


VOICE OF THE DIABETIC



A Support and Information Network



The Diabetes Action Network of the National Federation of

the Blind



Volume 11, No. 4, Fall Edition 1996



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     The VOICE OF THE DIABETIC, published quarterly, is the

national newsmagazine of the Diabetes Action Network of the

National Federation of the Blind.  It is read by those

interested in all aspects of blindness and diabetes.  We

show diabetics that they have options regardless of the

ramifications they may have had.  We have a positive

philosophy and know that positive attitudes are contagious. 



     News items, change of address notices, and other

magazine correspondence should be sent to:  Ed Bryant,

Editor, Voice of the Diabetic, 811 Cherry Street, Suite 309,

Columbia, Missouri 65201; telephone:  (573) 875-8911.



     Copyright 1996 Diabetes Action Network, National

Federation of the Blind.  ISSN 1041-8490



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FREE!  FREE!





     VOICE OF THE DIABETIC is offered absolutely free to any

interested person upon request.  Readers may receive the

publication in standard print, on audio cassette for the

blind, or in both formats.  To begin receiving the VOICE,

please complete the subscription form (or a facsimile),

found at the end, and mail it to the editorial office.



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Inside This Issue





We're Changing Our Name

     by Ed Bryant



Diabetic Peripheral Neuropathy



Codependency And Diabetes

     by Annette M. Krupper, MLS



The A1c Test



Great Expectations

     by Peter J. Nebergall, PhD



Dialogs About Diabetic Dynamos

     by Debra Frank, MS, MS



Impotence And How To Prevail

     by Ed Bryant



New Program For Blind Diabetics



Tactile Insulin Vials:  Movement Toward Solution

     by Ed Bryant



Scholarship Available For IDDM Diabetics

     by Debra Frank, MS, MS



Stepping Out With An Attitude

     by David Walker



Ask The Doctor

     by Wesley W. Wilson, MD



A Long Road A Winding

     by Douglas Campbell



Insulin Measurement Devices



Using Humalog Insulin



Questions To Ask Your Doctor About Blood Sugar Control



Recipe Corner



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

     (Resource Column)



Food For Thought



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We're Changing Our Name!



by Ed Bryant





Photo:  portrait of Ed Bryant



     At our Diabetics Division yearly meeting on July 1,

1996, held at the Annual Convention of the National

Federation of the Blind, in Anaheim, California, meeting

participants voted to change our organizational name to the

Diabetes Action Network of the National Federation of the

Blind.  NOTHING ELSE HAS CHANGED.



     Eleven years ago, members of the National Federation of

the Blind, moved by the facts that diabetes was the leading

cause of new blindness in the United States, and that all

diabetics are at risk of complications, founded the

Diabetics Division of the National Federation of the Blind. 

These founders saw the need for a support and information

network for all diabetics, to show people facing

ramifications that, regardless of personal circumstances,

they are not alone, and do have options.



     Our work continues.  From its initial circulation of

600, the VOICE has grown to a readership of more than

172,000, in all 50 states and more than 40 foreign

countries.  We work on a personal level, but also

nationally, interacting with equipment manufacturers, drug

companies, and the U.S. government, improving the options

for blind diabetics, those losing vision, and those who may

face such ramifications in the future.  Our voice is heard.



     Our purpose, our role, is the same as always.  It is

time, however, for more inclusive language about our

membership.  Along with diabetics, blind and sighted, their

friends and family members, caregivers, health and

rehabilitation professionals, distributors and manufacturers

of diabetes equipment and supplies,  we include a great many

people with interest and concern about the condition.  We

are a lot of different folks with a common focus; we are the

Diabetes Action Network of the National Federation of the

Blind. 



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Diabetes Action Network Support Committees





     For more than eleven years, our support committees have

been reaching out with listening ears and helping hands to

diabetics in need in the following committee areas: 

Blindness/Visual Dysfunction, Amputation--Prevention and

Treatment, Heart Disease and Stroke, Insulin Pump, Pancreas

Transplantation, Resources (Aids and Appliances), Renal

Failure--Dialysis and Transplantation, and Sexual

Dysfunction/Male Impotence.  Network members with personal 

experience in these topics offer advice and inspiration to

those needing information about diabetes complications.  To

learn more about our support committees, contact the VOICE

editorial Office.



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Diabetic Peripheral Neuropathy





Art:  Ancient Greek doctor examining a big foot



     Neuropathy is a general term for physical damage to or

impairment of the human nervous system.  It has many causes,

and many symptoms. Because a long period of time with

elevated blood glucose can damage nerve fibers, diabetes is

one cause of neuropathy.



     The human nervous system is enormously complex.  The

peripheral nerves carry information to and from the brain,

connecting it with the rest of the body.  These nerves can

be motor, sensory, or autonomic.  Motor nerves carry

messages from the brain for the contraction of different

muscles.  Sensory nerves relay to the brain sensations of

touch, temperature, position and pain, from the body's

periphery.  Autonomic nerves carry the brain's commands to

organs such as the heart, the stomach, lungs, and liver. 



     The longer the nerves, the more likely they are to be

damaged by long-term high blood glucose.  The first part of

a nerve to show damage is the part furthest away from the

central nervous system (brain and spine).  Once such damage

occurs, problems appear at the nerve terminals of feet,

lower legs, and hands.



     Symptoms of peripheral neuropathy can include

diminished tactile sensation, numbness, loss of reflex

reaction, "pins and needles," and various types and degrees

of pain.  As neuropathy progresses, the symptoms frequently

change.  Caution:  Diabetics experiencing neuropathy

sometimes have other ramifications as well, and these have

their own symptoms.  Sometimes symptoms overlap, and

diagnosis can be confusing.  Diabetic nephropathy, kidney

failure, can exacerbate neuropathy, due to the uremic

toxicity of the condition.  Other pain can be a symptom of

undiagnosed orthopedic problems.  If you are experiencing

pain or abnormal sensations in hands, feet, or legs, check

with your doctor.



     As diabetic neuropathy follows extended periods of

hyperglycemia, its best prevention is good blood glucose

management, "tight control," with numbers down in the normal

range.  A healthy lifestyle, with plenty of exercise and

careful attention to diet, helps too.  Incidentally, the

same "tight control" regime can help those with already

established neuropathy.  Although it is not clear exactly

how it happens, experience shows that getting your diabetes

under control, and keeping it there, can, over a several-

month period, alleviate at least some of neuropathy's

symptoms.



     Individual symptoms are as varied as individuals, but

the most common complaint is pain, and pain control becomes

the single biggest challenge in dealing with established

neuropathy.  Doctors have prescribed aspirin, acetaminophen,

and various other non-steroidal anti-inflammatory drugs, the

anticonvulsants Dilantin and carbamazepine (Tegretol), and 

tricyclic antidepressants such as amytriptaline (Elavil), or

a combination of vitamins B1, B6, and Glutamine, with

varying results.  Along with the drugs, some are prescribing

capsaicin cream (Zostrix and its equivalents), a topical

ointment originally formulated for arthritis pain.  Others

are investigating acupuncture, although not enough is known

about it to say for certain if it works in such a case. 

Researchers are experimenting with aldose reductase

inhibitors such as Sorbinil, but in the U.S., these are

still in the laboratory stage. 



     There is a lot of disagreement over effective

treatments for neuropathy pain.  Folks swear by their

particular remedy.  You need to find and use what works for

you.  Beware of extravagant claims for pill or technique;

there are no "miracle cures."



     None of the pills and creams is as effective in

bringing relief as is getting your blood sugars into good

control and keeping them there.  It is not known just what

mechanism causes neuropathy, or even why some healing can

occur, but it is established that the best chance for

symptom improvement comes with long-term improvement in

diabetes control.  Although damaged nerves may heal in time,

what has been destroyed will not regenerate.  Good control

is good medicine!



     The main reason we, as human beings, have a pain

reflex, is because pain lets us know something is wrong in

the affected area.  If it hurts, we do something about it. 

With its biggest symptoms being pain (when nothing is there)

and diminished sensation/numbness (when something is

present), neuropathy can seriously interfere with a

diabetic's self-care, especially care of the feet. 

Circulatory problems stemming from diabetes can lead to dry

skin on the feet, with the risk of ulcers and lesions. 

Lacking normal pain reflexes, the diabetic with neuropathy

may not be aware his or her feet are in trouble.  Even

stepping on a tack may be pain-free.  This means otherwise

treatable lesions are allowed to progress into severe

infection, sometimes into gangrene itself.  Amputation is a

common result of this progression of events, and

complications of diabetes account for the majority of

non-traumatic amputations in the U.S. today.  All diabetics

need to frequently inspect their feet, but individuals with

neuropathy need to be especially thorough.



     Although there are lots of variations, with the rule

being "do what works for you," there are a number of

non-medicinal ways folks cope.  One individual, who reported

"burning feet" at night, slept with her feet uncovered, and

a fan blowing cool air on them.  Many others cushion aching

feet with thick, seamless hikers' socks, especially those

made of cotton, or of new materials such as "Thorlo."



     Some folks report that exercise brings relief, however

temporary.  Others use meditation-based relaxation

techniques to help them manage.  Another approach, followed

by many, is to wear high-quality, proper-fitting athletic

shoes with good support, or support sandals such as

Birkenstocks, along with the socks mentioned above.



     Many individuals whose feet are affected by diabetic

neuropathy are also dealing with circulatory problems, and

perhaps have a history of ulceration, or even a partial

amputation.  Special therapeutic shoes, with custom inserts,

or "extra-depth shoes," or several other shoe modifications,

are covered by Medicare as durable medical equipment. 

Discuss this with your doctor.             



     Unexplained pain or abnormal sensation is a serious

matter.  It may indicate neuropathy, which may be from

diabetes, or it may stem from some other condition.  It is

NOT an inevitable ramification of diabetes, but you

shouldn't just "grin and bear it," either.  A lot of

different therapies and interventions bring relief to many

diabetics.  Keep the best control you can, keep your doctor

informed, and don't lose hope.



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Codependency And Diabetes



by Annette M. Krupper, MLS





Photo:  portrait of Annette M. Krupper



     Codependency is a condition in which the individual is

preoccupied with the needs of others, to the exclusion of

the self.  Codependency is considered an addiction; loss of

self in service, as the alcoholic seeks loss of self in

alcohol.  Codependency is a learned behavior. 



     The following example will help explain what I mean:  a

codependent person is preparing a snack in the kitchen. 

Another person comes into the kitchen and is also hungry and

asks what is there to eat.  The codependent person will most

likely give up their snack for the other person.  They will

be polite about it and say that it is no trouble, no matter

how much they really needed to eat.  By giving up their

snack, the codependent person is denying their own hunger in

order to satisfy the hunger needs of the other person.



     Other characteristics of codependency are:  A felt need

to control one's environment; isolation of oneself in order

to more easily achieve that control; low self-esteem and

lack of self-affirmation; and inability to recognize one's

own physical (or emotional) needs.  It goes with the

territory that codependent people have a rough time taking

care of themselves.



     Now what happens when a codependent person is also

diabetic?  I propose that following a good diabetic regimen

assists such a person in a way of acting that can guide them

on the road to recovery from codependency.  How?  It happens

because certain necessary actions, part of diabetes

self-management, counteract each of the  previously

mentioned characteristic of codependency.



     The first characteristic, the need to control one's

environment, is strongly opposed by the nature of diabetes

itself.  Diabetes is a disease of the metabolic system,

which means all systems of the body are involved.  There are

many variables that defy absolute control.  Daily there are

changes in the amount of insulin needed to handle the types

and amounts of foods we eat.  There also is the variable of

the amount of exercise that we have recently gotten or are

going to get during the day.  Another variable comes if we

are feeling ill or under stress, because both of these

extrinsic and intrinsic influences raise one's blood glucose

readings, altering the amount of insulin needed and what

foods we can or cannot eat at the moment. 



     Since there are so many variables to understand and

take into consideration when deciding what to eat when,

there is no way we can totally control every piece of the

food-eating-insulin equation.  As many of you have

experienced, you can eat the same foods, take the same

amount of insulin or orals and still your glucose test

results may differ from the day before.  The reason behind

this is that we are living organisms, human beings who can

be influenced by many things social as well as

psychological, and certainly by physical changes.



     Diabetes is a disease which we must try to control,

although it is not totally in our power to do so.  Once we

accept that diabetes is a disease we have to cope with

rather than try to control, then it is easier to accept.  We

have diabetes and can only do our best one day at a time. 

Acceptance of our incapability to have absolute control over

diabetes allows us to learn, little by little, to cope with

the uncontrollable situation of being  diabetic.  It also

helps the codependent person slowly begin to loosen the

reins of control on their environment.



     Being that we cannot totally and absolutely control our

environment, one of the necessary steps in treating diabetes

is asking questions.  The first, and primary, source of

answers is one's own physician.  Publications such as the

VOICE are good secondary sources.  But sometimes you just

want to talk to someone who really understands what you are

going through.  Having the courage to break out of the

silence and isolation, actually talking with a fellow

diabetic about personal diabetic problems or concerns leads

to instant camaraderie.  Who better can understand what it

feels like to have hyperglycemia or hypoglycemia but another

diabetic?  Yes, you can describe the condition to others,

but who will really understand better than someone who has

felt the panic and concern?



     Another way of breaking through the code of silence and

secrets is to take a more active role in one's own

treatment.  Don't just be a consumer--talk to the doctor and

diabetes management team about how one is coping with the

current treatment.



     Sharing information about how their own program is

going, better or worse, as well as other cares and concerns,

allows the codependent to present him/herself as a person of

worth.  The physician can only guess at how we feel or why

our insulin dosage or orals are not working when they worked

last month.  The more we are aware of our bodies, the more

prepared we are to assist the physician in figuring out if

changes need to be made in order to give us the best

possible treatment.  This communication from the patient to

the physician about one's own current condition causes the

patient to stand up and say "I am important!"  To talk about

oneself like this takes courage, requires assertiveness, and

gives one the ability to see oneself as a person with

self-worth.



     A codependent person is a person who lacks the ability

to recognize their own physical needs.  Diabetes insists

that the patient be aware of their own physical needs in the

following ways:



     1. Eat the proper foods at the proper times in the

     proper amounts 

     2. Monitor blood glucose readings 

     3. Adjust the eating and/or exercise patterns according

     to the glucose readings

     4. Make daily exercise and rest a priority

     5. Show constant awareness by sight and feel of the

     condition of our body, to protect against

     complications.  Notify the physician if something is

     suspected. 



     As the codependent person learns to meet each of these

physical needs of his/her own body, these processes become

habits.  Such a routine will diminish a codependent's

concentration on the physical needs of others, helping  to

focus on one's own immediate needs.



     Good diabetes management is not the total answer to the

disease of codependency, but its discipline and routine help

assist the codependent person in the process of recovery. 

Following proper diabetes treatment forces one to be

attentive to one's own bodily needs.  Joining others in

conversations about diabetes, physicians as well as fellow

diabetics, and acceptance of the body as a living human

organism that cannot be totally controlled, assists the

codependent person in overcoming the characteristics:  lack

of focus on ones needs, isolation, and need for control. 



     I find that when I take care of my diabetes, eating

properly and exercising, being aware of my body and its

needs, communicating to my physician and diabetes team my

concerns, my disposition is a much more happy one than when

I am slack on proper routine.  The problem of codependency

has not gone away, but at least I know I have a few

behaviors that will help me change and assist me on my road

to recovery.



     Diabetes is a disease where one has to take

extraordinary care of oneself in order to appear ordinary. 

And I think that everyone of us is worth that much and more.



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The A1c Test





     If you have diabetes, your daily blood-glucose tests

are important--but there is another test you should have

done at regular intervals.  This is the "A1c," also known as

"Glycosylated Hemoglobin" or "HbA1c Test."  Your doctor can

use this test to find what your average blood sugar level

has been over the past few months.



     Where your glucose meter tells you your blood sugar

level right now, the figure produced by the A1c is in fact

the average of all your highs and lows, for a period of

approximately two months preceding the test.  The greater

the average amount of sugar in your blood, the higher the

A1c results.



     Although doctors disagree over when to order the A1c

test for their patients, there is consensus that "every two

months" would be more accurate than longer intervals.  



     Although different labs (like different glucose

meters!) may produce slightly different findings, the theory

is the same:  Molecules of sugar attach to protein in

solution, in proportion to the amount of sugar present. 

Hemoglobin, a critical part of red blood cells, is a

protein.  The sugar attaches to the hemoglobin,

"glycosylates" it, in direct relationship to the blood

glucose level.  As red blood cells stay in circulation for

about 110 days, the percentage of hemoglobin that has sugar

attached to it, "glycosylated hemoglobin," provides a

reasonable estimate of the average blood sugar level during

the six to eight weeks before the test.



     It is important to remember this test measures the

average blood sugar level.  If a person has a "normal" A1c,

this may mean everything's OK, or it may mean they have

periods of excessive high blood sugars (as revealed by

monitor), "balanced" by periods of abnormally low blood

sugar levels.  A good example would be folks with high

daytime blood glucose, who have undetected nighttime

hypoglycemia.  This is why you need both tests; neither is a

substitute for the other.



     When you use your glucose meter to test your blood,

each test is a "snapshot."  Depending on your diet,

lifestyle, and general health, your glucose levels may

fluctuate greatly at different times of day.  The A1c yields

an "average," which, used with your monitor results, lets

your doctor know how you're really doing, so you can make

the necessary adjustments to get and keep those numbers

down, and cut the odds of complications.  Don't neglect this

important tool.



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Great Expectations



by Peter J. Nebergall, PhD





Photo:  portrait of Peter J. Nebergall



     I'm always interested in how other cultures approach

problems we find familiar.  I just finished reading an

article, published in a European diabetes journal, that

discussed adaptive equipment for blind diabetics and those

losing vision.  I found its attitude appalling, and I'd like

to share why. 



     In much of the world, the fact of blindness is treated

as synonymous with incompetence.  Many medical and

rehabilitation authorities can't imagine a blind person

performing precise activities, such as those necessary for

independent self-management of diabetes.  And what the

authorities don't know to be possible, they don't teach.     

                                           



     This negative attitude colors so much of their approach

that they are not even prepared to consider alternatives,

even when confronted with the evidence of their viability. 

The problem transcends both industrial chauvinism and

corporate rivalry--sadly, it has more to do with the

"meaning" of blindness, with the "mental template" marked

"blind."  And while the authorities stumble and grope about,

blind diabetics, who would be capable of independence if

they were provided the appropriate (and available) tools and

training, are forced to do without. 



     The best blindness rehabilitation counselors know that

when sight is failing, the client is best served by the

incorporation of nonsighted techniques, ideally before all

vision is gone.  The client so instructed does not have to

cling to scraps of failing vision, but is ready to deal with

total blindness, if and when it should come.  For this

client, there are talking glucose monitors, tactile insulin

measurement devices, and various other aids.  Well prepared,

this individual will remain independent and productive.



     Now consider a rehab agency, or a whole country, where

the above is not the rule.  So sure the absence of sight

means one can't, the authorities stress maximum utilization

of what vision is left, staving off "the moment" with

insulin pens, syringe magnifiers, pre-mixed insulins, and

large print.  It is not a question of technology, nor of

ignorance--these are top authorities, and the needed

adaptive equipment is freely available here in the U.S.  It

comes down to belief, to cultural conditioning.



     Teachers have known for years that the student who is

taught he or she can will outperform those taught they

cannot; that expectations shape performance.  The attitudes

of instructors, counselors, and journalists shape clients'

opinions of their own abilities.  In too many places, "the

authorities," by both omission and commission, continue to

pass on the doctrine that blindness equals inability.  When

the client has nowhere else to turn, no better source for

the truth, it does.



     What do we expect?  It matters.  Across the world we

encounter differing expectations of the capabilities of the

blind.  It is those expectations, much more than the

availability of adaptive technology or information, that are

the true "limiting factors."  No accident, then, that where

expectations are high, so is performance.  Those authorities

who cling to outdated and incorrect notions of "inability"

are not serving their people.  Those who move forward,

raising their expectations with each new development in

technology or treatment, will be rewarded.  We have a

choice.



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Dialogs About Diabetic Dynamos



by Debra Frank



Exercise Physiology M.S., Recreation Therapy M.S.





Photo:  portrait of Debra Frank

                          

                  Diabetes, Exercise, and Me



     In the past few decades both quality and quantity of

life have improved for diabetics.  The 1970s brought the

benefits of sports and physical fitness to the public

consciousness, and to the medical and health professionals. 

The obvious benefits of physical fitness were increased

self-esteem, self respect, and the obvious aesthetic

improvement.  But the real discovery was the increase in

overall physiological health.  People afflicted with chronic

diseases such as hypertension, arthritis, or diabetes, for

example, demonstrated scientifically substantiated increases

in overall health.  What does this mean to me and the

millions of others diabetics on this planet?  Not only is

exercise good for my mind, body, and spirit; it is now

considered part of my health care plan.



     In 1970 Dr. Kenneth Cooper wrote the book "Aerobics,"

which told the general public the truth about exercise. 

Further studies in sports medicine supported what Dr. Cooper

and others have been teaching.  Researching the pros and

cons of exercise for everyone, even diabetics with

ramifications, is now common practice.



     Specific investigations have been made into the impact

of different components of exercise on the diabetic.  In

1986 the first edition of the book, "Diabetic's Guide to

Health and Fitness," by Kris Berg, EdD, was published.  Dr.

Berg did not just approach the elements of exercise for the

diabetic from a scientific perspective; he included personal

research on a very captive study subject, himself.  All the

organizations serving the diabetic have released their

exercise recommendations, but for the most part that's what

they are--recommendations.  It is our job as diabetics to

take this knowledge and apply it to ourselves and our own

personal needs.



     But how do I start?  What is a reasonable workout

routine?  Can I join a recreational softball team?  Who do I

ask for advice on how to regulate my blood sugars, before,

during and after exercise?  Will the school, recreation

center, or health club question me about my diabetes, and

what should I tell them if they do?  Is it dangerous for me

to try to start on my own?  Maybe, taking all these

variables into consideration, I should forget the idea and

stick to my regular lifestyle of limited activity...  With

all this to consider, no wonder so many of us avoid starting

a program!  Well, you've just got to take it on, one step at

a time.



     First step:  Meet with your medical team and discuss

integrating an exercise program or sports activity into your

medical protocol.  You should be in good metabolic control

before you start this new activity.  It is suggested anyone,

regardless of the presence or degree of complications, find

an activity they can do at least three times a week, for at

least 40 minutes.  According to the ACSM (American College

of Sports Medicine), exercise should be comfortable and easy

to fit into your weekly routine.



     There are many exercise physiologists who specialize in

diabetes. Finding one of them to work with you and guide you

through the ups and downs of your new program is a great

idea.  If you are blind, or have other ramifications, these

experts can help you design your program. 



     Many diabetics are on other prescription medications as

well.  If you are, keep in mind the heightened circulatory

response to medication during and after exercise.  Exercise

can change the way your body responds to specific

medications, and you may need to take action.  You'll need

to pay special attention to your blood sugar levels before,

during and after exercise.  You and your trainer may decide

to add a snack to maintain your normative blood glucose

levels, or you might be told to cut back on insulin during

some activity.  Since the body uses more glucose during

exercise, it is important to be in good control prior to and

during a program of physical activity.  If your blood sugars

are elevated at the start, your body will have a negative

response to the exercise program.  Searching for the fuel to

feed the muscles, with insulin levels inadequate, instead of

dropping, your sugars will rise still further. Exercise is

suggested only when your blood glucose is under 220mg/dl. 

Although this is a high level, your sugars usually will drop

to within normal limits as a result of the activity.  If

your blood glucose is higher than 220, try to refrain from

initiating strenuous physical activity until you can get

them down to a healthier level.



     Prepare yourself properly, and begin slowly.  Keeping

snacks and water with you is a must.  Diabetics have a

tendency to dehydrate, and keeping the fluids plentiful will

benefit not only your level of hydration but every other

system of the body.  Dress for support.  Choose your

footwear wisely, and keep clean cotton socks available.



     Though all the preparation for "Fun and Fitness" seems

tedious, it truly pays off in the long run.  Whether you're

simply starting a daily walking routine, swimming before

work, or planning a 100-mile bike ride, be aware of your

body and the effect exercise has on your diabetes.  Improved

insulin sensitivity, weight loss and "body sculpturing" are

three primary results of any regular exercise/work out

program.  There's no secret formula--results are not

immediate--but they are worth the wait:  Improved body

composition, fat to muscle ratio, improved cardiovascular

condition, improved overall strength, weight loss or gain if

so desired, improved glycemic control if all elements are

attended to adequately.  So what have you got to lose

but...weight and inches?  Yes, there are those periods of

hypoglycemia, but you will learn to adjust your nutrition

and medication, finding your ideal formula for success.



     For information on starting an exercise program,

contact your medical team, local health club, or school

athletic program.  Some diabetics are Exercise Specialists,

and other Exercise Physiologists specialize in diabetes. 

There is even an organization called the IDAA, International

Diabetic Athlete Association, which does great things

supporting safely planned exercise and sports for diabetics. 

Each year diabetic athletes from around the world run the

New York City Marathon.  The IDAA arranged for glucose

monitoring stations every four miles, with test kits,

insulin and the food the runners requested.



     The bottom line is this, God made us diabetics extra

sweet, but he still wants us to live action-packed quality

lives, not merely to exist.  What are your goals?  A safe

rewarding fitness regime?  Playing ice hockey, or soccer? 

The Special Olympics?  Competing in a bodybuilding

competition someday?  Starting to snowboard this winter? 

Perhaps you merely want to feel more fit playing volleyball

at a family picnic?  Try incorporating a safely organized,

professionally supervised and medically approved training

program into your life. 



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



     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."



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



Impotence And How To Prevail



by Ed Bryant



Clip Art #1:  Couple walking along a tropical beach



Clip Art #2:  Older couple embracing



Clip Art #3:  Couple sitting at a table having coffee



     One of the most feared complications of diabetes,

erectile dysfunction, commonly known as impotence, is also

one of the most treatable.  More than 50% of diabetic men

may experience this complication, but over 95% of cases can

be successfully treated.  With proven treatment available, a

diabetic experiencing this problem does have options.  It

isn't something heor any other manor his partnershould

have to live with. 



     Many men do not feel their difficulties, especially

with sexual performance, are a fit subject to discuss with

their partners.  They couldn't be more wrong.  To avoid

making things worse, a man needs to move beyond the old idea

that the sex act is something he does.  He is part of a

relationship, and what interferes with one affects both.  A

man's partner is equally involved.  

 

     Achieving and sustaining an erection requires

interaction between the neurological, arterial, hormonal,

and psychological functions of the body.  Proper hormonal

balance, normal sex drive and emotional make-up, functioning

nerves and blood vessels, and healthy penile tissue are all

required.  Libido, the interest in sexual activity, and

potency, the ability to perform, must both be present. 

Several different sets of nerves are involved.  Erection is

a function of the parasympathetic nervous system, but orgasm

and ejaculation are controlled by a different set of nerves: 

the sympathetic system.  Both orgasm and ejaculation can

occur without erection.  



     "Erection is a hydraulic phenomenon, that occurs

involuntarily," says Arturo Rolla, MD, of Harvard University

School of Medicine.  "Nobody can will an erection!" 

Anything that limits or impairs blood flow can interfere

with the ability to achieve erection, no matter how hard a

man tries.   



     Although sexual vigor declines with age, a man who is

healthy, physically and emotionally, is able to produce

erections, and enjoy sexual relations, regardless of his

age. Impotence is not an inevitable part of the aging

process.



     On occasion any man may experience the inability to

achieve or sustain an erection.  Such transient episodes are

common and may be attributed to illness, fatigue, stress,

etc.  The occasional inability to perform, however traumatic

to both partners, is normal. 



     Repeated inability to achieve and sustain an adequate

erection can be caused by anything that affects a man,

psychologically or physically.  Psychological, or

"psychogenic," impotence can follow major life changes,

stressful events, or even the fear of becoming impotent. 

The physiological changes associated with fear can

themselves cause erectile dysfunction!  When a diabetic

discovers the source of his difficulties is not

physicalthat it is due simply to fear of

ramificationssexual function is usually restored.  But to

tell the difference between physical and psychogenic

impotence, and to make any progress against it, requires

that you TALK about this sensitive issue--with your partner,

your physician, and, ideally, with a urologist specializing

in male impotence.



     Sexual dysfunction can contribute to psychological

problems such as feelings of inadequacy, frustration, loss

of self-esteem, and despair.  Strained relationships with

partners may result.  It is important for men to discuss the

problem with their partners and to promptly seek medical

attention.  Many may find counseling helpful.



     Diabetic impotence is generally a result of the

blockage of blood vessels responsible for erection, damage

to the nerves that dilate those blood vessels, or a mixture

of the two.  In some cases, re-establishing good glycemic

control may decrease the impotence, though permanent damage

to nerves and vessels may not be reversible.

     

     A diabetic man can decrease his risk of impotence by

carefully controlling his diabetes.  Poorly controlled

diabetes and high cholesterol increase the chances of

vascular complications, especially vessel blockage, which

may lead to erectile dysfunction, or to other circulatory

problems. 



     Exercise regularly, and avoid nicotine and alcohol. 

Smoking causes constriction of the blood vessels and

contributes to arterial blockage.  Good health practices

help men prevent impotence.

     

     Impotence, the chronic inability to have and sustain an

erection adequate for sexual intercourse, may be a symptom

of more serious disorder.  Seeking prompt medical help for

sexual dysfunction can lead to early diagnosis of other

problems.  Identification of the source of impotence can

point the way to prevention of strokes, heart attacks, and

other life-threatening illnesses.  Learning is the first

step to recovery, especially when fear is the culprit. 



     Regardless of the cause, if a man does not have or

cannot sustain erections adequate for vaginal penetration,

and the problem continues over a period of four to five

weeks, he should recognize a problem exists, and seek

medical help.  Don't delayerectile dysfunction doesn't just

go away!



     In treatment of impotence, the choice of doctors is

most important.  Among the best choices are those practicing

at centers specializing in erectile dysfunction, urologists

who subspecialize in the treatment of impotence, and other

physicians specifically trained in this field.  Most

people's first contact is with their family doctor.  Ask

that first physician for a referral to a medical

professional who is particularly familiar with this

disorder.  Local hospital referral services may keep lists

of such experts who practice nearby.



     After the interview and physical exam, the doctor will

determine whether the erectile dysfunction is psychological

or physical in nature.  Where diabetes is present, a vast

majority of instances of erectile dysfunction have a

physical cause.  But based on examination and interview, the

doctor may determine the cause to be psychological, and if

so, refer the man to a qualified health professional

specializing in psychologically induced erectile

dysfunction.  This may be a psychiatrist, psychologist, sex

therapist, or marital counselor.  



     Troy A. Burns, MD, National Medical Director of the

Diagnostic Center for Men, in his "Getting Help:  A

Patient's Guide for Men With Impotence" (1994, publ. by

Integrated Medical Resources, of Lenexa, KS) reports that an

old at-home test for erectile activity during sleep (the

lack of which would suggest physically-caused impotence)

"was the postage-stamp test.  The patient was instructed to

wrap several stamps snugly around his penis at bedtime.  If

the stamps had perforated by the time he awakened, some

penile tumescence probably occurred!"  Of course more

sophisticated tests are used today.  



     Impotence is sometimes a side effect of medications

prescribed for other disorders.  Such medications include

some anti-hypertensives (diuretics and beta blockers), ulcer

medications, the heart medication Digoxin, antihistamines

used for allergy control, antipsychotics, commonly used

tranquilizers such as Diazepam, certain antianxiety drugs,

certain narcotics, anticholinergics, tricyclic

antidepressants, and many illegal drugs.  Elavil and other

tricyclic antidepressants, sometimes used to treat the pain

of neuropathy, can cause, trigger, or aggravate impotence. 

A person's unrelated disorders may also contribute to the

problem, as over-the-counter medications, including certain

eye drops and nose drops, have been associated with erectile

dysfunction.



     If you experience erectile dysfunction, and you are

using other medication, discuss it with your doctor.  By

adjusting the dosage of current medication(s) or by

switching to alternates, erectile dysfunction may be

alleviated.  Ask your doctor or pharmacist for information

about side effects, and be sure to read the package insert

in the container.  Consult a physician before discontinuing

any medications. 



     Much is now known about the causes and treatments of

erectile dysfunction, and impotent men should be aware of

their various treatment options.  Although surgery is one

choice, 95% of cases are resolved by non-surgical means, and

the National Institutes of Health recommends trying

non-surgical treatments before more invasive methods.  All

options should be considered, but the man's personal

preferences--and those of his partnerare vital in the

choice of treatment.  For purpose of discussion I've divided

treatments into three categories:  medications, external

mechanical devices, and surgery.



 

Medications



     External Vasodilators Improve Blood Flow:  When

diagnosis indicates a problem in the vascular system,

particularly arterial insufficiency, externally applied

vasodilators (example:  nitroglycerine ointment) can be used

to dilate arteries, improving blood flow into the penis. 

Commonly used in treatment of high blood pressure and

associated heart disease, the ointment is applied to the

penis to increase penile arterial flow and improve

erections.  The most notable side effect is that it may give

the female partner headaches, as it is absorbed into the

bloodstream through the vagina.  To prevent this, the man

should use a condom.  Another topically applied vasodilator,

Minoxidil, was found to have fewer side effects and be more

effective than nitroglycerine cream.  Although some cases of

erectile dysfunction respond well to this kind of therapy,

the effectiveness of vasodilator products has not yet been

determined by the scientific community.

  

     Yohimbine Therapy Shows Promise:  Yohimbine medication

comes from the bark of a tree that grows in Africa and

India. The extract, long used as an aphrodisiac and folk

remedy for impotence, has proved effective in some impotence

cases.  It is not known exactly how the medication works,

but it seems to affect the central nervous system by

suppressing nerves that normally restrict erection.  It's

thought that yohimbine may also increase libidodesirein

some men.  The few side effects of yohimbine tablets can be

easily alleviated.  Many doctors prescribe this therapy for

cases of very mild, physically caused dysfunction or for

psychological impotence.  This therapy does have merit and

should be considered.



     Many sources report that penile injection therapy has

an estimated 80% rate of success.  Injected directly into

the penis, the medication produces erection by relaxing

certain muscles, increasing blood flow into the penis and

restricting outflow.  The therapy has disadvantages, such as

risks of infection, pain, and scarringfibrosisin the

penis, and it may create "priapism,"  a prolonged, painful

erection lasting six hours or more (although reversible with

prompt medical attention).  Most popular medication is

Upjohn Corporation's Caverject, the first to be approved for

such use by the FDA.



     Drug Combination Injection Therapy:  Therapies using

combinations of drugs have been developed and are proving to

be a good "fallback" for individuals who experience

difficulties with Caverject alone.  "About 15% of all

individuals who try therapy with Caverject experience

significant pain at the injection site,"  says Troy A.

Burns, MD.  "For these 15%, a combination of Caverject,

Papaverine, and Phentolamine produces less or no pain."  





Alternatives



     The MUSE System is a non-invasive alternative to penile

injection.  The user dispenses his medication

(alprostadil/Caverject) with an eye-dropper-like applicator,

directly in the urethra.  No needles are required.  FDA

approval of the device is pending.



     "Rejoyn" is an inexpensive, non-prescription

alternative to the many vacuum-actuated devices described

below.  Described by its manufacturer as a "support sleeve,"

it does not "cause" an erection, but rather supports the

flaccid penis as if it were erect.



  

External Mechanical Devices



     This category of treatments for erectile dysfunction

includes external vacuum therapies; noninvasive external

mechanical devices that produce painless erections by

causing blood to flow into the penis while constricting

outflow of blood.  Such devices imitate a natural erection,

and  do not interfere with orgasmic experience.  External

vacuum therapy mechanisms are approximately 90% successful

in causing and sustaining an adequate erection. All are

portable, and cost approximately $400-$450, covered under

most insurance plans.



     The vacuum constriction device consists of a vacuum

cylinder, various sizes of tension rings, and a vacuum pump,

either hand-operated or electric. The penis is placed in a

cylinder to which a tension ring is attached.  Air is

evacuated from the cylinder by means of the pump, creating a

vacuum, which produces the erection.  The cylinder is

removed, leaving the tension ring at the base of the penis

to maintain the erection.  Most insurance companies do

provide coverage for this type of mechanism.



     Vacuum therapy devices have a few minor disadvantages. 

One must interrupt foreplay to use them.  THE TENSION RING

MUST BE REMOVED AFTER SUSTAINING THE ERECTION FOR 30

MINUTES, TO PREVENT PENILE BRUISING.  You must use the

correct-size tension ring.  Make sure you don't fall asleep

while wearing one of these devices.  Although considered to

be basically pain free, initial use may produce some

soreness.  Such devices may be unsuitable for men with

certain disorders related to blood clotting.  In general,

vacuum constriction devices are successful in management of

long-term impotence, and they enjoy wide physician

acceptance. 



     "At our institute," says Troy A. Burns, MD, founder and

medical director of the Diagnostic Centers For Men, "each

doctor regularly prescribes such devices 20 to 30 times a

month.  Complaints are rare; very rarely do we have anyone

bring them back.  They usually work really well." 





Surgical Treatments



     There are many other less-invasive and less-expensive

options, and surgery should be considered only after all

others have proved unsatisfactory.  Of the two kinds of

surgery performed, one involves implantation of a penile

prosthesis; the other attempts vascular reconstruction. 

Less than 5% of impotent men may benefit from vascular

surgery.  Expert opinion about surgical implants has changed

during recent years; today, surgery is no longer so widely

recommended.  Even though it is 90% effective, surgery is

expensive in both monetary and human terms, but it is one

available option for impotent men.  The decision to have or

not have surgery is one that should be made by the man and

his sexual partner.



     Companies that market surgically-implanted prosthetic

devices sell only to hospitals and physicians and will not

provide the selling price to consumers.  Through research I

have found that the malleable prostheses cost about $1400, 

and inflatable devices cost about $4000.  If the man elected

to undergo surgery, and fees were totaled (surgical,

operating room, and the markup on the prosthesis), the cost

would be about $9000 for the malleable and about $13,500 for

the inflatable device.  These prices reflect rates in

central Missouri and should not be considered national

averages.  The main risk associated with penile surgery is

infection.   Although every attempt is made during the

procedure itself to prevent infection, it can develop, and

may force removal of the prosthesis.  As with all invasive

procedures, there may be some pain, bleeding, and scarring. 

I also note that the device itself might fail to work

properly and may have to be removed.  If for some reason the

prosthesis or parts become dislocated, surgical removal may

also be necessary.  With a general success rate of about

90%, any of the devices will restore erections, but they

will not affect sexual desire, ejaculation, or orgasm.



     Prostheses:  Many different types of penile prostheses

are available, in three categories:  rods, inflatable

prostheses, and self-contained prostheses.  Semi-rigid or

malleable rods are the simplest and least expensive of all. 

Their main disadvantage is that the penis remains constantly

erect, which may cause problems with concealment.



     Inflatable prostheses are complex mechanical devices

that imitate the natural process of erection.  Parts are

inserted surgically into the penis and scrotum, and

activated by squeezing.  When erection is no longer desired,

a valve on the pump is pressed, and the penis becomes

flaccid.  Disadvantages include risk of mechanical breakdown

or leakage.  Fully inflatable devices are the most expensive

of the three categories, because of the complicated surgery

necessary to implant the parts.



     Self-contained single unit prostheses are similar to

the inflatable types, but more compact.  The entire device

is implanted into the penis.  When erection is desired, the

unit is activated by either squeezing or bending, depending

on which of the two types of self-contained prostheses is

used.  Some of the mechanical types have been known to fail

during intercourse; the inflatable device can sometimes be

difficult to operate.



     All penile implants will produce erections suitable for

intercourse.  When decisions are being made regarding the

kind of surgery, other factors should be considered. 

According to Bruce A. MacKenzie in "Impotence Worldwide"

(Volume 7, No.2), purpose is only one of several elements

considered when selecting an implant.  MacKenzie said, "To

those who wish to simulate nature to the furthest

extentthen a fully inflatable would be their choice; for

those who wanted something relatively simple, ready to use,

lower cost, one day less in the hospitaltheir choice would

be the hinged or malleable; to those who wanted a compromise

between the twoa hybridthey would choose a self-contained;

and for those who wanted the least expensive (low end of the

line)the semi-rigid would fit the bill."  



     Vascular Reconstructive Surgery for Impotence uses

highly sophisticated techniques and equipment to physically

correct the underlying causes of impotence in the penis. 

The surgeon may attempt reconstruction of the arterial blood

supply, or remove veins when the cause is due to leakage. 

Less than 5% of men with erectile dysfunction have such

surgically treatable impotence!



     When quality of life is affected by erectile

dysfunction, a man should seek a physician's helppreferably

that of a carefully chosen specialist.  Don't wait for your

doctor to ask you about sexual functioningtalk about it! 

Nothing is cured by silence.  Talk about it with your

partner/spouse too, as she is equally affected by this

condition.  Remember you're both involved, so she is

integral to the relationship, and deserves complete honesty. 

Relationships are solid only when couples consider each

other's feelings, so COMMUNICATE WITH YOUR PARTNER.   





COMPANIES THAT MARKET IMPOTENCE THERAPY SYSTEMS



     American MedTech Corporation, 2720 Nevada Avenue, New

Hope, MN 55427; telephone:  1-800-524-8014.  They offer

"Rejoyn," an over-the-counter impotence "support sleeve."



     Encore Medical Products Centre, 2300 Plantside Drive,

Louisville, KY 40299-1928; telephone:  1-800-221-6603.  They

offer vacuum constriction devices.



     The Impotence Information Center, American Medical

Systems, P.O. Box 9, Minneapolis, MN 55440; telephone: 

1-800-843-4315.  They offer prosthetic devices.



     Mentor Corporation, 5425 Hollister Avenue, Santa

Barbara, CA 93111; telephone:  1-800-235-5731.  They offer

both vacuum constriction and prosthetic devices.



     Osbon Medical Systems, P.O. Box 1478, Augusta, GA

30903; telephone:  1-800-438-8592.  They offer both vacuum

constriction and prosthetic devices.



     Pos-T-Vac, P.O. Box 1436, Dodge City, KS 67801;

telephone: 1-800-627-7434.  They offer vacuum constriction

devices.



     VIVUS, Inc., 545 Middlefield Road, Suite 200, Menlo

Park, CA 94025; telephone: (415) 325-5511.  They offer their

noninvasive MUSE delivery system for the drug alprostadil

(Caverject).





RESOURCE LIST OF INFORMATION AND SERVICES



     American Association of Sex Educators, Counselors, and

Therapists (AASECT), P.O. Box 238, Mount Vernon, IA 52314. 

For a list of certified AASECT members in your state, send

SASE. 



     The Diabetes Action Network of the National Federation

of the Blind, 811 Cherry Street, Suite 309, Columbia, MO

65201; telephone:  (573) 875-8911.  They offer free copies

of this article and other information pertinent to diabetes

and its ramifications.



     The Geddings Osbon, Sr., Foundation, Impotence Resource

Center, P.O. Box 1593, Augusta, GA 30903; telephone: 

1-800-433-4215.  They offer two booklets, free on request

(single copies, print or audiocassette)"Impotence:  A

Woman's Perspective," and "The Male Treatment Guide."  They

also offer physician referrals.



     Impotence Institute of America, 10400 Little Patuxent

Parkway, Suite 485, Columbia, MD 21044-3502; telephone: 

1-800-669-1603 or (410) 715-9605.  They publish a periodical

titled "Impotence Anonymous."



     Integrated Medical Resources, Inc.  8326 Melrose Drive,

Lenexa, KS 66214; telephone:  (913) 894-0591.  They publish

"Getting Help:  A Patient's Guide for Men With Impotence,"

by Troy A. Burns, MD.



     National Kidney and Urological Diseases Information

Clearinghouse, Box NKUDIC, 9000 Rockville Pike, Bethesda, MD

20892. They publish a comprehensive bibliography on

impotence, free upon request, "Impotence: Patient and

Professional Materials."



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



New Program For Blind Diabetics





Photo:  portrait of Diane McGeorge



     The Colorado Center for the Blind, a rehabilitation

center established by the National Federation of the Blind,

announces a new program for blind diabetics and those losing

vision.  Recognizing that blind diabetics face a unique set

of challenges, the Center's new three-month intensive

program (offered four times a year, and not limited to

Colorado residents) will focus on further development of

skills and attitudes necessary for full participation in the

mainstream.



     For the first six weeks, participants will attend

classes covering:  Medical and psychological implications of

diabetes, adjustment to blindness, planning for the future,

creating a healthy lifestyle, and strategies for setting and

achieving personal and vocational goals.  Both medical

professionals (including the Center's Nurse/Diabetes

Educator) and blind diabetics will offer presentations.



     In the second segment of the program, individual

participants will work, in their own home environment, with

members of the Center staff, translating lessons learned

into practice, and implementing their goals for community

and vocational involvement.  Student-staff contact will be

as frequent as is needed to ensure individual success in the

three areas highlighted by the program: Improved working

knowledge of independent diabetes self-management,

development and implementation of a healthy lifestyle, and

realistic expectations/plans for personal and vocational

development.



     Tuition for the three-month program is $2000 per month. 

If housing is needed, it is available at a cost of $350 per

month.  Students will be expected to provide for their own

maintenance.



     Regardless of ramifications, blind diabetics can draw

their own insulin, test blood glucose, and perform all the

other tasks of independent diabetes self-management.  They

are not alone.  The rapid pace of change, both in adaptive

technology and medical understanding of diabetes, means that

learning is an important part of the prescription.  The

techniques and technologies are there; programs like this

one can help provide the necessary knowledge and positive

attitudes.



     The Colorado Center for the Blind is one of the three

rehabilitation centers established by the National

Federation of the Blind across the United States.  For

information about its new diabetes program, contact:  Diane

McGeorge, Program Coordinator, The Colorado Center for the

Blind, 1830 South Acoma Street, Denver, CO 80223-3606;

telephone:  1-800-401-4632 or (303) 765-1330.



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



Tactile Insulin Vials:  Movement Toward Solution



by Ed Bryant





     For almost five years, the Diabetes Action Network of

the National Federation of the Blind has been lobbying and

campaigning to convince the Food and Drug Administration

(FDA) and the insulin manufacturers to incorporate tactile

markings on insulin vials.  Currently, all insulins are

still packed in identical vials (or pen cartridges), with

the different types distinguished only by writing on the

label.  Most diabetics, blind or sighted, mix insulins, but

how do you tell your R from from NPH, or Lente, or new

quick-acting Humalog, if you cannot read the label?



     For decades, blind diabetics and those experiencing

fluctuating vision (a condition in which vision may go from

adequate to unusable, and perhaps back again, in days or

hours) have had to mark their insulin types with tape or

rubberbands, or ask someone else.  Rubberbands break, and

tape falls off. Sighted aides are not always available, and

blind folks are entitled to their independence.



     In letters, calls, and meetings with insulin industry

and FDA representatives, we, the Diabetes Action Network,

have pushed for permanent, easily detectable tactile

markings on insulin vials, sufficiently prominent that

individuals with neuropathy could detect them.  Both Eli

Lilly and Company (on December 14, 1994), and Novo Nordisk

Pharmaceuticals Inc. (on January 10, 1995), the two insulin

manufacturers who serve the U.S. market, separately sent

representatives to meet with me.  Lilly showed me prototype

tactile vials at their meeting.  As part of their testing

program, Lilly met with students and staff at B.L.I.N.D.,

Inc., a rehab center established by the National Federation

of the Blind (NFB), and sent a representative to the NFB

1995 annual convention, held in Chicago, Illinois.



     After an intensive letter-writing campaign in which

you, VOICE readers, played the key role, the FDA called a

meeting of "interested participants" on October 19 of last

year.  Meeting participants discussed various proposals for

tactile insulin identification, and moderator John Short

gave "my persistence" full credit for making the meeting

happen (We know these changes are coming about because

they're overdue, because both blind and sighted diabetics

will benefit from tactile coding).  Minutes of that meeting

record that Lilly and Novo Nordisk were to come to the next

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

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

solutions."



     Although the second meeting was scheduled for January

of 1996, bad weather in the Washington DC area forced

postponement, and it was not held until April 10.  Both

Lilly and Novo Nordisk brought prototype vial markings to

the meeting.  Lilly had used the extended break between

meetings to confer with groups of blind people, and to more

fully explore the placing of raised horizontal lines on the

label.



     Novo Nordisk already uses a system of Braille-like dots

on the aluminum vial-stopper rim, in Europe, and they sought

to have their system adopted in the U.S.  At the meeting,

all blind participants, and the representative of the

American Association of Diabetes Educators, agreed Novo

Nordisk's dot-markings were too small to be reliably

detected by individuals with neuropathy, and that bars were

much more appropriate than dots.



     At the close of the second meeting, the FDA and Lilly

were ready to agree on a set of one through four horizontal

tactile bars to distinguish insulin classes.  Novo Nordisk

asked for more time "in which to test alternative

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

some time in July.



     July came and went without a word from Novo Nordisk. 

On August 5, I received the following fax: 



Prognosis

Strategic Research for the Business of Medicine

Folsom, CA

August 5, 1996



Ed Bryant

First Vice President

National Federation of the Blind

Diabetics Division

Columbia, MO



Dear Ed:



     Our firm is currently working with one of the major

insulin manufacturers to design a new tactile coding system

for blind patients with diabetes.  Our goal is to develop a

package coding system that will allow blind patients to

readily identify insulin types using a braille-like code. 

The codes will be used with insulin vials designed for a new

pen system that allows blind patients to measure and

administer insulin without assistance.



     We are now arranging meetings with small groups of

blind diabetic patients to discuss how they take insulin

currently, and to allow them to handle the insulin vial

prototypes.  The opinions of the patients and clinicians

will be used to determine the final tactile coding submitted

to the FDA for approval. 



     We would like to meet with the patients in your

practice that you feel are the most appropriate for this

project.  I believe that the meetings will be interesting

for the patients and that their contribution will benefit

all insulin-dependent visually-impaired patients.



Sincerely,



Jon Evans, President

Prognosis



     Mr. Evans (we spoke that day) had been hired by Novo

Nordisk.  A contact in California had suggested he seek help

from the NFB, and they had given him my name.  I reiterated

to him my promise, made to Lilly and Novo Nordisk several

years before, to provide the names of rehabilitation centers

where he might find blind diabetic students willing to help

test prototype tactile vial markings.  I helped him arrange

a meeting with blind diabetic students at the Colorado

Center for the Blind, another rehab center established by

the NFB. 



     Although Prognosis had been instructed to interview

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

Nordisk had given him no instructions to recruit individuals

with neuropathy for the test.  I was astonished at this

omission, as the subject of neuropathy, and its importance,

had been thoroughly covered at all previous meetings.  Lilly

had made certain that blind individuals with neuropathy were

part of their test population.



     Mr. Evans met with students at the Colorado Center on

August 20.  Diane McGeorge, Coordinator of the Center's

Diabetes Program, reports she offered him the opportunity to

meet each student separately (to lessen the impact of

persuasive individuals on the opinions of other

participants), but he refused, choosing to meet the group

together "to get it done in about an hour's time."   He

brought prototypes marked with dots, circles, or one through

six lines.



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

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

students from several locations) voted enthusiastically for

the horizontal tactile bars, finding them easiest to detect. 

I note his findings echo Lilly's, so there is absolutely no

reason Novo Nordisk should not agree to the adoption of

raised horizontal lines to mark the different classes.  He

"would be passing his finished report to Novo Nordisk in the

next few weeks."  Perhaps then we might have our

long-delayed meeting!  



     In the January 1997 issue of the VOICE, I will report

on the upcoming meeting with the insulin manufacturers and

the FDA. Hopefully this will be the last such report, and I

will be able to describe the system adopted, and give you a

target date for when it will be on pharmacy shelves.



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



Scholarship Available For IDDM Diabetics



by Debra Frank, MS, MS





     The Angelo Centano Golf Scholarship is here again!  The

Knights of Columbus "St. Therese" and "Father John Farrell"

Councils, of Long Island, New York, invite type I diabetics

to join in the "spirit of sport" and compete for a $500

prize.  Write a 300 to 600 word essay explaining how the

award could help you achieve a sport or fitness goal.  The

winning essay will be published in VOICE OF THE DIABETIC.



     The contest is in honor of the late Angelo Centano, a

blind, insulin dependent athlete who died in 1992.  Write

about any aspect of athletics or physical activity which

winning the prize would help you achieve.  If it is to buy a

tandem bicycle so you and a friend or family member can

enjoy riding together, or you want to hire a coach to train

you for the swimming events at the next Para-Olympics, or

you have any other sports- or exercise-based desire, pick up

your pen, or sit down at your computer, and GO FOR IT!  You

just might win!



     From the Editor:  Debra Frank encourages blind

diabetics to submit essays.  Entries should reflect any

activity good for physical health and positive living. 

Incidentally, a typed, double-spaced submission would be

approx. 1 1/2 to three pages long.



     All essays should be labeled "Golf Scholarship Essay

1996" and sent directly to the VOICE OF THE DIABETIC. 

Please send us your submissions by January 1, 1997.  The

winner will be chosen by committee and announced in the

VOICE, Spring 1997 issue.  We look forward to hearing from

you in the near future.  For more information on the

scholarship contact:  Ed Bryant, Editor, Voice of the

Diabetic, 811 Cherry St., Suite 309, Columbia, MO 65201;

telephone:  (573) 875-8911; fax:  (573) 875-8902.



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



Stepping Out With An Attitude



by David Walker





Photo:  portrait of David Walker



     (This article appeared in the July 1996 edition of the

BRAILLE MONITOR, published by the National Federation of the

Blind.)



     From the MONITOR Editor:  One of the most difficult and

painful dilemmas facing people who are gradually losing

their sight is the question of when to begin carrying and,

even more important, using the long white cane.  One

imagines how conspicuous and awkward it would feel to carry

a long stick and wave it around, advertising to the world

the fact that one is blind.  It is easy to understand why

week after week, month after month, even year after year

people who really aren't safe traveling without a cane put

off the decision to begin using it.  David Walker of

Missouri understands the problem, and he also understands

that the key to making a successful transition to using the

long cane is attitude.  One's technique can improve with

practice and the opportunity to observe good cane travelers. 

But if one never moves beyond the feelings of fear and

inadequacy, it doesn't matter how good one's technique is;

the person is likely to leave the cane standing unused in

the corner.  Here is what Dave has to say on the subject:





     I recently talked with a young woman who was concerned

about a friend with retinitis pigmentosa (RP) who refuses to

use a white cane despite difficulty in traveling.  I too

have been concerned about this when meeting blind people who

will not use a cane because they cannot accept their

blindness.  I hope this article, written by a person with

RP, will reach this woman's friend and others struggling

with this issue and help them adopt a positive attitude

about their blindness and travel. 



     I grew up with RP.  I learned to cope with the

progressive loss of vision which caused me to alter methods

of doing some things and cease only a few activities as a

matter of safety and common sense. One of the activities

which required alterations was independent travel.  My

adjustments were gradual because of the slow progression of

RP and because of my own evolving understanding.  I imagine

this is common among others with RP.



     Giving up my ten-speed bike was one of the most

difficult things in my life since I had a great love of

cycling as an independent mode of travel beyond a reasonable

walk.  However, my gradual loss of sight in my mid-twenties

forced me to reconsider riding a bike after a few close

calls and the resulting reductions in my biking to

restricted hours and reduced speed.  I had to resign myself

to the fact that safety was a real issue and eventually sold

the ten-speed extension of my powerful legs and independent

nature.



     My first experiences with a white cane were

humiliating.  I was a client of Services for the Blind in

Michigan in the early sixties, long before I sold my bike. 

At the time I had very good partial vision.  I could read

the signs on the buses, identify traffic lights, and see

oncoming vehicles at quite a distance.  I really didn't need

a white cane, but I was talked into getting one from the

Lions Club so that I could ride the buses free in Detroit. 

I was commuting into the city from the suburbs daily for

piano-tuning training, and the saved bus fares in the

maintenance money I was getting from the agency looked good

to me.  Keep in mind that I had never heard of the National

Federation of the Blind (NFB), so I didn't realize how much

damage those so-called free rides do to the self-respect of

the individual and the public's attitude toward blind people

in general.



     When I first held that thirty-eight-inch folding white

cane with the bright red tip out in front of me as I walked,

I felt as obvious as a neon sign.  I was convinced that

everyone was staring at me. I felt very odd.  I was with the

fellow student who had taken me to the place where I got the

cane, so I didn't feel completely alone.  It wasn't until

Charlie and I went our separate ways that I began to feel

really conspicuous.  When I got on the bus and started to

move toward a seat that I could see clearly, two people from

opposite sides of the bus grabbed my arms and said, "Sit

here." I found that reaction both unnerving and intrusive

since I could follow only one instruction at a time. 

Besides, my freedom to choose my own seat had just been

diminished by two strangers. After a few months of such

experiences and of people telling me I wanted to go where I

didn't want to go, I tossed my cane in the closet.



     For years after that I didn't use the cane because of

such experiences and because I could still see fairly well

to travel on foot and on my bike. I never denied that I was

legally blind; I just didn't like the idea of people feeling

sorry for me and thinking they had to tell me where I was

going.  When I went with family members or friends at night,

they always warned me of objects so I could walk around

them.  When my buddies and I went to a bar, they would give

me oral cues or an arm to get through the dimly lighted bar. 

I was comfortable doing this with family members and friends

with whom I had grown up.



     In 1970, while I was a student at a community college,

I had to take a couple of night classes. And although I was

familiar with the campus, I was uneasy about the thought of

traveling from building to building in the dark, walking

into students, or falling down stairs. So I took the old

cane out of the closet and put it in my brief case. I

remember how uncomfortable I felt using that cane and

worrying about what fellow students might say if they saw it

in my hand at night, even though they didn't see me using it

during the day. Actually, the thought that they would

recognize that I was legally blind did not bother me as much

as the idea of falling down stairs or walking into people

without using the cane.  At least the cane would warn me of

stairs, other objects, and people despite its shortness.  I

also learned that most people would not try to drag me where

I didn't want to go as had happened before, so I became more

comfortable with the cane.



     While I attended Michigan State University with its

very large and complex campus, I began using the cane more

and more frequently.  I found that it was very helpful in

finding paths in the snow; sidewalks; and those very hard,

shin-bruising, concrete benches all over campus.  As Charlie

had told me back in the sixties, "The cane does a lot of

talking to you," and it helped professors understand that I

was blind when I was requesting reasonable accommodations

for exams.  I had developed some pretty good cane travel

skills while at MSU, and I taught some other blind students

how to get around campus, but I did not use conventional

technique.



     While I was a student at Michigan State in 1972, my

brother introduced me to the National Federation of the

Blind. I attended a state board meeting held in Lansing and

met local Federationists.  I recognized that the Federation

and I shared a common philosophy, and through discussions

with members and reading the BRAILLE MONITOR, I developed a

better attitude about travel. I came up with a saying while

helping a blind student learn her way around campus:  "If

you can get lost, you can get unlost."



     After graduation I moved to Rochester, New York, and

became more active in the Federation, but I still used my

unconventional cane technique.  Since I was in a new city

and had to do a lot of traveling and nudging people and

other objects became more frequent, I signed up for

instruction in cane travel with a local agency.  My positive

attitude and past cane travel experience made learning more

conventional techniques easy.  Before I started lessons, I

bought a longer fiberglass cane from our NFB National

Office, which set me on a new path of independence.  Many

people, however, have trouble taking that first, positive

step--conceiving of the cane as a true alternative, leading

to independence; but believe me, avoiding those very

embarrassing situations by using decent cane technique is

far better for one's self-esteem than falling down stairs,

walking into people, or having a serious accident with a

motor vehicle.



     I have met many legally blind people who are obviously

in need of cane skills but who try to appear sighted.  This

is a serious mistake.  If people think you are sighted and

don't realize you are not, they will not take steps to avoid

a collision.  The person with diminished vision has the

responsibility not to put himself or others in danger. 

Refusing to use a cane in such circumstances is

irresponsible.  Those who fall down stairs or walk into

poles while trying to look sighted and therefore cool by not

using a cane succeed only in looking like fools.



     One day while returning to campus from the store, I

encountered a blind guy crossing Grand River Avenue, a very

busy street in East Lansing, Michigan.  He was carrying

groceries but had his cane tucked under one arm, pointing

behind him.  I thought, "What the hell are you doing?"  I

approached him and introduced myself, without saying what I

was thinking.  We became good friends.  I got him to use the

cane a little, but I could never get him to use his cane

properly.  He had been struck by numerous bicyclists on

campus because they did not realize that he was blind when

he stepped into their path without a cane.  Had he used his

cane, those cyclists would have seen it and taken

preventative measures.  The major problem with this blind

person is that he does not accept his blindness, despite all

the efforts of rehab services and friends to help him become

a self-respecting blind person.



     My late brother Jim, who had excellent cane travel

skills and even taught cane travel and attitude-adjustment,

went through denial as have so many others.  Once, before

either of us used a cane, he and I were in a bar with

sighted friends.  Jim went to the men's room, which was past

the pick-up point where waitresses got their orders.  Less

than a minute after he left the table, we heard the crash of

glasses and a tray.  I remember commenting, "He got her." 

Jim had not seen the waitress stepping from the bar with a

full tray of drinks, and she had no way of knowing that he

was blind in the dark.  They collided.  If Jim had been

using a cane and the excellent travel skills he later

developed, he could have avoided that embarrassing public

event.



     During the time when I refused to use a cane, I

remember suddenly stepping down a flight of stairs I didn't

see in a dark hotel lobby.  Luckily, I regained my balance,

but not until I had run down several steps to catch up with

myself and bounced off a door frame.  A few experiences like

these and also finding the National Federation of the Blind

helped me gain a healthier attitude.



     I can't count the number of times I have observed

legally blind people dodging themselves in mirrors as they

travel down the corridor of a hotel.  It is sometimes

amusing to watch such antics, but it's not really funny. 

This kind of public display makes our job of educating the

public about the abilities of blind people more difficult. 

It also gives writers lousy material for television

programs.  If these blind people used canes, they would

realize they were approaching a mirror and not an oncoming

person.



     I once stopped by the office of a blind woman here in

town to do an errand for her.  I told her that I had just

walked several blocks along the newly repaired section of

Madison Street to see what it looked like.  (The curbs and

sidewalks had just been replaced.)  Her response was curious

since she has known me for several years. She said, "Boy,

you're brave."  I told her that bravery had nothing to do

with it; they were just sidewalks.  It was not bravery but

attitude.



     I can assure those of you who share my old prejudices

about the white cane that a change in attitude is very

rewarding.  If you think you do not look blind without a

cane or do not want to be identified as a blind person by

using the cane, consider the alternatives.  You look more

foolish falling down stairs, bumping into people and

objects, dodging yourself in mirrors, than if you were to

walk with skill and grace, with dignity and self-respect,

using a long white cane.  The first step is to develop a

positive attitude about blindness and alternative methods of

travel.  After that, the rest comes much more easily. 

Before you know it, you are gaining confidence, and that

positive attitude goes with you everywhere.



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



Ask The Doctor



by Wesley W. Wilson, MD





Clip Art:  illustration of 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 an overweight type II diabetic from a big,

heavy family.  Did my weight (I have always been like this)

cause my diabetes?



     A:  Your question is appropriate, though difficult to

answer.  It is clear that overweight and type II diabetes go

together.  It is also clear that if a person who has

inherited a tendency toward type II diabetes keeps an ideal

weight and follows an adequate exercise program, type II

diabetes can be prevented or delayed.  (If and when symptoms

appear, diet and exercise can help keep them under control.)



     In an earlier article, I mentioned that the National

Institutes of Health is conducting a study to see what

measures might prevent the development of type II diabetes,

and the results of this study will help us answer questions

such as yours.  It appears type II disease is predominantly

an inherited condition.  Some populations, such as the Pima

Indians of Arizona, have a very high frequency, as high as

one in three, though, interestingly, type I diabetes is rare

in this population.  Other populations, especially Hispanic

and African American, also show a high frequency of type II

disease, as do women with a high birth weight (more than

nine pounds) baby.  Statistics suggest those most at risk

for type II are over 40, overweight, and have a family

history of the disease.



     Centers for Disease Control statistics suggest that

half the individuals with type II are unaware they have it. 

Particularly at its onset, type II tends to be mild, and may

cause no symptoms for some time, finally announcing its

presence through the appearance of its complications.  Only

then are tests administered, and the abnormal blood sugar

discovered.  It is much like finding termites in your house

by discovering the damage they have already done.



     Of course the obvious answer is for persons from

at-risk groups, such as I have outlined, to get regular

blood-sugar tests and examinations.  The only way we will

ever understand the frequency of the disease, or catch it in

its early stages, is to test often.  Detected early and

answered with tight blood sugar control, diabetes need not

necessarily lead to severe complications.           



     The inherited abnormality that leads to type II

diabetes is usually accompanied by a tendency toward

overweight.  The two disorders must be closely related,

since, as in your case, problems with obesity and problems

with diabetes run strongly in certain families and

population groups.  You have apparently inherited those

tendencies, but do not lose hope.  The key problem with

diabetes is the appearance of its complications, and those,

in both type I and type II, can be delayed, prevented, or

controlled by careful control of blood sugar levels.



     Unfortunately, efforts to control diabetes can be

troublesome.  They require lifestyle change, frequent

physician visits, and the need to follow advice about

exercise and dietary control.  Once the disease has been

detected, persons who carefully manage their diabetes, their

elevated cholesterol, and their elevated blood pressure,

will be least likely to develop their troublesome and

potentially lethal complications.  HCFA, the Health Care

Financing Administration (who regulates Medicare payment

policy), isn't helping, because currently the only tests

they will pay for in the Medicare-covered population are

those that follow a diagnosis.  If a person is not already

known to have diabetes, HCFA is not anxious to pay for tests

to see if they might have it.  We hope to see change here...



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



A Long Road A Winding



by Douglas Campbell





     I am told that I developed diabetes at approximately

three years of age.  I have had it now for 60 years, and a

lot of things have happened over that time.  As far back as

I can remember, when I first tried to start school, the

principal of the school was hesitant to have me accepted,

and school was put off for a year. 



     My family then moved to the Cape, that's Cape Cod,

where I started school in 1938 (I had developed diabetes in

'36).  A local doctor had the intelligence at the time to

advise my mother to take me to the Joslin Diabetes Clinic,

which was a Godsend for any diabetic.



     As any growing child, I was going to do as much as

everyone else did.  We would play cowboys and Indians, and

of course we would go across a field that had potatoes in

it, then we would dig them up and act like we were in the

Sahara Desert and cook some potatoes, not paying any

attention to my diabetes.  During the time period of

approximately 12 years of age until I was married at 23 I

was trying to eat and break my diet like crazy.  I ate

candy, ice cream, went to football games and ate hotdogs,

and all the other things that everybody else was having.



     Some 49 or 50 years ago I went to Camp Joslin for

Diabetic Children.  During that time we climbed Mt. Monadic. 

There were 10 diabetic children and a nurse who had a full

box of Hershey chocolate bars which were all completely used

up by time we climbed the mountain and came back down.  At

the same time being typical young diabetics we went across

the pond to try out sleeping on the ground over night.  Low

and behold there was a blackberry bush in the area just past

where we camped.  As you can imagine we all had our fill of

blackberries and our blood sugars told us.



     Being a typical young diabetic at one time I had a

blood sugar of 625 and Dr. Priscilla White entered me into

the Deaconess Hospital for additional insulin to bring my

blood sugar back down.  At that particular time I went up on

the roof of the building and taking a high-bouncing rubber

ball, threw it as hard as I could for as long as I could

until my blood sugar was forced back down again.  These

involvements I do not advise for any young diabetic, but you

try to tell a young diabetic what to do and what not to do

and they are going to do the opposite.



     Things have changed a great deal since then.  In the

beginning we even had to file our own needles on a small

stone, now they are just disposable.  At that time we had to

test urine, which took approximately five minutes of boiling

it in butadiene solution.  Now we have the new talking

glucose meters, a Godsend to me because I can now take my

own blood sugar which I have not been able to do for some 40

years that I have been blind.  Although my sight completely

went just prior to the development of the laser beam, I have

seen its results with my own brother, who has had laser

treatments for some 20 years.  Being married twice (my

second wife was also a diabetic), the two of us talked to a

Boston College graduating nursing class about blindness and

diabetes.  She had a dog and I used the cane.  We also

showed Kenneth Jernigan's movie about blind people and what

they can do.  (Editor's Note:  Dr. Jernigan is President

Emeritus of the National Federation of the Blind.)



     As I learned later in life, what you know about foods

can have a great bearing on you.  You not only can control

your blood sugar by intake of food,  but also by the

adjustment of regular insulin where necessary.  I do not

advise the use of additional insulin unless you have had

experience in using it--which is one of the things I learned

as a young student at the Joslin Clinic Camp. 



     At age 23, just going blind after 20 years of having

diabetes, I entered Perkins School for the Blind, to learn

piano tuning.  I then became a piano tuner for the

Commission of the Blind for Massachusetts.  This I did for

the next 30 years.  I managed to buy a small five-room home,

in which I thoroughly enjoy doing as much as I possibly can

alone; my wife passed away some 12 years ago (from diabetic

heart disease).



     To any diabetic I advise you to keep as active as you

possibly can, as exercise helps maintain the blood sugar at

a much more acceptable plane and keeps you more active all

the time. 



     There is very little that a blind diabetic or even just

a blind person can not do with a little bit of exception. 

Here's one example:  Because I did a lot of driving in the

four or five years that I drove before I went blind, my

friend (who had a Model A Ford, as this was in 1923), one

time asked me if I would like to try driving it on the Cape

while the tide was out.   When I got going at approximately

30 miles an hour, as I was told, I was all of a sudden told,

"TURN LEFT!" and when I didn't immediately turn left, I was

screamed at to quickly turn left, then realized afterward

that it was a big inlet of water, which I would have gone

right straight into.  Driving at 30 miles an hour did make

me feel very much uptight.  Another blind friend of mine at

one time, who lived in Nantucket drove his car home one

night when he had been to a dance with his brother.  And his

brother didn't want to go home at the time so Charlie got

out, took his white cane, walked about 30 yards ahead of the

car, then got back in the car, drove the 30 yards, then got

out repeated the process until he had driven the two miles

all the way home this way.



     So there are very few things that you can't do but it's

the degree of these things that is acceptable.  I wish all

of you the best of luck and I will just wait and see how

this winding road of mine continues.  Thank you very much

and God bless you all.



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



Insulin Measurement Devices





Photo #1:  Homemade insulin measuring gauges



Photo #2:  Insulin Measuring Devices



     Most diabetics, blind or sighted, want and need to

achieve control, independent self-management, of their

diabetes.  But if a diabetic cannot rely on vision to

accurately measure insulin, then, to maintain independence,

he or she MUST have effective alternative techniques,

specifically designed for individuals with partial or

complete vision loss.  Many manufacturers have risen to the

occasion, and with the appropriate adaptive equipment,

non-sighted self-management is a reality.  People's

abilities (and ramifications) vary, and it is important to

remember that different devices best meet different needs.



     Some diabetics, with fluctuating vision, will find that

at certain times of the day they can rely on their vision to

accurately measure insulin.  At other times their visual

acuity may diminish, leaving them guessing at their dose of

insulin or relying on sighted aid.  A diabetic's eye

condition can change daily, making reliance on visual

techniques unsafe. 



     The following is a catalog of alternative devices for

insulin measurement.  Some are designed for those with

partial sight.  Others are intended from the start for

non-visual operation.  A few are the simplest of home-made

aids, designed by resourceful blind diabetics, some members

of our Diabetes Action Network.



     NOTE:  Prices quoted do not include shipping charges.  





Insulin Measurement Systems



     The COUNT-A-DOSE:  This insulin measuring device is

manufactured by Jordan Medical Enterprises, 12555 Garden

Grove Blvd., Suite 507, Garden Grove, CA 92643; telephone: 

1-800-541-1193.  Cassette instructions are supplied.  Its

suggested retail price is $49.95, but the National

Federation of the Blind (NFB) sells it for $40, the lowest

price on record.  Order through:  Aids, Appliances, and

Materials Center (hours of operation 12:30 PM to 5:30 PM

EST), National Federation of the Blind, 1800 Johnson St.,

Baltimore, MD 21230; telephone:  (410) 659-9314. 



     Designed for the Becton Dickinson (B-D) .5cc LoDose

(50-unit) syringe, the Count-A-Dose holds two insulin vials

and directs the syringe needle into the vials' rubber

stoppers.  The user can easily mix two different insulins,

and the "T-bar" that holds the vials has clear and obvious

tactile marks to aid insulin differentiation.  Dose size is

adjusted with the thumb-wheel, which clicks for each unit

measured (clicks can be both heard and felt) up to 50 units. 

The device provides easy, reliable, and accurate non-sighted

insulin measurement.



     (NOTE:  The NFB Materials Center has a supply of the

older, now discontinued, 1cc/100-unit Count-A-Dose. 

Operation is similar, but this device uses the B-D 100 unit

syringe, and each click of the thumb-wheel draws two units. 

No audio instructions.  Price is $40.)



     The SYRINGE SUPPORT:  This device is manufactured in

Canada by the Fondation Centre Louis-Hebert, 525 Boulevard

Hamel Est, Aile J, Quebec City (Quebec) Canada GIM 2S8;

telephone:  (418) 529-6991.  Instructions (standard print

only) are bilingual.  In the U.S., the Syringe Support may

be purchased (cost $19.95) through:  Lighthouse Consumer

Products, 36-02 Northern Blvd., Long Island City, NY

11101-1614; telephone:  1-800-829-0500.



     The Syringe Support uses only the B-D 1cc/100-unit

disposable syringe, and measures insulin in 1- or 2-unit

increments, in doses of one to 100 units.  To mix insulins

with the device, it is necessary to remove vials from the

apparatus.  To draw a measured dose, the Syringe Support

depends on a set screw with a raised flange, its only

landmark, at twelve o'clock.  One full turn draws two units. 

One half-turn draws a single unit.  Although the dial lacks

definite tactile or audio indicators, in most cases any

error would be fractional.  Still, the Syringe Support

performs best for those who must draw doses of greater than

10 units. 



     The LOAD-MATIC:  This device is available for $49.95

from Palco Labs, Inc., 1595 Soquel Drive, Santa Cruz, CA

95065; telephone:  1-800-346-4488.



     This device allows two different measurement

increments:  10-unit and/or single units of insulin. It uses

only 1cc/100-unit B-D syringes. Depressing the lever

measures a 10-unit increment, and turning the dial one click

measures a single unit.  To mix insulins with the

Load-Matic, as with the Syringe Support, it is necessary to

remove and replace insulin vials from the device.



     Although an intriguing design, the Load-Matic features

an overly complex operating drill, with many opportunities

for user error.  Ambiguous and incomplete instructions take

a high degree of familiarity for granted, and may confuse

the inexperienced.  Its 10-unit lever, if incompletely

depressed, is capable of dispensing the unwary user an

incorrect dose.  The Load-Matic's cassette instructions tell

the blind user to draw only about 700 units out of an

insulin vial with the device, as "this assures that you will

never draw air into your syringe instead of insulin."  The

printed instructions lack this statement.  The instructions

make no provision for removing air bubbles from the syringe,

which can easily be accomplished by drawing four or five

units of insulin, reinjecting them into the vial, three

times, and drawing the full measured dose the fourth time

(insulin mixers need do this only with their Regular

insulin, the first they draw.  See accompanying article: 

"Update:  Blind diabetics can draw insulin without

difficulty.")





Homemade Insulin Measurement Gauges



     The simplest insulin gauges are devices which allow the

plunger on an insulin syringe to descend a set distance and

no more.  The distance corresponds to a measured dose of

insulin, and the gauge enables that dose to be reliably

duplicated without sight.  To draw a different dose, you

must use a different gauge.  You may need quite a

collection!  Gauges may be of a number of shapes (flat,

corner-molding, tube...), and can be constructed of many

different materials (wood, plastic, metal, old credit

cards...), but most of them will be rigid, flat, several

inches square, and on one end of the gauge there will be an

L-shaped notch.  This L-notch will fit on the plastic collar

located between the flanges and the plunger of the insulin

syringe.



     Further down the insulin gauge will be the small slot

where the plunger seats, once you have reached the correct

dose for that particular gauge.  When making an insulin

gauge, keep the slot very narrow, to insure that when the

plunger is seated in the slot there is no play (which would

allow a variation in the dose). The L-notch and the slot

must both be on the same side of the insulin gauge. 



     If you need help constructing an insulin gauge, Janet

Lee, Second Vice-President of our Diabetes Action Network,

will construct you a sample, but you must send her an

insulin syringe of the type and size you use.  Contact her

at:  Blindness:  Learning In New Dimensions (B.L.I.N.D),

Inc., 100 E. 22nd Street, Minneapolis, MN 55404; telephone: 

(612) 872-0100.



     Although many people make their own insulin gauges, out

of all types of materials, commercial gauges are available. 

Meditec, Inc., 3322 S. Oneida Way, Denver, CO 80224;

telephone:  (303) 758-6978, offers INSULGAGES, flat plastic

gauges analogous to the homemade types described above, but

labeled in Braille with raised numbers.  Priced at $9.75

each, these are cut for either B-D or Monoject syringes, and

many sizes are available; one insulgage per dose.  Use of

insulgages in conjunction with the Holdease needle guide and

syringe/vial holder, also sold by Meditec (cost: $12.75)

enables non-sighted insulin measurement.



     The best insulin gauges, homemade or commercial, are

those most durable.  Insulin gauges constructed from

cardboard or staples, however inexpensive, are NOT

RECOMMENDED.  They distort and break too easily.



     A more complex homemade insulin measuring device was

designed, years ago, by VOICE editor Ed Bryant.  His gauge

was a carefully carved block of wood that allowed precise

syringe placement, non-sighted insertion of needle into

vial, and reliable tactile duplication of preset doses.  To

change the dose, he had only to replace one wooden or

plastic preset with another.  It worked well, but he feels

that as most folks do not have access to the necessary

precision woodworking, blind diabetics would be better

served by the Count-A-Dose, which he now uses.



     The use of non-standard or homemade insulin measuring

devices should only follow a thorough checkout of such

devices.



     It is important to understand that insulin gauges are

"cut" for a specific brand and size of syringe.  Therefore,

an insulin gauge that has been cut for a Monoject, Terumo,

or other type syringe cannot be used, will not produce an

accurate reading, on a B-D syringe and vice versa.  An

insulin gauge cut for a 1cc B-D syringe cannot be

successfully used on the 1/2 cc (Lo-Dose) or 30-unit B-D

syringe, for the same reason.





Other Alternatives



Appliances and Holders



     The INSULCAP, a color-coded, tactile-cue equipped

plastic fitting, attaches to an insulin vial and guides

insertion of the syringe, holding the needle at the correct

depth.  The syringe won't shift and bend the needle, as the

Insulcap holds the bottle to the syringe, freeing both hands

for the filling operation.  Offered by Diabetic Insulcap,

Inc., P.O. Box 34347, Las Vegas, NV 89133-4347; telephone: 

(702) 363-0426, the Insulcap is sold in sets of two:  one

blue, without tactile cues; and one orange, with tactile

cues.  Suggested retail price is $7.95.  Individuals with

low vision, arthritis, or other conditions causing

unsteadiness may benefit, though those without sight would

be better served by devices such as the Count-A-Dose.



     The INJECT-AID is a syringe/vial holder incorporating a

preset that allows consistent non-sighted drawing of a set,

pre-determined insulin dose.  Note that insulin adjustment

requires sighted aid.  The Inject-Aid costs $7.95, and is

available from George Wright Industries, 3741 Faulkner

Drive, Apt. 301, Lincoln NE 68516; telephone:  (402)

423-3253.



       The UNI-CAL-AID is similar to the Inject-Aid, but

incorporates two adjustable preset stoppers, allowing two

different doses or insulin mixing.  It accepts all syringe

types, but any adjustment of dose requires sighted aid. 

Price $25 U.S. or $30 Canadian, available from: 

Uni-Cal-Aid, P.O. Box 1000, Hope, B.C., Canada V0X ILO;

telephone:  (604) 869-5648.





Pen Injection Devices



     The NOVOLIN PENS:  Novo-Nordisk Pharmaceuticals Inc.,

100 Overlook Center, Suite 200, Princeton,NJ 08540;

telephone: 1-800-727-6500, produces two pen-type devices

(their "Novo Pen" has been discontinued).  They offer the

"Novolin Pen," which retails at $40 (excluding insulin

cartridge), and uses 150-unit "Novolin System" insulin

cartridges (R, N, or 70/30 mix) and "Penneedle" replacement

needles.  This device delivers a measured dose of between

two and 38 units, in two-unit increments.  Novo-Nordisk also

offers "Novolin Prefilled" disposable syringes.  These

devices are smaller than a pen injector, hold 150 units of

R, N, or 70/30 mix insulin, and are packed five syringes to

a package; suggested retail price (package of five

syringes):  $19.10; comparable to the cost of cartridge

replacements for the Novolin Pen. 



     Pending FDA approval, Novo Nordisk intends to introduce

a new pen injection device, the "Novo Pen 1.5."  Similar to

the Novolin pens, it will use the 150-unit Novolin insulin

cartridges, and will deliver in one-unit increments.



     According to the manufacturer of the Novo-Nordisk pens

and the prefilled Novolin syringes:  "None of our devices

are recommended for use by blind or visually impaired

persons without sighted aid." 



     The AUTOPEN is a British-made insulin pen injector,

designed to use the Novolin system cartridges and disposable

needles.  In the U.S. it is marketed by Owen Mumford, Inc.,

849 Pickens Industrial Drive, Suite 12, Marietta, GA 30062;

telephone: 1 -800-421-6936.  It is available in two

versions: a one-unit increment (administers up to 16 units)

and two-unit increment (up to 32 units) pen, differentiated

only by color.  Each is priced at $33.50.



     Becton Dickinson Corporation and Eli Lilly and Company

plan to offer, as a joint venture, the HUMULIN CARTRIDGE

SYSTEM pen insulin injection system.  FDA approval has been

granted; any remaining problems are logistical.  Similar to

the Novo Nordisk and Mumford pens, the system will dispense

150 units of R, N, or 70/30 insulin, but in one-unit

increments, from one to 59 units.  As soon as Lyspro insulin

receives final FDA approval, Lilly plans to offer it in

cartridge form as well.





Syringe Magnifiers



     The INSUL-EZE 6000, manufactured by Palco Labs (listed

above) is a suringe-and-vial holder incorporating a

full-length 2x lens, allowing the insulin-drawing operation

to be closely monitored. Insulin vials can be changed for

mixing without disturbing the syringe.  Adaptable, the

insul-Eze works with most types of syringes in the 30-, 50-,

and 100-unit size.  Cost:  $11.



     The TRUHAND, a device similar to the Insul-Eze, is

offered by Whittier Medical, Inc., 865 Turnpike Street,

North Andover, MA 01845; telephone: 1-800-645-1115.  It

allows use of different syringe types and sizes, and firmly

holds the vial, while providing a 3x magnified view of the

scale.  Vials can be changed for mixing without disturbing

the syringe.  Cost:  $29.95.



     The MAGNIGUIDE, offered by Becton Dickinson Consumer

Products, One Becton Drive, Franklin Lakes, NJ, 07417-1883;

telephone:  1-800-237-4554, is another syringe magnifier. 

It attaches to the insulin vial, and provides 2.5x

magnification, to aid needle insertion, precise dose

measurement, and location of bubbles in the syringe.  The

Magniguide is available (cost: $3.95) from Independent

Living Aids, Inc., 27 East Mall, Plainview, NJ 11803-4404;

telephone:  1-800-537-2118.



     The EZY-DOSE-SYRINGE MAGNIFIER fits all 1/2cc and 1cc

syringes, and clips to the syringe barrel, magnifying the

scale 2x to aid precise dose measurement.  Manufactured by 

Apothecary Products, Inc., 11531 Rupp Drive, Burnsville, MN

55337-1295; telephone:  1-800-328-2742, the device does not

affect needle insertion, which must be done visually.  Price

$4.95, available from LS&S Group, Inc., P.O. Box 673,

Northbrook, IL 60065; telephone: 1-800-468-4789. 

     

     The CEMCO SYRINGE MAGNIFIER, available in three sizes

(to fit syringes of 1cc, .5cc, and .33cc), is offered by

Cemco, P.O. Box 31, Scandia, MN 55073; telephone:  (612)

433-3374.  The magnifier clips to the syringe and aids

precise filling, but needle insertion into the vial must be

done visually.  Price:  $5 retail, or $42 per dozen (any

combination of sizes).



     The Diabetes Action Network of the National Federation

of the Blind is a support and information network for all

diabetics.  We have many members willing to share their

expertise in non-sighted techniques of diabetes

self-management.  If you have any questions about diabetes

and blindness, feel free to contact us.



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



Using Humalog Insulin





     On June 14, 1996, the U.S. Food and Drug Administration

granted final approval to Eli Lilly and Company to market

Humalog insulin (generic name INSULIN LISPRO, sometimes

called LYSPRO).  At this time it should be available in most

pharmacies and hospitals.



     Humalog is an insulin analog, genetically modified to

more closely match normal (non-diabetic) human insulin. 

Thus a number of characteristics set it apart from "Regular"

insulin.



     1.  Humalog is faster than Regular, both in time of

onset and peak. Where Regular insulin starts working about

30 minutes after injection (different people will react at

different rates) and peaks in about 3.5 hours, Humalog

starts up in 10 to 15 minutes, and peaks in about 1 hour. 

It also has the shortest duration of any insulin, being "out

of the body" within about 4 hours. 



     2.  Humalog's extremely rapid onset both allows and

requires the user follow it with food.  Again, this new

insulin goes to work fast, and if you don't give it some

food to work on, you can find your blood sugars going down

in a hurry.  Used correctly, it allows greater mealtime

flexibility.  Lilly reports test users were able to "inject

while looking at their food." 



     3.  Because Humalog works so much faster than Regular,

some people might mistake the quickness of the resulting

blood-glucose drop for the onset of hypoglycemia.  The best

answer is to test blood glucose whenever in doubt.       

     4.  Because Humalog is the first representative of a

new insulin class ("quick-acting"), not a lot of experience

has been accumulated in its use. Because it is so different,

the FDA advisory committee that approved it recommended it

initially be available by prescription only.  It is expected

that once the diabetes community becomes more familiar with

this new product, this limitation will be removed.  Humalog

insulin is available in U-100 vials and cartridges for the

B-D insulin pen.  Lilly expects most users will combine it

with a longer-acting insulin (NPH or Lente), drawing up a

mixed dose.  Studies are underway at this time about its use

in an insulin pump. 



     Lispro promises to be a great new tool, a weapon in the

diabetes wars.  But, like a powerful new car, it needs to be

respected.  It gets you there faster, but you better watch

where you're going, and keep both hands on the wheel.



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



Questions To Ask Your Doctor About Blood Sugar Control





     This information came from the National Diabetes

Outreach Program, part of the National Institutes of Health.



     The Diabetes Control and Complications Trial (DCCT)

showed that people with insulin-dependent diabetes, who keep

blood sugar levels as close to normal as possible, can

reduce their risk of eye, kidney, and nerve diseases.



     Ask your doctor how you can improve blood sugar

control.  Questions you may want to ask include:



1.   What is my glycosylated hemoglobin (a test that

measures average blood sugar over the past two to three

months)?  What is a normal glycosylated hemoglobin?



2.   How can I get my glycosylated hemoglobin into the

normal range?



3.   How often, and under what conditions, should I test my

blood sugar?  What should I do with the results?  What

patterns should I try to achieve?



4.   What changes should we make in my program as a result

of the findings of the DCCT?



5.   Do I have microalbuminuria (tiny amounts of albumin in

urine, an indicator of early diabetic kidney disease)?



6.   What effect has diabetes already had on my eyes and

kidneys? 



7.   When should I get together with a dietitian to review

what I eat? 



8.   What exercises are best for me?  What adjustments to my

food or insulin should I make if I plan to exercise?



9.   What should my family and friends do if my blood sugar

goes so low that I need their help?



10.  (for women) What should I do about taking care of my

diabetes if I plan to get pregnant?



11.  How should I take care of my feet?  (Editor's Note: 

When you see your doctor, take off your shoes and socks

without being asked.  Not enough pysicians check diabetics'

feet.)



12.  Are there any diabetes groups I could attend in our

area?



     For an Information Kit, write:  National Diabetes

Outreach Program, One Diabetes Way, Bethesda, MD 20892-3600;

telephone:  1-800-438-5383.



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



Recipe Corner





Clip Art:  illustration of Fruit Basket



     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...    





Chayote Squash Salad (Salada de Chuchu)



from Dave Griffith

of London, Ontario, Canada





1 quart water

6 chayote squash, peeled and cored

3 cloves of garlic, crushed

1 large onion, thinly sliced

1/2 tsp. salt

1/2 tsp. freshly ground black pepper

6 tbsp. chopped Italian parsley

1/4 cup olive oil

5 tbsp. white vinegar (or even better, balsamic vinegar)



     Bring water to a boil and add squash.  Boil for 10

minutes.  Drain and slice squash.  Place in a salad bowl

with garlic, onion, salt, pepper, parsley, oil, and vinegar. 

Mix well and refrigerate before serving.



     Yield:  4 servings; Per 1 serving:  192 calories,

16.4gm carbohydrates, 2.7gm protein, 13.5gm total fat, 1.8gm

saturated fat, 10gm monosaturated fat, 1.1gm polyunsaturated

fat.





White Chili



from Dave Griffith

of London, Ontario, Canada





2 tsp. canola oil

1 lb. lean ground turkey

2 stalks celery, chopped

2 cloves garlic, minced

1 onion, chopped

1 tbsp. chopped jalapeno pepper

1 tsp. ground cumin

1 tsp. thyme

1/2 tsp. chili powder

1/2 tsp. salt

cayenne pepper to taste

1 bay leaf

2 cups cooked white kidney beans

1 cup chicken stock

1 cup diced raw potato

1 tbsp. lime juice

2 green onions, thinly sliced



     Heat oil over medium heat.  Cook turkey, celery, garlic

and onion.  Stir to break up meat and cook until meat is

done.  Stir in jalapeno pepper, cumin, thyme, chili powder,

salt, cayenne, and bay leaf.  Cook for 1 minute.  Add beans,

stock, and potato.  Bring to a boil.  Reduce heat and simmer

for 30 minutes.  Before serving, stir in lime juice and

remove bay leaf.  Garnish with green onions.



     Yield:  6 servings; Per 1 serving:  340 calories, 12gm

total fat, 3gm saturated fat, 64mg cholesterol, 27gm

protein, 32gm carbohydrate, 525mg sodium, 996mg potassium.





Lentil-Carrot-Corn Soup



from Omar Faruque

of New York, NY





1/3 cup dry lentils

1/4 cup fresh carrots (peeled and chopped to small cubes)

1/4 cup fresh corn

5 cups water

1/4 medium onion, chopped

1 clove garlic, finely chopped

1 tsp. fresh ginger, peeled and finely chopped

1 tbsp. vegetable oil

1 tsp. butter

1/4 tsp. (or less) turmeric powder (mixed in water)



     Wash the lentils, add 5 cups of water and a little

salt, bring to boil, reduce heat.  Remove the froth at the

top of the lentils with a spoon, then add the turmeric

water, then the oil.  Simmer for 30 minutes, then mix with a

hand mixer to dissolve the lentils.  Add carrots, corn,

onion, garlic, and ginger; simmer for another 20 minutes,

stirring occasionally.  Add the butter a few minutes before

completion.  Serve hot; use black pepper or other seasonings

to taste.



     Yield:  3 servings; per serving: 140 calories, 6gm

protein, 7gm fat, 14gm carbohydrate, 0.4gm fiber.





Lentil-Flour Pan Cake (Dal-Puri)



from Omar Faruque

of New York, NY





1/8 cup lentils

1 cup all-purpose flour

1/4 small onion, finely chopped

8 tsp. vegetable oil 

1/4 tsp. (or less) of ground spices including ginger and

garlic, mixed in a little water

1 cup water



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

cup of water; salt; bring to a boil.  Reduce heat, spoon off

the froth at the top, then add the spice water and the

onion.  Simmer uncovered for 1/2 hour or more; stir

occasionally; remove from heat when lentils are soft and

pasty.  Make a dough of the flour (lightly salted), and make

4 balls; then make a hole in each dough-ball and insert 1/4

of the lentil-paste in each.  Cover the hole so the

lentil-paste cannot come out again.  Roll it round with a

roller (generally 4 to 5 inches in        diameter); fry

both sides in a non-stick pan, using 2 tsp. of oil.  Use low

heat; periodically press down on the sides of the cake, to

counteract curling.  Serve lukewarm; relish with ketchup.



     Yield:  4 servings; Per Serving:  210 calories, 4.5gm

protein, 10gm fat, 25gm carbohydrate, 0.8gm fiber.



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



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



(Resource Column)



Clip Art:  illustration of hand reaching for book off of a

shelf



     Inclusion of materials in this publication is for

information only and does not imply endorsement by the

Diabetes Action Network of the NFB.





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



     If you are looking for a by-mail source for your

diabetes equipment and supplies, check out Medi-Mail, Inc. 

Because it is small, Medimail is able to offer a high level

of customer service.  They bill Medicare and secondary

insurance carriers, accept assignment, and stock

difficult-to-find items like Diascan test strips.  They also

carry diabetes literature and information, and all their

employees have received instruction from diabetes educators. 

For information, contact:  Medi-Mail, Inc., 1594 Northgate

Drive, Naples, FL 33942; telephone:  1-800-883-9146.





Computer Equipment



     Aicom Corporation of San Jose, CA, offers three models

of the Accent text-to-speech synthesizer, a device that

converts text on your computer screen to speech.  It has a

vocabulary of over 20,000 words. The models include a

full-length PC plug-in card for IBM-PC compatibles ($595), a

stand-alone unit with RS-232C link to any computer ($795),

or the Messenger-IC PCMCIA Type II ($995), as well as

others.  The Accent is supported by all major screen-reader

programs.  For further information contact:  Aicom

Corporation, 2381 Zanker Road, Suite 160, San Jose, CA

95131; telephone:  (408) 577-0370; fax:  (408) 577-0373.





Diabetes Educators



     The American Association of Diabetes Educators (AADE)

maintains a list of Certified Diabetes Educators in

different parts of the country.  To find a diabetes educator

near you, call:  1-800-832-6874.





Diabetes Supplies by Mail



     HHCS Pharmacy, a division of HHCS Health Group,

provides nationwide delivery of diabetes medications,

supplies, and equipment.  They offer monthly shipments,

refill service, patient/medication profiles, and 24 hour

consultation. They offer payment programs and direct billing

to third parties, and accept Medicare, Medicaid, and most

private insurance.  They include a free bottle of

multi-vitamins with each monthly order.



     For information, contact:  HHCS Pharmacy, Inc., 633

East Colonial Drive, Orlando, FL 32806; telephone: 

1-800-741-4427.





Diabetes Supplies



     Can-Am 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.





New Cookbook?



     The Diabetes Action Network might publish a cookbook. 

Would you be interested?  Tentatively, it would be quite

lengthy, would be published in large print, Braille, audio

cassette, and IBM computer disk.  It might cost as much as

$25.  All recipes would be "ready to go," with content/meal

plan information attached.



     Should we proceed?  What advice can you offer?  Which

format(s) would you want?  Drop us a note at the VOICE

office, 811 Cherry Street, Suite 309, Columbia, MO 65201;

telephone:  (573) 875-8911.





New Diabetes Books



     The American Diabetes Association has published two new

books.  "Reflections on Diabetes" is a 121-page motivational

collection of 39 real-life stories about coping with the

disease and its ramifications, drawn from the pages of

"Diabetes Forecast" magazine.  "Diabetes A to Z" is a

dictionary-style quick reference covering aspects of the

disease, terms and areas of interest. Many items are

discussed, from alcohol to blood glucose, to exercise, foot

care, high blood pressure, vegetarian diets, and your health

care team.  It covers a lot of territory in 195 pages.  The

books are priced at $9.95 each, and are available from: 

American Diabetes Association, 1660 Duke Street, Alexandria,

VA 22314; telephone:  1-800-232-6733.





NFB on the Internet



     The National Federation of the Blind has a homepage on

the World Wide Web.  At this website you can learn more

about our organization and its services, or review our

national publications.  From the homepage, you can also

access VOICE OF THE DIABETIC.



     To get to the NFB homepage, enter the following address

at the "URL" prompt:  http://www.nfb.org.  To reach the

VOICE from the NFB homepage, follow the link for "diabetes,"

and then the link for "VOICE OF THE DIABETIC." 





WINDOWS Screen Reader



     GW Micro has developed "WINDOW-EYES," a screen reader

for Microsoft WINDOWS.  Once equipped with a voice

synthesizer such as the Dectalk (your CD-ROM soundcard won't

do), any computer that can run WINDOWS can run WINDOW-EYES. 

The WINDOW-EYES program costs $495, and is available from: 

GW Micro, 310 Racquet Street, Fort Wayne, IN 46825;

telephone:  (219) 483-3625.





New 1995 Food Exchange List



     The new 1995 "Exchange Lists for Meal Planning" is now

available in Braille (74 pages) and on audio cassette.



     This update, the result of a joint effort of the

American Diabetes Association and the American Dietetic

Association, reflects the new emphasis on total carbohydrate

intake, rather than restricting specific sugar types.  Users

should find its new orientation simpler, and its meal plans

vastly more flexible.  In its new form, the Exchange List

will continue to play a pivotal role in dietary

self-management of diabetes.



     To purchase, make tax deductible checks payable to: 

National Federation of the Blind.  Cost:  Braille $10,

cassette $2.  Order from:  National Federation of the Blind,

Materials Center, 1800 Johnson Street, Baltimore, MD 21230;

telephone:  (410) 659-9314.





Greeting Cards



     The Iffin Group, a North Carolina-based graphic design

studio, has just released a series of greeting cards for the

blind and their families and friends.  Created by blind

artist Mickey Cabe, the cards, called "hAndrew," have both

visual and embossed elements.  The cards, which cover a

range of selections, have verses printed in both Braille and

ink.  More cards will be available in the near future.  For

information, contact:  The Iffin Group, PO Box 8847,

Asheville, NC 28814; telephone:  (704) 684-6176.



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



Food For Thought



Clip Art:  illustration of 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.





Oral Insulin Study



     Researchers at Joslin Diabetes Center are about to

commence a trial of oral insulin, not to control blood

glucose (orally-administered insulin can't), but to slow or

halt the autoimmune attack that produces type I diabetes. 

Part of the Diabetes Prevention Trial-Type I, this study

will attempt to build "oral tolerance" and thus decrease the

destruction of pancreatic islet cells by misguided

autoimmune attack.



     Participants, individuals who have not yet developed

type I diabetes but are considered at high risk, will be

divided into three groups.  One group will receive the oral

insulin pills, another will receive insulin injections, and

the third group will be given a placebo.  This will be a

"double-blind study," meaning neither participants nor their

physicians will know which group is receiving the placebo.



     The test will take three to five years.  For

information, or to find out about participating in this

research, contact: National DPT-1 Operations Coordinating

Center, PO Box 016960 (D-110), Miami, FL 33101; telephone: 

1-800-415-8361.





"Borderline" Diabetics



     In the past, many people with elevated blood glucose

were told they were "borderline diabetics."  Their numbers

were high, but not enough, in their doctors' judgement, to

justify insulin or oral diabetes medications.    



     Diabetes specialists do not use that term anymore. 

Taking into account the progressive nature of the condition

(the tendency of an impaired pancreas to worsen through

time), diabetologists recognize those once tagged

"borderline" as indeed diabetics, but in early stages of the

disease.



     It is hoped this change in terminology will inspire

those so described, for whom it is never too early to lose

weight, watch diet, and start an exercise program.





Talk to Your Computer



     While adaptive computers for the blind offer voice

output, speaking what would otherwise be presented on

screen, there are also computerized dictation-takers,

programs that allow your computer to carry out its functions

in response to voice input, your spoken command.  With these

programs, and hardware already standard in many computers

configured for Windows-95, you can enter dictation, send

e-mail, access databases, or perform computer operations, by

telling your computer to do it.



     Several firms offer such programs, but one that comes

highly recommended is DRAGON DICTATE, from Dragon Systems,

Inc.  Available in three sizes (small, medium, or large

vocabulary), the program makes use of Artificial

Intelligence (AI) to "learn" your speech patterns, and then

react to your commands as it would react to mouse or

keyboard.  For information contact:  Dragon Systems, Inc.,

320 Nevada Street, Newton, MA 02160; telephone:

1-800-825-5897; fax:  (617) 965-5200; E-mail: 

info@dragonsys.com, or on the World Wide Web at: 

http://www.dragonsys.com.





Can You Believe It?



     Is nothing sacred?  A recent study in the "Annals of

Emergency Medicine" found that doctors, nurses, and

emergency workers, so careful about antibiotics, antiseptics

and sterile procedures, were often spreading infection--with

dirty stethoscopes!  Study participants were asked how often

they cleaned their stethoscopes (7% of participants had

never cleaned them; only 48% cleaned them once a day), then

bacteria cultures were taken off the 'scopes.  One hundred

thirty-three (of 150) 'scopes grew Staphylococcus, making

the stethoscope "therefore a potential vector of infection."





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 172,000 VOICE readers could benefit

from your story.



     For information and article submission guidelines,

contact:  VOICE OF THE DIABETIC, 811 Cherry St., Suite 309,

Columbia, MO 65201; telephone:  (573) 875-8911.





Talking Merchandise



     We have been asked to announce:  "Speak To Me," a

merchandiser of useful, esoteric, and humorous items, all of

which feature synthesized speech, now offers their

Fall/Winter 1996 catalog.  Included are talking holiday

items, singing and talking greeting cards, children's items,

talking gags, and useful items like talking clocks, watches,

calculators, caller IDs, and even a talking bread machine. 

For a catalog, in print, cassette, or IBM computer disk,

contact:  Speak To Me!, 17913 108th Ave SE, Suite 155,

Renton, WA 98005; telephone:  1-800-248-9965.





New Braille Computer



     We have been asked to announce:  Blazie Engineering

announces the availability of the Braille Lite 40, a new,

lightweight, fully portable "personal data assistant" for

the blind and visually-impaired.  Weighing about two pounds,

with batteries, the Braille Lite 40 features a Braille

keyboard, voice output, and 40-cell refreshable Braille

display.  Both tactile and audio feedback are simultaneously

available.  Operation is similar to that of Blazie's

Braille'n Speak, but the new machine offers a host of

features, and is available in 14 different language

configurations.  For information contact:  Blazie

Engineering, 105 E. Jarretsville Road, Forest Hill, MD

21050; telephone:  410-893-9333.





For Sale



     Diascan SVM talking glucometer, $250 or best offer. 

Contact:  Mary Hurt, 624 Royer Court, Louisville, KY 40206;

telephone:  (502) 897-7420.





To Our Readers



     To hold down costs, both the VOICE and many of our

divisional mailings are sent via "bulk mail."  When we have

your current address, this works very well, but when we

don't, the Post Office throws it away, or returns it to us

with a hefty "postage due" attached.  They do NOT

automatically forward bulk mail!



     If you move, please let us know promptly.  If the VOICE

doesn't follow you to your new address, we may not have your

new address.  Don't miss a single issue.





Pedorthics Meeting



     We have been asked to announce:  The Pedorthic Footwear

Association, a non-profit group of individuals and companies

in the field of pedorthics (the fabricating and fitting of

therapeutic footwear) will hold its 38th annual symposium

and exposition November 14-17 in San Antonio, Texas.



     The theme of this year's meeting is "State-of-the-Art

Pedorthics:  Materials and Technology."  Symposium sessions

will explore gait-related changes, pathologies and

technologies, closed kinetic ambulation, computer and video

gait analysis, foot pressure measurements, physical

properties of footwear, and relevant resources on the

Internet.  In addition, there will be a 3-day exhibition of

pedorthic products and equipment, featuring goods available

from more than 60 major manufacturers.



     To register, or for further information, contact: 

Pedorthic Footwear Association, 9861 Broken Land Parkway,

Suite 255, Columbia, MD 21046-1151; telephone: 

1-800-673-8447.





Noninvasive A1c Test



     SpectRX, of Norcross, Georgia, working in conjunction

with scientists at the U.S. Department of Energy's research

facility at Oak Ridge, Tennessee, is developing a

noninvasive A1c test.  Not yet approved by the FDA, this

test will utilize a beam of light reflected from the retina. 

Changes in the character of the light reflect alterations in

the chemical make-up of the eye, many caused by glucose

level.  The new test should take less than a second. 

SpectRX hopes to have the new test available to physicians

sometime in 1997, pending FDA approval of the device.  Stay

tuned; the A1c test could get a lot easier!





For Sale



     Closed circuit TV/magnifier (1993 model), Telesensory

Chroma CCD, Excellent condition, price:  $1500 or best

offer.  Contact:  Tammy Cowley, D&H Machinery, Inc., 7247

West Central Avenue, Toledo, OH 43617; telephone:  (419)

841-3586.





Participants Needed



     The Miami Diabetes Research Institute is conducting a

study to test whether bone marrow infusions given with

pancreatic islet cells (both from the same donor) can

survive without traditional immunosuppressant medications. 

The biggest barrier to transplantation of healthy islet

cells into the pancreas of a diabetic has been rejection,

the immune system's destruction of foreign tissues. 

Successful islet transplantation would be a big step toward

a cure.



     To be eligible, you must be between 18 and 50, have had

insulin-dependent diabetes for more than five years, have

very poorly controlled diabetes, demonstrate therapeutic

failure despite state-of-the-art management, have been under

the care of an endocrinologist for at least six months prior

to the test, and meet other physical requirements.  For

information, call the Miami Diabetes Center; telephone: 

(305) 243-5557.





Infection and Hyperglycemia



     If you use insulin, and you "catch a cold," or

sinusitis, or bronchitis, or some other infection, that

infection is stressful, and can cause your blood sugar to

rise.  You'll see this when you monitor.  Hyperglycemia,

high blood sugar, promotes infection, and, if above 240

mg/dl, can interfere with your body's immune response,

making it still harder to get rid of that cold.  It won't

cure the common cold, but if on "sick days" you monitor

extra-carefully, and adjust your insulin accordingly,

increasing the dose if needed, it'll help you get well

faster.  Remember to talk to your doctor about insulin

adjustment.





Pamphlet in Spanish



     We have been asked to announce:  The Lighthouse, Inc.,

has published "La diabetes, la perdida de la vista y la

vejez," a Spanish-language version of its pamphlet

"Diabetes, Vision Loss, and Aging."  The pamphlet features

clear, illustrated descriptions of major visual

complications of diabetes, and a somewhat dated discussion

of adaptive equipment and where to find it.  It is good to

see an increase in Spanish-language diabetes information,

but the text could have been more up to date.              



     Single copies, in English or Spanish, are free;

multiple copies are $.50 each, and can be obtained from: 

The Lighthouse, Publications Department, 36-20 Northern

Blvd., Long Island City, NY 11101; telephone: 

1-800-334-5497.





Catalog for the Blind



     We have been asked to announce:  Easier Ways, Inc.,

offers their catalog of items for the blind. The catalog is

available free, in print, on 15/16 ips cassette, and

computer disk.  It is also available in Braille, for a $10

yearly subscription (three catalogs).



     Featured are tactile games, recorders and text readers,

adaptive household and kitchen products, and products for

personal care and security.  For more information, or to

receive their catalog, contact:  Easier Ways, Inc., 1049

Rock Hill Avenue, Baltimore, MD 21229-5134; telephone: 

(410) 644-4100.





Braille Books



     We have been asked to announce:  As part of its

"Century Series," the American Printing House for the Blind

now offers for private sale some of the same Braille titles

it produces for the National Library Service (NLS).  The

books are "over-runs" of NLS titles, and in all respects

identical to NLS circulating material.  The catalog runs the

gamut, from children's books to adult fiction, children's

and youth non-fiction, travel/access guides and motivational

books.  For information, contact:  American Printing House

for the Blind, PO Box 6085, Louisville, KY 40206-0085;

telephone:  1-800-572-0844.





Bible on Cassette



     We have been asked to announce:  The Aurora Ministries

Bible Alliance offers Bible tapes, without charge, to

persons who are legally blind or print handicapped. 

Forty-five different languages are currently offered, from

Amharic to Zande, and the service is without charge to

anyone who meets the criteria set up by the National Library

Service for the Blind and Physically Handicapped.  For

information, contact:  Aurora Ministries Bible Alliance, PO

Box 621, Bradenton, FL 34206; telephone:  (941) 748-3031.





No Blood Spots



     It happens.  You're out in public, at a restaurant

maybe, and its time to inject.  You stick the needle through

your shirt, and in goes the insulin, but when you pull the

needle out, you get a blood spot.  How do you keep from

ruining your clothes?



     There are a number of ways to deal with this.  The

simplest two are:  Inject through pants/slacks instead, or

pull your shirt aside and inject to skin.  You could put a

band-aid over the injection site in advance, then inject

right through the middle of the pad (it'll work), or you can

press down on the injection site as soon as you withdraw,

helping the blood to clot properly and not stain your shirt. 

           



     If you do stain your shirt, don't dispair.  Cold water

may wash it out, and hydrogen peroxide may shift the stain. 

A number of advanced commercial stain removers claim the

ability to remove bloodstains.



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



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.



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



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

133,000+, offers such an outlet.  Make your voice heard. 

For advertising information contact:  Voice of the Diabetic,

Ed Bryant, Editor, 811 Cherry Street, Suite 309, Columbia,

MO 65201-4892; phone:  (573) 875-8911



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



SUBSCRIPTION/DONATION FORM





     The VOICE OF THE DIABETIC is a free quarterly news

magazine published by the Diabetes Action Network of the

National Federation of the Blind (NFB) for anyone interested

in diabetes, especially diabetics who are blind or are

losing vision.  An outreach publication, it emphasizes good

diabetes control, proper diet, independence, and positive

outlook.



     Donations are gladly accepted and appreciated. 

Contributions are not only tax deductible; they are needed

to keep the VOICE and the Diabetes Action Network moving

forward; helping people with all aspects of diabetes.



     Members of the NFB Diabetes Action Network enjoy

priority services and unique benefits such as a continuous

free subscription to the VOICE, automatic access to

committees covering all aspects of diabetes, free counseling

concerning all facets of blindness and diabetes, as well as

access to diabetics who have experienced complications.



     The VOICE is free to any interested person upon

request.  Each subscription costs the Diabetes Action

Network approximately $20 per year.  To help defray

publication expenses, members are invited, and nonmembers

are encouraged, to cover the subscription cost.



     To begin receiving the VOICE, please check one:



[ ]  I would like to become a member of the NFB Diabetes

Action Network and receive the VOICE OF THE DIABETIC. 

(Members are entitled to special benefits.)



[ ]  I would like to receive the VOICE OF THE DIABETIC as a

nonmember.  (Nonmembers are encouraged to pay the

institutional rate of $20/one year; $35/two years; $50/three

years.)





Send the VOICE in (check one):



[ ] print      [ ] cassette tape for the blind          [ ]

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 11, Number 4, Fall

Edition 1996



