

VOICE OF THE DIABETIC



A Support and Information Network



The Diabetes Action Network of the National Federation of

the Blind



Volume 12, No. 1, Winter Edition 1997



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     The 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; telephone:  (573) 875-8911.



Find us on the World Wide Web at:  

http://www.nfb.org/voice.htm



     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





Skiing Blind

     by Debbie Dickinson



Diabetic Gastroparesis



My Insulin Reaction

     by Carol Anderson



Do It Yourself

   by John A. Yark



The new B-D Pen    



What is Diabetes Mellitus?     

     by Arturo Rolla, MD and Joan Stout



Scoring Against Diabetes

     by Charles L. Ray III



Dealing With Male Impotence:  Another Option

     by Allan Nichols



Insulin Vials With Tactile Marks:  The Project Continues

     by Ed Bryant



The Essence of Maturity                 

     by Marc Maurer          



Diabetes and the Feet          



Convention 1997:  We Go to New Orleans

     by Kenneth Jernigan



Ask The Doctor

     by Wesley W. Wilson, MD



Diabetes and Alcohol 

     by Peter J. Nebergall, Ph.D.



Recipe Corner



Cheese and Crackers

     by Karmeen Kulkarni, MS, RD, CDE



New Marker for Diabetes Identified



Dietary Fiber and Diabetes



Diabetes:  Prevention and early Detection

     by Laura R. Simpson, RN, MA, CDE



Hyperbaric Medicine for Wound Care

     by Donna Medina, RN, BSN



Control Your Blood Glucose -- Naturally

     by Claudia Graham, Ph.D., MPH



Dialogs about Diabetic Dynamos

     by Debra Frank, MS, MS



"Brittle" Diabetes



NFB Scholarship Program



What You Always Wanted To Know But Didn't Know Where To Ask

     (Resource Column)



Food For Thought



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SKIING BLIND

                                    

by Debbie Dickinson





     "No, no," I said to Michael, the adaptive ski

instructor at the Wintergreen ski resort in Charlottesville,

Virginia, "I don't think I really need any more adrenalin in

my life.  But, anyway, tell me how you handle those blind

skiers, just to satisfy my curiosity."

     

     Michael had just met me, and I could feel that he

wanted to convince me how I needed to add skiing to my life

experience list.  He responded, "We attach electrodes to

either side of your head."

     

     "Really!  Hmmm," I naively said.  I kind of liked the

idea, and I figured it seemed better than being flung around

on the end of a rope.

     

     Michael started laughing along with my friend Stewart

who had been skiing with him that day.  Stewart is

brain-injured due to an automobile accident, leaving him

with hemi-plegia and other brain dysfunctions.  He remains

an excellent skier.  Needless to say, a few days later I

ended up skiing with Michael.  He brought along Katie, a

volunteer in the ski program, who would be my guide after he

was through with me.  

     

     After Katie had done all the paperwork on my entire

life, out onto the field we went.  As we walked out, Katie,

a lovely, warm, and sensitive woman, attempted to reassure

me.  Admitting that she had never guided a totally blind

person before, she added that her direction sense was a bit

dyslexic.  Oh boy, I thought.



     Stewart had raved to me how great an adaptive equipment

ski instructor Michael was.  I was a bit worried about

Michael's particular sense of humor, however.  I decided to

use my years of meditation to "zone out" of this experience. 

I resolved that Michael's voice was clear, loud, and

directive, and therefore all I had to do was focus on it. 

This meant using a tremendous amount of concentration, in

order that nothing else distract me.  And that meant

stilling my mind, and praying!  I couldn't help the rising

feelings of apprehension as I noticed the unbelievable noise

level, and sounds such as I have not heard in 20 years; the

last time I had skied...



     I am now 43, diabetic since age eight, and due to a

miscarriage at 27, blind as well.  My kidneys have failed

also, but I now have a third kidney, thanks to a transplant.



     Now, what really happened on that ski slope?  First,

Michael fastened one ski to my boot, and had me walk.  Then

he attached a ski to the other boot and had me walk some

more until I felt familiar with the sensation of skis.  Next

he showed me how to change to the other side from where I

had been facing.  This was done by holding my weight on the

poles on one side, and taking short steps behind the poles

until I was facing the other way. After this he decided I

was ready for the snow-plow.  I was amused to hear all the

name changes since I had last skied, such as the "wedge,"

although later on I heard a voice swishing past say, "Don't

do the french fry, honey, but do the pizza."



     To teach me this concept called the "wedge," Michael

skied a little way down the slope, turned around and told

Katie to push me.  I went straight down and crashed into his

arms, just like I was told.  He asked, "What is with the

squinched up face and shut

eyes?"

    

     Twice we did this routine, until he declared it was

time for the turns.  At this point, figuring fear wasn't

helping, I stopped worrying, and thus began my crisscross

down the slope.  Flying down that ski slope, or so it

seemed, I had to adapt very quickly to the changing terrain. 

No one was going to stop for me, for I was not wearing any

marker that said I was  blind.  Back at the ski school

Michael had pulled out a ragged, faded piece of cloth that

was supposed to say "blind skier," but it was so old he

could not even untie the strings holding it together.  I

wished that I could have carried my cane, at least.



     The experience was ethereal.  Michael's voice became

amplified.  I noticed my adrenalin was gone, and my body

seemed to disappear, except for a point somewhere near my

navel.  It was wonderful:  I felt like I was in a tunnel,

the feeling was so strong the walls of that tunnel seemed

tangible.  I arrived at the bottom of the beginners' hill,

exhilarated, only to face the next challenge -- the chair

lift. This proved to be yet another peak experience. And off

I went, down the slope again!



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DIABETIC GASTROPARESIS





     Gastroparesis, "delayed gastric emptying," is one of

the more serious ramifications of diabetes.  We tend to take

the working of the stomach and intestines for granted, until

they stop working properly.  The digestive tract is closely

controlled by the brain, via the autonomic nerves. 



     Problems come with the development of neuropathy. 

Extended periods of time with high blood glucose, or with

the uremic toxicity that follows kidney failure, can damage

nerve fibers, and when the autonomic nerves are damaged,

stomach function can become increasingly unpredictable.  As

with neuropathy itself, an individual may have mild to

severe symptoms of gastroparesis.



     Gastroparesis may cause:  early satiety (feeling "full"

almost immediately after starting to eat), abdominal

bloating, gastric pain, nausea, and vomiting.  The

gastroparesis sufferer may burp or vomit up food consumed

many hours before--and find it nearly undigested.  The

nausea,  vomiting, and dehydration may become severe enough

to require hospitalization.  



     Anorexia, unwillingness to eat, can become a factor. 

With so much frustration and difficulty digesting food, the

person simply chooses not to eat, rather than be sick all

the time.  This creates further problems with blood sugar

control, and may lead to malnutrition.



     Gastroparesis alone is a double handful for anyone

struggling to cope.  When it follows diabetes, it can become

far more serious.  The "backbone" of diabetes

self-management is good scheduling--but such scheduling

assumes that food taken on time will be digested on time.  

The diabetic forever juggles food, insulin and/or oral

medications, exercise, and time-of-day, to optimize blood

glucose level.  Gastroparesis' unpredictability injects a

new variable into the equation, as the digestive system may

function on time, late, or not at all.  



     Meals may be missed; oral medications undigested.  The

correct amount of insulin, taken with a meal, may throw the

individual into hypoglycemia when the meal remains

undigested.  Compensating for expected difficulties, that do

not then materialize, the diabetic may experience

hyperglycemia.



     The serious consequences of severe gastroparesis are a

ringing argument for good, consistent diabetes

self-management, adopted before such ramifications have the

opportunity to develop.  The Diabetes Control and

Complications Trial (DCCT) proved that "tight control" of

blood glucose radically diminished the likelihood of such

complications as neuropathy, nephropathy, retinopathy, and

gastroparesis. 



     Diabetes is a sneaky disease.  You may do your best,

and still experience severe complications, or, you may have

developed the condition years before the DCCT, back when we

didn't know so much about good control.  If you have gastric

difficulties, talk to your doctor.  Gastroparesis is just

one of many conditions that can interfere with digestion.



     If your doctor determines that you have gastroparesis,

a number of options are open, depending on the severity of

your symptoms.  Medications such as Metoclopramide,

Bethanecol, Domperidone, Cisapride (Propulsid)  and,

surprisingly, the antibiotic Erythromycin, bring some

relief.  Your diet may need adjustment, toward

easy-to-digest foods.



     Not enough is known about gastroparesis, or about the

neuropathy that produces it.  Future studies should give us

better tools to deal with this ramification.  We do know

that diabetics who get their blood sugars under good control

and keep them there often see a lessening in the severity of

complications.  It is never too late to improve your

control.  .



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MY INSULIN REACTION



by Carol Anderson





     The Saturday before Christmas I was volunteering as a

receptionist at a local museum.  I would then go to a

Christmas party.  It had been a year since my kidney

transplant, and my life was filled with activities, now that

I was feeling well, and "getting back into the world again."





     I knew the woman giving the party. She had been

preparing the food for a whole week!  I ate sparingly that

day, "saving my appetite" for the big party.  Even then I

realized this was the wrong approach for an

insulin-dependent diabetic to take, but I felt I could

handle it. I'd done it before, and nothing had happened to

me in the past.

 

     I arrived at the party about 7 p.m. feeling a little

disoriented from hypoglycemia, so I began to eat hors

d'oeuvres. That wasn't enough.  My condition did not

improve, so I started drinking a glass of soda pop.  Too

late!  I felt myself getting weaker and weaker--then I

passed out.  Luckily, I was sitting at a table, and didn't

fall. 



     The next thing I remember is waking up, with all the

guests standing around the table looking at me.  The

hostess, who knew I was diabetic, had tried to give me

orange juice after I passed out.  That had not helped, and

after 20 minutes she called the rescue squad.  When they

arrived, they gave me intravenous glucose, and I came out of

it immediately.  Because I had been unconscious for half an

hour, the rescue squad took me to the local hospital to make

sure I was alright. 



     At the hospital, the emergency room physician examined

me, and though I was feeling fine by then, he suggested I go

to a different hospital, closer to my home, where my regular

physician could examine me.  I agreed.  I went.



     The emergency room at the hospital near my home was

having a busy night.  Soon after I was wheeled in, I talked

to a doctor who said I could leave as soon as he finished

his examination.  I was not in an emergency situation, so he

left me to attend more serious cases.



     Lying there, I began to feel very strange. I started to

shake with chills, my body felt achy, and I could not

breathe properly.



     When the doctor came back, he knew something was wrong. 

Immediately he ordered a chest x-ray and blood tests to

determine the oxygen content of my blood.  The results

suggested I had pneumonia!  The doctor's rationalization for

this happening so quickly was that I probably had aspirated

some food or juice when I was unconscious, leading to

"aspirated pneumonia."  They kept me at the hospital, and

placed me on intravenous antibiotics for a week.



     I spent Christmas in the hospital.  I did feel well

enough to go out on a pass on Christmas day for a few hours,

for which I was truly grateful. I recovered more quickly

than usual, according to my doctors, and was discharged two

days after Christmas.



     I consider myself extremely lucky to have "bounced

back."  I have learned, from my experience, never again to

"save my appetite" until the end of the day, and then eat a

lot.  It just doesn't work when you are a diabetic.



     We all make mistakes, but hopefully you can learn from

mine and avoid the serious problems I had.  Stay well. 

 

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THE NEW B-D PEN





     Users of the Novolin System pen injection devices, or

the Owen Mumford Autopens, now have a third choice.  Becton

Dickinson and Company now offers the B-D Pen.  Designed to

use the new Eli Lilly Humulin Cartridge System insulins, and

B-D Ultra-Fine disposable pen needles, the B-D Pen is also

compatible with insulins and disposable needles manufactured

by Novo Nordisk.



     Such a pen, while incapable of delivering a mixed

insulin dose (except the 70/30 factory pre-mix) offers

increased portability and convenience.  Each cartridge holds

1.5 ml of R, N, 70/30, or (eventually) Humalog (Lispro)

insulin, and delivers a dose of one to 30 units, measured in

1-unit increments.  A "wheel" at the top of the pen allows

visual, audio, and tactile-click confirmation of dose

setting.

 

     Although some blind diabetics successfully use insulin

pens, Becton-Dickinson and Company states:  "The B-D Pen is

not recommended for the blind or visually impaired without

the assistance of a sighted individual trained in the proper

use of the device."  Reloading the pen with a fresh insulin

cartridge, and re-zeroing the pen, could be difficult

without sight.  



     Already available at many pharmacies, the B-D pen

should cost about $40.  For further information contact: 

Becton Dickinson Consumer Products, Becton Dickinson and

Company, Franklin Lakes, NJ 07417-1883; telephone:

1-800-237-4554.

        

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WHAT IS DIABETES MELLITUS?



by Arturo Rolla, MD and Joan Stout



 

     Diabetes is a metabolic disorder that occurs when the

body cannot properly use glucose (a form of sugar), the

body's main source of fuel.  During digestion, most of the

carbohydrates we eat are converted to glucose, which passes

into the bloodstream where it is available to the cells for

use as energy.  80% of  the glucose in the blood goes to the

muscles.  But in order for glucose to enter the cells and be

used as energy, insulin, a hormone secreted in the islets of

the pancreas, must be present. Without insulin, the body

cannot convert food into energy. 



     The cells that produce insulin are called beta cells. 

They are normally stimulated to produce insulin by the

rising level of blood glucose.  In that way, the body has a

system by which the right amount of insulin is secreted for

the right amount of glucose present.  Once the glucose has

entered the cells, the blood glucose level decreases, and

the beta cells stop secreting insulin.





     Q:  What are the different types of diabetes?



     A:  There are basically two types of diabetes. In one

type, the beta cells are destroyed by the immune system and

no longer secrete insulin. This is called type I diabetes

and is characterized by an absolute deficit of insulin.  The

other type, called type II diabetes, is due to "insulin

resistance," an initial resistance of the body's cells to

obey the orders of insulin.  To overcome this resistance,

the beta cells secrete more insulin, and glucose is

eventually forced into the cells.  Glucose is maintained

within normal limits, but at the expense of increased

insulin secretion by the beta cells.  After many years of

such increased secretion, the beta cells become "tired" from

working overtime, and the fatigue process begins.  This

fatigue tends to be progressive, and in time the

compensation of insulin resistance disappears.  At that

point, blood glucose levels start going up.



     Type I diabetes is also called insulin-dependent

diabetes (IDDM) and was previously known as juvenile

diabetes.  We now recognize that type I can appear at any

age, even though it is most often diagnosed before the age

of 40.  Type I is an autoimmune disease, which means that

the body's defense against infection, the immune system,

attacks part of the body.  In type I, the immune system

attacks the beta cells in the islets of the pancreas and

destroys them.  The pancreas then produces very little or no

insulin, and the patient needs daily insulin injections to

live.  Symptoms typically appear over a brief period of

time, although the destruction of the beta cells may occur

over a period of months or years.  These symptoms include: 

Increased thirst and urination, weight loss despite

increased hunger and food intake, blurred vision, extreme

tiredness, and itching.  Coma and death can follow if

diabetes is not diagnosed and treated.



     Type II diabetes is also called noninsulin-dependent

diabetes (NIDDM) and was previously known as adult-onset

diabetes.  Type II usually occurs in adults over 40, but it

can appear at a much earlier age, including early

adolescence (maturity-onset diabetes of the young, MODY). 

About 80% of people diagnosed with type II diabetes are

overweight.  In type II, the pancreas produces insulin, but

the body is unable to effectively use the insulin. Insulin

resistance is common, and the patient may have large amounts

of insulin present in the bloodstream.  Symptoms of type II

typically develop gradually, over a period of months or

years. Symptoms include:  Increased thirst, increased

urination (especially at night), fatigue, weight loss,

blurred vision, frequent infections, and slow healing of

sores.  Because type II can be present for many years before

diagnosis, symptoms may include complications of diabetes,

such as heart disease, kidney disease, nerve problems, or

vision problems.





     Q:  What causes type I diabetes?



     A:  At this point, we do not know why the body's immune

system attacks the beta cells and destroys them.  The cause

may be a virus, an exposure to cow's milk at an early age,

genetics, or more likely a combination of factors.  Doctors

can determine who is at a high risk of developing type I by

testing their blood for antibodies against the islets in the

pancreas and by testing their capacity to secrete insulin. 

The hope is to prevent further beta cell destruction.





     Q:  What causes type II diabetes?



     A:  Most people who develop type II diabetes are

overweight.  Overweight people have excess adipose tissue in

the body, and the extra fat increases their resistance to

insulin, not only in the fat tissues but also in all the

other cells.  Diabetes is not caused by eating too much

sugar, but being overweight increases the chances of

developing type II diabetes.





     Q:  Who gets diabetes?



     A:  The following people have an increased risk for

developing diabetes:



     - people with family members who have diabetes

     - people who are overweight

     - African Americans

     - Native Americans

     - Hispanics

 

     These risk factors are much higher for type II than for

type I, although a genetic component is present for both

types.  For type II diabetes, risk factors include older

age, increased weight, decreased level of physical activity,

overfeeding or too rich diet, and family history of

diabetes.  Adults are much more likely to get type II

diabetes than are children, while type I tends to appear

more frequently in children.





     Q:  How many people have diabetes?



     A:  In 1995, the estimated prevalence of diabetes in

the United States was 16 million people, about half of them

not yet diagnosed.  For type I diabetes, the estimate of

diagnosed cases ranges up to 800,000.  About 30,000 new

cases of type I are diagnosed each year.  For type II

diabetes, the 1993 estimate was 7 to 7.5 million diagnosed

cases.  About 595,000 new cases of type II are diagnosed

each year.  Approximately 4.2 million women and 3.6 million

men have been diagnosed with diabetes.  For children age 19

years or younger, the estimate is 100,000 cases.  For adults

age 65 years or older, the estimate is 3.2 million cases.





     Q:  How is diabetes treated?



     A:   Daily insulin injections are required to treat

type I diabetes.  Many people with type I take multiple

injections daily.  A regimen of three or more injections per

day is called "tight control" or "intensive management." 

The insulin must be balanced properly with food intake and

exercise (including regular daily activities).  Frequent

blood testing is performed by the patient to monitor blood

sugar levels. This involves pricking a finger for a drop of

blood, applying the blood to a test strip, and inserting the

strip into a small machine that reads the strip and displays

the approximate level of blood sugar.  Type II is sometimes

treated with diet and exercise only.  Oral diabetes

medications, which are not insulin, are also used.  If these

methods do not work, type II is treated with insulin. 

People with type II must also balance their exercise and

food intake with their medication (whether oral medication

or insulin).  A weight loss diet is frequently a part of

treatment with type II.  Blood glucose testing by the

patient is also an important part of treatment.



     Both type I and type II diabetes are best treated with

a team approach, with the patient being the most important

part of the team.  The goal of treatment is to keep blood

sugar levels as close to normal as possible and so prevent

long-term complications.  As most of the daily care is the

responsibility of the person who has diabetes, patient

education is imperative. Other team members should include a

diabetes doctor (endocrinologist or diabetologist),

specialists as necessary (ophthalmologist, podiatrist, and

so on), a dietitian, and a diabetes educator.



     A 10-year study called the Diabetes Control and

Complications Trial (DCCT) was completed in 1993.  The study

included over 1,400 people with type I diabetes and compared

the results of intensive management with "standard"

management. The participants who followed intensive

management, keeping their blood sugar at lower levels, had

significantly lower rates of eye, kidney, and nerve diseases

than did the "standard management" group.  Although the

study only focused on type I diabetes, most doctors believe

that people with type II will also benefit from keeping

their blood sugar as close to normal as possible.





     Q:  What are the complications of diabetes?



     A:  Complications of both type I and type II include

eye disease and blindness, heart disease, strokes, kidney

disease and kidney failure, amputations, nerve damage, skin

infections, and gum disease.  Diabetes can also cause

complications of pregnancy and congenital malformations.  In

1992, diabetes contributed to at least 169,000 deaths.  In

1993, diabetes was the seventh leading cause of death listed

on death certificates in the United States. 





     Q:  How much does diabetes cost?



     A:  In 1992, the total cost of diabetes in the United

States was estimated at $92 billion.  This includes $45

billion for direct medical costs (only those costs directly

attributable to diabetes) and $47 billion for indirect costs

such as disability, work loss, and premature deaths. 



     Arturo Rolla, MD, is an endocrinologist at New England

Deaconess Hospital and an associate clinical professor of

medicine at Harvard Medical School.  Joan Stout is a

professional writer and editor.



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SCORING AGAINST DIABETES 



by Charles L. Ray III





Photo:  portrait of Charles L. Ray III



     I have had diabetes for 17 years.  Unfortunately for

me, for the first eight years, I chose not to take care of

myself.  I did not eat right.  I ate all the things

diabetics were not supposed to eat, then took additional

insulin "to compensate for it."  I never checked my blood

sugar to see how my diabetes was doing, and the worst thing

of all, I never used to exercise!       



     That was my daily routine for eight years.  I knew I

had to make a change for the better, as I always felt tired,

miserable, and cranky. I had spoken with my doctor, Dr.

Robert Mountcastle, about an insulin pump.  He explained the

pump to me very well, and told me I was not a prime

candidate for such a pump.  I would have to prove myself

worthy.



     I had to check my blood sugar three times a day for a

month, and bring him the results.  I had to do all the

things I had not done for the first eight years, and I had

to exercise.  Dr. Mountcastle told me that when I returned

to his office with my data, he would know if I was serious

about being put on the insulin pump...and that is how I

began to take control of my diabetes.     



     Currently I exercise five days a week, jogging two to

three miles, using the Stairmaster for six minutes after the

jogging, then finishing with a three-mile ride on the

exercise bike.  But that's not all.



     I eat more fish and chicken now, baked or broiled, and

I watch my sodium and fat intake.  Because I use an insulin

pump, I check my blood sugars eight to 12 times per day.  



     If I can turn my life around, and take charge of my

diabetes, anyone can do it, if they really want to! 



     Because I look very much like a well-known sports

figure, Charles  Barkley of the Phoenix Suns NBA basketball

team, I have made a number of Public Service Announcements

(PSA's).  I currently have one airing for the International

Diabetic Athletes Association (IDAA), and I am working on

another, to help inform African American and other ethnic

groups (who have a much higher percentage of developing

diabetes) of the organization.  Although it is difficult to

get sponsorship for billboard and television PSA's, I must

admit I enjoy the challenge of making them.



     Three years ago, I decided I would try to see if I

could somehow interest my famous look-alike, basketball star

Charles Barkley, in doing a PSA on diabetes with me.  Once I

found out through different diabetes publications that his

mother had been diagnosed with diabetes, I thought it might

happen.               

 

     On September 28, 1993, I received a letter from the

Phoenix Suns organization, stating that "Charles Barkley is

currently unable to participate in any additional charity

programs or projects, other than those he has already

committed to." 



     But I haven't given up hope.  Several contacts in the

Phoenix area have told me that if Charles Barkley were

actually to see the progress I have accomplished since 1993,

it is very likely he would agree to do a PSA with me.  Maybe

he'll read this article? 



     Charles Barkley, I challenge you to a 3 point shooting

contest!  



     A.  I will make every 3 point basket that Charles

Barkley makes.



     B.  For every 3 point basket I make, I would like

Charles Barkley to donate one hour of time to do a Public

Service Announcement with me, to help make everyone aware of

diabetes.  



     Charles Barkley, if you are listening, I look forward

to the challenge!



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



DEALING WITH MALE IMPOTENCE--ANOTHER OPTION



by Allan D. Nichols





Photo:  portrait of Allan D. Nichols



     Imagine you are a man in your mid-forties.  You have

been a diabetic for over 30 years.  You have fought, and

still fight, nearly every conceivable complication of that

insidious disease.  You are blind, and you have had a kidney

transplant following the loss of your own kidneys.  You have

long suffered from diabetic neuropathy, which has taken both

your feet and a couple of fingertips.  You know what it's

like to go through a painful divorce, due in part to the

fact of your impotence.  You travel about in a wheelchair. 

A chronic sore on one of your leg stumps does not allow you

to use your prosthetic legs for walking. Sounds like a good

recipe for a ticket straight to the nearest nursing home,

doesn't it?  Not necessarily!



     Reading the latest information about diabetes, talking

with my personal medical support team, networking with other

diabetics in the National Federation of the Blind--these

have immeasurably helped me to retain my independence. 

Recently, I met and married a wonderful lady who desires

many of the pleasurable experiences I do, including a

satisfying love life.  Encouraged by new treatments for male

impotence, I am enjoying a satisfying physical relationship

with my new wife.  Only a few short years ago, I would not

have believed this to be possible.



     In the spring 1992 edition of the VOICE, Ed Bryant

published two articles about male impotence, one of which he

authored. Ed's article mentioned several options for dealing

with this often depressing and heartbreaking condition. 

These included hormone treatments, penile implants, and

vacuum erection devices (VEDs), which I seriously considered

using.



     In the fall of 1992, I suffered an unwelcome separation

and subsequent divorce from my first wife.  Following that

devastating experience, I was very reluctant to risk

entering into a physical relationship with another woman.



     But life has a funny way of working itself out. 

Debbie, who became my second wife, is very understanding

about this particular diabetic complication.  When I decided

to pursue my options for having a satisfying love life with

her, I considered the costs, possible side-effects, and

reliability of each available option.  Then I discovered

penile injections.



     I conferred with my diabetologist, Dr. Eric Wedell, who

first tested my testosterone level (and found it normal)

before recommending I see a urologist.  I went on to see Dr.

Stacy Childs, here in Cheyenne, who provided me with the

details of how to use the medication he calls "triple

mixture."



     The process works like this:  Using an ultra-thin

syringe, a 291/2- or 30-gauge needle, between .2 cc's and .6

cc's are drawn. The tiny needle keeps the discomfort level

to a minimum.  Rarely does it feel much more uncomfortable

than injecting my insulin.  After cleaning the site with an

alcohol swab, quickly insert the needle into the side of the

penis.  (To avoid hematoma, infiltration of blood under the

skin, it is important not to inject into a blood vessel.) 

Slowly inject the liquid, then withdraw the needle.  Apply

pressure directly onto the injection site for a minute or

two, to help reduce likelihood of blood infiltration.  It

usually takes between five and ten minutes for the injection

to take effect.



     Penile injection therapy offers a number of advantages

for dealing with male impotence.  With this method, there is

no need for expensive surgery.  Its effects are temporary,

and include only a minimum of discomfort for the user.  The

erections give the user a sense of confidence, to me an

important psychological advantage.



     Disadvantages may include the need to use needles, the

cost per treatment, and an erection that does not subside in

a convenient and timely manner (though this may not bother

some men).  I have found that the prick of the needle is

outweighed by the pleasure of the enhanced physical

experience.  The idea of injecting myself there only

bothered me until I did it the first time.  By the way, I

usually go four to five days between injections, to avoid

any cumulative effects.



     The medication is not inexpensive.  A 10 cc vial, good

for 20 to 50 injections, costs about $70, plus cost of

syringes and alcohol preps.  Not every pharmacy stocks the

"triple mixture." For best effect, the ingredients are

combined at a local pharmacy.  Shelf life is three to four

months, though I have not detected any weakening of its

effects at its outer time limit.



     Sometimes it is not convenient to wait for an

injection-induced erection to diminish.  To quicken the

process, you can use a nasal decongestant, such as

"Neo-Synephrine".   As it does in the nasal passages, the

decongestant spray shrinks the mucous membranes, relaxing

the valves at the base of the penis, and allowing the

erection to shrink.



     Normally, the brain receives nervous stimulation and

responds by causing an erection.  However, diabetic

neuropathy can impair nerve function, and often a satisfying

erection cannot be obtained or maintained.  The use of

"triple mixture" helps the valves at the base of the penis

do their job, and for me has produced physical experiences

similar to those I enjoyed in my early 20s.



     Talking or writing about this very personal subject

isn't easy.  I am thankful I live in an era when it can be

discussed openly.  If men are going to enjoy physical

relationships with women, we must be willing to share this

type of information with each other.  Within the National

Federation of the Blind there are hundreds of diabetic men. 

Thousands, perhaps millions of diabetic men in this country

also suffer from impotence.  Until a cure is found for

diabetes and the other medical conditions which cause

impotence, we must seek out ways to cope with it.



     Don't give up on yourself!  Of course it's vital to

have a partner who understands your frustrations with the

condition as well.  I have been blessed in both categories. 

Successful resolution of this problem will go a long way

toward improving a marriage.  I speak from experience!



     Armed with information about the problem, sharing ideas

with a trusted physician and others in your counseling and

support team, you should be able to greatly improve your

quality of life.  The effort is worth the result.



     I would be glad to share my experiences with any VOICE

reader who suffers from male impotence.  If you have

questions, contact me.  My address is:  Allan D. Nichols,

1215 Monroe, Apt. 1, Cheyenne, WY 82001; telephone:  (307)

638-8073



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



INSULIN VIALS WITH TACTILE MARKS:  THE PROJECT CONTINUES



by Ed Bryant





Photo:  portrait of Ed Bryant



     Since January 1992, we, the Diabetes Action Network of

the National Federation of the Blind, have led the campaign

to bring tactile markings to the different insulin types. 

As long as insulins are packaged in identical vials,

differentiated only by the writing on the label, blind

diabetics (and many sighted individuals as well) are at risk

of mixing the different types, with potentially very serious

consequences.  We, and you our readers, have kept up the

pressure.



     We have already attended two meetings, along with

representatives from the insulin manufacturers (Eli Lilly

and Company, and Novo Nordisk Pharmaceuticals Inc),

regulators from the Food and Drug Administration, and other

organizations concerned with this issue.  A third meeting

was to have taken place some time last July, so we could

finish this business.  Lilly has been ready for months.  



     Novo Nordisk, who asked for and was granted extra time

to test tactile alternatives, agreed, before the second

meeting (held April 10 at FDA headquarters in Bethesda,

Maryland) concluded, to complete its "focus-group testing"

within 3 months.  Meeting minutes, prepared by the FDA, are

explicit on this point.  But, it appears Novo Nordisk didn't

even begin research until after the date they had promised

to complete it.



     Last October I received the following note from Mrs.

Shirley Masters, whose story reminds us that tactile

differentiation of insulin vials will benefit the sighted as

well as the blind.  Although her letter is addressed to Eli

Lilly and Company, she sent copies to a number of locations,

including the FDA and me at VOICE OF THE DIABETIC.



* * * * * * * *



TO WHOM IT MAY CONCERN:



     My godson is diabetic.  Before being diagnosed as

diabetic, he was an athletic, health conscious individual: a

cyclist, a runner, a swimmer, who entered into triathlons; a

student and practitioner of physical fitness.  Now, at 31,

he is changing careers and studying to become a nurse while

still enjoying his physical activities.



     THE POINT:  He is an alert, attentive, very aware

individual who made an easy to make mistake which could have

had dire consequences.



     THE MISTAKE:  He self-administered the wrong ELI LILLY

HUMULIN.  Both Regular HUMULIN and HUMULIN NPH are part of

his prescribed medication.  BOTH ARE IDENTICALLY PACKAGED in

orange-capped vials.  Under stress from various sources

currently, my godson mistook one bottle of HUMULIN for the

other, with serious consequences.  While not requiring

hospitalization, a frightening, grim night was spent

suffering the consequences of administering the wrong

HUMULIN.



     SUCH AN EPISODE COULD HAVE BEEN AVOIDED and PREVENTED

HAD THE MEDICATION CARRIED SOME FEATURES IN ITS PACKAGING

CLEARLY IDENTIFYING ONE INSULIN FROM THE OTHER.  This

episode could have been avoided simply by having different

colored caps on the medication to identify HUMULIN REGULAR

from HUMULIN NPH.  



     SUCH AN EPISODE COULD HAVE BEEN PREVENTED HAD THE

CONTAINERS NOT BEEN IDENTICALLY SHAPED; i.e., one medication

packaged as is and the other in a shorter, fatter container,

which would give both a visual and a physical indication of

the contents.



     Certainly different colored caps, at least, would be a

cost-effective possibility in packaging and would avoid for

some diabetic ELI LILLY HUMULIN REGULAR and NPH user a

"NIGHT OF FRIGHT" such as the one experienced by my godson.



     Please give these repackaging considerations your

serious consideration.



Sincerely,

Shirley W. Masters (Mrs. C. H.)

Redwood City, CA



P.S.  Imagine my consternation when I learned from my godson

the problem described here is already known to the industry. 

(See article in October 1995 "Diabetes Interview".)  IT IS

TIME TO RESOLVE THIS ISSUE!



* * * * * * * *



     At Mrs. Masters' request, I forwarded a copy to Novo

Nordisk Pharmaceuticals Inc., the other U.S. insulin

manufacturer.  I also included it with the following, which

I faxed, on November 12, to Mr. Randy Hedin, designated

moderator of the next meeting regarding tactile-marked

insulin vials at FDA.  



* * * * * * * *



DIABETES ACTION NETWORK

National Federation of the Blind

Columbia, MO 

November 11, 1996



TO:  Mr. Randy Hedin

        Division of Metabolism and Endocrine Drug Research

        Food and Drug Administration



FROM:  Ed Bryant

              National Federation of the Blind



RE:  Tactile-Marked Insulin Vials



Dear Mr. Hedin:



     On September 25 of this year I reminded you of work

left unfinished.



     About five years ago, we, the Diabetes Action Network

of the National Federation of the Blind, started our

campaign to convince the Food and Drug Administration and

the insulin manufacturers to incorporate permanent, easily

detectable tactile markings on insulin vials, sufficiently

prominent that blind diabetics with neuropathy could safely

and reliably use them.  We made calls.  We wrote a lot of

letters.  We seemed to get somebody's attention.  



     On October 19, 1995, FDA called a meeting of

"interested participants" to discuss this issue.  Minutes of

that meeting record that Eli Lilly and Company, and Novo

Nordisk Pharmaceuticals Inc. were to come to the next

meeting (scheduled in 3 months time) "with firm ideas for

short-term solutions, and other ideas for long-term

solutions."



     The second meeting was held on April 10, 1996, and both

Lilly and Novo Nordisk brought prototype vial markings for

evaluation.  At the meeting, all blind participants, and

many of the sighted (who could benefit from tactile markings

as well), agreed Novo Nordisk's dot-markings were too small

to be reliably detected by individuals with neuropathy, and

that bars were much more appropriate than dots.  



     At 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.  Novo Nordisk

asked for more time "in which to test alternative

prototypes," and we agreed to meet again in three months,

some time in July.  



     July came and went without a word from Novo Nordisk. 

On August 5, 1996,  I received a fax from Jon Evans,

president of "Prognosis", an independent medical research

organization (copy attached)  [published in VOICE, Vol. 11,

No. 4]. 



     Mr. Evans had been hired, by Novo Nordisk, to survey

the response of blind diabetics to their proposed tactile

marking systems.  I helped him arrange a meeting with

students at the Colorado Center for the Blind, a rehab

center established by the National Federation of the Blind.

  

     Although Prognosis had been instructed to interview

insulin- using blind diabetics, Mr. Evans told me Novo

Nordisk had given him no instructions to recruit individuals

with neuropathy for the test.  I was astonished at this

omission, as the subject, and its importance, had been

thoroughly covered at all previous meetings.  Lilly had made

certain that blind individuals with neuropathy were part of

their test population.



     When I spoke again with Mr. Evans, later that month, he

reported almost all of his test population (a total of 25

students from several locations) voted enthusiastically for

the horizontal tactile bars, finding them easiest to detect. 

Note: His findings echo Lilly's, so there is absolutely no

reason Novo Nordisk should not agree to the adoption of

raised horizontal lines to mark the different classes.  



     On August 19, I called Mr. Alan Scobie, Director,

Diabetes Care Marketing, Novo Nordisk Pharmaceuticals Inc. 

He was not available, but his secretary promised to have him

return my call.  He didn't.



     On September 11, I received further communication from

Mr. Evans at Prognosis, in which he informed me that Novo

Nordisk's research had been completed.



     On September 25 I called you, making you aware of the

above.  I believe your response was:  "Good.  Now it sounds

like we are in agreement, and I can arrange a meeting in the

next 6 to 8 weeks, and all we should need is to agree which

bars mean which types."



     But nothing more happened.



     On October 17, still without word of a meeting, I

reached Mr. Alan Scobie at his office.  He told me the

results of Prognosis' research were in, had been tabulated,

and had been sent to Novo Nordisk's home office in

Copenhagen, Denmark.  He said he would try to get them

moving on this project.



     I have heard nothing more from Mr. Scobie, or from

anyone at Novo Nordisk.  Have you?  When we spoke, you said

you'd contact them, and get this process moving.  Has Novo

Nordisk responded to your call?



     I do not understand the delay.  Regularly I hear from

concerned individuals (such as Mrs. Masters, whose letter is

attached) asking "why the hold up?"  Lilly was ready to

institute the system we discussed, one through four tactile

bars, at the last meeting.  Novo Nordisk has their answer;

blind diabetics found horizontal bars on the label to be

more efficient tactile cues than Braille-like dots.  There

is no further reason for delay.  This should have been

resolved some time ago.



     The question becomes: "What do we need to do to break

out of this situation?"  



     In the past, to get things moving, we started a mailing

campaign, asking our readers to write and express their

support for our position, to make their feelings known to

FDA Commissioner Kessler and the insulin manufacturers. 

Should we "call out the troops" again?  



     Mr. Hedin, you probably have this already resolved. 

The meeting promised for last July may now be scheduled.  I

may just not have heard yet...



     I hope this is the case.  I would not wish to think

that any manufacturer, in the face of evidence such as we

have presented, would engage in gratuitous stalling, hoping

we'd get bored and go away.  I would not wish to think that

a Federal regulatory agency, having extracted promises to

comply, would fail to intervene after such stalling.  Mr.

Hedin, there are a lot of diabetics waiting to see these

tactile markings happen.



     I HOPE WE CAN HAVE OUR MEETING, AND CONCLUDE OUR

BUSINESS, THIS YEAR.



     Hoping to hear from you soon, I am,



Ed Bryant

First Vice President

Diabetes Action Network

National Federation of the Blind 



cc:  Solomon Sobel, MD

     Director, Division of Metabolism and Endocrine Drug

Research

     Food and Drug Administration



* * * * * * * *



     Since I sent the above fax, I tried on several

occasions to reach Mr. Scobie at Novo Nordisk.  On November

21, he returned my call.  At that time he stated that Novo

had completed their research, and had passed their findings

on to Randy Hedin at FDA; that it was all up to him now;

they had fulfilled their responsibilities.



     I called Mr. Hedin at FDA on November 25.  I made him

aware of Novo Nordisk's position; but he stated he had

received no communication from Mr. Scobie, or anyone else at

Novo Nordisk, relative to completion of research or

readiness for a meeting.  Mr. Hedin hoped a meeting could be

scheduled for mid-January.  He was waiting to hear from Novo

Nordisk.  



     I phoned him again on December 12.  He told me he had

reached Novo about one week before.  The FDA had definitely

not received Novo Nordisk's study results!  Novo confirmed

this, and said they didn't want to forward the information

`til the end of December!  Mr. Hedin said he expected the

meeting will take place some time in February (as Novo

Nordisk wanted).  I still do not understand why Novo told me

one thing, and told the FDA another.  Also, as stated above,

FDA minutes clearly show Novo Nordisk had agreed to complete

their studies by July of 1996!  Why the delaying?



     Hopefully, the April issue of the VOICE will be the

last in which you will have to hear about tactile insulin

vials.  Much more time has been taken than was promised, but

the February meeting should see the end of it.    



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



     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."



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



THE ESSENCE OF MATURITY



by Marc Maurer





Photo:  portrait of Marc Maurer



     Mr. Maurer, President of the National Federation of the

Blind, delivered the following keynote address at the NFB

annual convention, Anaheim, California, July 4, 1996.



     Maturity is the exercise of intelligence in the fourth

dimension--time.  As Dr. Kenneth Jernigan, who was then

serving as President of the National Federation of the

Blind, said in 1986: "To the extent one ranges backward in

time to understand the causes of present conditions, and to

the extent one ranges forward to anticipate future

consequences of present acts, one is mature.  Maturity is

intelligence in depth."  So Dr. Jernigan said in 1986.



     Not only individuals need maturity, but civilizations,

organizations, and cultures need it as well.  Whether a

society can reach maturity depends on the maturity of the

people within it and its capacity to internalize their

maturity.  If a society is to mature, it must balance two

competing interests.  It must welcome diversity and

experimentation and at the same time maintain stability and

order.  Experimentation and diversification diminish

stability, but they are essential for growth.  However, if

stability is lost, there will be no structure in which to

experiment.  Both the instability of experimentation and the

stability of order are required.  



     Maturity for a society or an individual cannot be

achieved without reaching new understandings and

perspective.  This requires effort and a tolerance for

pain--sometimes financial, sometimes emotional, and

sometimes physical.  Individuals and societies that are

unwilling to expend effort or tolerate pain to achieve a

desirable goal in the future cannot attain maturity.  



     The maturity of the individual and the maturity of the

society are related.  One cannot develop without encouraging

the other.  One cannot diminish without inhibiting the

other.  To build a strong society it is essential to enhance

the maturity of its members, to incorporate that maturity

into the group as a whole, to tolerate pain in the interest

of achieving desirable goals, to welcome diversity, and to

maintain order.



     In the minds of certain people today the blind in some

respects are regarded as children.  We resemble children,

they would have us believe, because we lack the two

qualities that give significance to individuals or

groups--the capacity to make substantial contributions and

the capacity to cause serious trouble.  But the blind and

children, in this formulation, are not the same.  The

children will grow up; the blind will not.  The children may

commit indiscretions and be forgiven; the blind will be

inactive, with no indiscretions to forgive.  Maturity may

come to the one, but not to the other.  Growth and

development are to be expected with children, but the blind

(though we will grow physically) will not achieve the

development or perspective required for decision making--we

will not gain maturity.  Rather we will remain, according to

this view, as children in need of custody and care.  



     Those who believe that the blind should be viewed as

children have tacitly accepted the misguided notion that for

us there can be no future because there has been no past. 

Since they are part of the society in which we live, their

maturity affects our maturity--our growth, our

development--our capacity to exercise intelligence in time. 

But there is another side to that coin.  Since we are part

of the society in which they live, our maturity affects

their maturity--their growth, their development--their

capacity to exercise intelligence in time.  If we are to

gain maturity and if we are to enhance the maturity of our

society, we must demonstrate that this conception of

blindness is wrong.  We who are blind have the

understanding, the energy, and the will to direct our own

lives, to make our contributions, and (if need be) to meet

confrontation head on; and we will permit no one else to do

this for us.  Our past, though sometimes filled with

misunderstanding and misery, is the precursor of today.  Our

future is what we will make it.  We will act, recognizing

that the consequences will be determined by our capacity to

comprehend, our judgement, our courage, and our faith in

each other.  But above all we will act!



     In 1940 the brilliant blind scholar and professor Dr.

Jacobus tenBroek, and a small group of other like-minded

blind people, brought into being in Wilkes-Barre,

Pennsylvania, the National Federation of the Blind.  With

that one act, the future of the blind was altered for all

time.   As we came to organize, conditions for blind people

were bleak.  Employment for the blind was virtually unknown. 

Education occurred at schools for the blind, but the

administrators of those institutions rarely expected blind

students to continue their instruction at the university

level.  Libraries for the blind existed, but the collection

of books available for distribution was not large.  The

adult rehabilitation program operated jointly by federal and

state governments had been created, but the blind were not

part of it because it was felt that they couldn't benefit

from rehabilitation.  As rehabilitation officials said, we

were not "feasible."  The Social Security Act had been

adopted in 1935, providing some measure of support to the

blind, and the Randolph-Sheppard act to create vending

opportunities for the blind had been adopted in 1936, but

the small number of vending stands which had been

established were tiny operations selling (for the most part)

tobacco products, newspapers and candy.  In certain places

sheltered workshops for the blind had been in existence for

decades (some for as long as a century), but these offered

only repetitive hand assembly work at pitifully low wages in

miserable working conditions.



     A top-quality education; a career in government service

or the professions; employment in industry or the private

sector; a standard of living sufficient to permit dating,

marriage, the establishment of a family, and the  purchase

of a home; training and support to begin a private business;

and participation in politics--none of this was for the

blind.  However, Dr. tenBroek

and his small band of colleagues thought otherwise.  He and

the others with him believed that conditions for the blind

would not change unless the blind themselves controlled the

events of their own destiny.  He believed that blindness

need not be the determining factor of our future.  He

believed that unemployment and lack of opportunity could be

changed and that the future for the blind could be

different--but only if we made it happen.  He set the

Federation on the road we have followed ever since.  He gave

us a standard to follow and a method for achieving the goal. 

He told us it would not be easy--that it would require

effort and a tolerance for pain.  But he promised the effort

and the pain would bring results.  Look about you!  We the

blind have gathered here tonight in our thousands.  Dr.

tenBroek said that we could make a difference, and if he

were with us tonight, he would be pleased with what the

National Federation of the Blind has become--the strongest,

most positive, most vital force in the affairs of the blind

today.



     In the fall of 1995 members of the National Federation

of the Blind hosted a black-tie dinner at the National

Center for the Blind in Baltimore to support and promote one

of the most innovative developments in our history,

*NEWSLINE for the Blind*.  As Federation members know, this

is the completely automated digital network that brings

daily newspapers to the blind by touch-tone telephone. 

National Newspapers such as "USA Today", the "New York

Times", and the "Chicago Tribune" can be read by phone any

time during the day or night.  This development has

far-reaching implications.  The absence of knowledge

signifies the absence of the possibility for choice.  The

presence of knowledge indicates the exact opposite--the

awareness of opportunity, the possibility for choice, and

the freedom to act.  



     We invited the press to be present at our black-tie

dinner; we described the vital work of the National

Federation of the Blind; we demonstrated *NEWSLINE for the

Blind*, and we discussed the impact that broad-ranging

information services would have on the lives of blind

people.  But the story that appeared in the newspaper the

next day did not contain the drama of the work of the

Federation or the potential alteration in the future of the

blind.  Instead, to be perfectly frank, the reporter didn't

get it.  He reiterated the old, familiar theme, the

stereotype--the blind can become good musicians.  The

importance of the NEWSLINE event was not, he seemed to say,

the development of opportunity for the blind or enhanced

access to information.  It was music.  The item in the

newspaper began with the headline, "Boy upstages NEWSLINE." 

The text reads:



     The star of NEWSLINE night at the National Federation

of the Blind was, of course, NEWSLINE, a system that

converts newspapers into synthetic voice and delivers it

through phone lines to blind people.  It's an exciting new

on-ramp to the information superhighway, allowing the

nation's blind to "read" newspapers first thing in the

morning, the way the rest of us do.



     During the black-tie dinner at the NFB headquarters in

South Baltimore [the reporter writes] guests heard a

demonstration; a synthesized voice read excerpts of stories

fresh from "USA Today", one of the first newspapers to agree

to participate in the system.



     As impressive as NEWSLINE was [the article continues],

a kid in dark glasses and tails almost stole the show.



     Jermaine Gardner, a 12-year-old boy, was called to the

Yamaha grand in front of the dining room, then proceeded to

dazzle us with performances of classical selections, from

Mendelssohn to Beethoven, scherzo to sonata.



     I'm telling you, he was fabulous [says the reporter]. 

He was accompanied to the dinner by his "managers," James

and Jacqui Gardner.  They should be right proud.  Jermaine,

who was born blind, has been playing classical music since

he was two, performing since he was four.  By the way [says

the article], his business card notes that Jermaine is

available for weddings, socials, and "children's Barney

parties"



     This is what the newspaper said, and it is not that the

details are incorrect but that the perception, the tone, and

the depth of understanding are wrong.  Is it really

impressive that a blind boy of twelve can play the piano,

even that he can play it extremely well, even that he can

play it like a genius?  Maybe-- but the musical performance

fades into relative insignificance compared to the

revolutionary impact which NEWSLINE will make on the lives

of thousands and tens of thousands of blind people

throughout the nation, and ultimately the world.  NEWSLINE

was the star, of course, and the reporter simply missed it

and flubbed his opportunity.  And what was it that the

reporter thought was "fabulous"?  A blind kid playing the

piano.



     Did the reporter believe that blind people are unable

to play the piano?  Is that why he found the performance so

enthralling?  Or is it that he thought there was nothing

else in the evening worth reporting--nothing else that would

strike a chord with his readers?  Suppose he thought

NEWSLINE would change the world for the blind -- what

difference could it possibly make in the broader society? 

What difference could it make to the people who really

matter?  Unstated but always present is the silent assertion

that the future of blind people is not worth the trouble to

report.  Just give us the piano player -- that's where blind

people excel.  It never occurred to the reporter that blind

persons have already made contributions to society

(contributions he not only wants but needs) and that we will

continue to do so.  Apparently it never occurred to him that

we, who are part of the society in which he lives, will

necessarily help share his future.  He thought of NEWSLINE

as an impressive new toy with which the blind could amuse

themselves, but the blind (according to his understanding)

have nothing to give -- except a little music. He thought of

us as children. In fact, he concludes his newspaper item by

telling us that the blind musician is available for socials

and children's Barney parties. It matters very little how we

spend our time -- unless, of course, we can be entertaining

-- unless we can play the piano.



     This newspaper account completely misses the point. 

There are some of us who do play the piano -- play it well

-- and are proud of our ability. However, this is not what

defines us as human beings.  *NEWSLINE for the Blind*, on

the other hand, is opening to the blind entirely new vistas

of knowledge, of thought, and of experience.  Our capacity

to participate in the activities of our day is increased by

NEWSLINE.  No one can predict how important this is because

the impact that it will have has not yet been realized.  But

we are certain that it will add to our capacity to

contribute to our society.  It will give us the knowledge to

shape a better future not only for ourselves but also for

the very reporter who misunderstands us. Our past, even our

recent past, though sometimes filled with misunderstanding,

is the precursor of today's conditions.  We will act,

recognizing that the consequences, even though not always

wholly anticipated, will be determined by our capacity to

comprehend, our judgment, our courage, and our faith in each

other.  But above all, it is certain that we will act.



     We should not be surprised by newspaper reporters who

lack the perception and experience to understand the

importance and drama of our struggle to move from

second-class status to full equality in society.  But we

should expect something better from programs for the blind

-- something more knowledgeable, more in tune with reality. 

The purpose of governmental and private agencies for the

blind is, after all, to help blind users of their services

achieve their highest potential. 



     It is gratifying that an increasing number of the

agencies for the blind are working ever more closely with us

with positive results. However, there are, in a few

instances, still some so-called professionals in agencies

for the blind who regard the organized blind movement not as

a welcome partner but as an interfering adversary.  In such

agencies it is not astonishing that services for the blind

are minimal and poor.



     An article which appeared in the Sunday, April 21,

1996, edition of the "Hartford Courant", one of the most

widely-distributed newspapers in the state of Connecticut,

describes with pride the services of the Board of Education

and Services for the Blind (BESB), the state-run

rehabilitation agency.  Keep in mind that we are not talking

about ancient history.  The article was written less than

three months ago.



     It begins with the headline, "Jobs for the Blind," and

contains photographs of three workers who have been employed

at the workshop for from nine to 15 years.  The theme of the

article is contained in the subtitle, which reads: "At BESB

Industries, visually impaired workers gain self-esteem." The

impression conveyed by these statements is that blind

employees are offered long-term employment, job security, a

high level of self-esteem, recognition of their innate

normality and capacity, and a level of pay sufficient to

provide a livelihood. This impression is reinforced by the

portions of the article that describe manufacturing in the

workshop. The business at BESB is not trivial. The article

puts it this way:



     "Each month the employees, some using special sewing

machines, sew up to 20,000 pairs of sweat pants for the

Army, 1,200 life vests for the Navy, and 5,000 "kit bags"

for the Air Force, bags used as soft-sided luggage.



     In March, the company was awarded a $13 million

government contract to sew up to 800,000 T-shirts a year for

the Army."



     This is what the newspaper says, and with all of these

thousands of items being produced for all of these millions

of federal dollars, what do the blind get? The newspaper

tells us.  Here are excerpts from the article: 

     

     Inside a concrete and brick building the Board of

Education and Services for the Blind, or BESB Industries,

offers about 115 people--the majority of whom are completely

blind--the chance to hold a job and earn a salary. For many

of the workers the program has provided something more: a

chance to feel useful again.

    

     [The newspaper continues] "This job has given me the

opportunity to do the things I didn't think I would ever be

able to do" [said one of the sewing machine operators].



     "It's a challenge," he continued, "and it's good for

people to know blind people can be productive  members in

society."



     The 25,000-square-foot building housing BESB [the

article continues] is filled with people who strongly

believe that.  And they show up for work each day--some

making as little as $1.50 an hour -- to prove it to

themselves, and sometimes to others."



     I interrupt to observe that they are also coming to the

workshop to produce 800,000 T-shirts a year so that the

agency can get thirteen million federal dollars, but back to

the article:



     Overall, the average pay rate [says the article] is

$3.50 an hour, less than the minimum wage, now at $4.25 an

hour.  But for some of the employees at the West Hartford

workshop, pay is not an issue.

     

     Howie Schwartz, 59, of Southington [the article

continues], who has worked there for the past nine years,

said that his job has given him so much, he would work for

free.



     "Don't tell them, but I'd come here for nothing,

because this place has given me back some of my

self-respect. What I do counts."



     Schwartz [the article continues] lost his sight in

1985. When he had his sight, he was in charge of more than

80 employees in a manufacturing plant.



     Let me interrupt the article to emphasize what I just

read to you.  This man was in charge of more than 80

employees in a manufacturing plant, and now he is working

for substandard wages--and in an environment that has so

conditioned him that he would feel grateful to have the job

even if it gave him no pay at all.  Yet some people have the

nerve to tell us that we are being negative when we point

out the abuses of this kind of operation.  He supervised 80

employees!  Eighty employees--and now he works for a

pittance and has been conditioned to think so little of

himself that he is grateful.  But back to the article:



     Schwartz said he did not work for a year after losing

his vision. "You don't know what bored is until you've sat

at home for a year."



     "Now I'm using my past experiences and past contacts,

and I know I'm making a contribution," said Schwartz, who

worked for five years sewing various products before

becoming responsible for purchasing.



     "I'm useful."



     These are statements from the "Hartford Courant".  They

promise jobs and self-esteem for the blind.  But the promise

is false, and the dream is a nightmare.  One of the

essential characteristics of a job is that the person doing

the work gets paid--and at a salary commensurate with

ability and performance.  There is nothing wrong with

volunteering time and effort.  Most of the work of the

National Federation of the Blind is done through volunteers. 

However, we know when we are volunteering.  We don't pretend

that it is something else.  How different it is at the

agency for the blind in Connecticut.  At Services for the

Blind the choices are apparently simple.  Blind people who

want to work can sit at home and be bored or produce

T-shirts in the workshop at an average of $3.50 an hour. 

But they do get self-esteem.  Let me ask you this, shall we

offer to trade?  Will the supervisors at the workshop take

the subminimum wages and the self-esteem and let us have

their salaries?  Are they willing to work for $3.50 an hour? 

That comes to less than $7,500 a year.



     But there is more in the article.  Consider the

description of services provided to a woman who has been

receiving the benefit of this rehabilitation program for

over three decades.  She became blind in her twenties, and

she was understandably afraid.  What did the agency do to

help?  This is how the newspaper tells it:



     [Kathy] Lunge, 57, of Wethersfield, was 23, with a

newborn baby, when she was diagnosed with a brain tumor that

eventually took her vision.



     After she recovered from treatment for the brain tumor,

she was afraid to leave home.



     "It was hard to cope. I wouldn't leave the house" [the

blind mother said].



     Then she was told about a special program BESB runs for

blind people who are homebound.  Those in the program work

on crafts and other projects at home, and the products are

eventually sold, mainly through a joint program with local

Lions Club organizations.



     [The article continues] The program is designed to be

therapeutic, [Fred] Zaiko [BESB director of industries]

said, and give participants a feeling of self-worth.



     Today the program is solely for people who can't, and

probably won't ever, leave their homes [the article says].

But when social workers approached Lunge in the 1960s, they

hoped she would eventually be able to [you guessed it] work

at the workshop.



     She did.  [I interrupt the newspaper story to ask how

long did it take for Services to the Blind to assist this

blind worker to get out of the home and into the workshop? 

The article tells us.  Remember that services began for this

blind woman in the 1960s.]



     After gaining confidence while working in the home

program [says the article], Lunge in 1981 began traveling to

the workshop to sew. Now she's a receptionist there.



     In 1991 Lunge was chosen as the National Blind Worker

of the Year.  



     "If you don't have any goals, you just sit and feel

sorry for yourself. That's what I did," Lunge said. "Here

you don't have a chance to do that. Here you are a busy,

normal person going off to work. That is a gift you cannot

imagine."

     

     This is the description of services for the blind

printed in the newspaper. A young woman with a baby suffers

serious medical problems in 1962 and eventually becomes

blind. She remains homebound, being served by the agency for

the blind until 1981.  In 1981 she begins sewing at the

workshop and finally becomes a receptionist.  The lowest

wage for the blind at the workshop is $1.50 an hour.  The

average wage for blind people is $3.50 an hour. She is

grateful for her job. She does not believe she deserves such

good fortune.  Those who work at the agency have given her a

gift of such great value that it is hard to imagine.



     However, viewed in proper perspective, such a gift

might be known by the ugly name of exploitation. If Kathy

Lunge is today capable of being a receptionist, is it

believable that she was only capable of sitting at home year

after year?  The images clash.  The professionals at the

Connecticut agency for the blind have discovered that there

are blind people who believe that there is no alternative to

the boredom of sitting at home except work at the workshop. 





     Maybe these professionals don't know any better.  Maybe

they don't have any incentive to know any better.  Maybe if

their own lives were involved, they would find a way to know

better.



     In their despair (in the circumstances, how could it be

otherwise?), many of the blind caught in this trap are

prepared to take any alternative they can get--no matter how

small.  And they are prepared to be grateful for it.  The

professionals at the agency encourage that attitude.  



     The situation in Connecticut is further complicated by

the fact that the volunteer board responsible for the

operation of the agency seems both responsive and sensible,

but the professionals who administer the program have all

the advantages in their effort to maintain the status quo. 

I met the chairman of the board this spring.  He is an

intelligent, sensitive human being--and he has the strongest

possible motivation to see that programs for the blind in

Connecticut function imaginatively and well.  He has a blind

son.  But he is not knowledgeable in the complexities of the

federal/state bureaucratic maze, a maze in which the

professionals can hide and dodge and double talk.  Moreover,

he does not have an extensive background in dealing with

blind people.  What is he to do when he is told, "Yes, but

your son is different--your son is not like these other poor

helpless blind people, who can do nothing else but spend

their days in the workshop or at home!"  He will have to be

strong, indeed, to go up against the odds--to resist the

seduction of the flattery, to ferret out the facts from the

fiction, and to find the time and the courage to match wits

with the bureaucrats, who have nothing better to do all day,

every day but to wage the contest and build their image of

sensitive expertise.  Maybe he can do it.  I hope he can. It

sometimes happens.  But the odds are against him.  It goes

without saying that we will help him and the other members

of the board if we can, but it will be a race between

whether he can bring the professionals into line before they

get there first and poison him against the organized blind

movement.



     The professionals at the agency for the blind in

Connecticut may believe that the blind are unimportant--that

we resemble children.  But we know better.  We who are blind

are not inactive; we are not inferior; and we will not

behave as if we were.  Perhaps there was a time when

second-rate jobs and substandard wages in the sheltered shop

were all that the blind could hope to get, but that time is

no more.  We have the understanding, the energy, and the

determination; and we are prepared, if need be, to meet

confrontation with confrontation. We recognize that future

conditions will be the consequences of present acts.  But

above all, we will act.  



     A master's degree program to instruct teachers of the

blind at Northern Illinois University distributes to the

candidates for advanced degrees information about how to

assist the blind and those with low vision. This course of

study is euphemistically known as "Programs in Vision". 

Apparently the word blind is not to be used by the

professionals because it connotes inferiority.  One of the

teaching tools in the program is a document entitled "Over

65 Tips & Tricks for People with Low Vision to Use in the

Home."  The abstruse nature of this educational program and

the depth of understanding required to comprehend it are

indicated by its so-called tips.



     Keep in mind that this information is not offered in

undergraduate school but only in the master's program. Here

are some of the tips for you--if you're not totally blind,

that is--if you have enough remaining vision to be able to

perform these complex maneuvers.  Those who are totally

blind will have to wait.



     Here is tip number one: "Place the cat's food and water

on a small table to avoid stepping in it."



     That's not a bad idea. Maybe you could place the cat on

the table along with the food and water to avoid stepping on

it.  But back to the tips.  



     "Tie brightly colored ribbon bows to the ends of TV or

radio antennae."



     Why would a person want to do that? Is it easier to

locate the television if there's a bright red bow on the end

of the antenna?  Or do the professors in the vision program

at Northern Illinois University think that these bright

colors will cheer us up?  When I have visited blind people

in their homes, I haven't found any such bows--and there

aren't any in mine.  But then, of course,  I am totally

blind. But there is more.



     "Staple drinking straws onto cupboard shelves or

drawers [the document tells us] to create organizational

areas."



     [Or here's an imaginative one:] "Floating objects such

as ice cubes or a clean ping-pong ball help in determining

whether a glass is full."



     Think about this one for a moment.  Your company comes

over, and you want to offer refreshments.  So you fetch out

glasses and a bowl of ping-pong balls. You pour in a little

liquid and drop in a ping-pong ball.  If the ping-pong ball

thumps on the bottom of the glass, you can be sure more

liquid is needed.  If not, you have a choice. You can pour

more liquid or add more ping-pong balls.  But there are

unanswered questions which have not been addressed in this

list of helpful hints.  How many ping-pong balls should go

into the glass?  Do you give the glass to your guest with or

without ping-pong balls?  At Northern Illinois University

there is a program to study these weighty matters, and

professors to teach such things.  But here is another

tip--this is for the bathroom:



     "Use a contrasting color toilet seat cover so it's very

obvious whether the lid is up or down."



     The assumptions in these suggestions about the ability

of the blind would be amusing if they were not so serious. 

We can't figure out if the toilet seat is up or down, can't

find the TV without a big red bow, can't avoid stepping in

the cat food unless it's on a table, and can't organize

cupboards or drawers without stapling drinking straws to

them.  What do the professors at Northern Illinois

University think blind people are like?  If you still have

doubts, perhaps this suggestion about making the bed will

make the matter clear:



     Make the bed once with great care [the document says];

mark each sheet and blanket where it touches the corners of

the bed with safety pins--each time thereafter when the bed

is made up, simply line up the corners."



     I don't know when the professors at Northern Illinois

University learned to make their beds, but I remember doing

it when I was four or five years old.  My mother didn't know

it was so complicated.  She taught me to do it without the

pins.  Now that you have been informed by those who teach

the teachers of the blind that this task is more intricate

and difficult than you had imagined, you can go back to your

hotel rooms, locate the corners of your beds, and insert the

safety pins.  And for all of this you can thank the

professors at Northern Illinois University.



     Can they really believe it? Do they imagine that blind

people are so backward that teachers of the blind should

study bed-making for the blind at the post-graduate level? 

Do they think we resemble small children?  Oh, but I am

being presumptuous!  It is not the blind that they are

talking about.  They believe you have to have a little sight

to do the things they prescribe.  They don't believe the

totally blind can do these things at all.  If the

high-powered educators think this way, is it any wonder that

newspaper reporters and the general public sometimes

misunderstand?  We are not children, and we will not be

treated as children.  Let them teach bed-making to each

other if they want. But let them leave us out of it, and let

them leave educational programs for teachers of the blind

out of it. We prefer peace and goodwill, but we are prepared

to meet confrontation with confrontation if we must.  We

have the determination, the understanding, and the

energy--and we will act. 



     In 1996 are there still people who believe that the

blind resemble children?  Indeed there are, and sometimes

the message is being driven home with such force that it is

accepted and internalized even by some of the blind.  The

myth is powerful and destructive.  But no matter how

powerful or destructive, it can and will be changed. We of

the National Federation of the Blind are determined to make

it so, and we will not be swayed from the purpose. 



     There are newspaper reporters who fail to comprehend

that we are coming to be as much a part of society as they

are and that this trend must and will continue to

accelerate. There are professionals in agencies for the

blind who use us for their own ends--who tell us that

services for the blind are adequate when they get blind

people out of the home and into the workshop at subminimum

wages.  There are professors at the university who insist

that we tie bright ribbons on our television antennae and

put ping-pong balls in our glasses.  They say that matters

of such moment should be elevated to the university

classroom at the postgraduate level.  There are still blind

people who are beaten down and kept out--forced to sit at

home and accept custody and, moreover, made to like it.



     Since some may (either deliberately or otherwise)

misunderstand what I am saying, let me sort some things out

for the record.  Not all university programs that train

teachers for the blind are negative or trivial in their

performance.  Far from it.  Not all state agencies for the

blind are regressive in their behavior.  And not all

newspaper reporters are lacking in perception.  In fact, I

am glad to say that many of the universities, most of the

state agencies, and a growing number of reporters are living

in today's reality and working with positive and

constructive attitudes.  It is for this very reason that we

must call attention to those that are not.  A few (I

emphasize, a few) professionals in the field of work with

the blind still live in the yesterday of limited

understanding and negative concepts about the capacity of

the blind.  These we are determined to change, and we will

not be swayed from the purpose.  We are just as  determined

to support and work in partnership with those who live in

the present and look to the future.



     Yes, the things I have described are still occurring in

1996; and if that were all of the story, the picture would

be bleak beyond bearing.  But that is not all of the

story--not even the most important part of it.  You and I,

the National Federation of the Blind, are the other part of

the equation--the element that is making the difference, the

factor that has been of increasing importance since 1940 and

that today is the moving force.



     Maturity demands that we be prepared to expend effort

and tolerate pain.  It also requires that we range backward

in time to understand the causes of present conditions and

that we look forward to anticipate future consequences of

present acts.



     If the professors in Illinois, the agency officials in

Connecticut, and the reporter in Maryland are correct in

their assessment, blindness is intolerable and so is our

future.  But of course they are not correct. Their logic is

false, and their perceptions are those of a bygone era,

totally failing to take into account the realities of today

and the possibilities of tomorrow.  Their maturity is at the

level of the children they believe we resemble.  



     Let us leave it at that.  Ultimately our concern is not

with them but with what lies ahead. Our progress toward full

participation in society is accelerating, and our goal of

full citizenship is near at hand.  What stretches before us

will not be easy (none of the travel on our road to freedom

has been), but we have come a great way farther than we

still have to go.



     Let me conclude, as I have so often done, by reminding

you of the commitment that holds us together and guides our

actions.  As we go forward, you have the right to expect

that I as President will never ask you to make sacrifices

that I am not willing to make, that I will not ask you to

take risks that I am not willing to take. You have the right

to expect that I will lead and that I will do it decisively. 

You have the right to expect that I will give to you and our

movement my time, my effort, my devotion--and, yes, my love. 

And I have the right to expect certain things from you. 

This week you elected me again as President, and by that act

you undertook by implication an equal commitment.  You gave

me the responsibility of standing in the front ranks to lead

by example and not just with words.  Here in your presence I

publicly pledge to bring all that I have to the effort.  I

made that commitment ten years ago when you first elected me

to be your President, and I repeat it tonight.  I have tried

to live up to it every day that I have been in office, and I

will try to live up to it every day in the future.  



     That is my unequivocal commitment. Now let me say a

word about what is required of you. I have the right to

expect that you will support me in my efforts, that you will

share with me our triumphs, and also that you will stand by

me in time of trouble and disappointment.  These mutual

commitments are what make us a family and not just an

association, a movement and not just an organization.  As we

look to the year ahead, let us go with pride; let us go with

confidence; let us go with maturity. My brothers and my

sisters, we will make it come true.



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



DIABETES AND THE FEET





     Foot care is an ongoing issue for diabetics.  Avoiding

foot problems, dealing with minor issues before they become

major, and preventing serious infections that could lead to

amputation, are all concerns.  For all the recent progress

in wound care and intervention, prevention is still the best

place to begin.



     Diabetes, over a period of time, can cause circulatory

damage and neuropathy, both of which can affect condition of

the feet.  Because of impaired circulation, the body's

ability to heal itself is diminished.  Minor traumas, that

might otherwise heal quickly, persist and can become

infected.  Diabetic neuropathy, nerve damage, can impair an

individual's ability to detect foot problems.  Because it

doesn't hurt, you don't intervene, and small problems

escalate into big ones.  



     The best place to start is with your shoes and socks. 

Proper fit is essential!  Do not compromise--you have too

much to lose.  Make sure the shoe is wide enough, and don't

let it pinch your toes.  Shoes that "breathe," (either

leather or running shoes) are best.  Avoid sandals,

especially those with a thong between the toes.  Socks

should be seamless, athletic type, of cotton or one of the

new fibers like "Thorlo".  



     Before putting your shoes on (and after you take them

off), inspect your feet.  You are looking for anything out

of the ordinary, anything that might escalate from irritant

into infection.  Be thorough!  Blisters, bunions, corns,

splinters, raw or discolored patches, ingrown toenails, even

"athlete's foot" fungus can require action.  Don't assume it

will go away by itself!  When in doubt, consult your

podiatrist.



     Sight is not necessary to carry out daily foot

inspections.  Much can be revealed by feel and smell.  You

are looking for change, anything that shouldn't be there, or

that wasn't there before.  Swelling, hot or cold patches,

unexplained tenderness, unusual odors, all can let you know

something is not right.  It is amazing how much a tactile

inspection (with fingertips, back of hand, or even forearm,

if you have neuropathy in your hands) can reveal.   



     When you visit your doctor, ask to have your feet

inspected.  Take your shoes and socks off, before he or she

asks.  Also, your doctor may know that the progress of

neuropathy can be measured by  noninvasive tests of foot

sensation.  Such tests can be carried out with a device

called a "monofilament", which resembles a toothbrush with

only one bristle.  Your doctor can obtain a monofilament by

sending $15, and a request for a LEAP package, to:  Feet Can

Last A Lifetime, National Diabetes Outreach Program, 1

Diabetes Way, Bethesda, MD 20892-3600.



     Keeping your feet clean reduces risk of infection,

should you break the skin.  Wash with mild soap and

medium-temperature water, and dry carefully.  Many diabetics

have abnormally dry feet, and treatment after bathing (or as

needed) with a thin coat of moisturizing cream helps reduce

risk of abrasion and infection.  Do not put any moisturizer

between the toes.  The process of rubbing lotion into the

foot provides a stimulating massage, good for the

circulation, and offers one more chance to detect foot

problems.    



     Regular exercise helps stimulate circulation, and keeps

the feet healthy.  A regular walking program will provide

much benefit.  



     "Some foot problems can be prevented with good common

sense such as not walking barefoot on hot pavement..." says

Ron Scott, MD, Director of the Wound Care Clinic of North

Texas (at Presbyterian Hospital in Dallas), who also reminds

us that cigarette smoking aggravates circulatory problems,

and that diabetics should not smoke.  



     Going barefoot is never a good idea for a diabetic. 

Even at home, the carpet may hide staples and sewing

needles, and if you have any neuropathy, you may not feel

it.  Check inside your shoes too, before you put them on, as

small objects may have fallen in.  Plus, thumbtacks, brads

or sharp nails may penetrate through the soles of  your

shoes.



     "People with diabetes should NEVER use over-the-counter

medications on their feet without the approval of their

podiatrist or physician," says Neil Scheffler, MD, a

podiatrist from Baltimore, Maryland.  "Corn or callus

removers, for example, contain acids that can burn through

the callus and normal skin as well, with disastrous

results."  



     "Home surgery" such as using a razorblade on corns or

"planter's warts" is not recommended either.   Cut nails

straight across; don't shave calluses.  Minor irritations

such as the above, or even ingrown toenails, are worth a

call to the podiatrist.  In many cases Medicare covers such

service.



     Your podiatrist may recommend you use special

therapeutic shoes, or shoe inserts, to help protect your

feet.  As of May 1, 1993, if preconditions are met, Medicare

will pay for certain types of diabetic footwear. 



     The precautions described above should keep your feet

out of trouble, but diabetes is unpredictable, and you might

find problems developing in spite of your best efforts. 

Quick intervention is called for.  Regular foot inspections,

as discussed above, can reveal that unfelt blister, that

undetected cut, that tack you stepped on, before the wound

goes septic.  



     Diabetes is the biggest cause of non-traumatic

amputations in the United States.  Most of these are lower

limbs, where neuropathy, impaired circulation, and

undetected, untreated injuries can combine to create

non-healing, septic wounds.  When gangrene (tissue death)

develops, amputation can become necessary.



     New medical developments have cut the rate of

amputation.  Curative Technologies Incorporated (CTI)

operates the Wound Care Centers, a network of clinics where

patients with severe septic wounds are given aggressive new

therapies such as Procuren, a "growth factor"  obtained from

the patient's own body.  CTI claims an 80% healing success

rate, and notes, "these are patients who would likely have

lost a limb to amputation."   



     Hopefully you'll never need such intervention.  Stay

vigilant, use common sense, keep your health care team

informed, and you should keep your feet out of trouble.





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



CONVENTION 1997: WE GO TO NEW ORLEANS



by Kenneth Jernigan

(President Emeritus, National Federation of the Blind)





Photo:  portrait of Kenneth Jernigan



     This article appeared in the BRAILLE MONITOR, December

1996  edition, published by the National Federation of the

Blind.



     The time has come to plan for the 1997 convention of

the National Federation of the Blind.  As Federationists

know, our recent National Conventions in Chicago and Anaheim

were outstanding in every sense of the word--excellent

programs, good food and facilities, and wonderful

hospitality.  But New Orleans in '97 promises to be the best

we have ever had.



     And it also promises to be the biggest.  Our last

convention in New Orleans was in 1991, and we had the

biggest attendance in our history--2,760 registered

attendees, and the record still stands.  This time I hope we

can break 3,000, and I believe we will.



     We are bigger and stronger than ever and ready for a

wonderful convention.  President Joanne Wilson and the other

leaders and members of the NFB of Louisiana tell me that

plans are going forward for a spectacular meeting.



     We are returning to the Hyatt Regency New Orleans, at

500 Poydras Plaza, New Orleans, Louisiana 70140.  Those of

you who attended the 1991 convention know how good the Hyatt

Regency New Orleans is, and it has been remodeled and

improved since we were there.  It is among the best hotels

in the world.



     In recent years we have sometimes taken hotel

reservations through the National Office, and that is what

we are going to do this time.  Call the National Center at

(410) 659-9314 or write to National Convention, National

Federation of the Blind, 1800 Johnson Street, Baltimore,

Maryland 21230.  Reservations will be taken on a first come,

first serve basis, and no reservation will be valid unless

it has been made through the National Office of the

Federation.  A few people have already called the Hyatt

Regency New Orleans and have apparently been told that their

reservations are confirmed.  These reservations are not

valid and will not be honored.  They should be re-made

through the office here at the National Center for the

Blind.  As has been the case when we have followed this

procedure in the past, Mr. Cobb will take telephone calls

and deal with letters.



     In order to confirm a reservation, you will need either

to send a check or money order for $40 as a deposit or give

to Mr. Cobb a credit card number.  The credit card account

will be charged immediately.  If a reservation is canceled

prior to June 1, 1997, half of the deposit will be returned. 

After that date deposits will not be returned.  Exceptions

may be made in certain demonstrated emergency situations.



     The reason for this policy concerning reservations is

that we have only 1,100 rooms in the Hyatt Regency.  We

believe we will need 1,425 rooms, so after the 1,100 rooms

are gone, the overflow will be placed at another hotel.  In

order to make the situation workable and to be certain that

we get the maximum number of rooms at the Hyatt Regency, we

are handling reservations in the National Office of the

Federation.  I emphasize that no reservation will be valid

unless it is made through our National Office and that after

1,100 rooms are gone, an overflow hotel will be used.  Be

warned, and behave accordingly.  Those who do not read the

BRAILLE MONITOR or attend chapter meetings to hear

Presidential Releases have only themselves to blame.



     As is always the case, our hotel rates for 1997 will be

the envy of all who attend conventions.  Here they are: one

in a room, $40 per night; two in a room, $42; three in a

room, $44; four in a room, $46.  As you can see, these rates

are better than the ones we had in 1996 in California, which

were better than the ones we got in Chicago in 1995.  In

addition to the room rates, there will be a tax.  At the

time Mrs. Jernigan and I made the arrangements with the

hotel, it was 11 percent plus $3 a night.  There will be 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.



     The elegant Hyatt Regency New Orleans is located just

eight blocks from the French Quarter.  As those who were

there in 1991 remember, it features two towers--Poydras,

with 27 floors; and Lenai, with 11 floors.  In addition to a

swimming pool on the seventh floor, the Hyatt also features

several restaurants, cocktail lounges, and a large shopping

mall.



     This shopping mall includes a Waldenbooks store,

jewelry store, souvenir store, Cafe du Monde, Frank and

Stein--hot dogs and beer--and many other fast food meals. In

addition, Macy's Department Store is adjacent to the Hyatt

and is easily accessible. Passing through Macy's will lead

to the Super Dome, a colossal structure that is home to the

New Orleans Saints as well as many other gala festivities. 

A shuttle service to and from the French Quarter will be

provided to hotel guests during the National Convention.



     The huge rooms on the third floor of the Poydras Tower

will easily accommodate both the general sessions and our

exhibits, as well as the banquet.  The 1997 convention of

the National Federation of the Blind should offer enough

variety and enough space to make it the best ever.



     Remember that we need door prizes from state

affiliates, local chapters, and individuals.  Prizes should

be relatively small in size and large in value.  Cash is

always popular.  In any case, we ask that no prize have a

value of less than $25.  Drawings will be made steadily

throughout the convention sessions.  As usual the grand

prize at the banquet will be spectacular--worthy of the

occasion and the host affiliate.  The 1996 grand prize in

Anaheim was a thousand dollars in cash.  The 1997 grand

prize will be at least as good.  Don't miss the fun!  You

may bring door prizes with you or send them ahead of time

to:  Don Banning, 663 Grove Avenue, Harahan, Louisiana

70123-3840; telephone: (504) 737-4955.



     The displays of new technology; the meetings of special

interest groups, committees, and divisions; the exciting

tours; the 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!



* * * * * * * *



CONVENTION 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



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



Art:  National Federation of the Blind logo



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



ASK THE DOCTOR



by Wesley W. Wilson, MD





Art:  caduceus (physician's staff)  



     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:  I read in the diabetes journals about a test called

an A1C.  What is it, and how is it different from my daily

glucose monitoring?  My diabetes educator and my doctor

disagree about my need for this test.  How often should I

have an A1C?



     A:  Blood sugar, which you measure daily, fluctuates a

great deal from test to test and from hour to hour.  I am

sure you would agree it is very hard, if not near

impossible, to keep your blood sugars within your "target

range" at all times, but these measurements are essential,

particularly for insulin-using diabetics, as they reveal how

high or low you are after meals, after insulin injections,

and especially before meals.  A blood sugar reading from

your glucose monitor is a "snapshot," of your diabetes

control.  It is essential, but even if done several times

each day, it does not really show your average blood sugar

control during a given 24-hour period of time.  



     There is growing evidence that in type I (insulin

dependent, IDDM) and type II (non insulin dependent, NIDDM)

diabetes, complications correlate with the average blood

sugar level over time.  The higher the average blood sugar,

the greater the likelihood you'll develop diabetic

complications.  The precise mechanism of development for

these complications; eye disease, kidney disease, and nerve

conduction disease, remains to some extent unknown, but it

would seem the underlying process is somehow related to

abnormalities of the proteins making up these structures:

the eye, blood vessels, kidney and nerve fibers.  Increased

attachment of sugar to protein, a process known as

glycosylation (due to sustained high blood glucose levels)

seems a likely culprit. 



     Sugar attaches to proteins in any solution.  The

greater the amount of sugar in a given solution, the greater

the amount of sugar that attaches to nearby proteins.  It

has been known for years that sugar in the blood attaches to

the protein hemoglobin, a component of red blood cells.  The

sugar attaches to the hemoglobin, or glycosylates it, in

direct relationship to the level of sugar in the solution

(the blood).  Since red blood cells stay in the bloodstream

for about 110 days, measurement of the percentage of

hemoglobin that is glycosylated (has sugar attached to it)

can be used to give an estimate of the average blood sugar

level during the preceding six to eight weeks before blood

was drawn for the test.  One name for this is "glycosylated

hemoglobin test."



     Things always seem to become more complicated in

medicine!  It is now known that there are several

differences within the glycosylated hemoglobin family.  The

"hemoglobin A1C" you mentioned describes a single protein

with glucose attached to it.  It is the one used most

frequently in monitoring diabetes, but many labs also run a

"hemoglobin A1," which gives a different value since it is a

different protein.  The theory is the same, however.



     Since hemoglobin A1C level correlates with the risk of

development of diabetic complications over time, measuring

hemoglobin A1C every three months allows us to estimate

average blood sugar level quite well from year to year, and

helps us act to reduce the risk of ramifications. 

Unfortunately, there are considerable differences between

labs in the technique used to measure hemoglobin A1C and its

normal range.  (The American Diabetes Association is

currently making an effort to standardize hemoglobin A1C

measurement and reportage.)



     There must be some warning in interpreting hemoglobin

A1C values.  Certain blood diseases can affect the

hemoglobin A1C, and thalassemia, an inherited disorder of

red blood cells that affects many individuals, particularly

of Mediterranean ethnicity, often causes a falsely high

hemoglobin A1C reading, even in persons who have normal

blood sugar levels.  Many individuals with other blood

disorders can have falsely high hemoglobin A1C values.



     When reviewing test results, it is important to

remember that the A1C test measures the "average" blood

sugar level.  If a person has a "normal" hemoglobin A1C,

this may perhaps mean they have periods of excessive high

blood sugar, balanced by periods of abnormally low blood

sugar levels.  We see this in some individuals whose blood

sugars are a bit elevated during the day (as revealed by

glucose meter), but who may have undetected low blood sugars

at night, so they end up with a "quite normal" hemoglobin

A1C, even though their diabetic control would be classified

as very unsatisfactory.  That is why you need both tests: 

measuring blood sugar levels frequently during the day, and

at least occasionally at night, to discover the specific

sugar levels at various times, but also measuring hemoglobin

A1C values four or five times a year to ensure that the

average blood sugar levels indicate adequate control.



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



DIABETES AND ALCOHOL



by Peter J. Nebergall, PhD





Photo:  portrait of Peter J. Nebergall



     In his "When Diabetes Complicates Your Life"

(Chronimed, 1993), Joseph Juliano, MD, writes of a diabetic

man, in good health, who went to a dinner party, and drank. 

Active, dancing, and talking with friends, he had four

drinks of Scotch and soda over four hours.  As he had eaten

several snacks and sandwiches at the party, he skipped his

usual before-bed snack.



     Consumption of alcohol can lower blood glucose level. 

Between 4 and 5 a.m., Dr. Juliano reports, the drinker went

into an insulin reaction.  Normally, he would have awakened,

but the alcohol had dulled his senses.  With a blood glucose

of 23mg/dl, he went into convulsions, and was only brought

around by an emergency glucose infusion.  It was a very near

thing.



     "I was that man," reports Dr. Juliano.  



     What happens when you drink alcohol?  Three things:



     1.   Alcoholic drinks have measurable food value; so

many carbohydrates per drink.  These carbs have to be "paid

for."  To preserve the integrity of your meal plan, an

increase in carbs from beer would require a decrease in

carbs from other sources-- and you might need those foods

more than that glass of brew.



     2.   Alcohol can affect perception.  Most folks, most

of the time, won't feel more than a pleasant buzz, but if

you really "go on a bender," you may not be in the best

shape to self-monitor your blood glucose or draw up insulin. 

Take care.



     3.   Glycogen, stored in the liver, is normally

available for release into the blood as needed, to

compensate for a "low."  For most folks, this

"glycogenolysis" occurs spontaneously.  An injection of

glucagon (an emergency medication all diabetics should keep

on hand) sparks the same process.



     Consumption of alcohol interferes with the liver's

release of  glycogen.  A significant amount of blood alcohol

can completely stop glycogenolysis, leaving you "without a

parachute" if you get low.  This can mean an ambulance ride.



     Alcohol's effect on blood sugars is complex and

unpredictable.  A drinker may experience a rapid rise (from

the carbohydrate), followed by a steep drop.  But where he

or she might normally perceive the oncoming hypo, and take

action, alcohol "dulls the signals," and can lead to the

induced equivalent of hypoglycemia unawareness.  As Dr.

Juliano reports, this can lead to real problems.  



     The type II (NIDDM) diabetic, using one of the

sulfonylureas such as glyburide, glipizide, tolbutamide,

tolazamide, or chlorpropamide to help control blood glucose,

can experience another problem with the consumption of

alcohol.  In some individuals the sulfonylureas react with

the alcohol, producing a brightly flushed complexion.

  

     So should you drink?  People consume alcoholic

beverages for many different reasons, and those reasons

usually determine their drinking patterns.  Other than "if

you are going to drink, keep it moderate, and take with

food", there can be no easy blanket answer.  Alcoholic

beverages impose a new risk on the diabetic, who already has

a lot to juggle.  It is up to each individual to make an

informed judgement about how much of that risk is

appropriate, so talk to your doctor about how to drink

safely.  Ancient Greek physician Hippocrates' teachings of

moderation; of a healthy lifestyle, are never more

appropriate than right here and now.

      

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



LETTERS TO THE EDITOR





Art:  fancy quill pen



August 12, 1996





     Thank you so very much for sending me the free

newspaper to give to my patients.  You truly do wonderful

work.  God Bless You All.



Sincerely,

R. Muller, RN

South Logan County Health Dept.

Booneville, AR



* * * * * * * * *



August 27, 1996



     Thanks for putting me on the mailing list.  I enjoy

reading the articles, and you have such up to date

information on what's new for diabetics.  It never fails to

amaze me how little the doctors know about this devastating

disease.



     The best preventative is information.  Lately, it

seems, I supply my doctor with information.  That's pretty

sad.



     I would like to have a few extra copies for my doctor's

office and also for my diabetic eye care facility.  I know

people would enjoy knowing what you have to present.



Thanks again.  Stay Well.



Celia Henderson

Land O'Lakes, FL 

 

* * * * * * * *



September 8, 1996



     Editor of the VOICE OF THE DIABETIC, I want to thank

you for supporting your community and the nation as well. 

Your newsletter should be in every physician's office, all

senior centers and pharmacies.  The resource section is

dynamic, awesome and a valuable informative asset to all

humanity.  Your newsletter is informative and educational to

all who are fortunate enough to be aware of it.  I thank you

for your commitment and dedication to those of us who have

diabetes, and commend you for a job well done.  "Thank you."



Mrs. Cynthia Desrochers

Tolland, CT 



* * * * * * * *



September 9, 1996



     I look forward to your cassettes and find the material

informative and up to date.  I have attended one NFB

convention, which was in Charlotte, NC, and that was an

experience I still talk about.



Thank you.



Debra Dickinson

Staunton, VA



* * * * * * * *



September 12, 1996



     I have enclosed the subscription form from the VOICE OF

THE   DIABETIC" quarterly magazine.  My local library,

located in Dover, New Hampshire, had a few copies on the

shelf of the spring issue.  I found it to be one of the most

informative pieces on diabetes that I have come across.  I

was delighted to learn that it would be possible to receive

copies of this newspaper.



Looking forward to my next issue,



Ralph R. Harron

North Berwick, ME



* * * * * * * *



September 14, 1996



     I was just introduced to the VOICE OF THE DIABETIC, and

I fell in love with it immediately.  It is a very

informative publication.



     The article "Living with Diabetes" (in the summer

edition) hit home. I have been a diabetic for about 30

years, and it is starting to take it's toll.  Heart attack,

stroke, heart blockage, eye sight getting poor, you name it. 

I use insulin and oral medication.

                                                         

     I have tried to educate my family and friends, but they

do not seem to understand.  So I am requesting publications

for myself, and to distribute.



Thank you,



Catherine M. Miller

Johnston, PA



* * * * * * * *



October 14, 1996



     On behalf of the planning committee and sponsoring

agencies of "Diabetes, Texas Style II", I  want to thank you

for sending multiple copies of the VOICE OF THE DIABETIC. It

is a newspaper that I enjoy and benefit from reading, and I

know our attendees will also enjoy it.  Each time I

encounter a visually impaired person with diabetes, I make

sure he is aware of the capability of receiving current

information about diabetes on cassette tape.



     Thank you for assisting with this educational endeavor.



Sincerely,



Sue Edwards, RNC, BS, CDE

Hendrick Medical Center

Dept of Education

Abilene, TX                               



* * * * * * * *



October 15, 1996



     I commend you on the Diabetes Action Network

publication and feel it is an invaluable tool for me as an

educator.  I appreciate being able to receive the VOICE OF

THE DIABETIC for distribution at support group meetings.  I

feel able to keep abreast of current events in diabetes

management due to articles published in the paper.  I've

also learned a lot of new ideas just by reading the

articles.



Sincerely and Respectfully,



Kathy Dubbert, RN

Mexico, MO  



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



RECIPE CORNER





Art:  basket of fruit 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...    





Lentil-Egg White Sandwich

                                        

from Omar Faruque

of New York, NY



1/8 cup lentils (about 25 grams)

1 egg                             

1 tsp. vegetable oil

1/8 onion, finely chopped    

1/4 tsp. (or less) ground turmeric, ginger, cumin,

coriander, in a little water, mixed

3/4 cup water                        

4 slices sandwich bread         



     Wash the lentils, put in a non-stick pot, add the 3/4

cup water, and bring to a boil.  Reduce heat, spoon the

froth from the top, then add salt, oil, and the onions and

spice water.  Simmer uncovered for  hour or until the

lentils become very soft and pasty.  Separately boil the

egg, then slice it and remove the yolk.  Spread the egg

white and the lentil paste on bread; makes two sandwiches.  



     Yield:  2 servings (2 sandwiches); per serving:  220

calories, 11gm protein, 3gm fat, 38gm carbohydrate, 0.2gm

fiber.





Lentil-Potato Chop



from Omar Faruque

of New York, NY



1/4 cup lentils (about 50 grams)

1 small potato

1 1/2 cup water (to boil the lentils)

2 tbsp. (about 15 gm) beshan (ground chickpea) 

1 tbsp. bread crumbs

1/4 tsp. ground turmeric, garlic, chili, and black pepper,

in a little water, mixed 

1/2 tsp. cumin seeds

6 tsp. vegetable oil

1/8 of a small onion, finely chopped

1 tsp. peeled and finely chopped ginger



     Wash the lentils, and place in a non-stick pot.  Add

the water and some salt, and bring to a boil.  Reduce heat,

spoon the froth from the top, and add the spice water, and

simmer uncovered for 1/2 hour or more, stirring

occasionally, until the lentils become very soft and pasty. 

Separately boil the potato, then mash and mix it well with

the lentils; add the beshan, the cumin seeds, and the ginger

(also salt if needed); mix well.  Make four chops, roll each

on bread crumbs, then fry (both sides) in non-stick pan with

oil.  Serve hot.   



     Yield:  4 servings; per serving:  135 calories, 4.5gm

protein, 7.5gm fat, 13gm carbohydrate, 0.2gm fiber. 



     The following recipes appear in "Quick and Healthy

Recipes and Ideas For people who say they don't have time to

cook healthy meals" by Brenda J. Ponichtera, RD, published

by ScaleDown Publishing, of The Dalles, Oregon.

        



Clam Fettucini           



12 oz. uncooked fettucini noodles (eggless)

3 cans (6.5 oz. each) minced clams, undrained

3 tsp. chopped garlic

1/2 tsp. dried thyme

1 tbsp. lemon juice

1/4 tsp. salt (optional)



     Cook noodles to package directions; drain.  Return to

pan and add remaining ingredients. Heat thoroughly; turn off

heat. Cover and let sit until liquid is absorbed, or if you

prefer more moisture, serve immediately.  Serve topped with

a sprinkle of Parmesan cheese.



     Yield:  about 7 cups (7 servings); One serving:  1 cup;

Calories per serving:  225; Exchanges: 2 starch, 1 lean

meat.





French Glazed Chicken 



     The orange glaze adds color as well as flavor to the

chicken. 



1 lb. skinless, boneless chicken breasts

1/4 cup low calorie French dressing

2 tbsp. low sugar apricot jam

1 tbsp. dried onion 

2 tbsp. water



     Arrange chicken in a 9-inch pan that has been sprayed

with non-stick coating.  Follow directions below for

microwave or conventional oven.



     Conventional Oven:  Preheat oven to 350 degrees. Bake,

uncovered, for 20 minutes.  Mix remaining ingredients and

spoon over chicken.  Return to oven for 10 minutes or until

chicken is done and glaze is heated.



     Microwave Method:  Cover with plastic wrap, venting one

corner.  Cook on high for 6-8 minutes, depending on

thickness of chicken.  Rotate 1/4 turn halfway through

cooking.  Drain any liquid.  Mix remaining ingredients and

spoon over chicken.  Cook for 1-2 minutes or until glaze is

heated.



     Yield:  4 servings; One serving:  1/4 recipe; Calories

per serving:  190; Exchanges:  4 very lean meat, 1

vegetable.





New York Cheesecake

                                    

24 oz. nonfat cream cheese (bar type) at room temperature

1/2 cup sugar

1/2 tsp. vanilla extract

1/2 tsp. almond extract

3/4 cup egg substitute (equal to 3 eggs)

2 tbsp. packaged cornflake crumbs (optional)

2 cups fresh fruit, sliced



     Preheat oven to 325 degrees. In a large bowl combine

cream cheese, sugar, vanilla and almond extracts. Using an

electric mixer, beat at high speed until blended.  On low

speed, beat in egg substitute.  Increase speed to high and

continue to beat until well-blended.



     Spray a 9-inch pie pan with non-stick cooking spray. 

Add cornflake crumbs (optional) to the pan and shake lightly

to coat bottom and sides with crumbs.  Pour in cream cheese

mixture; bake for 45 minutes or until center is set but not

firm.  Cool on wire rack.  Arrange fresh fruit on top of

cheesecake before serving.  This dessert should be stored in

the refrigerator several hours before serving.



     Yield:  12 servings (one serving = 1/12 cheesecake);

Per Serving:  94 calories, 14gm carbohydrate, 9gm protein,

0gm fat; Exchanges:  1 skim milk.  For a variation, try

doubling the recipe for a 9-inch spring form pan and bake

for one hour and 35 minutes.  Makes 24 servings.  One

serving is equivalent to the same nutritional value as for

one serving listed above.

     

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



CHEESE AND CRACKERS



by Karmeen Kulkarni, M.S., R.D., C.D.E.





     Need a quick snack to tide you over until your next

meal?  Or are you looking for an easy-to-prepare appetizer

for your dinner guests? Spread some soft cheese on a cracker

and you have a simple cure for satisfying the munchies.  But

what about the fat and calories?  With the new

reduced-calorie and fat-free crackers and cheese spreads now

on the market, it is much easier to include these snacks in

a healthy meal plan.  In this installment of "Supermarket

Smarts", we will give you all the information you need to

choose the crackers and cheese spreads that are best for

you.





All Cracked Up



     Crackers are a versatile companion to dips, spreads,

soups, and salads.  Or you can munch them without

embellishing them.  Whatever your preference, you can find a

cracker to suit your taste and nutritional requirements.

They come in numerous flavors and run the gamut from

high-calorie, high-fat indulgences to low-fat,

health-conscious snacks. 



     The first point to keep in mind when you choose your

crackers is the serving size.  Clearly, this is partially

dependent on the size of the cracker.  But serving sizes

also vary considerably from one manufacturer to the next. 

For instance, the serving size for a large flat bread, such

as Kavli Norwegian crispbread, is usually one cracker.  But

a serving of small crackers, such as Ritz Bits, might

include eight to 12 crackers.  And, of course, it isn't

always easy to limit yourself to just a few crackers, so you

need to consider how many servings you are actually going to

eat.  And since most people snack on crackers between meals,

remember to factor the extra carbohydrate, calories, fat,

and salt into your meal plan for the day.





Finding Fiber



     Many people think that they can increase the fiber in

their diet by choosing whole grain crackers.  Unfortunately,

this is not the case.  Unless the crackers are made from

100% whole wheat flour (it will be the first and only flour

listed), "whole grain" crackers can actually be made of a

processed multigrain, rye, or wheat flour.  And the term

"stoned wheat" usually just refers to stone ground wheat

flour.  It may sound rustic, but that doesn't make it whole

grain. The only way to verify that your cracker is really

made from whole grains is to read the label.  Rest assured,

however, there are several authentic whole grain crackers,

made by companies such as "Health Valley" and "Barbara's".

And surprise: Nabisco's "Triscuits" are made from whole

wheat, too.



     If you want to add some fiber to your diet, the thin

and very crunchy crackers labeled "flat breads" and

"crispbreads" provide the most.  Brands such as "Kavli" and

"Wasa" provide two to four grams of fiber in a half-ounce

serving.  Compared with saltines, which have only 0.3 grams

of fiber, flat breads are your best bet.



     If you do choose to eat flat breads, pay attention to

the labels so you don't confuse them with "bread flats." 

Bread flats are made from refined flour, with B vitamins and

iron added later.  Since the grain and bran have been

removed, bread flats lack fiber, folic acid, pantothenic

acid, trace minerals, and vitamins B6 and E.  Clearly, bread

flats are the nutritionally impoverished cousins of flat

breads.





The Grease Test                                   



     As is often the case, with the good comes the bad. In

crackers, the "bad" means varying amounts of fat.  Your best

bet is to look for crackers that have no more than two grams

of fat per half-ounce serving.  Check the ingredient list to

see the types of fats used.  Steer clear of saturated fats,

such as lard, animal fats, palm oil, palm kernel oil, and

coconut vegetable oils.  Avoid partially hydrogenated fats

as well, since they can raise cholesterol levels the same

way that saturated fats can.  Watch for crackers that are

touted as "rich," "buttery," and "flaky," or are flavored

with meat or cheese.  These are "red flags" for high calorie

and fat content.  You can also check for a high fat content

using the "grease test."  Do your hands feel greasy after

handling the crackers?  Do the crackers leave a grease stain

on paper towels?  If the answer is yes, you know those

crackers are high in fat.  These tricks are especially

helpful if you are served crackers at a restaurant or a

party where you don't have access to the nutrition facts

panel.



     Crackers do not have to be high in fat, however. You

can choose reduced-fat crackers that have at least 25% less

fat (about 2.5--3.5 fewer grams of fat per serving) than the

original versions.  For example, per half-ounce serving,

Keebler's reduced-fat "Town House" crackers have only two

grams of fat, and their reduced-fat "Toasteds" have three

grams.  Hain makes fat-free crackers in a variety of

flavors, such as onion and herb.  These crackers stand apart

from others because they are made with organic whole wheat,

which translates into higher fiber and nutrient content.





The Salt Shake-Out 





     What about the sodium content of crackers?  A single

serving rarely contains more than 200 milligrams of sodium,

which is not a significant amount unless you are on a

sodium-restricted diet.  But if you add a salty cheese

spread or dip, or eat several servings, that sodium can add

up.  As with fiber, you need to watch the terminology here. 

The word "unsalted" doesn't necessarily mean that the

cracker is made with little or no salt.  Rather, it can mean

salt was not sprinkled on top as a flavoring.  Also, salt

may occur naturally in some of the ingredients.  So the

cracker itself can still have well over 140 milligrams per

serving.  According to The National Academy of Science, we

can safely eat 1100-3300 milligrams of sodium a day.  A

single serving is well under that limit, but if you can eat

multiple servings, that salt can add up.





Say Cheese



     Crackers are great on their own, or served with dips or

soups. But one of the most popular cracker partners is

cheese.  Crackers with sliced cheese and cheese spreads are

a staple on hors d'oeuvre trays, and with good reason; these

tasty duos are quick and easy snacks. However, cheese can be

high in fat, so choose carefully.



     Cheeses can be separated into two categories: natural

cheese and processed cheese. Natural cheeses, which were

showcased in the January/February 1993 issue of "Diabetes

Self-Management", are made from milk that has been allowed

to thicken.  Examples include cheddar cheese and mozzarella. 

Processed cheeses are blends of different cheeses that have

been pasteurized to lengthen their shelf life and treated

with gelatin thickeners to give them a smooth texture. 

According to U.S. Government standards, processed cheeses

must contain at least 51% cheese, although they often

contain more.  The remainder is made up of water, milk, skim

milk, buttermilk, powdered milk, or whey.  Cheese spreads

come in nearly every shape and flavor, from tubs of herbed

cheese to blocks of cheese with bacon. 



     The nutritional profiles of cheese spreads can vary

widely.  A serving of cheese spread is generally about one

ounce, which translates into two tablespoons, or enough for

two to four crackers.  But that measurement assumes you

don't spread the cheese on too thickly.  Keep in mind, too,

that you need to account for crackers.



     Cheese spreads tend to be high in sodium. For example,

Kraft's "American Cheese with Bacon" has 560 milligrams of

sodium and "Old  English's Sharp Cheese Spread" has 480

milligrams.  Even Weight Watchers' port wine cheese, which

has 70 calories and three grams of fat, has a hefty 190

milligrams of sodium.  But you can find low-salt versions of

several spreads.  Kraft's "American Cheese With Jalapeno

Pepper" has 95 milligrams and their pineapple cheese spread

has only 75 milligrams.





The Good, the Bad, and the Fatty



     The calorie and fat contents also vary; although some

spreads have quite a high fat and calorie content, several

manufacturers make healthier low-fat versions.  On average,

cheese spreads have 70-110 calories per ounce.  This may not

seem like a lot, but team that ounce of spread with four

crackers and you'll suddenly find yourself eating 160-200

calories.



     The fat content of cheese spreads ranges from three to

nine grams of fat per ounce.  Some spreads get a significant

amount of their calories from fat.  For example, an ounce of

Sargento Cracker Snacks' "American Cheese with Pimiento" has

nine grams of fat and 110 calories.  This means 74% of the

calories come from fat -- a hefty sum for the fat-conscious. 

And watch out for saturated fat:  Land O'Lakes Golden Velvet

cheese spread has six grams of total fat and four grams of

saturated fat, meaning 66% of the total fat is saturated.



     If it sounds as though the fat content will keep cheese

spreads off limits, take heart.  Several companies do make

heart-healthy versions. For instance, Kraft has a line

called "Healthy Favorites" that has 50% less fat than

Kraft's regular counterparts.  These products have three to

five grams of fat per ounce, with varying amounts of sodium. 

Healthy Choice makes a cheese spread with zero grams of fat

per ounce; however, it has 390 milligrams of sodium.  As a

general rule, as the fat content decreases, the sodium

content increases.  So, choose your cheese spread according

to your individual health concerns.



     Crackers and cheese spreads are delicious and easy

snacks. Although these munchies can be high in fat and extra

calories, you can now pick from many healthier options. 

Just choose wisely, and you'll have many great combinations

to work into your meal plan and enjoy. 



     (Note:  This article appeared in "Diabetes Self

Management", November/December 1995.  Reprinted with

permission.)



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



NEW MARKER FOR DIABETES IDENTIFIED





     Scientists at the National Institutes of Health have

identified a protein that is an important marker for type I

(insulin dependent) diabetes.  The protein can be used in

combination with two other known marker proteins to improve

diagnosis of individuals who have diabetes, and identify

those at risk of developing the disease.  It and other

marker proteins are candidates for experimental treatments

aimed at preventing the onset of type I diabetes.



     The identification of the new marker protein, as

reported in the "Procedings of the National Academy of

Sciences", is part of an ongoing study at the National

Institute of Dental Research.  Scientists at NIDR's

Laboratory of Oral Medicine are investigating the molecular

biology of diabetes, a condition which, on top of the risk

of heart, kidney, and eye complications, is known to

increase risk of gum disease and tooth loss. 



     IDDM, type I diabetes, is an autoimmune disease in

which the immune system produces antibodies that attack the

body's own insulin-manufacturing cells in the pancreas. 

These antibodies, called autoantibodies, form the basis of

the existing diagnostic test for IDDM.  In this test patient

serum reacts with sections of human pancreas tissue, a

labor-intensive procedure.  Recently, however, scientists

have been able to identify some of the target proteins (that

react with the antibodies) in the pancreas, and are using

this knowledge to improve detection of diabetes and

streamline the screening process.



     Doctors Michael Lan and Abner Notkins have now

identified two protein markers, IA-1, and IA-2, and cloned

and sequenced the genes for both.  Genetically engineered

versions of both have been produced in the laboratory.  The

two markers, when used in diagnostic tests, "recognized"

antibodies in 70% of IDDM patients.  Combining them with a

third marker, a protein called GAD-65, increased the

recognition rate to 90% in persons with IDDM.  Furthermore,

the presence of autoantibodies to the marker proteins in

otherwise normal individuals was highly predictive in

identifying those at risk of ultimately developing clinical

symptoms of the disease.



     "The identification and production of these markers

makes it possible to develop a rapid and effective test to

screen large populations for IDDM," says Dr. Notkins.  "In

addition, the proteins are candidates for immune tolerance

studies, which attempt to prevent the development of

destructive antibodies and subsequent disease." 



     Persons without diabetes also have the marker proteins

on their beta cells, but do not make antibodies.  The

scientists are hopeful their research will aid in uncovering

the actual cause of type I diabetes.



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



DIETARY FIBER AND DIABETES





     Health experts recommend strongly that we include more

fiber and less fat in our diets.  This is especially true

for people with diabetes.  A healthy fiber intake can help

to lower blood glucose levels and maintain weight control.



     The average American eats only about 11 grams of fiber

each day, but the National Cancer institute recommends a

daily intake of 20 to 30 grams and the American Diabetes

Association recommends that people with diabetes get as much

as 40 grams of fiber each day, from a range of sources like

vegetables, fruits, whole grains and cereals.  The best way

to include more fiber in your diet is to add a little bit

each day, slowly building up to the recommended level.  This

gives your body time to adapt to the changes and results in

regular, healthy digestion.



     There are two kinds of fiber, soluble and insoluble. 

Insoluble fiber does not dissolve in water, and is found in

wheat bran, whole grains, and vegetables.  Reports from the

National Cancer Institute suggest that a high-fiber, low-fat

diet may help reduce the risk of some types of cancer.  



     Soluble fiber does dissolve in water, and is found in

beans, psyllium, barley, and some fruits and vegetables. 

Experts report that soluble fiber may help to lower high

blood cholesterol levels and keep blood sugar levels under

control.  Both kinds of fiber are part of a healthy diet.  



     Both the American Diabetes Association and the American

Dietetic Association suggest tailoring any diet to meet your

own needs and lifestyle.  They also recommend replacing some

of the fat in your diet with carbohydrates, especially

complex carbohydrates.  This means eating more foods high in

complex carbohydrates, like fruits, vegetables, pasta,

cereals, and breads, and fewer fatty foods like butter, sour

cream, ice cream, and pastries.



     Weight control is a key factor in the control of type

II diabetes.  Diets high in fiber can be lower in calories

if they are low in fat.  This type of diet makes weight

control easier.



     Fiber is found in many plant foods like fruits,

vegetables, whole grains, cereals, and legumes (dried peas

and beans).  All of these foods are also low in fat.  There

is no dietary fiber in meat, fish, poultry, eggs, or milk.



     Many grain foods, including many breakfast cereals, are

good sources of fiber.  A one-ounce serving of Kellog's

All-Bran or Kellog's All-Bran with Extra Fiber has 10 to 14

grams of fiber.  



     You don't have to make major changes in your diet to

include more fiber and less fat.  With a little advance

planning, it's easy to include low-fat, high-fiber choices

in every meal.  



     When shopping, include fresh fruits and vegetables,

whole grains, beans and high-fiber cereals on your grocery

list.  Choose reduced-fat dairy products, lean cuts of meat,

and skinless chicken.



     It's easy to increase the fiber in your favorite

recipes, too.  About 2 to 3 tablespoons of Kellog's All Bran

cereal can add 4-6 grams of fiber to many recipes.  In some

recipes, you can add even more cereal.  Here are some ideas:



*  Quick Breads:  Stir 1/2 cup Kellog's All-Bran cereal into

finished batter for a dozen muffins or a loaf of banana

bread or quick bread.  



*  Yeast Breads:  Add Kellog's All-Bran cereal as you begin

to add the flour.  Use about 1/4 cup cereal for each loaf. 

You may need to use a little less flour.  



*  Pancakes:  Add about 1 cup Kellog's All-Bran cereal for

each cup of pancake mix.  Increase the liquid by 2 or more

tablespoons.  



*  Meatballs, Meatloaf, Burgers:  Add up to 1/2 cup Kellog's

All-Bran cereal for each pound of ground meat.  Add 2 or

more extra tablespoons of liquid, and soften the cereal in

the liquid before adding the ground meat.



*  Pie Crusts:  Replace some or all of the crumbs in a crumb

crust recipe with finely crushed Kellog's All Bran cereal.  



*  Casseroles:  Sprinkle 1/4 cup crushed Kellog's All Bran

cereal on top of casseroles for added crunch.



*  Soups and Salads:  Sprinkle 2 tablespoons of Kellogs

All-Bran cereal on soup, salad, other cereals, and cottage

cheese.  This will add about 2 grams of fiber.





Soluble Fiber Sources:



     Gum:  Oatmeal and other rolled oat products, dried

beans, psyllium, and barley.



     Pectin:  Squash, apples, citrus fruits, cauliflower,

green beans, cabbage, dried peas, carrots, strawberries, and

potatoes.





Insoluble Fiber Sources:



     Cellulose:  Whole wheat flour, unprocessed bran,

cabbage, peas, green beans, wax beans, broccoli, brussels

sprouts, and cucumber (with skin).



     Hemicellulose:  Bran cereals, whole grains, brussels

sprouts, mustard greens, and beet root.



     Lignin:  Bran cereals, unprocessed bran, strawberries,

eggplant, pears, green beans, and radishes.



     For more information on diabetes, or to join the

American Diabetes Association, contact your state's ADA

office (listed in the white pages) or call 1-800-232-3472.



     (Note:  Reprinted with permission of the Kellog's

Company.) 



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



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.

 

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



DIABETES: PREVENTION AND EARLY DETECTION



by Laura R. Simpson, RN, MA, CDE





     From the Editor:  Ms. Simpson, of the Medical Center of

Central Massachusetts, recently gave a presentation in

Worcester.  Members of our Diabetes Action Network were

present, and asked her to write a summary of her talk for

the VOICE.

     

     Are you one of the eight million undiagnosed with

diabetes?  Is there anything anyone can do to prevent type

II, Adult Onset Diabetes?





Early Detection



     Eight million people may have signs and symptoms of

diabetes that they do not realize mean diabetes:  Increased

thirst, increased urination, tired, irritable or sleepy,

blurred vision, dry itchy skin, slow healing infections or

sores, numbness or tingling in hands or feet, frequent

vaginal yeast infections.  Call your doctor if you have

these signs or symptoms. 





Prevention



     Type II diabetes may be prevented by weight control,

exercise, and stress management.  Weight control means not

being over your ideal weight for your height, if possible. 

Extra pounds create insulin resistance.  You can decrease

your insulin resistance by losing weight.  If you weigh 20%

or more over your ideal body weight (for example, a woman

five feet tall who should weigh 100 pounds but weighs 120

pounds or more) you have an increased risk or chance to

develop type II diabetes.



     Regular exercise means doing some form of aerobic

exercise (for example, walking, swimming, cycling, three or

more times per week for 20-30 minutes, not including warm-up

and cool-down.  Remember to ask your doctor, before starting

an exercise program, and remember to wear properly fitted

athletic shoes of good quality.  You may need to start your

exercise slowly, if you have not been exercising regularly,

for example, walking for five minutes and working up to

20-30 minutes.



     Stress management may be helpful.  Exercise, prayer,

meditation, hobbies, talking with a friend, counseling, or

listening to self-help tapes, all may be helpful.  Stress

results in the release of adrenaline into the blood--which

causes blood sugar to rise.



     Feel better.  Find out if you already have diabetes, or

begin work on prevention.



     A written risk quiz, with an "ideal weight" chart, is

available from the American Diabetes Association; telephone:

1-800-342-2383.  



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



HYPERBARIC MEDICINE FOR WOUND CARE



by Donna Medina, RN, BSN



     Diabetes mellitus is a major health problem that

affects as many as 16 million Americans.  One of its major

complications is non-healing foot wounds and infections. 

Twenty percent of current diabetics either have a foot wound

or have had one within past years.  Diabetics account for

60% of the non-traumatic amputations in the world.



     Several factors influence the diabetic toward the

development of infected, non-healing wounds.  Diabetics can

develop neuropathy,  decreased level of sensation, in their

feet and legs, making wounds difficult to detect before they

become infected or septic.  Also, diabetics can have

ischemia, poor circulation, in their feet.  If a wound or

ulcer develops in the foot, healing is difficult, as the

impaired circulation delivers decreased levels of oxygen to

the wound.  Diabetics can develop such poor lower extremity

circulation that spontaneous tissue breakdown can occur. 



     Because of these two factors, indetectability and poor

circulation, diabetic foot wounds are prone to infection. 

Allowed to progress, such infection, with its increased

demands upon an already weakened circulatory system, and the

tissue damage from the resultant swelling, can lead to

further complications, such as  osteomyelitis, bone

inflammation. Once such a major uncontrolled infection

occurs in a diabetic's foot wound, amputation of the limb

may be necessary.

     

     Hyperbaric medicine is the therapeutic delivery of 100%

oxygen under atmospheric pressure  greater than that found

at sea level. It is well known that hypoxia (oxygen

insufficiency) and infection are primary causes of problem

wounds, and hyperbaric medicine specifically addresses both

these factors.  This has been verified by extensive research

and clinical experience.



     Hyperbaric delivery of oxygen provides a major increase

in tissue oxygenation in an infected wound.  It promotes

wound healing by assisting with the replication of

fibroblasts, formation of collagen, and creating new

capillary beds at the wound site, thus increasing endogenous

oxygen level.  It also has a bactericidal effect by

increasing oxygen radicals.  



     Diabetics need to be aware that hyperbaric medicine may

be able to help heal their problem wound, and may help

prevent an amputation.  Hyperbaric treatment for diabetic

wounds is approved by Medicare, Medicaid and most insurance

companies for payment.



     Hyperbaric units have multiplied in the past few years,

but there are still only a limited number available.  To

locate such a facility, please contact:  The Undersea and

Hyperbaric Medical Society, 10531 Metropolitan Ave.,

Kensington, MD 20895; telephone:  (301) 942-2980.  They

offer a directory of hyperbaric facilities: "The Chamber

Directory; U.S. and Canada", which they will furnish for $25

(plus $5 shipping).  



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



CONTROL YOUR BLOOD GLUCOSE -- NATURALLY



by Claudia Graham, PhD, MPH, CDE





     Claudia Graham, PhD, MPH, CDE, is Director of Managed

Care at Vivra Health Advantage.  An exercise physiologist

for 14 years, Dr. Graham is also a Board Member-At-Large of

the American Diabetes Association, California Affiliate, and

co-author of the "The Diabetes and Sports Exercise Book".    

                           



     Q.  How important is exercise for people with diabetes?



     A.  It's absolutely critical.  Basically, it's a

natural way to control blood glucose.  By maintaining an

optimal weight, the body becomes more sensitive to the

insulin it produces.  Therefore, people with type I diabetes

may not need to take as much external insulin to lower their

blood sugar.  Also, exercise helps reduce cardiac disease

risk factors, which are very high in the type II population,

as well as control high blood pressure and make the bones

and muscles function stronger.  Similarly, in the type I

population, exercise helps maintain ideal body weight and

reduces cardiac disease risk factors.





     Q.  What about research which states that exercise can

reverse certain types of complications?



     A.  Exercise can prevent or delay the onset of some

complications, alleviate uncomfortable symptoms, and help

you cope with life when you have complications.  For

example, many type Is have neuropathy.  Exercise won't

reverse the nerve damage, but by strengthening the muscles

where the neuropathy is, it allows you to function more

independently. 



     Exercise can reverse peripheral vascular disease, in

which constricted blood vessels do not supply enough blood

to the legs, resulting in painful charley horses.  A

prescribed interval walking program, if done consistently,

will force the growth of new vessels - and new blood supply

- to the leg.





     Q.  What types of problems should people with diabetes

be aware of when exercising?



     A.  First off, the benefits far outweigh the problems,

so don't be afraid to exercise.  That said, there are a

number of general safety precautions you should be aware of. 

For people taking insulin, the biggest concern is

hypoglycemia.  It's not always easy to get the blood sugar

balance right, between what to eat, how much insulin to

take, and how much to exercise.  Don't exercise if your

glucose is low; and if you're exercising for more than an

hour, you should probably eat some carbohydrates or discuss

decreasing your insulin dosage with your physician. 

Self-monitoring of blood glucose is the key to understanding

the effect of exercise on your blood glucose, as well as to

ensuring your safety.



     In type IIs, exercise can exacerbate an existing,

underlying cardiac condition.  People who are over 35, are

inactive, or have had diabetes longer than 20 years should

get a stress test and a risk profile.





     Q.  The right amount of exercise differs from person to

person.  How can you tell if you're working hard enough?



     A.  Focus on duration, not intensity.  Technically, you

want your heart rate elevated to between 60% and 80% of your

maximum age-adjusted heart rate, depending on your doctor's

directions. But I also follow a rule of thumb that I call

"conversational intensity:" exercise at an intensity that

you can carry on a conversation.  If you're exercising with

a friend and trying to carry on a conversation, but you're

huffing and puffing, slow down a little bit!  You're working

too hard.  On the other hand, if you're able to sing, you

need to step up the pace!



     The "hidden benefit" of exercise is that it can lower

your blood glucose for 12-24 hours after exercising.  Just

remember to monitor, because reactions can also come late. 

But if you incorporate exercise into your regular routine,

eventually your glucose will remain lower, and perhaps you

can cut back on your medication -- that's what we want to

shoot for.





     Q.  Any final words of wisdom?



     A.  You don't have to run the Boston Marathon!  A

little bit is better than nothing at all.  The benefits may

take a little while to come, so don't expect a miracle

overnight.  The most important thing is to just do it.  Know

your risk factors, but get out there and have fun!



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

++





DIALOGS ABOUT DIABETIC DYNAMOS



by Debra Frank, MS, MS





Photo:  portrait of Debra Frank



Water Works Wonders



     Everyone can do it!  Regardless of swimming skill, age,

weight, height, or disability, exercise in the water allows

the body a quality workout, stimulating visceral,

cardiopulmonary, neurological and muscular responses, with

less stress than comparable land or weight-bearing

activities.  Water's gentle massage, combined with a

structured and scheduled workout program, can assist you in

regulating your blood sugars, and, as with any form of

exercise, can increase your sensitivity to insulin.  A

workout in the water  is fun, too.



     Since water diminishes the effects of gravity, it

lessens joint stress, and increases general joint

flexibility.  In the water, buoyancy increases resistance,

so the arm and leg muscles work when you push down as well

as when you push up.  Since buoyancy enhances range of

motion, many folks can do exercises in the pool that they

could not do on land.  And water's buoyancy cushions the

body, decreasing the chances of injuries common in land

exercise.  



     You burn more calories, working out in the water, than

you do with the same exercises on dry land.  It is important

to test your blood sugar more frequently, and of course

there is the possibility of hypoglycemia (as with any

exercise program), but in the water its onset may be less

acute.  People who are otherwise advised not to participate

in "land-based" exercise programs are often steered toward

water fitness, by their medical team.  



     It is imperative that you inform your personal medical

team of your participation in any exercise program, so they

can discuss your individual adjustments in medication and

food.  It is your responsibility to inform the instructor of

your diabetes, and to make him/her familiar with any special

needs you may have.  Of course all discussion will take

place in confidence, and will allow you to develop a

long-term successful fitness program.  



     Water based exercise programs have been around for

centuries, and are the primary phase one rehabilitation

programs in Europe, but Americans still have trouble finding

facilities and instructors for "Aqua/Water Exercise."  Most

YMCA's have qualified programs, as do many of the larger

health club facilities.  Many public recreation programs

offer similar, but may not be led by a certified instructor. 

Ask!  The Aquatic Exercise Association and the American

College of Sports Medicine have training and certification

programs throughout the country, and their graduates are

getting into every pool and puddle available.



     Exercise of any form increases self-image, body-image,

and self-esteem.  Choosing a program that allows you to

participate, no matter what level you start at or what

barriers you face, is a sound idea.  



     And don't make too much of those "barriers."  In my

classes I use the "buddy system."  We assist each other. 

This allows the visually impaired, the motor impaired, and

those with cardiac conditions to keep up with the group, but

work at their own pace, setting their own goals.  Nobody is

left out.  I know that even if somehow there is a cure for

diabetes, or a magic formula for fitness, I will continue

doing my water exercises.  Thirty years from now I will be

laughing and counting in the pool, with a tight body and a

serious gray bun on top of my head.  It truly makes me feel

good about me.  



     In March of 1996 I had the pleasure of talking to a

diabetic support group at South Nassau Hospital in

Oceanside, New York.  Following that presentation, one of

the women asked me about my Water Exercise Classes at

Hofstra University.  Because of her chronic neuropathy, she

was afraid to exercise, or even to walk.  Since she could

not swim, she had not previously embraced the idea of water

exercise.  With a little positive reinforcement, she decided

to register for the 12-week summer season.  When she came to

the first class she was so surprised to see me and many of

my students with makeup on, lipstick and all, hair pinned

neatly on our heads.  By the end of the first class she was

beaming.  Her body was moving better than it had in years,

and her feet, protected by water socks, were feeling no

pain.  Since that first class she has been joined by another

woman from her support group, and by her husband.  She and I

test our blood sugars after class, and if necessary, we sip

an orange juice or hand one another a glucose tab.



     Writer's note:  It just occurred to me how much passive

(as well as active) exercise and therapy I get from the

water.  As I sit down to finish this article I just came out

of my weekly "bath and shave" ritual.  Once a week, over and

above my daily showering and pampering, I do my best to take

a bath.  Usually it will be in the evening, before the

beginning of a hectic week, or like tonight, when I need to

chill out and relax before tying up loose ends and finishing

deadlines.  Warm water works wonders in my tense body.  It

is so rejuvenating and relaxing, and there I have time to 

massage my feet and do the other hygienic things we often

rush when we shower.  My mom was the one who started it all

-- over two decades ago, before exercise of any form was

part of the diabetic medical protocol, my mom put me on the

swim team.  When I got out of control, whether from being a

typical adolescent or from being off the diabetic Richter

scale, she would put me in the bath for a while to "chill

out."  Of course an hour later I had to scrub the entire

bathroom, tile by tile, but the lesson was learned and the

wonders of water were etched into my lifestyle.

        

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



"BRITTLE" DIABETES



     One of the most prominent features of diabetes is its

uniqueness.  No two diabetics respond in exactly the same

way to food, insulin, or exercise, and no two individuals,

even if they show the same test results, will suffer

precisely the same ramifications.  The disease is, by

definition, unpredictable.  Still, making allowance for

surprises, we know the effects of more insulin, less

insulin, more exercise, less exercise, more food, etc.  



     For most diabetics, most of the time, the "rules" work. 

"If I do this, or do not do that, I can expect this result." 

But there is a body of individuals for whom the rules do not

appear to apply, and to them is often applied the adjective

"brittle." 



     The problem becomes separating the truly "brittle" from

the non-compliant and the poorly-controlled.  Some

authorities insist that if all diabetics diligently

practiced "tight control" (as described by the DCCT), none

would be "brittle."  They're partially right; the numbers

would go down, but some would remain.



     There are some diabetics, practicing tight control,

whose blood glucose level "over-reacts" to minute changes in

diet, exercise, and/or insulin.  These individuals

experience unpredictable rises and swoops in blood glucose,

within very short periods, as the result of very small

departures from schedule.  Small changes "break" their

control, and they are thus said to be "brittle."



     If you are practicing tight control, are in good

compliance with your schedule, and are still experiencing

rapid, out-of- proportion blood glucose changes, talk to

your doctor.  You may be "brittle," but your instabilities

may be a sign of some other problem.

          

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



NFB SCHOLARSHIP PROGRAM 





Photo:  portrait of Peggy Elliott



     The National Federation of the Blind will award $88,000

in scholarships this year.  Individual scholarship amounts

range from $3,000 to $10,000, and the competition is open to

any legally-blind individual who will be a full-time

post-secondary student in Fall 1997.

                                                    

     All 26 scholarships are merit-based, and most are

unrestricted.  Entries will be judged on the criteria of

academic excellence, financial need, and service to the

community.  The committee making the award decisions will be

composed of blind citizens with distinguished academic and

community backgrounds from across the country.



     The scholarship winners will be presented their awards

in July, at the 1997 convention of the National Federation

of the Blind in New Orleans, Louisiana.  Scholarship winners

will also have all their expenses paid to attend the

convention.



     The National Federation of the Blind is an organization

dedicated to creating opportunity for all blind persons. 

With more than 50,000 members, it is the largest

organization of blind citizens in existence, and it awards

more scholarships to the blind than does any other group or

organization.  Recipients of Federation scholarships do not

have to be members of the NFB.



     Applications for the 1997 NFB Scholarship program must

be received by  March 31, 1997.  Scholarship winners will be

notified by June 1.  We receive approximately 500

scholarship applications each year, so don't delay! Anyone

interested may request as many application forms as needed

from:

                                                            



     1.   Mrs. Peggy Elliott, Chairman, National Federation

of the Blind Scholarship Committee, 814 4th Avenue, Suite

200, Grinnell, IA 50112; telephone:  (515) 236-3366.



     2.   National Federation of the Blind Scholarship

Committee, 1800 Johnson Street, Baltimore, MD 21230;

telephone:  (410) 659-9314.



     3.   All NFB Affiliate presidents.



     4.   Financial Aid Offices of educational institutions. 





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



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



(Resource Column)





Art:  Hand reaching for a book on a shelf



     Inclusion of materials in this publication is for

information only and does not imply endorsement by the

Diabetes Action Network of the NFB.





Diabetes Supplies



     American Diabetic Supply, Inc., will ship your diabetes

supplies to your door.  They handle all insurance claims,

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



     If you are looking for a by-mail source for your

diabetes equipment and supplies, check out Diabetes

Supplies, Inc (formerly Medi-Mail, Inc.).  Because it is

small, the company is able to offer a high level of customer

service. They bill Medicare and secondary insurance

carriers, accept assignment, and stock difficult-to-find

items like Diascan test strips.  They also carry diabetes

literature and information, and all their employees have

received instruction from diabetes educators. For

information, contact: Diabetes Supplies, Inc., 1594

Northgate Drive, Naples, FL 33942; telephone: 

1-800-883-9146.





Diabetes Information



     Johns Hopkins Medical Institutions, one of the most

respected names in American medicine, publishes a series of

yearly monographs called "The Johns Hopkins White Papers". 

Each deals with a specific topic; one of them is "Diabetes

Mellitus".  Written by top professionals, the 1997 edition

includes in-depth articles and definitions, and reflects the

latest developments in insulins, prevention of diabetic

nephropathy, and treatments for type II diabetes.  Regularly

priced at $19.95, this and other texts are available from: 

The Johns Hopkins White Papers, Subscription Department, PO

Box 420083, Palm Coast, FL 32142-0083. 





WINDOWS Screen Reader



     GW Micro has developed "WINDOW-EYES," a screen reader

for Microsoft WINDOWS.  Once equipped with a voice

synthesizer such as the Dectalk (your CD-ROM soundcard won't

do), any computer that can run WINDOWS can run WINDOW-EYES. 

The WINDOW-EYES program costs $495, and is available from: 

GW Micro, 310 Racquet Street, Fort Wayne, IN 46825;

telephone: (219) 483-3625.      





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.





New Resource Guide

        

     The NFB Diabetes Action Network announces the updated

"Resource Guide to Aids and Appliances".  Once again, we

have compiled a list of companies and individuals who offer

products and/or information for diabetics, especially those

blind or losing vision, to help them self-manage their

diabetes.  The "Resource Guide" features six subject

categories:  General and Miscellaneous, Automatic Insulin

Injection Systems, Blood Glucose Monitoring Systems, Syringe

Magnifiers, Insulin Pumps, and Large Distributors of

Diabetes Equipment and/or Supplies.



     Blind diabetics can and do accurately draw up insulin,

monitor blood glucose, and perform the other tasks of

independent self-management.  By using alternative

techniques and products they can continue being independent,

and can control their diabetes as efficiently as do their

sighted peers.  Limitations are usually self-imposed --

often all that is needed to overcome negative thinking is

simply to know where to go for information.



     The new "Resource Guide" costs $2 per copy and is

available in Braille (30 pages), large print (14 pages), and

audiocassette.  Make checks payable to National Federation

of the Blind (Visa, MasterCard or Discover also accepted). 

Order from:  National Federation of the Blind, Materials

Center, 1800 Johnson Street, Baltimore, MD 21230; telephone: 

(410) 659-9314.





Ski for Light 



     We have been asked to announce:  Ski for Light, Inc.,

announces its 22nd "International Week" gathering for blind

or mobility-impaired adult skiers, who will be teamed with

non-disabled instructor-guides.  About 250 people, from a

number of countries, are expected to participate.  The event

will be held at Cragun's Hotel and Conference Center, in

Brainerd, Minnesota, from February 23 to March 2, 1997.  

Cost of the event is $575, double occupancy, plus

transportation.  For applications, call Larry Showalter;

telephone: (614) 478-7898.For information, contact:  Ski For

Light, Inc., 1455 West Lake Street, Minneapolis, MN, 55408-

2648; telephone: (612) 827-3232; or on the World Wide Web

at:  http://www.tmn.com/sfl/home.html  





New Magnifier



     We have been asked to announce:  Telesensory

Corporation announces a new SVGA screen magnifier, called

Genie".  A member of their "Aladdin" family of

magnification devices, Genie displays in full color, high

contrast black and white, negative (colors reversed), and 24

color combinations (such as green-on-black and yellow-on-

blue), and will magnify computer images as well.  For

information about Genie and their other products, contact: 

Telesensory Corporation, Marketing Communications, 455 N.

Bernardo Avenue, Mountain View, CA 94043-5237; telephone: 1-

800-804-8004.  





Finger Skin Cream



     Diabetics who suffer from sore, cracked or calloused

fingers because of frequent use of blood lancets for glucose

monitoring may find new relief.



     "Formulated For Fingers", a new skin cream by Can-Am

Care Corporation, features the Australian Tea Tree Oil as a

moisturizing and soothing ingredient. 



     This cream, packaged in 4-oz. squeezable bottles, is

priced at $9.99. For more information contact:  Can-Am

Corporation, Cimetra Industrial Park, Box 98, Chazy, NY

12921-0098; telephone:  1-800-461-7448.





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, contact: 

Sugar Free Marketplace, 6710 N. University Drive, Tamarac,

FL 33321; telephone:  1-800-726-6191.





New Diabetes Books



     The American Diabetes Association has published two new

books.  "Reflections on Diabetes" is a 121-page motivational

collection of 39 real-life stories about coping with the

disease and its ramifications, drawn from the pages of

"Diabetes Forecast" magazine.  "Diabetes A to Z" is a

dictionary-style quick reference covering aspects of the

disease, terms and areas of interest.  Many items are

discussed, from alcohol to blood glucose, to exercise, foot

care, high blood pressure, vegetarian diets, and your health

care team.  It covers a lot of territory in 195 pages.  The

books are priced at $9.95 each, and are available from: 

American Diabetes Association, 1660 Duke Street, Alexandria,

VA 22314; telephone:  1-800-232-6733.





Computer Equipment



     Aicom Corporation of San Jose, CA, offers three models

of the "Accent" text-to-speech synthesizer, a device that

converts text on your computer screen to speech.  It has a

vocabulary of over 20,000 words. The models include a

full-length PC plug-in card for IBM-PC compatibles ($595), a

stand-alone unit with RS-232C link to any computer ($795),

or the Messenger-IC PCMCIA Type II ($995), as well as

others.  The Accent is supported by all major screen-reader

programs.  For further information contact:  Aicom

Corporation, 2381 Zanker Road, Suite 160, San Jose, CA

95131; telephone:  (408) 577-0370; fax: (408) 577-0373. 





Board Members



     The Diabetes Action Network of the National Federation

of the Blind. 



     President:  Tom Ley, Baltimore, MD



     First Vice-President:  Ed Bryant, Columbia, MO



     Second Vice-President:  Janet Lee, Cedar, MN 



     Treasurer:  John Yark, Stamford, CT 



     Secretary:  Sandie Addy, Prescott Valley, AZ            

                   



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



FOOD FOR THOUGHT





Art:  dancing fruits and vegetables



     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.





In Espanol?



     Health statistics show the impact of diabetes is

disproportionately high among the Hispanic population.  It

has been suggested that we at VOICE OF THE DIABETIC reprint

one article each issue in Spanish.  What do you think of

this idea?  Should we do it?  What kinds of articles should

we translate?  Write or phone your responses to us at the

VOICE office.  Thanks.  





Type I Diabetes Prevention Trial



     The National Institutes of Health has launched a

research study to determine whether daily insulin

injections, given to persons judged at risk of developing

type I diabetes, will prevent the disease.  Researchers are

looking for close relatives of persons with type I diabetes,

to participate in the study.  Eligible participants must: Be

between the ages of three and 45, be willing to accept

either "injecting" or "control group" assignment, have blood

test results that show the person is at high risk of

developing type I diabetes, and must have a close relative

with type I diabetes.



     Ten different diabetes centers, located in California,

Minnesota, Washington State, Florida, and Massachusetts,

will gather data.  Participants living in other areas can

have tests forwarded by their family physician.  For

information and a list of screening sites, call the National

Coordinating Center, located in Miami, Florida; telephone: 

1-800-425-8361.





Thank You!  Thank You!



     To all of you who responded to our recent donations

drive, an enormous THANK YOU!  It costs more than $150,000

per year to publish VOICE OF THE DIABETIC, the principal

communication tool of our Diabetes Action Network.  Through

the generosity of the National Federation of the Blind, we

offer subscription without charge; but our advertising

income covers only a portion of production costs, so we

depend on YOU, our readers, to help us keep on carrying our

message to more diabetics, family members, health

professionals, and individuals with an interest in the

condition.  As our circulation has now grown beyond 187,000,

our need for your assistance grows more acute.  Twice a year

we send out requests for donations.  To those of you who

responded--Thank You again!         





Nutrasweet



     Rumors have been circulating that the artificial

sweetener Aspartame, sold as NUTRASWEET, has been found to

cause brain tumors.  The Food and Drug Administration (FDA)

has found such claims to be without merit at this time. 

Data from the National Cancer Institute show that the recent

increased incidence of brain and central nervous system

cancers began in 1973--and Aspartame was approved in 1981. 

The FDA continues to watch all food additives.  





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.



     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 editorial office.





Fruit Juice



     If asked to choose which is "better for you," a glass

of fruit juice or a can of soda pop, most of us would reach

for the juice.  However, if you read the label, there may

not be much difference.  Most fruits are naturally sweet,

and many contain added sugar--a lot of added sugar!  Eight

ounces of orange juice contains 24 grams of sugar, and eight

ounces of cranberry juice contains 34 grams, as much as an

equivalent measure of root beer!  It is best to be very

cautious with high-sugar, high-carb drinks, unless you are

treating a low blood sugar (hypoglycemia).



  

Infections and Insulin



     Especially now, in the middle of the flu season, it is

well to remember that infection causes a stress on the body,

and may well result in a blood glucose rise.  You need to

meter more carefully if you are sick.  Plus, hyperglycemia,

elevated blood sugar, promotes and encourages infection.  As

if that were not enough, if your sugars are up above 240,

your immune system can be compromised.  What an argument for

good self-management, even when you (a-choo!) feel lousy. 



                                    

Blind Poet's Work Available



     "Hearing the Sunrise" by Nancy Scott is a collection of

28 poems, many previously published in national magazines. 

They explore everything from the sound of solder and snow,

the memories evoked by the feel and smell of good wood, to

coping with a blind six-year old with a squirt gun. 

"Hearing the Sunrise" is available in Braille for $4.50 per

copy (shipped free matter) or in standard print for $6

(includes shipping).  To order, make check payable to: 

Nancy Scott, 1141 Washington Street, Easton, PA 18042.  



      

Implantable Insulin Pump



     A new type of insulin pump is currently undergoing

trials.  This is the "MiniMed 2001 Implantable Pump."  Where

current insulin pumps, about the size of phone pagers, are

external, delivering insulin through a catheter, the hockey-

puck sized implantable pump is surgically installed in the

abdominal cavity.  Before meals, the patient holds a small

transmitter device over the pump site, programming it to

deliver extra insulin.  Because the pump uses a special

high-concentration insulin (U-400), users should be able to

go up to several months on one reservoir of insulin.  



     Implantable pumps have some drawbacks.  First, the

implantable is NOT an "artificial pancreas," and the user

must continue to test blood glucose, as often as with a

conventional pump.  Second, the pump needs to be "refueled,"

recharged with insulin, by the doctor, who injects insulin

under the skin, into the pump (reloading it yourself, at

home, is not possible).  Third, in recent tests, a number of

users experienced mechanical failures--and for nine of the

59 test participants, those failures required further

surgery to correct.       



     Not yet approved by the FDA, the pump "works", but

offers challenges and inconveniences beyond those of the

current generation of external insulin pumps, those made by

MiniMed and its competitor, Disetronic.  Development work

continues, and with luck we shall soon see an "interactive

pump," a self-adjusting insulin pump incorporating a blood

glucose monitor, more closely approaching an "artificial

pancreas."  



     For more information about the MiniMed 2001, or its

other insulin pumps, contact:  MiniMed Technologies, 12744

San Fernando Road, Sylmar CA 91342; telephone: 818-362-5958.





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.





1996 Raffle Winners 



     At the keynote banquet for the 1996 annual convention

of the National Federation of the Blind, in Anaheim,

California, the winning ticket was drawn in the Diabetes

Action Network raffle.  Winning ticketholders were Ed and

Toni Eames, of Fresno, California.  Told of her $500 prize,

Mrs. Eames stated:  "We were delighted to win; the money

will be put to good use..."



     Lots of people helped sell tickets, and the following

folks each sold 50 or more.  In descending order of tickets

sold:  Eileen Rivera, of Baltimore, MD; Olivia Ostergaard,

of Fresno, CA; Ken Staley, of Chicago, IL; Marlene Curran,

of Oak Lawn, IL; Karen Mayry, of Rapid City, SD; Ed Bryant,

of Columbia, MO; Martha Young, of Kansas City, MO; Betty

Walker, of Jefferson City, MO; Maurine Barcelo, of Pasadena,

CA; Gisela Distel, of Albany, NY; Kerry Smith, of St. Louis,

MO; Edna Stevens, of Springfield, MO; and John Yark, of

Stamford, CT. Truly a winning performance--See you next

time!





Obesity and NIDDM



     Consider obesity.  "Overweight" can come from a number

of causes, separately, or together in the way we call an

"unhealthy lifestyle."  If you are genetically predisposed

toward type II diabetes (NIDDM), and an astonishing number

of people are, being overweight and sedentary can greatly

increase your chance of developing the disease.



     Years ago, before the age of convenience devices,

convenience foods, television and couch potatoes, most

people's lifestyle kept them physically fit.  Few but kings

had the opportunity now provided to all by household

devices.  We use our "conveniences" instead of our muscles,

and we are not looking after our diet, or our exercise.  Too

often, we pay for it.



     Being overweight by itself does not cause diabetes. 

There are many overweight people with perfectly normal blood

sugars and A1C tests.  But if you are genetically

predisposed toward NIDDM, a fit and healthy lifestyle is the

best thing you can do to keep the wolf from the door. 





Tax Help



     For assistance with completing your 1996 tax forms, you

can telephone the Internal Revenue Service, toll-free:  1-

800-829-1040.





Dialysis at National Convention



     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!





Braille Calendar



     The American Action Fund for Blind Children and Adults

is offering, free-of-charge, an attractive 1997 calendar in

Braille. Contact the American Action Fund for Blind Children

and Adults, 1800 Johnson Steeled, Baltimore, MD 21230;

telephone: (410) 659-9314.                              





What's Coming Up



     The next edition of the VOICE, Volume 12, No. 2, will

include information on renal failure, dialysis, and

transplantation, a report on progress at our latest meeting

with the FDA and the insulin manufacturers regarding efforts

to include tactile cues on insulin vials, and our regular

columns and features.  As always, articles covering

different aspects of diabetes will be presented.





Talk it Over



     The information and advice contained in VOICE OF THE

DIABETIC is for educational purposes, and is 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

187,000+, offers such an outlet.  Make your voice heard. 

For 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 free quarterly news

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, proper diet, independence, and positive

outlook.



     Donations are gladly accepted and appreciated. 

Contributions are not only tax deductible; they are needed

to keep the VOICE and the Diabetes Action Network moving

forward; helping 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 and physically handicapped

(recorded at slower-than-standard speed of 15/16 IPS)



[ ]  both



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 1, Winter

Edition 1997

