious.  High blood
sugar causes complications; and the better job you do of
keeping your blood glucose numbers down where they should
be, the less your chance of developing conditions such as
nephropathy.  The importance of this cannot be overstated: 
Good self-management is the BEST way to cut the risk of any
diabetes complications.

     There are other things you can do to cut the risk. 
Some of them come under the heading of "healthy lifestyle." 
Nicotine, the narcotic active ingredient in tobacco, is a
vasoconstrictor, raising blood pressure, stiffening
capillaries, and making it harder for the kidneys to filter
wastes.

     Urinary tract infections need prompt treatment, to
limit the damage they can do to already strained kidneys. 
Tell your doctor promptly, if you think you have such an
infection.

     Excessive obesity both raises blood pressure and
increases insulin resistance.  Keeping your weight at or
below your recommended level helps in general, and the
resultant blood pressure drop is good for your kidneys.

     Heart specialists have known for years that high levels
of stress can be damaging.  Excessive stress, driving up
blood pressure, can harm the kidneys by raising fluid
pressure, further straining already weakened filter
networks.  Stress reduction is part of a healthy lifestyle.

     Generalized high blood pressure (hypertension),
whatever its cause, strains kidneys weakened by diabetes. 
The kidneys also maintain a fluid pressure of their own, the
better to perform their cleansing job.  Partially controlled
by blood pressure, kidney fluid pressure is also dependent
on the health of the organ.  Any scarring or occlusion of
the filters will drive up fluid pressure (kidney disease
often raises blood pressure as well), further straining
damaged filter networks.  This can easily set up a vicious
cycle, hastening complete destruction of kidney function. 
But there is treatment.

     Angiotensin-Converting Enzyme ("ACE") inhibitors like
Captopril (trade name Capoten), nominally blood pressure
medications, have been successfully used to reduce the rate
of kidney failure in type I diabetics who show early stages
of kidney damage.  The ACE inhibitors act directly to relax
and open up weakened kidneys, lessening the strain and
slowing, sometimes almost halting, the rate of failure.  
Even when the individual's blood pressure is within normal
range, ACE inhibitors can make a tremendous difference,
reducing fluid pressure, allowing healing, and delaying the
onset of End Stage Renal Disease, that point at which
dialysis or transplantation becomes necessary.

     Although the tests that led to Captopril's FDA approval
for treatment of kidney disease were performed on insulin-
dependent diabetics, most doctors believe type II diabetics
who show signs of kidney failure also would benefit from use
of Captopril or other ACE inhibitors.  Please note that ACE
inhibitors are not safe for pregnant women.

     Other blood pressure medications, the "beta blockers,"
and  the "calcium channel blockers," confer some of the same
benefit, and are "second choices" if there is an allergy or
other consideration.  Sources agree that prompt adoption of
a treatment regimen that includes ACE inhibitors, as soon as
possible after diabetic kidney disease is detected, can make
a significant difference.  Ask your doctor about ACE
inhibitors.

     There are also medications you should avoid, if you
have any trace of kidney failure.  Certain classes of over-
the-counter pain medications can cause kidney damage in non-
diabetic individuals.  Ibuprofen and Aleve are two of this
potentially dangerous group.  For minor "aches and pains,"
most health professionals now recommend Acetaminophen (as in
Tylenol), which is far safer on the kidneys.  Be sure to
discuss this with your doctor.

     Wesley Wilson, MD, of the Western Montana Clinic in
Missoula, Montana, reminds us:

     If there is any kidney disease, the fewer drugs you
take, the better.  Many of the medications we use for pain
or other conditions can increase kidney damage, or their
effect can be harder to predict, because the drug may be
retained by the poorly functioning kidneys.  Certainly do
not take any drug unless you need it, and be sure to discuss
your choice of nonprescription drugs with your physician. 
In addition....other measures felt to be important in
preserving kidney function include avoiding dehydration,
reducing dietary protein, and carefully controlling both
blood glucose and blood pressure.

     Dr. Wilson brings us to the next point.  Many
clinicians believe that protein restriction will help reduce
the rate of kidney decline, once kidney disease is present. 
Traditional "kidney failure" diets featured radical
restrictions on protein intake, but dietitian Mimi Moore,
RD, writing in VOICE Vol. 11, No. 1 (Winter 1996), stated
the recommendation that protein be decreased is not as
severe as it was in the past.  "Today," (she stated), "for a
renal diet, the target should be about .8 gram of protein
per kilogram of body weight, which is about the American
adult recommended amount."

     Ms. Moore went on to state that the average American
eats far more than the recommended adult amount of protein,
and that  keeping to the limit, along with other frequently-
exceeded limits such as those on potassium and sodium, is
part of a healthy lifestyle.

     What about the other part of a "healthy lifestyle"--
exercise?  Ramesh Khanna, MD, Professor of Medicine,
Division of Nephrology, University of Missouri Hospital and
Clinics, states that once renal failure is detected, the
patient should continue the physical activities to which
he/she is accustomed.  "Do not let renal failure slow you
down," he states.  He goes on to state that as long as no
heart problems are present, you should be as active as you
can.  Of course seek medical supervision for such an
exercise program.

     This is in marked contrast to the exercise
possibilities open to the kidney patient who has received a
transplant.  As long as general health and immunosuppressive
regimes are maintained, transplant patients are as capable
of athletic achievement as are those with two healthy
kidneys.

     There is a lot of disagreement among doctors over the
specifics of what will prevent kidney failure.  So much is
genetics; more may be environment, or other factors we are
not yet aware of.  Other than "keep your diabetes under the
best possible control, and live a healthy lifestyle," we can
offer little advice about prevention.  The manual THE
PREVENTION AND TREATMENT OF COMPLICATIONS OF DIABETES
MELLITUS, published (1991) by the Centers for Disease
Control, states:  "At present, strategies for preventing
diabetic nephropathy must be viewed as limited in their
effectiveness, since the exact pathogenic factors
responsible for this condition are unknown."

     Once kidney disease is diagnosed, however, a great deal
can be done to retard its progression, and sometimes
interventions such as described above are sufficient to keep
the need for dialysis or transplantation well at bay. 
Current statistics suggest up to four out of every ten
diabetics may experience kidney disease.  With
considerations such as described in this article, many of
these individuals should be able to avoid End Stage Renal
Disease.

     If you do your best and still experience kidney
failure, it is not time to despair.  Whether you choose
transplantation, or one of the forms of dialysis, the
outlook is good and getting better all the time.

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1997 NATIONAL CONVENTION


     It will soon be time for the 1997 convention of the
National Federation of the Blind, to be held at the Hyatt
Regency New Orleans, 500 Poydras Plaza, New Orleans,
Louisiana 70140.

     All hotel reservations must be made through our NFB
National Office.  Call the National Center at (410) 659-9314
or write to: National Convention, National Federation of the
Blind, 1800 Johnson Street, Baltimore, Maryland 21230.  No
reservation will be valid unless it has been made through
the National office of the Federation.  As in the past, Mr.
Cobb will take telephone calls and deal with letters; to
confirm a reservation, you will need either to send a check
or money order for $40 as a deposit, or give Mr. Cobb a
credit card number.

     Here are our hotel rates for 1997:  one in a room, $40
per night; two in a room, $42; three in a room, $44; four in
a room, $46.  In addition to the room rates, there will be a
tax of 11 percent plus $3 a night.  No charge for children
under 12 in a room with parents, as long as no extra bed is
required.  If you want to come a few days early or stay a
few days late, convention rates will apply.

     Here are the convention dates and schedule.  Notice
that we are one day off from our usual schedule:

SUNDAY, JUNE 29 -- Seminars for parents of blind children,
blind job seekers, and vendors and merchants; several other
workshops and meetings.

MONDAY, JUNE 30 -- Convention registration, first meeting of
the Resolutions Committee, other committees, and some of the
divisions.

TUESDAY, JULY 1 -- Meeting of the Board of Directors (open
to all), division meetings, committee meetings, continuing
registration.

WEDNESDAY, JULY 2 -- Opening general session, evening gala.

THURSDAY, JULY 3 -- General sessions, tours (interesting
ones throughout the New Orleans area).

FRIDAY, JULY 4 -- General sessions, banquet.

SATURDAY, JULY 5 -- General sessions, adjournment.

     An important part of the convention will be our
Diabetes Action Network's two seminars.  The first will be
on Monday, June 30, from 2 to 4 pm.  Eli Lilly will provide
us a speaker who will discuss the new quick-acting Humalog
insulin.  On Tuesday, July 1, we will have our second
seminar, starting at 6:30 pm.  Our keynote speaker will be a
dietitian, who will discuss "carb counting" as a meal-
planning tool.  Both seminars are free and open to the
public.  Locations will be posted in the Agenda (provided
when you register).

     The elegant Hyatt Regency New Orleans is located just
eight blocks from the French Quarter.  In addition to a
swimming pool on the seventh floor, the Hyatt also features
several restaurants, cocktail lounges, and a large shopping
mall.  The huge rooms on the third floor of the Hyatt's
Poydras Tower will easily accommodate both the general
sessions and our exhibits, as well as the banquet. The
displays of new technology; the meetings of special interest
groups, committees, and divisions; exciting tours; 
hospitality and renewed friendships; the solid program
items; and the exhilaration of being where the action is and
where the decisions are being made--all of these join
together to call the blind of the nation to the Hyatt
Regency New Orleans Hotel in July of 1997.  Come and help
make it happen!

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NEW DIABETES DRUG APPROVED


     An FDA advisory panel recently recommended approval of
the drug troglitazone (trade name Rezulin, from Parke-
Davis), for treatment of type II (NIDDM) diabetes.  FDA
final approval quickly followed; then a lot of media hype
about "the new miracle drug."  Just what is Rezulin, and
what will it do?

     Where traditional oral diabetes medications stimulate
the pancreas to produce more insulin, Rezulin directly
attacks the problem of insulin resistance, the increasing
inability to process insulin, that is the chief component of
type II diabetes.  Although the drug would be useless for
type I (insulin-dependent) diabetics, many type IIs, whose
bodies are still producing some insulin, might benefit from
its use.  
     
     As with other oral diabetes medications, Rezulin's
effectiveness depends on the presence of insulin.  If
sufficient insulin is not present, it must be injected, and
Rezulin therapy will not change that fact.  Where insulin
supply rather than insulin resistance is the issue, Rezulin
therapy offers nothing.  What Rezulin offers is not a "magic
bullet," but another useful tool, a way for type II
diabetics to improve their numbers and perhaps prolong the
time before they must switch to insulin injection therapy.

     Troglitazone has been under investigation for some
time, and with final approval, commercial availability
should come shortly.  For more information, consult your
doctor.

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KIDNEY FAILURE, DIALYSIS, AND TRANSPLANTATION

by Ed Bryant


Photo:  portrait of Ed Bryant

     I have a special interest in renal failure, as I have
had a kidney transplant for more than 13 years, and I feel
great.  I know folks who've had transplants far longer than
I have, and they're doing fine, too.  I hope the following
answers some questions.

     Many long-term diabetics face the prospect of kidney
failure, End Stage Renal Disease (ESRD).  For them, there
are three options for treatment.  In hemodialysis, the
patient's circulatory system is temporarily linked with a
machine that performs the blood-cleansing functions of the
human kidney.  In peritoneal dialysis (CAPD or CCPD) a tube
is inserted into the patient's peritoneal cavity, allowing
urine and unneeded fluids to periodically drain from the
body. The third option is kidney transplantation, in which a
donated kidney is surgically implanted into the patient's
body.

     According to U.S. Renal Data System (USRDS) figures,
there are more than 189,954 kidney patients undergoing
dialysis in the United States today.  In 1992, the last year
for which Centers for Disease Control (CDC) figures are
available, there were 19,790 new cases among persons with
diabetes, and 56,059 diabetics were undergoing dialysis or
transplantation treatment that year.   U.S. Health Care
Financing Administration statistics show that about 30% of
all individuals facing dialysis are there because of
diabetes complications, and about 40% of those commencing
dialysis or seeking a transplant at this time are diabetic. 
Some remain on dialysis long-term; others make use of the
process while awaiting a kidney transplant.  As an aside,
before 1970 few diabetic ESRD patients were dialysed; they
simply sickened and died.  Those who did dialyses faced a
high mortality rate.  Medicine has come a long way since
then, and the odds have improved with the options.  Dialysis
techniques have improved substantially since my personal
experience with them.

     How is kidney failure measured?  Several tests measure
creatinine, a waste product from muscle mass.  Although
everyone produces creatinine, people whose kidneys are
failing cannot properly excrete it.  One test measures the
amount of creatinine in the blood, and the other is
"creatinine clearance," a 24-hour urine test.  Normal "blood
creatinine," for someone with healthy kidneys, is about 0.7
to 1.3.  Government guidelines (April 1995) recommend
dialysis when the blood creatinine reaches 6 or above. 
However, some diabetics will experience kidney failure
before that point.  There is much variation between
individuals, and the actual range is from 3 through 8--but
at or above 6, Medicare will pay for dialysis.

     "Creatinine clearance" is considered a more reliable
test.  In this 24 hour urine test, the numbers produced
approximately indicate the percent of normal kidney function
remaining to the individual.  The 1995 government guidelines
(which relate to Medicare part B eligibility) state they
will fund dialysis when the test produces a reading of 15 or
less.  This test measures how much creatinine comes out in a
24 hour period.

     Individuals experiencing impaired kidney function, but
whose test results indicate that they do not yet need
dialysis or transplantation, might benefit from two new
therapies.  Captopril (trade name Capoten), a common blood
pressure medication, in carefully monitored tests,
significantly reduced further kidney degeneration.  The FDA
has recommended use of Captopril for patients showing early
signs of kidney damage.  It reduced fluid pressure in the
kidneys, and cut in half the rate of kidney failure in its
test population.  Note:  Use of "ACE inhibitors" such as
Captopril, for keeping blood pressure down in the normal
range, carries many benefits, such as reduced rate of kidney
failure, and less strain on eyes and cardiovascular system.

     Aminoguanidine is the second possibility.  Tests are
still underway, but this drug appears to reduce the damage
done to the kidneys by excess glucose in the blood (and may
reduce retinopathy as well).

     Another possible option (currently under lab
investigation) is  use of PKC-beta II inhibitors, chemical
"blockers" that resist the complication-causing effects of
high blood glucose.  It will be years before we know if this
approach has merit.  Other options are certain to
materialize, both for those with impaired kidney function
and for those whose kidneys have failed.

     Dialysis is not an "artificial kidney."  A person
undergoing hemodialysis must be hooked up to a machine three
times a week, three to four hours per session.  A normal
vein cannot tolerate the 16-gauge needles that must be
inserted into the arm during hemodialysis, so the doctor
must surgically connect a vein in the wrist with an artery,
forming a bulging fistula  that will better accommodate the
large needles needed for treatment.

     Like the kidney, a hemodialysis machine is a filter. 
Where it uses tubes and chemicals, the kidney uses millions
of microscopic blood vessels, fine enough to pass urine
while retaining suspended proteins.  Long-term high blood
glucose can damage the kidney's filters, leading to
scarring, blockage, and diminished renal function.  Diabetes
is the leading cause of kidney disease, and each year over
15,000 diabetics will either need a kidney transplant, or to
start some form of dialysis.

     Long-term diabetics often have cardiovascular and blood
pressure problems, and the added strain of hemodialysis,
with its rise in blood pressure straining eyes and heart
function, can be too much for some. The diabetic dialysis
patient spends, on the average, 30% more time in the
hospital than does the non-diabetic dialysis patient,
according to USRDS figures.

     Some patients choose CAPD (continuous ambulatory
peritoneal dialysis) mr its variant, CCPD (continuous
cycling peritoneal dialysis), both of which can be carried
out at home, without an assistant.  CAPD works inside the
body, making use of the peritoneal membrane to retain a
reservoir of dialysis solution, which is exchanged for fresh
solution, via catheter, every four to eight hours.  CCPD
makes use of an automated cycler, which performs the
exchanges while the patient is asleep.  Although more
complicated and machine-dependent, it does allow daytime
freedom from exchanges, and may be the appropriate choice
for some.  Though the risk of infections is heightened (as
it is with any permanent catheterization), these two
processes have advantages, one being that insulin can be
added to the dialysis solution, freeing the patient from the
need to inject, and giving good blood sugar control.

     Kidney transplantation is a logical alternative for
many.  It substantially improves a patient's quality of
life.  Although the transplant recipient must be on
anti-rejection/immunosuppressive therapy for life, with the
inherent risk from otherwise nuisance infections, a
transplant frees the patient from the many hours spent on
hemodialysis procedures each week, or from the periodic
"exchanges" and open catheter of CAPD, allowing a nearly
normal lifestyle.  For those ESRD patients who can handle
the stresses of transplant surgery, the resulting gains in
physical well-being add up to real improvement in quality of
life and overall longevity.

     "Fifty percent of all kidney transplantations taking
place today are into diabetics," states Giacomo Basadonna,
MD, PhD, a transplant surgeon at Yale University School of
Medicine, in New Haven, Connecticut.  He reports that
success rates are identical with kidney transplants
performed on non-diabetic ESRD patients.  "Today," he
advises, "average kidney survival, from a living donor, is
greater than 15 years."

     One of the areas where we are seeing rapid improvement
is immunosuppressive medication.  Daniel M. Canafax, PharmD,
FCCP, Professor, College of Pharmacy, University of
Minnesota, reports that Prograft (FK 506, tacrolimus), from
Fujisawa, and Cellcept (RS 61443, mycophenolate mofetil) by
Roche/Syntex, have been approved by the FDA, and
Deoxyspergualin (DSG), by Bristol-Myers-Squibb, and
Rapamycin (sacrolimus, Rapamune), by Wyeth/Ayerst, are
currently being tested.  The risk of rejection is always
present, but each new development increases the chances of
success.

     I and others knowledgeable in kidney transplantation
advise you to pick the best transplant center possible. 
Once you have read their statistics, ask your prospective
center the following questions.  If they don't answer to
your satisfaction, you should consider going to another
center.

1.   Do you have an information packet for prospective
donors and recipients?

2.   Can you put me in touch with someone who has had a
transplant at your center?

3.   What is your "graft survival" (success) rate?  

4.   Who will my transplant surgeon be?  If a fellow or
resident, will he/she be supervised by a practicing
transplant surgeon?

5.   How long have your current surgeons been doing kidney
transplants?  How many have they done?  That your center has
35 years experience with kidney transplants is of no
consequence if my surgeon has only done fifteen in his or
her career.

6.   What is the average post-operative stay in your
hospital?

7.   When I come for my transplant, or come back for
follow-ups, will there be any affordable housing for me
and/or my family?  (Ronald McDonald House, or other lodging
with discount rates...) or will I get stuck in a luxury
hotel for $90 a night?

8.   How often will I need to come back to the center for
follow-ups?  Can my nephrologist do the blood tests and send
you the results?

9.   Can you recommend a nephrologist in my area?  Do you
correspond with this physician?

10.  Do you have a toll-free number to call for
after-transplant information?

11.  What is your policy on people with insufficient health
insurance?  Will you work with an uninsured patient?  What
will it cost?

12.  Are you prepared to satisfy my doubts?  Will you show
me the documents that answer my questions?  Will you
guarantee the price quoted?


Here's what some folks have said:  

     Eivind Frost, from Montana, received a cadaver kidney
on April 24, 1973, at University of Minnesota Hospital in
Minneapolis, and is doing fine.  He tells us, "I've been
feeling great for 23 years now."

     Ken Carstens, from Minnesota, who received his kidney
transplant at University of Minnesota Hospital in
Minneapolis, on September 10, 1975, states, "It's been 21
years now, and I'd make the same choice again."

     Karen Mayry, from South Dakota, received her kidney
transplant at University of Minnesota Hospital in
Minneapolis, on January 12, 1977.  She declares, "I feel
great!"

     Betty Walker, from Missouri, received her transplant on
July 13, 1978, at Yale-New Haven Hospital in Connecticut. 
In her words:  "I was just existing on dialysis; and my
transplant gave life back to me."

     Eric Knoeppel, from Missouri, received his kidney at
Clarkson Memorial Hospital, in Omaha, Nebraska, on July 5,
1981.  He says, "After my transplant, it was nice to be able
to go back to work!  Before, I was dependent on government
assistance."

     Linda Bingham, from Ohio, who received a dual
transplant (kidney and pancreas) at University  Hospital in
Cincinnati, Ohio, on December 10, 1981, says, "I feel great. 
I have been given a whole new life."

     These folks know what they're talking about. 
Collectively, they have more than 113 years experience
living with kidney transplants!  All of them would choose a
transplant again.  Although kidney transplantation is not
for everyone, it should be given strong consideration.

     What is the success rate for kidney-transplant surgery?
According to the "United States Renal Data System 1993
Annual Data Report," published by the National Institutes of
Health, about 75% for a cadaver-donated kidney, better than
90% with a kidney donated by a living relative, with an
overall success rate of better than 85%, better than 90% in
some centers.

     What percentage of type I diabetics will face ESRD? 
Current statistics suggest 20%.

     Must the ESRD patient be on dialysis before being
considered for a transplant?  NO!  Although some
behind-the-times nephrologists still believe so, University
of Minnesota Transplant Center, which pioneered diabetic
kidney transplantation, recommends that once your physician
has determined kidney failure is on the way, further delay
could be harmful.  The more time spent subjecting your body
to the toxic excesses of kidney failure and the strains of
dialysis, the greater the risk of serious complications like
retinopathy and cardiovascular (heart) degeneration.  And,
the success rate for diabetics needing kidney
transplantation is approximately the same as for
non-diabetic transplant recipients.   People with diabetes
tend to take better care of themselves than does the general
public.

     Your nephrologist (kidney specialist) should be able to
tell you more about your options.  For information about
kidney transplantation, contact a reputable transplant
center (there are more than 239 in the U.S. today), or the
United Network for Organ Sharing, 1100 Boulders Park, Suite
500, Richmond, VA  23225; telephone:  1-800-243-6667.  For
information or assistance with interpreting transplant
center data, contact:  Health Resources and Services
Administration, Bureau of Health Resources Development,
Division of Organ Transplantation, 5600 Fishers Lane, Room
11A22, Rockville, MD 20857; telephone:  (301) 443-7577.

     Renal failure is not a kiss of death.  There are
options, and at least one of them will be right for you. 
Keep your diabetes under good control, and your blood
pressure down, to cut the risks--but if it happens (like it
did to me) remember that with proper care you stand every
chance of living just as long as you would have with healthy
kidneys.  I've had my transplant 13 years, and I'm planning
on being here a long time more.


More Resources:

     American Association of Kidney Patients, 100 South
Ashley Drive, Suite 280, Tampa, FL  33602; telephone:  1-
800-749-2257.  Publishes the quarterly magazine Renalife,
with articles about dialysis and transplantation.  

     American Kidney Fund, 6110 Executive Boulevard, Suite
110, Rockville, MD 20852; telephone: 1-800-638-8299. Offers
financial aid ($200 limit), provides written and phone
information on kidney diseases.

     National Diabetes Information Clearinghouse, 1
Information Way, Bethesda, MD 20892-3560.  Provides free and
low-cost publications on aspects of diabetes.

     National Kidney Foundation, Inc., 30 East 33rd Street,
New York, NY 10016; telephone: 1-800-622-9010.  Provides
services such as: doctor referrals, patient peer counseling,
education, medication programs, transportation, and
financial services.

     National Kidney and Urologic Diseases Information
Clearinghouse, 3 Information Way, Bethesda, MD 20892-3580. 
Provides free and low cost publications about kidney and
bladder diseases.  Their booklet KU-50 is "End Stage Renal
Disease, Choosing a Treatment That's Right for You."

     National Organization for State Kidney Programs;
telephone: 1-800-733-7345.  Provides information on
different state programs that would help people pay for
kidney failure costs.

     National Transplant Assistance Fund; telephone: 1-800-
642-8399; World Wide Web URL:
http://www.LibertyNet.org/~txFund/.  Helps patients set up
fundraising programs to cover transplantation  costs on any
organ; also offers small emergency grants.

     Organ Transplant Fund, 1102 Brookfield, Suite 202,
Memphis, TN 38119; telephone: 1-800-489-3863.  Advice and
instruction on fund-raising to cover transplant costs on any
organ.

     PhRMA, Pharmaceutical Research and Manufacturers of
America, Publications Department, 1100 15th Street NW,
Washington, DC 20005; telephone: (202) 835-3400.  A catalog
of member companies offering free or low-cost
drugs/medications for the indigent.    

     Renal Failure--Dialysis and Transplantation Support
Committee, Diabetes Action Network, National Federation of
the Blind, 811 Cherry Street, Suite 309, Columbia, MO 65201;
telephone: (573) 875-8911.  Offers information,
encouragement, and support on a person-to-person basis for
diabetics.

     Stadtlanders Pharmacy, 600 Penn Center Boulevard,
Pittsburgh, PA 15235-5810; telephone: 1-800-238-7828. 
Medication, delivery, and insurance billing; organ
transplant recipients receive free express delivery of
medication, anywhere in the U.S.A.

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

LETTERS TO THE EDITOR


Art:  fancy scroll pen

November 4, 1996

     I would like to take this opportunity to express my
appreciation, and that of my clients, for the fine job you
are doing with the VOICE OF THE DIABETIC.  The articles are
most informative.  The printed and taped versions of the
VOICE are in constant circulation.

     Again, thanks for the good work.  We need and
appreciate unbiased, dedicated people like you on our side,
speaking not only for those of us who are blind diabetics,
but for all diabetics in our troubled society.

Sincerely,
John Getsy, Coordinator
Somerset County Office for the Disabled
Somerville, NJ

* * * * * * * * * * 

November 19, 1996

     Thank you for some great work for people like myself. 
I'm not blind but I'm a diabetic.  I wish there was more I
could do to help.

Always,
Charles G. Powell
Pelzer, SC

* * * * * * * * * * 

November 20, 1996

     I greatly appreciate this informative magazine.  It is
of great interest to me since I am diabetic and losing my
vision.  It takes me a long time to read it but I do manage.

God Bless,
Hazel Gerrez
Chattanooga, TN

* * * * * * * * * * 

November 22, 1996

     Thank you for your work for us.  I am a new member, but
your newsletter is great.

Your friend,
Ron Vogel
Saginaw, MI

* * * * * * * * * * 

November 25, 1996

     My brother just sent me a packet of info related to
diabetes and I became reacquainted with an old friend of
mine and my U.S. patients.

     I have been a Diabetes Educator for 24 years, 19 in the
U.S., and former president of A.A.D.E. (American Association
of Diabetes Educators).  In 1993 I started the first full
time diabetes program in Sub Saharan Africa.

     I used to encourage membership for my visually impaired
patients to VOICE OF THE DIABETIC.  I felt such nostalgia
seeing it again.  I want a copy here for my patients and the
health professionals I am continually training.

     I am in Africa for the rest of my life in order to
start diabetes education as a health care specialty.  The
level of care (or noncare) is horrifying: the doctors and
nurses are extremely out of date and could care less.  But
the diabetics really try hard to get information to help
themselves.

     Through Eli Lilly, I am traveling around East Africa
teaching health professionals and hopefully raising the
level of care.

     Please keep up the good work and count your blessings.

Jean Suren, KRN, BSC, CDE
Nairobi, Kenya, Africa

* * * * * * * * * * 

January 10, 1997

     I have been reading (and enjoying) your publication for
two years now.  I do the diabetes education for our hospital
and also am a type I since age 11.  Currently, I am working
toward my CDE.  I share and recommend your very interesting
newspaper with many of my patients.  Especially, I enjoy
reading the patient testimonials.

     Thank you.  Keep up your fine work.

Sincerely,
Susan Clifford, RN
Diabetes Education
Kishwaukee Community Hospital
De Kalb, IL

* * * * * * * * * * 

February 4, 1997

     We have received a copy of the VOICE OF THE DIABETIC,
and we are impressed with the articles.

     We work at a wound care center in a small rural
community, with an estimated population of 9,000.  The
majority of our clients are diabetic.  Your newspaper would
offer a valuable service to help fill in the support gap
that our clients experience.

     We would like to obtain issues, so that we could
distribute them to our clients and their physicians.  Thank
you for your time.

Sincerely,
Brenda Ayala, RN, Unit Director
Emil Kozlowski, RN, Clinical Coordinator
Wound Care and Hyperbaric Therapy Center
Pleasanton, TX

* * * * * * * * * * 

February 7, 1997

     I love this newspaper.  I have been diabetic for 26
years.  I have also experienced most all of the
complications from this disease, but I do my best to keep
going.  The articles are great and so helpful.  I still
learn something new each time I read it.

Thank you,
Tina Shipley
Harrisonville, MO

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

DIABETES:  THE SPACE CONNECTION


Art:  a picture of a space shuttle centered inside the
article

     Astronaut and protein crystallographer Larry DeLucas,
PhD, has launched several experimental insulins into orbit. 
These include Humalog, the long-awaited, recently approved,
short-acting insulin lispro.  Outer space has provided him
with a laboratory environment unavailable on Earth.  In the
gravity-free environment of space, DeLucas can grow flawless
crystals of complex proteins.  Such crystals are easier for
crystallographers to examine, and they provide more accurate
"blueprints" for pharmaceutical manufacturers.

     It may seem odd to think of insulin as a crystal. 
DeLucas points out, however, that the cloudiness in vials of
NPH and ultralente insulin is nothing more than undissolved
insulin crystals.  Regular insulin is clear because the
insulin is already dissolved--and thus faster acting.  Some
animals--rats, for instance, actually have insulin crystals
undissolved in their pancreas.

     For more than four decades, scientists have
experimented with new forms of insulin.  Most of these
variants, or analogs, offer insulin users different
durations of action.  Insulin lispro, for instance, begins
acting within minutes after injection to control the rise of
blood glucose immediately after meals.  On the other hand,
researchers are developing an extra-long acting variety of
insulin.  Such an insulin analog might deliver a basal dose
lasting 2 days or more, instead of the maximum 28-hour cover
now available with ultralente.

     Eli Lilly's Humalog was approved for sales in the U.S.
market last June.  A long-acting analog, however, is on the
more distant horizon--literally.


Why Grow Crystals in Space?

     In 1992, DeLucas donned a spacesuit himself as a
payload specialist for the National Aeronautics and Space
Agency (NASA).  He wanted to learn the rigors and practical
realities of research in a weightless environment.  Now that
he has designed a successful crystal-growth system, he
prepares experiments on Earth and ships them to space aboard
space shuttles, where other astronauts tend the projects.

     "Crystals produced on Earth are usually flawed because
of gravity-induced movements within the liquid,
crystal-growing medium," explains DeLucas.  "But in space,
the liquid is motionless, which greatly slows the growth of
some protein crystals.  The more slowly you grow crystals,
the fewer the flaws in their structure." 

     The atoms and molecules of space-grown crystals are
aligned more perfectly.  This allows their structures to be
seen at higher resolutions.  

     DeLucas, who studies crystals at the Center for
Macromolecular Crystallography at the University of Alabama
at Birmingham, said he could not have designed his system
without his actual space trip in 1992.  "I could see what
changes I needed to make," he said.  "So many simple things
happen differently in space, like stirring a drop of liquid
with a syringe tip -- the drop of liquid wouldn't stay in
position in the container.  Instead the drop of liquid stuck
to the syringe tip, moving with the tip as I used it to try
to mix the liquid drop.  Another nuisance was bubbles in the
syringe.  To get rid of them, I had to create artificial
gravity -- using my arm to swing the syringe around in a
bag."

     DeLucas said that he has worked with insulin for years
as a "practice" crystal to develop his techniques and
equipment for crystal-growing in space.  Insulin stopped
being just for practice, however, when DeLucas began
collaborating with Dr. G. David Smith.  Smith, at the
Hauptman-Woodward Medical Research Institute in Buffalo, New
York, has worked extensively on the insulin lispro analog
with Hauptman-Woodward colleague Dr. Ewa Ciszak, PhD.  They
grew insulin lispro crystals on two space flights during
1995.  Smith published the structure of insulin lispro
recently and has answered some of the difficult questions
explaining its fast-acting behavior.

     Smith spent 14 years studying insulin structures with
the goal of developing an ultra-slow-dissolving insulin. 
Smith had experimentally altered ordinary insulin by adding
a small "guest molecule."  This, in turn, "buries" the
insulin's zinc ions, which play an important role in
stabilizing the insulin. Isolating the zinc makes insulin
harder to dissolve.  Smith tried two guest molecules--
Tylenol and p-hydroxybenzamide (BZN).  Unfortunately, the
Tylenol made the insulin slightly toxic.  While Earth-grown
BZN-altered crystals were adequate to determine the insulin
structures, it was hoped that the space-grown crystals of
BZN could be studied more closely.


Surprises From Space

     After careful review to choose the most promising
experiments, a BZN-insulin growing chamber was sent into
orbit on the NASA-sponsored Space Habitat mission number
STS60, in 1994.  Back on Earth, the crystal surprised Smith,
even after 10 years of insulin research.  To his amazement,
the BZN additive had actually attached itself in pairs to an
insulin molecule. 

     "This was the first time something like this had ever
been observed," Smith noted.  "In hindsight, there were
indications from the Earth-grown crystals, but we might have
missed the paired structure without the space-grown
crystals." Smith said that the BZN-insulin is unlikely to
result in a new product at this time.  However, he says that
he and DeLucas will probably be asked to grow other insulin
crystals in upcoming space flights.

     DeLucas has grown several other diabetes-related
proteins in space.  Space-grown variants of aldose reductase
crystals have also been produced.  Aldose reductase, an
enzyme, has been implicated as a cause of various diabetes
complications.  By building perfect, space-grown crystals of
aldose reductase bound to different inhibitors, DeLucas says
scientists hope to design a matching compound to more
effectively block the enzyme's activity.  Previous attempts
to design such a drug have not been completely successful. 
The precision of space-grown crystals offers another chance
of finding a medication that actually works.

     (Note:  This article appeared in DIABETES DATELINE,
Fall 1996, published by the National Diabetes Information
Clearinghouse, National Institute of Diabetes and Digestive
and Kidney Diseases, National Institutes of Health.)

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

ADVISING THE ADVISORS:  THE NEED FOR SPECIALISTS

by Peter J. Nebergall, PhD


Photo:  portrait of Peter J. Nebergall

     When we're sick, when we perceive there is something
wrong with our bodies, we head for the doctor.  We assume,
we have to assume, he/she "knows what is good for us."  We
want to get well, and we're ready to "do as the doctor
ordered."

     In the past, we saw the "General Practitioner," and
today, in the day of the HMO, many of us see a similar
"Primary Care Provider," who we expect to either have the
answers, or send us on to someone who does.

     The human body is enormously complex.  Medicine is not
like math; even the basic principles routinely fall to new
research.  Especially in diabetes research, the pace of
change has been tremendous.  To expect one individual,
however well trained, to have all the answers, to be "up" on
the latest research findings on our problem, is unrealistic-
-but too many folks, both patients and doctors, give medical
pronouncements the status of Holy Writ.

     Consider all the different things a General
Practitioner has to learn.  Now consider, once a few years
out of medical school, keeping "doctor's hours," how much
time doctors have to keep their knowledge current,
especially of conditions they see infrequently, such as
ramifications of diabetes.

     Those who think they know the answer are unlikely to
further pursue the question.  If a given treatment was the
rule in 1975, when Dr. X completed his internship, and he
hasn't had occasion to  think about it since, given the
demands on his time, is it any surprise he orders that
treatment in 1997, even though the latest research indicates
otherwise?  He's the doctor.

     So what's the answer?  I am calling for a different way
of looking at the medical profession, both by patients and
by doctors themselves.  To expect the single generalist to
"have it all," to be the ultimate unimpeachable authority,
in this age of explosive change and exponentially increased
information availability, is  unrealistic, even unfair.  We
should not expect it of our doctors, and they should not
expect it of themselves.  There is too much to learn; far
too much for one mind, however brilliant, to fully
assimilate.  We already have our medical specialists; our
problem lies with their gatekeepers, the generalists who
control our access to them.

     Most primary care doctors are careful and
conscientious, but the rest of us, the consumers of their
product, have placed them on a high pedestal.  We ask more
of our primary physicians than they can possibly deliver--
and it takes a strong, well balanced doctor to admit his/her
limitations and say:  "No, I don't have the answer, I have
to send you on to someone who does."  It's very easy,
especially with HMO directors watching the bottom line, to
instead reach for a treatment modality that was current 20
years ago...

     ALL OF US need to accept our doctors' limitations. 
They dispense knowledge and good judgement, not gospel.  In
many cases, that is sufficient; but where it is not, sending
the patient on to the diabetologist, the nephrologist, or
the endocrinologist, can be a matter of life and death. 
There is a role for the diabetes specialist, just as there
is a role for the dietitian and the diabetes educator.  Our
primary physicians need to stop seeing their/our need for
specialist assistance as a personal defeat.  We're all on
the same side.

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++


SPOTLIGHT:  ROBERT KRAMER


     Until quite recently, diabetics were told in so many
ways that they would not live as long as other people.  Even
the doctors assumed the disease inevitably meant a shortened
lifespan.  But if you look, if you ask, you find "it's not
necessarily so."

     Robert Kramer, from La Grange, Illinois, has had
diabetes since he was 16.  That was in 1934.  It didn't slow
him down.  He was in the foundry business for eight years,
and a salesman for another 35.  Up 'til age 70, he "played
golf, and did everything else."  He continued driving a car
"until five or six years ago."

     In the last few years his diabetes has begun to catch
up with him.  He is dealing with some neuropathy and some
vision loss, but "outside all that, I'm in great shape!"

     He credits his long period without complications to his
exercise program ("I think exercise is about the most
important thing to do") and to not cheating on his diet ("if
you cheat, you're only hurting yourself").  "No smoking or
drinking," he adds, "and, for me, lots of golf."  To his
healthy lifestyle he adds his vitamin supplements, and of
course his positive outlook.

     There is nothing quite like a positive example.  Robert
Kramer has had type I diabetes since the early days; and
even remembers PZT insulin, a type no longer made!  Think
how much diabetes care has improved since; you should
certainly do as well...

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

SOCIAL SECURITY, SSI, AND MEDICARE FACTS FOR 1997

by James Gashel


Photo:  portrait of James Gashel

     This article appeared in the December 1996 edition of
the BRAILLE MONITOR, published by the National Federation of
the Blind, for whom James Gashel serves as Director of
Governmental Affairs. 

     The beginning of each year brings with it annual
adjustments in Social Security programs.  The changes
include new tax rates, higher exempt earnings amounts,
Social Security and SSI cost-of-living increases, and
changes in deductible and co-insurance requirements under
Medicare.  Here are the new facts for 1997.

     FICA and Self-Employment Tax Rates:  The FICA tax rate
for employees and their employers remains at 7.65 percent. 
This rate includes payments to the Old Age, Survivors, and
Disability Insurance (OASDI) Trust Fund of 6.2 percent and
an additional 1.45 percent payment to the Hospital Insurance
(HI) Trust Fund, from which payments under Medicare are
made.  Self-employed persons continue to pay a Social
Security tax of 15.3 percent. This includes 12.4 percent
paid to the OASDI trust fund and 2.9 percent paid to the HI
trust fund.

     Ceiling on Earnings Subject to Tax:  During 1996 the
ceiling on taxable earnings for contributions to the OASDI
trust fund was $62,700.  The taxable income ceiling for
contributions to the OASDI trust fund during 1997 will be
$65,400.  All earnings are subject to the HI trust fund tax
contribution of 1.45 percent for employees or 2.9 percent
for self-employed persons.

     Quarters of Coverage:  Eligibility for retirement,
survivors, and disability insurance benefits is based in
large part on the number of quarters of coverage earned by
any individual during periods of work.  Anyone may earn up
to four quarters of coverage during a single year.  During
1996 a Social Security quarter of coverage was credited for
earnings of $640 in any calendar quarter.  Anyone who earned
$2,560 for the year (regardless of when the earnings
occurred during the year) was given four quarters of
coverage.  In 1997 a Social Security quarter of coverage
will be credited for earnings of $670 during a calendar
quarter.  Four quarters can be earned with annual earnings
of $2,680.

     Exempt Earnings:  The monthly earnings exemption for
blind people who receive disability insurance benefits was
$960 of gross earned income during 1996.  During 1997 the
monthly exempt amount is $1000.  Technically, this exemption
is referred to as an amount of monthly gross earnings which
does not show "substantial gainful activity."  Earnings of
$1000 or more per month before taxes for a blind SSDI
beneficiary in 1997 will show substantial gainful activity
after subtracting any unearned (or subsidy) income and
applying any deductions for impairment-related work
expenses.

     Social Security Benefit Amounts for 1997:  All Social
Security benefits, including retirement, survivors,
disability, and dependents' benefits are increased by 2.9
percent beginning with the checks received in January, 1997. 
The exact dollar increase for any individual will depend
upon the amount being paid.

     Standard SSI Benefit Increase:  Beginning January,
1997, the federal payment amounts for SSI individuals and
couples are as follows:  individuals, $484 per month;
couples, $726 per month. These amounts are increased from
individuals, $470 per month; couples, $705 per month.

     Medicare Deductibles and Co-insurance:  Medicare Part A
coverage provides hospital insurance to most Social Security
beneficiaries.  The co-insurance payment is the charge that
the hospital makes to a Medicare beneficiary for any
hospital stay. Medicare then pays the hospital charges above
the beneficiary's co-insurance amount.

     The Part A co-insurance amount charged for hospital
services within a benefit period of not longer than 60 days
was $736 during 1996 and is increased to $760 during 1997. 
From the sixty-first day through the ninetieth day there is
a daily co-insurance amount of $190 per day, up from $184 in
1996.  Each Medicare beneficiary has 60 "reserve days" for
hospital services provided within a benefit period longer
than 90 days.  The co-insurance amount to be paid during
each reserve day is $380, up from $368 in 1996.

     Part A of Medicare pays all covered charges for
services in a skilled nursing facility for the first 20 days
within a benefit period.  From the twenty-first day through
the one hundredth day within a benefit period, the Part A
co-insurance amount for services received in a skilled
nursing facility is $95 per day, up from $92 per day in
1996.

     For most beneficiaries there is no monthly premium
charge for Medicare Part A coverage.  Those who become
ineligible for Social Security Disability Insurance cash
benefits can continue to receive Medicare Part A coverage
premium-free for 39 months following the end of a trial work
period.  After that time the individual may purchase Part A
coverage.  The premium rate for this coverage during 1997 is
$311 per month.  During 1997 this premium rate is $187 for
individuals who have earned at least 30 quarters of coverage
under Social Security covered employment.

     The Medicare Part B (medical insurance) deductible
remains at $100 in 1997.  This is an annual deductible
amount.  The Medicare Part B basic monthly premium rate will
increase from $42.50 charged to each beneficiary and
withheld from Social Security checks during 1996 to $43.80
per month during 1997.  Medicare Part B coverage may be
continued for people who complete a trial work period and
become ineligible to receive Social Security Disability
Insurance cash benefits.  This monthly premium rate is
$43.80, the same amount paid by Social Security
beneficiaries through withholding from their monthly Social
Security checks.

     Programs Which Help with Medicare Deductibles and
Premiums:  Low-income Medicare beneficiaries may qualify for
help with payments.  Assistance is available through two
programs--QMB (Qualified Medicare Beneficiary program) and
SLMB (Specified Low-Income Medicare Beneficiary program).

     Under the QMB program states are required to pay the
Medicare Part A (Hospital Insurance) and Part B (Medical
Insurance) premiums, deductibles, and coinsurance expenses
for Medicare beneficiaries who meet the program's income and
resource requirements.  Under the SLMB program states pay
only the full Medicare Part B monthly premium ($43.80 in
1997).  Eligibility for the SLMB program may be retroactive
for up to three calendar months.

     Both programs are administered by the Health Care
Financing Administration (HCFA) in conjunction with the
states.  In order to qualify in any state, the income of an
individual or couple must be less than the threshold amount
which is announced for each year. The threshold amount is
revised annually to reflect changes in national poverty
level guidelines.  The rules vary from state to state, but
in general:

     A person may qualify for the QMB program if his or her
income is approximately $665 per month for an individual and
$884 per month for a couple.  These amounts apply for
residents of 48 of the 50 states and the District of
Columbia.  In Alaska the income threshold used to define
poverty is approximately $825 per month for an individual
and $1,099 per month for couples.  In Hawaii income must be
less than approximately $763 per month for an individual and
$1,014 per month for couples.

     For the SLMB program the income of an individual or a
couple cannot exceed the poverty level by more than 20
percent.

     Resources--such as bank accounts or stocks--may not
exceed $4,000 for one person or $6,000 for a family of two
(Resources generally are things you own).  However, not
everything is counted.  The house you live in, for example,
doesn't count, and in some circumstances your car may not
count either.

     If you qualify for assistance under the QMB program,
you will not have to pay:

+   Medicare's hospital deductible, which is $760 per
benefit period in 1997; 

+   The daily co-insurance charges for extended hospital and
skilled nursing facility stays;

+   The Medicare Medical Insurance (Part B) premium, which
is $43.80 per month in 1997;

+   The $100 annual Part B deductible;

+   The 20 percent co-insurance for services covered by
Medicare Part B, depending on which doctor you go to.

     If you qualify for assistance under the SLMB program,
you will not have to pay:

+   The $43.80 monthly Part B premium.

     If you think you qualify but you have not filed for
Medicare Part A, contact Social Security to find out if you
need to file an application.  Further information about
filing for Medicare is available from your local Social
Security office or Social Security's toll-free number, (800)
772-1213.
     
     Remember, only your state can decide if you're eligible
for help from the QMB or SLMB program.  So, if you're
elderly or disabled, have low income and very limited
assets, and are a Medicare beneficiary, contact your state
or local welfare or social service agency to apply.  For
more information about either program, call HCFA's toll-free
telephone number, (800) 638-6833.

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

DIALYSIS AT NATIONAL CONVENTION

by Ed Bryant


     During this year's annual convention of the National
Federation of the Blind in New Orleans, Louisiana (Sunday,
June 29 through Saturday, July 5, and see "Convention 1997"
article in this issue) dialysis will be available.
Individuals requiring dialysis must have a transient patient
packet and physician's statement filled out prior to
treatment.  Conventioneers should have their unit contact
the desired location in the New Orleans area for
instructions.

     Individuals will be responsible for, and must pay out
of pocket, prior to each treatment, the approximately $30
not covered by Medicare, plus any additional physician's
fees.

     DIALYSIS CENTERS SHOULD SET UP TRANSIENT DIALYSIS
LOCATIONS AT LEAST THREE MONTHS IN ADVANCE.  THIS HELPS
ASSURE A LOCATION FOR ANYONE WANTING TO DIALYZE.  New
Orleans is a popular tourist destination, and in July,
everything is very busy.


Here are some dialysis locations:                   

*    Saint Charles Dialysis, 3600 Prytania, Suite 83, New
Orleans, LA 70115; telephone: (504) 895-3992. About 10
minutes by taxi from the convention hotel.

*    Uptown Dialysis has two locations.  A:  Truro Hospital,
on Foucher Street, New Orleans, LA 70115; telephone: 
504-897-7946.  Social Worker is Mary Wendt; contact her for
information about either Uptown Dialysis facility.  B: 
Uptown Dialysis, 3434 Prytania Street, Room 200, New
Orleans, LA 70115.  Use the same phone, 504-897-7946, for
both; and both are about 10 minutes from the hotel.

*    BMA New Orleans, 2000 Tulane Avenue, New Orleans, LA
70112; telephone: (504) 581-6363.  For further information
contact:  Jennifer Wallace, administrator, at (504)
455-5535.  About 10 minutes from the hotel.  

*    DCI of New Orleans, 1400 Canal Street, New Orleans, LA,
70112; telephone:  (504) 593-9895.  Although DCI reports
itself "full" they may well have a cancellation.  About 10
minutes from the hotel.

*    Napoleon Dialysis, 2817 Napoleon Avenue, New Orleans,
LA 70115; telephone: (504) 891-8176.  About 15 minutes from
the hotel.


     PLEASE REMEMBER TO SCHEDULE DIALYSIS TREATMENTS EARLY,
TO INSURE SPACE.  You will be expected to pay, at time of
service, the 20% Medicare copayment (about $30 for each
treatment), plus any non-covered physician's fees, and any
charges for EPO or Calcijex.

     If scheduling assistance is needed, contact:  Diabetes
Action Network First Vice-President Ed Bryant at (573)
875-8911.  See you in New Orleans!

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

LESS PROTEIN MAY REDUCE DIALYSIS DEATHS


     Scientists at Johns Hopkins Medical Institutions have
found that a low-protein diet before dialysis may prolong
the lives of kidney failure patients during their first two
years of dialysis.  The findings also suggest the diet may
postpone the start of dialysis for some patients.

     The Hopkins team studied 44 patients placed on a
special supplemented diet and given dietary counseling at
least four months before dialysis began.  During the first
two years of dialysis, two patients died.  National
statistics predict 11 to 12 deaths in a group this size.

     "The study suggests that changes in pre-dialysis care
could reduce the number of deaths on dialysis
substantially," says Josef Coresh, MD, PhD, the study's lead
author, an assistant professor of epidemiology.

     Protein restriction, with or without dietary
supplements, has long been studied as a way to prevent
kidney failure.  But this study, funded by the National
Institutes of Health, is the first to show the death rate on
dialysis is lowered by a very low-protein diet with ketoacid
and amino acid supplements and close clinical monitoring
before dialysis, the scientists say.  

     "The diet not only worked but also prevented
malnutrition in most patients.  In some cases, it reversed
it," says Coresh.

     The results of the research, which are published in the
current issue of the Journal of the American Society of
Nephrology, suggest that a broader study of the diet is now
warranted, says Mackenzie Walser, MD, the study's senior
author, a professor of medicine and pharmacology. 
Researchers cannot explain why the restrictive diet helps
but say it appears to prepare patients for the rigors of
dialysis.  The 44 study patients ate no meat, fish, poultry,
eggs, milk, or cheese.  They took tablets of amino acids or
synthetic substitutes to make up for the lack of essential
components normally provided by protein.

     The kidneys filter the blood, reabsorb important
components, and excrete into the urine the protein breakdown
product:  urea, excess minerals, toxins and fluid.  Low
levels of protein in the blood are a strong predictor for
death in dialysis patients.  An earlier Hopkins study showed
that the scientists' very low protein diet produces normal,
rather than low, levels of bloodstream protein at the start
of dialysis.

     "We think the diet eliminates some component of
high-protein foods that makes it difficult for kidney
patients to metabolize protein properly," says Walser.

     The diet can be followed by most chronic kidney failure
patients, and the essential amino acid supplements are
commercially available and cheaper than the foods they
replace, according to Walser.

     For the past decade, the number of kidney patients has
increased about 11 percent each year.  About 200,000 people
currently undergo dialysis, a technique to remove waste
products and excess fluid from the body as a treatment for
kidney failure.  About 80,000 Americans die each year from
complications on dialysis.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

VOICE DISTRIBUTORS NEEDED


     Since the VOICE is now offered free, our Diabetes
Action Network will provide extra copies to anyone wanting
to help spread the word.  We will gladly send from five to
five hundred-plus copies each quarter to be used as free
literature.  Medical facilities can order as needed for
patients.  Individuals can usually place copies of the VOICE
in libraries, pharmacies, hospitals, doctors' offices, or
other public locations.

     Diabetes education is essential.  Anyone who
distributes the VOICE will be helping people with diabetes,
and their families, to learn about the disease and its
ramifications; to learn that they have options; and that
their world is far greater than whatever "limits" may be
imposed by the disease.  If you would like to help spread
the word by distributing the publication, please contact: 
VOICE OF THE DIABETIC, 811 Cherry Street, Suite 309,
Columbia, MO 65201; telephone: (573) 875-8911.

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

     If you or a friend would like to remember the Diabetes
Action Network of the National Federation of the Blind in
your will, you can do so by employing the following
language:

     "I give, devise, and bequeath unto the Diabetics Action
Network of the National Federation of the Blind, 1800
Johnson Street, Baltimore, Maryland 21230, a District of
Columbia nonprofit corporation, the sum of
$___________________" (or "___________ percent of my net
estate" or "the following stocks and bonds:___________") to
be used for its worthy purposes on behalf of blind persons."

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

TRAVEL, VACATIONS, AND DIABETES

by Celia Henderson


Photo:  portrait of Celia Henderson

     You have insulin-dependent diabetes; it's time for
vacation.  How should you handle your diabetes?  Will you be
able to go away for more than a day?  Could you go to
Europe, or on an extended  cruise?

     There is no reason to avoid travel just because you
have diabetes.  With a few extra precautions, you can take
as many trips to as many places as your imagination can
suggest.  A little advance planning and common sense are all
that is required.


General Do's and Dont's

     Do carry extra supplies with you, enough to last longer
than you plan to be away.  That way, if you decide to stay
longer, or if you are delayed, you won't have to worry about
finding the supplies you need.  A good rule of thumb is to
carry twice the supplies you normally need for trips of a
week or less, and one week's extra for longer trips.  You'll
need your insulin, syringes, swabs, blood testing and urine
testing equipment.  Make sure you also have some form of ID
that advises that you have diabetes, such as a bracelet or
wallet card.  Make sure your equipment is in good repair,
and that batteries are fresh; carry MORE test strips than
you need.  If you need special meals, call the airline one
week ahead to request; check again the day before departure. 
Carry extra food, in case meals are missed, or are
inappropriate to your dietary requirements.

     Don't pack diabetes supplies in your checked luggage;
it and you can become separated.  Pack your diabetes
supplies in your carry-on case.  Remember to include a
letter and prescription from your doctor, covering your
insulin, syringes, and any other prescription medication you
carry with you.  Don't forget to pack your glucose tablets,
motion sickness pills, medicine to relieve possible vomiting
or diarrhea, and any other appropriate medications. 
Consider packing the emergency medication glucagon.  Discuss
travel plans with your doctor.


Traveling By Car

     Auto trips can be very enjoyable.  If you are doing the
driving, be on guard against low blood sugar and possible
insulin reaction.  Take frequent breaks (every two hours is
recommended--specially if you have to cope with foreign
traffic!), watch yourself for disorientation, and test your
blood glucose levels frequently.  Keep a small piece of
fruit, a package of raisins, some graham crackers, and your
glucose tablets close at all times.


Buses and Trains

     When you travel by bus or train, regular rest stops and
meal times may not match your schedule.  There can be
unexpected delays, and the available food can be very
inappropriate.  Carry a snack so that you can provide your
body with the sugar it needs.  Although it is best to travel
with a companion who understands your condition and what to
do about it, if you are traveling alone it may be a good
idea to let the driver or conductor know that you have
diabetes, just in case you should have a problem.


Travel By Air

     On a long flight, you may be scheduled for an injection
while you're in the air.  Follow your normal procedure, with
one difference.  Put only half as much air into your insulin
bottle as you normally would.  Cabin air pressure in
high-altitude flight is lower than pressure on the ground,
so you won't need as much pressure inside the bottle to
balance the insulin you draw.


Crossing Time Zones

     Your normal insulin dosage is designed to protect you
for a set period of time.  When changing time zones quickly,
as you do when in East/West flight, you may need to adjust
your dosage.  Discuss such adjustment with your doctor in
advance.  On a long flight, leaving your watch on "Home"
time might make it easier for you to know your schedule,
especially if you will need to inject while in flight.  Once
you arrive, reset it to local time, and note the difference. 
If you are mixing insulins, time your injections so that
your insulin will have the same relationship with your new 
meal times as it does at home.  If your meals will be timed
or spaced very differently from at home, ask your doctor if
you should use a different injection schedule or proportion
of short- and long-acting insulins.

     Again, carry your insulin, syringes, swabs, and
diabetes ID card/bracelet, with you rather than in your
luggage, just in case your luggage becomes lost.  Keep the
name and phone number of your doctor at hand.  Many foreign
physicians speak good English, and a surprising number
studied in U.S. or British medical schools.


Care of Your Insulin

     Unopened insulin can keep at room temperature (approx.
68 Fahrenheit, 20 Celsius) for a month without refrigeration
(the "expiration date" applies to refrigerated storage), but
extremes of heat or cold can damage it and make it
ineffective.  Once you start using vial or pen cartridge,
the manufacturers recommend you store the product no more
than 30 days, and one week in some cases.  Be sure to read
and follow the cautions and instructions packed with your
product; consult the insulin manufacturer's "help line" for
further information. 

     Summer heat can raise the temperature inside a parked
car to over 140 Fahrenheit, so avoid storing insulin in your
car's trunk or glove box.  Airline baggage compartments are
unheated.  They get cold at 35,000 feet!  Your insulin can
freeze, severely damaging it.  Insulin you suspect has been
exposed to extremes should be discarded.


Foreign Travel

     In some foreign countries U-40 insulin is the only
strength available.  Your dosage is based on U-100 strength
insulin, so you'd have to take 2.5 times as much U-40 (by
fluid volume) to get the same amount of insulin.  In other
countries, U-80 insulin may be the standard.  Know before
you go!  Although you are bringing all your supplies with
you, just in case, you should find out which insulin
strength is standard in your destination country, and know
how to use it.  Remember that "U" describes how many units
of insulin are in one cc, or cubic centimeter.  U-100, the
dilution sold in the U.S., is more concentrated, and U-40
contains only 40 units of insulin per cc. It is important to
remember you need the right number of UNITS OF INSULIN,
regardless of the concentration.  The UNITS are marked on
the syringes of each insulin strength, so as long as you use
the correct syringe (the syringe DESIGNED FOR THE
CONCENTRATION YOU'RE DRAWING), you can still measure your
dose accurately.  If you must use local syringes, make sure
you understand their markings!  If you will be staying
somewhere long enough to need locally-available insulin,
discuss this with your doctor, as source and brand
differences should be considered as well.  Note that in many
countries, syringes and bottles are color coded--but in
other countries the same color codes may mean something
different.  Be cautious!  It is best to bring more than
enough of what you're used to, and leave local insulin and
syringes strictly for emergencies.

     It may sound trivial, but if you have sensitive skin,
pack a familiar soap.  Many foreign brands are very
different, and in some places soap may be in short supply. 
Veteran world travelers often carry a supply of toilet paper
as well.  The same goes for toothpaste.  (From the Editor: 
The newsletter, THE DIABETIC TRAVELER, offers a free list of
diabetes associations in 84 countries, along with other
useful advice.  For information, contact:  THE DIABETIC
TRAVELER, PO Box 8223 Rw, Stamford, CT 06905; telephone: 
(203) 327-5832.)

     Get your immunization shots ahead of time.  Some
immunizations can upset your system and put you "out of
balance."  It's much easier to deal with these reactions at
home.  Plan your shots three to four weeks before you are
ready to leave home.


Carry A Sugar Source

     Always carry some form of sugar that can be eaten
easily.  This could be food such as raisins, sugar cubes or
a piece of fresh fruit.  Glucose tablets are very
convenient.

     While traveling, chances are your routine will be
different from home, with increased risks of an insulin
reaction.  Even people who are normally aware of the signs
of a reaction can be caught off guard by the stress and
excitement of travel.  The odds are your vacation will
impact your diabetes; be ready to deal with it.


Blood Testing

     The changes in your daily routine, meal timing, and
kinds of food can all affect your blood sugar levels.  Test
your blood for sugar at least four times a day.  It may be
better to try to control you blood sugar levels with small
adjustments to your activity levels and food intake than by
changing your insulin dosage--discuss this with your doctor.


Caring For Your Feet

     Never go barefoot.  Cuts and scrapes on your feet can
lead to infection and ruin your vacation.  Don't wear new
shoes for more than an hour the first day.  If you're
planning a lot of walking, wear a thin pair of socks under
your regular socks, or choose seamless athletic socks of
cotton or new materials like Thorlo.  It is best to travel
with shoes that are well broken in and comfortable.  If you
develop blisters, don't break them. Unbroken skin is your
best defense against infection.


Diets and Meals

     Extra pounds are easy to put on during vacations. 
Chances are your eating schedule will be harder to stick to
when you're away!  The foods available may be different from
what you're used to eating.  Note that many restaurants can
provide foods that will fit your meal plan, even though they
do not appear on the menu.


Foods to Avoid 

     Diarrhea is unpleasant for anyone.  For a person with
diabetes, it can be downright dangerous, because diarrhea
eliminates both fluids and unabsorbed glucose.  If that
happens, you will find it difficult to balance your insulin. 
Where sanitary conditions are in doubt, for your safety, be
prepared to avoid ice cream, milk, soft cheeses, cream
sauces, raw leafy vegetables and fruits peeled by someone
else.  Drink bottled water or beverages, and be cautious of
ice cubes.  Coffee and tea are OK if the water is brought to
a boil first.


Activities

     Exercise burns sugar, so watch your carbohydrate
intake, cut down for lazy days, increase for busy times, and
test blood sugars when in doubt.  Discuss exercise plans and
insulin adjustment with your doctor.

     Have a wonderful, happy and safe trip.  Bon voyage! 

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

ASK THE DOCTOR

by Wesley W. Wilson, MD


Art:  picture of medical caduceus

     NOTE:  If you have any questions for "Ask the Doctor,"
please send them to the VOICE editorial office.  The only
questions Dr. Wilson will be able to answer are the ones
used in this column. 

     Wesley Wilson, MD is an Internal Medicine practitioner
at the Western Montana Clinic in Missoula, Montana.  Dr.
Wilson was diagnosed with type I diabetes in 1956, during
his second year of medical school.


     Q:  When I am sick and can't keep food down, should I
skip my next insulin injection?

     A:  Your question is excellent, and points up an area
of uncertainty that gets a lot of folks with diabetes into
significant problems.  Remember that a number of factors
raise blood sugar levels: Lack of insulin, infections, lack
of exercise...  A profound deficiency of insulin (you
skipping a shot) certainly can cause a rise in blood sugar,
even if with no food intake.

     A flu-like illness, with vomiting, can set the stage
for development of diabetic ketoacidosis, which is a serious
problem for folks with type I diabetes.  Ketoacidosis (DKA)
can appear quite rapidly, and seems to be caused by a
combination of dehydration and lack of insulin effect.  In a
flu-like illness, a person not able to take fluids is likely
to be dehydrated.  If they omit their insulin dose, they are
particularly likely to have significant tissue lack of
insulin effect, which sets up the possibility of developing
diabetic ketoacidosis.  The problem is that when you are
unable to eat, you may be fearful of taking insulin, as
there is no way you can counteract an excessively low blood
sugar, should it occur.   You certainly don't want to have
an insulin reaction--"hypoglycemia"--when you cannot take in
food to get your blood sugar back up.

     Flu-like illnesses with nausea and vomiting are almost
certain to occur during the lifespan of anyone with type I
diabetes. Therefore, it is important to discuss this problem
beforehand with your health care provider.

     The single most important thing you can do is CHECK
YOUR BLOOD SUGAR MORE FREQUENTLY when you are ill than when
you are well.  It's often a shock to folks who have not
taken food for a fairly long period of time to check their
blood sugar--they are surprised to find it higher than
normal, related to their illness and often  to lack of
adequate insulin effect.

     The standard treatment for illness with nausea and
vomiting in a person using insulin is first to check the
blood sugar.  If it's high, take some dose of insulin, the
amount of which should be discussed with your health care
provider before the illness.  Next, try to take some form of
fluid which does not contain carbohydrate calories--soda
pop, juice, apple juice.  Anything with some calories and
fluid is helpful, and not likely to cause major problems as
long as the blood sugar is checked frequently.  The dose of
insulin may require a change, but it is still essential, and
only by testing blood sugars frequently can you determine
what dose should be used.

     Forewarned is forearmed!  Plan for this problem in
advance.  Each person may require a bit of individualized
approach, so it's important to work out the details of sick
day management, but the key thing is to check blood sugars
frequently during illness.  If there are nausea, vomiting,
and elevated blood sugars, it's particularly important to
check the urine for acetone or ketones, so you should always
have a supply of acetone testing strips available for your
use.  If protracted nausea and vomiting occur, receiving
intravenous fluids with some carbohydrate calories and with
some insulin coverage can often avoid serious consequences.

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

CAN I EAT SUGAR?


     Until quite recently, most diabetics were told to
avoid, to minimize, even to fear foods rich in sugar.  Sugar
was the enemy, the source of high blood glucose, so sweets
were avoided as a matter of life and death.  But we know
better now; we have a new understanding of what sugar is,
where those high BG numbers come from, and how we must eat
to keep them where they should be.

     The key is understanding where blood glucose (the stuff
we measure) comes from.  During digestion, the human body
breaks down carbohydrates (both simple and complex) and
turns them into glucose, which feeds you, and shows up on
your test strip.  Doctors used to believe that "sugars"
(sucrose, dextrose, fructose, glucose, maltose, levulose,
etc.)  were more rapidly absorbed by the body than were the
"starches" (complex carbohydrates such as found in potatoes,
pasta, bread, etc.), and thus were harmful for diabetics. 
This belief was strong, but when it was tested, it was found
to be false.  Sugar is absorbed no faster than is any other
carbohydrate.

     This breakthrough, endorsed by both the American
Diabetes Association and the American Dietetic Association,
has meant a broadening of the diabetic diet and a lessening
of restrictions.  Now, what matters is the total volume of
carbohydrate consumed, and sugar is counted as a
carbohydrate. 

     Imagine you want that cookie, or that piece of pie. 
You already know, from your meal plan, how much carbohydrate
you can eat.  Once you know how much carbohydrate is in that
treat you want, you "pay for it" by deleting the equivalent
amount of carb from somewhere else in your meal plan.  It's
like balancing your checkbook.

     There is a problem.  Many healthy and nutritious foods
contain sugars, and that's OK if you allow for it, but most
sweets are not particularly nutritious, and if you make
space for them in your meal plan, you may not have any room
left for the healthy foods you need.  Just like the man with
the checkbook, moderation is the rule -- the things you need
have priority over the things you want.

     By the way, some food labels proclaim "NO ADDED SUGAR!" 
As far as diabetes goes, this is a meaningless distinction. 
Whether sugar is naturally-occurring, or added by the cook,
is of no account.  What matters is the total.

     What you need is to know your meal plan, and to know
how much carbohydrate you can eat without raising your
numbers too high.  With that figure, and knowledge of how
much carbohydrate is in that candy bar, that glass of juice,
that slice of pizza,  you can set up, and adhere to, a diet
that will keep you as healthy as possible.  Confer with your
dietitian.  

     The American Diabetes Association (1-800-232-3472) has
a pamphlet to help you:  "The 1995 Exchange Lists for Meal
Planning."  If you need this useful pamphlet in Braille, or
on 15/16 ips audiocassette, contact the National Federation
of the Blind.  (See "Resource Column" for complete ordering
information.)         

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

TACTILE INSULIN VIALS--PROGRESS REPORT

by Ed Bryant


     For more than five years, we, the Diabetes Action
Network of the National Federation of the Blind, have been
leading the campaign to get the insulin manufacturers and
the Food and Drug Administration (FDA) to reform the way
insulin is packaged.  Currently, all types of insulin sold
in the United States are packaged identically, either in
10cc vials or 1.5cc pen cartridges, with only the writing on
the label to tell them apart.  

     Insulin mixing has been standard practice for decades. 
The welfare of almost all insulin users depends on not
confusing their Regular with their NPH, or their Lente, or
their Ultralente, or their new, quick-acting Humalog. 
Misidentification can be deadly; you can't afford to make
mistakes.

     Where does all this dependence on small print leave the
blind, the visually impaired, children, the aged, overworked
nurses, hospital workers, hurried people, folks who make
mistakes sometimes, and the rest of us?  Not in a very safe
place.  Those of us who cannot reliably read insulin labels
have been forced to depend on impermanent tactile cues like
tape or rubber bands to tell one insulin from another, or
else left to depend on sighted assistance.  Tape falls off,
rubber bands break, and both can wind up on the wrong vial. 
Sighted assistance is not always forthcoming.

     There has been some discussion between the insulin
manufacturers and the FDA about "color coding" the different
insulin types.  While a universal color-scheme to
distinguish the different insulin durations and mixes will
doubtless reduce dispensing errors, and is thus commendable,
it does not address the difficulties faced by those who
cannot see the label!

     Diabetes is the leading cause of new blindness in the
United States today.  The Centers for Disease Control
estimates diabetes costs 15,000 to 39,000 people their sight
every year.  This is not a small problem.

     The solution has been obvious from the start.  We need
standardized, permanently-attached tactile cues,
sufficiently prominent that blind individuals can use them
to reliably distinguish between the insulin types.  Knowing
this, I have written, faxed, telephoned, and met with
insulin industry executives and FDA regulators, formally and
informally solicited 
your input on the best means to achieve non-sighted insulin
vial identification, spearheaded several letter-writing
campaigns, and pushed for face to face meetings between
insulin industry representatives, FDA regulators, and
associations concerned with blindness or diabetes.  You,
VOICE readers, helped by writing Dr. David Kessler, then
Commissioner of the FDA, and making your views  known on
this public safety issue. 

     It took a long time, but with your support, we
convinced the FDA to call for a face to face meeting of
interested participants.  On October 19, 1995, at FDA
headquarters in Rockville, Maryland, we had our first
meeting.

     At that meeting, participants agreed that nonsighted
insulin vial identification was a necessity.  A general
consensus was reached that such coding should be factory-
applied, durable, and sufficiently prominent that blind
diabetics with neuropathy could use it.  Minutes of the
meeting record that the insulin manufacturers, Eli Lilly and
Company and Novo Nordisk Pharmaceuticals Inc., were to come
to the next meeting "with firm ideas for short-term
solutions, and other ideas for long-term solutions."

     Although the second meeting was scheduled for January
of 1996, bad weather in the Washington DC area forced
postponement, and that meeting was not held until April 10,
1996.  Both Lilly and Novo Nordisk brought prototype vial
markings to the meeting; Lilly's horizontal lines on the
label and Novo Nordisk's raised dots on the aluminum vial-
stopper rim.          

     By the close of the second meeting, the FDA and Lilly
were ready to agree on a set of one through four horizontal
tactile bars to distinguish insulin classes.  All that
should have remained was to determine how many bars
signified which class.

     But Novo Nordisk, deeply committed to a tactile marking
system meeting participants had already found unacceptable,
asked for more time, "in which to test alternative
prototypes."  We agreed to meet again, some time in July.

     Documents discussed in the last issue of the VOICE
reveal Novo did not even begin their research until after
the time they were supposed to have completed it.  They
were, in marked contrast to Eli Lilly and Company, in no
hurry to get it done.

     But finally they did.  After months of delay, including
a number of weeks after research was completed, Novo Nordisk
shipped their long-awaited findings to the FDA.

     Mr. Randy Hedin, the FDA's Tactile Coding Meeting
Facilitator (who had the responsibility of scheduling the
next meeting) repeatedly told me he'd "get it done."  When I
spoke to him on September 25, he assured me the third
meeting could be scheduled "six to eight weeks after the
study arrives from Novo."  I wrote him a long letter on
November 11 (published in VOICE Vol. 12, No. 1) outlining
what I knew of Novo Nordisk's study -- and I sent a copy to
his supervisor at FDA, Solomon Sobel, MD.  When we spoke, on
November 25, Mr. Hedin said he'd like to shoot for about
January 13.  On December 12, he told me, "...meeting would
be some time in February."

     But when I reached him on February 3, he asked, "Did I
realize we didn't get the study from Novo Nordisk until the
end of December?"  He repeated that he had a lot to do, but
said the meeting looked like it would happen perhaps the
first week in March.  

     On February 24 I received a fax from Julie Rhee, CSO,
DMEDP, of the FDA, who was querying previous meeting
participants, looking for a date amenable to all--but
between March 25 and April 17.  Four days later, she sent
another--reporting no consensus within the stated range, and
asking each what days were "off limits" in May and June!

     The original "rematch" was to have been (as reported in
previous editions of the VOICE) July 1996.  The new meeting
(now scheduled for June 3) will take place almost one year
late.
     
     Questions remain unanswered.  Although Eli Lilly and
Company, once persuaded, did complete their research in a
timely manner, Novo Nordisk's repeated delays seem to me
those of a company preoccupied with market share, industrial
politics, and sheer organizational inertia.  This is my
opinion.    

     By statute, the Food and Drug Administration is charged
with the responsibility of protecting the health of all U.S.
citizens.  When presented with the specifics, the FDA must
act.  It is their job.

     We have presented them with specifics.  They know the
problem,  and they know that each week of delay brings more
misdosages, more midnight ambulance rides, perhaps more
fatalities.  Knowing that insulin has a two year shelf-life
(so any new marking system will take that long to completely
replace the current vial labels), had the FDA exerted itself
in 1995, the four-bars-on-the-label system  might be coming
on line about now.  

     But they sat.  Perhaps terrified to upset a big
multinational corporation, the FDA regulators were here
sorely deficient in their primary job -- regulating.  They
could have, for your safety, brought pressure to bear on
Novo Nordisk, but they did not.  When presented with
interminable delays, they could have reminded Novo of their
agreement, recorded in the minutes of the April 10, 1996
meeting at FDA headquarters, to have all research completed
and ready for presentation in July 1996.  They could have
sanctioned Novo Nordisk for their blatant failure to keep
that commitment.  They did not.

     Once Novo finally got their materials in, the FDA could
have  promptly scheduled the meeting.  One wonders if their
lackadaisical attitude toward this issue is a reflection of
their attitude toward the blind, or...?

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

COOKING TIPS FOR THE MICROWAVE


     If the food would splatter in the pan, it will splatter
in the microwave--cover bacon with paper towels; wrap
wieners in paper towels, and remember to pierce them so they
won't burst.  When melting butter or margarine, cover the
dish with wax paper (better than plastic) to avoid
splatters.

     Your microwave heats food from the inside
outward--remember to pierce whole potatoes before baking, so
they won't explode.  The same goes for chicken livers or
gizzards.  Heating a tomato?  It can pop too!

     And this is important:  Make sure the dish you put in
the microwave is "microwave-safe."  Some plastics will melt,
some ceramics will split, and any metal (even gold leaf on
fine china) will blow up your microwave.

     Take care, and enjoy.

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

RECIPE CORNER


Art:  picture of fruits and vegetables

     Send your great food ideas to the editor.  Your recipes
will be evaluated by dietitians, and if necessary, adjusted
to make them more diabetically appropriate.  Then he gets to
taste them...


Nonfat Salad Dressing

from Ann S. Williams
of Cleveland, Ohio


     Here is a nonfat salad dressing with variations that is
the current salad fad in my family:

Mix together:

1 cup nonfat yogurt
2 to 4 tbsp. lemon juice
1 or 2 cloves of garlic put through a garlic press
1 tsp. salt (less if you must limit salt)

     You can add many kinds of flavorings for variety.

My daughter likes to blend it in a food processor with:
     a large handful of fresh basil and parsley

My husband likes to mix in:
     about 1/4 cup of crumbled feta or bleu cheese

My son, a garlic fiend, adds:
     lots of extra garlic (2 or 3 more cloves)

My own current favorite is to add:
     1/4 tsp. cayenne pepper
     1 tsp. ground coriander
     1  to 2 tsp. ground cumin

     Yield:  2 tablespoons:  15 calories

     Exchange:  Free Food


Leg of Lamb stuffed with Pine Nuts, Herbs and Feta Cheese

from Dave Griffith
of London, Ontario, Canada


3.5 lb. boneless leg of lamb
1/4 bunch of (each), fresh dill, mint and oregano, chopped
2 green onions, chopped 
1/4 cup pine nuts, lightly toasted
2 oz feta cheese, crumbled
1 egg
2 cloves garlic, chopped
salt and freshly ground black pepper to taste
1 tbsp. vegetable oil

     Preheat oven to 375 F.  Lay lamb horizontally and roll
into shape as though bone were still in it.  Cut off narrow
portion.  Unroll lamb and place with grain of meat running
horizontally.

     Combine herbs, onions, pine nuts, cheese, egg, garlic,
salt and pepper.  Cover inside surface of leg with stuffing,
leaving 2" all around for rolling.

     Roll leg, keeping grain horizontal.  Tie roll tightly
with butcher's twine.  Place in roasting pan with oil and
sprinkle with salt and pepper.  Roast for about 35 to 45
minutes.

     Per serving (5 oz.):  290 calories, protein 33 grams,
fat 16 grams, carbohydrates 3 grams

     Exchange:  5 Lean Meats


Basil and Lentil stuffed Tomatoes (Pomodori Ripieni)

from Dave Griffith
of London, Ontario, Canada


2 firm tomatoes
2 tbsp. chopped celery
1 tbsp. chopped onions
1 tbsp. chopped fresh basil
Crushed red pepper flakes to taste
Salt and freshly ground black pepper
1/2 cup cooked lentils
2 tsp. freshly grated Parmesan

     Cut the top of the tomatoes, CAREFUL! just a thin
slice!  Spoon out the pulp and juice; transfer to a saucepan
and place the 
tomato shells inverted somewhere to drain.

     Add the celery, onion and basil to the saucepan, and
cook at medium heat until the celery is just tender.  Season
to taste with the pepper flakes, salt and black pepper.  Add
the lentils and mix well.

     Spoon the mix into the shells and place in a muffin pan
so they don't tip over (this is the VOICE of experience
talking here).  Sprinkle with the cheese and bake at 350F
until the cheese begins to turn a golden brown.

     Makes 2 servings

     Per serving:  96 calories, 6g protein, 16g
carbohydrate, 54mg sodium, 450mg potassium

     Exchanges:  1 Vegetable, 1 Starch


Kiwi Fruit Fool

from Dave Griffith
of London, Ontario, Canada


1 1/2 cups sliced Kiwi fruit
1 tsp. finely grated lemon rind
Artificial sweetener to taste
2 cups low-cal dessert topping
Some fresh raspberries, blueberries and/or sliced Kiwi fruit 
(This is for garnish purposes, so if you don't care if your
food looks pretty, you can leave it out)

     Puree the Kiwi fruit with the lemon rind and sweeten to
taste with the sweetener.  Cover and let chill for several
hours.

     Fold in the desert topping and transfer to a serving
bowl.

     Garnish with the above mentioned fruit if you feel so
inclined.  You can try this with other fruit such as
raspberries, blueberries, strawberries, peaches, bananas,
etc.......

     Makes 6 servings.

     Per serving: 71 calories, 3g total fat, 2 mg
cholesterol, 1g protein, 9g carbohydrate, 17mg sodium, 61mg
potassium

     Exchanges:  1 Starch or 1 Fruit
  
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

HEAR YE, HEAR YE, A RAFFLE


     The Diabetes Action Network of the National Federation
of the Blind reaches out and provides support and
information to thousands of people.  Because it costs to
operate this valuable network and to produce the VOICE OF
THE DIABETIC, we must generate funds to help cover these
expenses.  Our Diabetes Action Network has elected to hold a
raffle, which will be coordinated by our treasurer, John
Yark.

     THE GRAND PRIZE WILL BE $500!  The winning ticket will
be drawn, and the winner's name announced, on July 4, 1997,
at the banquet held during the annual convention of the
National Federation of the Blind.

     Raffle tickets cost $1 each, or a book of six may be
purchased for $5.  Tickets may be purchased from state
representatives of our Diabetes Action Network or by
contacting the VOICE Editorial Office, 811 Cherry Street,
Suite 309, Columbia, MO 65201; telephone: (573) 875-8911. 
Anyone interested in selling tickets should also contact the
VOICE Editorial Office.  Tickets are available now!  Names
of persons who sell 50 tickets or more will be announced in
the VOICE.

     Please make checks payable to the National Federation
of the Blind.  Money and sold raffle ticket stubs must be
mailed to the VOICE office no later than June 10, 1997, or
they can be personally delivered to Raffle Chairman John
Yark, at this year's NFB convention in New Orleans,
Louisiana.  This raffle is open to anyone age 18 or older,
and the holder of the lucky raffle ticket need not be
present to win.  Each ticket sold is a donation, helping
keep our Diabetes Action Network moving forward.

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

WHAT YOU ALWAYS WANTED TO KNOW
 BUT DIDN'T KNOW WHERE TO ASK

(Resource Column)


Art:  picture of hand taking a book from book shelf

     Inclusion of materials in this publication is for
information only and does not imply endorsement by the
Diabetes Action Network of the NFB.


Diabetic Skin Care Products

     The Anastasia Marie Diabetic Pure Skin Therapy Total
Skin Care System for Face and Body is a complete line of
products specifically formulated for diabetic dry skin,
including:  Diapedic Foot Cream, Hand and Body Cream,
Azulene Night Repair, and Day Protection Formula SPF 15. 
These products are available at pharmacies nationwide.  For
information or ordering assistance, call:  Consumers Choice
Systems, Inc., Bellvue, WA 98005; telephone: 1-800-479-5232.


Sugar Substitute

     Sweetening without sugar is an issue for people with
diabetes.  Many sweeteners use aspartame, which only works
on cold food -- you can't cook with it.  But now there is
another choice.  Smoky Mountain Sweetener is a liquid
concentrate utilizing saccharin.  Equally effective hot or
cold, containing no carbohydrates, calories, or sugar, it
can put some of those hot, sweet dishes back on your table!  
For a free 4-oz. sample and more information, please write
to:  Smoky Mountain Sweetener, PO Box 507, Knoxville, TN
37901-0507.


Impotence treatment

     Male impotence is a not-infrequent complication of
diabetes.  Treatments are available; and one of the most
effective involves use of vacuum constriction devices like
the ErecAid System, Manufactured by Osbon Medical Systems. 
U.S. Medical Corporation, located in St. Louis, Missouri,
stocks the ErecAid System and many other medical supplies. 
For information, contact:  U.S. Medical Corp.; telephone: 
1-800-408-7633.  Medicare assignment accepted.


Insulin Vial Identification

     The Ident-A-Cap system, manufactured by Terron, Inc.,
is a simple way to mark different insulin types, helping to
cut misidentification and dosage errors.  Utilizing
brightly-colored plastic snap-caps with raised letters, it
can help pharmacists, caregivers, and some visually impaired
diabetics distinguish between insulins.  Until the insulin
industry adopts uniform tactile vial markings, this may be a
worthwhile option.  For information contact:  Terron, Inc.,
202 B. North 4th Street, Sanger, TX 76266; telephone:  1-
800-862-2348.


New 1995 Food Exchange List

     The new "1995 Exchange Lists for Meal Planning" is now
available in Braille (74 pages) and on audio cassette.

     This update, the result of a joint effort of the
American Diabetes Association and the American Dietetic
Association, reflects the new emphasis on total carbohydrate
intake, rather than restricting specific sugar types.  Users
should find its new orientation simpler, and its meal plans
vastly more flexible.  In its new form, the "Exchange List"
will continue to play a pivotal role in dietary
self-management of diabetes.

     To purchase, make tax deductible checks payable to: 
National Federation of the Blind.  Cost:  Braille $10,
cassette $2.  Order from: National Federation of the Blind,
Materials Center, 1800 Johnson Street, Baltimore, MD 21230;
telephone:  (410) 659-9314.


WINDOWS Screen Reader

     GW Micro has developed "WINDOW-EYES," a screen reader
for Microsoft WINDOWS and WINDOWS-95.  Once equipped with a
VOICE synthesizer such as the Dectalk (your standard
soundcard won't do), any computer that can run WINDOWS can
run WINDOW-EYES.  A free demo disk is available!  The
WINDOW-EYES program costs $495, and is available from:  GW
Micro, 310 Racquet Street, Fort Wayne, IN 46825; telephone: 
(219) 489-3671.


BRAILLE MONITOR by E-Mail

     You can now get the National Federation of the Blind's
monthly magazine THE BRAILLE MONITOR shipped each month
automatically to your e-mail address.  To get on the mailing
list:  Send, to listserv@braille.org, an electronic message
containing the line "subscribe brl-monitor <your
firstname/lastname>."  Send your request from the e-mail
address where you wish to receive the electronic text (the
software will use your return address as the destination
address for the MONITOR).  You will receive an e-mail
acknowledgement.  For more information, including delivery
problems, how to cancel your subscription or change your
address, e-mail to postmaster@braille.org


New Diabetes Cookbooks

     The American Diabetes Association announces two new
cookbooks by nutritionist Robyn Webb.  The first, DIABETIC
MEALS IN 30 MINUTES OR LESS, features more than 140 recipes,
plus dozens of tips on meal preparation and planning,
storage and cleanup.

     The second book, THE FLAVORFUL SEASONS COOKBOOK,
provides over 400 recipes that coincide with the seasons of
the year.  "Three French Hens" and "Ginger Bread Pudding
with Vanilla Sauce," "Fresh Tomato Herb Bisque," and
"Moroccan Chicken Tajine" are a few of the recipes.

     DIABETIC MEALS IN 30 MINUTES OR LESS costs $11.95, and
THE FLAVORFUL SEASONS COOKBOOK costs $16.95.  Both are
available at bookstores, or from the American Diabetes
Association, 1660 Duke Street, Alexandria, VA 22314;
telephone:  1-800-232-6733.


Sugar Free Marketplace

     Not quite everything for sale at the Sugar Free
Marketplace is good for the diabetic diet.  They also sell
cookbooks, books about diabetes, and diabetic socks.  The
edible products they list, according to the catalog, are all
made without refined sugar, corn syrup, honey or molasses.

     For more information about the many food products
offered by the Sugar Free Marketplace, or their non-food
product lines, or for a free copy of their catalog (print or
tape), contact:  Sugar Free Marketplace, 6710 N. University
Drive, Tamarac, FL 33321; telephone:  1-800-726-6191.


Magazines on Tape

     We have been asked to announce:  The American Printing
House for the Blind (APH) offers its own audiocassette
versions of two of America's most popular magazines: 
NEWSWEEK, and READER'S DIGEST.  Each magazine is recorded in
four-track at 15/16 ips ("talking book" speed, 1/2 normal
music cassette speed), then mailed to the reader.  Tapes do
not have to be returned.

     One year of NEWSWEEK on audiocassette, 52 weeks, costs
$47.  One year of READER'S DIGEST, 12 months, costs $15. 
Contact:   The American Printing House for the Blind, PO Box
6085, Louisville, KY 40206-0085; telephone:  1-800-572-0844. 
  

     To listen to these tapes, you will need a four-track
cassette player.  These players are available free through
the National Library Service for the Blind and Physically
Handicapped.  Telephone:  1-800-424-8567 for information. 
APH also sells such machines.


Large Print Magazine

     READER'S DIGEST magazine offers a 12-month subscription
to its large-type edition, for $11.95 per year.  Each issue
contains 352 book-size pages, fully illustrated, and is
printed in a single column, for easier reading.  Order from: 
READER'S DIGEST, LARGE TYPE EDITION, Dept. LTE, PO Box 241,
Mount Morris, IL 61054-0241.


Skin Care Products

     From the Editor:  MI FINE SKIN is a line of skin care
products of interest to diabetics.  The line includes a
cream, a lotion, and a soap-free cleanser, all appropriate
for the dry skin we face as a consequence of our diabetes. 
I've used the lotion and the cream, and highly approve of
them both.  The cream is especially appropriate for our dry
feet, and has been endorsed by diabetes educators and
podiatrists as appropriate for diabetic foot care (a useful
"diabetic foot care" pamphlet is furnished with the cream).
I tried the cream on my feet; it's not greasy, and it works!

     The soap-free cleanser comes in two varieties: "for
normal, dry, or sensitive skin" (16 oz. bottle) and "for
oily skin" (8 oz. bottle). The face and body lotion comes in
an 8 oz. bottle, and the cream is packed in a 4 oz. jar. 
FREE SAMPLES OF THE CREAM AND LOTION ARE AVAILABLE.

     For information, or to obtain a free sample, contact: 
MI SKIN, INC., 3645 Warrensville Center Road, Suite 321,
Shaker Heights, OH 44122; telephone:  1-800-754-6066.


Diabetes Supplies

     American Diabetic Supply, Inc., will ship your diabetes
supplies to your door.  They handle all insurance claims and 
provide free delivery. Folks with Medicare and/or private
insurance (no HMOs) may receive supplies with no further
cost.  For information contact:  American Diabetic Supply,
Inc., 115 E. Granada Blvd., Suite 9, Ormond Beach, FL 32176;
telephone:   1-800-453-9033.

Diabetes Supplies

     Can-Am Care Corporation carries a full line of diabetes
supplies, including: test strips, Dex-4 glucose tablets,
skin cream, etc.  The company also markets the Monoject line
of insulin syringes and lancets.  Many Can-Am products are
also sold as "house brand" at major pharmacy chains.

     For information, contact:  Can-Am Care Corporation,
Cimetra Industrial Park, Box 98, Chazy, NY 12921-0098;
telephone:  1-800-461-7448.

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

FOOD FOR THOUGHT


Art:  picture of dancing fruits and veggies

     We invite blurbs and tidbit articles for inclusion in
this column.  Materials received may be edited and used as
space permits.  Products and services included in this
column are for information only and do not imply endorsement
by the Diabetes Action Network of the NFB.


Correction

     In the last issue of the VOICE, in the article titled: 
"1996 Raffle Winners," one name was left out.  We omitted
Joy Cardinet, of Reseda, California, who sold 101 tickets. 
Thanks for a job well done, Joy!


Diabetes Studies

     The Chicago Center for Clinical Research is studying
investigational treatments for people suffering from
diabetes.  Whether you are diet-controlled, on oral diabetes
medications, or using insulin, you may be eligible to
participate in a research study of one of these treatments. 
It is only upon successful completion of such research
studies that new treatments become freely available -- you
can help!  To learn more about participating in one of these
clinical studies, telephone:  1-800-494-2227.  


Water Warning

     If you are undergoing dialysis, be aware that many
municipalities are switching from chlorine to chloramines to
disinfect their water supply.  Official documents state: 
"Although chloraminated water is safe for anyone to drink,
it can be a serious problem to individuals with kidney
disease undergoing dialysis on artificial kidney machines. 
The chloramines must be reduced to acceptable levels..."

     If you are, or will shortly be, using dialysis, check
with your water supplier!


Catalog on Internet

     Blazie Engineering, maker of the Braille'n Speak and
other products for the blind, is now on the internet.  Their
"home page" features graphics, sound clips, and many
documents previously available only in print or Braille.

     The home page contains Blazie's products catalog, their
quarterly newsletter, and complete owner's manuals for many
Blazie products.  The page also features a "forum," where
users can ask questions and leave comments.

     To access Blazie Engineering's home page on the World
Wide Web, type:  http://blazie.com/.  For more information,
or help in getting connected, contact:  Blazie Engineering,
105 E. Jarrettsville Rd., Forest Hill, MD 20150; telephone: 
410-893-9333.


Non-visual Guitar Instruction

     We have been asked to announce:  Bill Brown, who has
taught guitar for over 25 years, has created an all-cassette
(no written materials) guitar course.  The course is
intended for beginners, and even includes a telephone
"tuning hot line" in case the student needs help tuning the
guitar.  Upon completion of the course, the student will
know the basic guitar chords, most common rhythm patterns
using these chords, the names of notes on the strings, and a
number of songs.  The student will also be able to access
the entire Guitar By Ear library of songs.  To order, send a
check for $34.95 to:  Bill Brown, 704 Habersham Road,
Valdosta, GA 31602; telephone:  (912) 249-0628.


VOICE Formats

     VOICE OF THE DIABETIC is offered in two formats: 
standard print, and 15/16 ips audiocassette, "talking book"
speed.  Anyone who is currently receiving the VOICE in print
and having difficulty reading it, may receive it on cassette
at no charge.  VOICE tapes require the special tape player
available free to the legally blind from Regional Libraries
for the Blind and Physically Handicapped, which can be
obtained by telephoning the National Library Service at: 
1-800-424-8567.  Note:  Attempting to play VOICE tapes (or
any other tapes in NLS format) on a conventional music-speed
tape player will yield incomprehensible "chipmunk sounds."

     Periodically we receive requests for the VOICE in
Braille or Large Print.  It is not available in either of
those formats at this time.

     All a subscriber needs to do, to switch from standard
print to tape, or to receive both formats, free of charge,
is contact us at the VOICE OF THE DIABETIC Editorial Office.


Articles Needed!

     If you have diabetes, are a family member or friend of
a diabetic, or a health professional with an interest in
diabetes, we invite you to submit an article for publication
in the VOICE OF THE DIABETIC.

     Our philosophy regarding diabetes is positive.  Do you
have an inspiring, enlightening story?  We, the Diabetes
Action Network of the National Federation of the Blind, seek
to show people they are not alone, and do have options,
regardless of diabetic complications.  If you have
experienced ramifications, others, who may be facing the
same side effects, could benefit from what you have to say.

     Perhaps you have not experienced side effects?  Your
unique insight, coping strategies, and lifestyle can still
inspire others.  Are you a relative, a friend, or a health
professional?  More than 187,000 VOICE readers could benefit
from your story.

     For information and article submission guidelines,
contact: VOICE OF THE DIABETIC, 811 Cherry St., Suite 309,
Columbia, MO 65201; telephone: (573) 875-8911.


Erythropoietin

     Erythropoietin (EPO), a drug routinely given to
patients on dialysis, is actually a hormone that occurs
naturally in healthy human kidneys.  It stimulates the
production of red blood cells.  If the kidneys are damaged
(by diabetes or other conditions), natural EPO production
diminishes, and anemia, low red blood count, can result. To
correct this anemia, restoring a healthy blood count, the
patient is given recombinant human EPO.

     Therapeutic use of EPO helps correct anemia and reduces
blood transfusion requirements for patients experiencing
chronic renal failure or End Stage Renal Disease.


Job Opening

     Wanted:  Diabetic Education Specialist.  Opening for an
individual who understands the skills of blindness, and
believes in the abilities of blind diabetics to
independently self-manage their condition.  Must be able to
teach alternative methods of diabetes management, manage
projects, work independently, and must be willing to travel
(South Dakota area).  Will train medical staff and educate
community.  Medical background not required, but ability to
communicate/interact with medical community necessary.  BS
degree and two years related experience required. 
Competitive salary and benefit package, including
comprehensive health plan.  For more information, telephone: 
1-800-658-5441, and ask for Martin.


Scholarship Winner

     In the summer 1996 edition of the VOICE, Debra Frank
announced the Angelo Centano Golf Scholarship.  Sponsored by
the St. Therese Knights of Columbus, of Valley Stream, NY,
the event was a memorial to the late Angelo Centano, a
blind, insulin-dependent diabetic athlete whose motto was
"quitters never win and winners never quit."  Open only to
contestants with type I diabetes, the contest required a
300-to 600-word essay about any aspect of athletics or
physical activity which winning the scholarship would help
the entrant achieve.

     VOICE readers rose to the occasion.  Responses were of
high quality.  The prize, a $500 scholarship, was claimed by
James Elekes, of Springfield, New Jersey, who wrote of the
need to maintain tight blood glucose control, and the
special difficulties he faced trying to maintain an exercise
program after being injured in a train accident.  After
being told of his victory, he stated:  "Your notification
had added significance, as it was made on the sixth
anniversary of my kidney transplant from my younger brother
Michael."  He reiterated that the scholarship would enable
him to purchase physical fitness equipment necessary to
maintain good diabetes management, improve cardiac and
circulatory function, and enhance his overall quality of
life.

     Blindness is no barrier to athletics, physical
activity, strenuous exercise, nor good diabetes control. 
James Elekes is a fine example.  Take note, folks--you can
do it too!


Diabetes Action Network Seminars

     At the 1997 convention of the National Federation of
the Blind, in New Orleans, Louisiana, our Diabetes Action
Network will have two seminars.  The first will be on
Monday, June 30, from 2 to 4 p.m.  There Eli Lilly and
Company will provide us a speaker, who will discuss the new
quick-acting Humalog insulin.  An open diabetes discussion
will follow.  On Tuesday, July 1, we will have our second
seminar, starting at 6:30 pm.  Our keynote speaker will be a
dietitian, who will discuss "carb counting" as a meal-
planning tool.  Both seminars are free and open to the
public.  Locations will be posted in the agenda (provided
when you register).


Elections Coming Up

     At this year's national convention in New Orleans,
Louisiana,  elections will be held to fill divisional board
positions.  These are one-year terms, running from July 1,
1997 to June 30, 1998.  Positions to be filled are: 
President, First Vice-President, Second Vice-President,
Secretary, and Treasurer.  If you are interested in a board
position, or know someone who you think would do a good job,
then contact our Diabetes Action Network President, Tom Ley. 
Yes, hard work and dedication are prerequisites for each
board position.  Anything worthwhile is usually challenging,
and requires hard work.  Leadership should be a positive
force, and one must lead by good example.


Plan Ahead and Be Prepared

     At this year's annual convention of the National
Federation of the Blind there will be many insulin-dependent
diabetics in attendance.  Each of us should have the
foresight to bring extra insulin and syringes so as to avoid
needing to search for a pharmacy.

     At every convention, a few diabetics undergo avoidable
hypoglycemic attacks.  Hotels are jammed, and restaurants
are packed, with long waits for a table.  We diabetics
should always be prepared for an insulin reaction.  THINK
AHEAD!  Always carry something sweet, such as candy or
glucose tablets, that can be used for reactions.  We should
be sure to have, in our rooms, snack foods to help control
our food needs.

     We diabetics can travel anywhere and do almost anything
we want, except go without food.  Our bloodstreams should
have a balance of insulin and glucose.  If there is not
enough glucose (food) then we have an insulin reaction.

     "Plan ahead and be prepared."


Display Tables

     For this year's annual convention of the NFB, our
Diabetes Action Network has reserved space in the exhibit
hall, where we will display literature and equipment of
interest to blind diabetics and others interested in
diabetes.

     There will be hundreds of other display tables with
products and information that may be of interest to blind
persons.

     CAN YOU HELP?  It takes many people to work the display
tables, and If you can help for two hours, four hours, or
more, please contact our Display Table Committee Chairman: 
John Yark, 218 Seaton Road, Apt. 2, Stamford, CT 06902;
telephone: (203) 324-7862.


JOB Seminar and Breakfasts

     The 1997 Job Opportunities for the Blind (JOB) National
Seminar will be held on Sunday, June 29, 1997, from 1 p.m.
to 4 p.m., at the Hyatt Regency New Orleans in New Orleans,
Louisiana. This will be an exciting three hours of blind
persons talking about their jobs and how they got them.
Admission is free; come for practical tips from those who
know best because they've been there.  This year as before,
recruiters from federal agencies and private firms have
plans to visit the seminar.

     The JOB Networking Breakfasts, held every morning of
convention for the past six years, will be offered again in
1997, providing further opportunities.  All begin at 7 a.m.,
in "The Courtyard" restaurant (come early for good seats),
and all are BYOB (buy your own breakfast).  Some examples
include:  The JOB First-Timers' Breakfast (a chance to meet
convention veterans and start the process) on June 29 and
30; Emergency dispatchers on June 30; Braille Proofreaders
and Transcriptionists, and another for Blind Persons in
Medical Fields, on July 1; Artists and Craftspersons on July
2; A new JOB Networking Breakfast on July 3; Blind Computer
Access Teachers on July 4; an (invitation only) Breakfast
for Employment Professionals on July 5, and more!   June 30
through July 4, there will also be "Generic Breakfasts for
Job Seekers," to help you get started.  All of these will be
crowded, so reservations are recommended.

     Job Opportunities for the Blind (JOB) is a joint
program of the National Federation of the Blind and the U.S.
Department of Labor. If you have any questions, or want to
make breakfast reservations, call JOB at 1-800-638-7518.

     Further information about the JOB seminars and the NFB
National Convention will appear in the BRAILLE MONITOR,
published by the National Federation of the Blind, 1800
Johnson Street, Baltimore, MD 21230; telephone:  (410)
659-9314.


Smoking Research

     Researchers in Japan (where smoking is becoming
increasingly popular) report solid new links between tobacco
use and type II (NIDDM) diabetes.  The eight-year study,
conducted by .Gifu University School of Medicine, found that
those who started smoking at age 18 or younger were 3.9
times more likely to develop type II diabetes than those who
did not.  Also, after statistically screening out other
factors such as obesity, inactivity, alcohol use and family
history, the researchers found that those who smoked 16 to
25 cigarettes per day were 3.27 times more likely to develop
type II diabetes than were those who never smoked. 
Ex-smokers were more than twice as likely (2.25 times) to
develop the disease, compared with lifetime non-smokers.  If
you don't smoke, congratulations.  If you do, quit now!


Talk it Over

     The information and advice contained in VOICE OF THE
DIABETIC are for educational purposes, and are not intended
to take the place of personal instruction provided by your
doctor, or by your health care team.  Discuss any changes in
your treatment with the appropriate health professionals.

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

ADVERTISERS


     Effective advertising doesn't scream at its audience. 
It persuades.  It sells.  The key to cost-effective
advertising is making your voice heard where an audience is
already listening.  VOICE OF THE DIABETIC, circulation 189,
635, offers such an outlet.  Make your voice heard.  For
VOICE OF THE DIABETIC advertising information contact:

Eileen Rivera
National Advertising Sales Manager 
726 E. Belvedere
Baltimore, MD, 21212
phone:  (410) 435-3648
fax:  (410) 435-6159

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

SUBSCRIPTION/DONATION FORM


     The VOICE OF THE DIABETIC is a quarterly magazine
published by the Diabetes Action Network of the National
Federation of the Blind (NFB) for anyone interested in
diabetes, especially diabetics who are blind or are losing
vision.  An outreach publication, it emphasizes good
diabetes control, diet, and independence.

     Donations are gladly accepted and appreciated. 
Contributions are not only tax deductible but are needed to
keep the VOICE and the Diabetes Action Network moving
forward to help people with all aspects of diabetes.

     Members of the NFB Diabetes Action Network enjoy
priority services and unique benefits such as a continuous
free subscription to the VOICE, automatic access to
committees covering all aspects of diabetes, free counseling
concerning all facets of blindness and diabetes, as well as
access to diabetics who have experienced complications.

     The VOICE is free to any interested person upon
request.  Each subscription costs the Diabetes Action
Network approximately $20 per year.  To help defray
publication expenses, members are invited, and nonmembers
are encouraged, to cover the subscription cost.

     To begin receiving the VOICE, please check one:

[ ]  I would like to become a member of the NFB Diabetes
Action Network and receive the VOICE OF THE DIABETIC. 
(Members are entitled to special benefits.)

[ ]  I would like to receive the VOICE OF THE DIABETIC as a
nonmember.  (Nonmembers are encouraged to pay the
institutional rate of $20/one year; $35/two years; $50/three
years.)


Send the VOICE in (check one):

[ ] print          [ ] cassette tape for the blind         
[ ] both               and physically handicapped
                       (recorded at slower-than-
                       standard speed of 15/16 IPS)


Optionally check this box:

[ ]  I would like to make (or add) a tax-deductible
contribution of $__________ to the Diabetes Action Network
of the National Federation of the Blind.


Please print clearly

Name:__________________________________________________

Address:_______________________________________________

             
_______________________________________________

City:______________________  State:________  Zip:__________

Telephone: (    )________________________


Send this form or a facsimile to:

Voice of the Diabetic
811 Cherry Street, Suite 309
Columbia, MO 65201


Please make all checks payable to:

NATIONAL FEDERATION OF THE BLIND

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++


END of VOICE OF THE DIABETIC, Volume 12, Number 2, Spring
Edition 199