                         VOICE OF THE DIABETIC

                   A SUPPORT AND INFORMATION NETWORK

    The Diabetics Division of the National Federation of the Blind

                           Volume 11, No. 1

                          Winter Edition 1996

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     The VOICE OF THE DIABETIC, published quarterly, is the      
national news magazine of the Diabetics Division 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. 
                                
     Copyright 1996 Diabetics Division, National Federation of the
Blind. 

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New Voice Phone


     On January 8, 1996, the VOICE OF THE DIABETIC Editorial Office gets
a new area code!  To call us, you will dial (573) 875-8911.  Our old
(314) area code is being replaced.

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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 print, on
audio cassette for the blind, or in both formats.  To begin receiving
the VOICE, please complete the subscription form (or a facsimile),
located at the end, and mail it to the editorial office.

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Inside This Issue

Diabetes:  A Food Improvement
   by Shelley J. Alongi

Food and Drug Administration Hosts Meeting:  Insulin Vial Designs
Discussed
   by Ed Bryant

Acarbose:  A New Diabetes Drug

New Insulin

Now I Know Better
   by Terry Lee Jackson

Letters To The Editor

Ask the Doctor
   by Wes W. Wilson, M.D.

Gift of Life/Gift of Hope
   by Royanne R. Hollins

Review of Oral Diabetes Medications
   by Peter Nebergall

The Heritage of Conflict
   by Marc Maurer

Dialogs About Diabetic Dynamos
   by Debra Frank, MS, MS

Scholarship Winners

New Dietary Guidelines For Diabetes Management
   by Mimi Moore, MS, RD

Recipe Corner

Medicare Says OK
   by Irving Mushlin

Update:  Blind Diabetics Can Draw Insulin Without Difficulty
   by Ed Bryant

Assessing the Impact of Intensive Therapy on the Health-care System
   by William H. Herman, MD, MPH

What You Always Wanted To Know But Didn't Know Where To Ask (Resource
Column)

Food for Thought

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                     Diabetes:  A Food Improvement
                         by Shelley J. Alongi

[Photo: portrait.  Caption:  Shelley Alongi]


     Diabetes has been part of my family history for as far back as I
can remember; my grandparents, my maternal aunts, and yes, now me.  Just
having graduated from college and finishing a hair-raising schedule of
recital preparation and performance, I had not been paying much
attention to my health.  I had been drinking extra amounts of water, and
experiencing lethargy, but I chalked it up to stress and the hectic pace
I had been keeping.  In for my first checkup in years, this 209 pound
woman was not surprised when a frantic medical technician rushed into
the room and told me I was a diabetic.  Diagnosed at age 28 with type II
diabetes, which affects more than 11.5 million Americans, I was
immediately put on glucotrol, and sent off to cope with my insulin
deficiency by myself.

     The resulting changes to my lifestyle surprised me; and I must
admit these changes have been positive and exciting.  My response to the
diagnosis was to stop and think:  "Alright, I have an insulin
deficiency, now what?"  Change in lifestyle and attitude came when I
began to do something I had never cared to do before--lose weight.

     One of my biggest dreams in life is to own a restaurant, so food
has always played an important role in my life.  Food is the center of
social and business activity in the United States, and I was no
exception to that delicious rule.  Bad eating habits were part of my
daily life, and I began to look at them--years of them.  Donuts, large
late meals loaded with yummy fat, large plates of spaghetti, and a
continual procession of Taco Bell burritos did not say much about my
concern for balanced eating.  I finally admitted I had lost control. 
When I had lived at home, my food amounts were regulated--breakfast,
lunch, dinner, a snack or two.  When I moved into a college dormitory, I
experienced "freshman spread," enthusiastically experimenting with all
the foods in the cafeteria.  I had no limits--and it felt wonderful! 
Before I knew it, I had put on weight.  I really did not care. It was my
prerogative to be overweight; I would not let society dictate its norms
to me.

     But my body was dictating its dislikes to me, even if I wasn't
paying attention.  Perhaps my transition out of a college environment,
my newfound confidence as a maturing adult, and my sudden concern for my
health added up--suddenly I realized that I could control my health by
controlling the type and amount of food I consumed, and best of all, I
realized I wanted to change my bad eating habits.  First, I limited
serving size, and added an evening snack to my eating routine.  I
meticulously measured a half-cup of this, a quarter-cup of that, until I
knew I could control the amount that went on my plate.  Queen of the
irregular eating schedule, I consciously began to eat at three regular
times during the day.  I made sure the meals I ate were filled with
nutritious vegetables and not whole packages of macaroni and cheese.  I
discovered an interesting fact; that it costs just as much to fill a
grocery cart full of vegetables as it does to fill it full of those
"stick to the ribs" foods that show up on the test strip.

     I love to go out to eat.  There is nothing like sitting over a good
meal and a wonderful cup of coffee, enjoying a conversation with a
friend.  But now, when I go out to eat, I draw some boundaries.
Recently, I went to dinner with my sister at a Mexican restaurant.  I
ordered a tostada, which had everything it needed to be a balanced meal,
except the shell was too big, so I left the empty shell on my plate.  Do
I ever eat at McDonalds?  Certainly, but I choose wisely, enjoy every
bite, and lose weight to boot!

     A favorite pastime of mine was to stand at the food table at a
meeting or church function, snacking on the cookies, chips, and cake. 
No more of that!  I eat small amounts, and then walk away and enjoy a
stimulating conversation rather than a fattening snack.  I know I can't
resist, so I don't.  But I do control my non-resistance!

     It works.  In six months I have lost 23 pounds and I'm working on
my next five.  My goal is to lose 20 more pounds by Christmas.  I am the
first to acknowledge that losing weight, and maintaining control is hard
work.  But I am dead serious about reaching my normal weight, and I
intend to have fun doing it.

     The secret of my control comes from one premise--I must, so I
really desire to reach and maintain a healthy weight.  Food has a direct
effect on my diabetes, and because I really want to control it, I make
the effort to eat properly.  I don't count calories.  I never tell
anyone I'm on a diet.  I say "I am changing my lifestyle."  Do I eat
fast food?  Do I make mistakes? Of course, but when I do, I regain
control.  I do not indulge in feelings of inadequacy when I make
mistakes.  I look at the big picture.  I'm going to be a diabetic for
life.  I'm going to love food for life. I'm going to keep controlling my
diabetes for life, and eating healthily is a wonderful way to do it.  If
I feel the need to eat poorly, I simply draw on my over abundant stock
of bad eating habits, and once again, I'm ready to eat right.  Eating
right, with some hard work and maintenance, is really a lot of fun.

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              Food and Drug Administration Hosts Meeting:
                     Insulin Vial Designs Discussed
                             by Ed Bryant

[Photo:  portrait.  Caption:  Ed Bryant]

     Four years ago, the Diabetics Division of the National Federation
of the Blind began campaigning for modifications in insulin packaging,
so blind insulin-users could safely distinguish between insulin types. 
The specifics have been discussed in past VOICE articles; what matters
is that change is needed.

     Adaptive equipment is available, allowing blind diabetics or those
with significant vision loss to accurately and dependably draw insulins,
test blood glucose, and perform most other tasks of daily diabetes self-
management.  The only missing element, the only step these users cannot
yet take with confidence, is to safely identify the type of insulin in a
specific vial.  Such identification is essential for our safety,
especially with the new "quick-acting" insulin type, Lyspro, now
awaiting FDA approval. 

     In January of 1992, I received a letter from a VOICE reader,
pointing out the danger of confusing vials of the different types of
insulins.  In April 1992, I wrote a letter to the insulin manufacturers
about this problem, and I forwarded a copy to Dr. David Kessler,
Commissioner of the U.S. Food and Drug Administration (FDA). In May of
1992, I wrote directly to Dr. Kessler.  In June of 1992, an FDA Consumer
Safety Officer delivered the official response, and in July of 1992, our
Diabetics Division sponsored a national survey about insulin vial
design, so as to come up with a consensus.

     Ninety-four percent of the survey respondents (a mix of blind and
sighted diabetics and rehabilitation professionals) felt some sort of
change was needed.  Fifty-six percent said to change the shape; 38
percent said to add tactile markings.  Of those preferring tactile
markings, most did not indicate a preference for vial or label.  Twenty-
nine percent of respondents voted for a combination of distinguishing
vial shape and tactile label markings.  Regarding colored labels as a
solution, only six percent approved.  I interpreted these figures as
ample evidence most survey respondents would like to be able to
distinguish insulins by touch.

     Since then, numerous articles in the VOICE have reviewed our
progress.

     In time, with your support (hundreds of you wrote to Commissioner
Kessler) we convinced the FDA to bring all the interested parties
together, finally discussing the problem of tactile insulin vial
identification, face to face.

     Before the meeting, scheduled for October 1995, I circulated a memo
(below) to all scheduled participants:  the National Federation of the
Blind, the American Association of Diabetes Educators, the Institute for
Safe Medication Practice, the American Council of the Blind, the
American Diabetes Association, the Juvenile Diabetes Foundation, the
Food and Drug Administration, Novo Nordisk Pharmaceuticals Inc., and Eli
Lilly and Co.                                             
       * * * * * * * *

Diabetics Division
National Federation of the Blind
Columbia, MO
September 11, 1995

TO:       FDA Meeting Participants
FROM:     Ed Bryant 
SUBJECT:  Oct. 19, 1995 meeting 

RE:       Tactile Markings on Insulin Vials

     A number of tactile cues could facilitate non-visual insulin
identification.  They are here ranked in order of their desirability.

(1)  In the past, some insulins were packaged in containers having a
square cross-section (shoulder) and some in containers with hexagonal
shoulders.  Although the concentration so regulated is no longer
manufactured, this federal regulation is still on the books.  Stability
testing is required when any changes are made to the primary container
of any injectable medication, but the FDA has, in the past, considered
it safe for insulin to be packaged in containers with round, square, or
hexagonal top cross-sections.

     Under the scheme we propose, short-acting insulins would remain as
they are today, packaged in cylindrical vials.  Intermediate-acting
insulins would be packaged in similar vials, but having cross-sections
(shoulders) of rounded square shape, and all long-acting (L or U)
insulins would be packaged in cylindrically-shaped vials with hexagonal
shoulders.  There would be no other changes to the primary container,
and internal dimensions would remain as today.

(2)  Although standard Braille is out of reach of many blind diabetics,
large embossed letters would not be.  Fishburne Enterprises of Hemet,
California, markets the "Fishburne Alphabet," a series of symbols
embossed onto thin sheets of vacuum-formed plastic, designed expressly
for blind persons with diminished tactile sensation (such as diabetic
neuropathy).  Samples are enclosed.

      Significant for our purpose is not the Fishburne Alphabet itself,
but the material upon which it is embossed.  The thinsheets of
polystyrene can easily receive standard print, so no current labeling
information needs to be altered or deleted.  I would note that the print
should be as bold and contrasty as possible--ideally black-on-white. 
Before it is attached to the vial, the plastic label would receive two
simple sets of embossed symbols.  At the right side of the 3 x 7 cm
label, where the letters "R", "N", "L", or "U" are now printed, those
letters would be embossed as well.  They would be raised, and could thus
be felt by those who could not see them.  The bigger the better, but I
note the current letters are 1cm in height, however 1.5cm would be more
certain.  Larger letters, embossed after printing, would also help
address the problem of fluctuating vision.

     Along the left side of the label, near where some products show a
bar code, the label would bear one, two, or three raised dots (tests
might show the feasibility of a fourth dot for "U" insulins).  "R"
insulin would bear one dot, "NPH" would have two, and the slow-acting
"L" and "U" would have three.  These dots could be further improved by
roughening, perhaps by application of a "grainy" material during the
label printing process.  Of course they would be of sufficient size, and
far enough apart, that a blind individual with severe neuropathy should
be able to determine the number of dots with a finger or fingernail.     

     The raised dots on the label should resemble the dots on the Count-
a-Dose T-bar (sample enclosed).  Where two or three (or four if testing
so indicates) are used, they should have a space of 5 to 7 mm between
them, arranged in a single vertical row.    

     Please note the dots and the raised letters are meant to be used
together.  Each tactile cue-type supports the other.  When this system
is tested (by insulin-users with varying degrees of sight loss and
neuropathy), other symbol systems, such as raised square, circle, and
triangle, or dots and bars as per the Fishburne Alphabet, might be
tested for comparison as well.

(3)  In the past, pharmaceutical bottles were cast in bivalve molds.
Raised embossed lettering was the rule.  Such lettering was
astonishingly durable, and frequently survives--archaeologists dig up
old bottles, and pharmacists collect them.

     A variant for today, if all other modifications were unacceptable,
might be to cast a radial pattern of raised dots into the shoulder of
the vial; one for Regular, two for NPH, and three for L and U.  Like
those Jordan Medical puts on the Count-A-Dose T-bar, these dots would
have to be "tall" enough to be detectable by individuals with
neuropathy.  A radial pattern is less desirable than a linear one, but
better than systems that depend on sight.  The vial's shoulder provides
adequate surface area for such a pattern of symbols, unlike the wildly
impractical idea to emboss the lateral edge of the aluminum ring that
retains the rubber stopper.  Not only is the ring too small to carry
symbols of sufficient size; any change to its current conformation would
seriously impact makers of a number of adaptive insulin measurement
devices for the blind and those losing sight.


The Problem of Fluctuating Vision Blind diabetics are not the only ones
who would benefit from the adoption of a system of bold tactile cues. 
Daniel L. Lorber, M.D., Editor in Chief of "Practical Diabetology",
reminds us in a recent editorial (Volume 14, No. 2) that the average
sighted diabetic mixes up insulins at least once a year.  Tactile cues
could cut that frequency.  He also states:

     And let's not forget the large number of sighted, but visually
impaired, patients who have difficulty reading insulin bottle labels. 
There are far more people with decreased acuity due to macular
degeneration or capillary closure than one might think.  In my own
diabetes practice, visually impaired patients far outnumber the blind.  


     Many diabetics experience the insidious visual impairment known as
fluctuating vision.  One day their vision is fine; but on the next,
reading may be difficult or impossible.  Couple this with the natural
reluctance of so many individuals to admit, even to themselves, to
losing vision--you have a very strong argument for the inclusion of
tactile cues on all insulin bottles.

     Some diabetics use prefilled or reloadable "insulin pens," and
though such systems preclude mixing (one uses "premixed" cartridges or a
second insulin pen), users could still benefit from the presence of
tactile cues.  Systems vary, and precise placement of such cues would be
a matter for experimentation.


Conclusion

     Any system adopted to help blind and visually impaired diabetics
distinguish between insulins must be simple, reliable, and universal. 
"Simple" means it must contain no more information than is required for
self-management.  "Reliable" means unambiguous--different users should
achieve the same results.  It also means "durable," in that the tactile
cues must survive for the life of the insulin in the vial. "Universal"
means it must be part of all insulin vials, NOT simply available as a
pricey option.  There are as many as two million legally blind diabetics
in the U.S., and if they and the sighted are to benefit from a system
such as we describe, it must be part of all insulin vials. 

     The amount of insulin dispensed in the United States is not a
guess.  With the completion of the DCCT, and the rise of tight control
and multiple-injection regimens, the opportunity for misidentification
is rising dramatically.  What all participants in this meeting need to
keep uppermost is that one simple mistake, one insulin mix-up, the
product of avoidable ambiguity, can be fatal.  Adoption of a system of
universal tactile cues will help alleviate this deadly ambiguity. 

        * * * * * * * *     On October 19, 1995, the meeting took place
at the Parklawn Building, FDA headquarters, in Rockville Maryland. 
Moderated by Consumer Safety Officer John Short, of the FDA's Division
of Metabolism and Endocrine Drugs, the meeting brought together two
representatives from the insulin industry, organizations of the blind,
and associations concerned with diabetes.
     
     Mr. Short began it by stating that the meeting would not have taken
place "but for the efforts of Ed Bryant and the Diabetics Division of
the National Federation of the Blind. ....Ed  forced the meeting to
happen" he stated, and he was glad of it. 

     Mr. Short went on to relate that for a number of years the FDA had
discussed the blind drawing insulin, but:  "until recently we were
pretty much under the impression that totally blind diabetics always
needed assistance, someone sighted measuring and giving them their
insulin on a daily basis.  ....It didn't take long for Ed to straighten
me out on this" he told the audience, "informing me that totally blind
diabetics are very capable of taking care of themselves."  He related
how I had told him that, to cause the needed changes, I needed
assistance from the insulin manufacturers and the FDA. 

     He hoped the participants would conclude with concrete suggestions
that the insulin manufacturers feel they could implement, so that
diabetics with impaired vision could have total assurance they are
administering the correct insulin.                                       

     Several participants made formal presentations.  I delivered the
first, a recap of points covered in the memo (above).  

     Eli Lilly and Company, the manufacturer with 80% of the U.S.
insulin market, made no presentation, but Novo Nordisk Pharmaceuticals
Inc., the only other insulin maker in the U.S. market, brought examples
of different possibilities for tactile marking, and discussed them in
detail.  Most of the meeting was spent in the informal exchange of ideas
between the industry, the consumer organizations present, and officials
of the FDA.

     One option Novo Nordisk discussed was supplying tactile labels to
the pharmacist, to attach to the insulin vial before a sale.  They had
done it (in Europe) but found little demand, so they discontinued.  The
same fate overtook their plastic snap-on insulin vial collars, also
supplied to the pharmacist.  Someone had to attach them.  Novo expected
the colleague or parent of a blind insulin user would fill this task.

     One diabetes educator observed that Novo Nordisk's snap-on collar
would not have allowed use of the Load-Matic insulin measuring device.
Any vial modification that inhibits use of tactile insulin measuring
devices (like the Count-A-Dose and Syringe Support) is unacceptable.

      Most participants (including the manufacturers) agreed that after-
the-fact add-ons, whether attached by pharmacist or consumer, are no
better than the rubber bands and tape used by many as tactile markers. 
Tactile cues need to be permanent, universal, and attached by the
manufacturer.

     One participant, with expertise in the safe handling of
pharmaceuticals, observed that nurses and other caregivers sometimes
administer the wrong insulin because vials (identical except for the
printed label) have been unintentionally switched in their boxes.  He
stated:  "If vials were differentiated by shape, or had some other
strong tactile cue to help people differentiate, we would have far fewer
medication errors in insulin use."

     Other participants related how different insulin formulations are
sometimes switched in their boxes at the pharmacy, with a less expensive
formulation being sold in the box of a more expensive product.  FDA
officials present confirmed this occurrence.

     What is needed is something universal, on all insulin vials,
applied by the manufacturer, the same symbols for both manufacturers,
sufficiently clear that an individual with severe neuropathy could
distinguish between types.  One way to achieve such is by changing
insulin vial shape, using vials with different dimensional features for
the different insulin types:  R, N, L, U, and soon Lilly's quick-acting
Lyspro.

     Although they had done so in the past, and although Novo Nordisk
packages insulin for sale in Europe in slightly different vials than it
does for the United States, the manufacturers showed no interest in
changing vial shape.  Current insulin vials are produced from glass
tubing, and shaped or embossed types would require molded glass. 
Several antique, molded-glass insulin vials were passed around the
audience, and all but the manufacturers agreed it was extremely easy to
achieve tactile identification with the old-style bottles.

     The manufacturers presented a variety of objections to changing
vial shape.  Most were centered around increased per-unit cost.  Even
though Burroughs-Wellcome Company markets a neuromuscular blocker, for
surgical use, in a molded vial with a hexagonal neck, the insulin
manufacturers insisted cost considerations precluded such approach to
insulin packaging.  There was some discussion of increased breakage risk
with molded vials, though which was the culprit, the molding or glass
formulations of the 1950s, was never specified.  The manufacturers
showed no inclination to change vial shape, and the FDA showed less to
push them.

     Both manufacturers, having long since agreed something needed to be
done, were pursuing schemes of their own.  Lilly's answer seems to be
some sort of device, currently in the patent-application stage, so
details could not be revealed.  When I asked one Lilly representative
about it, he responded:  "Some things can't be talked about."  

     Novo Nordisk, who wants to mark only the "R" insulins, proposed a
scheme, already used in Europe, to place a raised dot on the aluminum
ring holding the stopper onto the insulin vial.  "R" insulins would bear
the dot; other types would be smooth.  They distributed samples of vials
bearing this mark, for our inspection.  

     It was very hard to feel the dot.

     Several individuals commented that, to be sufficiently obvious to
individuals with neuropathy, the dot needed to be much more sharply
raised, like Braille.  An experienced diabetes educator stated that many
diabetics could not feel such a dot, and if it were kept small enough
not to interfere with use of the Count-A-Dose and other tactile insulin
measurement devices, it would be indetectable by people with profound
neuropathy, even if they were using a fingernail.  

     Novo Nordisk also manufactures a line of pen injection devices, 
and some of these are used by blind and visually impaired diabetics,
even though in the U.S. the products carry a warning stating:  "Not for
use by blind or visually impaired persons without sighted aid." Insulin
mixing in a pen device is impossible; a user who needed to mix would
load factory-premixed cartridges, or use two pens.

     To distinguish between pens loaded with different insulin
formulations, pen manufacturers use different-colored trigger buttons,
which of course is no help to the blind.  At the meeting Novo Nordisk
distributed samples of pen devices marked with a tactile dot, and the
same objection holds for that dot as for the dot on the stopper-ring of
the insulin vial--TOO SMALL. 

     A diabetes educator pointed out that designating pen-injection
devices as "for tactile, non-sighted use" (as Novo Nordisk recommends)
while including the legal disclaimer against unassisted use by blind
individuals "seems like a little cognitive dissonance."

     Another non-sighted way to distinguish between insulins, covered at
the meeting, was with raised symbols on the label. Inclusion of a
tactile symbol on the label would require a switch from the paper or
nylon labels, currently in use, to plastic sheets (as described in the
memo to participants, above). The manufacturers pointed out that
switching to embossed plastic labels would require retooling of the
labeling process and could raise the per-unit cost of insulin.  Lilly
pointed out that the durability of any such raised tactile cue is not
known, and would require further study.

     There was much discussion of the proposal to tactile-mark only the
"R" insulins.  Diabetics who mix insulins almost always use only two
types, with "R" as one of the types, the other being "N" or "L" or "U". 
To mark the vial of "Regular" insulin would cut, though not eliminate,
the ambiguity.

     Note:  Once the new quick-acting Lyspro insulin analog is
available, some users, while not likely to mix Lyspro with Regular
insulin, may have three vials to keep track of.  A rare few patients,
users of continuous cycling peritoneal dialysis, might use a Lyspro/NPH
mix in the daytime, and Regular at bedtime, to deal with the extra
glucose coming in during the cycling procedure.

     Lilly stated that if the goal were to mark only the one type,
rather than distinguish between all types, they would be more willing to
consider, as long as such marking did not include vial shape change.     

     Novo Nordisk described such as a minimum solution.  Most meeting
participants agreed that tactile-marking only the "R" insulin would be
an acceptable short-term solution, while something better is worked out,
though a number cautioned that the short-term solution needed to not
become a long-term solution by simple default.

     The insulin manufacturers, along with German manufacturer Hoechst
A.G. (who had an observer at the meeting), had just concluded a series
of negotiations with the FDA, to set up a scheme for universally color-
coding the different insulin types.  The goal is commendable, and the
adoption of uniform color codes will certainly reduce dispensing errors
at the pharmacy counter (both blind and sighted participants reported
such errors), but the system they have adopted does not address the
needs of blind diabetics, who, with the appropriate tools, are fully
capable of independent self management.

     Both insulin manufacturers expressed the sentiment that any tactile
insulin marking should not "cause discomfort" to sighted insulin users,
those without visual impairment, by "reminding them that such may be
looming in the background" for them.  I asked them:  "Is the issue that
you don't want anyone to think they may become blind?"

     Finding their quaint attitude astonishing, I suggested to the
manufacturers that many diabetics might take better care of themselves
if they knew some of the ramifications of diabetes.  Education, not
silence, is the answer.

     Equally quaint was their assumption that tactile labeling was only
for the blind.  Dr. Daniel Lorber, editor of "Practical Diabetology",
reminds us (in the memo I sent to meeting participants, discussed above)
that the average sighted diabetic mixes up insulins once a year, and
tactile cues could cut that frequency.  Color-coding and large-print
labels help, but cannot answer the needs of the blind, or those with
fluctuating vision, whose ability to distinguish shape and color may
change unpredictably from one day to the next.  Both the insulin
manufacturers and the FDA seemed preoccupied with issues of world-wide
distribution, surprising for the FDA, which is charged by statute with
protecting the health of Americans.    

     A number of other possible tactile-marking ideas were proposed. 
One involved some sort of shrink-wrap around the insulin vial (rejected
by Lilly, who said the shrink-wrap oven's heat would damage the
insulin).  Another involved a tactile-raised label placed on the bottom
of the vial (rejected by Lilly, who stated the weight of the vial could
flatten any tactile marking on its base).  Still another involved an
extra-long label end, that could be folded up and over to make a tactile
mark (rejected by Novo Nordisk, who stated there was new technology for
attaching labels without glue, and was sure such label change "would
cause problems in the equipment lines, as so many labels fed through,
and they'd be sure to jam equipment").

     Lilly stated that there is no one obvious solution, but many
possible solutions, some too costly--others "cost-effective." "Anything
is `doable'," they stated, "but the need is to achieve the best system
possible--and for that you have to go back to the manufacturer."  They
reminded the audience that pharmacist applied tactile labeling systems
have another, heretofore unmentioned weakness:  The increasing number of
consumers who obtain their insulins from mail-order supply houses. 
These individuals never meet their pharmacist.

     Lilly also pointed out that insulin has a shelf-life of 2.5 years
(before expiration date).  Once a change is introduced, even if it is
universal, it will be at least 2.5 years before all insulins on the
market reflect that change.

     Moderator John Short, at the meeting's close, stated this would be
an ongoing discussion, and that in future we might involve folks in the
labeling and packaging business in our meetings.  Tom Ley, President of
the Diabetics Division of the National Federation of the Blind, reminded
the audience that consumers will make the final decision whether a given
proposal works or not.  "The best solution is a tactile solution," he
informed the manufacturers.

     We agreed to meet again in three months time.


Summary:

     We've come a long way.  The issues are on the table, and both
manufacturers and regulators know what we need and why we need it.  We
are aware the real work of insulin vial change is just beginning; talk
without action is not sufficient.  

     Our Diabetics Division has been lobbying the manufacturers for four
years now.  Novo Nordisk, who made an extensive presentation at the
meeting, did not put forward any proposal that had not existed before
our campaign began.  Eli Lilly, who has been helpful and supportive
throughout, is in the final stages of product development, and made no
presentation.

     I hope Lilly's focus on their new product, to which I am sure they
have committed substantial financial resources, will not preclude them
from considering other possible solutions that may emerge at our
meetings.  I look forward to seeing what positive use both insulin
manufacturers make of the suggestions already generated.  

     While we search for a permanent solution satisfactory to all, a
number of temporary solutions, quick to implement, have been proposed. 
The best of these involve a definite tactile cue on the Regular/fast-
acting insulins, separating them from N, L, and U types.  As I stated
above, it is critical not to allow any temporary solution to become the
permanent solution by default.  Work most go forward.  

     Several proposals have emerged since the meeting.  The simplest of
these involves attaching a thin circular band of embossed plastic (like
Dymotape) around the insulin vial, above or below the label.  This
strip, attached by the manufacturer as part of the labeling operation,
would be embossed with
appropriate tactile marks. Alternatively, the tape might be transparent,
wider, and placed directly over the label, with embossed symbols--but
applied by the manufacturer either way.

     Another proposal involves a slight modification in vial-making
procedure.  To manufacture vials, a long tube of hot glass is trimmed
like sausages, and then shaped appropriately.  To receive its flat
bottom, the hot vial is pressed against an anvil.  This proposal would
incise a tactile symbol on the anvil, so that its reverse would be
printed on the bottom of each vial.  Vial shape would be unchanged; the
bottom would merely bear a tactile symbol.

     On November 13, 1995, I forwarded the above proposals to the
insulin manufacturers and the FDA, for their consideration.

     On November 17, I sent details (and an illustration) of another
possible tactile marking on to the insulin manufacturers and the FDA. 
This one would involve a 3 x 3mm downward projecting tab, as part of the
vial's aluminum stopper-ring.  The resulting projection (on vials of
Regular or fast-acting) would be easily detectable, even by individuals
with severe neuropathy. The tab would not interfere with use of any
tactile insulin measurement devices, would not modify vial shape or
label, and should require only one modification on the assembly line, at
the point where the ring is clamped tight to seal the filled vial. 

     I expect other new proposals, and one of them may be the "best
answer" we are all working for.  Hopefully we will see real
breakthroughs at the January 1996 meeting.  The Diabetics Division of
the National Federation of the Blind will continue to lead the way, and
the VOICE OF THE DIABETIC will keep you informed.

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

                    Acarbose:  A New Diabetes Drug

     A new diabetes drug that acts like no other is in the works. It may
be approved for use in the United States by the end of the year.  And,
unlike other pills for diabetes, it may be useful for people with type I
diabetes and those with type II diabetes.

     This new drug is acarbose.  It's already used by people with type
II diabetes in Japan, Germany, Great Britain, and other countries.

What Does Acarbose Do?

     People with diabetes often have sharp jumps in their blood glucose
levels after eating.  The most healthful diet is one consisting mostly
of complex carbohydrates.  Yet, carbohydrates play a big role in the
increase of glucose after meals.  Acarbose slows down the body's
digestion of carbohydrates.  Glucose from carbohydrates hits the
bloodstream slowly instead of all at once. So glucose levels stay more
even.

How Does Acarbose Work?

     Acarbose is a kind of drug called a carbohydrase inhibitor. 
Carbohydrases are the enzymes that break carbohydrates down and turn
them into glucose.  Acarbose, when taken with a meal, temporarily stops
carbohydrases from doing their job.  Digestion is slowed.  And so
glucose enters the blood much more slowly.

Who Might Acarbose Help?

     Acarbose might be the most wide-ranging drug treatment for diabetes
yet.  It may help several kinds of people.  Acarbose might be used as
the only drug therapy for some people with type II diabetes.  Acarbose
might be used along with insulin, a sulfonylurea drug, and/or metformin
for other people with type II diabetes.  Acarbose may also be used along
with insulin in some people with type I diabetes.  It might let them
reduce their insulin dose and prevent leaps in glucose levels after
meals.

Does Acarbose Have Any Side Effects?

     The main side effects of acarbose are digestive problems.  Acarbose
can slow digestion of carbohydrates down so much that the food enters
the large intestine undigested.  There, bacteriaeats the carbohydrate. 
The result is gas, bloating, and diarrhea.

     Doctors can often help people avoid this problem by starting them
on smaller doses at first.  Also these side effects gradually go away
for most people.  In addition, black people seem to have fewer side
effects from carbohydrase inhibitors than white people do.   

     Another problem is that if someone has a low blood glucose
reaction, he or she must take glucose as a treatment.  Acarbose slows
the digestion of foods with sucrose, like soft drinks.  So they do not
work well to treat reactions in people taking acarbose.  

What Else is in the Pipeline?

     Another carbohydrase inhibitor called miglitol is being studied. It
should have effects much like those of acarbose.

     (Note:  This article appeared in "The Diabetes Advisor", Volume 3,
No. 4, published by the American Diabetes Association.  Reprinted with
permission.)

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

                              New Insulin

     Eli Lilly, & Co., maker of Humulin insulins, announces a new and
radically different insulin product.  Called Lyspro, it is neither R nor
N nor L, but a new class, best described as "quick-acting."

     Under development for some time, Lyspro was submitted to the Food
and Drug Administration for evaluation in March of 1995.  Review of new
pharmaceuticals normally takes 12 to 18 months, but when a given product
will be approved is anybody's guess.  The product has already been
approved for sale in Russia and South Africa, and is expected to be
commercially available there shortly. 

     What is the role of this new insulin?  Kelly Sego, Communications
Associate at Lilly, describes Lyspro as "another alternative,"
especially for those insulin users practicing "tight control" as spelled
out in the Diabetes Control and Complications Trial.  She says that for
some users Lyspro, designed to more closely mimic the insulin produced
by a healthy pancreas, may replace Regular insulin.  With Lyspro,
insulin users can be more flexible in injection and meal scheduling. 
Ms. Sego reports that some of the test subjects were able to "inject
while looking at their food."  Insulin is a powerful medication, with
serious consequences if used incorrectly.  Lyspro insulin, because it
starts to work almost immediately (much faster than Regular insulin),
demands a high degree of precision in dosage.  Designed to peak quickly,
Lyspro may help cut the frequency of insulin reactions, but its speed
demands the user promptly follow injection with food.  Remember to
discuss any planned change in insulin regimes with your physician.

     Look to VOICE OF THE DIABETIC for further information about Lyspro
and other new products.  

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

                           Now I Know Better
                         by Terry Lee Jackson

     When Ed Bryant asked me to write a story, I was thrilled.  As I sit
here, I find there are many stories.  I was first diagnosed as a
borderline diabetic in the summer of 1975.  Within two weeks, the
doctors decided I was an actual diabetic.  But I was in my early
twenties, young and carefree.  I really did not know much about
diabetes.  I stayed on my diet when I felt like it.  The doctors put me
on oral medications, but I got worse, so I was switched to insulin
shots.  I lost weight, and was able to cease the shots and go back to
oral meds.  Then I went right back to ignoring my diet.  I didn't know
any better.  Would you believe I did this for years? 

     Now I'm paying the price.  I'm 43, on insulin, and have diabetic
neuropathy in both feet.  I am blind in one eye and legally blind in the
other.  For years I wished I could talk to someone, be part of some sort
of support group.  I didn't know about the ramifications of diabetes.  I
didn't know about the National Federation of the Blind, our Diabetics
Division, or the VOICE OF THE DIABETIC. 

     Now I feel it is my goal in life to reach those of you who are
where I was twenty years ago.  Learn from my experiences!  Now I know
better, and I want you to know as well.  Write me or call me and I'll be
there to listen.  Maybe we can help each other through the hard times of
trying to take proper care of ourselves.  God bless all of you. 

     Terry Lee Jackson, 9211 Dale Ln. Ct #166, Ft. Worth, TX 76108;
telephone:  (817) 246-3010. 

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

                         Letters to the Editor

[Illustration:  quill pen in ink well]
October 3, 1995

     As a not-for-profit organization serving the blind and visually
handicapped in our and neighboring counties, we would be pleased to
receive 10-12 copies of your quarterly magazine for distribution to our
diabetic members and clients.

     We have many walk-in contacts who frequently have no idea where to
go for information such as you make available through your excellent
publication.

     Thank you for your assistance.

Sincerely,

Patricia Williams
Akron Blind Center and Workshop, Inc.
Akron, OH

       * * * * * * * *

October 13, 1995
   
     I have received your generous shipment of VOICE OF THE DIABETIC
which arrived on October 6, 1995.  Thank you so very much.  Our Meals-
on-Wheels driver has delivered copies to all our clients and I am
already receiving positive feedback.  With so many of our clients
suffering from diabetes, either directly or indirectly through loved
ones, your service is both a valued and welcome one.

     Last year, I knew very little about the disease.  Today, working
with diabetics and educating myself with the help of organizations like
yours, I am able to be more supportive and empathetic.

     Thank you again.  Your generosity is most appreciated and most
helpful. 

Very Truly Yours,

Claudia Lefcheck 
Special Diet Coordinator

Edward E. Sullivan Senior Center
Torrington, CT

       * * * * * * * *

 October 15, 1995

     Thanks so much for publishing a wonderful, informative newsletter! 
Also, we appreciate the two announcements regarding Braille/Print cards
by Tessa Creations.  Thanks, Ed Bryant!  Enclosed is a donation for $50
to help such a great cause.

Sincerely,

Mary Jo Edwards
Robin Bader
Tessa Creations 
Blue Island, IL

       * * * * * * * *

October 20, 1995

     I am a volunteer facilitator for a senior support group with
diabetes.  We are sponsored by the American Diabetes Association and
meet monthly at our local community center.  My group of seniors has
been meeting and supporting each other for eight years now.  It's
amazing what support can do for those suffering the same disease as
yourself.

     Last week one of our members brought your newsletter, VOICE OF THE
DIABETIC, to the meeting and my attention.  We reviewed and read many of
the articles (it was the fall edition 1995--Volume 10, Number 4).  What
a wonderful paper and the articles were discussed at great length.

     Would it be possible for you to put my name on your mailing list
for VOICE OF THE DIABETIC?  I know it would spark many good discussions
and I could use it as a great resource.  Thank you for any help.

Dorothy Hase
Minneapolis, MN

       * * * * * * * *

October 30, 1995

     I am enclosing some names of clients who would be interested in
receiving a copy of your VOICE OF THE DIABETIC.  I received a copy as a
complimentary sample and have shared it and do feel it provides
excellent information and updates in diabetes.  I am a diabetic nurse
educator and that is how these names have been obtained.  I am enclosing
a check for $20 and plan to post [the VOICE] in my clinic for clients to
enjoy and keep me informed.  I appreciate your help in allowing more
diabetics to be informed of the ongoing changes.

Valerie R. Nelson, Capt, USAF, NC
Manager, Diabetic Nurse Managed Care
Ellsworth AFB, SD

       * * * * * * * *

November 1, 1995

     Would you please send me at least six copies of all the current and
back issues of your VOICE OF THE DIABETIC magazine?  A friend loaned me
her copy and I found it very helpful and informative.  Plus, it is
interesting reading.  I have at least five diabetic friends who will
appreciate it as much as I do.  Myself, as well as some, if not all of
them, will try and send donations in the future.  Thank you so much.

Martha McNally
Kansas City, MO

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

                            Ask the Doctor
                       by Wesley W. Wilson, M.D.

[Illustration:  medical caduceus]

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

     Wesley Wilson, M.D. 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 have been taking oral medications for my type II diabetes for
many years.  They do not work so well anymore.  How is the action of
insulin different from that of oral diabetes medicine?  Is it more
dangerous?


     A:  It is important to understand that over 90% of cases of
diabetes are of type II, so it is appropriate to spend some time on type
II diabetes.  Both type I and type II diabetes share the feature of
elevated blood sugar levels and share many of the same complications,
but otherwise they are quite distinct diseases. Unfortunately, with the
passage of time, type II diabetes often becomes more pronounced and
harder to control, as you describe.  The beta cells of the pancreas may
lose their ability to produce insulin, perhaps on the basis of overwork. 
Progression of the disease can eventually lead to the need for injected
insulin.

     Type II diabetes seems to arise because of genetically determined
resistance to the action of insulin.  Often persons with type II
diabetes have considerable insulin in their blood,but it seems not to
work adequately.  They exhibit what we call "insulin resistance."

     Most oral medications prescribed for type II diabetes act to
increase the release of insulin from the beta cells of the pancreas. 
Greater amounts of insulin seem able to overcome the resistance to
insulin action and bring down blood sugars.  Remember, regular exercise,
diet control, and weight loss often markedly improve type II diabetes
and reduce the degree of insulin resistance, in some cases sufficient to
achieve good control without the need for medication.      

     A new drug, Metformin, is now available in the United States, which
may be of help in regaining control of type II disease.  This agent
seems to increase tissue response to insulin or reduce insulin
resistance, and works sufficiently in somefolks to allow control when it
is added to the previous oral medications.  Like all medications, there
may be significant side effects with metformin, but in some persons with
type II diabetes it has allowed control without resorting to insulin
injections.

     Another medication, Acarbose, acts to impaire absorption of
carbohydrate from the intestine and thereby decreases the elevation of
blood sugars that occurs after meals.  This also seems to be helpful in
many persons with type II diabetes and should be on the market within
the next several months.  Acarbose and Metformin may also reduce
elevated cholesterol.

     Your question regarding the differences between oral agents and
insulin is therefore hard to answer briefly, since the action of oral
agents depends on which specific agent.  The sulfonylureas (which
include glipizide, glyburide, tolbutamide, chlorpropamide) seem to act
primarily by causing the release of insulin from the pancreas.  The
Metformin-type drug acts to improve sensitivity to insulin, and Acarbose
seems to decrease the challenge of carbohydrate sugars after meals, and
results in lower blood sugar and lower insulin levels.

     Perhaps the key part of your question is the last part.  Yes,
insulin is more immediately dangerous, largely because it is a more
potent agent that will lower the blood sugar no matter what the blood
sugar level is.  Therefore, low blood sugar, or hypoglycemia, is the
most frequent side effect of insulin treatment.  At times, this can
cause confusion, falls, erratic driving, and other dangerous acts.  As
with many powerful medications, the very effectiveness of insulin can be
the source of problems.  Insulin therapy certainly demands far more
regularity of diet, exercise, meal times, and exercise times than is
necessary with the oral agents.  But if your diabetes is at a stage
where oral medications are no longer effective, the long term
consequences of poor blood sugar control are far more serious than are
the immediate risks of insulin therapy.

     The medical community feels that careful control of blood sugars is
as important in the prevention of complications ofdiabetes in type II
disease as it was proven to be in type I disease in the Diabetes Control
and Complication Trial (DCCT).

     In many ways, type II diabetes presents more puzzles than type I
disease.  I understand that a new study is being launched to see if type
II disease can be prevented.  As you know, the Type I Diabetes
Prevention Trial is now ongoing and is open for first-degree relatives
of persons with type I disease.  Progress is being made.  There are
still many uncertainties and unanswered questions, but improvements are
being seen.

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

     If you or a friend would like to remember the Diabetics Division 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 Division 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."

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

                       Gift of Life/Gift of Hope
                         by Royanne R. Hollins

[Photo:  portrait.  Caption:  Royanne R. Hollins]

     On October 4, 1994, my wait came to an end.  I had been waiting for
a pancreas transplant for two years, three months, and two-and-a- half
weeks.  To be sure, it had been a long wait.

     During the waiting period, many things were going wrong with my
body.  My brittle insulin-dependent diabetes had been diagnosed  in 1963
when I was nine.  By 1989, diabetes complications had me  certified
legally blind.  In 1991, the University of Minnesota  approved me as a
pancreas transplant candidate.  That same year  I was also approved by
the University of California at Davis  Medical Center.  I was offically
listed on the UNOS (United  Network of Organ Sharing) waiting list on
June 25, 1992.

     But that wasn't the end of it.  Although my name was on the list
for a transplant, my health continued to deteriorate.  More
complications arose with the passage of time.  My vision continued to
worsen.  I lost all vision in one eye and continued to lose acute vision
in the other eye, while I waited on the UNOS transplant list.
 
     My eyes weren't the whole of it.  Diabetes had begun to affect my
stomach (gastroparesis), intestines (enteropathy), legs and feet
(peripheral neuropathy) and my heart rate (autonomic neuropathy).  I
began to pass out without warning--day or night--due to wide swings in
blood sugar levels, the condition known as "hypoglycemia unawareness". 
My friends and co-workers were uncomfortable alone with me, fearing an
emergency might arise and they might not know what to do.  My husband
and I traveled with Glucagon emergency kits, in case I passed out in a
store, in the car, or at the theater.  My kidneys were changing as well,
and it would only be a matter of time before those changes would get
serious.  I was needing 12 to 16 hours of sleep every day just to
function.  All I could do was hope that a donor with the proper type of
tissue would come in. 

     Finally, on October 4, 1994, at 2:28 a.m., I received the call that
changed my life.  My long wait was over; the match came in and was
offered to me.  The operation was successful.
 
     The post-transplant course has been awesome!  Some of the
complications are already abating!  Since I got the pancreas transplant
before my kidneys were too far gone, they should stabilize. The
neuropathy in my stomach has already lessened; neuropathy in the
intestines, legs and feet should diminish with time.  Although there are
no guarantees as far as my eyes are concerned, there is always hope.  At
least, the deterioration of my vision will cease.  I can function, quite
actively, on eight hours of sleep, and I feel energized again.

      This gift of life, so graciously given to me by a loving family,
has now given me hope for a brighter future.  I no longer feel as though
a cloud of doom and gloom hangs over me.  I no longer even have
diabetes; I haven't needed any insulin since the day of the transplant!

    Please talk to your family about organ donation.  Take advantage of
family gatherings to hold discussions about it.  This is so important to
so many persons who are awaiting a suitable organ!  Signing an organ
donor card and indicating your wishes on your driver's license are not
enough.  You must inform your family of your decision!

     A loving, giving family was able to turn their personal tragedy
into triumph for another person--for me.  In a way, their loved one
lives through me and others as well.  I am so thankful for this gift of
life, this gift of hope, this gift of a brighter future.

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

                  Review of Oral Diabetes Medications
                          by Peter Nebergall

(Staff Reporter)[Photo:  portrait.  Caption:  Peter J. Nebergall]

     Currently there are an estimated 16 million diabetics in the United
States.  Perhaps 10 percent are insulin-dependent; the rest are type II
diabetics, controlling their condition with diet, exercise, and oral
medications.

     Oral medications are not insulin pills; rather three classes of
drug designed to improve the body's utilization of what insulin is still
present.  These are:  The sulfonylureas, metformin, and acarbose.

     Most "diabetes pills" are sulfonylureas, a class of chemicals that
stimulate the pancreas to produce more insulin, effectively lowering
blood glucose levels.  Type II diabetics, those who need more than diet
and exercise can provide, turn to these medications, tolbutamide,
chlorpropamide, tolazamide, glyburide, and glipizide, for effective
self-management.  The sulfonylureas are effective only so long as the
pancreas maintains some part of its insulin-making capacity. 

     But the sulfonylureas grow ever less effective with the passage of
time.  They drive the failing pancreas to greater effort, but the
patient may require ever-increasing doses.  At some point, no further
increase in medication will be effective; the pancreas isn't doing its
job, and the patient needs to start injecting insulin.  When the islet
cells of the pancreas stop making sufficient insulin, insulin must be
injected.

     Metformin, the second of the oral diabetes medications, works to
raise the body's sensitivity to its own insulin.  Used for decades in
Europe, it can be prescribed alone or with the sulfonylureas.  Metformin
helps the type II diabetic make better use of the insulin he or she has
left.  Like the sulfonylureas, it becomes useless when the pancreas
ceases producing adequate insulin.  (Metformin's predecessor,
phenformin, had dangerous side effects, such as lactic acidosis, and any
consumption of alcohol, or use with liver impairment, could bring death. 
It has been withdrawn from sale in most parts of the world.)

     Acarbose, the third of the current "oral meds" is completely
different.  A carbohydrase inhibitor, it temporarily suppresses the
digestive enzymes which turn carbohydrate into glucose, slowing
digestion and glucose absorption, keeping glucose levels more even. 
More a management tool than an antidote to insulin shortage, acarbose,
just now "coming on line" in the U.S.A., will help some diabetics keep
more constant blood glucose levels.

Problems 

     Unfortunately, oral medications are often eventually insufficient. 
Many type II diabetics, diagnosed as young adults, at first successfully
control their condition with diet and exercise, but find they need the
pills as they grow older.  A number of years (and dosage increases)
later, these diabetics have reached the limit of what oral medications
can do for them; they are "maxed out," and really need to start
injecting insulin.  Regular, frequent blood glucose monitoring will show
if you have reached the point where you should begin insulin therapy.

     Here we encounter what the drug companies call "psychological
insulin resistance."  Some of this is plain old fear of sticking
yourself with needles--nurtured by memories from our childhood in the
bad old days of dull-as-nails reusable syringes!  Many men would rather
face a bayonet.  But some doctors contribute to the problem when they
don't make it clear to the patient what the high glucose levels
consequent to remaining on now-useless oral medications will bring in
their wake.  Yes, insulin is a powerful medication, with risks if used
incorrectly--but what in this world DOESN'T have risks if used
incorrectly?   The risks of remaining on oral diabetes medications once
pancreatic insulin has diminished or ceased entirely are far greater
than the risks of taking insulin.  

The Future

     Researchers at Johns Hopkins are testing aminoguanidine, a new
medication that may prevent or reduce some of the ramifications of
diabetes.  Since 1992, other researchers have been testing troglitazone,
which, like metformin, appears to reduce insulin resistance and improve
glucose disposal for type II diabetics.  Troglitazone, which may be
useful for preventing type II, is currently undergoing clinical safety
trials.  Swedish and American researchers are testing still another (APO
A1 MILANO, covered in VOICE Vol. 10, No. 4) that may help reduce
diabetic heart disease. Other oral medications are constantly being
evaluated for possible diabetic applications. Change is coming quickly.

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

                       The Heritage of Conflict
                            by Marc Maurer

[Photo:  portrait.  Caption:  Marc Maurer]

     Mr. Maurer, President of the National Federation of the Blind,
delivered the following keynote address at the NFB annual convention,
Chicago, Illinois, July 6, 1995.

     The history of the world is, according to one notion, the biography
of inspired human beings who have faced and surmounted prodigious
obstacles--who have been instruments in the instigation or resolution of
conflict.  Conflict challenges order and stability, but it can sometimes
also channel and focus energy and power.  Conflict can be a destructive
force, but not all conflict is regressive.  Frederick Douglass said:

            The whole history of the progress of human liberty
            shows that all concessions yet made to her august
            claims have been born of earnest struggle. If there
            is no struggle, there is no progress.  Those who
            profess to favor freedom, and yet deprecate agitation,
            are men who want crops without plowing up the ground.
            They want rain without thunder and lightning.  They
            want the ocean without the awful roar of its many waters.

     Even if all progress must be stimulated by conflict, conflict
itself is not enough.  Whether the conflict is productive or destructive
depends on the imagination, the insight, the spirit, and the courage of
the people involved.  It is essential that the objective to be gained be
worth the risk, for no conflict exists without an element of loss.  It
is how we respond to the risk and the possibility of loss that
determines not only the outcome of the current dispute but to some
extent the prospects for the future as well.

     If we are so timid that we are unwilling to let our convictions
compete with those of others, and if we fail to support our convictions
with reason, effort, and resources, then progress can never be ours. 
But if we recognize that the history of the world must include the
biography of inspired human beings (be they blind or sighted) who have
faced and surmounted prodigious  obstacles, then a future with greater
opportunity than we have ever  known (both for us and for society as a
whole) is an achievable  goal. Much of the world's history has been
written without us because until recently we had not developed the
mechanism to handle conflict.  But we will be absent from the
biographer's notebook no longer.  We have created the vehicle; we are 
collecting the resources; and we have certainly found the will.  We, the
National Federation of the Blind, are prepared to meet contention and
have conflict if we must, but our purpose must be seen in perspective. 
We recognize that, even for the winner, all conflict has within it an
element of loss; we recognize that the potential gain must equal or
outweigh the risk; and above all, we recognize that progress cannot come
without conflict, even for those who want peace.  With that
understanding and in that context, let me make one point unmistakably
and irrevocably clear:  We intend to have progress!

     There are two dangers in conflict:  one that we will have too much
of it; the other that we will have too little.  In the beginning of our
organization (in 1940 when Dr. Jacobus tenBroek and those few others who
were with him brought the National Federation of the Blind into being in
Wilkes-Barre, Pennsylvania), there was almost no conflict at all about
blindness or the blind.  Blind people had traditionally been without
power, and until we came to know our strength, this remained true.  It
is not that there was no hardship.  God knows, there was plenty of that.

      Employment opportunities for blind people were almost nonexistent. 
The vending program established under the federal Randolph-Sheppard Act
was in its infancy, with very few participating vendors; and working
conditions and wages in the sheltered shops for the blind were dismal. 
Education for blind children was narrowly focused and dead-end in nature
even though the schools for the blind had existed for a hundred years
and even though some of them had excellent academic programs. Training
in mobility and the skills of daily living that the blind need in order
to function and compete in the world at large had not yet been
developed--at least, not as we know those skills today.  Although the
Social Security Act had been adopted five years earlier in 1935, the
programs for the blind that are now a part of it had not been created.
Despite these disadvantages, we found the strength to organize--and
then, necessarily, we found ourselves in the midst of conflict.

      By the 1950's our activities had expanded to include making
surveys of state programs for the blind.  In these surveys we, the
organized blind, criticized the programs that were not providing
adequate services--which at the time meant most of them.  This role of
vigilant monitor of programs dealing with blindness remains as important
today as it was then. Programs established to serve the blind must be
responsive to the needs of the blind.  The blind who are to be served by
these programs are, collectively, the best judges of their performance.

     However, some of the officials in the field of work with the blind
had never imagined that the blind (the people they thought of as their
clients) might try to speak and act and think for themselves.  They
believed that it was somehow inappropriate for the blind to examine the
performance of the governmental and private agencies established to give
them service.  With our insistence that the blind have a right to a
voice in shaping programs that affect their lives, there came a
heightened awareness of the Federation, as well as increasing
controversy. If there was to be any progress at all, how could it
possibly have been otherwise!

     During the decades that followed, conflict within the field of work
with the blind ebbed and flowed, but it was always present.  Most of the
time the disputes involved the organized blind on the one hand and
officials of governmental and private agencies for the blind on the
other.  By the late 1980's, however, the bitter clashes that had so long
characterized matters dealing with blindness had diminished to such an
extent that they had become--if not nonexistent, then certainly muted.

     What happened to cause this alteration?  And of even greater
importance, what does the change signify for the future?  If there is no
conflict, there can be no progress, but we must always keep in mind that
the first great danger in conflict is its potential for destructiveness-
-the risk that it may get out of hand and eliminate the good along with
the bad.  We must, however, with equal clarity remember the second great
danger inherent in conflict (just as destructive as the first, and
perhaps more threatening--certainly more insidious because it is usually
not recognized) that there may be too little of it--that the total
absence of controversy may signify stagnation.  The trick, then, is to
strike a balance--the minimal amount, enough but not too much.

     Is the apparent diminution of controversy an indication that the
creative spirit regarding blindness and the blind is gone? Although
confrontation within the field of work with the blind is no longer one
of its principal characteristics, conflict regarding blindness still
exists.  The basic misunderstandings about blindness and the blind have
not been totally eradicated. There are still many among officials of
agencies for the blind, among the members of the general public, and
even among the blind themselves who believe that blindness means
inferiority--that the loss of eyesight is equivalent to the loss of
productive capacity.  This means that conflict (although not always
represented by confrontation) is still very much with us.

     However, there are also an increasing number of people who
recognize that blindness is not the devastating affliction that, at one
time, it was almost universally thought to be.  This alteration in the
perception of the nature of blindness has largely occurred because of
our strength and our activities--because of the determined efforts of
the National Federation of the Blind.  Today, in many instances, those
managing programs for the blind have come to realize that blind people
are not enemies but potential allies.  Furthermore, acceptance of blind
people as valued participants in the broader community is increasing. 
The process has been a long and painful one.  But through the strife and
confrontation we have accomplished an objective which was, at one time,
not only implausible but virtually unimaginable.  We have created the
potential for alliances within the field of work with the blind that
permit us to expand our efforts.  If we properly assess the
opportunities which are becoming available to us (with all of the
dangers that accompany those opportunities) and if those involved in
programs for the blind can bring themselves to make the same
assessments, we will no longer face the disadvantage of constant
abrasive conflict within the arena of blindness.  We may even be able to
forge a cohesive alliance that can bring real equality and full
independence to the blind.  This is the heritage of conflict.

     The possibility of alliances with the agencies for the blind offers
opportunities which have not been available in the past, but if those
alliances come, they will not come without danger. Those who join
alliances must, of course, have a shared objective, a mutual
understanding, and a common bond.  The best alliances demand not only
commonality of purpose but mutual trust as well.  If we let the agencies
trust us, we must be prepared to trust them.  If we engage in alliances
with others, we accept and promote (even if only passively) the
positions they espouse and the actions they take.  Consequently, we must
guard against the danger of being bamboozled by the rhetoric of
cooperation. Otherwise, we may come to believe that those things which
in the past we deplored in the performance of many of the agencies were
really not so bad--when it is perfectly clear that they were.

     We may be tempted to assume that, because we have formed alliances,
it would be difficult or impossible to survive without them.  On the
other hand, if we are not quick on our mental feet, we may fail because
of former conflicts--struggles that are no longer relevant--to take full
advantage of the cooperation that might be achieved.  Despite all of the
dangers that accompany our burgeoning relationships with programs for
the blind, these growing interactions give us the opportunity for more
progress than was formerly possible.  Although conflict need not be in
the form of confrontation, it must occur for future growth. Therefore,
if the agencies for the blind want to join with us, what are they
prepared to bring to the table?  Our agenda will always be action-
oriented, and anybody who makes an alliance with us must be willing to
help promote our projects, and not just expect us to promote theirs.

     What will be the focus of our collective effort today and in the
years ahead?  Although conflict within the field of work with the blind
has diminished, misunderstanding about blindness in the public mind
remains all too common.  Unless this misunderstanding is eliminated, we
who are blind will be prevented from reaching our potential.  Therefore,
the direction of our action in the years ahead is perfectly clear.

     There are still some people who believe, even today, that blindness
is entirely negative and that the blind have nothing to contribute.  A
report from the National Eye Institute, a division of the National
Institutes of Health, entitled Vision Research, A National Plan: 
1994-1998, describes the plight of blind people in a way that holds out
little hope for those who are unfortunate enough to be afflicted with
that condition.  The report says in part:

                 Although seldom fatal, eye diseases cause suffering,
            disability, and loss of productivity for millions of
            people in this country and throughout the world. These
            diseases may have their most pronounced effects on an
            individual's quality of life, affecting the ability to
            act independently, recognize family and friends, read,
            drive a car, and perform a host of other activities that
            we consider routine daily tasks.

     So says the report, but the writers from the National Eye Institute
add something else.  They tell us that sight is "our most precious
sense."  It will come as no surprise that the report contains nothing
about the abilities of blind people or the alternative techniques used
by the blind.  We who are blind (the National Eye Institute would have
us believe) have lost our independence, our ability to read, our
productivity, our capacity to recognize family and friends, and our
chance to engage in a host of other routine activities.  There is one
small consolation though:  Blindness may cause suffering, but at least,
as these authors tell us, it is seldom fatal.

     What a dismal picture! Is it true that our lives are devastated by
the loss of sight?  Can it really be said that sight is our most
precious sense?  What about the sense of touch?  If we were totally
without it, we would lose one of our greatest protections, the ability
to feel pain, which really means the ability to survive since pain tells
us when our bodies are being injured by hot or abrasive objects, or when
we are too cold or have eaten or drunk damaging substances.  Of course,
the reverse of pain is pleasure, and certainly the sense of touch
provides more of that than most of us have thought about.  Begin with
sex, and take it from there.  But all of this quibbling about which of
the senses is most precious misses not only the meaning of daily purpose
for the blind but the purpose of life for everybody.

     Life is more than the five physical senses.  There are other
senses, those that make us human.  What about the sense of judgment; the
sense of commitment to family and community; or, for that matter, the
sense of humor?  Perhaps one of our most important senses is the good
sense to know when to disregard the opinions of the National Eye
Institute.

     We are not saying that sight is of no importance--it is.  However,
sight is not the essence of life.  It may be pleasant to see a face or
drive a car or watch a sunset, but the absence of these things does not
in and of itself cause mental imbalance, physical immobility, or
economic destruction--nor does it rob us of pleasure or the capacity for
a full life.  We who are blind are no longer willing to permit fear and
misunderstanding about blindness, dressed up in the language of a
scientific report, to limit our lives.  We will avoid conflict when we
can, but as I have said before, we intend to have progress.

     The research of the National Eye Institute has what might be called
a sight bias.  Without examining the fundamental reason for doing so,
these researchers assume that those who possess eyesight will do well
and those who are without it will not.  These researchers are not the
only ones who conduct business from this point of view.

     Here, for example, is a report from the Baltimore Sun for August
10, 1994:

                 Some scholars [the article says] believe most
            audiences tend to hear what someone says first
            with their eyes.

                 "The research on how listeners process vocal
            messages shows that 55 percent of the impact
            is visual, 38 percent is vocal [meaning the
            tone of voice] and 7 percent is verbal," says
            Andrew Wolvin, chairman of the department of
            speech and communication at the University of
            Maryland, College Park.

     How does this research as reported by the Baltimore Sun apply in
practice?  If only 7 percent of a message arrives verbally, and 38
percent is conveyed by the tone of voice, does this mean that the blind
are deprived of the remaining 55 percent?  What about sighted people who
talk on the telephone?  Do they lose 55 percent of the message?  On the
other hand, do blind people (being deprived of sight) concentrate more
fully on the language being presented?  Is the visual information (all
55 percent of it) a distraction from the real meaning of the speaker?

     You can argue it both ways, and the Arkansas Gazette demonstrates
this.  On February 12, 1995, an article appeared which declared that, in
certain instances, sight is more of a hindrance than a help.  The paper
reported in part:

                 A study published recently says the best chance
            of catching a lie is when you're not distracted
            by how the liar looks.

                 "People [the article continues] spend a lot of
            time remembering what they are doing with their
            faces," said Joseph Cappella, professor at the
            Annenberg School for Communication at the University
            of Pennsylvania.

                 "We have a strong visual bias," agreed Judee
            Burgoon, professor of communication at the
            University of Arizona.  If you're watching
            for lies, "it's not a bad idea to close your
            eyes."

     This is the report from the Arkansas Gazette, and following its
logic, it may be argued that the blind, not being distracted by the
visual image, get more out of a speech or an audio presentation than the
sighted.

     This proposition is reinforced by a scientific study being
conducted by the National Institutes of Health.  According to a report
drafted in the winter of 1995, the visual cortex of a blind person's
brain is activated by non-visual stimuli.  Even though our hearing is no
different from the hearing of the sighted, perhaps a larger segment of
the brain of a blind person is used to process auditory information,
which means that the processing is done with more efficiency, more
speed, and more analytical power.

     Or does all of this speculation miss the point?  The need to gather
information is as important for the sighted as it is for the blind, and
as important for the blind as it is for the sighted.  Human beings are
inventive.  They use alternative channels to get the same information. 
As long as the knowledge is obtained, it makes very little difference
what mechanism is used to get it.  Our experience demonstrates that the
blind can compete on equal terms with the sighted, and those who
describe us as lacking in perception because of our inability to see
(or, for that matter, as having more of it because we don't) have a lot
to learn.  Perhaps they should go back to the drawing board and try
again.  As it is, they invite controversy without purpose.

     Maybe the members of the press and the researchers at the National
Institutes of Health can be excused for their lack of comprehension
because they have very little experience with the blind.  However, those
who are in the field of work with the blind should have a more thorough
understanding--and, thankfully, many of them do.  A book of helpful
hints for the visually impaired, published in 1994 by Vivian Younger and
Jill Sardegna, titled "A Guide to Independence for the Visually Impaired
and Their Families," expresses the view that blindness is completely
debilitating.  It is, they suggest, possible (by using the material
contained in their book, of course) to regain a measure of independence. 
However, blindness (they say) alters dramatically almost every aspect of
life.  For example in the chapter dealing with social interactions, the
authors say this:

                 The more impaired your vision becomes, the less
            you may feel a part of the sighted world.  Vision
            is a major source of information gathering, and
            without it you are cut off from a lot of clues
            you once unconsciously depended on.  Where you
            were once able to see a friend's facial expression,
            you may now be able to see only his shadow.  He
            may eventually become a disembodied voice.


                 You also may [the publication continues] feel
            detached from your own body. You may wonder
            what your face is doing or what emotions it is
            expressing.  You may even feel faceless.

     I interrupt the narrative to ask:  Can they really believe it?  I
have heard many bizarre experiences ascribed to the blind, but I have
never before in my life known anybody to believe that blind people
become detached from their own bodies and unconnected with their own
faces.  Have you ever really wondered what your face was doing?  Yet
there are those who will question why we object!  But there is more:

                 How [ask the authors] do you deal with
            these problems and start becoming reoriented
            to the world?

                 Ask a friend over to watch television--and
            you can serve canned juice and potato chips.  Have
            your children take turns walking with you to the
            corner each evening until you feel safe and
            confident traveling alone.

                 You can call family members and say, "We're
            having a change of menu.  I'm serving pizza and
            soda this week--and by the way, can you pick
            up the pizza on your way over?"  Serve that double
            cheese and anchovy deluxe on paper plates and drink
            your soda from cans until you have mastered pouring.

     This is the advice given in Chapter 10, and it speaks for itself. 
Although some newly blinded persons may temporarily have trouble in
pouring, there is really nothing very intricate about it.  The trouble
with this book is not the detail of it but the emphasis and the overall
perspective, the custodial tone and the looking down.

     But these authors have not exhausted their recommendations to
assist us in gaining full and independent lives.  Earlier in the
publication (in the chapter called "Getting Reacquainted with Your
Home") there is a passage offering advice to the blind person about the
bathroom.  If I hadn't read this myself, I would have found it hard to
believe.  See how this strikes you.  The authors say:

                 It is unavoidable--you will need to find
            your way around the bathroom almost immediately.
            Fortunately, because it is small-- and because
            we often use it in the dark--the bathroom may
            be the easiest room in the house to get accustomed
            to with little or no vision.

                 Make your starting point [the authors say]
            the entrance to the bathroom.
     
      I interrupt to ask where else would you make the starting point? 
But back to the text:

            Although you can probably count the number of steps
            to the toilet, start by following along the wall
            using the sweep/step method.  Notice the contrast
            of the bath mat to the floor, the towels to the
            wall, or the tub wall to the floor.  If you are
            worried about slipping on the bath mat, you can
            tape it down or replace it with the nonskid type.

     This is what the authors say--and again, the trouble is with the
emphasis and the talking down.  If a person is elderly and frail, then
he or she (whether sighted or blind) may be concerned about slipping on
the bath mat and may want to tape it down or replace it with the nonskid
type.  But age is not mentioned.  It is blindness.  And as all of us in
this room know, blindness has absolutely nothing to do with slipping on
a bath mat.

     As to the foolishness about counting the steps from the  bathroom
door to the toilet, I won't dignify it with a comment.  Persons who need
to use that method won't know why they started or what to do when they
arrive.  As to trailing the wall with a sweep/step method:  Forgive
them, Lord.  They know not what  they say.

     But we are not through with the bathroom.  Consider how these
authors deal with the bathtub.  Here is what they say:

                 When you get to the bathtub or shower, take
            a few practice attempts getting in and out. If
            you have trouble getting into the tub, face the
            wall and brace yourself against it with your hands
            for support.  Next, feel with your knee for the top
            of the tub.  While holding onto the wall, step up,
            over, and into the bathtub.

                 To get out of the tub, just follow these
            directions in reverse.

     This is the advice from the guidebook for those who have become
visually impaired.  It was published in 1994.  Is all conflict in the
blindness field at an end?  Don't you believe it!  But before we leave
the bathroom, here is one final hint from the authors:

                 The biggest problem you will probably ever
            have in the bathroom [they say] is finding the
            toilet paper.  The dispenser is often located
            in the most inconvenient and illogical place.
            So take time when exploring this room to practice
            finding the toilet paper while sitting on the toilet.

     I remind you that the authors are speaking about the exploration of
the bathroom in your own home.  How often have you lost the toilet paper
dispenser?  How much practice is required to find it?  You may even have
designed the layout.


     With self-proclaimed experts like these offering advice to the
blind, is it difficult to understand why we sometimes face attitudes
which question our initiative, our judgment, our competence, and our
very capacity to be full citizens and human beings?  How should we
respond?  Even though all conflict has within it an element of loss, we
cannot accept this erroneous description.  It must and it will be
challenged.  We have created the vehicle to handle conflict, and you can
put money in the bank on this:  We intend to have progress!

     The writings of the public press are often a reflection of 
popular thought.  A report from the Denver Post on December 18, 1994,
describes the reactions of a veteran reporter when visiting a program
for young blind children.  This emotionally charged feature titled
"Brightening the Lives of Blind Babies" says:

                 Their mysterious, dark world is full of
            danger and unimaginable challenges.  They hear
            voices but cannot see faces.  They hear music
            but cannot see the band play.

                 They must learn to walk without ever having
            seen someone take a step.  They must learn to
            grasp without ever having seen a hand.  They must
            learn to read without ever having seen a word.
            They must learn to eat without ever having seen
            a spoon.

                 They are blind babies.

     That's what it says--and it just gets you right here, doesn't it? 
Whether it's little kittens--little hungry, sore-pawed kittens--or
whether it's a blind baby who has to learn to walk without ever having
seen somebody else do it, the emotion just drips, and the tears come
rolling after.  As Mark Twain said in another context:  Great legend;
great lie.  Pass on!

     And, of course, it is a lie, but that is not the real trouble with
it.  I have no objection to letting people clean out their sinuses,
their tear ducts, or their guilty consciences with a heavy dose of false
beliefs and misplaced emotion--but I do have an objection to condoning
such exercises when they damage lives and blight futures.  And in this
case that is exactly what is happening.

     Of course, blind children learn to eat without having seen a spoon,
and they continue eating that way for the rest of their lives--along
with a knife and a fork into the bargain.  Most of us here in this room
have done it tonight, but we haven't mixed tears with our gravy--and
that goes for the sighted among us, too.

     Have I been too hard on this reporter? Not at all.  Listen to more
of what he says:

                 Nothing in thirty years of journalism--three
            decades of seeing misery and sorrow and suffering
            on five of the Earth's continents--had prepared
            me for the emotional impact of this assignment.

                 When I first walked into the room, the sadness
            overwhelmed me.  I stood there, a veteran journalist
            who isn't supposed to get choked up--and I fought
            back tears.

     So have I been too hard on him?  You bet I haven't.  As any blind
person with an ounce of sense knows (and most sighted people, too, if it
comes to that), this is a bunch of disgusting twaddle.  Yes, it does
make you want to cry--and yes, for the blind children about whom he is
writing.  But not for the reasons he gives.  The tears come for the
damage this so-called "veteran journalist" is doing--the doors he is
helping to close, the dreams he is helping to kill, the futures he is
helping to twist and destroy.  But he is not finished:

                 A little blind girl was sitting cross-legged
            on the floor of a darkened room [he says], next to
            a bright white table of light, desperately trying to
            pick up the brightly colored plastic triangles, squares,
            and circles.

     The operative word, of course, is "desperately."  If she had just
tried to do it by using her sense of touch, she might not have had any
problem with it.  But back to the text:

                 Without a bright light [the reporter continues],
            the little girl couldn't see the shadowy shapes--but
            even with brilliant light, she can't see the colors.

                 One of her playmates today is a little girl who
            was born without eyes and who will never detect a dim
            shadow or a vague shape. 

     There you have it--the cause of misery:  two little girls playing
together--both blind. Is that really tragic?  But the author is not
finished:

                 My first impression [he says]--as is most
            visitors'--is one of near hopelessness.

                 Every tiny lesson is a monumental struggle for
            the child and for the parent. Learning how to pour
            milk into a glass can take years.

     If it takes years, probably you can't learn to do it at all. But
back to the report:

                 By the end of my second visit [he says], I had
            begun to conquer that sense of awful hopelessness.

                 I had seen the smiles, and heard the laughter,
            and witnessed the courage.

                 They exercise, they discover, they socialize.
            They talk, and they sing, and they laugh, and they
            touch--but all the time they are learning to cope
            with the unseen, scary world around them.

     So says the reporter.  The children have courage.  The world is
scary.  This description reminds me of a conversation I once overheard
between two sighted volunteers who were planning an outing for blind
people who were members of a large church.  One volunteer said to the
other:  "First we give them lunch.  Then we walk them on the lawn."

     Undoubtedly our veteran journalist would have felt right at home
"walking them on the lawn."  But we should not do this man an injustice. 
He has not written casually.  He has thought it through and has a
philosophy of blindness:

                 Since 90 percent of a person's learning is by
            sight [he says], these kids suffer the biggest
            learning handicap of all--and many of them have
            other physical disabilities to add to their burden.
     
     In the spirit of his philosophy, here is how he describes the
techniques used by these blind children to identify objects:

                 To find his seat at the lunch table [the veteran
            journalist tells us], four-and-a-half-year-old Vincent
            feels along the row of chairs, touching an item on the
            back of each.  When he finds the piece of macaroni, he
            knows that's where he sits.

                 Vincent has chosen macaroni as his sign, to mark
            his chair and his storage cubicle--because he can't see
            his own name.

     Does it occur to you to wonder what stimulated this tear-jerking
piece of trash?  Well, the answer is not hard to find.  The article
appeared a week before Christmas, and the program for the blind in
question was being hyped to receive donations from the 1994 charity
drive then being conducted by the Denver Post.

     The final portion of the article is thoroughly appropriate in the
context. Here is what it says:

                 To contribute, use the coupon on Page 8T in
            today's Denver Post.

                 Please--do it for the Macaroni Kid.

     So that's the Christmas present the Denver Post gave to the blind
of the nation last year.  If any of you leave your chairs and plan to
return, I assume you will tie a lettuce leaf on the back or smear a
little gravy for identification.

     But enough of this foolishness!  In reality it isn't funny.  We are
dealing with something that is as sinister and serious as the lives and
destinies of us all.  The fact that most people won't see it that way
doesn't lessen the damage.  It makes it worse.  As to the Macaroni Kid,
he won't thank the Denver Post as he grows up--or if he does, there will
truly be cause for tears and pity--tragedy indeed.  His chance for a
full life will be much enhanced if articles like the one I have just
quoted cease to be written.

     And here is where we come in, we of the National Federation of the
Blind.  If we are willing to let this article (and others like it) go
unchallenged, all will be peace and goodwill.  But if we challenge and
debunk such articles (as surely we will and must), conflict and
resentment will inevitably result.  In the circumstances and with
carefully considered and deliberate purpose, I say:  Let it be so.  Let
the conflict come.  In fact, if it does not come to hunt us, we will go
and hunt it.  We will do it for the blind of the nation; we will do it
for ourselves; and, yes, we will do it for the Macaroni Kid.  He
deserves better than he got, and we will help him get it.

     And it is not just the Macaroni Kid who gets hurt by articles like
the one in the Denver Post.  This spring, as I was preparing for the
convention of the National Federation of the Blind, I received a call
from a woman who was clearly in a state of agitation.  She told me that
she had been receiving our literature and that she didn't want it
anymore.  From the tone of her voice I could tell that she was extremely
upset.  I asked her what the trouble was, and she responded by telling
me that she had asked in the past to be removed from the mailing list to
receive our literature and our monthly magazine, the Braille Monitor,
and that she could not have this literature coming to her home.  She
said that her children would see it.  I said that our literature might
be of help to her, and she said: "I realize that, but my children are
not dumb.  They will know."

     With real reluctance and great sadness I removed her name from the
mailing list.  This woman is becoming blind.  We had been sending her
our literature because she clearly needs it. However, she thought that
she could hide her blindness from the members of her own family--and she
felt the need to do so.  She won't accept our help because she is
ashamed of becoming blind, and she is making a desperate effort to
prevent others from learning that she is losing her sight.  She wants to
keep this from her children.  She wants to protect them from the shame,
and she wants to hide.

     With such an attitude this woman is destined for failure. Such is
the result of articles like the one in the Denver Post. Such is the
predictable fate of the Macaroni Kid unless we can change it.  Such is
the tragedy of blindness.  Such is the challenge for all of us.

     As I have said, we in the Federation will avoid controversy when we
can, but we will meet it when we must.  We have the vehicle to handle
conflict, and we know how to use it.  We know that all conflict contains
an element of loss but that without conflict there is stagnation.  There
is no progress.  And one thing is certain--we intend to have progress.

     As everybody knows, we live in a time of turmoil.  The federal
government is re-examining its role in programs for the blind, and the
state governments are doing the same.  So is the private sector, and so
are we.  A few years ago many of the groups of the disabled (including
some of the blind) seemed to think that the Americans With Disabilities
Act would solve all (or, at least, most) of our problems--but we in the
Federation never felt that way--and we don't feel that way now.  Whether
the restructuring of public buildings, the redesigning of the workplace,
and the reconfiguration of the environment mandated by the ADA are good
or bad things is not pertinent to what I am saying tonight.  What is
pertinent is this:  Ultimately government cannot make us free, cannot
make us equal participants in society.  Business cannot do it; the press
cannot do it; the public at large cannot do it; and the agencies for the
blind cannot do it.  We will either do it for ourselves, or it will not
be done.  Others can help (and certainly they can hinder)--but in the
total scheme of things they cannot give us freedom, and they cannot keep
us from having it.  We have come too far for that.  We are too strong,
too determined, too well organized, too knowledgeable about our own
needs and strengths, and too close to the final goal to allow it to
happen.

     I want to be clearly understood.  We are not seeking unnecessary
conflict, and we are not trying to belittle the importance of the help
which agencies for the blind and the general public can give.  Without
goodwill and understanding on the part of the public, we can't make it. 
But the same is true of every other segment of society.  I believe we
will have public goodwill and understanding because we will work for it
and earn it.  I also think we need the assistance of the governmental
and private agencies doing work with the blind, but we must establish
the context and define the terms.  The nature of the contact with the
agencies and the extent of their influence must be limited, not total. 
We must have partnership, not custody.

     There is still much to be done as we move from second-class status
to first-class membership in society.  Certain representatives of the
press; some of the scientific community; the remaining misguided, self-
proclaimed experts in the field of work with the blind; and even some of
us who are blind hold outmoded notions that look to yesterday instead of
tomorrow.  But with all of our problems we are making more progress than
we have ever made, and our future is bright with hope.

     As to our relationship with agencies for the blind, conflict has
diminished, and increasingly we are considering alliances and turning
outward to broader confrontations.  This does not mean that all conflict
inside the blindness field is finished or that it will not recur.  It
simply means that we are making progress. We take pride in our heritage,
both in the progress and in the conflict which was necessary to achieve
it.  What we have done has worked.  Look about you tonight for the
evidence.  We, the blind, have come here in our thousands.  We have come
from every part of the nation.  We have come with our hopes and dreams. 
We have come to reaffirm our unity and purpose as the strongest
collective force for growth in matters dealing with the blind.  We have
come, not only to remember the past, but to plan for today and to build
for the years and the decades ahead.  We have come with the knowledge
that we possess the capacity to meet the challenge.  As we have
repeatedly said, we want no strife or confrontation, but we will do what
we have to do.  Our future is in our own hands, and it has never looked
better.  If we do not go the rest of the way to full membership in
society, the fault will be ours--not somebody else's.  We can ask no
more; we will accept no less.  And make no mistake!  We intend to have
progress!  My brothers and my sisters, let us make it come true.

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

                    The Courtesy Rules of Blindness

[Illustration:  blind man walking with long cane and briefcase]

     When you meet me, don't be ill at ease.  It will help us both if
you remember these simple points of courtesy:

1.   I'm an ordinary person, just blind.  You don't need to raise     
your voice or address me as if I were a child.  Don't ask my spouse what
I want --"Cream in the coffee?"-- ask me. 

2.   If I am walking with you, don't grab my arm; let me take     
yours.  I'll keep a half-step behind, to anticipate curbs and steps.

3.   I want to know who's in the room with me.  Speak when you     
enter.  Introduce me to the others.  Include children, and tell me if
there's a cat or a dog.  Guide my hand to a chair.

4.   The door to a room, a cabinet, or a car, left partially open, is a
hazard to me.

5.   At dinner I will not have trouble with ordinary table skills.

6.   Don't avoid words like "see."  I use them too.  I'm always     
glad to see you.

7.   I don't want pity.  But don't talk about the "wonderful     
compensations" of blindness.  My sense of smell, touch, or hearing did
not improve when I became blind.  I rely on them more, and therefore may
get more information through those senses than you do -- that's all.

8.   If I'm your houseguest, show me the bathroom, closet, dresser,
window -- the light switch too.  I like to know whether the lights are
on.

9.   I'll discuss blindness with you if you're curious, but it's an old
story to me.  I have as many other interests as you do.

10.  Don't think of me as just a blind person.  I'm a person who     
happens to be blind.

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

                    Dialogs About Diabetic Dynamos 

                        by Debra Frank, MS, MS

An Interview with Bill Davidson

[Photo:  portrait.  Caption:  Debra Frank]


     For decades now Harley-Davidson has been a familiar name in the US
and worldwide.  Bearing the name, with all its notoriety, is a real
responsibility, but Bill Davidson, grandson of the motorcycle company's
founder, is used to responsibility.  He has had insulin dependent
diabetes mellitus (IDDM) since age three and to this date is one of the
most congenial and healthy diabetics on the planet.

     Things were not always easy for him at work.  Bill didn't walk into
the H-D main office at age 18 and say:  "Hi guys!  It's my turn to run
the show."  When he felt he had completed an adequate amount of academic
and professional training (he has a graduate degree in business), Bill
made an appointment with the company's chief executives and interviewed
for an administrative position.  It took him three sets of interviews,
but he finally landed a job he was suited for. 

     For three decades Bill has been balancing his life around his
diabetes.  "I am a diabetic," he says without a flinch, "I never hide my
responsibility or hesitate to discuss it with anyone.  I was lucky my
parents learned as much as they could, so when I was old enough I was
able to take care of myself with little trouble and no hang-ups.
Diabetes is a serious disease, but denying it, ignoring it, or being
ashamed of yourself is not the way to approach it,"  says Bill, "I have
to travel a great deal with my job and I find people around the world
are understanding first, then very curious.

     Bill lists several things he does to prepare for travel.  "It is
important to maintain your routine," he states, "and often difficult
when you cross time zones and enter countries with little public
awareness of the diabetic diet.  For instance, I always carry my own
artificial sweetener and diet beverage overseas.  Finding a diet soda is
not always that easy!  Additionally, I try to adjust my eating and
medicine schedule a few days before I travel, so I am not dealing with
both jet lag and the change in time."

     Bill lives with his family in Milwaukee, Wisconsin, the home of
Harley-Davidson Motorcycles.  Having been brought up within a community
of free-spirited yet loyal family and friends, Bill has always taken
responsibility for his health care and is a true role model for other
diabetics.  Over the years he has shared his experiences with many other
diabetics and their families.  In the 1990s he has become increasingly
active in education and research for the American Diabetes Association. 

     Personally, Bill Davidson is living the good life, embracing his
diabetes, appreciative of his positive state of health.  He enjoys his
work, and often goes on the road adventuring, road-testing new products. 
Particular about his daily routine, Bill makes blood testing and
multiple injections an absolute priority.  He follows a daily exercise
routine and enjoys almost any outdoor sport from windsurfing and scuba
diving to serious Alpine/downhill skiing.

     Bill Davidson's story is truly inspirational and one I am glad to
share. 

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

                          Scholarship winners


     In the Summer 1995 edition of the VOICE, Debra Frank announced the
Angelo Centano Golf Scholarship.  Sponsored by the St. Therese Knights
of Columbus, of Valley Stream, NY, the event was a memorial to the late
Angelo Centano, a blind, insulin-dependent diabetic athlete whose motto
was "quitters never win and winners never quit."  Open only to
contestants with type I diabetes, the contest required a 300- to 600-
word essay about any aspect of athletics or physical activity which
winning the scholarship would help the entrant achieve.

     A number of VOICE readers rose to the occasion.  Responses were of
such high quality that the prize, originally one $500 scholarship, was
expanded to include an award of $250 for second place (donated by
Diabetes Home Care, of Crescent City Florida).

     Nick Petnick, of State College, PA, winner of the $500 scholarship,
wrote of the victories he has won against diabetes, blindness, leukemia,
and despair.  His special desire?  To have a tandem bicycle, so he could
ride with his family.  We wish him many happy miles.

     Sherry Gordon, of Kalamazoo, MI, winner of the $250 prize, wrote of
how her blindness (from diabetic retinopathy) has changed the types of
sports in which she participates, but has not affected her level of
competitive participation.  A member of the Michigan Blind Athletic
Association, she travels frequently to tournaments, and states that her
award will be used for athletic travel expenses and equipment.  We wish
her many victories.

     These winners prove that blindness need not be any barrier to
athletics and physical activity.  They do, indeed, "run on insulin."

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

            New Dietary Guidelines for Diabetes Management
                         by Mimi Moore, MS, RD

     Ms. Moore, a Registered Dietitian, gave the following as a keynote
address at the 1995 annual conference of the Diabetics Division of the
National Federation of the Blind.  The conference took place on July 3,
1996 at the annual convention of the National Federation of the Blind in
Chicago.  

     Diet is very important in the maintenance of quality of life. 
Progression in science has guided us in making the very best food
choices in our daily menu planning.  As the saying goes, "you are what
you eat."  Life span increases as we learn to eat more nutritiously.

What about diet and diabetes?

     Research results have provided us with some new recommendations for
diabetes care and management.  Many of you have heard of the Diabetes
Control and Complications Trial (DCCT).  This was a ten-year project
that involved 1441 participants.  Each volunteer was randomly assigned
to one of two groups, the conventional treatment group or the intensive
treatment group.  After nine years the study was halted and results
given:  Complications of diabetes can be prevented or delayed with
intensive management.

     One year ago, revised nutrition recommendations for diabetes
management were issued and supported by the American Diabetes
Association (ADA).  The emphasis was placed on individualization of
care.  There is not just one standard plan of mangement for all persons
with Type I and Type II diabetes.

What is meant by intensive therapy?

     Modified care and management has developed through use of the
health care team (nurse, dietitian, physician, pharmacist, counselor and
exercise physiologist may all be part of the team). This was one of the
main factors in the success of the DCCT.  Intensive therapy is now
advised for optimal blood glucose control.

     Intensifying management means improving control, by increased daily
blood glucose checks, multiple injection therapy, and making continuous
adjustments in the coordination of diet, exercise and insulin or
medication.

     Nutrition therapy is a necessary component in the daily plan for
diabetes management.

Long-term dietary goals include:

*    Maintenance of near normal blood glucose levels

*    Achievement of optimal blood lipid levels

*    Providing adequate calories for reasonable weight
     maintenance, normal growth and development, pregnancy and lactation

*    Prevention and treatment of acute and long-term nutrition related   
     complications (hypoglycemia, short-term illness, renal disease,     
     hypertension, cardiac disease)

*    Improvement of overall health, incorporating guidelines and         
     nutrient recommendations for all healthy Americans.  These goals    
     are not accomplished by one single method of meal planning. 

      Traditionally, the meal plan has been conveyed via the Food
Exchange System, which provides a good basic foundation for
understanding the nutrition principles of diabetes management. 
Variation in this method occurs with food choices made within each Food
Exchange Group.  Individualization depends on the amount and type of
food eaten.  In 1986 the ADA dietary guidelines recommended set nutrient
proportions for nutrient composition of the diet:  Up to 60% of daily
total calories from carbohydrate, 12-20% of daily total calories from
protein and 30% or less of daily total calories from fat.
     
     The new 1994 dietary guidelines recommend a shift in nutrient
proportions.  The distribution of carbohydrate and fat is based on the
individual's treatment plan with no mandatory percentages, and 10-20% of
daily total calories from protein.

     The American Diabetes Association's position statement (published
in Diabetes Care, May 1994) follows research regarding blood sugar
response to various sources and types of carbohydrate.   The
recommendation now states that the emphasis on carbohydrate  intake
should be on total amount versus type of carbohydrate.  The  two types
of carbohydrate are simple (sugars) and complex  (starches and fiber). 
In the past we had all been advised to  avoid foods containing sugar or
simple carbohydrate.  Now, with  scientific evidence for support, we
have learned that it is  acceptable to have sugar-containing foods, as
long as they are worked into the daily meal plan and not just added. 
This liberalization of guidelines has allowed for much greater
flexibility in day to day meal planning.

How do we carry out these recommendations and implement intensified
therapy?

     The changes in carbohydrate and dietary guidelines coincide with
recommendations for intensive therapy.  Continual adjustment is the name
of the game--adjusting food to insulin and insulin to food based on
blood glucose levels.  Greater lifestyle flexibility is an outcome.  You
are able to eat a meal or exercise "off schedule."  Carbohydrate
counting has become a popular method in response to modified therapy.

What is carbohydrate counting?

     The focus is on the nutrient carbohydrate because it has the
greatest impact on blood glucose levels.  The other two energy yielding
nutrients, protein and fat, do not affect blood glucose levels to the
same extent.  Therefore, attention is placed on the food groups that
contain carbohydrate.  All foods are made up of a combination of six
nutrients; carbohydrate, protein, fat, water, vitamins and minerals.  In
turn, all foods are categorized into one of six groups; starches, meats,
vegetables, fruit, milkand fat.  Because starch, milk, and fruit are the
main carbohydrate containing groups, they become the focus of meal
planning.  One Food Exchange portion from each of these food groups
equals one carbohydrate serving (15 grams carbohydrate = one
carbohydrate serving).  This is where knowledge of the Food Exchange
System is helpful.  You can use the Food Exchange portions for
reference.
     
     A specific number of carbohydrate (CHO) servings are assigned to
each meal in creating the meal plan.  For instance, three CHO servings
at breakfast, four CHO servings at lunch and six CHO servings at dinner
may be one person's meal plan.  Individualization is key.  Every
individual's meal plan will be different depending on preferences.
     
     One person may eat two fruit and one starch portion for three CHO
servings.  Another person may eat two starch and one milk portion for
three CHO servings.  Suppose you wanted a slice of cake.  The food label
on your packaged cake says 45 grams carbohydrate per slice.  This would
equal three CHO servings.      

     Since the focus is on carbohydrate-containing foods, meat and fat
are not counted for CHO servings.  But do not get carried away with
portion amounts on these foods!  Guidelines are given individually for
these food groups.
     
     No restrictions are placed on moderate consumption of vegetables. 
If large amounts of vegetables are eaten, they need to be counted. 
Three vegetable Food Exchange portions equal one CHO serving.

How does all this fit into the total management routine?

     This is where the health care team is needed.  Insulin doses are
set for the usual carbohydrate serving meal plan.  If more carbohydrate
than the base plan is desired, more insulin is taken.  If less
carbohydrate than the base plan is desired, less insulin is taken.  Each
person's insulin adjustment dose is based on blood glucose values.  It
takes weeks of testing, record keeping and communication with the health
care team to establish the appropriate regimen.
     
     I have gone into detail about carbohydrate counting because it is
the method that now seems best matched to intensive insulin therapy. 
The key is to find a system or routine best suited to your lifestyle and
preferences, making it easy to maintain optimal blood glucose control.

     As a philosopher once said, "Man should eat to live, not live to
eat."  It's good to know that those times when I want to live to eat, it
is OK.  It just takes a few minor adjustments in my routine.

     The following were questions the audience asked Ms. Moore at the
completion of her presentation...

     Q:  When you use the term "intensive insulin therapy," what does it
mean?  Is there a minimum number of shots per day?

     A:  As per the DCCT, the term means three or more insulin
injections per day, to be counted as "multiple injection therapy". 
"Intensifying insulin therapy" could mean going to two shots per day if
you currently take only one--then you are "intensifying" it.  But when
we use the term "intensive insulin therapy." we are talking about pump
therapy (where you have continuous injection) or three or more shots per
day and blood glucose monitoring four or more times per day.  

                 
     Q:  What about a type II diabetic, on just oral medications? What
does "intensive therapy" mean for me?

     A:  As far as the recommendations, these were made for type I
diabetics...But we're assuming that they can also be carried over to
type IIs, because you still need to test frequently to know where your
blood sugars are.  That's important.  You can still adjust your
carbohydrate servings, so that's all a part of it.  As far as working
with your medication, that you need to do with your physician.  However,
you can still carry through many components of the intensive therapy. 
It's just that you don't have any insulin to adjust.

     Q:  Does the ADA have a "Recommended Renal Diet" or is that
something to be developed individually between me and my doctor?

     A:  That's a good question.  It's still individualized, but the
recommendation that protein be decreased is not as severe as it was in
the past.  Today we're saying, for a renal diet, the target should be
about .8 gram of protein per kilogram of body weight, which is about the
American adult recommended amount.  

     Q:  In many situations, diabetics don't get the kind of dietary
advice they need, probably because they're on some sort of state
Medicaid program.  What do you recommend?

     A:  As far as being able to obtain diet counseling with Medicaid,
it is difficult.  You could try contacting the ADA, as a start.  Find
out what programs are available in your area.  Which are hospital-based? 
As far as reimbursement issues, that changes constantly, and varies from
state to state as to item and amount reimbursed. 
     
     For the best results, we need a team approach.  We're seeing that
education does help curb costs in the long term.  If you're able to take
care of yourself, you're able to stay out of the hospital.  We need to
have more teams, to provide better healthcare.  The public health
department usually has access to at least one professional, perhaps a
nurse educator.  There should be a dietitian too.  Check with the public
health department in your city--that would be a good place to start.

     Q:  If you check your blood sugar, and find that it's high, is
there a set formula for how much insulin physicians think you should
take, according to the amount your blood sugar is over?

     A:  There is no standard formula, because it all depends on how you
as an individual respond.  You might come down a given percent per unit
injected, but someone else might need less or more.  It's very
individualized.  You would have to set up a program, establish some kind
of scale, in order to know how much insulin to take when your blood
sugar is past a certain level.  Everybody responds differently, and
there is no set answer.  And if you as an individual are elevated,
perhaps 180, not quite 200, what you may  need is exercise or dietary
adjustment, eating less at mealtimes.  This holds true for special
occasions, times you wish to eat more, as well.


     Q:  What are the "norms" for blood sugar levels?  What are the
current recommendations?

     A:  For NON-diabetics, the acceptable range is 60 to 110 mg/Dl. 
For a diabetic, we recommend aiming for 70 to 120.  Of course the best
range for you depends on your condition.  You need to be careful of
hypoglycemia, especially if you have cardiac complications.  Depending
on the individual person, what complications they have, and how active
they are, the optimum range may change.  With children and infants it is
very hard to detect hypoglycemia, so the ranges may be a little higher. 
Intensive insulin therapy is not recommended for children with diabetes
under under two years of age.

     Q:  We diabetics who are on dialysis face two contrary sets of
dietary requirements.  When one says "you can eat this," the other says
"you can't."  It is hard to establish an individualized diet plan.  Can
you explain?

     A:  The diabetic on dialysis faces the most frustrating of diets,
because there are so many restrictions on it.  You can feel like there's
nothing you're allowed to eat.  There is controversy about what the
standards should be.  Should protein be kept low?  High?  No animal
protein?  Plant only?  How many calories?  Until more is known about how
diet directly impacts renal disease, there will continue to be
controversy.           

     You look at the "macro nutrients;" carbohydrates, proteins, and
fat, but you're also looking at minerals too.  You've got to go deep
into it and pay close attention to your food types and amounts.     

     A higher incidence of hypoglycemia is associated with renal
disease, and you have to figure that into the diet too.  Traditionally,
health professionals have said "treat hypoglycemia with orange juice",
but then somebody comes along and says "no more!" and you have to find
something new.  That's where it helps to work with the same dietitian,
who knows you as an individual, long term.  But do recognize that as
renal disease progresses, you will have to make changes in your diet.    
         
     Q:  You've talked about minerals.  Why do food labels never mention
potassium or phosphorous content?  Where can I get that information? 

     A:  There is a book you can buy, titled Food Values of Portions
Commonly Used, 16th ed., 1994, by Bowes and Church.  This guide lists
all food products, with their analysis.  If you're on dialysis, you need
your own copy.  But the food labels don't have that information because
the average American doesn't need it.
     
     Another source for the detailed materials you need is available
from most dietitians working with renal issues.  This is the information
commonly called a "renal packet."  It is a very difficult diet to
follow, because there are so many factors you need to coordinate.  You
may feel like you have to follow it exactly, but really you don't.  Just
work toward some sort of balance each day.  (Editor's Note:  The NFB
Materials Center in Baltimore has the ADA Food Exchange Lists in Braille
or cassette.)

     Q:  Can anybody use an insulin pump?  What are its advantages and
disadvantages?  How does one deal with the risk of infection at the
injection site?   For diabetics with cardiovascular problems, is an
insulin pump a possibility?

     A:  It should be an option, but needs to be evaluated individually. 
In some cases, like pregnancy, the insulin pump is recommended, because
it does a better job of coping with the ups and downs, and will provide
tighter control.  As far as the risk of infection at the pump site, you
minimize that by frequent changing of your tubing, your catheter,
perhaps more often than the recommended time.  Some people are allergic
to the adhesive tape used to attach the tubing, but that's another
problem.      

     If you are using the pump, you will need to test your blood sugars
four to six times per day minimum.  This is important.  If you want the
pump, you need to commit long term to the testing.  Some people don't
like the feel of the pump at night.  The insulin pump may not be for
everybody.  It is individually evaluated.  It is one of the recommended
ways to institute intensive insulin therapy.

     Q:  If you are overweight, is there a safe way to lose weight while
controlling both diet and insulin?  Should I just go to my dietitian for
that?  Are there other resources?

     A:  Start with your dietitian.  The dietitian may connect you  with
a counselor who'll help you work on behavior changes, not just food
changes.  Any changes of this type, you'll want to be long term. 

     Plan on going "multistep;" one step at a time, set small goals. 
Lose four or five pounds at a time--this amount is advantageous!

     Q:  What if I want some ice cream?  How would I "count" it as a
carbohydrate?

     A:  Are you talking about regular or "lite" ice cream?  We no
longer have just the conventional, high-fat type out there.  Today there
are also ice milks, frozen yogurts, sorbets, and sherbet.  All have
varying degrees of fat. 
     
     If you really want that premium ice cream, what will you leave out
of your diet to balance all that fat?  You have to exchange!  For one
half-cup you have to exchange one bread but also two or three fat
servings.  Somewhere in your meal plan you can eat less meat, so as to
leave out some of that fat.  If you want more for your dollar, have the
sorbet instead, and leave off just a few pieces of bread.  Sorbet is
nonfat.  And remember:  Just because something is "fat-free" doesn't
mean it is calorie-free, or sugar-free!  Even ice cream made with
NutraSweet or sorbitol can be high in carbohydrates, especially if it
has a milk base.
     
     Still another trap is "no sugar added", or "sugar-free". They
contain carbohydrates, because fruit has been added for sweetening. 
Sometimes the fruit-sweetened product contains more carbohydrate than
does the sugar-sweetened one.  Look at the total carbohydrate content on
the label.

     Q:  When I look at a box of cereal, I see listed:  "Total
carbohydrates, complex sugars, dietary fiber, and other carbohydrates." 
With the new guidelines, what should I be looking at?

     A:  Cereal is a hard product to work with.  There is so much
variability, and the different cereals have different serving sizes. 
One-half cup of one may contain the same amount of carbohydrate as one
third cup of another.  I would start by looking at the serving size.  If
I want to eat a big bowlful, I'll look for a flake cereal.  Next, I
would look at fiber content.  If I want high fiber, I will choose bran,
wheat, or oats, as the corn flakes or rice krispies don't have a high
fiber content.        

     As far as the new recommendations, what we're saying is that the
total amount of carbohydrate is what matters, more than what kind.  If
you want frosted sugar flakes, go have it, but then look at what your
total carbohydrate serving is.  That is more important to focus on than
the sugar.  If there are 36 grams of carbohydrate in a half-cup portion,
that's going to count for two servings of carbohydrate.  Look at the
total amount of carbohydrate per serving.  I would also look at fiber
content and serving size.   

     Q:  How do I know if there's sugar in my food?

     A:  Dextrose, fructose, lactose, corn syrup, honey...those all are
sugars. If it ends in  "---ose," it's a sugar.  All simple sugars have
the same calorie content per gram.  With the old recommendations, when
we used to watch out for different types of sugars, we had so much more
to sift through.  Was it corn syrup or was it fructose?
     
     Now, with the new recommendations, we are saying the type of sugar
doesn't matter--you need to look at the total amount.  There may be corn
syrup in one product, fructose in another, but 15 grams of carbohydrate
will react the same, no matter what form it takes.

     Q:  How much carbohydrate per day should a person have?  And what
kind?  If too much of the total comes from sugar, won't that burn off
quickly and cause reactions?

     A:  We used to say that up to 60% of a person's total caloric
intake should come from carbohydrate.  Now, we look at the individual.
There are a lot of "ifs" about total amount.      

     When you're looking at carbohydrate intake, it doesn't matter the
source.  If you have 30 grams, as far as its impact on your blood sugar,
it doesn't matter whether it comes from sugar or starch.  If you eat a
mixed, balanced meal, and stay on your program, you are at no greater
risk for reactions than before.  In fact, compared to fats and proteins,
carbohydrates are the fastest to be metabolized.

     Q:  Can you talk about sodium?  How much should we  have per day?

     A:  As you eat more salt, you crave more salt.  The average
American probably consumes 6000 milligrams per day.  We recommend that a
healthy American consume 2400 to 3000 mg of sodium per day, and 2400 mg,
a "low sodium diet," is what people with diabetes should aim for.

     The more processed foods you eat, the more salt you are consuming. 
Convenience foods, fast foods, anything processed usually has salt or
sugar added.  These alone can probably take you to the 6000-mg mark.

     Q:  I've been told intensive insulin therapy won't work for me,
because I have "hypoglycemia unawareness."  It that right?

     A:  You have to do what is appropriate and safe for you.  What we
call "full-blown intensive therapy,"  with its increased risk of
hypoglycemic episodes, may not be appropriate in your case.  Perhaps you
can intensify, improve your control, without going as far.  Keep those
blood sugars under the best possible control.

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

                       Voice Distributors Needed

     Since the VOICE is now offered free, our Diabetics Division 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.

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

                             Recipe Corner

[Illustration:  fruits and vegetables]

     Recipes this issue are from Mimi Moore, MS, RD, of Chicago,
Illinois.

            Moroccan Couscous with Chickpeas and Tomatoes 

     (Couscous, a wheat product not unlike grits, can be found in
international markets and health food stores)

   1 cup couscous
   1/3 cup dried currants or raisins
   2/3 cup boiling water or vegetable broth
   1 can (16-oz.) chickpeas, drained
   1 can (10-oz.) diced tomatoes with chilies
   1/2 cup tiny frozen peas, thawed
   1/2 tsp. ground cumin
   1/3 cup chopped cilantro
   salt, cayenne pepper to taste

     Combine couscous and currants in medium bowl.  Pour in boiling
water or broth; mix with fork so all couscous is moistened; cover and
let stand five minutes.  Combine drained chickpeas and tomatoes with
their liquid in a microwave safe dish or small saucepan; microwave on
high power for three minutes (or cook) until hot; add peas and cumin;
mix well.  Add salt and cayenne pepper, to taste, to couscous; fluff
with fork to separate grains.  Spoon into serving bowl; top with
chickpea mixture and sprinkle cilantro over top.

     Yield:  8 servings; Per 1 serving:  210 calories; 40 grams
carbohydrate; 9 grams protein; 2 grams fat. 


                      Green Beans with Red Pepper

   1 Tbs. olive oil
   1 large red pepper, cut in thin strips
   1 large onion, thinly sliced
   1 lb. green beans, cooked tender-crisp and drained
   2 Tbs. cider vinegar
   1/8 tsp. crushed dried red pepper

     In medium skillet heat oil over medium-high heat.  Add red pepper
strips and onion.  Saute three to four minutes or until tender. Add
beans; heat through.  Toss with vinegar and dried red pepper. 
 
     Yield:  4 servings; Per 1 serving:  90 calories; 12 grams
carbohydrate; 3 grams protein; 4 grams fat.

 
                          Vegetarian Lasagna

   6 lasagna noodles (about 4 oz. by weight)
   2 quarts water
   2 Tbs. olive oil
   1 cup chopped onion
   1-1/2 cups thinly sliced carrots (4 medium carrots)
   2 tsp. minced garlic (1 clove)
   1-3/4 cup spaghetti sauce (1-15 oz. jar)
   1/2 cup water
   1 tsp. basil
   1/2 tsp. oregano 
   2 eggs
   2 cups lowfat cottage cheese (1-16 oz. carton)
   4 Tbs. parmesan cheese
   1 10-oz. package frozen chopped spinach, thawed and drained
   1 cup sliced mushrooms
   1 cup quartered and sliced zucchini
   1 cup shredded part-skim mozzarella cheese (4 oz.)

     Cook lasagna noodles in boiling water about 12 minutes.  Drain,
rinse and cover with cold water.  Heat vegetable oil in sauce pan. Add
onions, carrots and garlic; saute about 10 minutes. Add spaghetti sauce,
water and spices; bring to a simmer.  Beat eggs and blend in cottage
cheese, parmesan cheese and vegetables.  Spread a thin layer of sauce
over bottom of 9 x 13-inch baking pan.  Cover with layer of noodles;
spoon half of cheese mixture over noodles.  Cover with half of sauce;
repeat. Cover with foil and bake at 350 degrees for 35 minutes.  Remove
foil; sprinkle with cheese.  Bake uncovered about 15 minutes, or until
center is bubbly.  Let cool about 10 minutes to set layers.

Cut 4 1/2" x 4" pieces.

     Yield:  4 servings; Per 1 serving (4 1/2" x 4" square):  320
calories; 30 grams carbohydrate; 25 grams protein; 10 grams fat.


                          Banana Nut Muffins

   2-1/4 cups unprocessed oat-bran
   1 Tbs. baking powder
   1/4 cup brown sugar
   1/4 cup chopped walnuts or pecans
   1-1/4 cups skim milk
   2 very ripe bananas
   2 egg whites
   2 Tbs. vegetable oil

     Preheat oven to 425 degrees.  Mix the dry ingredients in a large
bowl.  Mix the milk, bananas, egg whites, and oil in a bowl or blender. 
Add to the dry ingredients and mix.  Line the muffinpan with paper
baking cups and fill them with batter. Bake 17 minutes.

      Yield:  12 servings; Per 1 serving:  125 calories; 23 grams
carbohydrate; 4 grams protein; 4 grams fat.

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

     Update:  Blind Diabetics Can Draw Insulin Without Difficulty
                             by Ed Bryant

     A major aim of the Diabetics Division of the National Federation of
the Blind is to provide support and information for blind diabetics, so
they might better maintain or regain independence and productivity.  Our
national support and information network allows communication across a
wide area, something important for blind or visually impaired diabetics
and their families.  With the trauma of sight loss, sometimes the newly
blinded do not realize that most blind men and women with diabetes CAN
self-manage safely and accurately, by use of alternative techniques.

     I became blind from diabetic retinopathy about 17 years ago. When I
first lost sight, I didn't use insulin gauges to help draw my insulin,
as I had never heard of such devices!  Fourteen years ago, I designed my
own insulin gauge, and I used it for approximately three years, with no
difficulties.  I do not advocate the use of nonstandard or homemade
insulin-measuring devices, unless they have been checked out by someone
knowledgeable in insulin-measuring techniques.

     Members of the health care community sometimes forget that although
a diabetic may be newly blinded, he or she has often been successfully
self-managing the disease for 15 years or more.  Most long-term type I
diabetics have had years of experience drawing their own insulin. 
Veteran blind diabetics often have more experience with adaptive insulin
preparation devices than do many sighted health professionals. The
following observations are only a small sample.
 
     Because of my experience with diabetes and blindness and my
editorship of VOICE OF THE DIABETIC, I am often asked to evaluate
insulin-measuring gauges designed for the blind or visually impaired.  I
have tested numerous measuring devices, and in my opinion the Count-A-
Dose, from Jordan Medical Enterprises, wins the blue ribbon.  I hasten
to add that no one instrument is ideal for everyone; however, the Count-
A-Dose provides a very easy method of insulin dispensing.  Designed for
the Becton Dickinson LoDose syringe, the Count-A-Dose holds two insulin
vials and directs the syringe needle into the vials' rubber stoppers. 
Using the thumb-wheel, which clicks for each unit measured (clicks can
be both heard and felt), the blind diabetic can reliably draw and mix
his or her own insulin.

How to Get Air Bubbles Out of an Insulin Syringe 

     There are techniques by which a blind diabetic may draw and mix
insulin without drawing air into the syringe.  Like many others, I have
used them successfully for years.  I first draw four or five units of
regular insulin into the syringe and then inject all of it back into the
vial.  I then repeat the operation two more times.  The fourth time, I
draw the full amount of insulin needed from the first vial.  Then, when
I draw insulin from the second vial, I draw the exact amount needed.  I
have put this to the test; 100 repetitions without air bubbles. 
Diabetics Division Second Vice-President Janet Lee has twice performed
the same test.  In both cases the complete absence of air in the syringe
was independently verified.

     "Tapping the syringe to remove air bubbles," a common technique
used by the sighted, becomes unnecessary.  The one to two units of air
in the hub of the needle (where needle meets syringe) are expelled
during the procedure used with the first vial of insulin.  I demonstrate
this technique to nurses, who are delighted to see that air bubbles are
not present and the insulin measurement is accurate.  Of course long-
term insulin users will be familiar with the need to inject as much air
into the vial as the amount of insulin they withdraw, to facilitate
getting the insulin into the syringe.  For further information, consult
your health care team.

How to Know When an Insulin Vial is Getting Low

     Each vial of insulin contains 10cc, 1000 units.  The maximum number
of units used per day, divided into the vial's 10 cc (1000 units)
capacity, gives the maximum number of days the bottle can be used.  When
I open a new vial of Regular insulin, I divide its 1000 units by 20
units, the maximum I use daily, so one supply should last me 50 days,
but as a safeguard, I assume that the new bottle contains only 940 units
(9.4cc), which should last a maximum 47 days instead of 50.  I measure
my NPH insulin in a similar manner.  As long as at least 60 units of
insulin remain in the vial, the needle will remain submerged while
filling, and there is no danger of drawing air.  In drawing out the
insulin, I keep the syringe vertical, needle straight up in the vial, so
as not to inadvertently draw out air. Many blind consumers (and diabetes
educators) are unaware of this point's importance--that the natural
tendency is to tilt or slant while drawing, which can lead to inaccurate
filling and air in the syringe.

      Many methods exist to determine how long a supply will last.  One
way to keep track of the amount of insulin in the container is to set
aside the number of syringes that will be needed for 940 units of
insulin.  Another might be to employ Braille, large print, tape
recorders, or personal computers, to record how much insulin has been
used each day.  Many blind consumers, like myself, realize the
importance of keeping their blood glucose under tight control, and
follow regimes of insulin mixing and multiple injections, both of which
increase the need for precision.  I have found the more precise the
record of insulin drawn, the easier to safely predict when it is time
for a new supply.  Note:  Though it not as precise, before drawing
insulin you can gently shake the vial and, with practice, easily
determine whether it is full, half full or nearly empty.

The Possibility of Inserting a Needle into a Blood Vessel

     Since injection sites are in fleshy areas, and insulin needles are
short, chances of inserting a needle into a blood vessel are minimal. 
The worst that can be done is to hit a small capillary, which would
result in a small area becoming infused with blood--a hematoma.  Again,
it is unlikely the needle will be inserted into a small blood vessel. 
The amount of insulin entering the bloodstream via a capillary would be
insignificant, and would cause no harm. 

Something to Think About 

     I periodically have my insulin gauge checked for accuracy; it has
always measured precisely.  If the diabetic is careful, difficulty in
measuring insulin will not occur.  I have found that inaccuracy is often
the result of haste or carelessness.

     It is reported that insulin gauges are more accurate than sight.
When the plunger is pushed firmly to the gauge, the same amount of
insulin will be obtained every time.  Sometimes my sighted friends make
errors in drawing insulin.  Perhaps they would be more accurate if they
used insulin gauges.  Note:  Syringes are mass-produced.  Although there
is quality control, some errors are made in syringe markings.  If a
gauge is used, the measurement will be accurate no matter what the
syringe shows.

     At first hearing, all this may sound like a lot to remember, but it
is not difficult.  Marla Bernbaum, MD, CDE, Assistant Professor at St.
Louis University Medical School Dept. of Endocrinology, states:  "In our
experience here, most blind and visually impaired diabetic patients have
been capable of drawing their own insulin with complete accuracy." 

     Janet Lee, Director of the Independent Management for Blind
Diabetics Program at BLIND, Inc., Minneapolis, Minnesota, states: "In my
ten years of working with blind diabetics, hundreds of them, there have
maybe been two who, because of a combination of disabilities, could not
measure their own insulin."

     Ruth Ann Petzinger, RN, MS, CDE, Diabetes Care
Manager/Educator at St. Peters Medical Center, New Brunswick, New
Jersey, states:  "During the time I have been working with persons with
diabetes and visual impairment, I've never had a patient who truly
wanted to be independent with insulin administration or blood glucose
monitoring who was not able to achieve these goals."

     Ann Reardon, RN, MSN, CDE, with the Georgia Dept. of
HumanResources/Medical College of Georgia, states:  "In my experience,
with proper training almost all diabetics are able to prepare and
administer their own insulin safely, regardless of visual impairment." 

      Ann Williams, MSN, RN, CDE, Diabetes Program Coordinator,
Cleveland Sight Center, and her colleague Marylin Teasley, RN, CDE,
state:  "In the last eight years we have taught about 800 visually
impaired and blind people to measure and administer their own insulin
independently.  Vision loss does not preclude safe and effective insulin
self-administration."

     I have no problems managing and keeping my diabetes under control. 
I control it through the use of alternative techniques, some of which
are described here.  Many members of our organization, the National
Federation of the Blind, use them daily to live active lives.  With
alternative techniques, blind diabetics can be as productive as when
they were sighted.

     Come to us and ask for assistance.  We are ready, willing, and able
to help.  We want you to know that no matter what your diabetes
ramifications, you are not alone and do have options.  We in the
National Federation of the Blind know that blindness is not synonymous
with inability.

Resources

     Our Diabetics Division publishes the "Resource Guide to Aids and
Appliances", a compilation of equipment and information for diabetics,
especially blind diabetics.  Categories include:  General and
Miscellaneous, Automatic Insulin Injection Systems, Blood Glucose
Monitoring Systems, Insulin Pumps, and Large Distributors of Insulin
Equipment and/or Supplies.  Available in Large Print, Braille, or
cassette, copies cost $2 each, and can be ordered from: Materials
Center, National Federation of the Blind, 1800 Johnson Street,
Baltimore, MD 21230; telephone:  (410) 659-9314.

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

                           Medicare says OK
                           by Irving Mushlin


     Closed circuit television magnification (CCTV) is a technology that
allows people with severely limited vision to read standard-print
materials.  Like much "high-tech," it works, but is quite expensive, and
its price tag has tended to limit its appeal.  But vision-impaired
individuals may no longer have to pay for such equipment themselves. 
Medicare has approved coverage in several recent cases.

     Mine was one of the first.  I purchased my CCTV in 1992, and duly
filed a claim for Medicare reimbursement.  Medicare denied payment,
stating that this type of equipment was not covered.  I followed the
appeals procedures, and we ended up at a hearing before an
Administrative Law Judge in June, 1995.  After hearing our arguments,
the judge ruled that the CCTV, when properly prescribed, meets the legal
definitions of "durable medical equipment" and "prosthetic device".   I
won.

     So, after nearly three years, Medicare paid its share of the cost
of my CCTV magnifier.  Another case, heard by a judge in Louisville,
Kentucky, resulted in a similar outcome.

     Here are a few tips that may be helpful:

     1. Be sure to get a doctor's prescription for your CCTV             
        before you buy it.

     2. File a standard Medicare Part B claim, attaching the             
        prescription and the provider's itemized bill. Claim             
        forms are available at any Social Security office.

     3. You may be able to get free legal assistance if you need         
        to appeal a denial.  Many agencies provide such counseling.

     Medicare's policy shift in regard to the CCTV puts a new light on
both employment and daily living for many visually-impaired Americans.

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

  Assessing the Impact of Intensive Therapy on the Health-Care System

                     by William H. Herman, MD, MPH

(Division of Endocrinology, University of Michigan Medical Center)

     The Diabetes Control and Complications Trial (DCCT) demonstrated
that intensive diabetes management effectively delays the onset and
slows the progression of diabetic retinopathy, nephropathy, and
neuropathy in persons with insulin-dependent diabetes.  Based upon these
results, the DCCT research group recommended that intensive therapy,
with the goal of achieving glucose levels as close to the nondiabetic
range as possible, be employed in most insulin-dependent diabetes
mellitus patients.  However, the increasing demand for health services
and the rising cost of health care in the United States have led to
questions about the relative effectiveness and value of new treatments.

     Currently, the DCCT research group is conducting economic analyses
of the DCCT to formally compare the incremental cost of intensive
therapy with the potential savings associated with averting
complications.  The costs of intensive and conventional therapy and the
costs of the adverse side effects of therapy must be measured.  In
addition, the costs of treatment of the chronic complications of
diabetes must be assessed.  Intensive therapy uses more resources and is
more expensive than conventional therapy, but it is also associated with
a lower incidence of chronic complications.  By averting complications,
intensive therapy has the potential to save money.

     Total costs of intensive therapy include the costs of inpatient
services (hospitalization), outpatient services (clinic visits,
surveillance of complications), case management services (telephone
calls, letters, team meetings), and self-care (syringes, monitoring
equipment and supplies, insulin, glucagon, and glucose tablets).  The
costs of side effects of therapy include those related to treatment of
hypoglycemia and weight gain.  The benefits of intensive therapy include
savings from diagnostic procedures and treatments for complications that
are not required.  These are related to diabetic retinopathy,
nephropathy, and neuropathy and include costs related to visits to
health-care providers, fundus photography, fluorescein angiography,
laser photocoagulation, angiotensin-converting enzyme inhibitor therapy,
end-stage renal disease treatment (ESRD), and amputation.  Improvement
in quality of life and length of life are also potential benefits of
intensive therapy.

     Preliminary analyses suggest that intensive therapy costs two to
three times more than conventional therapy, and pump therapy is more
expensive than multiple daily injections.  These differences in costs
are largely attributable to the greater frequency of outpatient visits
and self-monitoring of blood glucose with intensive therapy compared to
conventional therapy, and the greater cost of pumps and pump-related
supplies compared to multiple daily injections.  These cost must,
however, be weighed against the costs of blindness, ESRD, and lower-
extremity amputations.  From the perspective of the federal government,
the direct medical costs of blindness are nearly $2,000 per patient per
year; those of ESRD are nearly $45,000 per patient per year; and those
of lower-extremity amputation are approximately $9,400 per patient per
event.

     To crudely estimate when the difference in cost between two
therapies is offset by the cost of complications averted, a break-even
analysis can be performed.  Such an analysis suggests that if the cost
difference between intensive and conventional therapy is about $4,400
per year, intensive therapy could be implemented at a cost of
approximately $20,000 per year of life gained.

     To estimate the lifetime benefits and costs of DCCT therapy, the
DCCT research group developed a Monte Carlo simulation model. Benefits
were assessed with respect to years free from complications, years of
life, and quality-adjusted life years (QALYs).  These analyses
demonstrate that implementing intensive therapy for a person with IDDM
meeting DCCT eligibility criteria would result in improved quality of
life, a net gain in years of sight, years free from ESRD, and years free
from lower-extremity amputations.  Implementing intensive therapy would
also result in a gain of length of life.  The incremental cost of QALY
gained is estimated to be less than $20,000 per year.  

     The decision to implement a new therapy largely depends on the
incremental cost required to achieve benefit.  The question is a simple
one when the experimental therapy is more effective and less expensive
than conventional therapy.  It is more difficult when experimental
therapy is both more effective and more costly.  Most would argue,
however, that treatments that cost less than $20,000 per QALY gained
should be adopted.  Such treatments include coronary-artery bypass
grafting for left main coronary artery disease and anti-hypertensive
therapy for middle-aged men with moderate to severe hypertension.

     DCCT intensive therapy reduces complications, improves quality of
life, and can be expected to increase length of life. Intensive therapy
is cost-effective even though it is initially more costly than
conventional therapy.  Health policy in the United States should foster
the adoption of intensive therapy by individuals with IDDM eligible for
such treatment.

     (NOTE:  Reprinted with permission of the American Academy of
Ophthalmology, San Francisco, 1994.  Published in Autumn 1995"Diabetes
2000 Newsletter".)

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

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

(RESOURCE COLUMN)

[Illustration:  hand removing a book from a shelf of books]

     Inclusion of materials in this publication is for information only
and does not imply endorsement by the Diabetics Division of the NFB.

New Resource Guide
        
     The NFB Diabetics Division 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.  Available February 1, the "Resource Guide" will feature 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, large print, 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.

Beat Medicare Paperwork

     If you are an insulin-controlled diabetic, paying for  supplies
with Medicare or private insurance, Diabetic Medserv, Inc. will ship you
your supplies and complete your paperwork.  They accept Medicare
assignment, so you'd only be liable for the 20%, and if you have private
supplemental insurance, you shouldn't owe anything at all.  For
information, call 1-800-575-7557.

Generic Syringes

     Many stores will soon offer "store brand" generic insulin syringes,
manufactured by Monoject.  According to Can-Am Care Corporation,
distributor of Monoject products, no other company sells customized
store brand syringes.  For information on Monoject syringes, contact
Can-Am Care Corporation, Cimetra Industrial Park, Box 98, Chazy, NY
12921-0098; telephone:  1-800-461-7448.

Newsline for the Blind

[Photo:  portrait.  Caption:  Kenneth Jernigan]

     The National Federation of the Blind announces the startup of
"Newsline," an electronic publication of major daily newspapers,
specifically tailored for blind and visually-impaired readers.  Already
operational in the Baltimore--Washington area, "Newsline" electronically
"reads" all of each day's edition, which is immediately made available
via modem to local distribution centers.  Users telephone their local
center (or place a long-distance call to the National Center for the
Blind) and listen to the articles they choose.  There is no subscription
fee or other charge to access the system.

     "USA Today," "The New York Times," and the "Chicago Tribune" have
agreed to participate.  More publications, including local papers, are
expected to join shortly.  This will be the first time that blind
individuals will have rapid and comprehensive access to daily print news
media.  It will be a substantial improvement over "live reader"
services.  Our goal is to make the service available to every blind
person in the country, and soon.

     The NFB is looking for individuals and organizations willing to
sponsor and maintain the required local distribution centers.  For
further information, or to listen to a sample, contact Newsline Network,
National Federation of the Blind, 1800 Johnson Street, Baltimore, MD
21230; telephone:  (410) 659-9314.

Complete Shoe Store

     Brown's New Balance Heritage Store offers a full line of athletic
and outdoor shoes.  UPS 2nd Day Air shipping is free on all catalog
purchases.  They offer extra-depth diabetic footwear in 2A to 4E widths,
and a staff podiatrist to make sure you are properly fitted.  For
information or free catalog, contact:  Brown's New Balance Heritage
Store, P.O. Box 382, Washington, MO 63090; telephone:  1-800-728-6247.

Rover Seeing Aid

     The Rover Seeing Aid is a new device for the blind.  Its
lightweight sensor mounts on a person's wrist, and reads light and dark
areas, facilitating orientation and mobility.  With a few waves of the
hand, the brain can assemble a complete picture of its surroundings
through tactile feedback.

     The Rover Seeing Aid, released by The POSSIBILITIES Company in
Columbia, Missouri, is priced under $100.  It comes with a no-risk, 30-
day home trial, and a one-year warranty.  For more information call: 
1-800-566-3333.

Braille Calendar

     The American Action Fund for Blind Children and Adults is offering,
free-of-charge, an attractive 1996 calendar in Braille. Contact the
American Action Fund for Blind Children and Adults, 1800 Johnson Steet,
Baltimore, MD 21230; telephone:  (410) 659-9314.

Dietary Supplement

     Progressive Research Labs announces "Diabetic Nutrition Rx," a
dietary supplement specifically formulated for diabetics.  Along  with a
number of vitamins and minerals especially needed by  diabetics, the
product contains vanadyl sulfate and chromium  picolinate, two
substances said to regulate blood sugar levels and improve the action of
insulin, especially in cases of  type II diabetes.

     A bottle of 90 capsules (15 days' supply) costs $16.95, plus $3
shipping.  For information, or to order, contact:  Progressive Research
Labs, 9396 Richmond Avenue, Suite 514, Houston, TX 77063; telephone: 
1-800-877-0966.

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
($745), a stand-alone unit withRS-232C link to any computer ($995), 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, 1590 Oakland Road, Suite B112,
San Jose, CA 95131; telephone:  (408) 453-8251; fax:  (408) 453-8255.

Blood-Sampling Pipets

     Transfer-Ease, Inc., makes single-use blood-sampling pipets
designed to help blood placement on a glucose test strip.  Intended for
people who have difficulty placing the lanced finger directly over the
proper part of the test strip, the pipets allow precise transfer of
blood to the correct location.  They come in two types:  Straight, and
vacuum-bulb.  Unlike the old glass pipets, these are discarded in a
sharps container immediately after use, reducing the danger of disease. 
Note:  May not be suitable for non-sighted use.  Prices, per box of 500,
are $22.89 for the straight pipets, and $24.99 for the vacuum-bulb type,
shipping included.  To order, or to receive a free sample, contact: 
Transfer-Ease, Inc., P.O. Box 108, Emerson, NJ 07630-0108; telephone: 
(201) 357-0114.

Patient Manual

     "Stepping Toward Control" is a new manual for people with type I or
type II diabetes.  Available for $3.75, this 72-page text contains
useful definitions and explanations, a sample meal plan, a sample of the
ADA exchange list, and advice on drawing and injecting insulin. 
Discussion of common complications and how to avoid them is frank and
upbeat.  Throughout, the message is:  "It's up to you!"  Contact HERC
Publishing, Inc., P.O. Box 30090, Lincoln, NE 68503; telephone: 
1-800-676-0321.

Diabetes Books

     Chronimed Publishing Company announces the availability of the
following diabetes books:

*    "Outsmarting Diabetes," by Richard Beaser, MD, shows how intensive
therapy, as described in the Diabetes Control and Complications Trial,
can dramatically reduce the effects of insulin dependent diabetes and
its long-term complications.  256 pages, paper, cost:  $14.95. 

*    "Diabetes 101" (Revised and Expanded 2nd Edition), by Betty      
Page Brackenridge, MS, RD, CDE, and Richard O. Dolinar, MD, is a clear,
simple, jargon-free guide to living healthfully with type I diabetes. 
175 pages, paper, cost:  $9.95.

*    "In Control:  A Guide for Teens with Diabetes," by Jean Betschart,
MN, RN, CDE, and Susan Thom, RD, LD, CDE, illustrated by P.S. Mueller,
is a guide for teens with diabetes.  They'll learn how to take good care
of their diabetes without letting it get in their way.  128 pages,
paper, cost:  $9.95.

*    "Everyone Likes to Eat" (revised and updated second edition), by
Hugo J. Holleroth, EdD and Debra Kaplan, RD, MS, is written for
elementary school-age children, to show them how they can eat most of
the foods they enjoy and still take care of their diabetes.  The book is
filled with puzzles, activities, and problem-solving exercises.  136
pages, paper, cost:  $12.95.

     To order these, or any of their many other health-related books,
contact:  Chronimed Publishing, P.O. Box 50932, Minneapolis, MN
55459-9686; telephone:  1-800-848-2793.

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

                           FOOD FOR THOUGHT

[Illustration:  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 Diabetics Division of the NFB.

Unscrambling Medicare "Assignment"

     What does it mean that a given physician or supplier "accepts
assignment?"   Suppose your doctor prescribes a particular procedure or
piece of equipment.

     The provider (note not all providers accept assignment!) sends the
claim to Medicare.  Medicare maintains a list of approved amounts, the
"Fee Schedule", for reimbursable procedures and supplies.  Very often
the approved amount for a given procedure  or piece of medical equipment
is LOWER than the retail price.  The provider who accepts assignment
agrees to accept Medicare's approved amount for the item or procedure as
the full price of that item or procedure.  The "Fee Schedule" keeps
prices down.

     What confuses people is the fact that Medicare doesn't pay 100% of
the approved amount.  Even though your provider has "accepted
assignment" and adjusted the price accordingly, you are still liable for
the $100 annual deductible, and for 20% of the approved amount. Medicare
pays 80% of the approved amount listed on its "Fee Schedule."

     To cover the 20% which Medicare does not pay, many people maintain
"Medicare supplements," private insurance policies specifically designed
to fill the gap between "approved amounts"and the amount actually
disbursed.  

     Ask your health provider, "Do you accept assignment?"  If the
answer is "no," you may wish to comparison-shop.  The provider who
accepts assignment is required by law to submit your billing paperwork
to Medicare for you.  If you have "Medicare supplement" insurance, you
may have to handle that paperwork yourself.

     For further information on this or any other aspect of Medicare,
contact your local Social Security office, or call 1-800-772-1213.

                   Florida Diabetes Insurance Change

     In June of 1995 Florida Governor Lawton Chiles signed SB486, an
insurance coverage bill, into law.  The new law should have positive
consequences for diabetics living in the state of Florida. 

     Now any private health policy sold in Florida:  "Must provide
coverage for all medically appropriate and necessary equipment,
supplies, and diabetes outpatient self-management training and
educational services used to treat diabetes, if the patient's treating
physician or a physician who specializes in the treatment of diabetes
certifies that such services are necessary."  In plain language, that
means Florida diabetics can now get their glucometers, strips, and
diabetes education paid for by their insurance carrier.  NOTE:  This
statute does not affect Federal programs such as Medicare and Medicaid. 

     VOICE OF THE DIABETIC hopes more states will follow in Florida's
footsteps, and suggests you contact your state legislator(s).  Make it
happen!

                             Did You Hear?

     There was a man scheduled to have a transplant--but then he had a
change of heart! 

     There was a baby tomato who couldn't keep up with his family--but
he got squished--and that made him ketchup!

                        Tight Control Matters 

     According to the recently-completed Diabetes Control and
Complications Trial (DCCT), intensive insulin therapy, "tight control,"
has a number of benefits.  These include decreased risk of the major
diabetes complications:  Retinopathy, nephropathy, and neuropathy.  For
those practicing tight control of their type I (insulin-dependent)
diabetes, the risk of retinopathy, the most common cause of adult
blindness in the U.S., is decreased up to 76% (as opposed to traditional
insulin therapy).  The risk ofnephropathy, the most common cause of
kidney failure in the U.S., is similarly decreased, up to 56%.  Risk of
diabetic neuropathy, the nerve damage that leads to lower extremity
amputation in more than 25,000 people each year in the U.S., decreases
up to 60% for diabetics who practice tight control.

     From the Editor:  Centers for Disease Control statistics for
diabetics in general (type I and type II combined) show far higher
incidence of diabetes-related lower extremity amputations, approximately
54,000 in 1990.  Although the DCCT only surveyed type I diabetics,
health professionals agree that tight control would benefit all
diabetics.

                         1995 Raffle Winners 

     At the keynote banquet for the 1995 annual convention of the
National Federation of the Blind, the winning ticket was drawn in the
Diabetics Division's raffle.  The winning ticketholder was Cora Young of
Kansas City, MO, who received the $500 prize.  Told of her victory, Mrs.
Young stated:  "I didn't know my daughter-in-law (Martha Young) had
bought a book of tickets for me, so it was a real surprise!  Thank you
and the entire Diabetics Division..."

     Lots of people helped sell tickets, and the following folks each
sold more than 50.  In descending order of tickets sold:  Karen Mayry,
of Rapid City, SD; Betty Walker, of Jefferson City, MO; Ed Bryant, of
Columbia, MO; Ken Staley, of Chicago, IL; Martha Young, of Kansas City,
MO; Pat Tussing, of Indianapolis, IN; Daryel White, of Valley Park, MO;
Joy Cardinet, of Reseda, CA; Marlene Curran, of Oak Lawn, IL; and Grace
Herdeman.  Truly a winning performance--and we are all winners!

                      Hear Ye, Hear Ye, A Raffle

     The Diabetics Division 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 Diabetics Division has elected to hold a raffle, which
will be coordinated by our treasurer, John Yark. 

     THE GRAND PRIZE WILL BE $500!  The name of the winner will be drawn
on July 4, 1996, 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
Diabetics Division 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 17, 1996, or they can be personally delivered to Raffle
Chairman John Yark, at this year's NFB convention in Anaheim,
California.  This raffle is open to anyone, and the holder of the lucky
raffle ticket need not be present to win.  Each ticket sold is a
donation, helping keep our Diabetics Division moving forward.

                               Smoking?

     A recently-concluded investigation into tobacco use by diabetics in
the U.S., employing National Health Interview Survey data from 1974,
1985, and 1990, reports that adult diabetics are "kicking the habit" at
the same rate as the general population; down approximately 10% since
1974.  But, the study reported, the young, males, and those with less
than a high school education were more likely to be smokers.  One in
four diabetics currently smokes, in spite of smoking's association with
diabetic retinopathy.

                       Talking Book Disks Cease

     Mr. Frank Kurt Cylke, head of the National Library Service talking
book program, has announced that the production of magazines on flexible
disk is being phased out, to be replaced with cassettes.  The price of
the records has risen, that of cassettes has dropped; so at this time
cassettes are more economical.

     The National Library Service supplies the necessary cassette
players, free of charge, to legally blind or physically handicapped
individuals (commercial music-cassette players run at the wrong speed). 
To apply for a tape player, or to learn more about the National Library
Service for the Blind and Physically Handicapped, telephone: 
1-800-424-8567.  

     If you have difficulty reading standard print, and this difficulty
cannot be corrected by glasses, you probably qualify for the above
program.  To receive VOICE OF THE DIABETIC on 15/16 inch audiocassette,
contact our Editorial Office at: (573) 875-8911.

                       Descriptive Video Service

     We have been asked to announce:  Descriptive Video Service (DVS)
makes movies on home video (and now certain television programs)
available to blind and visually impaired viewers.  DVS provides narrated
description of key visual elements without interfering with dialogue or
sound effects.  Its narration describes visual elements such as actions,
locations, costumes, and body language.

     To watch these movies and hear these descriptions, you need no
special equipment--only a regular VHS videocassette player and a
television.  

     To receive DVS television (many Public Broadcasting Service
affiliate stations offer it), you will need either a stereo TV or VCR
that includes the Second Audio Program (S.A.P.) feature, or you will
need a S.A.P. TV receiver (sometimes called a decoder) that enables your
existing TV system to receive DVS.  Many people already have VCRs that
include S.A.P.  Decoders, such as Recoton Corp.'s F.R.E.D. III, are
available from Recoton Corp., 4623Crane Street, Long Island City, NY
10011; telephone: 1-800-732-6866, or from Lighthouse Consumer Products,
36-02 Northern Blvd., Long Island City, NY 11101-1614; telephone:
1-800-829-0500.

     For a number of years, DVS has offered its adaptations of dozens of
commercial movie releases, at the same price as the commercial releases,
and has listed them in its periodical, the "DVS Guide."  Due to
reductions in federal funding, publication of the "DVS Guide," in print
and Braille, has been suspended, but DVS information will continue to be
available, through their toll-free information line:  1-800-333-1203, or
on World Wide Web (http://www.wgbh.org/dvs).  DVS also offers its free
"Home Video Catalogue," in large print or Braille.  To receive the
catalog, or to find about more about DVS, contact:  WGBH, 125 Western
Avenue, Boston MA 02134, or the above toll-free telephone number or
World Wide Web internet address.

     Also, some branches of the National Library Service for the Blind
and Physically Handicapped (NLS) offer a number of DVS titles on loan. 
For information about the NLS and its free lending programs, telephone:
1-800-424-8567.

                           Positive Outlook 

     Famous racing driver Tazio Nurvolari was once asked "aren't you
afraid out there on the track, since so many people have been killed
doing what you do?"

     He answered, "Sir, I suppose you hope to die in bed?"  Receiving
the affirmative, he continued, "Then aren't you afraid to turn out the
lights?" 

                        Thank You!  Thank You!

     To all of you who responded to our recent donations drive, an
enormous THANK YOU!  It costs more than $100,000 per year to publish
VOICE OF THE DIABETIC, the principal communication tool of our Diabetics
Division support and information network. Through the generosity of the
National Federation of the Blind, we offer subscription and Division
membership 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 the message about blindness and diabetes to more
diabetics, family members, health professionals, and individuals with an
interest in the condition.  As our circulation has now grown beyond
121,000, 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!

                         Learn WordPerfect 6.0

     We have been asked to announce:  National Braille Press now offers
the new instructional manual titled "Learning Wordperfect 6.0 Using a
Screen Access Program," by Kathleen Beaver. 

     Similar to their earlier tutorial for WordPerfect 5.1, the new text
contains a self-paced, step-by-step instruction book, plus two practice
disks to give new users hands-on experience using the new features of
this updated WordPerfect, whether using Braille or Speech access.       

     The book assumes no prior familiarity with WordPerfect, and covers
both basics and advanced features.  It is available in Braille (two
volumes) or audiocassette for $23, or in print for $28.  Prices include
shipping.  Order from National Braille Press, 88 St. Stephen Street,
Boston, MA 02115; telephone:  (617) 266-6160.

                       NFB Scholarship Program 

[Photo:  portrait.  Caption:  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 1996.

     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 1996 convention of the National Federation of the Blind in Anaheim,
California.  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 1996 NFB Scholarship program must be received
by March 31, 1996.  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.

                               Dialysis
                                  
     During this year's annual convention of the National Federation of
the Blind in Anaheim, California (Sunday, June 30 through Friday, July
5) 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 Anaheim area for instructions.

     Unit social workers may also contact the Shearer Program, American
Kidney Fund, 6110 Executive Blvd., Suite 1010, Rockville, MD 20852;
telephone:  1-800-638-8299.  Shearer will pay or reimburse the Medicare
20% copayment (about $30) for transient dialysis (up to three treatments
in a given year), as well as any physician's fees for treatment.  The
program, however, does not cover the drug Erythropoietin (EPO), chart
readings, or lab work.

     If conventioneers do not have Medicare, but have Medicaid, Shearer
will pay $100 toward the cost of dialysis each year.  Patients wishing
reimbursement must send receipts to the American Kidney Fund Shearer
Program no later than two weeks after the last day dialyzed.  If Shearer
is not used, 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.  Anaheim is the home of Disneyland, and in July,
travel is very heavy.

     Here are some dialysis locations:                   

*    California Kidney Centers of Anaheim, 2051 East Cerritos Ave. Suite 
     8A. Anaheim, CA 92806; telephone:  (714) 778-1530.  About 5 to 10   
     minutes from the convention hotel.

*    UCI Dialysis, 101 City Drive, Building 51, Orange, CA 92668;        
     telephone: (714) 456-5555.  About 10 minutes from the hotel.

*    Garden Grove Artificial Kidney Center, 12555 Garden Grove Blvd.,    
     Suite 100, Garden Grove, CA 92643; telephone: (714) 741-7255.       
     About 10 minutes from the hotel; openings after 5:30 p.m. weekdays.

*    Westminster Artificial Kidney Center, 290 Hospital Circle,          
     Westminster, CA 92683; telephone: (714) 895-3698.  About 15 minutes 
     from the hotel.  Very new unit; open Monday, Wednesday, and Friday.

      PLEASE REMEMBER TO SCHEDULE DIALYSIS TREATMENTS POSTHASTE 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 charges for EPO or Calcijex.

     For transportation to and from dialysis centers, contact the Orange
County Transit Authority (OCTA), "ACCESS" Division; telephone: 
1-800-564-4232 or (714) 636-7433.  Their rides for persons with
disabilities cost $1.70 each way.  This service requires application in
writing WELL IN ADVANCE!  Approval (not guaranteed) takes a minimum of
21 days.  There is also MEDIVAN, a private van service specializing in
medical transportation; telephone:  (714) 974-8840.  It accepts private
insurance and MediCal.  Charges are $29.42 round-trip, plus $1.08 per
mile.  Contact them at least one week before you need them.

     If scheduling assistance is needed contact:  Diabetics Division
First Vice-President Ed Bryant at (573) 875-8911.  See you in Anaheim!

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

                              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 121,000+, offers such an outlet.  Make your voice
heard.  For advertising information contact:
     VOICE OF THE DIABETIC
     Ed Bryant, Editor
     811 Cherry Street, Suite 309
     Columbia, MO 65201-4892
     (573) 875-8911

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

                      SUBSCRIPTION/DONATION FORM

     The VOICE OF THE DIABETIC is a free quarterly news magazine
published by the Diabetics Division 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
Diabetics Division moving forward; helping people with  all aspects of
diabetes.

     Members of the NFB Diabetics Division 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 Diabetics Division 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 Diabetics Division 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 Diabetics Division of the NFB.  

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 11, No. 1, Winter 1996 edition,
published by the Diabetics Division of the National Federation of the
Blind.
