
                    VOICE OF THE DIABETIC



              A Support and Information Network



                   The Diabetics Division 

           of the National Federation of the Blind



            Volume 11, No. 2, Spring Edition 1996



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     The VOICE OF THE DIABETIC, published quarterly, is the

national newsmagazine of the Diabetics Division of the

National Federation of the Blind.  It is read by those

interested in all aspects of blindness and diabetes.  We show

diabetics that they have options regardless of the

ramifications they may have had.  We have a positive

philosophy and know that positive attitudes are contagious. 



     News items, change of address notices, and other

magazine correspondence should be sent to:  Ed Bryant, Editor,

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

MO 65201; telephone: (573) 875-8911.



     Copyright 1996 The Diabetics Division, National

Federation of the Blind.  ISSN 1041-8490



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                       NEW VOICE PHONE



     On January 8, 1996, the VOICE OF THE DIABETIC Editorial

Office got a new area code!  To call us, you will dial (573)

875-8911.  Our old (314) area code is being replaced.



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



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                      INSIDE THIS ISSUE



Dad

   by Annette M. Krupper, MLS



Talking Blood Glucose Monitoring Systems

   by Ed Bryant



Glucose Meter "Shell Game"

   by Daniel L. Lorber, M.D.



Ask the Doctor

   by Wesley W. Wilson, M.D.



Social Security and SSI Facts for 1996

   by James Gashel



Insulin Vials With Tactile Markings Discussed at FDA

Headquarters

   by Ed Bryant



A Look Back:  Diabetes Then and Now

   by Peter J. Nebergall, PhD



Noninvasive Glucometer Flunks Its Exam



In Sickness and in Health

   by Maile George Lipe



Dialogues About Diabetic Dynamos

   by Debra Frank, MS, MS



Volunteers Needed for Research Studies



Convention 1996:  We go to Anaheim

   by Kenneth Jernigan



Dialysis at National Convention



Dental Care for People With Diabetes

   by R. Keith Campbell, RPh, FASHP, FAPP, CDE



About the New Nutritional Guidelines

   by Davida F. Kruger, MSN, RN, C, CDE



Letters to the Editor



Recipe Corner



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

(Resource Column)



Food For Thought



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                             DAD



                 by Annette M. Krupper, MLS



[Photo: portrait.  Caption: Annette M. Krupper (photo by James

E. Toney)]



     My dad had diabetes for as long as I can remember.

Diabetes makes people change their lifestyles, but my dad made

managing diabetes a way of life.  As I look back on our times

together, it seems he made watching his diet and exercise so

"second nature," so much a part of his normal routine, that

sometimes we forgot his diabetes!



     A non-insulin-dependent diabetic, he was on the oral

medication diabinase, a sulfonylurea.  His medication

stimulated his pancreas to produce sufficient insulin.  But

there were other things he did. 



     I remember the diet his doctor gave him, with the

exchanges, posted on the refrigerator door.  Several times I

went on the diet with him, and while I was on the diet, I felt

better than ever before.  But I was not as diligent as he

was--after all, I wasn't a diabetic!



     My mom was cooperative in what she cooked, and Dad didn't

have to refuse many of her foods, but I do remember him

skipping mashed potatoes, and choosing Jello instead of cake. 

Mom would bake special apple or berry pies with sweetener

instead of sugar for him.  After a while, we all got used to

eating less sugar, and these were the only pies she baked!  We

appreciated what Dad chose to eat, and didn't link it with

"him being a diabetic."



     Exercise was not a regimented routine of sit-ups,

running, or jogging.  Dad was not one for formal exercise. 

Every summer there was the garden to hoe, and then the

tomatoes, peppers, cucumbers and zucchinis to plant.  During

the summer there was the weeding of the garden, the grass to

cut, and then the harvesting of vegetables.  We used to fight

over who would get the first ripe tomato!



     In the fall, there were the wild edible mushrooms, such

as sheepshead, and the little brown mushrooms to pick in the

moist dark woods around our house.  When winter came, there

was the driveway to shovel, wood to chop for the fireplace, or

coal to shovel into the coal bin for the furnace.



     In the spring, Dad would go out to pick wildflowers, or

raspberries and blackberries for my mom's sugar-free homemade

pies.  If he felt the need for further exercise, he would just

go for walks, exploring the woods and countryside around our

town's valley.  It was like a treasure hunt--we never knew

what he was going to find and bring home, from an old Spanish

coin found at the roadside, to an old medicine bottle from a

long-past medicine show.



     My father's example has shown me that diabetes is not

something that needs to control your life.  Once you accept

it, and work what you need to do into the fabric of your life,

you can learn to cope with it.  With creativity and

soul-searching, you can find ways to include exercise in your

daily routine.  I don't want to portray Dad as "perfect"--he

did occasionally stray from his diet, but he usually

compensated by eating less carbohydrates at the next meal.  He

was aware of the foods he ate, and what they could do to his

blood sugars, even though testing was done with urine and

test-tape, not a glucometer.



     I feel privileged to have had such a fine example of how

to take care of yourself with diabetes.  I am especially glad,

because two years ago I too was diagnosed with NIDDM.

Following in my father's footsteps, I am currently working on

my own enjoyable daily routine and good eating habits; like

Dad, making diabetes management a part of my life.



     From the Editor:  Ms. Krupper dedicates this article to

the memory of her father, the late Joseph J. Krupper, Sr., who

set a fine example of diabetes self-management.  How many of

us give thought to the examples WE set for our children and

grandchildren?



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          TALKING BLOOD GLUCOSE MONITORING SYSTEMS 



                        by Ed Bryant



[Photo #1: portrait.  Caption: Ed Bryant]



     As editor of VOICE OF THE DIABETIC, I am often asked

about the relative strengths and weaknesses of the various

glucometers with voice enunciation available today.  There is

no "best" talking glucometer; there is no one blood glucose

monitoring system ideal for everyone.  Features, prices,

convenience, and clarity of instructions vary, and new

equipment periodically appears.



     Although many companies make blood glucose monitors, and

some glucometers display their results in large print, only

three currently available meters allow voice enunciation, in

which the device's voice synthesizer "speaks" the glucometer's

instructions and test results.



     The meter most often adapted to voice enunciation is the

now-discontinued LifeScan One Touch II.  Although LifeScan,

Inc., of Milpitas, CA, the manufacturer, has ceased

production, thousands remain on dealer shelves, and it is a

proven and reliable piece of equipment.  The "voice boxes,"

small synthesizer modules that plug into the glucometer and

give it voice, are not made by LifeScan, but by several

competing firms, described below.



     LifeScan's new glucometer, the One Touch Profile, is a

refinement of the One Touch II, and the two meters have much

in common.  The Profile is slightly smaller, but its angled

display screen is more than twice as large, (though the extra

space is used to convey more information, not larger

numerals).



     Both meters use the same procedures, the same test

strips, and feature the same detachable test strip holder. 

Both meters are equally accurate, but the Profile, with its

vastly expanded memory, allows its user to store up to 250

test records with date and time, to record insulin types and

dosages with time and date, to insert "event markers" to help

track the impact of specific activities on blood glucose

levels, to compute test averages for the past 14 or 30 days,

and many other features.  To achieve these "bells and

whistles," it is electronically more complex than its

predecessor, so much so that voice synthesizers designed for

the One Touch II will not operate with the Profile.



     Although LifeScan once regularly supplied an

instructional cassette with the One Touch II (still available

upon request, from LifeScan:  1-800-227-8862), it makes no use

of tactile landmarks, and is of little utility to the blind. 

No cassette is offered with the Profile.  There is real need

for an adaptive instructional audiocassette designed for blind

users of the LifeScan Glucometers.



     Several manufacturers have been producing voice

synthesizer units for the One Touch II, and now offer updated

versions of their voice boxes, for use with the Profile.





Talking Glucometers and Voice Boxes



     1.)  The Voice-Touch speech synthesizers, for the

LifeScan One Touch II or LifeScan Profile:



     Technology For Independence, Inc. (TFI), 529 Main Street,

The Schrafft Center--Annex, Boston, MA 02129; telephone:

1-800-331-8255, or (617) 242-7007.



     TFI makes a pair of light, compact, convenient, and

reliable glucometer speech modules.  The two models are not

interchangeable.  The Voice-Touch modules clamp firmly to the

glucometer, adding little bulk, and forming a single reliable

unit.  There are no separate switches to remember; the modules

operate off the controls of the LifeScan glucometer.  A switch

allows the user to choose male or female voice enunciation. 

A Spanish-speaking Voice-Touch for the One Touch II is now

available; other languages are promised.



     TFI offers the Voice-Touch speech synthesizers for $189,

the LifeScan meters alone for $135, or the combination for

$324.  An optional AC adapter is offered for $12.  TFI says

their new instructional cassette, in production at press time,

will explain both voice box and Profile meter.  Their cassette

for the One Touch II's synthesizer clearly explains the speech

module, but does not describe operation of the LifeScan

glucometer.



     The LifeScan One Touch II meter and Voice-Touch speech

synthesizer are also offered by the National Federation of the

Blind (NFB), Materials Center, 1800 Johnson Street, Baltimore,

MD 21230; telephone: (410) 659-9314.  The NFB offers the

combination (meter plus voice module) for $309 (the lowest

price for a talking glucometer in the U.S.), the voice module

alone for $189, or the glucometer alone for $120.  An optional

AC adapter costs $11.



     2.)  The Digi-Voice modules:



     Science Products, Box 888, Southeastern, PA 19399;

telephone:  1-800-888-7400.



     Science Products makes several versions of their robust

and reliable Digi-Voice speech module.  The Digi-Voice Deluxe

functions with the LifeScan One Touch II, as does one version

of their smaller Mini Digi-Voice.  Another version of the Mini

Digi-Voice operates with the Profile.  Voice boxes designed

for the One Touch II will not operate with the Profile, and

vice versa!  The Digi-Voice modules connect to the glucometer

by a 22-inch patch cord, providing audio output for the meter.

Controls are simple; on the Deluxe a volume control knob and

a toggle switch run the voice synthesizer, separate from the

glucometer's controls.  The Mini's single button both turns on

the voice box and adjusts the volume control, again, separate

from the glucometer's controls.  Readings are announced in a

clear, somewhat military, male voice.  Clear and thorough

cassette instructions explain both voice box and Profile

glucometer [Science Products' instructional cassettes do not

cover operation of the One Touch II glucometer].  Science

Products sells the Digi-Voice Deluxe module alone for $275

($395 with glucometer), and the Mini Digi-Voice modules alone

for $199 (9-volt battery) or $219 (with ac adapter), or for

$319 and $339 respectively, with glucometer.



     3.)  The Touch-N-Talk voice synthesizer units:



     Lighthouse Consumer Products, 36-02 Northern Boulevard,

Long Island City, NY 11101-1614; telephone:  1-800-829-0500.



     The Touch-N-Talk II voice synthesizer operates with the

LifeScan One Touch II meter, and the Touch-N-Talk P voice box

works with the Lifescan Profile.  Again, the two units are NOT

interchangeable; voice boxes designed for the One Touch II

will not work with the Profile!  Meter and voice synthesizer

join by a 12-inch patch cord.  A brief instructional cassette

is included.  The unit uses one 9-volt alkaline battery, not

included.  An AC adapter is available at an additional cost of

$11.95.



     Perhaps in the interest of engineering simplicity, the

Touch-N-Talk units have simple on-off switches and traditional

volume controls.  These voice boxes lack any provision for

automatic shutoff, and if you forget to turn them off, you can

run down your battery.



     The Lighthouse sells the Touch-N-Talk voice synthesizers

for $219.95.  They sell the LifeScan meters for $149.95, or

the combination for $369.90.

     

     4.)  The LHS7 Module, a new voice box for the LifeScan

Profile: 



     LS&S Group, P.O. Box 673, Northbrook, IL 60065;

telephone: 1-800-468-4789.



     The small and light LHS7 attaches to the bottom of the

Profile glucometer by means of a velcro patch, and operates

through the glucometer's controls.  Two-position volume

control (loud-soft); AC adapter included in purchase price. 

English-language voice only; no audiocassette instructions are

provided.  Cost $199. 



     5.)  The Diascan Partner talking glucometer:  



     Home Diagnostics, Inc., 2300 NW 55th Court, Suite 110,

Ft. Lauderdale, FL 33309; telephone:  1-800-342-7226.

 

     The Diascan Partner is unique in that its voice

synthesizer is internal, part of the glucometer.  There is no

separate speech module to attach or cords to plug in.  This

slim, "user friendly" unit allows somewhat more leeway in

application of blood to test strip--with care, blood may be

"painted" onto the strip; all other speech assisted units

require a hanging drop of blood.  Powered by two AA batteries;

weight approximately eight ounces. 



     Some individuals with limited dexterity may find the

Partner difficult to operate, as its test strips are designed

to receive the blood outside the machine, on a flat surface

like a table, so there is no strip guide to aid correct finger

placement.  Others may appreciate this feature, as it allows

movement of strip to sample site, where others require

movement of sample site to glucometer.



     An over-the-shoulder tote bag with adjustable straps is

included.  An easy-to-understand audiocassette with clear

operating instructions is also supplied.  Suggested retail

price is $399. 



Medicare



     Medicare recognizes glucometers as "Durable Medical

Equipment," and coverage is provided, for insulin-using

diabetics, under Medicare Part B.  Glucometers without audio

output have one specification on the "Fee Schedule" (EO607),

and glucometers with voice synthesis, or add-on voice boxes

for home blood glucose monitors, have another (EO609).  Be

sure to follow all guidelines for reimbursement.



Hints and Tips



     If an insufficient amount of blood is placed on the test

strip, the glucometers will indicate "not enough blood."  You

may even have to prick your finger again!  There are several

possible explanations for this frustrating occurrence:



     A.   The initial drop of blood was too small:  Some folks

don't bleed enough.  They can get more blood by holding hands

below waist level for about 15 seconds, shaking them, and/or

washing/soaking hands in warm water for a few minutes before

the test.  Warm water stimulates the flow of blood to the

fingers.  A slightly longer lancet, with deeper penetration,

may help some.  "Milking the finger" (squeezing it gently) can

also help, as can wrapping a doubled rubber band between the

first and second joint of the finger to be lanced.  This will

help cause the finger to become engorged with blood.  Hold the

rubber band down with the thumb while lancing.  Remove the

band as soon as you lance.



     B.   There may have been enough blood, but it was placed

onto the wrong part of the test strip:  Some folks bleed fast,

and may lose the blood off the finger before they're ready. 

By the time they get finger to test strip, the blood has

fallen, in the wrong place.  A fast bleeder needs to work

closer to the test strip, and perhaps to employ one of the

blood placement aids discussed in this article.  Users of the

Diascan Partner should try bending up the tail of the test

strip as an aid to location and placement. 



     C.   Some enthusiastic people, placing the blood on the

strip, press down too hard and push the blood out of its

correct position, squishing it onto the wrong part of the

strip:  It is best to very gently deposit a hanging drop of

blood onto the test strip.  Marla Bernbaum, MD, writing in

"The ADEVIP Monitor," offered the following suggestion:

     

      "I have discovered another way to apply blood to the

LifeScan test strip, which has been useful for several of our

patients.  This method allows them to stick the tip rather

than the side of the finger.  We use the same platform

modification [described below], with a dot of Hi-Marks or

t-shirt paint on each side of the strip guide near the

depression where the blood is to be applied.  For this

approach the meter should be turned sideways.  The patient can

then place the pad of the finger on the raised dot

perpendicular to the length of the strip and rock the finger

forward so that the tip of the finger lines up with the

depression on the strip and deposits the blood droplet in the

appropriate place.  This method increases the portion of the

fingertip that can be used, and is preferable for some

patients, particularly for those who bleed slowly and

therefore must place the blood drop in precisely the right

location."



LifeScan Modifications



     If you use any of the LifeScan glucometers, some blood

placement problems can be solved by modification of the Test

Strip Holder (LifeScan Part #043-123, and note this same part

fits all LifeScan glucometers).  The idea is simply to provide

tactile locating aids for finger location and placement of the

blood sample on the test strip.  A raised dot on either side

of the test strip will work for some, but diabetics with

limited sensation in the fingertips may find a U-shaped guide

more useful.  Most diabetics puncture the side of a fingertip,

but those with severe neuropathy, who can't feel the lancet,

and who prick the center of the fingertip, may be helped by

the U-shaped guide.  With practice, and the use of such

tactile cues, blind diabetics can correctly place blood

samples on the test strip. 



     (Editor's Note:  Thanks to Ann S. Williams, MSN, RN, CDE,

of the Cleveland Sight Center in Ohio, for providing me with

the two modified LifeScan Test Strip Holders pictured in the

photograph.)



     The Test Strip Holder is detachable, and modifications as

described will in no way interfere with the operation,

accuracy, or cleaning of the LifeScan meter.  LifeScan's

Technical Services Dept. (phone: 1-800-227-8862) will provide

a spare Test Strip Holder upon request, without charge.  It is

recommended that the modifications be to this spare. 



     The dots and U-shaped ridge in the photograph were

created with t-shirt paint, of the type that stands up sharply

from a fabric surface.  Upon application, the paint spreads a

little, so apply sparingly.  Best results come from

"tack-painting," applying a small amount, then letting it dry

(minimum 12 hours), with subsequent applications to build up

the height.  Practice first on some other material

(posterboard or paper plate), as the paint can come out

quickly.  Be sure to have the Test Strip Holder OFF THE METER

when applying the t-shirt paint.  For best results, insert a

test strip in the holder as an aid to placement of the dots or

U-shaped ridge.  T-shirt paint is inexpensive and is available

at most craft and fabric stores.  Although a full spectrum of

colors is available, bright, contrasty colors like orange may

aid in low vision situations.  Brands and types vary; find one

that gives you a nice hard tactile ridge.  Some paints feel

too rubbery.  "Puffy paint" flakes off too easily.  You may

have to experiment.



     Several vendors offer commercial alternatives to

modifying the test strip holder.  One slips over the LifeScan

meter, and the other attaches directly to the test strip

holder.  Both aid proper finger placement, and serve to guide

the drop of blood more surely to the test strip.  Science

Products (address above, telephone:  1-800-888-7400), makes

the Sure Drop, which slips over the body of the meter.  The

special teflon-like coating on the surface of the device helps

direct the blood, but can be damaged by bleach or hard

brushing--clean with mild soap and warm water.  A Sure Drop

made for the One Touch II will not fit the Profile, and vice

versa.  The unit for the Profile appears well-made and easy to

use.  Both units are priced at $24.95 each. 



     Smart Dot, 2655 West Central Avenue, Toledo, OH 43606;

telephone: 1-800-984-1137.  The Smart Dot clips directly to

the test strip holder of ANY LifeScan meter.  The same device

fits Basic, One Touch II, and Profile.  This plastic platform

is easy to clean (both devices should be cleaned before the

blood dries) and convenient to use, but there have been cases

of it detaching from the meter in mid-test.



     Don Kramolis and Gary Allman, Manual Skills Specialists

at Blind Rehab Clinic, VAMC, Waco, Texas 76700; telephone: 

(817) 752-6581 ext. 7489, have developed the Waco-U-Finger

Guide, which, like the Smart Dot, fits any LifeScan Meter. 

Much like the t-shirt paint described above, the Waco Guide

helps finger orientation.  The guide's other features help

tactile strip insertion.  Its designers do not sell finished

guides, but offer plans and advice to interested individuals.



     I have discussed the strengths and weaknesses of the

blood glucose monitoring systems with voice enunciation

currently manufactured.  This evaluation should help blind

diabetics and those losing vision, who are just as capable as

the sighted of independently testing their blood glucose

levels, and performing all the other tasks of daily diabetes

self-management.  Both blind and sighted diabetics are

encouraged to consult with their health care team, and with

individuals experienced in use of glucose monitoring

equipment. 



     Choosing the most appropriate glucometer is an important

step in diabetes self-management.  As blind diabetics increase

their participation in the mainstream, efficient glycemic

control is needed, to maintain good quality of life.  The

Diabetics Division of the National Federation of the Blind, a

support and information network, welcomes input on blood

glucose testing.



     [NOTE:  Article included photos of glucometers, voice

synthesizers, and finger guides.  Photos by Peter Nebergall.]



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



                 GLUCOSE METER "SHELL GAME"



                  by Daniel L. Lorber, M.D.





     Dr. Lorber is Editor in Chief of "Practical Diabetology." 

The activities I describe in this editorial are completely

within the law.  Ethics are a different matter.



     John B., 70 years old, has insulin-requiring type II

diabetes.  He has been using the same blood glucose meter from

Company A for several years.  He is happy with it and we have

cross-checked its accuracy against results from our

laboratory.  Mr. B. recently replied to a mail order flyer

that promised:  "Medicare assignment accepted...  No out of

pocket expenses for your diabetes supplies."  Since John tests

his blood glucose 20 to 30 times a week, this offer was quite

attractive.  So he replied.

     

     The next offer was even better:  "Free meter...  We will

send you a brand new, state-of-the-art meter for free.  Just

sign a Medicare form."  This sounded even better.  John was

happy with his current blood glucose meter, but "free" was an

offer he couldn't refuse.  So he sent in the order and

received his new meter by return mail.  The new meter, made by

Company B, is also one we recommend to patients.  But, for

some patients, we prefer Company A's meter and, for others, we

prefer Company C's.  In John's case, the visual backup

provided by Company A's meter was an advantage we recommended. 

The meter from Company B was a good one, but it did not have

a visual backup.  Never mind, John was happy with his "free"

meter.  Imagine his consternation, then, when the Medicare

Explanation of Benefits (EOB) arrived from the meter sales

company.  Medicare had been charged $200 for a meter that

retails (before commonly offered discounts and rebates) for

$80.  As if that weren't bad enough, the finger-sticking

device that is included in the $80 meter kit was billed to

Medicare for an additional $25.  All of this was perfectly

legal.  Our blood glucose meter prescription form didn't say

"Dispense as Written" (it does now!) and the company was able

to substitute one meter for another.



     When John brought the EOB to our office, I couldn't

figure out why the company switched meters on him.  Both the

Company A and Company B meters could be sold for the same

exorbitant price; their wholesale prices were roughly

equivalent.  The answer was in the next shipment:  generic

reagent strips!  The sales company had substituted generic

reagent strips for the manufacturer's original strip.  Of

course, the bill to Medicare was the same high rate for both

generic and brand-name strips.



     The issue of generic reagent strips is in litigation as

I write this.  Even if I accept generics as equivalent, I want

the right to determine which my patient uses.  We are all

familiar with the issues concerning the prescription of

generic medications, but how many of us write prescriptions

for brand-specific reagent strips?



     Not only was Medicare legally ripped off for the cost of

the blood glucose meter, but John was switched to a different

meter and to generic reagent strips without his doctor's

knowledge.  As I read about the new Congress's plans to cut

Medicare further and my state's plans to cut Medicaid, I know

that they are talking about physician and hospital fees.  The

glucose meter suppliers have gotten away with our equivalent

of the Air Force's $45,000 toilet.  Medicare refuses to supply

state-of-the-art glucose monitoring for patients with

non-insulin-dependent diabetes who are treated with diet,

exercise, and oral agents.  And it harasses those who do use

insulin with endless paperwork.  For every insulin-treated

person who buys a blood glucose meter through this "shell

game," two people with diabetes who are not using insulin

could get a meter as well.  It's time to review our fiscally

foolish policies about "Durable Medical Equipment" supplies. 

Then maybe we'll be able to afford more intensive diabetes

care for all people with diabetes and really save money.



     (Note:  This article appeared in "Practical Diabetology,"

March 1995.  Reprinted with permission.)



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



                       ASK THE DOCTOR



                  by Wesley W. Wilson, M.D.





     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:  Many members of my family have diabetes and some are

experiencing severe complications.  Is it inevitable that I

will do the same?  (I'm 19.)



     A:  I suspect your family has type II diabetes, since

type II diabetes tends to be a very strongly inherited

disease.  Despite your family history and despite the fact

that there is a strong genetic factor in type II diabetes, I

cannot answer your question with certainty, but I hope I can

encourage you a bit.  Type II diabetes does tend to be

inherited, probably part of a cluster of abnormalities

inherited together, including a tendency to be overweight, and

resistance to insulin's action, so that even if insulin is

present, its action is blunted or impaired.  Frequently

included in this "package" is an abnormality of lipid

metabolism, bearing elevated cholesterol or triglyceride and

increased risk of circulatory problems.



     Your question pinpoints a puzzle for diabetes

researchers. Can type II diabetes be prevented or

significantly delayed?  We know that anything that improves

insulin action or insulin sensitivity can delay the onset of

clinical (diagnosable) diabetes.  Maintaining an ideal weight

is not easy, especially for a person who has inherited a

tendency to gain excessive weight, but maintaining an ideal

weight certainly can delay, and may in some cases prevent, the

onset of type II diabetes.  You can best approach this goal

with careful diet and active physical exercise, such as the

program developed by the American Diabetes Association.



     To deal with your question more directly, it is a good

idea for you to exercise regularly, maintain your ideal

weight, and work to avoid fats in your diet.  This last will

help control any tendency toward lipid abnormalities you may

have inherited.  Keep your cholesterol level down, and watch

your blood pressure; these will help too.  There is a test

underway, the Diabetes Prevention Trial Type II, and we must

await its results to learn what other measures may be helpful

for the prevention of type II diabetes. For now, the ones I

have listed make the most sense.



     If, despite your efforts to avoid it, you develop

diabetes, remember complications can be reduced, sometimes

avoided entirely, if you achieve and maintain good glycemic

control.  The Diabetes Control and Complications Trial (DCCT),

a major study of type I diabetics, proved that maintaining a

blood sugar as near normal as possible and a glycosylated

hemoglobin (A1C) value as near normal as possible avoids or

delays the onset of typical diabetes complications involving

the eyes, kidneys, and nerve conduction.  Although there were

no absolutes (some DCCT participants did develop

complications) the percentages were far better for those

participants who practiced tight control than for those who

did not.  It seems safe to assume that careful control of

blood sugar will reduce, delay, or prevent diabetic

complications for type II diabetics in the same manner.



     In summary, you may be able to prevent or delay the onset

of diabetes by our old tried and true methods:  weight

control, exercise, and careful attention to diet.  We now have

new and effective ways to improve diabetes control.  It can be

a lot of work, but if you are unfortunate enough to develop

type II diabetes, you can avoid, prevent, or delay its

complications by controlling your blood sugars, cholesterol,

blood pressure, weight, and exercise.



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



           SOCIAL SECURITY AND SSI FACTS FOR 1996



                       by James Gashel



[Photo: portrait.  Caption: James Gashel]





     (This article appeared in the January 1996 edition of the

"Braille Monitor," published by the National Federation of the

Blind.)



     From the Monitor Editor:  Jim Gashel serves as Director

of Governmental Affairs for the National Federation of the

Blind.  Here is his 1996 report on Social Security and

Supplemental Security Income:



     The beginning of each year brings with it annual

adjustments in Social Security programs.  The changes include

new tax rates, higher exempt earnings amounts, and

cost-of-living increases.  Each year we make an effort to

report on these changes in the January issue of the "Braille

Monitor."  This year is no exception.  However, the budget

controversy at the federal level has made it impossible this

year to include information on the annual adjustments in the

Medicare program.  For that reason the Medicare changes will

be reported later.  Meanwhile, here are the new facts which we

can report for 1996:



     FICA and Self-Employment Tax Rates:  The FICA tax rate

for employees and their employers remains at 7.65 percent. 

This rate includes payments to the Old Age, Survivors, and

Disability Insurance (OASDI) Trust Fund of 6.2 percent and an

additional 1.45 percent payment to the Hospital Insurance (HI)

Trust Fund, from which payments under Medicare are made. 

Self-employed persons continue to pay a Social Security tax of

15.3 percent.  The self-employment tax rate of 15.3 percent

includes 12.4 percent which is paid to the OASDI trust fund

and 2.9 percent which is paid to the HI trust fund.



     Ceiling on Earnings Subject to Tax:  During 1995 the

ceiling on taxable earnings for contributions to the OASDI

trust fund was $61,200.  The taxable income ceiling for

contributions to the OASDI trust fund during 1996 is $62,700. 

As was true in 1995, there is no ceiling on earnings that are

subject to the HI trust fund tax contribution of 1.45 percent

for employees or 2.9 percent for self-employed persons.



     Quarters of Coverage:  Eligibility for retirement,

survivors, and disability insurance benefits is based in large

part on the number of quarters of coverage earned by any 

individual during periods of work.  Anyone may earn up to four

quarters of coverage during a single year.  During 1995 a

Social Security quarter of coverage was credited for earnings

of $630 in any calendar quarter.  Anyone who earned $2,520 for

the year (regardless of when the earnings occurred during the

year) was given four quarters of coverage.  In 1996 a Social

Security quarter of coverage will be credited for earnings of

$640 during a calendar quarter.  Four quarters can be earned

with annual earnings of $2,560.



     Exempt Earnings:  The earnings exemption for blind people

receiving Social Security Disability Insurance (SSDI) benefits

is the same as the exempt amount for individuals age 65

through 69 who receive Social Security retirement benefits. 

The monthly exempt amount in 1995 was $940 of gross earned

income.  During 1996 the exempt amount is $960.  Technically,

this exemption is referred to as an amount of monthly gross

earnings which does not show "substantial gainful activity." 

Earnings of $960 or more per month before taxes for a blind

SSDI beneficiary in 1996 will show substantial gainful

activity after subtracting any unearned (or subsidy) income

and applying any deductions for impairment-related work

expenses.



     Social Security Benefit Amounts for 1996:  All Social

Security benefits (including retirement, survivors,

disability, and dependents' benefits) are increased by 2.6

percent beginning with the checks received in January, 1996. 

The exact dollar increase for any individual will depend upon

the amount being paid. 



     Standard SSI Benefit Increase:  Beginning January, 1996,

the federal payment amounts for SSI individuals and couples

are as follows:  individuals, $470 per month; couples, $705

per month. These amounts are increased from:  individuals,

$458 per month; couples, $687 per month.



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



            INSULIN VIALS WITH TACTILE MARKINGS 

                DISCUSSED AT FDA HEADQUARTERS



                        by Ed Bryant





     For almost five years, the Diabetics Division of the

National Federation of the Blind has been agitating, lobbying,

pressuring, and campaigning, making our voice heard about the

need for modification in insulin vial packaging, so blind

insulin-users could safely distinguish between insulin types. 

We are being heard; there are signs of real progress.



     Last October we met with the insulin manufacturers,

regulators from the Food and Drug Administration, and other

agencies and associations in the blindness and diabetes

fields.  At that meeting, held at FDA headquarters in

Rockville, Maryland, we achieved a measure of consensus about

the need for insulin vial reform.  Participants agreed on the

necessity for a long-term solution, and on the need for a

short-term "temporary" fix while the specifics of such

permanent solution are being worked out.



     Most of the October meeting was spent in informal

exchange of ideas about specific proposals.  Representatives

from the insulin manufacturers agreed to investigate the

feasibility of these proposals, and to report their findings

at a return meeting, to be held at FDA headquarters in three

months' time.



     Winter intervened, and the January 1996 meeting never

took place.  We were rescheduled for April, allowing the

manufacturers almost three more months to study proposals, and

giving us time to come up with a few more of them.



     Shortly before the April 10 meeting, I circulated a memo

(below) to all scheduled participants:  The National

Federation of the Blind, the American Association of Diabetes

Educators, the Institute for Safe Medication Practice, the

American Council of the Blind, the American Diabetes

Association, the Juvenile Diabetes Foundation, The West

Company, CCL Label, Inc., the Food and Drug Administration,

Novo Nordisk Pharmaceuticals Inc., and Eli Lilly and Co.



             * * * * * * * *



Diabetics Division

National Federation of the Blind

Columbia, MO 65201



March 22, 1996



TO:       FDA Meeting Participants

FROM:     Ed Bryant

          First Vice-President

SUBJECT:  April 10, 1996 meeting

RE:       Tactile Markings on Insulin Vials



     At our last meeting on October 19, 1995, we achieved

agreement on the need for nonvisual identification of insulin

vials, so that blind diabetics might safely and reliably

distinguish between their different insulin formulations and

avoid dangerous dosing errors.  A number of different ways to

achieve tactile insulin identification have been proposed. 

Some were covered at the meeting; others have surfaced since. 

The manufacturers were to study whether specific proposals

were technically achievable and financially reasonable.



     At the October meeting it was agreed to pursue a quick

"temporary" solution while researching a viable permanent

answer.  Major changes (and the required FDA "stability tests"

of those changes) might take years, and something was needed

in the interim.  Such solutions would mark the "R" or

"fast-acting" insulins.



*    Novo Nordisk has, in European distribution, a system of 

     marking the aluminum stopper ring on its vials of

     "Actrapid" (fast-acting insulin) with a raised dot.  This

     tactile landmark is not present on its other European

     insulin formulations, such as "Actraphane," and might

     furnish a minimal tactile solution to the problem at

     hand.  Manufacturers were to investigate the feasibility

     of switching the stoppers of American insulin vials to

     European standards, and, hopefully, the feasibility of

     making the raised dot bigger and easier to detect without

     interfering with the use of tactile insulin measuring

     devices such as Jordan Medical's Count-a-Dose.



*    Novo Nordisk also offered samples of insulin pens

     distinguished by a similar tactile dot.  As with the

     tactile dot on the European "fast-acting" insulin vial,

     the proposal was a good idea, but too small for reliable

     identification, if neuropathy is present.  Could the dot

     be enlarged?  Lilly, now also making insulin pens, was to

     also examine possible tactile pen markings.



*    The insulin manufacturers and the FDA discussed plans to

     standardize color-coding of insulin labels, and to make

     the identification letters:  "R," "L," "N," or "U," as

     large and contrasty as possible.  If the "R" were made

     sufficiently tactile as well, this would be an adequate

     temporary solution, as discussed above.  Manufacturers

     were to investigate the feasibility of placing raised

     embossed markings on the label (the letter "R" or various

     dot patterns), as well as the durability of such

     markings.



*    One proposal was to modify label size and shape, allowing

     an unglued flap to project free of the vial.  Done on

     vials of "R" insulin only, the result would be an easy

     and reliable landmark.



*    Another alternative brought up at the meeting was the

     application of a radial pattern of raised dots to the

     shoulder of the insulin vial.  Applied as part of the

     vial manufacturing process, such might be a practical

     short-term solution.



*    Several proposals for tactile markings have emerged since

     the October meeting.  The simplest of these involves

     attaching a thin circular band of embossed tape (like

     Dymotape) around the vial, either above or below the

     label (with the vial resting on its base).  This strip,

     attached as part of the labeling operation, would be

     embossed with appropriate tactile marks:  dots, a

     continuous line, dashes, or no markings.  Alternatively,

     the tape might be transparent, wider, and placed directly

     atop the label, with embossed symbols. Many items are

     Braille-labeled in exactly such manner.



*    Another proposal involves a slight modification in

     vial-making procedure--although no change in vial shape. 

     To manufacture vials, a long tube of hot glass is

     trimmed, like sausages, and then shaped appropriately. 

     To receive its flat bottom, the hot vial is pressed

     against an anvil.  This proposal would incise a tactile

     symbol on the anvil, so that its reverse would be printed

     on the bottom of each vial. 



*    On November 13, 1995, I forwarded the narrow tape, wide

     tape, and vial-anvil proposals to the insulin

     manufacturers and the FDA, for their consideration.



*    On November 17, I sent details and an illustration of

     another proposal to the FDA and insulin manufacturers.

     This one involved a 3 x 3mm downward-projecting tab--a

     flanged extension of the vial's aluminum stopper ring. 

     The resulting projection (on vials of "R" or fast-acting

     insulin) would be easily detectable, even by individuals

     with severe neuropathy.  Such a tab would not interfere

     with use of tactile insulin measurement devices, would

     not modify vial shape or label, and should require only

     one modification on the assembly line, replacement of

     rotary roll-crimping by a squeeze-clamping operation. 

     (The West Company, a new participant in these meetings,

     maker of aluminum stopper rings for Lilly, has already

     stated that the tab is not compatible with current

     crimping techniques.)



*    A more recent proposal is to use nylon "cable-ties."  One

     would go around the neck of the "R" insulin, like a dog

     collar.  These permanent ties would not alter vial shape,

     label, or access to adaptive insulin measurement

     devices--and the cable-ties are inexpensive.  There is

     little danger of the "dog-collar" coming off--it takes a

     razorblade to remove it.  The 4-inch size (smallest

     available at the corner hardware store) was 100%

     successful with European-pattern vials, but slightly too

     large to allow U.S. vials to use the Count-a-Dose device. 

     A smaller size cable tie should remedy this one

     objection.



     As I have stated earlier, a successful proposal must be

simple, reliable, durable, and universal.  "Simple" means it

must contain no more information than is necessary for insulin

identification and successful diabetes self-management. 

"Reliable" means unambiguous--different users should achieve

the same results.  "Durable" means the tactile cues must

survive for the life of the insulin in the vial.  And finally

"Universal" means that the system must be part of all insulin

vials, not merely an extra-price aftermarket option.  There

are as many as two million blind diabetics in the U.S., and if

they and the sighted are to benefit from a system such as we

describe, it must be standard for all insulin vials.

     

     We have taken major steps; we are part way to our goal. 

It is up to us, right here and right now, to go the distance. 

If we drop the ball now, everybody loses.



            * * * * * * * *



     In our next issue, Volume 11, No. 3, of VOICE OF THE

DIABETIC, we will review what took place at the April meeting.

Hopefully, there will be breakthroughs, and we can turn from

talking about a solution to implementation of a solution.  The

Diabetics Division of the National Federation of the Blind

will continue to lead the way, and the VOICE will continue to

keep you informed.



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



             A LOOK BACK:  DIABETES THEN AND NOW



                 by Peter J. Nebergall, PhD 

                      (Staff Reporter)



[Photo: portrait.  Caption: Peter Nebergall]



     Although the Bible states that the years of a man shall

be threescore and ten (70), average life expectancy in the

ancient world was less than 40.  Many died in infancy, or fell

in battle.  Diseases arising from poor sanitation, especially

in the cities, took others.  And then there was diabetes.



     In the superstitious tribal world where disease process

was not understood, and was frequently blamed on hostile

magic, a man who sickened and died without immediately obvious

cause was considered a spiritual battle casualty--victim of

the nearest hostile witch doctor.  Retaliation, not further

study, was the order of the day. 



     In most of the ancient world, the presence of

debilitating disease was considered evidence of spiritual

pollution.  Disease came from sin, and diseased persons were

to be shunned.  The Biblical treatment of "leprosy" is one

such example.  It is interesting to note that modern "Hansen's

Disease" (leprosy) is quite different from the ancient

scourge.  One wonders just what disease process the ancients

were observing.



     Individual physicians did record their observations.  We

have Egyptian documents (c 1500 BC) and Indian records (c 1000

BC).  Hindu physicians Susruta and Charaka even described type

I and type II diabetes, almost 3000 years ago!  But these

visionaries were battling the ethos of their time. 



     For all the Egyptian physicians' skill with wound care

and surgery, it was not until Classical Greece (550-300 BC)

that the study of disease broke free of the constraints of

religion.  Greek physicians interpreted disease as "imbalance"

rather than evidence of moral degeneracy.  Freed from value

judgement, they could study specific afflictions with clear

eyes.



     The great physicians' school at Kos, home of Hippocrates,

taught that a healthy lifestyle, consisting of proper diet and

plenty of exercise, was good therapy.  It still is!  Those

diabetics who consulted Hippocrates and his fellows doubtless

received some benefit.  In 100 BC, Greek physician Aretaeus

described the symptoms of diabetes in detail, and named the

condition, from the word dia-bainein "to pass out" or "pass

through."



     Hellenistic and Roman physicians drew on the work of

Greek masters, but, through time, the process of inquiry

dwindled.  Knowledge repeated too long without question

becomes dogma, not  science but an article of faith.  The

"dark ages" of medicine arrived even before the fall of Rome. 



     In Medieval times, as in so much of the ancient world,

the person with a disease was seen as a moral

degenerate--someone needing expiation, remission, absolution,

forgiveness--not someone whose body was simply malfunctioning. 

Since ill health was "evidence of moral imperfection,"

families took pains to conceal their chronically ill or

disabled members from public view.  The word "idiot" comes

from Greek otitic, meaning "something private."   When the

morality of the sufferer was automatically in question,

rational inquiry was not likely.  Not until the Renaissance

would the lot of the diabetic improve. 



     Tracking diabetes in the Middle Ages is like navigating

in a fog.  There are tantalizing hints that the Anglo-Saxon

Royal House of Wessex, the family of Alfred the Great,

Athelstan, Edgar, and Edmund Ironside, was diabetic.  All

these great leaders sickened in their early thirties, dying

shortly after. Chroniclers, who didn't recognize the cause,

did make it clear the condition was inherited, and that each

scion of the Royal family was watched closely as he approached

the vulnerable age. 



     The Renaissance brought renewed interest in medicine, and

a return to the search for rational explanation of disease

process.  Although early studies focused on pestilence

(plague, malaria, smallpox), understanding of diabetes

improved as well.



     In 1650, researcher Thomas Willis described the sweet

taste of urine in people with diabetes.  In 1750, a scientist

named Cullen added mellitus, Greek for "honey-sweet," to the

name of the condition, which now aptly described the urine: 

"passes through honey-sweet."  Not until the late 19th century

was the source of diabetes identified.  Paul Langerhans, who

described the islet cells of the pancreas in 1869,

misidentified them as lymph glands.  But in 1889 Von Mering

and Minkowski proved that removal of the pancreas in dogs

caused diabetes, and in 1901 Eugene Opie clearly linked

diabetes to the islet cells.



     In 1910, urinalysis for the measurement of blood glucose

was developed.  Diabetes could now be easily and reliably

diagnosed -- but nothing could be done for it.  The loss of

insulin action meant the same thing in 1915 as in 1015, an

early death.



     Real progress came with the identification of insulin

action.  In 1921 Banting and Best extracted insulin from the

pancreases of dogs, and almost immediately "animal source

insulin," what we now call "regular," or "short-acting," was

made available for the treatment of diabetes. 



     Early advertisements make it clear that the nature of

insulin was not widely understood.  In 1926, Metropolitan Life

reminded readers of the "National Geographic:"  "Occasionally

a patient, under insulin treatment, feels so much better that

he is tempted to abandon his diet and eat everything he wants. 

But when he does he is likely to suffer a relapse and die. 

Then insulin is blamed..."



     For years insulin-dependent diabetics tested their urine

(not blood), and used big, dull, "reusable" syringes to

administer their insulin.  Urinalysis was not the

still-familiar visual test strip, but a matter of putting

urine in a test tube, applying a chemical reagent, watching

the fizzing reaction, and making calculations based on both

test results and food intake, to come up with the insulin

dosage required for the next day.  The calculations:  Read

test percentage, multiply by volume to get grams, calculate

food intake (grams of carbohydrate x 1, of protein x 4, of fat

x 9), subtract that from total, divide by insulin units taken

= next day's dose, are probably beyond today's math competence

without a computer.  However difficult, life with diabetes in

the early days of insulin was vastly better than the

alternative!  In 1936, PZT insulin, a long-acting type, was

developed, and in 1938, the familiar NPH.  Now insulins could

be mixed.  The outlook for diabetics had improved so much that

a Metropolitan Life advertisement, dated May 1941, could

state: "The diabetic whose disease is discovered early; who

promptly puts himself under and stays under his physician's

guidance; and who masters the details of his treatment, stands

a good chance of living as long as he could reasonably expect

to live without diabetes."



     What a long way had we come.      



     1952 saw the introduction of intermediate-duration Lente

insulin, and 1956 saw the first of the sulfonylureas, oral

medications to lower glucose in type II diabetics.  Up through

the 1960s, however, urinalysis and reusable syringes were

still the rule.  When it took a week just to get the result of

a blood test back from the hospital pathology lab, "tight

control" was hardly possible. 



     In 1961 Becton Dickinson introduced the single-use

syringe, and in 1969 Ames Diagnostics introduced the first

portable, fairly instantaneous, blood glucose meter.  Ten

years later, glucometers for home use became standard.



     Innovations have come quick and fast.  Glucometers with

voice synthesis for the blind and visually impaired,

recombinant-DNA insulin, easier testing procedures, new oral

medications for better control of type II diabetes...and in

1993 the results of the Diabetes Control and Complications

Trial, the huge, Federally-funded study that proved the best

approach to diabetes management was to keep closely to the

blood sugar levels of the non-diabetic. 



     We look back, and the past looks "quaint" and "barbaric."

But non-invasive blood glucose testing is on the horizon.  Our

children will look at our ridiculous glucometers and horrid

little lancets, and laugh, glad that they live in a better

day. As we in our dotage tour the museum of medical

curiosities, gazing again on lancets and test strips, let us

remind our descendants that though the tools change, each

generation must do the best it can with the tools it has at

hand.





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



           NONINVASIVE GLUCOMETER FLUNKS ITS EXAM





     On February 26, Biocontrol Technologies, Inc. (BICO),

showed its Diasensor 1000 noninvasive blood glucose monitor to

examiners from the Food and Drug Administration, and they

turned thumbs down.  The panel decided that company tests had

not been sufficiently rigorous, and that test results from the

no-finger-stick machine were not statistically reliable.



     Frank Vinicor, president of the American Diabetes

Association, stated "many members of the audience were

perplexed that (Biocontrol's application) did get this far"

with such inadequate data.



     Richard Kahn, the ADA's chief scientific and medical

officer, who sat on the panel as a non-voting member, declared

he was "disappointed" by the company's lack of adequate data. 

"What they had was imperfect," he said.



     The version of the Diasensor examined by the FDA panel

requires individual calibration to a specific user, and if

that calibration is off, accuracy suffers.  Data presented by

the company in support of its application suggested that at

most perhaps one in four diabetics might use the machine, and

test data did not convince the panel that the machine was a

reliable substitute for traditional blood glucose monitoring.



     BICO was invited to improve their machine, perform more

rigorous testing, and resubmit for FDA approval.  In the 

meantime, many other companies are researching noninvasive

blood glucose testing, with Futrex (The Dream Beam) and Cygnus

(the Glucowatch) perhaps ready for FDA examination in the near

future. Change will be rapid.



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



     If you or a friend would like to remember the Diabetics

Division of the National Federation of the Blind in your will,

you can do so by employing the following language:



     "I give, devise, and bequeath unto the Diabetics Division

of the National Federation of the Blind, 1800 Johnson Street,

Baltimore, Maryland 21230, a District of Columbia nonprofit

corporation, the sum of $___________________" (or "___________

percent of my net estate" or "the following stocks and

bonds:___________") to be used for its worthy purposes on

behalf of blind persons."



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



                  IN SICKNESS AND IN HEALTH



                    by Maile George Lipe



[Photo: portrait.  Caption: Maile George Lipe]





     What I remember most about the onset of my diabetes was

my tremendous thirst.  One afternoon, when I was eleven, my

family and I were touring Golden Gate Park, in San Francisco. 

I walked a long distance to locate a drinking fountain.  When

I finally slurped voraciously from the thirst-quenching arc of

water, I wondered what was going on with my body.  My mother

noticed my unusual symptoms:  thirst, frequent urination, and

weight loss.  She made an appointment with my pediatrician.



     The doctor recognized my symptoms immediately.  After

confirming his suspicions with a urine glucose test, he

proclaimed that I had diabetes mellitus.  I was admitted to

the hospital on that sunny May afternoon, not realizing that

the diagnosis had changed my life forever.  I was told that

sugary candy, sugar-laden sodas, cookies and gooey cakes and

pies were all now off limits.  I would be dependent on

injected insulin, because my pancreas didn't produce the

hormone any longer.  Even though I did not have a huge sweet

tooth, this was alarming news for an eleven-year-old! 



     One day, while still in the hospital, I felt quite

peculiar.  My joints felt weak and shaky, my forehead was

sweaty, and I hungered for all the things I had just been told

I could never eat again.  The nurse came with a can of sweet

juice, which I drank quickly.  She explained that I had just

experienced an insulin reaction, that my blood sugar had

dropped too low.  I felt better within minutes.  This was the

first of many hypoglycemic episodes I was to encounter in my

life.



     Toward the end of my hospitalization, the staff

instructed me on administering my own injections.  I was shown

how to draw up the insulin into a syringe (no problem), then

how to inject it into an orange (also no problem).  When they

told me to plunge that needle into my own flesh, it became a

problem!  I did not master this aspect of my diabetes care

until much later, when my parents bribed me with a sleepover. 

I would not be allowed to go unless I could give my own shot. 

After sitting for what seemed like hours with the needle

poised above my tender thigh, I finally stuck myself.  Feeling

relieved and accomplished, I joined the others at the slumber

party.



     The first couple of years with the disease were a game to

me.  I felt special.  Instead of being embarrassed about

having to fiddle with my urine, I thought of it as a chemistry

experiment.  I even invited the neighbor children over, so

they too could witness the wizardry of the fizzing reagent

tablet and the yellow potion in the test tube.



     The holidays brought many temptations.  I do not recall

feeling particularly deprived, even though I couldn't eat the

candy canes, Christmas cookies, and foil-wrapped chocolate

coins.  One Easter, however, at my grandmother's home, all of

the other kids were going through their baskets filled with

chocolate eggs, marshmallow bunnies, and jelly beans.  In my

basket, I found the usual decorated hard boiled Easter eggs

and a set of "days of the week" underwear.  Those panties

lasted much longer than the candy my cousins received, but on

that Easter morning, I felt cheated.



     Like any teenager, I was constantly asking, "How normal

am I?"  My diabetes caused me to feel alienated, so I decided

to hide it as best I could.  I did, however, use it to get out

of certain undesirable activities, like swimming and oral

presentations, usually claiming a hypoglycemic reaction.



     I was not aware of the dreadful complications of the

disease; the things that could occur if the diet, insulin and

urine testing were not adhered to.  Often I would run the

bathroom tap, so my parents would think I was testing.  I

would deceive my parents by discarding unused syringes, and I

would sneak prohibited food.  One time I drove to three

different ice cream parlors and ordered double scoops at each. 

I thought I was invincible, and that the horrible side effects

some diabetics experienced would never touch me.



     I continued in denial of my disease in my college years. 

I told very few people of my condition.  Even those who knew

I had diabetes didn't understand it very well.  Some thought

I needed to drink orange juice all the time.  Others knew I

had a condition that necessitated injections, but still

encouraged me to eat, drink, and party with them.  I wanted

desperately to fit in, so I joined them.



     Later I discovered that by not taking my injections, I

could eat all I wanted and not gain weight.  Like many of my

sorority sisters, I had gained the "freshman ten," so this

seemed a perfect remedy.  I developed bulimia, a

life-threatening eating disorder, and it was now dangerously

out of control.  I managed to keep the weight off, but because

of my antics, my health deteriorated.  I was hospitalized

several times for hyperglycemia (high blood sugar) and

diabetic ketoacidosis.



     Somehow, even though I was exhausted most of the time, I

graduated from college.  I was still trying to minimize the

importance of managing my diabetes.  When I was in my early

twenties, the complications that were never supposed to happen

to me started happening to me.  I almost lost my lower legs

from diabetic leg ulcers and poor circulation.  I developed

nerve damage in my stomach, causing it to not empty properly. 

My hair lost its pigment, and grew in stripes--dark when I was

healthy and light when I was not.



     Finally I started losing my sight.  Numerous painful

laser treatments were administered.  These were supposed to

cauterize the abnormally-growing capillaries in my retinas. 

The retinopathy progressed, however, and surgery was finally

recommended.



     It took three surgeries to arrest the problem. 

Fortunately, one of my eyes still has limited vision.  I am

eternally grateful to the expert eye surgeon for that!  The

other eye is completely blind, the retinal damage now beyond

repair.



     Many of the debilitating complications might have

occurred even if I had taken care of my disease.  I will never

know.  Because diabetic management technology is constantly

improving, today I can test my blood sugars with a talking

glucometer, a method far more accurate than the old-fashioned

urine tests.  Now I take four injections a day, and I

administer them myself.  Though my figure is far from ideal,

I am not fat, and I do not obsess over food as I previously

did.  I only wish I could have coped with the disease more

effectively in my youth.  After having felt sick with guilt

and shame, I now know that confronting the disease, managing

it, and not hiding it are what it takes.  Today I feel healthy

and grateful to have survived my earlier neglect.



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



              DIALOGUES ABOUT DIABETIC DYNAMOS 



                   by Debra Frank, MS, MS



[Photo: portrait.  Caption: Debra Frank]



Being a Research Volunteer



     Over the past two decades many medical organizations and

pharmaceutical companies have been doing preventive and

corrective research on human volunteers.  One such study was

the Diabetes Control and Complication Trial (DCCT).  Its

findings affirmed the value of frequent monitoring and

multiple insulin injections, to stay as close as possible to

the "normal" blood glucose values of the non-diabetic.  As I

felt it was my responsibility, I volunteered for this study.



     I was randomized into the conventional regimen group, but

by my eighth year in the study I had become so knowledgeable

about my diabetes that I requested permission to change my

insulin format to one of "tight control."  I had learned.



     In the past few years there have been several research

studies testing the effects of various pharmaceutical agents

on Diabetic Kidney Disease.  I volunteered for one, but that

experience truly made me feel like a guinea pig rather than a

welcome and appreciated research volunteer.  One Monday

morning in July 1995, I entered the research center, delivered

my 24-hour urine sample, and completed a thorough physical

exam.  Three days later the nurse called me up at home and

said:  "We are surprised with the elevated levels of protein

in your urine, compared to all your other normal tests

results.  You might have qualified for the study.  We will

call you back in two months to reevaluate you."  CLICK!!



     No exact numbers, no accurate test results.  The woman

didn't even leave her name!  I was freaked out.  When, in a

calmer state of mind, I repeatedly tried to call the center,

they were too busy to return my calls.  A month later they

closed the study and left me hanging.



     After that ominous call, I immediately called my medical

team, and made an appointment ASAP.  With another 24-hour

urine in hand, and a resting heart rate of 140 (only kidding),

I went to my doctor, who scheduled me for a four-hour renal

test just to add reassurance to my other test results.  His

first comment to me was, "Look at your test results for the

past nine years from the DCCT and the past year.  You have

always been in the normal range.  Debra, did you exercise the

day you collected your 24-hour urine?"  My reply was, "Well,

yes, I taught three 40-minute water aerobic classes, but they

are not overly strenuous..." 



     Dr. Engle shook his head and laughed at me.  "You're an

exercise physiologist," he chided. "You know that when any

person exercises they break down protein.  That's why we

always remind you to not do any form of exercise for 24 hours

before you collect the urine.  This research doctor did not

remind you of this."  This made me feel really foolish, but

also emotionally toyed with.  My knowledge of human physiology

and the effects of exercise is vast, but little is known of

the direct acute and chronic effect of exercise on persons

with IDDM.  There were too many questions.  I fell prey to

ignorance from all sides.  The research center team, who could

have spared me this panic, ignored that aspect completely. 



     Volunteering for medical research studies that are not

overly demanding of my personal or professional time keeps me

on the cutting edge of diabetes treatments, and allows me to

have a stronger relationship with my medical family.  It also

brings us that much closer to a cure.  Give volunteering a

try!  The researchers need our participation, and the "bad

apple" I encountered does not spoil the barrel.



     Until a cure is found, I intend to stay as healthy as

possible so all my systems will be ready to 'go' when the cure

comes our way.



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



           VOLUNTEERS NEEDED FOR RESEARCH STUDIES





     Once new therapies and medications successfully pass

their animal laboratory tests, they must be tested on human

volunteers.  To be such a volunteer is to help change the

world as we know it--to participate in making our world a

better place.  Here are some opportunities to participate,

courtesy of the Diabetes Research Institute, in Hollywood,

Florida, part of the University of Miami School of Medicine.





Type I Diabetes Prevention Trial (DPT-1)       



     First and second-degree relatives of individuals with

type I diabetes are needed to participate in a study of

diabetes prevention in individuals considered at risk of

developing this disease.  The study requires volunteers age

three to 45 who have a first-degree relative (daughter, son,

parent, brother, or sister) and volunteers age three to 20 who

have a second-degree relative (cousin, nephew, niece, aunt,

uncle, or grandchild) with type I diabetes.  Participants

should not have diabetes, and should have no history of being

treated with insulin or oral diabetes medications or other

therapy for preventing type I diabetes.  They also should have

no serious diseases, and women planning a pregnancy in the

next six years are discouraged from participating in the

trial.



     Volunteers for this National Institutes of Health study

will receive free screening for islet cell antibodies (ICA)

and, if at risk, genetic, immunologic and metabolic testing. 

Those at high risk will take either insulin injections or will

be observed, for the next six years.  Those at moderate risk

will be given either an oral medication, or a placebo, for the

next five years.  During the treatment period, the study

provides physical exams, study-related medication, a blood

glucose meter, and strips, at no charge.  Participants will be

required to visit the clinical center every six months for

five to seven years.  For more information, please contact

Della Matheson, RN, CDE; telephone: (305) 547-3781.





Genetic Screening For Diabetes



     A genetic screening program associated with the Diabetes

Prevention Trial--Type I (DPT-1) is seeking family members of

individuals with type I diabetes, to participate in a study to

determine which genes are responsible for providing protection

from or susceptibility to type I diabetes.  Volunteers need

not be enrolled in the DPT-1 study.  However, all first-degree

relatives within a family are required to participate in this

genetic screening.  This study involves a one-time visit for

a blood test at no charge.  For more information, please call

Della Matheson, RN, CDE; telephone:  (305) 547-3781.





Type I Diabetes and Kidney Disease



     Volunteers, age 22-50 years, with type I diabetes are

needed to participate in a four-year clinical study evaluating

the study and efficacy of an investigational medication in

preserving renal function.  Participants must have protein in

their urine, onset of insulin dependent diabetes mellitus

(type I) prior to age 30, and duration of at least seven

years.  All medical exams and testing will be provided at no

charge.  Compensation per visit will be provided.  For more

information, call Robert Agramonte, RN; telephone:  (305)

547-6573.





Diabetic Foot Ulcer



     Volunteers age 18 or older, with type I or type II

diabetes and an infected foot ulcer, are needed for this

trial.  In this study, ulcers will be treated, for 14 to 28

days, either with an antibiotic taken by mouth, or an

investigational topical cream antibiotic.  Participants will

receive study-related medications, dressings, and wound care

at no charge.  For more information, please call Diana Graham,

RN; telephone:  (305) 547-6145.





70/30 Prefilled Syringe



     This study seeks volunteers age 40 to 70 with type II

diabetes, who have been on the maximum dose of pills for

diabetes, but who continue to have blood glucose values

greater than 200 mg/dl.  Participants will discontinue pills

and start taking either 70/30 insulin from a prefilled syringe

or NPH insulin by standard injection.  A blood glucose meter,

strips, and study-related medications and supplies will be

provided at no charge.  This is a 22-week study, and it will

require six clinic visits.  For information, please call

Aleida Saenz, RN; telephone:  (305) 547-6145.





Depression and Diabetes



     Volunteers age 30 to 70 with type II diabetes of one to

12 years duration, who also have depression, are being sought

for a study to evaluate the effect of treating depression with

an antidepressant over a three-month period.  Participants

must be treating their diabetes with pills, and may take one

insulin injection per day.  The study provides diabetes pills,

the antidepressant, and visits with a psychiatrist and a

dietitian, at no charge.  For information, please call Arlynn

Owens, RN; telephone:  (305) 547-6145.





New Oral Medication



     Volunteers age 30 and older, who have type II diabetes

and are treated with pills or diet alone, but not insulin, are

needed to test a drug recently approved for use in diabetes. 

Participants receive study medications, laboratory tests,

EKGs, and physical exams at no charge.  This study requires 11

clinic visits over a four-month period.  For information,

please call Diana Graham, RN; telephone:  (305) 547-6145.

                 



Extended Release Oral Medication



     This one-year study is designed to evaluate the effects

of three dose levels of an extended release oral medication on

blood glucose in persons with type II diabetes.  Candidates

must be over age 30 and not receiving treatment with insulin. 

Participants receive a blood glucose meter, strips, study

medications, laboratory tests, EKGs, and physical exams at no

charge.  There are approximately 14 clinic visits over the

year.  For information, call Arlynn Owens, RN; telephone:

(305) 547-6145.



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



             CONVENTION 1996:  WE GO TO ANAHEIM



                     by Kenneth Jernigan



[Photo: portrait.  Caption: Kenneth Jernigan]





     This article appeared in the December 1995 edition of the

"Braille Monitor," published by the National Federation of the

Blind.  Dr. Jernigan is President Emeritus of the Federation.



     The time has come to plan for the 1996 convention of the

National Federation of the Blind.  As Federationists know, our

recent National Conventions in Detroit and Chicago were

outstanding in every sense of the word--excellent programs,

good food and facilities, and wonderful hospitality.  But

Anaheim in '96 promises to be the best we have ever had.  The

last time we were in California was Los Angeles in 1976,

twenty years ago.  We now return to Southern California,

bigger and stronger than ever before in our history and ready

for a wonderful convention.  President Jim Willows and the

other leaders and members of the NFB of California tell me

that plans are going forward for a spectacular meeting.



     We are going to the Anaheim Hilton at 777 Convention Way

in Anaheim.  Those of you who attended the 1995 convention at

the Hilton and Towers in Chicago know how good a Hilton can

be, and the one in Anaheim is among the best.  A short

distance away from Disneyland, the Anaheim Hilton has all of

the elements required for a tremendous convention.





     Let's begin with the room rates:  one in a room, $45 per

night; two in a room, $47; three in a room, $54; and four in

a room, $57.  As you can see, these rates are slightly better

than we had last year in Chicago.  In addition to the room

rates, there will be a tax.  At the time Mrs. Jernigan and I

made the arrangements with the hotel, it was just under 15

percent.  There will be no charge for children in a room with

parents as long as no extra bed is required.  If you want to

come a few days early or stay a few days late, convention

rates will apply.



     As to the meeting facilities, there are two side-by-side

ballrooms (the Pacific Ballroom and the California Pavilion)

located on the ballroom level.  We will use one for our

general sessions and the other for exhibits.  This will give

us maximum efficiency and convenience.



     In recent years we have sometimes taken hotel

reservations through the National Office, but for the 1996

convention you should write directly to Anaheim Hilton, 777

Convention Way, Anaheim, California 92802-3497, Attention: 

Reservations; or call (714) 750-4321.  Hilton has a national

toll-free number, but do not (we emphasize NOT) use it. 

Reservations made through this national number will not be

valid.  They must be made directly with the Anaheim Hilton in

Anaheim.



     Here are the convention dates and schedule:  Saturday,

June 29--seminars for parents of blind children, blind job

seekers, and vendors and merchants; several other workshops

and meetings.  Sunday, June 30--convention registration, first

meeting of the Resolutions Committee, other committees, and

some of the divisions.  Monday, July 1--meeting of the Board

of Directors (open to all), division meetings, committee

meetings, continuing registration.  Tuesday, July 2--opening

general session, evening gala.  Wednesday, July 3--general

sessions, tours (you can bet that Disneyland will be on the

list).  Thursday, July 4--general sessions, banquet.  Friday,

July 5--general sessions, adjournment.



     There are two major airports one can use when flying into

the Anaheim area.  They are Los Angeles International Airport

and John Wayne Orange County Airport.  It may be easier to

find a flight into Los Angeles International, but John Wayne

is closer to the Anaheim Hilton.  Keep both of these airports

in mind when you make your travel arrangements.



     Remember that we need door prizes from state affiliates,

local chapters, and individuals.  Prizes should be relatively

small in size and large in value.  Cash is always popular.  In

any case, we ask that no prize have a value of less than $25. 

Drawings will be made steadily throughout the convention

sessions.  As usual the grand prize at the banquet will be

spectacular--worthy of the occasion and the host affiliate. 

The 1995 grand prize in Chicago was a thousand dollars in

cash.  The 1996 grand prize will be at least as good.  Don't

miss the fun!  You may bring door prizes with you or send them

ahead of time to Patsy and Bob Ramlo, 401 Livingston Avenue,

Placentia, California 92670-2420.



     The displays of new technology; the meetings of special

interest groups, committees, and divisions; the exciting

tours; the hospitality and renewed friendships; the solid

program items; and the exhilaration of being where the action

is and where the decisions are being made--all of these join

together to call the blind of the nation to the Anaheim Hilton

Hotel in California in July of 1996.  Come and be part of it

all.



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



       AT A GLANCE:  1996 CONVENTION DATES & SCHEDULE





Saturday, June 29 -- 

     seminars for parents of blind children, blind job

     seekers, vendors and merchants; several other workshops

     and meetings.



Sunday, June 30 --

     convention registration, first meeting of the Resolutions 

     Committee, other committees, and some of the divisions.



Monday, July 1 --

     meeting of the Board of Directors (open to all), division 

     meetings, committee meetings, continuing registration.



Tuesday, July 2 --

     opening general session, evening gala.



Wednesday, July 3 --

     general sessions, tours (you can bet that Disneyland will

     be on the list).



Thursday, July 4 --

     general sessions, banquet.



Friday, July 5 --

     general sessions, adjournment.



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



               DIALYSIS AT NATIONAL CONVENTION



                                  

     During this year's annual convention of the National

Federation of the Blind in Anaheim, California (Sunday, June

30 through Friday, July 5) dialysis will be available.

Individuals requiring dialysis must have a transient patient

packet and physician's statement filled out prior to

treatment.  Conventioneers should have their unit contact the

desired location in the Anaheim area for instructions.



     Be advised that the American Kidney Fund's Shearer

Program, which formerly paid or reimbursed the Medicare 20%

copayment for transient dialysis, has exhausted its funds, and

other arrangements will need to be made.  Individuals will be

responsible for, and must pay out of pocket, prior to each

treatment, the approximately $30 not covered by Medicare, plus

any additional physician's fees.

           

     DIALYSIS CENTERS SHOULD SET UP TRANSIENT DIALYSIS

LOCATIONS, AT LEAST THREE MONTHS IN ADVANCE.  THIS HELPS

ASSURE A LOCATION FOR ANYONE WANTING TO DIALYZE.  Anaheim is

the home of Disneyland, and in July, travel is very heavy.



     Here are some dialysis locations:                   



*    California Kidney Centers of Anaheim, 2051 East Cerritos

     Ave., Suite 8A, Anaheim, CA 92806; telephone:  (714)

     778-1530.  About 5 to 10 minutes from the convention

     hotel.



*    UCI Dialysis, 101 City Drive, Building 51, Orange, CA

     92668; telephone:  (714) 456-5555.  About 10 minutes from

     the hotel.



*    Garden Grove Artificial Kidney Center, 12555 Garden Grove 

     Blvd, Suite 100, Garden Grove, CA 92643; telephone:

     (714)741-7255.  About 10 minutes from the hotel; openings

     after 5:30 p.m. weekdays.



*    Westminster Artificial Kidney Center, 290 Hospital

     Circle, Westminster, CA 92683; telephone:  (714)

     895-3698.  About 15 minutes from the hotel.  Very new

     unit; open Monday, Wednesday, and Friday. 



     PLEASE REMEMBER TO SCHEDULE DIALYSIS TREATMENTS POSTHASTE

TO INSURE SPACE.  You will be expected to pay, at time of

service, the 20% Medicare copayment (about $30 for each

treatment), plus any non-covered physician's fees, and charges

for EPO or Calcijex.



     For transportation to and from dialysis centers, contact

the Orange County Transit Authority (OCTA), "ACCESS" Division;

telephone:  1-800-564-4232 or (714) 636-7433.  Their rides for

persons with disabilities cost $1.70 each way.  This service

requires application in writing WELL IN ADVANCE!  Approval

(not guaranteed) takes a minimum of 21 days.  There is also

MEDIVAN, a private van service specializing in medical

transportation; telephone:  (714) 974-8840.  It accepts

private insurance and MediCal, though only with prior

authorization.  Be aware that many insurance carriers do not

cover transportation services. Charges are $29.42 round-trip,

plus $1.08 per mile.  Contact them at least one week before

you need them. 



     If scheduling assistance is needed contact: Diabetics

Division First Vice-President Ed Bryant at (573) 875-8911. 

See you in Anaheim!



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



            DENTAL CARE FOR PEOPLE WITH DIABETES



         by R. Keith Campbell, RPh, FASHP, FAPP, CDE





     One often overlooked chronic complication of diabetes is

gum and tooth disease.  People with diabetes have at least

twice the incidence of cavities and gum problems as

non-diabetics.  There is a simple explanation for this:  If

your blood sugar is elevated, then saliva sugar is elevated as

well.  The increased sugar in the mouth is a perfect

environment for bacteria to grow and lay down that sticky film

known as plaque around the teeth.  The bacteria can also

attack gums, leading to increased infections, periodontal

disease and other significant dental problems.



     It is especially important for those of us with diabetes,

who have a higher risk of developing dental-related disorders,

to take daily aggressive action to prevent gum disease and

dental cavities, for they can lead to the eventual loss of

teeth.





Step One:  Manage Your Blood Sugar



     The first step in both treating and preventing these

problems is to keep blood sugar levels as close to normal as

possible, through diet, exercise, and medications.  You should

also do frequent self-monitoring of blood sugar, keeping track

of the results, so you and your doctor will know what

adjustments in your therapy may need to be made.





Step Two:  See Your Dentist Regularly



     You should see your dentist at least two to three times

each year.  Having a dental hygienist clean your teeth and

giving the dentist the opportunity to discover early any

dental or gum problems makes it much easier to correct these

problems.  As gum disease progresses, treatment becomes

increasingly more difficult.





Step Three:  Floss and Brush Frequently



     Everyone, but especially people with diabetes, should

floss if possible after each meal.  It is especially important

to floss before bedtime so that food doesn't remain between

your teeth waiting for plaque-creating bacteria.



     Along with flossing, frequent brushing of your teeth is

also extremely important.  People who brush frequently and

properly (have your hygienist give you a demonstration) have

fewer cavities and less gum disease.  It is a little-known

fact that those bacteria that create problems in your mouth

also remain in the bristles of your toothbrush.  Therefore, it

is very important that you get a new toothbrush every six

weeks; throw the old one away.  Many people think that not

only are flossing and brushing useful, but in addition the use

of mouthwashes--especially the anti-plaque kind--are part of

the steps to good oral hygiene.





Step Four:  Investigate New Dental Care Products



     Many new products are being developed to make dental care

easier and more effective.  Among these are battery-operated

toothbrushes with rotating bristles, and devices that provide

sonic vibrations to enhance your ability to prevent gum

disease and cavities.



     You should discuss with your dentist the use of some of

the following products.  Oralgenie:  I have personally found

this device to be very useful.  The rotating brushes not only

clean the teeth but also stimulate the gums to the tooth line

and provide a thorough cleaning.  I've heard from several

dentists who say they really notice a significant difference

when their diabetic patients use an Oralgenie-type of product. 

Other devices with rotating bristles that clean teeth and

stimulate gums include Inter Plak and Plaq-Trak.  Another new

product, Sonicare, has recently come onto the market.  It is

a complete dental hygiene system that sends out sonic

vibrations which supposedly improve cleaning ability.



     In summary:  Never forget the importance of good

preventive dental care.  Keep your blood sugars close to

normal, see your dentist regularly, and brush and floss on a

frequent and regular basis.  That's the way to keep smiling

with a full set of teeth!



     (Note:  Reprinted courtesy of "The Diabetic Reader."  For

a free copy of the Reader, call 1-800-735-7726.)



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



                        BOARD MEMBERS



     The Diabetics Division of the National Federation of the

Bind.



     President:  Tom Ley, 726 E. Belvedere, Baltimore, MD

     21212; telephone:  (410) 893-3777.



     First Vice-President:  Ed Bryant, 811 Cherry Street,

     Suite 309, Columbia, MO 65201; telephone:  (573)

     875-8911.



     Second Vice-President:  Janet Lee, 555-199th Ave. NE,

     Cedar, MN 55011; telephone:  (612) 872-0100.



     Treasurer:  John Yark, 218 Seaton Road, Apt. 2, Stamford,

     CT 06902; telephone:  (203) 324-7862.



     Secretary:  Sandie Addy, 2775 Indian Wells Drive,

     Prescott Valley, AZ 86314; telephone:  (602) 775-5912.



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



                    LETTERS TO THE EDITOR





January 18, 1996



     Please send along 10-20 copies per issue.  I have just

come across your paper for the first time and really enjoyed

reading it!  I am quite sure my patients with diabetes would

appreciate such a newsletter!



Sincerely,



Lisa J. Trevorron, RD

St. Joseph's Mercy of Macomb

Clinton Township, MI 



          * * * * * * * *



February 8, 1996



     I recently had the pleasure of reading your Winter

Edition of the VOICE OF THE DIABETIC.  As a health care

provider, diabetes educator and diabetic, I found your

newspaper most informative.  It would make a great addition to

our diabetes educational materials distributed to our diabetes

patients.



     Your box on page 18 of the Winter Edition stated that

multiple copies could be obtained free of charge for patient

distribution.  Would it be possible to send 25 copies each

quarter to be disseminated from our nutrition clinic?



     Thank you again for your assistance and for providing

such a great publication for persons with diabetes.



Sincerely yours,



Peter E. Schwager, RD, LD

Chief, Nutrition Care Division

United States Army Medical Department 

Redstone Arsenal,  AL



          * * * * * * * *



February 14, 1996



     First of all, I want to commend you for the excellence of

the VOICE OF THE DIABETIC.  I really enjoy the down to earth

discussions and articles of common concern to all diabetics.



     I note in your Winter Edition an item about a change in

Florida's law that mandates insurance companies to pay for all

[diabetic] supplies.  Currently, most companies (also Medicaid

and Medicare) pay for insulin, syringes and oral medications,

but not for the most costly item, glucose blood testing

strips.  I believe the strips are as vital to blood sugar

control as the meds.  The testing is the only method we as

diabetics have to assess the good or bad being done by our

medications, whether oral or injections.



     Since I am an "out-of-control" diabetic, I test my blood

sugars four to six times per day.  At a cost of 69 to 75 cents

per strip, monthly cost is $105-$125.  My current insurance

plan pays for a 90-day supply of meds for $7-$12.  I would be

pleased if I could even get a one-month supply of strips for

the $12.



     I have written to my insurance company, our state

legislature and even the U.S. Congress because normally, if a

supply is covered by Medicare, it is also covered by private

insurance.  This letter is written to encourage other

diabetics to write letters too.



     Thanks again for an excellent educational tabloid.



Sincerely,



Kathi Granum

Volga, SD



     From the Editor:  I agree with Ms. Granum.  This is a

good idea!  I suggest to all VOICE readers that you contact

your legislators, state and federal.



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



            ABOUT THE NEW NUTRITIONAL GUIDELINES



            by Davida F. Kruger, MSN, RN, C, CDE





     For years, the belief was that people with diabetes could

dangerously increase blood glucose levels by eating simple

carbohydrates (sugars, like fruit, honey, or table sugar). 

These were thought to be absorbed into the bloodstream faster

than complex carbohydrates (starches, like potatoes, rice, and

grains), possibly causing hyperglycemia.  Sophisticated new

research conducted at some 15 centers around the country led

the American Diabetes Association to review these theories. 

Last May, the Association announced revised dietary

recommendations for people with diabetes.



     Davida Kruger provides "The Monitor" with an overview of

these nutritional guidelines.  Ms. Kruger is Senior Vice

President of the American Diabetes Association, as well as a

Nurse Practitioner at the Henry Ford Hospital, Division of

Endocrinology and Metabolism, in Detroit, Michigan.





     Q:  Can you recap the ADA's new nutritional guidelines?



     A:  The research has proven that whether simple or

     complex, "a carbohydrate is a carbohydrate is a

     carbohydrate."  There's no longer a recommended "diabetes

     diet" that applies to everyone.  Now, the key is in

     individualizing the diet according to each individual's

     situation:  type of diabetes, overall health, weight and

     cholesterol levels, lifestyle, exercise habits, family

     history, likes and dislikes.  Based on this information,

     the dietitian can tailor an appropriate program that the

     person can adhere to comfortably.





     Q:  Does this mean greater "freedom of foods?"

     

     A:  Yes, we can actually include things like cookies and

     cakes and ice cream in a limited amount, which certainly

     makes the diet more acceptable.  But as in anyone's diet,

     it's in a limited quantity.  You need to maintain a

     balanced diet with quality nutrition.  This means making

     substitutions:  for every sugary indulgence you must give

     up an equal amount of other carbohydrates.





     Q:  Clearly this offers many opportunities for people

     with diabetes.  What about any challenges?



     A:  The biggest challenge is keeping up a healthy diet

     and not gaining weight.  We've kind of opened the

     floodgate.  For so long we've said, "absolutely no cakes,

     cookies, or candy."  Now we're saying that an occasional

     use of simple carbohydrates is acceptable, provided it

     doesn't increase your overall caloric intake. 

     Appropriate adjustments to diet, medications, and

     exercise must be made.





     Q:  Do you anticipate an "attitude adjustment" factor to

     the new guidelines?



     A.  Yes it will be hard for some people.  It's been

     drummed into our heads for years that this is not food

     you can eat.  Now we're saying those choices are okay, if

     they're taken in proper amounts and incorporated into the

     diet.  In fact, for many people, real sugar may actually

     be better than sugar-free foods.  Sugar-free foods can

     still be high in calories, fats, or other types of

     carbohydrates, which can increase glucose levels. People

     need to understand that, and make the switch.





     Q:  Can you foresee a whole new set of guidelines in

     another 20 years?



     A:  Who can say what will happen in 20 years?  There's

     always a possibility.  The ADA continues to fund quality

     research with high quality outcomes.  The research in the

     15 centers across the country clearly supported the need

     to change our nutritional guidelines.





     Q:  So these are the principal concepts:  Make

     substitutions, not additions; practice moderation; follow

     a healthy diet for your individual needs; and enjoy the

     new flexibility.



     A.  I like it!



     (Note:  This article appeared in "The Monitor,"

Vol.5/No.3, published by LifeScan, Inc.)



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



                        RECIPE CORNER



     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...





                  Mushroom and Barley Soup



                     from Dave Griffith

                 of London, Ontario, Canada



8 cups beef stock

1/2 cup barley

1 bay leaf

3 large carrots, chopped

1 celery stalk, chopped

1 large onion, chopped

1 potato, chopped

2 cloves of garlic, minced

1/4 tsp. dried thyme

1 1/2 cups chopped mushrooms

salt and freshly ground black pepper to taste



     Combine stock, barley, and bay leaf.  Bring to a boil.

Reduce heat, cover, and simmer for 1 hour.  Add carrots,

celery, onion, potato, garlic, and thyme.  Simmer, covered,

for 20 minutes.  Add mushrooms and simmer until tender. 

Season with salt and black pepper to taste.



     Yield:  8 servings; Per 1 serving:  110 calories, 0 grams

fat, 5 grams protein, 20 grams carbohydrates.





                     Three Bean Terrine



                     from Dave Griffith

                 of London, Ontario, Canada



1 1/2 cups romano beans, cooked

1 1/2 cups white beans, cooked

1 1/2 cups red kidney beans, cooked

1/2 cup crumbled feta cheese

1/4 cup shredded cheddar cheese  (use reduced fat type)

3 egg whites

1/4 cup light sour cream   (use nonfat sour cream)

1/2 packet frozen spinach leaves

2 tsp. lemon juice

1/4 tsp. salt

1/4 tsp. ground nutmeg

1/4 tsp. freshly ground black pepper

2 tbsp. chopped sun dried tomatoes

2 tbsp. millet

1 tbsp. chopped almonds

1 1/2 tsp. yeast extract (Marmite or Vegamite)

1 clove garlic

1/2 tsp. dried basil and chili powder

1/4 tsp. ground thyme



     Spray an 8" X 4" loaf pan with a nonstick coating and

line bottom with waxed paper.  Combine white beans, feta and

cheddar cheese, 1 egg white, and 1 tbsp. sour cream.  Puree in

food processor and transfer to a bowl.



     Drain liquid from spinach and add romano beans, lemon

juice, salt, nutmeg, pepper, 1 egg white, and 1 tbsp. sour

cream.  Puree in food processor and spread into lined loaf

pan.  Spread white bean mixture over top.



     Mix red kidney beans, tomatoes, millet, nuts, yeast

extract, garlic, basil, chili powder, thyme, 1 egg white, and

remaining sour cream.  Puree in food processor and spread on

top of white bean mix. 



     Bake at 350 degrees for 75 minutes in pan of water.  Cool

on a rack for 10 minutes.  Turn onto serving platter.



     Yield:  8 servings; Per 1 serving:  200 calories, 5 grams

total fat, 3 grams saturated fat, 19 mg cholesterol, 15 grams

protein, 30 grams carbohydrates, 225 mg sodium, 600 mg

potassium.





              Spring Asparagus and Fiddle Heads



                     from Dave Griffith

                 of London, Ontario, Canada



1/2 lb. asparagus

1/2 lb. fiddle heads (use asparagus if can't find fiddle

heads)

1/4 cup low-fat yogurt

1/2 tsp. honey

2 tbsp. orange juice

2 tbsp. lime juice

1/4 cup minced shallot or green onion

1 tbsp. chopped fresh coriander

salt and fresh ground black pepper to taste



     Bring skillet of water to a boil.  Add asparagus and

fiddle heads.  Boil for 3 minutes or until crisp and tender. 

Drain.  Beat honey, orange juice, lime juice, shallot, and

coriander into yogurt.  Season to taste.  Spoon over asparagus

and fiddle head mixture.  Yum!



     Yield:  4 servings; Per 1 serving:  45 calories, 4 grams

protein, 0 grams fat, 8 grams carbohydrates.





                      Meringue Dessert



                   from Mimi Moore, MS, RD

                       of Chicago, IL



1-1/2 cups Vanilla Wafer crumbs

1/4 stick margarine (2 Tbs), melted



Combine and place in 8 inch square pan:



4 egg whites

1 tsp. vanilla

1/2 cup granulated sugar

1 cup Cool Whip Dessert Topping



     Beat egg whites until soft peaks form.  Add vanilla

extract.  Add sugar, gradually.  Spread over crumb crust. 

Bake at 350 degrees for 20 minutes or less.  Cool.  Spread

with dessert topping.  Refrigerate and serve with sliced fresh

fruit.



     Yield: 12 servings; Per 1 serving:  120 calories, 30

grams carbohydrate, 2 grams protein, 4 grams fat.





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



                         COOKING TIP



     Here's a tip for boiling eggs.  If you do it this way,

they will peel easier, come out intact, and the yolk will be

in the center, so you can make good devilled eggs.



     Start with a pan of cold water.  Make sure it is big

enough to accommodate all the eggs without too much

crowding--that they have room to roll around.  Put the eggs on

the stove, cover, and bring to a full boil.  Then shut off

your burner.  Start your timer, or keep track of your time for

20 minutes, which is the time it should take for the boiling

water to grow cool again.  At that time, your eggs should be

boiled and tender. 



     If you want the yolks to be in the center, try this:

Uncover the pan five minutes after turning it off.  Stir the

eggs with a large spoon.  Replace the lid, and finish as

above.  It works!



     To have eggs that peel more easily, immerse them in cold

water upon completion.  Enjoy!



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



                  VOICE DISTRIBUTORS NEEDED



     Since the VOICE is now offered free, our Diabetics

Division will provide extra copies to anyone wanting to help

spread the word.  We will gladly send from five to five

hundred-plus copies each quarter to be used as free

literature.  Medical facilities can order as needed for

patients.  Individuals can usually place copies of the VOICE

in libraries, pharmacies, hospitals, doctors' offices, or

other public locations.



     Diabetes education is essential.  Anyone who distributes

the VOICE will be helping people with diabetes, and their

families, to learn about the disease and its ramifications; to

learn that they have options; and that their world is far

greater than whatever "limits" may be imposed by the disease. 

If you would like to help spread the word by distributing the

publication, please contact:  Voice of the Diabetic, 811

Cherry Street, Suite 309, Columbia, MO 65201; telephone: 

(573) 875-8911.



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



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



                      (RESOURCE COLUMN)



     Inclusion of materials in this publication is for

information only and does not imply endorsement by the

Diabetics Division of the NFB.





New 1995 Food Exchange List



     The new 1995 Exchange List 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 and

cassette $2.  Order from:  National Federation of the Blind,

Materials Center, 1800 Johnson Street, Baltimore, MD 21230;

telephone:  (410) 659-9314.





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.





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 Resource Guide

        

     The NFB Diabetics Division announces the updated

"Resource Guide to Aids and Appliances."  Once again, we have

compiled a list of companies and individuals who offer

products and/or information for diabetics, especially those

blind or losing vision, to help them self-manage their

diabetes.  The "Resource Guide" features six subject

categories:  General and Miscellaneous, Automatic Insulin

Injection Systems, Blood Glucose Monitoring Systems, Syringe

Magnifiers, Insulin Pumps, and Large Distributors of Diabetes

Equipment and/or Supplies.



     Blind diabetics can and do accurately draw up insulin,

monitor blood glucose, and perform the other tasks of

independent self-management.  By using alternative techniques

and products they can continue being independent, and can

control their diabetes as efficiently as do their sighted

peers.  Limitations are usually self-imposed -- often all that

is needed to overcome negative thinking is simply to know

where to go for information.



     The new "Resource Guide" costs $2 per copy and is

available in Braille (30 pages), Large Print (14 pages), and

audiocassette. Make checks payable to National Federation of

the Blind (Visa, Mastercard or Discover also accepted).  Order

from:  National Federation of the Blind, Materials Center,

1800 Johnson Street, Baltimore, MD 21230; telephone:  (410)

659-9314.





New Books



     (The following appeared in "Diabetes Dateline," June

1995) "Quick and Healthy Recipes and Ideas," by Brenda J.

Ponichtera, RD, offers 150 easy-to-prepare recipes for foods

low in fat, cholesterol, sodium, and calories.  The cookbook

includes grocery lists, menus, exchange lists, and tips about

weight control.  The book is available for $16.95, plus $2

shipping, from:  Brenda J. Ponichtera, RD, 1519 Hermits Way,

the Dalles, OR 97058; telephone:  (541) 296-5859.



     "Low-Calorie Sweets," by Charlet Snyder, includes more

than 100 recipes for dieters, diabetics, or anyone interested

in cutting down sugar and salt intake.  Recipes are sweetened

with fructose instead of sugar.  The nutritional information

for each recipe includes potassium, fiber, and sodium content. 

Priced at $10, the cookbook is available from:  Charlet

Snyder, P.O. Box 1421, Holland, MI 49422-1421.



     "Diabetes:  Your Complete Exercise Guide," by Neil F.

Gordon, MD, PhD, explains the value of exercise for diabetics. 

The book offers practical, easy-to-understand advice about the

different types of diabetes, treatment, and how exercise may

improve diabetes control.  It includes guidelines for exercise

and physical fitness programs, and introduces a health points

system to help people gauge their progress and keep motivated.

The guide includes information about blood glucose monitoring,

hyperglycemia, hypoglycemia, and the warning signs of possible

problems during exercise.  It is available for $11.95 from: 

Human Kinetics Publishers, P.O. Box 5076, Champaign, IL

61825-5076; telephone:  1-800-747-4457.



     The following books are available in bookstores, or from:

Chronimed Publishing, P.O. Box 59032, Minneapolis, MN

55459-9686; telephone:  1-800-848-2793.



     "Diabetes Made Easy," by Allison Nemanic, RN, Gretchen

Knauth, RD, and Marion Franz, RD, is available in English or

Spanish.  Written at the second-grade level, this booklet

discusses healthy eating, exercise, blood sugar testing,

insulin injections, preventing foot problems, and coping with

emotions. It is priced at $9.95. 



     "Beyond Alfalfa Sprouts & Cheese:  The Healthy Meatless

Cookbook," by Judy Gilliard and Joy Kirkpatrick, RD, features

125 meatless recipes for soups, salads, spreads, dips, main

dishes, and desserts.  The book offers cooking tips and

provides complete nutrition information and exchange values. 

It is priced at $12.95, with a $3 shipping fee for mail

orders.





National Odd Shoe Exchange



     The National Odd Shoe Exchange, begun in 1943, is a

nonprofit organization dedicated to helping people with

different sized feet, or with only one leg, to find shoes. 

Headquartered in Phoenix, Arizona, the Exchange charges a

one-time registration fee, then a yearly "membership" fee--but

for that investment, you get your shoes free.



     Children under 5 or seniors 75 and above pay nothing,

children 6 through 17 and seniors 62 through 74 pay a reduced

rate of $15 registration and $10 per year.  Adult members pay

$25 registration and $15 per year.



     The Exchange can also provide names and phone numbers of

an individual's "mismate"--someone who wears the other shoe

from your set.  "If the shoe fits, share it!"  For

information, contact:  National Odd Shoe Exchange, 7102 N.

35th Ave., Suite 2, Phoenix, AZ 85101; telephone:  (602)

841-6691; fax: (602) 841-3349.





New Talking Glucometer



     LS&S Group, Inc., announces a new voice synthesizer for

the LifeScan One Touch Profile glucometer.  This light,

compact unit attaches to the LifeScan Profile by a velcro

strip, and operates through the glucometer's controls, using

a 9-volt battery or AC adapter.  The clear male voice has two

volume settings, and can work into a headset.



     The unit is offered with the LifeScan Profile, for

$328.95, or separately, if you already have a Profile, for

$199.  The AC adapter is included without charge.  For

information, or to receive their free catalog of products for

the visually and hearing impaired, contact:  LS&S Group, Inc.,

P.O. Box 673, Northbrook, IL 60065; telephone: 1-800-468-4789.





Sugar Free Marketplace



     Not everything for sale at the Sugar Free Marketplace is

good for the diabetic diet.  They also sell cookbooks, books

about diabetes, and diabetic sox.  The edible products they

list, according to the catalog, are all made without refined

sugar, corn syrup, honey or molasses. 



     For more information about the many food products offered

by the Sugar Free Marketplace, or their non-food product

lines, or for a free copy of their catalog, contact:  Sugar

Free Marketplace, 6710 N. University Drive, Tamarac, FL 33321;

telephone:  1-800-726-6191.





For Sale



     Diascan Partner talking glucometer, $75 or best offer;

Lo-Dose Count-a-Dose tactile insulin measurement device, $20

or best offer; NEW Lo-Dose Count-a-Dose, $35.  Contact:  Kerry

Smith, 7232 Sarah, Apt. 4-3, Maplewood, MO 63143; telephone:

(314) 644-7733.





Rover Seeing Aid



     The Rover Seeing Aid is a new device for the blind.  A

hand-held sensor, it reads light and dark areas, facilitating

orientation, translating its findings into tactile feedback. 

With a few waves of the hand, The Rover provides a substantial

picture of the environment.



     The Rover Seeing Aid, priced at $99, comes with a

no-risk, 30-day home trial, and a one-year warranty.  For

information, contact:  The POSSIBILITIES Company, 2103

Burlington Street, Suite 600, Columbia, MO 65202; telephone: 

1-800-566-3333.





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 compatible ($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.



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



                      FOOD FOR THOUGHT



     We invite blurbs and tidbit articles for inclusion in

this column.  Materials received may be edited and used as

space permits.  Products and services included in this column

are for information only and do not imply endorsement by the

Diabetics Division of the NFB. 





Lyspro Insulin Passes Test



     On February 29, Eli Lilly and Company's new Humalog

insulin (generic name Lyspro) was unanimously recommended for

marketing clearance by an advisory panel of the U.S. Food and

Drug Administration.  This decision clears the way for final

governmental review, scheduled to take place as we go to

press. 



     The FDA advisory panel, cognizant that this insulin is

very different from past formulations, recommended that

Humalog initially be available only by prescription.  The

panel also asked Lilly to continue its ongoing studies, and

plan studies with other patient groups that might benefit from

Humalog.



     Humalog, a recombinant-DNA insulin characterized by very

rapid action, was engineered to more closely mimic the healthy

body's naturally occurring insulin.  It has already been

approved for sale in Switzerland, Russia, South Africa, and

Lithuania, and recommended for approval in the 15-member

European Union.





New Drug May Reduce Kidney Damage



     We have been asked to announce:  Researchers at Johns

Hopkins Medical Institutions have been performing animal

trials and limited tests with humans of aminoguanidine, a new

drug that appears to reduce or prevent kidney damage.  The

drug appears to prevent protein molecules from becoming

enlarged with a "sugar-coating" of excess glucose.  Such

enlarged molecules, one result of high blood glucose, can clog

blood vessels and eventually cause kidney failure, forcing

patients into dialysis or a transplantation to survive.  Blood

vessels in the eyes can become similarly clogged, leading to

retinal damage.



     A successful outcome to the tests of aminoguanidine could

mean much to the 16 million Americans with diabetes, of which

half a million already have kidney damage.





DVS Videos at Blockbuster



     We have been asked to announce:  Blockbuster Video, Inc.,

a large national chain of video rental outlets, has launched

a test project to see if they should regularly stock DVS

described video titles.  DVS videos are regular commercial

releases to which a descriptive narration track has been

added, allowing blind and visually-impaired people to follow

the action, while in no way impairing the film's original

elements.



     DVS videos have previously been available only from DVS

(for purchase) or on loan (through the National Library

Service for the Blind and Physically Handicapped).  To have

them on the shelf at the local video outlet represents a

significant expansion of availability.



     Ten Blockbuster Video stores, spread across the country,

are part of the test.  Each now offers 16 DVS titles, current

releases like Forrest Gump, The Lion King, Beauty and the

Beast, Father of the Bride, and Schindler's List.  The DVS

cassettes are offered at a reduced rental rate of $2.



     Blockbuster Video outlets participating in the test are

in: Charlotte, NC (704-521-8020), Morganton, NC

(704-437-1199), Austin, TX (512-477-3396 and 512-302-3434),

St. Louis, MO (314-535-5656), Denver, CO (303-691-9811 and

303-320-1290), Chicago, IL (312-880-5688), New York, NY

(212-686-0022), and Woodland Hills, CA (818-813-9990).  If

demand for DVS described video is judged sufficient at these

outlets, Blockbuster expects to expand its availability to

other locations. 



     For further information contact your local Blockbuster

Video store, or DVS, Descriptive Video Service, WGBH, 125

Western Avenue, Boston, MA 02134; telephone:  1-800-333-1203. 



Children's Book on Blindness



     Most blind children attend public schools.  There is very

little material on blindness written for their sighted peers,

who need to know how blind people function.  When presented

appropriately, children find Braille, white canes, talking

computers, and other adaptive equipment fascinating.



     The National Federation of the Blind of Idaho has created

a children's activities book about blind children.  Titled

"Julie and Brandon, Our Blind Friends," it includes samples of

Braille, puzzles using Braille, word games, a short story

about a blind child, pictures to color, a  great deal of

information about blind children, and more.  It can be used in

the classroom, or by other groups.



     Price of the book is $4 (plus $1.50 shipping--discounted

on bulk orders).  To order, contact:  National Federation of

the Blind of Idaho, 1301 S. Capitol Blvd., Suite C, Boise, ID

83706; telephone:  (208) 343-1377. 





3M Home Health Products



     We have been asked to announce:  3M Corporation, maker of

many bandages, dressings, and wound-care products routinely

used in hospitals, now offers many of the same items for home

use.  Skin closures, paper, cloth, or plastic bandage tape,

wound dressings, even masks and stethoscopes, are included. 

3M has established a Health Care Customer Hotline, to give

both doctors and patients access to technical/clinical

assistance and literature:  1-800-228-3957.



     For information about 3M's home health products, contact

3M, Health Care, 3M Center Building 275-4E-01, St. Paul, MN

55144-1000; telephone:  1-800-548-6972.





JOB Seminar and Breakfasts

                                                      

     The 1996 Job Opportunities for the Blind (JOB) National

Seminar will be held on Saturday, June 29, 1996, from 1 p.m.

to 4 p.m., at the Anaheim Hilton in Anaheim, California.  This

will be an exciting three hours of blind persons talking about

their jobs and how they got them.  Admission is free; come for

practical tips from those who know best because they've been

there.



     This year as before, recruiters from federal agencies and

private firms have plans to visit the seminar.  The JOB

Networking Breakfasts, held every morning of convention for

the past five years, will be offered again in 1996, providing

further opportunities.  All begin at 7 a.m. in "The Oasis,"

the main restaurant of the Anaheim Hilton, and are BYOB (buy

your own breakfast).  Some examples include:  the JOB

First-Timers' 

Breakfast (a chance to meet convention veterans and start the

process) on June 29 and 30; Blind Lawyers on June 30; Braille

Proofreaders and Transcriptionists on July 1; Artists and

Craftspersons on July 2; Blind Computer Access Teachers on

July 4, and more!   June 30 through July 4, there will also be

a "Generic Breakfast for Job Seekers," to help you get

started.  All of these will be crowded, so reservations are

recommended.



     Job Opportunities for the Blind (JOB) is a joint program

of the National Federation of the Blind and the U.S.

Department of Labor.  If you have any questions, or want to

make breakfast reservations, call JOB at 1-800-638-7518.



     Further information about the JOB seminars and the NFB

National Convention will appear in the "Braille Monitor,"

published by the National Federation of the Blind, 1800

Johnson Street, Baltimore, MD 21230; telephone:  (410)

659-9314.



                             

Brave Souls



     To prove their macho, Aztec warriors used to drink hot

chocolate without sugar!





Kicking the Soft Drink Habit



     (from the internet)  When one cola-drinker heard that his 

beverage was "good for cleaning rusty nails," he tried both

major brands.  They worked.  Since then, he reports, he has

used soft drinks to clean the terminals on the car battery, to

remove bugs from the windshield, to remove tar stains off the

car's chrome, and to remove grease from his hands after

changing a flat. "Every time I do that," he reports, "I lose

my appetite for the drink. If it can do all that, I wonder

what it does inside me?"





We Need One!



     Lots of people would like to send us a fax--but we don't

have a fax machine.  If anyone has one they could donate to

the VOICE office, it would really be a help.  Thanks in

advance!





It's Confidential!



     The names, addresses, and phone numbers of subscribers to

VOICE OF THE DIABETIC, and members of the Diabetics Division

of the National Federation of the Blind are confidential--we

don't give your name out.  Many organizations make money

selling lists of their customers/subscribers to others--which

is where all those catalogs you never asked for come from.  We

have never engaged in this practice, and never will.  We can

keep a secret.





Hear Ye, Hear Ye, A Raffle



     The Diabetics Division of the National Federation of the

Blind reaches out and provides support and information to

thousands of people.  Because it costs to operate this

valuable network and to produce the "VOICE OF THE DIABETIC,"

we must generate funds to help cover these expenses.  Our

Diabetics Division has elected to hold a raffle, which will be

coordinated by our treasurer, John Yark.



     THE GRAND PRIZE WILL BE $500!  The name of the winner

will be drawn on July 4, 1996, at the banquet held during the

annual convention of the National Federation of the Blind.



     Raffle tickets cost $1 each, or a book of six may be

purchased for $5.  Tickets may be purchased from state

representatives of our Diabetics Division or by contacting the

VOICE Editorial Office, 811 Cherry Street, Suite 309,

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

interested in selling tickets should also contact the VOICE

Editorial Office. Tickets are available now!  Names of persons

who sell 50 tickets or more will be announced in the VOICE. 



     Please make checks payable to the National Federation of

the Blind.  Money and sold raffle ticket stubs must be mailed

to the VOICE office no later than June 17, 1996, or they can

be personally delivered to Raffle Chairman John Yark, at this

year's NFB convention in Anaheim, California.  This raffle is

open to anyone, and the holder of the lucky raffle ticket need

not be present to win.  Each ticket sold is a donation,

helping keep our Diabetics Division moving forward.





Stop Smoking



     Cigarette smoking is statistically associated with

increased risk of developing neuropathy.  That means, if you

have diabetes and you smoke, you are making it more likely you

will develop this complication.  Your best advice is to STOP

SMOKING!  Nicotine is a "vasoconstrictor"--it shrinks

capillaries, reduces circulation efficiency, and raises blood

pressure, even in otherwise healthy individuals.  Going

"smoke-free" not only cuts your risk of vascular

complications, it also helps slow the progression of

neuropathy already underway.  So put it out.





Old Time Radio



     We have been asked to announce:  Radio Spirits, Inc.,

will send callers a free catalog listing thousands of Old Time

Radio programs available for sale on cassette. For information

contact: Radio Spirits, Inc., P.O. Box 2141, Schiller Park, IL

60176;  telephone:  1-800-729-4587.





Elections Coming Up

                                                        

     At this year's national convention in Anaheim,

California, elections will be held to fill divisional board

positions.  These are one-year terms, running from July 1,

1996 to June 30, 1997. Positions to be filled are:  President,

First Vice-President, Second Vice-President, Secretary, and

Treasurer.  If you are interested in a board position, or know

someone who you think would do a good job, then contact our

Diabetics Division President, Tom Ley.  Yes, hard work and

dedication are prerequisites for each board position. 

Anything worthwhile is usually challenging, and requires hard

work.  Leadership should be a positive force, and one must

lead by good example.





Plan Ahead and Be Prepared



     At this year's annual convention of the National

Federation of the Blind there will be many insulin-dependent

diabetics in attendance.  Each of us should have the foresight

to bring extra insulin and syringes so as to avoid needing to

search for a pharmacy.  



     At every convention, a few diabetics undergo avoidable

hypoglycemic attacks.  Hotels are jammed, and restaurants are

packed, with long waits for a table.  We diabetics should

always be prepared for an insulin reaction.  THINK AHEAD! 

Always carry something sweet, such as candy or glucose

tablets, that can be used for reactions.  We should be sure to

have, in our rooms, snack foods to help control our food

needs.



     We diabetics can travel anywhere and do almost anything

we

want, except go without food.  Our bloodstreams should have a 

balance of insulin and glucose. If there is not enough glucose

(food) then we have an insulin reaction.



     "Plan ahead and be prepared."        





Steroids and Diabetes



     Medications containing steroids can increase insulin

resistance.  In a person with a tendency toward type II

diabetes, steroid use may accelerate its onset.  Prednisone,

a frequently-used steroidal medication, can be tolerated by a

healthy pancreas, but its potential diabetic consequences may

be outweighed by the severity of the diseases it is used to

treat. Talk to your doctor.





Maine Legitimizes Insulin Adjustment by RN, CDEs 



     The Maine State Board of Nursing has determined that a

registered professional nurse who is a certified diabetes

educator may make insulin adjustments when a physician has

delegated this authority.  The Board's determination followed

a discussion about the common but unstated practice of insulin

adjustment by diabetes educators.

                                 

     VOICE OF THE DIABETIC applauds this acknowledgement of

reality, and hopes other states will take note and follow. 

Insulin adjustment is an important part of "tight control,"

the value of which was proved by the Diabetes Control and

Complications Trial.  No purpose is served by its further

administrative restriction. 





Display Tables



     For this year's annual convention of the NFB, our

Diabetics Division has reserved space in the exhibit hall,

where we will display literature and equipment of interest to

blind diabetics and others interested in diabetes.



     There will be hundreds of other display tables with

products and information that may be of interest to blind

persons.



     CAN YOU HELP?  It takes many people to work the display

tables, and if you can help for two hours, four hours, or

more, please contact our Display Table Committee Chairman: 

John Yark, 218 Seaton Road, Apt. 2, Stamford, CT 06902;

telephone: (203) 324-7862.





Phone Change!



     On January 8, a large part of Missouri, including

Columbia where our editorial office is located, received a new

area code.  You used to call (314) 875-8911 to reach us; now

you need to dial (573) 875-8911.  Please make a note of this

change, because, after July 8, if you use the "314" area code

to call us, the strange noise you hear in the receiver will

not be Editor Ed Bryant's voice!





Neuropathy and type II Diabetes



     A study recently published in the "New England Journal of

Medicine" explored the relationship between

non-insulin-dependent diabetes mellitus (NIDDM, type II

diabetes) and clinical neuropathy.  After 10 years, 20% of the

type II patients showed painful neuropathy, 30% showed

paresthesia (prickling sensation, "pins and needles"), and 44%

showed loss of Achilles tendon reflex.  Compared to a

non-diabetic "control group," nerve amplitude diminished

30-40% and nerve conduction velocity diminished 10% among the

NIDDM patients. 



     The study suggests that low insulin levels and higher

glycosylated hemoglobin (A1C) levels are associated with

worsening of neuropathy.  The researchers point out that

worsening neuropathy and higher mortality from cardiovascular

disease are strongly associated with poor glycemic control.



     Partanen J, Niskanen L, Lehntinen J, et al: "Natural

History of Peripheral Neuropathy in Patients With

Non-Insulin-Dependent Diabetes Mellitus."  "New England

Journal of Medicine" 1995; 333:89-94.





Fructose



     If an item is labelled:  "Contains no sugar--sweetened

with fructose," be careful!  Fructose, "fruit sugar," is as

much of a carbohydrate as is glucose.  It has calories, and it

WILL impact your blood glucose, because your body either

converts it to glucose or stores it in the liver (in

glycogen).  So if it says "fructose," its still sugar; you'd

better count it as part of your meal plan.



                     

Children's Books in Braille                              



     We have been asked to announce:  National Braille Press

announces its Children's Braille Book Club.  This service

offers print-Braille children's books, for the same price as

the print editions.  Much like "Book of the Month Club,"

membership is free, and a new title is offered each month. 

For information, contact:  National Braille Press, 88 St.

Stephen Street, Boston, MA 02115; telephone: 1-800-548-7323.





1996 NFB Diabetics Division Seminar

                                          

     The NFB Diabetics Division will hold our yearly business

meeting and seminar at this year's National Federation of the

Blind annual convention.



     This year's keynote speaker will address the subject of

peripheral neuropathy.  This meeting will take place on Monday

July 1, beginning at 6:30 p.m.  The conference location will

be in the agenda, available at the registration table.



     Plan, prepare, and be rewarded.  This year's convention

will be great!





Erythropoietin



     Erythropoietin (EPO), a drug routinely given to patients

on dialysis, is actually a hormone that occurs naturally in

healthy human kidneys.  It stimulates the production of red

blood cells.  If the kidneys are damaged (by diabetes or other

condition), natural EPO production diminishes, and anemia, low

red blood count, can result. To correct this anemia, restoring

a healthy blood count, the patient is given recombinant human

EPO.



     Therapeutic use of EPO helps correct anemia and reduces

blood transfusion requirements for patients experiencing

chronic renal failure or End Stage Renal Disease.





The Price of Diabetes



     Diabetes, which affects about 5 percent of the U.S.

population, accounted for almost 12 percent of total health

care expenditures in 1992, according to a study recently

published in the Journal of Clinical Endocrinology and

Metabolism.  Using data from the 1987 National Medical

Expenditure Survey database, a team headed by Dr. Robert J.

Rubins at Lewin-VHI, Inc. analyzed the full range of costs

associated with diabetes and its ramifications.  The team

determined that the direct medical costs of

physician-confirmed diabetes were $85 billion in 1992.

Indirect costs, such as disability, work loss, and premature

mortality, amounted to $47 billion in 1992, bringing total

estimated costs of diabetes in that year to $132 billion.



     Dr. Rubin's study estimated that in 1992, per capita

annual health expenditures for people with physician-confirmed

diabetes were four times greater than for people

without--$11,157 versus $2604.  Inpatient hospital care

accounted for 63% of the former figure, compared to 46% for

the latter. 





The A1c Test



     If you have diabetes, your daily blood-glucose tests are 

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

every two to three months.  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 two or three months.



     Where your glucometer 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.  The greater the average

amount of sugar in your blood, the higher the A1c results.



     If you test two to four times per day, each test is a

"snapshot."  Depending on your lifestyle and general health,

your glucose levels may fluctuate greatly at different times

of day. The A1c 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.





Caffeine and Hypoglycemia



     Diabetes, whether treated with insulin or oral

medications, carries the risk of hypoglycemic episodes, "low

blood sugar reactions."  Many veteran diabetics report a

lessening of their ability to recognize the onset of a

hypoglycemic reaction. Because this "hypoglycemia unawareness"

imperils their safety, researchers have been searching for

ways to lessen the danger.



     As reported in the journal "Lancet", Vol. 347, 1996, pp

19-24, caffeine, a common ingredient in coffee, tea, soft

drinks, and certain over the counter medications, in dietary

amounts (i.e., two to three cups of coffee), "could be

beneficial by helping to improve the ability of patients with

IDDM to detect the onset of hypoglycemia without adverse

effects on cognitive function."  So maybe what you need is a

nice hot cup of coffee..





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



                      WHAT'S COMING UP



     The next edition of the VOICE, Volume 11, No. 3, will

include information on hypoglycemia and how to deal with it,

a report on progress at our latest meeting with the FDA and

the insulin manufacturers regarding efforts to include tactile

cues on insulin vials.  Expect our regular columns and

features; as always, articles covering different aspects of

diabetes will be presented.



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



                         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

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



End of VOICE OF THE DIABETIC -- Volume 11, No. 2, Spring 1996