

                     VOICE OF THE DIABETIC

               A Support and Information Network

              The Diabetes Action Network of the 
               National Federation of the Blind

             Volume 12, No. 3, Summer Edition 1997

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

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

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

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

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

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                         FREE!  FREE!


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

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                       INSIDE THIS ISSUE


FDA MEETING REPORT:  INSULIN VIAL LABELS WILL HAVE TACTILE
MARKS
     by Ed Bryant

PANCREAS TRANSPLANTATION
     by G. P. Basadonna, MD, PhD

EUGENE PAYNE, JR. SETS AN EXAMPLE

A SECOND OPINION
     by Brenda Taliaferro

NEW DIABETES DRUG FOR TYPE II INSULIN USERS

DIALOGS ABOUT DIABETIC DYNAMOS
     by Debra Frank, MS, MS

FIVE YEARS OUT
     by Donovan Cooper

ASK THE DOCTOR
     by Wesley W. Wilson, MD

SPOTLIGHT:  RUTH WOODWORTH

THE PURPOSE OF DIABETES EDUCATION
     by Peter J. Nebergall, PhD

WORLD DIABETES CONFERENCE REVEALS NEW RESEARCH
     by Ed Bryant

FEDERATIONISTS, FUNDRAISING, AND FREE ENTERPRISE
     by Marie Cobb

SUGARS & DIABETES
     by Madelyn Wheeler, MS, RD, CDE and Marcia Levine Mazur

RECIPE CORNER

INJECTING INSULIN THROUGH CLOTHING

FOOD FOR THOUGHT

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

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                     FDA MEETING REPORT:  
           INSULIN VIALS WILL HAVE TACTILE MARKINGS

                         by Ed Bryant


Photo:  portrait of Ed Bryant

     Early in 1992 I was contacted by a blind diabetic, who
informed me that he and his fellows, perfectly capable of
accurately drawing up their insulins, had no reliable way to
distinguish between insulin types.  All insulins, fast-,
intermediate- or long-acting, could only be told apart by
reading print on the label.  This, I was reminded, placed
many in grave danger, as consequences of vial
misidentification could be severe.

     I conducted a national survey:  Was change needed? 
Should insulin vials have tactile markings, to help blind
diabetics, those losing vision, the hurried, the elderly,
the young, busy medical professionals, overworked
pharmacists, and the rest of us?  Survey results were clear
and unequivocal--change WAS needed.  For the best of
reasons, safety and independence, insulin types should be
identifiable by touch.

     Representing the Diabetes Action Network of the
National Federation of the Blind, I campaigned for this
goal:  to make tactile-marked insulin vials available.  I
wrote letters to the U.S. insulin manufacturers (Eli Lilly
and Company, and Novo Nordisk Pharmaceuticals Inc.) and to
the Food and Drug Administration (FDA).  Hundreds of you,
VOICE readers, joined me in the letter-writing campaign. 
Many nurses and other medical professionals wrote in
support, acknowledging the print was so small they had
trouble reading it, and that misdosage mistakes were made in
hospitals.  Pharmacist error was covered, too (and this
actually happened to me!).

     We finally persuaded the FDA to call a meeting of
interested participants:  Insulin manufacturers, diabetes
educators, drug packaging/labeling firms, diabetes
associations and organizations of the blind.  The first
meeting took place on October 19, 1995, at FDA headquarters
in Rockville, Maryland.

     At that meeting, participants agreed that non-sighted
insulin vial identification was a necessity, and that such
coding should be factory-applied, durable, and sufficiently
prominent that blind diabetics with neuropathy could use it. 
The insulin manufacturers were to come to the next meeting
(to be held in three months' time) with both short-term
prototypes and long-term proposals.  

     Bad weather and scheduling conflicts forced
postponement of the second meeting, which was not held until
April 10, 1996.  By the close of that meeting, Lilly and the
FDA were ready to agree on a set of one through four tactile
bars on the label, as a means of distinguishing insulin
classes.  But Novo Nordisk asked for more time "in which to
test alternative prototypes."  We agreed to meet again, some
time in July 1996.

     For reasons still unclear, Novo Nordisk was not ready
by the July deadline, and did not transmit its findings to
the FDA until the end of December.  FDA officials attempted
to schedule the "rematch" in March or April of 1997, but
scheduling conflicts delayed the final meeting until June 3,
almost one year late.

     At the June meeting, the insulin manufacturers
presented their test findings.  Lilly related how their
researchers had sought out blind diabetics with differing
degrees of neuropathy (mild, moderate, and severe), then
tested their success in distinguishing dot codes, vertical
lines, and horizontal lines on the vial label.  Lilly found
that although a few individuals had neuropathy too severe to
recognize any system, a series of wide horizontal bars
provided greatest accuracy:  over 98% successful tactile
recognition.  (Note:  This finding mirrors the consensus of
ALL consumer groups present at the meeting.)

     When the question of tactile-label durability was
raised, Lilly related how they had tested the bars under a
wide variety of conditions, including long-term immersion in
alcohol, and experienced no failures.  A representative from
CCL Label, a national company that makes vial labels for
pharmaceuticals, confirmed that his company could guarantee
durable tactile bars on vial labels.  I pointed out that
even if there were the rare label failure, the system would
be more reliable than at present, where blind insulin users
are stuck with rubber bands or tape.

     Novo Nordisk, who had tested tactile prototypes with
blind diabetics but not considered the impact of neuropathy
on label conformation,  raised a number of objections.  In
spite of Lilly's tests and CCL Label's guarantees, in spite
of the FDA's satisfaction with the system, Novo Nordisk
continued doubting its appropriateness and reliability.  A
very early tactile-label prototype, that had failed "torture
tests" over a year ago, was put forward as "evidence" that
the four-bar system was not sufficiently durable.  Perhaps
Novo's label-supplier in Denmark is having difficulties--I
find it interesting that Lilly's supplier has mastered the
problem.

     All organizations present except Novo Nordisk accepted
the four-bar system as presented.  A Lilly representative
told me his company was "readying their production line." 
The FDA stated that once they had completed the approval
process, one company could proceed without waiting for
consensus from its competitor.  Because the FDA "didn't want
Novo Nordisk to feel they were being treated unfairly," they
suggested Novo could raise the issue at the International
Diabetes Federation (IDF) meeting, to be held this July in
Helsinki, Finland.  If they raised sufficient objection, and
there was strong support at that meeting, FDA might reopen
the discussion process.

     The FDA promised that on August 1 they would fax
meeting participants their final determination.  They stated
we would go with the system as agreed, unless there is
substantial international objection.

     The above disturbs me greatly.  Although it is unlikely
the IDF would support Novo Nordisk in the face of the
evidence, outside the USA Novo Nordisk is a very major
provider of funding to diabetes agencies and foundations. 
Also, such a decision allows the IDF to "sit in review" of
FDA policymaking, a serious surrender of FDA's statutory
responsibilities to an international body.  I hope it
doesn't come to that.

     To review:  At the meeting, we agreed on the following
system of four horizontal tactile bars on the insulin vial
label:  One bar = fast-acting insulins such as Humalog; two
bars = Regular insulins; three bars = any mixed insulin
(70/30 or 50/50); and four bars = longer-acting insulins
(NPH, Lente, Ultralente).

     Once final approval is granted, Lilly estimates it will
take between six and 18 months for the tactile-marked
insulin vials to reach pharmacists' shelves.  Insulins have
a shelf-life of two years from date of manufacture, so it
may be as long as two years from the start of tactile-
labeled insulin production before all the older, unmarked
vials are off pharmacists' shelves, though the bulk will be
replaced far sooner.

     It has taken a long time, but hopefully the next report
the VOICE carries about tactile-marked insulin vials will be
a review of the first to reach production, and the impact
they have on our safety, independence, and diabetes self-
management.

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                   PANCREAS TRANSPLANTATION

                  by G.P. Basadonna, MD, PhD

       Division of Organ Transplantation and Immunology
                     Department of Surgery
              Yale University School of Medicine


     Pancreas transplantation is the only treatment for type
I diabetes that establishes an insulin-independent,
euglycemic state; glycosylated hemoglobin levels are
normalized for as long as the graft functions.  But the
penalty for constant normoglycemia is the need for
immunosuppression.  Thus, for nonuremic patients, pancreas
transplants are currently performed only when the problems
of diabetes are perceived to be more serious than the
potential side effects of the anti-rejection drugs required
by transplantation.

     For uremic diabetic patients who need a kidney
transplant, the addition of a pancreas has become routine. 
Such patients are already obligated to immunosuppression,
thus there is usually no reason not to make them insulin-
independent as well as dialysis-free.


Adding a Pancreas to a Kidney in Diabetic Transplant
Recipients

     Since constant euglycemia is unachievable for diabetic
patients by any practical mode of exogenous insulin
administration, and since hypoglycemia is intolerable,
chronic hyperglycemia (as documented by measurements of
glycosylated hemoglobin) is the norm.  However, after years
of debate, it has now been unequivocally shown that the
rates of development of neuropathy, retinopathy, and
nephropathy are related to the degree to which glycemia is
controlled.  Complication secondary to dysmetabolism 
afflict the eyes, nerves, and kidneys of more than 50
percent of the patients who have had diabetes more than 20
years.  A successful pancreas transplant, with the resulting
achievement of euglycemia, significantly improves both
general health and life expectancy.  Thus, a rationale for
pancreas transplantation, as a method of providing perfect
metabolic control, exists.

     Although one of the long-range goals of pancreas
transplantation is to ameliorate the secondary
complications; not every diabetic patient gets
complications, and it is difficult to predict, at the onset
of the disease, who is at risk for complications.  Thus,
pancreas transplantation is usually performed after
complications have appeared, and at a time when they may be
self-perpetuating.  Because immunosuppression also has side-
effects, and it is uncertain if these would be more or less
severe than those that might occur from diabetes, the
reluctance to transplant early is understandable.

     Complications involving the eyes and nerves are often
far advanced in diabetic patients who have kidney failure. 
However, it is generally accepted that quality of life is
better for people who are immunosuppressed and not dialysis
dependent, compared with those who are not immunosuppressed
but are dialysis dependent.  Thus, almost all uremic
diabetic patients are best treated with a kidney transplant. 
In such patients, correction of diabetes can be achieved,
with only the surgical risks of adding a pancreas graft to
be considered, and the quality of life is improved even if
insulin-independence is the only benefit achieved other than
the correction of uremia.

     At the moment, pancreas transplantation is most widely
applied to the diabetic renal failure population.  But it is
clear that diabetic control problems are obviated by a
successful pancreas transplant.  Thus, pancreas transplants
alone (not alongside kidney replacement) are being performed
at this time for individual diabetic patients who are labile
or have hypoglycemia unawareness, and should be considered
as the therapeutic option for any patient in whom the
management of diabetes is so difficult as to seriously
interfere with day-to-day living.  For such patients,
managing their diabetes should be more of a problem than
being immunosuppressed.

     This is a judgment call.  However, a successful
pancreas transplant can compensate for the impairment in
counter-regulatory mechanisms that occurs in some patients
with long-standing diabetes.  A retrospective study of
recipients of solitary pancreas transplants found them to be
nearly unanimous in stating that being immunosuppressed and
insulin-independent gave them a better quality of life than
before the transplant.

     In nonuremic patients, a successful pancreas transplant
can induce regression of early, but not advanced,
microscopic lesions of diabetic nephropathy.  In renal
allograft recipients, a successful pancreas transplant,
performed either simultaneously with or within a few years
after the kidney transplant, will prevent recurrence of
diabetic nephropathy in the new graft.  In this situation,
immunosuppression is necessary in order to have renal
function at all; by keeping diabetic lesions from re-
occurring, long-term renal graft function is likely to be
improved.

     In contrast to the positive effect on kidneys, the
probability that advanced retinopathy will progress is not
altered in the first one to two years after a pancreas
transplant.  However, in patients with long-term functioning
grafts, retinopathy tends to stabilize; in those with failed
grafts it continues to deteriorate.

     Neuropathy improves or stabilizes in most pancreas
transplant recipients.  Nerve conduction velocities and
evoked muscle action potential increase.  Indeed, in
patients with severe autonomic neuropathy, those who undergo
a successful pancreas transplant have a significantly higher
probability of survival than those who are not transplanted,
or who have unsuccessful transplants.

     Pancreas transplants in patients with hyperlabile
diabetes and extreme difficulty with metabolic control can
improve quality of life, simply by inducing insulin
independence.  Kidney transplants also improve quality of
life in uremic patients by obviating the need for dialysis. 
For diabetic patients with both problems, the effect of a
double transplant can be dramatic.  With one surgical
procedure, two difficult clinical problems are corrected--
for as long as rejection is prevented by immunosuppression. 
For diabetic patients without nephropathy, however, the
price (immunosuppression) is paid simply to be rid of their
diabetes.  Although some diabetologists have expressed doubt
as to whether such benefit is worth that price, pancreas
transplant recipients have emphatically stated that it is.


Results

     Over 6,000 cadaver donor cases were reported world-wide
between October 1987 and July 1994.  The overall one-year
patient survival rate was 91 percent, and the one-year
insulin-independent rate (graft functional survival) was 70
percent in the U.S. (n=2573).  Five years after surgery,
patient survival is 78 percent and pancreas survival
(insulin independence) is 60 percent.  At all locations,
most were SPK (Simultaneous Pancreas and Kidney transplant). 
At Yale since June 1994, 20 pancreas transplants have been
performed.  (11 patients received simultaneous pancreas and
kidney, 11 received a pancreas following a previous renal
transplant and one received a pancreas transplant alone.) 
Overall patient survival in these cases is 95 percent and
pancreas survival (insulin independence) is 85 percent.

     To give an indication as to whether the addition of a
pancreas to a kidney transplant in uremic diabetic patients
influences patient and renal allograft survival rates one
way or another, an analysis was performed by the University
of California at Los Angeles (UCLAIUNOS Kidney Transplant
Registry) on the cases of renal allotransplantation from
cadaver donors in type I diabetic recipients reported to the
registry since October 1987.  The recipients were divided
into those who underwent a kidney transplant alone (KTA-D
n=5853), versus those who received a simultaneous
kidney/pancreas (SKP, n=1772) transplant.  The results in
both groups were compared to a non-diabetic cohort who
underwent cadaver kidney transplants alone to treat renal
failure from glomerulonephritis (KTAGN, n-6615).  The
patient survival rate curves for the two diabetic groups
were superimposed, with 92 percent of SKP and 91 percent of
KTA-D recipients alive after one year, while renal allograft
survival rates were slightly, but significantly higher in
the SKP than in the KTA group (83 percent versus 78 percent
at one year).  Patient survival rates were slightly higher
for the KTA-GN groups than either of the SKP or KTS-D
groups, but interestingly, the KTA-GN renal allograft
survival rates were lower than in the SPK group.

     Thus, there is no apparent difference in mortality
risks for uremic diabetic patients undergoing a simultaneous
pancreas/kidney versus a kidney transplant alone.  If
anything, those selected for a SKP transplant have a lower
risk of renal allograft loss.  This was true in all
categories, with one year kidney graft survival rates for
SPK vs. KTA recipients being 84 percent (n=425) vs. 80
percent (n=670) in those 21-30 years old, 83 percent (n=831)
vs. 79 percent (n=t7l4) in those 31-40 years old, and 82
percent (n=437) vs. 78 percent (n=3176) in those more than
40 years old.


Quality of Life

     Although much has been written about the potential for
pancreas transplantation to have a favorable effect on
secondary complications of diabetes, it is the overall
impact on quality of life, including that associated with
insulin independence per se, that should be emphasized.  The
studies conducted so far are nearly unanimous in finding
that patients with successful pancreas transplants rate
their quality of life to be better after than before the
transplant.  In the largest study to date, 131 patients were
analyzed one to 10 years post-transplant; half had
functioning grafts (n=65) and half had grafts that
ultimately failed (n=66).  Overall, 92 percent felt that
managing immunosuppression was easier than managing
diabetes.  When asked which was more demanding on their
families' time and energy, the transplant or diabetes, 63
percent felt that their diabetes was more demanding, 29
percent felt the two were equal, and 9 percent felt that the
transplant was more demanding.  Of the 65 patients with
functioning grafts, 89 percent stated that they were more
healthy than before the transplant. Indices of well-being as
quantified by standard tests were significantly higher in
patients with functioning grafts than those without. 
Virtually 100 percent of the patients with continuous graft
function and 85 percent of those whose grafts ultimately
failed would encourage others with similar complications of
diabetes to consider pancreas transplantation.  In addition,
most of the patients with failed grafts desired
retransplantation, and those with functioning grafts said
they would undergo a retransplant if their current graft
failed.


Discussion

     Currently, the major role of pancreas transplantation
is as an adjunct to kidney transplantation in pre-uremic,
uremic, or post-uremic diabetic patients.  Nonuremic
patients with hyperlabile diabetes or emerging complications
must be carefully selected for the procedure.  Current
immunosuppressive regimens have many side effects.  HLA
matching, though it improves the probability of long-term
success, cannot eliminate the need for immunosuppression. 
Immunosuppression sufficient to prevent rejection is usually
sufficient to prevent recurrence of disease.  Again, the
recipient's problems with diabetes must be such that the
potential side-effects of immunosuppression are an
acceptable trade-off, as is true in choosing between
dialysis and a kidney transplant for treatment of renal
failure.

     Nearly all uremic diabetic candidates for a kidney
transplant are also candidates for a pancreas transplant. 
The best treatment option is to receive a living related
donor kidney transplant first, followed later by a pancreas
transplant.  For those without a living related donor for a
kidney, a pancreas transplant can be performed
simultaneously with a kidney transplant from a cadaver
donor.  A living-related kidney donor is associated with the
highest long-term renal allograft functional survival rates,
and coupled with a subsequent pancreas transplant kidney
transplant first is more compelling than ever, since the
insulin-independence rates with a PAK can be as good as with
a SPK transplant.


Glossary:

     Euglycemic, Normoglycemia:  both terms denote blood
glucose levels in the consistently normal range

     Uremic:  uremia is the end result of kidney failure--
the buildup of unexcreted toxins in the blood

     Immunosuppression:  suppression, by medication, of the
body's natural graft-rejection system; necessary to maintain
a viable transplant

     Exogenous insulin administration:  insulin dosage by
injection

     Chronic hyperglycemia:  extended periods of blood
glucose levels above normal range

     Dysmetabolism:  improper or unbalanced metabolic
process

     Labile, Hyperlabile:  uncontrolled, "brittle"

     Allograft:  a graft from another individual

     Glomerulonephritis:  A serious kidney inflammation,
which may seriously impair kidney function; extreme cases
require dialysis or transplant

     Allotransplantation:  transplantation from another
individual, live or cadaver

     Diabetic lesions:  in nephropathy, microscopic damage
to the kidneys; most often the result of chronic
hyperglycemia  

     Cyclosporine:  a widely-used immunosuppressive
medication

     Nerve conduction velocities:  a measure of the speed at
which electrical impulses travel a nerve path; decreases
with increasing neuropathy

     Evoked Muscle Action Potential:  efficiency of muscle
response to measurable stimulus; decreases with increasing
neuropathy

     HLA matching:  "Human Leucocyte Antibody," a test of
genetic compatibility between donor and recipient

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               EUGENE PAYNE, JR. SETS AN EXAMPLE


Photo:  portrait of Eugene Payne, Jr.

     In a time when "volunteering" and "community service"
are much talked about, we can learn a lot from the fine
example of Mr. Eugene Payne, Jr.  Not only is he an active
federationist and member of the Diabetes Action Network,
distributing VOICE OF THE DIABETIC in inner-city and
suburban Detroit, he also finds time for a great deal of
community service.  To top that, he's running for city
council!  Why?  "I want to set an example for blind people,
to show them they can get out and do things,"  he says.

     Mr. Payne is president of Christian Outreach
Association, president of the New Cop Block Club (a
neighborhood watch organization), president of the Displaced
Persons Association, a member of the Detroit Urban League,
the Michigan Consumers' Lobby, the Michigan Senior Citizens'
Group, the City Council Community Action Group, the
University New Gratiot Lions' Club, the Michigan State
Police Association, the Detroit Police 9th Precinct Buoy,
and the Michigan Landlord Association.  He was a Democratic
National Convention delegate in 1992, and is a licensed
Notary Public.  In the course of his service, Mr. Payne has
collected quite a few testimonials and certificates of
appreciation, from the City of Detroit, Wayne County, and
the State of Michigan.  

     We can all learn from a good example.  Eugene Payne
provides one of the best.  Thanks, Eugene!

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                       A SECOND OPINION

by Brenda Taliaferro


Photo:  portrait of Brenda Taliaferro

     I am 47 years old, and have had diabetes 40 years. 
Though I don't have 20/20 vision, I can still read and drive
a car.  I keep busy--I have learned I can't take the time to
feel sorry for myself with diabetes -- I have to stay very
active.

     In 1995, I stepped on a staple.  I was told by several
doctors that my foot would have to be amputated.  They
seemed in a hurry, and I wouldn't let them.  I left the
hospital, and headed straight for my podiatrist, who put me
on a 12-month course of antibiotics and debridement, three
times a week.  I lifted weights, and (with my podiatrist's
approval) started jogging daily.

     My alternative to amputation worked.  I got a "second
opinion," I did the necessary things, and I won.  I still
have my foot.  We need to use our minds, before we let the
doctors rush us into an amputation.  I made it clear I would
do whatever was necessary to save my foot, if at all
possible.  I got my "second opinion" from my podiatrist.  

     I'm glad I spoke up.   Amputation is very final.  

     From the Editor:  Soliciting a "second opinion," from
another medical professional, is a good idea in many cases. 
Where there is ambiguity, uncertainty, disagreement, or even
complexity, an outside specialist can provide important
input.  Maybe there is an alternative to radical procedures
such as amputation.  Maybe there is not.  Either way, you
can be that much more certain the step you take is the right
one.  Go ahead and ask for a second opinion.  It's your
body.       

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          NEW DIABETES DRUG FOR TYPE II INSULIN USERS
                               

     Troglitazone (trade name Rezulin, from Parke-Davis), is
the first of a new class of oral medications, the
thiazolidinediones, for treatment of type II (NIDDM)
diabetes.  Where the sulfonylureas, the traditional oral
diabetes medications, stimulate the failing pancreas to
produce more insulin, Rezulin directly attacks the problem
of insulin resistance, the increasing inability to process
insulin, that is the chief component of type II diabetes. 
In tests, Rezulin therapy enabled many insulin-using type II
diabetics to reduce volume and frequency of insulin
injections.  A few were able to discontinue insulin
injections entirely.

     As with other oral diabetes medications, Rezulin's
effectiveness depends on the presence of insulin.  If
sufficient insulin is not present, it must be injected, and
Rezulin therapy will not change that fact.  Where insulin
supply rather than insulin resistance is the issue, Rezulin
therapy offers nothing.

     As per who may benefit from use of this medication,
Parke-Davis states:

     "Rezulin is indicated for use in patients
with type II diabetes [who are] currently on
insulin therapy, and whose hyperglycemia is
inadequately controlled (HBA1C >8.5%) despite
insulin therapy of over 30 units per day, given as
multiple injections... Rezulin should not be used
in type I diabetes or for the treatment of
diabetic ketoacidosis."

     Published data state that although degree of renal
insufficiency has no effect on Rezulin dosage, persons with
hepatic (liver) disease should exercise caution.  Other data
suggest that in premenopausal anovulatory women, Rezulin
therapy may result in resumption of ovulation, and risk of
pregnancy.  There is further  recommendation to proceed with
caution if the individual is taking antirejection drugs such
as cyclosporine or tacrolimus.  

     The arrival of a new diabetes medication is always a
time of great excitement.  Rumors abound, and what we don't
know about the new drug can lead us to wild speculation,
then disappointment.  For more information, consult your
doctor.    

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                DIALOGS ABOUT DIABETIC DYNAMOS

by Debra Frank
                               

Photo:  portrait of Debra Frank


The Steve Caggiano Story

     The popularity of body-building as a sport has grown
enormously in the past decade.  Champions like Arnold
Schwarzenegger, Lou Ferrigno, and Beverly Francis have
become household names.  As this sport expands, the
difference between "unnatural" (steroid-enhanced) and
"natural" body-building becomes a major issue for
competitors and event promoters.  

     Many athletic organizations allow only "natural" body-
building competitions, and the athletes' blood and urine are
tested before each event.  A competitor in such a drug-free
event has no shortcuts, and must achieve and maintain top
physical form without outside influence.  Strict nutrition,
safe dieting, and serious weight training, combined with
cardiovascular conditioning and continual
flexibility/stretching are the tools for success.  Is this
the place for a type I diabetic?

     Stephen Thomas Caggiano has had IDDM, insulin dependent
diabetes mellitus, since the age of six.  For 30 years, this
man has taken insulin to keep his body functioning normally,
and to stay alive.  And since high school, he has been
seriously involved in weight training and bodybuilding.

     Stephen remembers being one of the smallest guys in his
high school graduating class.  As a young boy, his sports
and exercise were closely monitored, and, because of his
diabetes, he was often overlooked for team sports.  He found
out early that weight training enhanced his insulin
sensitivity and allowed him to lower his daily dosages.  He
also found that he was good, very good, at it.

     At the All Natural Physique and Power Conference
(ANPPC) Eastern Regional Competition in 1996, Stephen
utilized his natural abilities and skills, and the
discipline he learned mastering a much harder variable, his
diabetes, to win against non-diabetic competitors! 
Afterward, the others complimented him on his physique, and
asked him what kinds of supplements he takes to stay so
"ripped," in such good competitive form.  When he answered
that he only takes a multivitamin, to keep up the essentials
he might lose if he has a "hypo" or excessive urination
overnight, folks were astonished, and asked him to reveal
his training program.  The rest of us want to know, too.

     Stephen trains four days on, one day off, an average of
two hours each session.  He warms up with some "cardio"
exercises (5-10 minutes) and then a full body stretch.  Each
day of his four-day cycle he works one specific body area: 
Day one; chest/bicep.  Day two;  back/rear deltoids.  Day
three; shoulders/triceps.  Day four; legs only.  He does
more "cardio" exercises, every other day, for 20 minutes or
so, and works his abdominal and calf muscles every other
day.

     Balancing diabetes, insulin injections, and food is a
science by itself, but add the strain of serious body-
building, and it takes a disciplined and dedicated
individual to live up to the test  (Stephen says that's his
secret).  He takes Regular and NPH insulin twice a day,
morning and night, and adds a lunchtime injection as needed. 
He eats approximately five times a day, and tests his blood
sugars at least six times, so he can carefully adjust food
and insulin to his anticipated level of exertion and his
present blood sugar level.  Because of his diabetes,
carbohydrates and fats are limited in his diet, so he has to
be creative and careful in balancing the diabetes,
medication, nutrition, and exercise.  He makes it work.  His
HbA1C is 5.8 now, and his doctor has commented on how
Stephen's tight control has slowed the possible progression
of diabetes complications.  If I didn't know his personal
regime, it would be hard for me to believe he has IDDM.  

     Stephen, a member of the Amateur Body-building
Association, took the same formula used by millions of
diabetics to live long and healthy lives, mastered it, then
used it to beat the odds and the competition.  He is a
champion.  

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

                        FIVE YEARS OUT

                       by Donovan Cooper


Photo:  portrait of Donovan Cooper

     From the Editor:  Donovan Cooper is a former President
of the Diabetes Action Network of the National Federation of
the Blind, and remains an active federationist.  Although he
has experienced more than his share of complications, he
doesn't let the side effects of diabetes slow him down.


     I received a kidney/pancreas transplant at the
University of Minnesota Medical Center in June of 1991.  I
subsequently wrote two articles about my experience for
VOICE OF THE DIABETIC, one personal and one speaking in more
general terms about the financing of transplantation.  By
the time you read this status report, it will have been six
years since my surgery and five years since the publication
of those articles.

     I am happy!  All of the things projected for me by the
transplant surgeons have come true.  The damage to my
cardiovascular and nervous system caused by diabetes has
been arrested.  Perhaps in ways measurable only by clinical
instruments, I have demonstrated improvement in neurological
responses, but I don't notice any difference.  What counts
is that things are no longer getting worse.  One major
improvement is no more hypoglycemic episodes--because I no
longer need to take insulin!  Hypoglycemia unawareness was
very troubling before the transplant -- and it is no longer
a problem.  My glucose levels are always within the normal
range and my hemoglobin A1C tests always come back in the
four to five range.  You just can't beat that for blood
sugar control!

     I no longer test my blood sugar on a daily basis.  I
have only a monthly set of lab tests, or more frequently as
needed.

     I went back to work at my old job, two months after my
transplant, and have been working there ever since, except
for another traumatic set of medical events two years after
my transplant.

     Prednisone is part of the necessary immunosuppressant
drug "package" required after transplants.  These are
powerful drugs, with potential adverse effects, and
prednisone use can lead to some  serious problems.  As a
combination kidney/pancreas recipient, my long-term
prednisone dosage has been set at 10mg per day.  Some
(kidney-only) recipients can eventually reduce their dosage
to 5mg per day, or less, but it is very doubtful that this
will happen to me.

     Because of my prednisone usage, I experienced aseptic
necrosis of the right hip.  Part of the ball in the hip
joint died, and the joint had to be replaced.  During the
hip replacement surgery, the already-damaged nerve traveling
past the hip joint to my right foot was further damaged,
enough to give me what the neurologists call a "dropped
foot."  I eventually regained the ability to lift my toes,
but the foot still sometimes involuntarily drops, causing me
to trip over things.  Wearing shoes to keep the foot
straight helps, but I do limp and there are certain things
that I cannot do with that right leg.

     Unrelated to the hip bone disease, on the day after the
hip surgery, I had a heart attack.  I was fortunate to be in
the hospital, and being visited by a friend, when I stopped
breathing.  My autonomic neuropathy had brought on a
painless heart attack!    There was no warning.  I just
stopped breathing.  Help was summoned, and I eventually
regained the ability to breathe.  The following day, I was
given an angiogram, and was told that I needed quadruple
bypass surgery, which took place three days later.  

     The recovery from hip and heart surgery at the same
time was difficult and, again, it was a little more than two
months before I could return to work.  But, I have been
working ever since, both as a Federal employee and as an
Officer in the National Federation of the Blind of
California.

     Prednisone sometimes causes weight gain.  I am one of
the unfortunate ones who has become obese as a result of
this drug--combined with my body's new-found ability to
produce all the insulin it will ever need.  I gained 70
pounds after my transplant.    Recently, my doctor placed me
on the appetite suppressant Redux.  Having only been on it
for two weeks as of this writing, weight loss, other than
water loss, is not yet very evident.  But I am eating less,
so I am quite encouraged.

     Life as a kidney/pancreas transplant recipient is good,
except for the extra weight I lug around.  But, with a
little help from the pharmacy, the weight load becomes
almost tolerable.  I hope to lose much of my extra weight
over the next few months, and then, when the reduced weight
makes my joints more comfortable, I will be able to keep it
off, by putting much more exercise in my life.

     My out-of-pocket costs for medical care have been
dramatically lowered.  A year after the transplant, I felt
comfortable switching to an HMO.  They won't pay for my
occasional trips back to Minnesota, but they are otherwise
very helpful in keeping medical costs down.

     All in all, I am glad I had the two-organ transplant,
and would recommended it to those who are eligible
candidates.  There are now many good transplant centers
across the country offering pancreas transplants, either in
combination with kidneys or without.  Many transplant
centers shy away from pancreas-only transplants, considering
the necessary immunosuppression therapy too risky.  Of
course, when you get a kidney transplant, such drugs are
necessary for life, and that fact helps to justify the
inclusion of a new pancreas either with the new kidney, or
in another surgery at a later time.

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

                        ASK THE DOCTOR

                    by Wesley W. Wilson, MD


Art:  caduceus

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

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


     Q:  I am told that my kidneys are starting to fail.  I
have taken ibuprofen for my general aches and pains and am
now told that I can't.  Why?  And what pain pills can I take
with these bad kidneys?

     A:  I am sorry to hear that you have kidney disease. 
The key strategy for you now must be to preserve your kidney
function as long as possible.  The DCCT (Diabetes Control
and Complication Trial) showed that even in the early stages
of kidney disease, tight control of blood sugars slowed
further progression of kidney disease.  Some persons without
diabetes show signs of kidney damage with prolonged and
heavy use of anti-inflammatories.  Ibuprofen is a member of
this drug family called non-steroidal anti-inflammatory
drugs (NSAIDs).

     Since this class of drugs can cause kidney injury in
persons with normal kidneys, it seems appropriate to avoid
these drugs if there is any kidney disease present.  For
your interest, Aleve, also available over the counter, is
another member of the same anti-inflammatory drug family.

     Your question of which drug should be used for pain
relief is more difficult.  You certainly should not be
forced to suffer severe pain without some type of treatment. 
On the other hand, especially if there is any kidney
disease, the fewer drugs that you take, the better.  Many of
the medications that we use for pain or for other conditions
can increase kidney damage, or the drug's medicinal effect
can be harder to predict because the drug may be retained in
the blood by the poorly functioning kidneys.  Certainly do
not take any drug unless you need it, and be sure to discuss
your choice of medications with your physician.  In addition
to careful restriction of over-the-counter drugs, other
measures are felt to be important in preserving kidney
function in persons with kidney disease related to their
diabetes.  You should avoid dehydration, reduce dietary
protein, and keep careful control of diabetes and blood
pressure.  All of these are very important factors.  Also,
many physicians feel that a class of antihypertensive drugs,
the ACE inhibitors, has a particular benefit in protecting
the kidneys from diabetic damage.  These  ACE inhibitors
(the most well-known is Capoten) seem to be quite effective
in protecting damaged kidneys from further harm caused by
diabetes.

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

                  SPOTLIGHT:  RUTH WOODWORTH


     It is human nature to fear the unknown.  Ruth
Woodworth, of Casenovia, New York, has spent a lifetime
proving that unnecessary.  "It was just an everyday matter
of things," she says.

     Diagnosed at age two, 59 years ago, she vividly
remembers the early days of urine tests and PZT insulin:  

     "...When I was little, I hated to go to the doctor and
get my finger pricked--I used to scream.  He always gave me
a piece of Black Jack Gum.  To me that is the most ungodly
gum there is in the world..."

     "I remember urine testing with that blue Benedict's
Solution ... you put the urine in it.  I wasn't big enough;
Mother did it.  I was 14 when I started taking my own shots,
same time as my sister, who was 12--I figured when she
started, I would too."

     "I don't remember going out that much until near high
school; we lived in the country, and it wasn't easy to get
places.  I couldn't spend the night with girlfriends until I
started taking my own insulin.  You get used to it, then you
really don't think anything different."

     And she has kept right on going:  "I'm one to work
outside and do things; I'm not an inside girl!"  

     She relates:  "With taking insulin, I have to be
careful, because I have reactions quite easy.  I have to eat
carefully so that I don't have reactions."

     Her advice:  "Mom was very strict with me about food. 
Eat right, watch for (hypoglycemic) reactions, test your
blood, and take your shots on time."

     That's good advice.  With proper care, discipline, and
a positive outlook, diabetes can be reduced to the level of
an irritation.  Ruth Woodworth has already shown us how. 
          
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

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

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

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

               THE PURPOSE OF DIABETES EDUCATION

                  by Peter J. Nebergall, PhD


Photo:  portrait of Peter J. Nebergall

     For many years, we have been telling you that
"education is critical for diabetes management."  You might
even be growing tired of our endless repetition of "you need
to know..."  But don't, OK?

     In medicine, unlike physics or higher math, we start
with the results (like "you have diabetes!") and work back
toward the causal factors, the underlying principles.  It's
like detective work, where you start with the obvious
evidence, then determine the cause, and finally deal with
it.

     Our understanding of diabetes has substantially
improved in the last few decades.  An experienced medical
professional, 20 years out of school, might be as much as 20
years removed from "state of the art"--and "state of the
art" is where we find the breakthroughs that save life and
limb.  

     The "bridge" between the experimenters" on the cutting
edge" of diabetes research and everyone else is education. 
We all need it.  Clinicians need the latest tools,
procedures and test results.  Diabetics need to know what
they should be doing now, in order to best manage their
condition and forestall its possible ramifications.  And
diabetes educators, whose job is to make folks aware of the
appropriate tools, need to keep abreast of the fast-moving
pace of change.

     And change has been coming fast.  The Diabetes Control
and Complications Trial (DCCT) in 1993 proved that intensive
self-management, "tight control," with blood sugars as close
to non-diabetic "normal" as possible, is the best way to
deter ramifications.  New understanding of the nature of
sugar as a carbohydrate, as reflected in the 1995 "Exchange
List," has brought greater ease to diabetic meal planning. 
Steady improvement in home blood glucose monitoring
equipment, coupled with greatly-increased distribution, has
placed another important tool in far more hands.  (You can
buy meters and strips at Wal-Mart!)

     New research has brought us Acarbose, Metformin,
Rezulin (troglitazone), new sulfonylureas, Humalog insulin
(lispro), and other medications to alleviate or deter
complications.  More "investigational" medications are
constantly undergoing clinical tests--and some of them will
find their their way onto pharmacy shelves.

     The efficacy of various surgical procedures is
constantly being monitored.  Sometimes new findings overturn
"the old wisdom."  Balloon angioplasty, to open clogged
veins, is less invasive than "bypass heart surgery," but for
many individuals with diabetic heart disease, the
traditional "heart bypass" operation brings greater success,
in the form of long-term survival statistics, the ones that
matter.

     Now, back to you, your family doctor, and your diabetes
clinic.  It's human nature to "get set in your ways."  We
learn our particular tasks, whether they are those of self-
management, diagnosis, or long-term treatment, and there we
sit.  We have "better things to do."  We would go on giving
the same answers to the same questions, because when we
learned them, they were the Right Answers.  

     But they are no longer.  Not only do our bodies change,
requiring constant readjustment of the balancing act that is
diabetes self-management, but the most appropriate
therapies, the best options, are constantly being upgraded
or replaced.  New and better ways are coming out all the
time.  We all want the best possible options.  How are we
supposed to find out about these things?  

     This is the true purpose of diabetes education.

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

                   VOICE DISTRIBUTORS NEEDED


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

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

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

        WORLD DIABETES CONFERENCE REVEALS NEW RESEARCH

                         by Ed Bryant


     On March 19, 1997, the Juvenile Diabetes Foundation
International (JDFI) sponsored a unique event; an
international teleconference press-briefing with some of the
world's leading diabetes researchers.  Held at the close of
the JDFI's Fourth World Conference, in Athens, Greece, it
brought together  140 specialists in all aspects of diabetes
research, with the hope that their sharing and networking
might advance the cause.   

     Several researchers gave short presentations, and then
the session was opened to questions from members of the
press.  I was fortunate to be invited to participate in this
event.  The researchers were linked from different places
(one was calling by cell-phone from an airport!), and the
reporters were all linked to them, from our different
locations, through the conference operator.  It was quite an
experience.

     First, Philippe Halban, PhD (University of Geneva,
Switzerland), Scientific Co-Chair of the Conference,
outlined the areas covered by the Athens Conference.  As he
reported, sessions were organized along five tracks: 
Insulin action and resistance; Pancreatic Beta cell growth,
differentiation, and death; Ramifications of diabetes; New
methods of treatment, new ways to administer, and new ways
to monitor, and; Immunology and islet cell transplantation. 
Participants, involved in different aspects of research
toward prevention, treatment, or cure of diabetes, were
encouraged to interact, and to become more
interdisciplinary.

     The next speaker was Arthur Rubenstein, MD, from the
University of Chicago.  He is an expert on trends and
statistics of diabetes, and, as he stated, much of that
information is not readily appreciated.  "It's importance
should be recognized by all of us who are thinking about the
impact of chronic disease on the health care system," he
told us.

     He revealed how there is tremendous variation in IDDM
occurrence world-wide, with some countries, like Finland,
having as many as 35 occurrences per 100,000 individuals,
while others, like China, have as low as 1 per 100,000, and
the U.S.A. is closer to the middle, with 5 to 10 per 100,000
individuals.  He stated that type I diabetes is the most
common chronic disease of childhood, more common that all
childhood cancers combined.  

     He discussed the genetic connection, and the fact that
chances of developing type I diabetes are much higher (up to
5 per 100 individuals) in a family with an affected parent
or sibling.  "IDDM is becoming more common," he reported,
"with quite a dramatic increase in the last 30 years, even
increasing in the last 10 or 20 years."

     Dr. Rubenstein related some of the changes that had
taken place since the last JDFI conference, in 1992. 
Through changes in genetics, we know far more about who is
at risk.  Our better immunological understanding of
antibodies and autoimmune disease process enables, for the
first time, diabetes prevention studies, which are currently
underway in the U.S., Europe, and Australia.  

     We have new techniques to identify who is at risk, even
before diagnosis, and, since the publication of the Diabetes
Control and Complications Trial, in 1993, we have a new
approach to the treatment of diabetic complications, one
that in 1992 was not even considered possible, he reported. 
Dr. Rubenstein mentioned ACE inhibitors, "growth factors,"
anti-neuropathy drugs, new developments in transplantation,
and cell engineering.  New insulin preparations and oral
drugs are under analysis, and may prove useful.  Many
important avenues of inquiry, for both basic science and
patient-oriented care, are currently being followed.  This,
he stated, should lead to rapid advances.      

     The next presenter was Leonard C. Harrison, MD,
Professor, head of the Burnet Clinical Research Unit,
University of Melbourne, Australia.  He spoke on the
autoimmune nature of type I diabetes and its onset.  With,
in his words, "the explosive increase in this knowledge in
the last decade or so," and the recognition that this
disease is due to the interaction of many genes that act
together to predispose an individual, placing them at risk,
it may be possible to protect against the disease through
genetic analysis.

     Dr. Harrison reported on our vastly improved
understanding of the role of T-cells.  Although, as he
stated, we still do not know what triggers this destructive
autoimmune response (the killing the Beta cells of the
pancreas that causes type I diabetes), it is now known how
the T-cells find their targets, the specific peptides they
single out for attack.  Thus, he hoped, we might someday be
able to intervene and subvert this process.

     Dr. Harrison's research has revealed that the prime
target of the rogue T-cell attack that causes type I
diabetes is insulin itself, or more specifically proinsulin,
its parent compound.  With his research, he hopes to
intervene in people at risk, modifying the immune response
before the T-cells can destroy the Beta cells and the
pancreas' insulin-making ability, causing type I diabetes.

     The mucous membranes in the nasal cavity are now known
to have their own separate "immune system," primarily to
prevent or restrict inappropriate immune response to
proteins inhaled or ingested.  Dr. Harrison's research team
has been administering insulin and proinsulin orally and
intranasally to mice, then to humans, not for blood sugar
control but to ameliorate T-cell attack, in a type of
"vaccination" designed to create immunity from such T-cell
attack.

     Aerosol administration of insulin in mice cut their
frequency of type I diabetes from 90% to 25%.  A new human
trial, in children and young adults already at high risk
(who show antibodies and T-cell attack, with more than 50%
chance of developing diabetes) started July 1996.  (By the
way, aerosol administration of insulin to regulate blood
glucose was tested several years ago--it failed.)  The goal
of the research trial is to determine whether this
treatment, effective in mice, will work in humans.  By the
end of 1998, the first stage will be completed, and if
successful, research will proceed to investigating the
possibility of prevention. 

     John Todd, PhD, Professor of Human Genetics, Oxford
University, spoke of new understanding of the gene defects
that predispose an individual to type I diabetes.  Using the
database called "The Human Genome Project," he reported we
can now identify the specific genes, and the nature of their
defect or malfunction.

     Professor Todd related two specific examples.  The
first and most important is an "immune response gene," that
normally controls identification/differentiation between
"friend" and "enemy" particles in the human body, leaving
one unharmed and summoning killer T-cells to destroy the
other.  Normally this gene plays a positive role, but it is
the gatekeeper, controlling the identification of the Beta
cells as friendly or as something to be destroyed by immune
action.  What causes this important gene to turn traitor? 
Once known, can this knowledge be used to identify those at
higher risk?

     Dr. Todd revealed that the human pancreas is not the
only source of insulin; the hormone is also produced in the
thymus gland.  Significantly, the thymus is also the organ
that prevents autoimmunity.  One gene in a healthy thymus
protects against the onset of type I diabetes.  If a second
gene goes defective, and attacks the first, diabetes will
result.  

     Another study Dr. Todd related concerns Interleukin-2,
the T-cell growth factor.  This substance's main function is
to prevent autoimmunity; in autoimmune-prone individuals, it
is reduced.  There is possibility that a test for this
defect, reduced levels of Interleukin-2, could reveal
incipient diabetes.  "There must be at least 10 other
susceptibility genes that remain to be discovered," he
stated.  

     Dr. Todd related that the autoimmune process by which
the body attacks and destroys the Beta cells of the
pancreas, causing type I diabetes, is identical to the
process by which the body rejects a transplanted organ.  As
our understanding of the one process grows, we should be
better able to deal with the other.

     Emily Spitzer, the Juvenile Diabetes Foundation's Vice
President of Research, then made a short presentation about
the need to press on for a cure, and to "move basic advances
closer to the patient."  She reiterated the goals of the
JDF, which in 1996 awarded more than $30.3 million to
diabetes research, and which has given $220 million for such
research since 1970.  She reminded listeners that people are
"not at fault," if they develop diabetes, or its
complications.  She then introduced the "Q & A section," in
which members of the press could, through the special
conference-call hookup, ask questions of specific
presenters.  

     Although any "question-and-answer session" is by
definition random and unstructured, subjects covered here
continued to hold listener interest.  A question about
nasal-spray (aerosol) administration of insulin (or
proinsulin) revealed that such administration can protect
against autoimmune attack and the development of insulin-
dependent diabetes mellitus (IDDM, type I diabetes) even
after the autoimmune attack has begun.  It seems there are
"regulatory T-cells," as well, and these, if properly
directed, protect against attack.   

     Of course the question came up:  "How close are we to a
cure?"  The responders pointed out that there are a number
of meanings to the word "cure," and that pancreas
transplantation, which eliminates the need for insulin or
oral medications, could be described as a cure for diabetes. 
Islet cell transplantation, to reestablish insulin-making
capacity in the diabetic pancreas, is in the experimental
stage.  Sometimes it works.  As the problems are worked out,
look for real progress in this area.  

     Part of the difficulty with transplantation, either to
mitigate diabetes ramifications or for other conditions, is
the problem of immunosuppression.  At this time, a
transplant recipient must take heavy doses of
immunosuppressive drugs, to keep his or her immune system
from destroying the new organ (in exactly the same way the
diabetic autoimmune system destroys islet cells).  Safer,
more specific ways to prevent transplant rejection are
needed.

     There is a lot of research underway in the area of
nerve fiber growth and regeneration.  Up to this time,
although damaged nerve fibers might heal, if destroyed, they
would not regenerate.  If we can stimulate damaged nerves to
better "repair" themselves, we can reduce many of the
ramifications of diabetes.  

     The doctors argue that no "cure" for diabetes can take
place without the achievement of reliable diabetes
prevention.  When individuals in the early stages of
diabetes can be treated with something that stops the
disease in its tracks, and when individuals considered at
high risk can be "vaccinated," so that diabetes never
starts, then we will have a real "cure."            

     The subjects covered in this unique international press
conference were promising, even exciting.  While we work
day-to-day to perfect our self-management techniques, keep
the best possible blood glucose control, and thus minimize
our risk of ramifications, world-class researchers are
pressing on with the search for breakthroughs that will make
it all unnecessary.  The search for a cure goes on--and some
good folks are on the job.  May it come soon.

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

       FEDERATIONISTS, FUND-RAISING, AND FREE ENTERPRISE

                         by Marie Cobb


Photo:  portrait of Marie Cobb

     (This article appeared in the BRAILLE MONITOR, March
1997, published by the National Federation of the Blind.)


     From the MONITOR Editor:  Federationists who have
enjoyed meals in the dining room at the National Center for
the Blind know that Marie Cobb, who runs the kitchen from
which all those meals are served, is a wonderful cook and a
gifted caterer.  In fact, she has many talents and is always
adding something new to her list of responsibilities.  Here
she describes the latest work she is doing for the
Federation:

     As many of you know, some of the National Federation of
the Blind's traditional sources of funding are becoming less
cost-effective each year.  In order for us to meet this
challenge, we are constantly searching for new sources of
revenue.  Last spring President Maurer signed the NFB on as
a distributor for the American Communications Network,
marketer for LCI International long-distance.  This project
will succeed or fail in direct proportion to the number of
people who agree to participate in the program.

     There are about ten Federationists who own ACN
distributorships under the NFB, and we are all committed to
making this relationship between the NFB and ACN a lucrative
one. We believe that the combination of excellent service
and attractive rates will help to make our commitment a
reality.  At the same time each of us is working to build a
profitable business for ourselves.  The more successful we
are as individuals, the larger the residual income will be
for the NFB.

     We want to be certain that everyone understands to whom
the commission from his or her long-distance or any other
ACN account will be paid, so here is the agreement we ten
have with Mr. Maurer.  The NFB's ACN representatives will
hold business opportunity meetings at Washington seminars
and at national conventions.  We will seek customers and
offer those who are interested a chance to examine the
business plan.  We will also have a booth in the exhibit
hall for the same purposes.  Any person who wishes to become
an ACN customer during the Washington seminar or at national
convention will automatically be placed directly under the
Federation instead of the associate who acquires the
account.  We, the associates, will be building our personal
businesses during this time by recruiting new associates to
work with us.


Here is the way you can participate:

     1.  Fill out a simple form to change your long-distance
carrier to LCI.  There is no charge for the switch, and LCI
provides excellent service at a lower rate than many other
long-distance carriers.  If for any reason you are
dissatisfied with the service after 90 days, you can go back
to your original carrier at no cost to you.

     2.  Ask your friends and family to help the NFB by
switching their long-distance carrier to LCI as well.

     The National Federation of the Blind will receive three
to eight percent of every dollar spent on long-distance
calls each month on all of these direct accounts, and one-
quarter of one percent to five percent of all accounts which
are generated for our personal businesses.

     Long-distance service is just the tip of the iceberg. 
There is also cellular service through the most advantageous
carrier in each area, and pager service through Pagenet. 
There will soon be voice paging as well.  In the near future
we will also be able to offer cable access, local dial tone
service, Internet access, and utilities.  The potential
income for the NFB is really exciting.

     The bottom line is that this costs you nothing and
indeed will save you money each month.  It will also help to
fund the important work in which we are all engaged.  So
please contact an ACN representative as soon as possible. 
If you do not know an ACN representative or wish to explore
becoming one yourself, please contact me, Marie Cobb, at: 
(410) 659-9314 or (410) 644-6352.  I have volunteered to
take calls which come into the National office or my home
and see that those accounts go directly to the NFB. 
However, I am also building a file of personal accounts on
other occasions.

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

                       SUGARS & DIABETES

          by Madelyn Wheeler and Marcia Levine Mazur


     Recently, "Diabetes Forecast" received a letter about a
subject that concerns many people with diabetes:  sugar. 
The writer wanted to know why a magazine for people with
this disease would publish a recipe (March 1996, p. 34
"Coconut Pineapple Compote") that had 20 grams of sugars in
one serving.

     It's an excellent question and one that "Forecast"
would like to answer in print, not only for the writer, but
for all our readers who have similar "sugar" concerns.


Reader Is Right

     First, we agree.  The sugar content in the recipe is
high.  But that's not the whole story.

     The sugars in the compote come mainly from the fructose
(fruit sugar) in the pineapple, while a small percentage
comes from the lactose (milk sugar) found in the milk and
yogurt.

     Clearly, many nutritious foods have some form of sugar
or a combination of sugars in them.  Fruits, in fact, are
particularly high in sugar.  That means that virtually any
fruit we eat--if it had a food label--would list a large
quantity of sugar on that label.  (To be more scientific, it
would list most of its carbohydrates as sugar, but more
about carbohydrates later.)

     If "Forecast" could not print recipes that contained a
large quantity of sugars--such as the 20 grams of sugars per
serving in the Pineapple Compote--it could not print recipes
that had fruit in them.

     But "Forecast" does print such recipes, because sugars-
-when used appropriately--are not forbidden foods for people
with either type of diabetes.


What's Wrong With Sugar?

     It's understandable that people with diabetes worry
more about sugar than about any other food.  For centuries,
sugar has been considered the enemy, the worst possible
thing people with diabetes could ever consume.

     Why?  The very name of the disease for one thing.  For
years diabetes mellitus was commonly referred to as "sugar
diabetes." (Mellitus roughly translates as "sweet.")

     That name came about because doctors once diagnosed
diabetes by tasting the urine of the affected person.  A
sweet urine meant diabetes.  (The urine of people with
uncontrolled diabetes contains glucose.)  Doctors then
erroneously concluded that eating too much sugar had to be
the cause of this disease.

     In fact, one of the great pioneers of diabetes
research, Dr. Frederick Allen, reported in 1920 in "The
Journal of Experimental Medicine" that "sugar is a more
dangerous food for human beings with any predisposition to
diabetes than starch."

     Dr. Allen didn't have the equipment and methods today's
scientists have.  And his conclusion has been disproved. 
But he was certainly not alone in telling people with
diabetes to stay away from all sugars.

     Researchers in more recent times have given the same
advice.  They knew that sugars such as sucrose (table
sugar), fructose, lactose, and maltose (a sugar found in
cereals, grains, and legumes) have simple molecular
structures and have been called simple carbohydrates.  (The
scientific name is monosaccharides or disaccharides.)

     They also knew that foods such as pasta, potatoes,
bread, and crackers have complex molecular structures and
have been called starches, or complex carbohydrates.  (The
scientific name is polysaccharides.)      

     They then reasoned that the body must digest and absorb
foods with a simple molecular structure faster than it does
foods with a complex molecular structure.  They also
concluded that quickly absorbed foods must raise blood
glucose faster than more slowly absorbed foods.

     Relying on these assumptions, they reinforced the
message that sugars are harmful for people with diabetes. 
But few nutritionists actually experimented to see if these
conclusions were true.


No Evidence 

     In the 1970s, several researchers were no longer
satisfied with these assumptions.  They began asking:  How
do we really know that sugars affect blood glucose levels
faster than any other foods?  Where is the evidence that
proves sugars are especially harmful for people with
diabetes?

     The resulting research served to challenge long-held
"truths" about the connection between diabetes and sugars. 
Within the American Diabetes Association, a consensus began
to develop that it was time to take a closer look at the
subject.

     In 1993 the American Diabetes Association convened a
panel of experts to review all the recently published
scientific literature on nutrition and diabetes.

     The panel's findings were a surprise.  It uncovered no
scientific evidence to support the belief that people with
diabetes should eat little or no sugar of any kind.

     In fact, the panel concluded that sugars, when used as
part of a regular meal plan and when consumed with other
foods, do not harm blood glucose control in people with
either type I or type II diabetes.


Just Another Carbohydrate

     The reason is that sugars are not a special kind of
food.  They are carbohydrates.  And the body processes all
carbohydrates--simple and complex--in the same way. 
("Forecast"'s nutrient listings, which accompany each
recipe, and Nutrition Facts on commercial food labels
actually list sugars under Total Carbohydrates.)

     It is the total amount of carbohydrates that you eat
that affects your blood glucose levels, not where they come
from.

     But the sugar story is even more complex.  Scientists
now know that many factors besides the food itself affect
blood glucose levels.  For example, how has the food been
processed?  Cooked?  What other foods are being eaten before
or at the same time?  How quickly is the meal consumed?


Different Sugars

     Various sugars, too, have different effects on blood
glucose levels, because sugars themselves have different
components.

     Sucrose (table sugar), for example, is actually made of
glucose and fructose in equal parts.  That is why nutrition
labels list "sugars" rather than "sugar."

     However, these differences tend to equalize when you
consume sugars in combination with other foods.  For this
reason, dietitians recommend that you have your sugary foods
as part of a total meal.


Wait A Minute

     But wait.  This does not mean to go ahead and have all
the sugars you want.  It does mean that you can have sugars
as part of your diabetic diet if, like any other foods, you
work them into your total daily food plan.

     Also, although it's not the case with the compote
recipe that prompted our reader's letter, many foods high in
sugars, particularly sucrose, are also often high in
calories and fat.

     It's important to limit high-calorie, high-fat foods
when you have diabetes.  High fat diets have been linked to
heart attack and stroke, and either type of diabetes is also
an additional risk factor for these diseases.

     Finally, sugars are not particularly healthy additions
to the diet.  While they add flavor and can fill a good
percentage of your day's quota of carbohydrates and calories
(they contain four calories per gram), sugars don't add any
vitamins, minerals, or fiber.


Naturally Occurring Versus Added Sugars

     Some people divide sugars into two categories: 
"naturally occurring" (such as the fructose in fruit) and
"added" (such as the sucrose in a cookie).  They think there
is a significant difference between the two.  There isn't.

     To date, there is no scientific evidence showing that
our bodies make a distinction between sugars that grew in
the food, or sugars that are added by the cook or the
processor.


Wait a Minute

     Don't be misled.  The latest findings on sugar do not
give people with either type of diabetes a green light to
consume all the sugars they want.

     Rather, they let people with diabetes know that they
can substitute sugar for other carbohydrates in their total
daily food plan, and that sugary foods are best eaten with
the meal.

     For example, if you wanted to have a small piece of
cake after a meal, you would substitute it for a food or
foods that have approximately the same number of total
carbohydrates.  You might, for instance, have the cake
instead of a bread roll or a portion of pasta.  The key word
is "substitute."

     That's why it's important to know the number of sugar
grams as well as the total number of carbohydrate grams in a
food or recipe.


They All Mean Sugar

     Here are some of the terms you'll see on a label that
translate into "sugar."

     Beet Sugar
     Brown Sugar
     Cane Sugar
     Carob Powder
     Confectioner's Sugar
     Corn Sweetener
     Corn Syrup
     Dextrose
     Fructose
     Galactose
     Glucose
     Granulated Sugar
     Honey
     Invert Sugar
     Lactose
     Levulose
     Maltose
     Maple Sugar
     Molasses
     Powdered Sugar
     Raw Sugar 
     Sucrose
     Sorghum
     Sugar Cane Syrup
     Table Sugar
     Turbinado


Sugar Alcohols

     The human body does not process (metabolize) sugar
alcohols the same way it processes sugar.  For that reason,
The U.S. Food and Drug Administration (FDA) generally does
not require them to be listed on a food label.  They must be
listed only if the product makes a specific sugar claim, say
that it is sugar free.

     However, when sugar alcohols are on the label, they are
placed in a separate line under Total Carbohydrates.  The
following example is from a label for hard candies that
contain sugar alcohol and claim they are sugar free:

     Total carbohydrates 13
     Dietary Fiber 0 grams
     Sugars 0 grams
     Sugar Alcohol 12 grams

     Sugar alcohols have a minimal effect on blood glucose
levels.  But although the FDA counts sugar alcohols at two
to three calories per gram (rather than the four calories
per gram for other sugars), they are not problem free.

     Because sugar alcohols are not completely digested in
the stomach, many people find that eating too much sugar
alcohol causes cramping and gas in the lower intestine.

     Some sugar alcohols you'll find on labels:

     Hydrogenated Starch Hydrolysate
     Isomalt
     Lactitol
     Mannitol
     Malitol
     Sorbitol
     Xylitol


     Madelyn Wheeler, MS, RD, CDE, is coordinator for
research dietetics at the Diabetes Research and Training
Center of Indiana University Medical Center in Indianapolis. 
Marcia Levine Mazur is senior editor of "Diabetes Forecast."

     Reprinted with permission from "Diabetes Forecast,"
February 1997.  Copyright 1997 American Diabetes
Association.  For information on joining ADA and receiving
Diabetes Forecast, call 1-800-806-7801.

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

                         RECIPE CORNER


Art:  fruits and vegetables

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


                     Low-Fat Potato Salad

                 from Ann S. Williams, RN, CDE
                      of Cleveland, Ohio


1/2 cup low-fat mayonnaise
3/4 cup no-fat yogurt
2 tbsp. yellow mustard
1/4 - 1/2 cup finely chopped onion, to taste
1/2 cup chopped pepper, red or green
1 hard-cooked egg, chopped very fine
4 cups cooked, peeled, cubed potatoes (5 to 6 medium)
1 cup chopped dill pickle
1 1/2 cups chopped celery

     Stir together first six ingredients.  Add remaining
ingredients and mix well.  Cover and chill at least one
hour.

     Makes 12 servings; serving size = 1/2 cup.

     Per serving:  91 calories, 3 grams protein, 1.2 grams
fat,  17 grams carbohydrate, 420mg sodium, 24mg cholesterol,
1.1 grams fiber.  Exchanges:  1 starch.


                  Egg Foo Yung  (Fu Yong Hai)

                      from Dave Griffith
                  of London, Ontario, Canada


1/2 cup chopped cooked chicken, pork, shrimp, or firm tofu 
3 sliced green onions
1 shredded zucchini   
1 shredded carrot
1 cup bean sprouts
1 clove of minced garlic
3 egg whites
1 egg
2 tsp. flour
1 tsp. low sodium soya sauce 
1/2 tsp. Worcestershire sauce
1/4 cup chopped fresh cilantro
1/4 tsp. "five spice" powder
Cayenne pepper to taste
freshly ground black pepper

     Beat the egg, egg whites, flour, soya sauce,
Worcestershire sauce, Cayenne and black pepper together.  
Now mix everything together in the  bowl.  At medium high
heat, in a nonstick skillet, with a little cooking spray,
spoon out 1/4-cup batches of the mixture.  Flatten the mix
into pancakes; cook until brown on both sides.

     I like mine with a little President's Choice Memories
of Bangkok Thai Sauce (a sugar free product sold in Canada).

     Makes 4 servings; Per serving: 121 calories, 2g total
fat, 0g saturated fat, 79mg cholesterol, 15g protein, 8g
carbohydrate, 177mg sodium, 332mg potassium.  Exchanges:  2
very lean meats, 1/2 starch.


                         Curried Sole


     The following recipe appears in "Quick and Healthy
Recipes and Ideas for People Who Say They Don't Have Time to
Cook Healthy Meals" by Brenda J. Ponichtera, RD, published
by ScaleDown Publishing, of the Dalles, Oregon.


1 lb. fillets of sole
1/4 cup light mayonnaise
1 tsp. lemon juice
1 tsp. curry
1 tbsp. dried parsley

     Arrange fish in a 9"x13" baking pan, or microwave-safe
dish, that has been sprayed with non-stick cooking spray. 
Set aside.  Meanwhile, mix mayonnaise, lemon juice, and
curry.  Spread in fillets.  Sprinkle with parsley.  Follow
directions below for microwave or conventional oven.

     Conventional Oven:  Preheat oven to 450 degrees.  Bake
for 4-5 minutes per half-inch thickness of fish, or until
fish flakes easily with a fork.

     Microwave Oven:  Cover with plastic wrap.  Cook on high
4-6 minutes, depending on thickness of fish.  Rotate dish
halfway through cooking.

     Yield:  4 servings; One serving:  1/4-recipe; Per
serving:  147 calories, 2 grams carbohydrate, 21 grams
protein, 6 grams fat.  Exchanges:  3 lean meats.


                   Curried Lamb  (Vindaloo)

                      from Dave Griffith
                  of London, Ontario, Canada


1 lb. lean stewing lamb
2 tsp. canola oil
2 chopped onions
1 stalk of chopped celery
1 clove minced garlic
1 tbsp. curry powder 
Ground cloves and cinnamon to your taste (just a touch)
1 chopped apple
1 cup chicken broth
2 tbsp. tomato paste
1/4 cup low fat yogurt
2 tsp. tapioca flour (or all-purpose flour if you can't find
any)

     Cut the meat into 1" cubes.  Heat the oil in a skillet
at medium heat; cook onion, celery, and garlic until the
onion is translucent.  Add the curry powder, cloves and
cinnamon; stir well.  Add meat and apple; cook until the
meat is well covered.  Add broth and tomato paste and bring
to a boil.  Reduce heat, cover and simmer until the meat is
tender.

     Add tapioca flour and yogurt in a bowl; mix well.  Stir
into the broth mixture and simmer until the sauce thickens. 
Serve with some nice white or brown Basmati rice.

     Yield:  6 servings; Per serving:  157 calories, 5 grams
total fat, 2 grams saturated fat, 52mg cholesterol, 17 grams
protein, 8 grams carbohydrate, 204mg sodium, 362mg
potassium.  Exchanges:   2 lean meats, 1/2 starch.

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

              INJECTING INSULIN THROUGH CLOTHING


     Ever since Semmelweis, Lister, and Pasteur, doctors and
nurses have been taught to follow sterile antiseptic
technique, especially where a medical procedure (such as an
injection) breaks the skin.  Thus those diabetics who must
daily inject insulin have been taught to remove clothing,
alcohol-swab the injection site, and otherwise preserve
maximum cleanliness.  But some authorities state such
precautions are unnecessary.  How clean is clean enough? 
There has been much argument.

     The American Diabetes Association's professional
journal "Diabetes Care" (Vol. 20, No. 3, March 1997)
published the results of a study by Doris Fleming, MSN, RN,
CS, CDE; James Fitzgerald, PhD; George Grunberger, MD; Scott
Jacober, DO, CDE; and Melissa Vandenburg, BSN, RN, CDE, in
which 50 insulin-using diabetics performed injections both
by traditional antiseptic techniques and through a single
layer of clothing.  Was there any significant difference,
either in diabetes control, or in side effects such as
nuisance infections?

     The researchers were thorough.  All participants had a
skin assessment, A1C, and leucocyte count before the test,
at the 10-week point (halfway), and again at completion. 
Problems, benefits, type of clothing (from nylon to denim)
and other comments were recorded by the subjects in an
"injection log."

     Over the 20-week period, approximately 13,720
injections were performed by the participants.  None of the
subjects experienced erythema, induration, or abscess at
injection sites.  Neither the glycated hemoglobin levels nor
the leucocyte count differed between the conventional or the
experimental (through clothing) injection regimens.  During
the injection-through-clothing phase of the study,
participants' logbooks recorded only minor problems, such as
small bloodstains or bruising.  Subjects reported that
insulin injection through clothing offered benefits such as
convenience and saving time.

     The researchers' conclusion:  "It is safe and
convenient to inject insulin through clothing."


     From the VOICE Editor:  I have made many injections
through my clothing, without problems.  However, I would
recommend you do this only if you and your clothes are
clean.  I note that if you are on immunosuppressive therapy
(or otherwise immune-compromised), you might need to be more
cautious of infection, and avoid this practice.  I saw that
the above study was also noted in "New England Journal of
Medicine"'s newsletter "Healthnews" (March 1997).

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

                       FOOD FOR THOUGHT


Art:  Dancing fruits and vegetables

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


                     NEUROPATHY TREATMENT

     "The Johns Hopkins Medical Letter," for September 1996,
reports that some peripheral neuropathy sufferers have found
relief from night-time symptoms of tingling, numbness, and
"crawling sensations" in the feet and legs, by taking, with
their doctor's approval, 50mg of diphenhydramine (Benadryl)
before going to bed.  The letter suggests that half that
dose, 25mg, might help with similar daytime symptoms, but to
beware of drowsiness.  Discuss this with your doctor.


                           NEW MUSIC

     VOICE reader Hazel Trujillo, a singer-songwriter in
Miami, Florida (who is also a deejay, classical guitarist,
self-defense instructor, diabetes educator, and blind
diabetic!) announces the availability of her two record
albums, "Hazel," and "On Golden Wings."  Her romantic music
has been played in Central and South America, many
Mediterranean countries, and on Miami radio stations. 
"Hazel," the first album, is sung in Spanish, while "On
Golden Wings" is all English, with several instrumentals. 
Both are her own original material.  EDITOR'S NOTE:  I've
listened to both tapes, and I enjoyed them.

     The tapes are priced at $10 each, or the pair for $15. 
Send check or money order to:  Hazel Trujillo, PO Box
430049, Miami, FL 33243-0049.


                   PHONE RECORDING EQUIPMENT

     Individuals who are blind or otherwise dependent on the
tape recorder as a note-taking device know that sometimes it
is necessary to record a telephone call.  Traditional "phone
mikes," for those of us who don't have a brother in the CIA,
have been complex, unreliable, with more batteries and
suction cups than a four-year old's Christmas toy, and their
recordings have hardly been crystal clear.  That has now
changed.  

     Federationist Jerry Maccoux has developed the Phonote,
a compact, no-batteries device that greatly simplifies the
task of recording your phone conversations.  It also gives a
loud, clear, undistorted sound, as if the other party were
in the room with you.  You will need:  The device, a tape
recorder with an "aux-input" or remote microphone jack, and
an extension phone line (which can be as simple as a Y-jack
and six-foot phone line running from your modular plug). 
Plug the second line into the Phonote, the Phonote into your
recorder, and you're ready.  Please note a number of laws
restrict the taping of phone conversations.  To be safe,
inform the other party a recording is being made.

     The Phonote, priced at $12 (plus $3.50 shipping), is
available from:  Phonote, PO Box 6021, St. Joseph, MO 64506;
telephone: (816) 279-4562; e-mail:  donnajo@ccp.com


                      NEW FOOT PAIN DRUG

     If you have diabetes, you know that peripheral
neuropathy, a progressive nerve degeneration causing
numbness, pain, or tingling in the legs and feet, can occur
after a number of years with the condition.  But the same
pain can be a symptom of another condition, one called
intermittent claudication, sometimes a symptom of peripheral
arterial disease, or PAD.

     Peripheral neuropathy and PAD have different
treatments, so it is important to tell them apart (note they
can occur at the same time).  If you are experiencing such
symptoms, talk to your health care team, as treatments are
available.

     We have been asked to announce that Trental
(manufactured by Hoechst Marion Roussel) is now available to
treat the symptoms of intermittent claudication.  As part of
a complete, doctor-guided, program that includes diet and
exercise, Trental could put your feet in a better place. 
For information about Trental, contact your pharmacist, or: 
Cold Feet, PO Box 6309, West Caldwell, NJ 07007-6309;
telephone:  1-800-925-5669, extension 109.


                 BLINDED VETERANS ASSOCIATION

     We have been asked to announce:  The Blinded Veterans
Association (BVA) is a privately-funded non-profit support
and advocacy organization for all blind veterans of military
service, their families and friends.  They offer
information, advocacy, and needs-assessment services to all
blinded veterans, and the vision loss does not have to be
service-connected.  BVA volunteers, themselves blind
veterans, work in Veterans' hospitals, do community
outreach, and help other blind veterans in the formal VA
claims process.  The BVA works closely with government
agencies, in matters pertinent to blind veterans, and each
year, delivers its list of legislative priorities to the
House and Senate Committees on Veterans Affairs.  The
association publishes the periodical "The BVA Bulletin," in
large print and cassette.  

     For more information, contact:  Blinded Veterans
Association, 477 H Street NW, Washington, DC 20001-2694;
telephone:  1-800-669-7079.


                        PESKY MACHINES

     When that wonderfully convenient little machine
"develops a mind of its own," and starts giving you trouble,
do you ever wonder why it never uses that "mind of its own"
to do something useful?


                  DRAIN CLEANER AND DECLOGGER
(From the internet)

Requires:       1/4 cup baking soda
                1/2 cup white vinegar

     Pour the baking soda into the doubtful drain.  Follow
with vinegar.  Close or cover drain until fizzing stops. 
Flush with a pot of boiling water.


                 ILLINOIS MEDICARE INFORMATION

     The Health Care Service Corporation (HCSC) is the
Medicare Administrator for the state of Illinois.  To
expedite its task of providing high-quality, timely service
to program beneficiaries within the state, HCSC has
developed the Beneficiary Outreach Program.  The program's
Beneficiary Outreach Committees, composed of both providers
and beneficiaries, provide feedback on new and pending
changes, brief government agencies, congressional staff
members and consumer organizations (such as the Senior
Health Insurance Program, SHIP), serve as information
resources in Social Security Administration offices, and
help train those who counsel Medicare beneficiaries.  For
information, contact:  Health Care Service Corporation, 233
North Michigan Ave, Chicago, IL 60601; telephone:  1-800-
642-6930.


                       NEW RESOURCE LIST

     We have been asked to announce:  Linda Schall has
assembled a list of diabetes equipment for blind or visually
impaired diabetics.  Talking glucose monitors, tactile-
marked insulin pens, insulin gauges, syringe magnifiers and
more, along with a listing of suppliers and information
resources, all are listed in her "Medical Resources for
Visually Impaired Diabetics."  Available in standard print,
large print, or Braille, price $30, the list is available
from:  Community Integration Consulting, 14 W. Park Blvd.,
Westmont, NJ 08108; telephone:  (609) 854-7711.


                       JEWISH MATERIALS

     We have been asked to announce:  The Jewish Heritage
for the Blind is pleased to announce the availability of the
"Megilas Esther" and the "Haggadah" in large print.  For
ordering information, please call, fax, or write to:  The
Jewish Heritage for the Blind, Department of Large Print
Publications, 1655 East 24th Street, Brooklyn, NY 11229;
telephone:  (718) 601-9128; fax:  (718) 338-0653.


                    NEWSLINE FOR THE BLIND

     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" already participate.  More publications, including
local papers, are expected to join shortly.  As the system
expands, more blind individuals will have rapid and
comprehensive access to daily print news media,  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 more of the required local
distribution centers.  For further information, or to listen
to a sample (read by the DECtalk speech synthesizer),
contact Newsline Network, National Federation of the Blind,
1800 Johnson Street, Baltimore, MD 21230; telephone:  (410)
659-9314.


                       BUFFERED INSULIN

     You may see mention of "buffered insulin," and wonder
what it is.  Buffered insulin is for use in insulin pumps. 
An additional ingredient has been added to ensure smooth
flow of insulin through the pump.  Although some pump-users
employ unbuffered insulins (the same as used in a
conventional insulin syringe), and do well, the potential
for a stoppage exists.  Use of buffered insulin in a pump
lessens the odds and cuts the risk.


              NONINVASIVE GLUCOSE MONITOR UPDATE

     Biocontrol, developers of the Diasensor 1000 non-
invasive glucose monitor, began a new round of clinical
tests of the device on February 3, 1997.  This study,
requested by the FDA, is to determine whether the
difficulties that led to previous denial of FDA approval to
market the device have been overcome.  Upon successful
completion of this trial, anticipated to take 120 days, the
510(k) notification, application to market in the United
States, will be resubmitted.  Further details of the study
are described as "confidential at this time."


                         BOARD MEMBERS

     The Diabetes Action Network of the National Federation
of the Blind.

President:  Tom Ley
     Baltimore, MD

First Vice-President:  Ed Bryant
     Columbia, MO

Second Vice-President:  Janet Lee
     Cedar, MN

Treasurer:  John Yark
     Stamford, CT

Secretary:  Sandie Addy
     Prescott Valley, AZ


                        ARTICLES NEEDED

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

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

     Perhaps you have not experienced side effects--your
unique insight, coping strategies, and lifestyle can still
inspire others.  Are you a relative, a friend, or a health
professional?  More than 194,449 VOICE readers could benefit
from your story.

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

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

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

(Resource Column)


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


                          FREE VIDEO

     Insulin manufacturer Eli Lilly and Company is offering
a free VHS videocassette titled "Stop:  Take Control of
Diabetes."  To obtain a copy, while supplies last, call:  1-
800-785-3226.


                      DIABETIC FOOT CARE

     Comforteze Sock Company manufactures large,
comfortable, non-binding, all-cotton socks.  Sizes medium,
large, and extra large, they fit easily over bandages, and
provide relief for sore and swollen feet.  Price $6 per
pair; money back guarantee.  Call toll-free:  1-888-433-
6636.


                   TALKING LIFESCAN PROFILE

     Myna Corporation, maker of the Voice Touch speech
synthesizer for the LifeScan One Touch II glucose monitor,
announces the Voice Touch Pro speech synthesizer for the One
Touch Profile.  The Pro attaches firmly to the base of the
LifeScan monitor, and works entirely through the meter's
controls.  

     Purchasers may order the Voice Touch Pro with male or
female voice, and English or Spanish language speech.  Myna
Corporation offers a one-year warranty.  The unit is priced
at $189 (9-volt alkaline battery included).  An AC adapter
is available for $15 additional,  and a carrying case for
another $15.  Myna Corporation also offers the LifeScan
Profile glucose monitor for $125.  For information, contact: 
Myna Corporation, 239 Western Avenue, Essex, MA 01929;
telephone:  (508) 768-9000.


                    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!  Diabetic
Medserv also stocks safe, simple, and reliable vacuum
therapy devices for male impotence.  For information, call: 
1-800-575-7557.


                  DIABETIC SKIN CARE PRODUCTS

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


                    REHABILITATION CENTERS

     Many "blind rehab" centers offer training in the
adaptive skills of blindness, but the following three work
closely with the National Federation of the Blind, and
adhere to its philosophy:  that with appropriate training,
equipment, and opportunity, blind people can be fully
independent, productive, and involved in the mainstream.  If
you have need of training in non-visual computer skills,
travel skills, or general life skills, or know someone who
does, please consider:

     B.L.I.N.D., Inc., Director:  Joyce Scanlan, 100 E. 22nd
Street, Minneapolis, MN 55404; telephone: (612) 872-0100.

     The Colorado Center for the Blind, Director:  Homer
Page, 1830 S. Acoma Street, Denver, CO 80223-3606;
telephone: 1-800-401-4632.

     The Louisiana Center for the Blind, Director:  Joanne
Wilson, 101 S. Trenton, Ruston, LA 71270; telephone:  1-800-
234-4166 or (318) 251-2891.


                       TALKING COMPUTERS

     Henter-Joyce, Inc., maker of the "JAWS" series of
computer screen readers, offers screen-to-speech software 
such as "JAWS For WINDOWS" (JFW), now capable of reading
WINDOWS 95.  The company promises shortly to release JAWS
for WINDOWS NT.  Find out more at their website: 
http://www.hj.com, or contact them for information:  Henter-
Joyce, Inc., 11800 31st Court North, St. Petersburg, FL
33716; telephone:  1-800-336-5658; fax: (813) 803-8001;
email:  info@hj.com.


                      ADAPTIVE EQUIPMENT

     Maxi Aids is a supplier of adaptive equipment for the
blind.  They offer a free catalog (in print), and stock many
diabetes-care items, such as talking glucose monitors,
tactile insulin measurement devices, and many other tactile
and low-vision products.  For information, contact:  Maxi
Aids, 42 Executive Boulevard, PO Box 3209, Farmingdale, NY
11735; telephone:  1-800-522-6294.


                       DIABETES SUPPLIES

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

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


                     TALKING CALLER ID BOX

     Today many people enjoy the convenience of "caller ID"
service on their incoming phone calls.  These machines help
you decide, before you pick up the phone, if you really want
to talk to that person right now.  Now, caller ID service is
available to the blind.  CIDney is a speech-equipped caller
ID box, that both recites the incoming caller's number and
allows you to pre-program a number of spoken IDs, such as
"Mom calling!" in your own voice (many sighted folks might
enjoy this feature too!).  The CIDney units start at $59,
and are available from:  Full Life Products, PO Box 490,
Mirror Lake, NH 03853; telephone:  (603) 569-2240.


                  INSULIN VIAL IDENTIFICATION

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


                      ADAPTIVE COMPUTING

     HumanWare, Inc., a leader in adaptive computer
technology for the blind and visually impaired, offers
Braille computer terminals, Braille printers, electronic
magnifiers (CCTVs), talking palmtop organizers, speech
synthesizers, adaptive software products, specially
configured talking computers, scanners and reading systems. 
New to their catalog are the Kurzweil Omni 1000 and Omni
3000 text-to-speech systems, Ultimate Reader and TextHELP,
and the Braille Window display.  For information about these
and other products, contact:  HumanWare, Inc., 6245 King
Road, Loomis, CA 95650; telephone:  1-800-722-3393.


                      SKIN CARE PRODUCTS

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

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

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


                       DIABETES SUPPLIES

     Heritage Diabetic Supply is a small, personalized
source for your diabetes needs (insulin included), offering
reasonable prices and one-on-one service.  If you need
something hard to find (like Diascan test strips), they will
get it for you.  Heritage handles Medicare and private
insurance paperwork (no HMOs), and offers a free RSG glucose
monitor just for signing up!  Contact:  Heritage Diabetic
Supply, PO Box 1270, Marion, NC 28752; telephone:  1-800-
267-6509.  


                  SUGAR-FREE FOODS AVAILABLE

     The following is an alphabetized list of suppliers and
manufacturers of low-calorie, low-fat products appropriate
to the diabetic diet.

     BERNARD FOOD INDUSTRIES, Inc., PO Box 1037, Evanston,
IL  60204; telephone:  1-800-325-5409, offers a selection of
low-fat and sugar-free foods.  Free catalog.

     CALCO FOODS CO., Inc., 3540 W. Jarvis, Skokie, IL 
60076; telephone:  800-325-5409,  manufactures a line of
sugar-free and low-fat foods.  Free catalog.

     COZY CABIN SUGAR FREE PRODUCTS, 167 Portland Street,
St. Johnsbury, VT 05819; telephone:  1-800-525-2540, offers
a sugar-free maple syrup.

     DIABETIC DELIGHT, Inc., 1298 W. Roger Blvd., PO Box
686, Skiatook, OK  74070; telephone:  1-800-396-7776, offers
sugar-free, low-fat, diabetes treats.  Free catalog.

     SUGAR FREE MARKETPLACE, 6710 N. University Drive,
Tamarac, FL 33321; telephone:  1-800-726-6191, offers a
selection of diabetic foods.  Free catalog, in print or
tape.

     THE SUGARLESS SHOP, 700 Merritt Blvd., Baltimore, MD  
21222; telephone:  (410) 282-7571, offers a selection of
diabetic foods.  Free catalog.


                      FOOD EXCHANGE LIST

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

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

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


                           NEW BOOKS

     "Stop the Rollercoaster" is the closest thing yet to an
"owner's manual" for diabetes.  It contains chapters on
everything from types of diabetes to charting with
computers, from exercise to pregnancy, from tips on insulin
to ketoacidosis, and a great deal more.  Packed with charts
and simple case studies, it offers the lay reader material
previously presented only in professional texts.

     Written by diabetes educators John Walsh and Ruth
Roberts, and physician Lois Jovanovic-Peterson, "Stop the
Rollercoaster," priced at $21.95, is available direct from
Torrey Pines Press, 1030 West Upas Street, San Diego, CA
92103-3821; telephone:  1-800-988-4772; fax:  (619) 497-
0900.

     The "Diabetic Goodie Book" is a new text dealing with
that sweetest of subjects:  dessert.  Written by Kathy
Kochan, a cooking instructor at Joslin Diabetes Clinic in
Livingston, NJ, it tells you how to make over 150 different
cookies, cakes, cheesecakes, coffeecakes, fruit desserts,
puddings, pies, and more, all with full dietary and exchange
information, and all designed for the lowest possible impact
upon your diabetic meal plan.  Ms. Kochan's book also
includes many substitutions, how-to's, and other useful
meal-planning information.  "Don't cheat on your sweet
tooth," she states, and with the "Diabetic Goodie Book"
(price $15.95), you won't.

     To order, contact:  Appletree Press, Inc., 151 Good
Counsel Drive, Suite 125, Mankato, MN 56001; telephone: 
507-345-4848.
      
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

                          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 195,
449, offers such an outlet.  Make your voice heard.  For
VOICE OF THE DIABETIC advertising information contact:

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

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

                  SUBSCRIPTION/DONATION FORM


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

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

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

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

     To begin receiving the VOICE, please check one:

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

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


Send the VOICE in (check one):

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


Optionally check this box:

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


                     Please print clearly


Name:__________________________________________________

Address:_______________________________________________

             
_______________________________________________

City:______________________  State:________  Zip:__________

Telephone: (    )________________________


Send this form or a facsimile to:  

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


Please make all checks payable to:

NATIONAL FEDERATION OF THE BLIND

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

END of VOICE OF THE DIABETIC, Volume 12, Number 3, Summer
Edition 1997

