


                      VOICE OF THE DIABETIC



                A Support and Information Network



 The Diabetics Division of the National Federation of the Blind



              Volume 11, No. 3, Summer 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, Missouri 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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                           FREE! FREE!



  VOICE OF THE DIABETIC is offered absolutely free to any

interested person upon request. Readers may receive the

publication in standard print, on audio cassette for the blind,

or in both formats. To begin receiving the VOICE, please complete

the subscription form (or a facsimile), found at the end, and

mail it to the editorial office.



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                        INSIDE THIS ISSUE



Living With Diabetes

  by Jim Reed



Non-invasive Glucose Monitors......



Hypoglycemia -- And How To Deal With It

  by Ed Bryant



I've Gotten Attached To My Insulin Pump

  by Veronica Elsea



Spotlight: Lois Klug



Ask The Doctor

  by Wesley W. Wilson, MD



Tactile Coding Meeting At FDA Headquarters

  by Ed Bryant



Blindness Information



Medicare Facts For 1996

  by James Gashel



Recipe Corner



New LifeScan Glucometer



New Diabetes Research



Cardiovascular Health: Bypass May Be Better For Diabetics



My New Lifestyle

  by Frederick R. Claus



Diabetic Ketoacidosis



Dialogs About Diabetic Dynamos

  by Debra Frank



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

(Resource Column)



A New Approach To Heart Disease

  by Robin McRee



The Culture Of Misunderstanding

  by Peter J. Nebergall, PhD



Food For Thought



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                      Living With Diabetes



                           by Jim Reed



  I have been asked many questions about living with diabetes and

what the future holds; good questions, but very hard to answer.

You see, we never know about the future. We can only do the best

we can with what we have.



  Yes, diabetes sucks. It sucks big time! For me, I have had to

live with it and with its consequences for most of my life. I am

47 now and was diagnosed with IDDM at age 5 on 5 August 1954, 42

years ago. During that time I have been told I would likely die

before I was out of my teens, age 25, age 30, and....be blind,

deaf, impotent, a vegetable, etc., if I lived that long. I was

told to take more insulin, less insulin, different types of

insulin. I was told eat this diet, that diet, and every

combination and permutation of food you can dream of as the

absolute best diet for a diabetic. I was told not to play sports

--that the extreme physical exercise would kill me. In short, I

have heard just about everything I can imagine on the best and

worst ways to survive diabetes.



  And do you know what? They were all right and they were all

wrong! I could have died young. Heaven knows many people have

done so. Sports might have killed me, but I played at very high

levels and I am still here. All of these things could, and likely

did, affect me to some extent. At age 47, I do have several forms

of neuropathy affecting my feet and legs, my digestion and

potency. I do have some vision problems, some of which are

related to diabetes and some not. I have had several

opportunities to leave this earth but I didn't.



  More than once as a boy, I cried myself to sleep because of my

diabetes. Sometimes I get frustrated enough to still shed a tear

or two. I used to worry about the future and sometimes I still

worry. But over the years, I have learned a couple of things. One

is that what we know changes all time. Today is no predictor of

tomorrow. And what we know tomorrow will not be the same thing

that we know next year, or in ten years. Current blood glucose

testing will be surpassed by noninvasive testing in the near

future. I can remember burning my fingers on a test tube and

cursing that old method of testing! Cursing the reason I had to

do it! And praying for some better way to test. I can remember

getting injections with a big old syringe and crying with the

frustration of it all. Things change. That's the point. And who

knows, maybe in time you won't have to worry about diabetes

anymore. Maybe that day will come before you have to worry about

complications compromising how you want to live. Maybe it won't.



  You must learn as much as possible and follow those "new

methods" of diabetes care that make sense to you. Get yourself a

good medical team. Refuse to take a back seat in your diabetes

care. Refuse to be a victim. Support research toward better

treatment and a cure. And go out and live life to the fullest.

Live without regrets. If complications do come to you, do your

best to manage them and minimize their impact on your life.



  My life is different now than it was twenty, ten, and even five

years ago. I can't do some of the things I used to do in the

recent past or at least I can't do them with the same

proficiency. But those represent changes, not losses.



  Finally, share your thoughts and concerns about these things

with those who love you. They are a part of you and your life too

and deserve to be given the opportunity to help you. It is

amazing how much your outlook can improve when your are on the

verge of screaming or tears, and someone who loves you and whom

you love gives you a big hug to let you know you aren't alone. My

wife is an anchor at times and she keeps me from falling off the

face of the earth. There is no charge for the love and support

she gives me.



  Hang in there and live. Learn and do what needs to be done.



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                  Non-invasive Glucose Monitors



  The weakest link in traditional blood glucose monitoring is the

requirement to pierce a fingertip and draw a blood sample. More

than 40 companies are researching new non-invasive blood glucose

monitoring techniques that would dispense with the lancet. The

new technology will give diabetics an easy, painless way to check

and control their blood-sugar levels, helping them avoid or

minimize long-term organ damage.



  Several of the monitors under development use a beam of light

reflected through the skin to measure blood glucose levels. This

Near Infrared Spectroscopy (NIR), dubbed the "Dream Beam" by

Futrex, Inc., of Gaithersburg, Maryland, one company researching

the technology, can determine the chemical makeup of an object by

analyzing the signal changes in the wavelengths of light after it

has passed through that object. By measuring the glucose-

reflected signals, concentration of blood sugar levels can be

determined. However, glucose accounts for only 1/1000 of the mass

of blood, making it hard to measure the wavelengths absorbed by

glucose (also absorbed by other more sizable bodily components

such as water and fat). The trick is to focus on those specific

wavelengths that, although weakly absorbed by glucose, are even

less captured by surrounding tissue.



  Biocontrol Technology, Inc., based in Indiana, PA, was the

first to submit an application to the Food and Drug

Administration for approval. Their glucometer, the Diasensor

1000, uses NIR technology to measure glucose levels. In 1996, an

FDA advisory panel turned down the Diasensor, asking Biocontrol

to improve its accuracy and provide better documentation before

resubmission.



  The Diasensor 1000 needs to be calibrated to the specific

individual user. It cannot be used in a clinic or hospital

setting, and will need to be recalibrated periodically by

Biocontrol. And it's big. The Diasensor 1000 is an 11" x 18.5" x

11" machine, not particularly portable. Its expected price will

be between $6,000 and $8,000.



  Another non-invasive technology, being developed by the

University of California at San Francisco and Cygnus Therapeutic

Corporation in Redwood City, CA, does not employ light. This

monitor, the Glucowatch, measures sugar levels transdermally by

means of a process called reverse iontophoresis. Worn like a

wristwatch, this device uses a minute, steady electrical current

to extract glucose molecules from the body, which are then

continuously measured. It has two components: the electronics

(the Glucowatch) and the sensitized patch (the Glucopad). Cygnus,

the eventual manufacturer, envisions daily replacement of the

sensitized patch, to insure accuracy. Cygnus is currently in the

process of miniaturization. When the production version of the

Glucowatch (which the company would like to offer for about $400)

is ready, there will be more tests.



  Solid-State Farms, from Reno, Nevada, is working on a portable

non-invasive meter, the size of a pocket calculator, that will

measure glucose levels with high-frequency electromagnetism.

Their technology is based on the observation that different ionic

solutes respond to alternating electromagnetic fields in

predictable ways. These "normal" responses are impeded by the

presence of molecules of substances such as glucose. The device

uses the behavior of blood sodium as a referent, and, as

variations in blood glucose modulate the resonance of blood

sodium in known amounts, measurement of that modulation should

yield percentage of blood glucose. The company, which claims a

high degree of accuracy for its process, is continuing its

research; clinical testing on humans has not yet commenced. The

home blood glucose testing market is today worth well over 1.5

billion dollars, and many companies are looking at possible

entries. The field is constantly changing, as new participants

and technologies appear, and some established players discontinue

their efforts. No one knows who will be first!



  When non-invasive monitors hit the market, they may cost

several thousand dollars, though the price is expected to drop

with time. The higher price of the non-invasive glucometers will

be at least partly mitigated by an end to the need for expensive

test strips. A diabetic using a traditional glucometer, testing

four times a day, can easily spend $1000 per year in test strips

alone.



  The Centers for Disease Control estimates each year 15,000 to

39,000 people become blind from diabetes. Just as there are a

number of conventional glucometers for which voice synthesis is

available, once a non-invasive monitor is approved by the FDA,

company representatives say that voice synthesizers may become an

accessory.



  Meter accuracy, accessibility, and affordability still need to

be worked out. FDA approval will come when a manufacturer

demonstrates its product is reliable and accurate. Demand for the

new meters will be high. Companies involved in the research are

aware of the immense profit to be gained by the first to come out

with a non-invasive monitor. However, until affordability can be

guaranteed, the non-invasive monitors won't benefit anyone--

consumers or manufacturers.



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             Hypoglycemia -- And How To Deal With It



                          by Ed Bryant



[Photo: portrait; Caption: Ed Bryant]



  A "hypoglycemic reaction," also called an insulin reaction,

insulin shock, or low blood sugar reaction, occurs when blood

glucose drops to a point where the individual becomes confused

and disoriented. By definition, hypoglycemia is "low blood

glucose" (described by many health professionals as any blood

glucose level below 60mg/dl), and it can affect both insulin-

dependent and non-insulin-dependent diabetics, though type Is are

more at risk.



  To maintain good health, a person with diabetes must control

both extremes; monitoring blood sugar levels and adjusting diet,

exercise, oral medications and insulin, to keep those numbers in

the normal range. It is not always easy, and sometimes, working

hard to keep our sugars down, we dip too low.



  Prevention is the best way to treat a low blood sugar reaction.

Though the personal "threshold" varies, and some folks can

function at levels that would have others disoriented or

unconscious, if your sugars stay up around 80 to 120mg/dl, a

hypoglycemic reaction won't happen. (Although there is some

argument over exactly what is an appropriate "normal" for a

diabetic in good control, the point is to provide yourself a

healthy range, while ensuring a margin of safety against "hypos."

"Tight control" doesn't mean continuously staying below normal

range.



  Don't just wait for symptoms of a "low" to clue you in; all

that shakiness, sweatiness, and confusion; too often a reaction

comes on without much warning. Frequent blood glucose monitoring

is the best way to warn yourself of impending hypoglycemia. By

observing patterns of low blood sugar, by learning how much your

body needs, you can make the changes necessary to prevent a

reaction. Although some diabetics can function perfectly well

with their blood glucose in the low 60s, meters are imperfect--

there is a 10% "fudge factor" either way, and an indicated "60"

may in fact be closer to a very unsafe "54." To be safe, keep

your sugars in the normal range!



  Although every effort should be made to prevent hypoglycemia,

almost every diabetic, especially those who use insulin, will

occasionally experience a reaction. Common causes include

straying from the prescribed diet, taking too much insulin or

oral medication, not eating the proper amount at the proper time,

or doing vigorous exercise. Sometimes a "low" comes on for no

apparent reason at all. Alcohol and certain drugs (certain

sedatives, sleeping pills, and the "beta blockers") can also

lower blood sugar and bring on a reaction. Individuals practicing

strict "tight control," holding to a low blood glucose level,

increase their risk of hypoglycemic episodes. Although the long-

term benefits of tight blood glucose control are great, some

individuals may need to relax the numbers a bit, trading higher

glucometer readings for an increased margin of safety. THE GOAL

SHOULD BE TO USE THE TIGHTEST CONTROL THAT IS RIGHT FOR YOU.



  Symptoms vary between people; learn what yours are when you

"get low." Studies suggest a diabetic's awareness of his or her

hypoglycemia is a learned response, is taught, and can be

improved by more education. There's no substitute for your

glucometer, but "when I feel like this my blood is doing that" is

a good line of defense. The old saying "know thyself!" makes

sense here. Once you recognize the symptoms, you can take quick

action to correct the condition.



  If your blood sugars have been quite high for some time, and

you act to quickly bring them down, you may experience some

hypoglycemic symptoms--but your glucometer can reassure you that

it is just your body trying to get used to the new lower level.

It will pass.



  Symptoms of low blood sugar reaction can be divided into two

general stages. The first stage, usually occurring early in a

reaction, includes symptoms such as shakiness, sweating,

nervousness, fast pulse, dizziness, headache, and pale skin

color. Symptoms may appear suddenly. The second, more advanced

stage of hypoglycemia, includes mood/behavior changes, confusion,

poor coordination, and difficulty in speaking. If you think you

might be going into a reaction, have a snack now. Better safe

than sorry.



  Next to prevention, the best way to treat a low blood sugar

reaction is to "nip it in the bud." To do so requires that you

realize it is happening. Many diabetics have learned to recognize

a reaction by the way they feel. For example, I have learned to

recognize that at the first sign of a "low," I feel a kind of

inner shakiness, although it is not physically visible to anyone

around me. Although difficult to describe, it is a sensation I

have learned, and recognize as an early sign of low blood sugar.



  Note: Some people have "hypoglycemia unawareness," and cannot

sense when a reaction is coming on, or even that a reaction is in

progress. There may be few initial symptoms, or they may fail to

recognize them. By the time symptoms manifest, these individuals

may be too disoriented to help themselves. These folks should be

particularly careful to keep to their insulin and eating

schedules, and to monitor themselves for low blood glucose

levels. (Note: studies suggest a long period of euglycemia,

normal blood glucose, achieved by tight control, may restore some

ability to perceive low blood glucose.) When such persons

experience a reaction, it may appear at the "second stage," with

disorientation, confusion, or even loss of consciousness. A

diabetic in this condition, while still conscious and able to

swallow, needs a concentrated, refined sugar immediately.

CAUTION: DO NOT FORCE ANYTHING DOWN THE THROAT OF AN UNCONSCIOUS

PERSON--IT CAN BE ASPIRATED INTO THE LUNGS!



  At the first sign of a reaction, a diabetic needs to put

energy, food, into the body immediately. If you have consumed

sugar to ward off a "low" (many of us carry glucose tablets for

just that purpose) and the symptoms have cleared, food containing

complex carbohydrates, such as milk, fruit, crackers, or a peanut

butter sandwich, should be then taken. Glucose tablets, sugar

cubes, and cake icing all act quickly, but they "burn off"

quickly too, and unless they are followed by more substantial

food, there is a risk the hypoglycemia will recur. (Note: The

Diabetes Control and Complications Trial suggested that diabetics

who had experienced a reaction stood a 50% risk of another within

24 hours, and a 25% risk of another in the next 24 hours.) The

complex carbohydrates in the foods listed above enter the blood

more slowly than does refined sugar, but their effects endure,

helping re-establish euglycemia, proper blood glucose level.

Don't gorge yourself here! You need to eat--but if you keep

"stuffing it in," you may find your blood sugar up above 300 or

more! Eat enough to re-establish euglycemia, and STOP, WAIT for

the shakiness to fade.



  If the diabetic "misses the signals," if, for whatever reason,

no action is taken to bring the blood sugars back up, the

reaction will progress. The diabetic may shake or sweat. When

someone asks if something is wrong, the response may be, "There's

nothing wrong," or "I'm all right." Having become confused, the

diabetic may ask the speaker to repeat himself, or may state that

the question was not understood. A person undergoing a low blood

sugar reaction may appear distant, meditative, unusually quiet,

"in another world." He or she may stop conversing, or might

respond very slowly to questions. Some may become uncooperative

or belligerent, spewing obscenities at the offer of assistance.

The diabetic experiencing a "low" may seem intoxicated.

Unfortunately, every year a few diabetics, thought by police to

be drunk, are jailed overnight "for drunkenness." Before morning,

their untreated low blood sugar reactions can lead to brain

damage, even to death.



  I strongly recommend that all diabetics wear medical

information jewelry, either a bracelet or necklace, and carry a

medical information card with them at all times. I wear a

bracelet, and my card is in my wallet. Such information,

available at most pharmacies, alerts law enforcement and

emergency personnel that the bearer is diabetic, and is subject

to low blood sugar reactions. Because hypoglycemia is easily,

quickly and inexpensively treated, wearing a medical ID might

help prevent an expensive and unnecessary trip to the emergency

room.



  The diabetic should inform friends and fellow workers about low

blood sugar reactions. Relate symptoms and remedies. Tell friends

and fellow workers: "When in doubt, give me sugar."



  Remember: Never use diet drinks, insulin, or "sugar-free" candy

to combat a low blood sugar reaction! Sugar substitutes provide

no benefit, and one of them, aspartame, in fact slows the

absorption of what sugar might be present. Candy bars containing

chocolate and nuts should not be used either--unless nothing else

is available--because they are too slow. Their high fat content

slows absorption of their sugars into the blood. Honey, composed

of two sugars, acts rapidly, but may get messy if the diabetic is

shaky and disoriented.



  Many kinds of concentrated sugar products, developed

specifically to combat low blood sugar reactions, are available

over the counter in pharmacies. Many are pure glucose. I like

Can-Am's "Dex-4" glucose tablets, because they dissolve quickly

in the mouth, and the container is easy to open. I take three or

four of them to combat a reaction.



  Such a dose should bring you out of the reaction, to the point

where you can eat some complex carbohydrates, more substantial

food, as stated above. However, if there is no improvement after

15 to 30 minutes, if you are still unaware, still unsteady, you

should consume another three or four glucose tablets, or another

small tube of cake decorator's gel. All diabetics are different;

one individual may require more or less glucose and time than

another, to come out of a low blood sugar reaction.



  One inexpensive (and tasty) "insurance policy" against a "low"

is Lifesavers! Five of these little candies add up to 12.5 gm of

sugar, and provide the same dose as three glucose tablets (though

not quite as quickly absorbed). They're easily available, which

can be a big advantage.



  Another ideal treatment can be granulated table sugar

(sucrose). It is far more economical than over-the-counter

glucose products, and raises the blood glucose level nearly as

rapidly. I am often asked how much table sugar should be taken

for a reaction. As a general rule, if an adult diabetic is able

to safely swallow without choking, give two heaping tablespoons

(about 25 grams) of granulated (table) sugar. Some diabetics will

come out of the reaction rapidly, others may take longer. If 15

to 30 minutes don't bring total awareness, give another two

heaping tablespoons of sugar. And then, of course, as soon as the

diabetic is able, he or she needs to eat more substantial food

containing complex carbohydrates as described above, to keep the

reaction from recurring.



  If a diabetic having a reaction is unable to take some form of

refined sugar without assistance, but still able to swallow,

someone should mix two heaping tablespoons of sugar in four to

five ounces of water and help the individual drink the solution

(This method works best with a calm, cooperative person). When a

person is unsteady, has trouble opening their mouth, or is

uncooperative, it is still possible to use this method, but it

can get messy. In the past, when I experienced insulin reactions

and my wife tried to get me to drink sugar water, much of the

solution went on me rather than in me. To insure that the

solution goes into the mouth, try using a 60cc syringe. Draw the

sugar-water solution into the syringe, and squirt the solution

in, SLOWLY. Make sure the recipient is able to swallow! You

should be able to obtain large syringes (without needles) from

hospital pharmacies or dialysis centers. In lieu of a large

syringe, you might employ a plastic turkey baster, a common

kitchen utensil.



  Another source of emergency sugar is cake decorating gel

(icing). I purchased a small tube of Betty Crocker decorating

gel, and found it easy to work with. It weighed .68 oz. (19

grams), with about 65% refined sugar solids, a combination of

corn syrup and sugar, and the balance water. A small tube of

decorating gel contains about 12 grams solid sugar, ample to

treat a low blood sugar reaction in most people. If one tube does

not bring a diabetic out of the reaction in 15 to 30 minutes, use

a second.



  A 35mm film canister is a convenient container for carrying

table sugar. It will hold approximately two heaping tablespoons,

about 25 grams; the top fits snugly, so the sugar will not spill.

Many photography shops have empty film canisters, and shop

personnel are often happy to dispose of them.



  I also keep sugar cubes on hand. If I am shaky, it is sometimes

easier to pop them into my mouth than to take loose table sugar.

Three small sugar cubes equal one tablespoon of granulated sugar,

about 12 grams.



  When a diabetic is unconscious due to a low blood sugar

reaction, many physicians recommend an injection of glucagon, a

prescription drug. It acts rapidly and causes the liver to

release stored glucose directly into the blood stream. After an

injection, the diabetic should regain consciousness within 10 to

30 minutes. Expect a lot of variation--no two diabetics, and no

two reactions, are the same.



  After giving the injection, apprise the diabetic's physician of

the situation. The glucose released after a glucagon injection

burns off rapidly. To prevent recurrence of the reaction, it is

important for the diabetic to take some food, especially complex

carbohydrates. Glucagon may make some diabetics nauseated (there

is a risk of vomiting--turn the patient's head to one side and

guard against choking). Some individuals may need to wait 20 to

30 minutes after glucagon is administered before having any food.

Incidentally, glucagon is expensive. In my area, it costs about

$38 per prescription, but I recommend all diabetics keep glucagon

emergency kits on hand. Glucagon keeps without refrigeration.



  There seems to be no medical consensus regarding how much time

should elapse before emergency help is sought. However, if a

diabetic is not cognizant after two rounds of sugar or two

injections of glucagon, emergency medical help should be

summoned.



  A diabetic walks a thin line between high and low blood sugar.

To keep diabetes under control, he/she must follow the

recommended diet and exercise, and must take the proper dosage of

medication, on time. DON'T OBSESS OVER "TIGHT CONTROL." YOUR GOAL

SHOULD BE TO USE THE TIGHTEST CONTROL THAT IS RIGHT FOR YOU. Keep

to your schedule--it's your first line of defense. If and when

you experience a reaction, the best way to ensure your safety is

to know how bring yourself out, keep the tools close at hand

(glucose tablets, cake icing, glucagon), and tell your family,

friends, and co-workers what to do when you cannot help yourself.

A hypoglycemic reaction is an emergency situation, and should be

treated quickly to restore normal blood glucose level. Plan,

Prepare, and Be Rewarded!



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             I've Gotten Attached To My Insulin Pump



                        by Veronica Elsea



  From the Editor: Veronica Elsea is a professional musician with

her own studio, and a member of the Diabetics Division of the

National Federation of the Blind. Here she provides, based on her

own experience, a detailed explanation of how blind diabetics can

independently use insulin pumps. Many blind diabetics

successfully do so. Of course pump therapy is not for everyone,

but it is an option worth considering. Here's what she says...



  With the recent awareness of the benefits of tight glycemic

control, many of you may be considering the use of an insulin

pump. Yet along with the curiosity, excitement, and optimism come

some challenges for blind persons. We must often start by

convincing our health care professionals that yes, we can make

use of this new technology; a tricky proposition if we've never

actually seen or used the device ourselves! I hope that by

describing how I manage my pump, this challenge will be more

quickly and easily met.



  I am totally blind, a type I diabetic, and I have been using

the Disetronic (H-Tron V) insulin pump since September of 1991.

The learning process was quick. I had the entire kit: pump,

supplies and manuals, sent to me ahead of time. I did not then

own an optical scanner, so my husband read the manual to me, and

I had the time to privately explore the pump. This process took

one evening, and I found it very helpful.



  The pump is small, about the same size and shape as a little

travel pack of facial tissues. It has only three buttons, two on

top and one on the front. There are no complex menus or screens

to learn. In fact, for a totally blind person, the training is

usually very quick, as most "training time" is spent learning the

print symbols for cartridge, battery, etc.



  Everything you do is confirmed by beeps. Press once on either

top button, and three short beeps tell you your pump is running;

one long beep will tell you your pump is stopped. (When in stop

mode, the pump also beeps every minute to remind you of this. So

if I'm removing my pump and don't wish to wake my husband while I

shower, I temporarily turn off the beeps.)



Batteries:



  The pump uses two batteries, which are very easy to install and

remove. There is a low battery alarm which I'll cover later.



Filling the Cartridge:



  The pump uses a glass cartridge, holding 315 units of regular

insulin. Filling it is a very blind-friendly process. I simply

place the cartridge in its holder, attach a needle to one end,

and its plunger to the other. After removing the cap from the

needle, I insert the needle into an insulin vial, upright on my

table. I then turn the whole works upside down, and grasp the

holder in my left hand. I can then push the plunger all the way

up, and begin pulling it out, slowly and steadily, filling the

cartridge with insulin. The holder prevents the plunger from

being pulled out too far.



  The question most sighted people ask is about preventing air

bubbles. I find it's easy to get air bubbles because it's hard to

pull the plunger out evenly. So, after I fill the cartridge, I

slowly push the plunger back in again, and surprise; the air

bubbles are very audible! I usually do this a few times, pushing

and withdrawing the plunger, sometimes tapping randomly on the

holder. When I push in and hear nothing, I stop, pull it back

out, and that's it! I then pull the insulin vial off, cap the

needle, unscrew the plunger and the needle, put a little cap on

the cartridge, and lift it out of the holder. Sometimes just to

be safe, I fill the cartridge in the evening, and let it stand

overnight, before placing it in my pump the next morning. This

allows the air bubbles to dissipate. Disetronic is now

recommending this procedure for sighted pumpers as well.



Priming the Pump:



  Near the battery compartment there is a hole into which the

cartridge fits. I insert what's called the "piston rod" into the

cartridge, where the plunger had been. This piston rod is what

moves, forcing the insulin out of the cartridge. Once the

cartridge is in the pump, I pull off its cap and put on what's

called the "gray adapter." It forms an airtight seal and has an

opening in the top where the tubing is attached.



  By pushing a few buttons, I tell the pump it has a new

cartridge, and it sets its display accordingly. The pump beeps

when the process is complete.



Getting Insulin Where It's Needed:



  The insulin is delivered through a needle or cannula, which is

placed anywhere you'd give an injection with a syringe. I only

use my abdomen; I find it easier and more reliable. I use a

Teflon cannula called "Tenders," made by Disetronic. I find them

easy to insert and very forgiving. In fact, if you have any

neuropathy in your hands, you may actually find these cannulas

and cartridges quite a blessing, as they're fatter and larger

than regular syringes. The "Tenders" are inserted at an angle,

anything up to 45 degrees or so. I just hold it at a slant, push

it in and don't worry about it! As you might expect, once you

insert the cannula and remove its insertion needle, it is held in

place with tape. With the new "Tenders" the tape is part of the

cannula, so I no longer find myself holding something in place

while searching for a piece of tape somewhere on a table! It's

designed for one-handed operation by a sighted person, which

means we can do it easily and comfortably with two.



Tubing:



  The cannula is connected to the pump through special tubing.

One end of the tubing is pushed into the end of the cannula, and

the other screws into the gray adapter, as mentioned above.

Before I connect the tubing, it must be primed (filled with

insulin). This is very simple: Press all three buttons at once.

When priming, I hold the end of the tubing in my left hand, and

extend one finger until it rests directly under the spot where

the insulin will come out. When that finger is damp, I know my

tubing is completely primed. I stop the insulin flow by pushing

one button with my right hand. I then attach the tubing to the

cannula. Priming is treated as a separate function because the

pump keeps track of your daily insulin usage, so the amount of

insulin used in this process is not added on to your total.



Insulin Delivery:



  With a pump, you receive insulin in two different ways, the

basal and the bolus. When your pump is running, you will

automatically receive insulin every few minutes. You program

(set) an hourly rate. For instance, my basal rate for this

current hour is .4 units. The pump then portions that amount over

the hour. I can set a different rate for each hour, or make many

of them the same, depending on my needs. (I keep a list of my

rates in a file in my Braille Lite.)



  The process of setting basal rates is one of counting beeps.

With the pump stopped, I push one button to move from one hour to

the next. The remaining two buttons allow me to go either up or

down, .1 unit at a time. There are special shortcuts (button

combinations) for some tasks, such as setting all rates alike, or

repeating the same setting for the next hour, etc. And yes, if

you really get lost, you can just go back to "0" and start over.



  When you eat, or if you need to take extra insulin because

you're high (elevated sugars), you give yourself a "bolus." When

the pump is running, a press of either button on top will deliver

.5 units of insulin. So if you wanted three units, you'd press

the button six times. The pump will beep as you press the button,

and then will repeat the beeps back to you, before actually

delivering the insulin. By the way, these buttons are designed to

be felt through clothing, so you need not stop and fish out the

pump. I have often given myself a bolus while standing in the

buffet line, making my food selection. In the same manner, you

can temporarily reduce your basal rate in cases such as extra

exercise.



Carbohydrate Counting:



  This is a skill you will learn as part of your pump training.

In my case, I take one unit of insulin for every 12 grams of

carbohydrates, except in the morning, when one unit covers 10

grams. I worked with a dietitian to learn portion sizes, and read

food packages. There are many print books which list the

carbohydrates and calories for various foods, and I'm hoping

we'll shortly find this information on line. (Editor's Note: The

Diabetics Division of the National Federation of the Blind offers

the 1995 edition of the ADA's "The Exchange Lists for Meal

Planning," in Braille and on audiocassette. See our "Resource

Column".)



Alarms:



  The pump has alarms for low batteries, occlusion, electronic

problem, "out of insulin" and end of use of your pump. Although

the same beep sounds, the different alarms behave differently.

Disetronic has expressed willingness to make these alarms easier

to understand by having the beep match the "error number." For

instance, error 3 means a low motor battery. In the future, the

alarm for this might be a repeating pattern of 3 beeps (it

doesn't yet). But for now, we just have to learn what the beeps

mean. An alarm will beep constantly until you silence it. If you

do nothing else, you'll get beeped at again in one hour. This

process can go on for as long as 12 hours.



  I have learned that I usually get about two months' use on one

battery set. So if I'm planning a trip, I usually just change

them when I think it's about time, not waiting for the alarm.

Incidentally, the pump does not forget your basal settings when

you change batteries. The occlusion alarm, on the other hand,

will emit the same constant beep until you silence it. But you'll

hear it again every time the pump tries to deliver insulin, every

few minutes. It also puts the pump in stop mode.



  The pump lets you know as you're approaching the end of your

cartridge. You hear one beep when you have 20 units of insulin

left, (I often miss this one), two for 15, three for 10, four

when you have 5 units left, and an alarm when you run out. This

alarm acts like the occlusion alarm, but it has of course been

preceded by all those warnings!



The Display:



  I have not found any way to successfully read the display; it's

too small to read with my Optacon. This display shows the amount

left in the cartridge, the total amount of insulin used since

midnight, the amount and time of the last bolus, and the current

basal rate. It also shows symbols or numbers as you prime,

install a cartridge, set the clock, and set basal rates. At

first, I used a calculator to keep track of my insulin usage, but

now I know that under normal conditions, a cartridge lasts me

about eight days. Once in a great while, I just ask my husband to

check a number, or to double check my readjustment of my basal

rates. I rarely miss this display.



  The clock is also set by counting beeps. It can get a bit

tedious though, as you can only go forward; just be patient when

changing back to standard time!



Wearing the Pump:



  It only weighs a few ounces, has very rounded edges, and is

very rugged. Many people place the pump in a pants pocket or on a

belt loop. I prefer wearing mine tucked in my bra or in a shirt

pocket. If I'm wearing a very nice dress, I often put it around

my waist (You can buy all sorts of pouches for holding the pump).

It doesn't hurt to roll over on it, bump it or anything. I find

that I only occasionally startle someone who gives me a big hug

and wonders what that "thing" is! I've gone swimming with mine,

hiking, shopping, dining and more.



  Until the arrival of the "Tenders," I carried the pump into the

shower every day. I would put it in a bag that I could hang on

the faucet, or clip to a shower curtain, and yes, the tubing is

long enough to allow plenty of room for moving around. You can

buy tubing in different lengths, although I prefer the shortest,

31 inches long.



  Only once during an exuberant "good morning" did my guide dog

reach up and catch her paw in the tubing. It's a weird feeling

when you catch the tubing on something, but it takes real effort

to knock out the cannula.



Questions or Problems:



  I have found the people at Disetronic to be very helpful when I

had a problem. They've done very well at giving blind-friendly

descriptions of things over the phone, listening to my

suggestions, and sending me things for trial purposes.



Advantages:



  I really notice a difference in my control. I use less insulin,

have fewer highs and lows, and just plain feel better. I also

love the flexibility; I decide when it's mealtime, and can easily

make adjustments if I am surprised by things like a sauce they

didn't mention, or a walk that was longer because some street

didn't go through! I love the convenience of not having to carry

around all those little bits and pieces. Here's one example: I

regularly attend breakfast meetings. I test my blood before I

leave home. Since I never know when breakfast will actually

arrive, I wait until the meeting has started, then just reach up

and push the button. People don't even notice that I'm doing it;

their pagers and mobile phones are much louder.



  I feel very efficient and inconspicuous, just the way I like

it. If I'm out and unable to test, or don't get a valid test, I

find the pump very helpful. I take the amount of insulin which

will match the upcoming carbohydrates or familiar diet pattern,

and know that it's easily straightened out later, just by pushing

a button. I'm also not so worried about going out and getting in

trouble from low blood sugars, since there's no long acting

insulin. If I'm low, once I eat something, I know I'll be okay.



  I sincerely hope that relating my experiences with the pump

will help you have a constructive discussion with your health

care team about whether or not the pump is right for you, based

on your diabetes, not your blindness.



Note:



  Disetronic Medical Systems (H-Tron V Insulin Pump): 5201 River

Road, Suite 312, Minneapolis, Mn 55421-1014; telephone:

1-800-688-4578. Control buttons are raised, and easy to

distinguish by touch. The device has clear audio cues.



  Minimed Technologies (Minimed 506 Insulin Pump): 12744 San

Fernando Road, Sylmar, CA 91342; telephone: 1-800-933-3322.

Control buttons require modification for non-sighted use. The

device is not as accessible as the Disetronic, though some blind

diabetics use it quite successfully.



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





                      Spotlight: Lois Klug



[Photo: portrait; Caption: Lois Klug]



  Lois Klug, a National Federation of the Blind member from

Grafton, North Dakota, is a direct, plain-spoken lady who has run

her own business for decades. She has also been blind for 36

years, and diabetic since 1943, and has let neither stand in her

way.



  Although she can't remember the month, Lois remembers how ill

she felt, as a child in 1943. She was drinking a lot of water,

and she "peed a lot." She remembers "burning lamps," and how she

had to collect urine and mix it with "Benedict's Solution," then

heat in a test tube and read the color, to determine her glucose

level. Those were the days of glass syringes "you had to boil"

and reusable needles, and of $2.98 vials of insulin. She agrees

diabetes self-management has come a long way.



  When her vision failed (acute glaucoma in the right eye,

retinal detachment in the left), doctors were confused, and Lois

went to three different hospitals, winding up at University of

Minnesota, where the iris was removed from her right eye. It made

no difference; she has been totally blind since.



  Diligent in her diabetes self-management, she has always tried

to eat what she was supposed to, and to exercise regularly. Her

care has paid off in good health and no complications.



  At the time she became blind, her daughter was 13 months old.

No family member was nearby to act as "caretaker," but she wanted

to learn how to do things for herself. Had the family been

nearby, someone would have stepped in, but her solitude spurred

her independence. She has made such good use of her skills that:

"Many folks don't believe I'm blind."



  She started her babysitting/daycare business after losing

sight, and has run it alone since. Bells on their shoes help her

keep track of the children, and a chime on the door announces

arrivals, even before they speak.



  Since the onset of her blindness, she and her husband have

adopted five more kids. The youngest is now eight years old.

Three of her children are at home, two more in college.



  Twenty years ago she bought a tandem bike, which she rides

"when a co-pilot is available." She has a treadmill and an

exercise bike to go with the tandem.



  Recently, she obtained an Arkenstone reading machine, a Count-

a-Dose to measure her insulin, a talking thermometer, and a

talking glucometer, from her local rehab agency. Before that,

family members helped her with testing. "Adaptive devices weren't

available out here," she says.



  Lois hasn't had time for much travel. "Too busy," she says, but

she doesn't view her blindness as a handicap. "I'd rather be

blind than a lot of things," she says.



  What's her formula for success? "You just have to learn what

you can about diabetes, get exercise, and don't overdo

yourself..."



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





                         Ask The Doctor



                     by Wesley W. Wilson, MD



  NOTE: If you have any questions for "Ask the Doctor," please

send them to the VOICE editorial office. The only questions Dr.

Wilson will be able to answer are the ones used in this column.



  Wesley Wilson, MD is an Internal Medicine practitioner at the

Western Montana Clinic in Missoula, Montana. Dr. Wilson was

diagnosed with type I diabetes in 1956, during his second year of

medical school.



  Q: I control my type II diabetes with careful diet and a daily

aerobics workout. Do I need to do all that blood sugar testing

too?



  A: I'm pleased you are following a healthy lifestyle, and I'm

sure you would agree that it's particularly important for

individuals with diabetes to use all available methods to avoid

health problems. Persons with diabetes, even if they exercise,

watch their diet, and keep blood sugar level near normal, still

are at increased risk for diabetic complications. The Diabetes

Control and Complications Trial (DCCT) showed that intensive

control reduced the risk of complications, but unfortunately did

not show intensive treatment, "tight control," would eliminate

such risk. One still needs to remain vigilant.



  Type II diabetes tends to be more stable than type I, usually

with less variation in blood sugar levels. However, in type II

diabetes, blood sugars do tend to vary from hour to hour and from

day to day, and a person with very stable diabetes often shows

marked change in blood sugar levels with relatively little

changes in diet, exercise, illness or stress. Our current

lifestyle, deadlines, and demands upon our time often interfere

with schedule-keeping, setting the stage for the possibility of

significant fluctuations in blood sugar levels.



  Many persons with diabetes feel they can "sense" blood sugars

that are too low or too high. I'd challenge that idea, since most

of us cannot detect moderate fluctuations in blood sugar level.

Most individuals are unable to detect blood sugar elevations to

190 or 200 mg/dl, but such a blood sugar level seems to increase

the risk of diabetic complications, if it is frequent or

repeated. Only by testing can anyone be sure their blood sugar is

within the safe range they and their physician have established.



  I'm sorry, but in addition to exercise and diet, your still

need to do blood sugar testing, and in addition, you should have

periodic hemoglobin A1c testing to determine what your average

blood sugar has been.



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





           Tactile Coding Meeting At FDA Headquarters



                          by Ed Bryant



  For the last four and one-half years, the Diabetics Division of

the National Federation of the Blind has campaigned to make

insulin vials identifiable for the blind and those losing sight.

Currently, all insulins are packed in identical vials,

distinguished only by the print on the label. Today, to achieve

good diabetes control, most diabetics mix their insulins. If you

can't read the small print on an insulin vial, you risk injecting

yourself with the wrong insulin, and inducing a hypoglycemic

reaction -- which, depending on degree of misdosage, can have

very severe consequences. A serious error can put you in the

hospital, or kill you. Tactile coding on insulin vials will

enable blind insulin users to safely distinguish between the

insulins they must mix, without recourse to impermanent cues such

as tape or rubber bands, or to sighted aides.



  This is a safety issue for sighted insulin users as well. Dr.

Daniel Lorber, Editor in Chief of "Practical Diabetology," in a

recent editorial (Vol.14, No.2), reminded readers that the

average sighted diabetic mixes up insulins at least once a year.

Tactile cues will cut that frequency for the estimated 16 million

diabetics in America today.



  After numerous letters, telephone conversations, and articles

in the VOICE, the Food and Drug Administration (FDA) finally

agreed insulin vials needed tactile markings. The insulin

manufacturers, Eli Lilly & Co., and Novo Nordisk Pharmaceuticals

Inc., agreed to participate in meetings to determine what sort of

tactile symbols ("codes" or "cues") were needed.



  The first meeting was held at FDA headquarters, in Rockville,

Maryland, on October 19, 1995. Participants discussed various

proposals for tactile insulin identification. The meeting ended

with both insulin manufacturers agreeing to three months further

study of the ideas that had been put forward. Minutes of that

meeting (discussed more fully in VOICE Vol.11, No.1) give all

credit for making the meeting happen to the Diabetics Division of

the National Federation of the Blind, and to my persistence.



  The minutes also state that at the close of the (October)

meeting, all participants had agreed that Lilly and Novo Nordisk

were "to come to the next meeting with firm ideas for short-term

solutions, and other ideas for long-term solutions."



  The second meeting was scheduled for January 19, 1996.



  The threat of winter storms forced postponement of the second

meeting, and it was rescheduled for April 10, 1996. As at the

earlier meeting, participants included: FDA staff, organizations

of the blind, diabetes associations, and other private

organizations. I made the first presentation, reminding the

audience that it had been almost six months since the last

meeting; that the insulin manufacturers had agreed to evaluate

the proposals for tactile marking put forth at that time; and

that I was looking forward to seeing what they had accomplished.

I distributed a memorandum of my own, with descriptions and

photos of a number of tactile-marking proposals (these proposals

were also published in the last issue of the VOICE).



  Novo Nordisk had used the time between meetings to expand and

refine the marking system they already use in Europe, in which

"R" insulins are marked with a raised dot on the vial's aluminum

crimp seal (they had brought European insulin vials to the

October meeting).



  Their new system would allow them to provide one, two, or three

dots, but they agreed these were not appreciably more detectable

than their original dots, which all blind meeting participants

had previously agreed were too small (see VOICE, Vol.11 No.1).

Novo Nordisk also showed samples of a "milled-rim" insulin vial,

that was quite detectable, but whose markings would not allow

multiple coding.



  Discussing tactile cues on the label instead, Novo Nordisk said

they "could put tactile stripes on labels," but they had not yet

tested such marks, to see if they were sufficiently durable. They

preferred to mark the metal crimp seal. They stated that placing

markings on insulin pen cartridges might be impossible, as the

cartridges fit snugly into the insulin pens. They stated that the

injection-molded plastic body of their prefilled syringes would

easily allow inclusion of tactile codes on the pen body.



  Novo Nordisk spent some time discussing the need to

differentiate between groups of products, in meaningful ways that

reflected actual usage patterns. They proposed to group all

insulins into three classes: long-acting, rapid-acting, and

mixes. Assuming users would not mix the new quick-acting

Lispro/Humalog insulin with Regular insulin, they proposed to

code both the same.



  Lilly's presenters agreed with the need to assign specific

insulins to one of several groups, rather than attempting tactile

identification of individual insulin formulations. They discussed

the need for a "universal code," meaning that all insulins with

the same time of onset would bear the same code, world-wide,

regardless of their trade name. Such universality would benefit

all insulin users, as a sighted American, visiting Russia or the

Middle East, unable to read the foreign script, could still

distinguish between insulins, as the tactile markings would be

the same as those used at home.



  Lilly strongly recommended that quick-acting insulins (such as

their new Lispro/Humalog) not be assigned to the same code-group

as Regular insulin. They argued there is enough "time/action

profile" difference between the two that to mix them up would be

a safety issue, as Lispro starts acting about 10 to 15 minutes

after injection,and peaks in an hour, while traditional "Regular

insulin" starts in about 30 minutes, and peaks some three hours

later. They proposed that group #1 be for quick-acting insulins

such as Lispro/Humalog, group #2 be "Regular" insulins, and group

#3 be all intermediate and long-acting insulins. In support of

such division, they pointed out that the FDA advisory committee

that had approved Lispro mandated its distribution as a

prescription drug (first time for an insulin), precisely because

it was so different from previous insulin formulations.



  Lilly acknowledged that no matter what coding system was

finally adopted, there will need to be a period of user-

education. They pointed out that the system might have to be

expanded, when new insulins with different time/action profiles

are developed. Distinguishing between insulins with different

time-of-onset is a safety issue.



  Lilly's presenters talked about their testing program. One

proposed coding system consists of horizontal bars or "stripes"

on the label, and these have already passed tests for

manufacturability, durability, and low cost. Lilly has also

involved about 20 blind individuals, most of whom were diabetics,

in tests of code placement and detectability. "All we haven't

done yet," they stated, "is look at what regulatory requirements

would be, in order to implement."



  Lilly is also researching "dot" coding on the vial label, and

there was much discussion about which cues, dots or bars, were

more detectable by blind individuals and those with neuropathy.

Both cue types have supporters. Lilly plans on consulting with at

least one more group of blind diabetics, in the next few weeks,

to optimize details of cue spacing and placement.



  Asked about making the letters "R," "N," "L," or "U" themselves

tactile, Lilly responded that they thought it could be done--but

that it would be more difficult, as codes would have to coincide

with the letters, and a given insulin may have different names in

different locations. They also noted some insulins don't have

letters. Enlarging the letters on the label, which they agreed

would help in low-vision situations (and which I strongly support

--both companies should do that now), they termed "a separate

issue."



  The FDA, asked how much time between code approval and

implementation, answered "not very long." Lilly interjected that

once the FDA's regulators were finished, they would be able to

move quickly.



  There was much discussion of whether or not anyone would ever

mix Lispro/Humalog and Regular insulin. Lilly pointed out that

doctors had figured out ways to mix every other insulin in

existence, and would probably continue to do so.



  When a Novo Nordisk representative asserted that no one would

ever mix Regular with Lispro, and thus the two should bear the

same code (he "just couldn't see folks mixing two types of short-

acting insulin"), there was general disagreement with his

proposal. Lilly pointed out that Lispro's extremely rapid onset

makes the ability to distinguish it from other types a safety

issue. They reminded the audience that the coding they propose is

not just for Lispro, but also for all the other quick-acting

insulin analogs that will surely follow.



  There is still a great deal of philosophical difference between

meeting participants, and it showed in the subjects discussed.

Novo Nordisk, which does not currently offer a competitor to

Lilly's quick-acting Lispro/Humalog, strenuously resisted

creation of a separate code-group for such quick-acting insulins.

Novo's presenters said they feared that, for marketing reasons,

manufacturers would seek a new code-group for every new insulin.

Yet they wanted to tactile-code the differences between insulin

sources, such as beef, pork, mixed beef, recombinant DNA...



  Lilly (which does not currently offer a premixed insulin) had

originally proposed not to place any code on mixed insulins, such

as 70/30. As the meeting progressed, they changed their position,

suggesting that initial time of onset should determine mixture

coding -- that a mixture's coding should reflect the presence of

its quickest-acting component. A mixture containing Lispro would

thus bear a different mark than one containing Regular. Lilly

then reminded the audience that we were working on the "short-

term solution," and that some codings would have to wait for the

long-term.



  Novo Nordisk, deeply committed to its dot-cues on the rim, did

also bring samples of tactile bars on the vial label, but these

appeared to be hand-fashioned, and they admitted they had not

tested the bars: "At this point we just haven't done what Lilly

has. As a result we just don't have data in our pocket to

present."



  I informed Novo Nordisk that I belong to a number of support

groups, and I had taken samples of their vials with the little

dot, for inspection by sighted, visually-impaired, and blind

diabetics. Some said they could distinguish the dot, but several

mentioned that with much sight loss, or any appreciable

neuropathy, lines on the label would be easier to distinguish.



  There were many other exchanges. Both companies seemed

determined not to accept each others' proposals. But it came down

to the fact that Lilly had more thoroughly "done its homework."

Novo Nordisk, who, like Lilly, had agreed at the October 1995

meeting to test and evaluate all major proposals for tactile

marking, wound up asking for three more months, in which to test

prototypes.



  We agreed to meet again in three months.



  Since the meeting, I have been in contact with both insulin

manufacturers. Although they did not reveal it at the meeting,

many blind participants in Lilly's tests had preferred dot-cues

to tactile bars. Of course the test participants had been told

what to look for, but, as covered at the meeting, a new insulin

user, or one with profound neuropathy, would find the bars easier

to detect.



  I suggested to both companies, who are currently investigating

a set of four horizontal bars to identify the different insulin

types, that they consider a horizontal row of close-spaced dots

(instead of one bar) as a cue for the quick-acting (Lispro) code

group.



  In the next issue of the VOICE, I will let you know what

progress was made at the July meeting. Hopefully then we will

have an implementation date for our long-delayed "short-term

solution."



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





                      Blindness Information



[Photo: portrait; Caption: Kenneth Jernigan]



  "If Blindness Comes," by Kenneth Jernigan, is a 248-page large

print book published by the National Federation of the Blind

(NFB). It is packed with information about the Federation and its

services, and with tips on how to cope with vision loss. The book

is formatted in large print (single copies free) and

audiocassette ($3 each), and is available from the NFB Materials

Center, which also offers a variety of products and publications

for the blind. The Materials Center stocks everything from white

canes and Braille-marked utensils to talking glucometers and

thermometers, from check-writing guides to adaptive insulin

measurement devices.



  To learn more about the NFB, to obtain a large-print or Braille

copy of the "Aids and Appliances Order Form," or to order any of

our products or literature, contact: National Federation of the

Blind, Materials Center, 1800 Johnson Street, Baltimore, MD

21230; telephone: (410) 659-9314. The Materials Center is open

12:30 to 5:00 p.m. Eastern time, Monday through Friday.



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





                     Medicare Facts For 1996



                         by James Gashel



[Photo: portrait; Caption: James Gashel]



  Note: This article appeared in the April 1995 edition of the

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

Blind.



  From the "Monitor" Editor: Jim Gashel is the Director of

Governmental Affairs for the National Federation of the Blind.



  In the January, 1996, issue of the "Braille Monitor," we

reported the annual Social Security program adjustments now in

effect for 1996. The article was titled "Social Security and SSI

Facts for 1996." Since changes are made in Social Security

programs at the beginning of each new year, we ordinarily report

the new information in the "Monitor." Medicare facts are usually

included. Due to the controversy over the federal budget, changes

in Medicare for 1996 had not been decided, however, when our

January article was prepared. That controversy is not yet

settled, but the Medicare facts for 1996 are.



Here are the new facts for 1996:



  MEDICARE DEDUCTIBLES AND CO-INSURANCE: Medicare Part A coverage

provides hospital insurance to most Social Security

beneficiaries. The co-insurance payment is the charge that the

hospital makes to a Medicare beneficiary for any hospital stay.

Medicare then pays the hospital charges above the beneficiary's

co-insurance amount.



  The Part A co-insurance amount charged for hospital services

within a benefit period of not longer than 60 days was $716

during 1995 and is increased to $736 during 1996. Beginning the

sixty-first day through the ninetieth day, there is a daily co-

insurance amount of $184 per day, up from $179 in 1995. Each

Medicare beneficiary has 60 "reserve days" for hospital services

provided within a benefit period longer then 90 days. The co-

insurance amount to be paid during each reserve day is $368, up

from $358 in 1995.



  Part A of Medicare pays all covered charges for services in a

skilled nursing facility for the first 20 days within a benefit

period. From the twenty-first day through the one hundredth day

within a benefit period, the Part A co-insurance amount for

services received in a skilled nursing facility is $92 per day,

up from $89.50 in 1995.



  For most beneficiaries there is no monthly premium charge for

Medicare Part A coverage. People who become eligible for Social

Security Disability Insurance cash benefits can continue to

receive Medicare Part A coverage premium-free for 39 months

following the end of a trial work period. After that time the

individual may purchase Part A coverage. The premium rate for

this coverage during 1996 is $289 per month. During 1996 this

premium rate is $188 for individuals who have earned at least 30

quarters of coverage under Social Security covered employment.



  The Medicare Part B (medical insurance) deductible remains at

$100 in 1996. This is an annual deductible amount. The Medicare

Part B basic monthly premium rate will decrease from $46.10

charged to each beneficiary and withheld from Social Security

checks in 1995 to $42.50 per month during 1996. Medicare Part B

coverage may be continued for those who complete a trial work

period and become ineligible to receive Social Security

Disability Insurance cash benefits. This monthly premium rate is

$42.50, the same amount paid by Social Security beneficiaries

through withholding from their monthly Social Security checks.



  PROGRAMS WHICH HELP WITH MEDICARE DEDUCTIBLES AND PREMIUMS:

Low-income Medicare beneficiaries may qualify for help with

payments. Assistance is available through two programs--QMB

(Qualified Medicare Beneficiary program) and SLMB (Specified Low-

income Medicare Beneficiary program).



  Under the QMB program states are required to pay the Medicare

Part A (Hospital Insurance) and Part B (Medical Insurance)

premiums, deductibles, and coinsurance expenses for Medicare

beneficiaries who meet the program's income and resource

requirements. Under the SLMB program states pay only the full

Medicare Part B monthly premium ($42.50 in 1996). Eligibility for

the SLMB program may be retroactive for up to three calendar

months.



  Both programs are administered by the Health Care Financing

Administration (HCFA) in conjunction with the states. The rules

vary from state to state; but in general:



  An individual may qualify for the QMB program if his or her

income is near the national poverty level, approximately $7,980

annually for an individual ($665 per month) and $10,608 annually

for a family of two (or $884 per month). These amounts apply for

residents of 48 of the 50 states and the District of Columbia. In

Alaska the income threshold used to define poverty is

approximately $9,576 annually for an individual (or $798 per

month) and $12,780 annually for a family of two (or $1,065 per

month). In Hawaii the income threshold used to define poverty is

approximately $8,856 (or $738 per month) annually for an

individual and $11,796 annually (or $983 per month) for a family

of two.



  For the SLMB program annual income must be 110 percent or less

of the national poverty levels. Under both programs $20 in

monthly income is not counted toward the limit.



  Resources such as bank accounts or stocks may not exceed $4,000

for one person or $6,000 for a family of two. (Resources

generally are things you own. However, not everything is counted:

the house you live in, for example, doesn't count, and in some

circumstances your car may not count either.)



  Here's an idea of what the QMB program provides in 1996. Under

Part A the hospital insurance deductibles are $736 for the first

60 days of a hospital stay and $184 per day for days 61 through

90 in the hospital. The QMB program will pay these expenses for

eligible beneficiaries. However, to qualify for help under the

QMB program, you must file an application. If you think you

qualify but you have not filed for Medicare Part A, contact

Social Security to find out if you need to file an application.

Further information about filing for Medicare is available from

your local Social Security office or Social Security's toll-free

number: (800) 772-1213.



  Remember, only your state can decide if you're eligible for

help from the QMB or SLMB program. So, if you're elderly or

disabled, have low income and very limited assets, and are a

Medicare beneficiary, contact your state or local welfare or

social service agency to apply. For further information about

either program, call HCFA's toll-free telephone: (800) 638-6833.



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



  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."



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





                          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...





                    Mexican Fiesta Casserole



                       from Betty Johnson

                         of Lewiston, ID



1/2 lb. extra lean hamburger

1 1/4 cups red beans, cooked

1 small onion

1/2 tsp. garlic salt

2 (8-oz.) cans tomato sauce

1 cup lowfat plain yogurt

1 cup lowfat cottage cheese

1 small can chilies, chopped

1 (6-oz.) package taco chips

1 1/2 cups (6-oz.) Mozzarella cheese, shredded



  Brown hamburger and onion together in a nonstick pan. Drain.

Add garlic salt, red beans, and tomato sauce. Mix yogurt, cottage

cheese, and chopped chilies together. Crush taco chips. In a

2-qt. casserole, layer half the chips, meat mixture, cottage

cheese mixture, and shredded cheese. Repeat layers, bake at 350

degrees for 30 minutes.



  Yield: 8 servings; Calories: 330; Exchanges: 2 lean meats, 2

starch, 1 fat.





                        Tangy Cauliflower



                   from Boone Hospital Center

                         of Columbia, MO



1 medium head cauliflower

1/2 cup fat-free mayonnaise

1 1/2 tsp. prepared mustard

1 green onion, sliced

2 oz. reduced-fat cheese, grated (or 1/2 cup)



  In large saucepan, cook cauliflower in boiling water until

crisp-tender. Drain well and place in serving dish. Meanwhile, in

small bowl combine mayonnaise, mustard and onion. Mix well. Spoon

and spread over hot cauliflower. Sprinkle with cheese. Cover. Let

stand a few minutes until cheese is melted.



  Yield: 8 servings; Per serving: 45 calories, 5gm protein, 2gm

fat, 0.3gm saturated fat, 4gm carbohydrates, 130mg sodium;

Diabetic Exchanges: 1 vegetable, 1/2 fat.





                       Savory Green Beans



                   from Boone Hospital Center

                         of Columbia, MO



4 cups fresh green beans (or 1 16-oz. bag frozen)

1/4 cup water

2 tbsp. butter flavor granules (or 2 tbsp. reduced-fat margarine)

1 tablespoon lemon juice

1 tbsp. chopped fresh summer savory (may substitute 1 tsp. dried

savory)



  Bring water to boil in medium saucepan. Add beans and cook over

medium heat 10 to 15 minutes or until crisp-tender. Drain. Stir

in remaining ingredients and mix well.



  Yield: 8 servings (1 serving = 1/2 cup); Per serving: 15

calories, 1gm protein, 0gm fat, 0gm saturated fat, 4gm

carbohydrates, 22mg sodium; Diabetic Exchanges: free.





                    Holiday Cherry Cheesecake



         from Cosmopolitan International Diabetes Center

                         of Columbia, MO



1 whole graham cracker, crushed

1 cup 1% cottage cheese

1 small package sugar-free Jello

2/3 cup boiling water

8 oz. fat-free pasteurized processed cream cheese spread

2 cups Cool Whip Lite

1 cup reduced-calorie cherry pie filling



  Spray a 9-inch pie-pan with nonstick spray (like "Pam").

Sprinkle sides of pan with half the graham cracker crumbs.

Dissolve Jello in boiling water; pour into blender. Add cottage

cheese and cream cheese. Blend at medium speed for two minutes,

or until smooth; pour into large mixing bowl. Gently fold in Cool

Whip. Pour mixture into pie-pan and smooth. Sprinkle remaining

crumbs on top. Chill until set (approximately four hours). Before

serving, top cheesecake with pie filling.



  Yield: 8 servings; calories 120; 2.3gm fat. Exchanges: 1 skim

milk, 1/2 fruit.



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







                     New LifeScan Glucometer



[Photo: LifeScan SureStep meter shown actual size; Caption:

LifeScan SureStep (Actual size)]



  LifeScan, Inc., of Milpitas, California, maker of the "One

Touch" series of glucometers, announces a new meter. Called

"SureStep," it is much smaller than their other meters, and is

not part of the "One Touch" system. The SureStep measures only

3-3/8" x 2-3/8" x 7/8", and uses a new test strip and testing

technique.



  The SureStep test strip is designed to receive the blood sample

("dropped or dabbed") outside of the machine. The strip's

absorbent pad allows easy application of the blood sample, and

its blue "confirmation dot" shows when enough blood has been

applied. Operating procedures are simple and straightforward, and

the system is meant to be forgiving of imprecise user technique.

Although there is no provision for voice synthesis, the meter's

numerical display is bold and easy to read, 150% larger than that

of the much larger One Touch Profile (19/32" as opposed to

13/32", 15mm vs 10mm).



  Test strips for the new meter (which should cost about the same

as One Touch strips) have been specifically designed to cut strip

wastage and lessen the need to re-test. Also, the strip's

absorbent pad guarantees it will enter the machine almost dry,

making cleaning easier. The application of blood sample to strip

before insertion into the machine, the "enough blood"

confirmation dot, and the overall extreme simplicity of meter

operation may make this meter a good choice for the beginning

tester or the diabetic whose physical limitations interfere with

traditional strip use.



  We tested the meter, using the new technique of bringing test

strip to lanced finger. We "dabbed" (touched the test square to

the blood drop), then checked that the dot had turned blue.

Everything functioned perfectly.



  Retail price for the SureStep meter should be about $62.50, but

a $30 manufacturer's rebate and a $20 trade-in allowance for your

old glucometer can reduce the price to around $12.50. For

information, contact your pharmacist or LifeScan, Inc., 1000

Gibraltar Drive, Milpitas, CA 95035-6314; telephone:

1-800-227-8862.



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





                      New Diabetes Research



  Not a week passes without details of some new research of

potential interest to the diabetic community! At this time,

Washington University School of Medicine, in St. Louis, Missouri,

is researching a number of new developments.



  A team headed by Janet McGill, MD, is testing the efficacy of a

new investigational insulin specifically formulated for veteran

type II diabetics who are ready to make the switch from oral

medications to injected insulin. Oral diabetes medications often

lose their efficacy after a number of years, requiring a switch

to insulin injections to maintain good control. There is always a

certain reluctance to switch from pills to injections (industry

insiders call this "psychological insulin resistance") and it is

hoped the new formulation can ease the transition.



  Other Washington University studies include evaluation of the

new kidney drug aminoguanidine, and a study of treatments for

neuropathy pain. Researchers at Washington University School of

Medicine and many other centers are always looking for

volunteers, people with type I or type II diabetes, to

participate in their clinical evaluations. We at VOICE OF THE

DIABETIC suggest you consider participation.



  Readers in the St. Louis area can telephone the Washington

University School of Medicine's "Volunteer for Health" line at:

(314) 362-1000.



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





    Cardiovascular Health: Bypass May Be Better For Diabetics



  Individuals with severe coronary artery disease face the risk

of vascular blockage, which can lead to angina, weakness, and

heart attack. Traditionally, these folks have received one of two

treatments: CABG (bypass surgery) or PTCA (percutaneous

transluminal coronary angioplasty, "balloon angioplasty").

Diabetes is a major cause of heart disease, and enough diabetics

have undergone one or the other procedure to form a statistical

picture of these procedures' effectiveness.



  PTCA uses a catheter, which is inserted into the obstructed

vessel from an entry point in the groin, and inflates like a

balloon, to dilate the blocked vessel at the point of

obstruction, allowing blood to flow past the blockage. CABG, a

major operation, involves opening the chest and providing a new

channel, or "bypass," for the blood to flow. Both treatments

alleviate the effects of coronary artery disease, but neither

alters the natural course of the disease.



  One might expect the "success" rates of the two procedures to

be about the same, or for the less invasive, PTCA, to be better.

Beginning in August 1988, the Bypass Angioplasty

Revascularization Investigation (BARI), a major study sponsored

by the National Heart, Lung, and Blood Institute, part of the

National Institutes of Health, compared the effectiveness of the

two procedures. Results were surprising.



  Using "mortality after 5 years of follow-up" as a yardstick,

the BARI study found that for non-diabetic patients, both

procedures scored equally, with a 9% mortality rate. For

diabetics on insulin or oral hypoglycemics (type I or type II),

the 5-year mortality rate following PTCA, the less invasive

procedure, was 35%, and the rate for CABG, bypass surgery, was

19%. Although the higher overall mortality rate from diabetic

heart disease was not unexpected, the excess mortality with

balloon angioplasty had not been anticipated.



  Results of the study indicate that bypass surgery should be the

preferred treatment for diabetic patients on insulin or oral

medications, who have multivessel coronary artery disease and

need a "first coronary revascularization" (first-time PTCA or

CABG). As the Centers for Disease Control reports that, in 1989,

about 48% of all diabetes-related deaths had major cardiovascular

disease as the underlying factor, these findings are expected to

have major impact.



  Patients were eligible for the BARI trial if they had coronary

artery disease with a 50% or more luminal obstruction (as

measured by calipers) in at least two of the coronary vessels

supplying two or three major coronary territories. They had to

have clinically severe ischemia (measurable obstruction to blood

flow), and no prior revascularization. Patients were ineligible,

if, for example, they had insufficient angina or ischemia,

required emergency revascularization, had left main stenosis of

50% or greater, had a noncardiac illness expected to result in

limited survival, primary coronary spasm, or a poor-quality

angiogram (x-ray examination of the circulatory system). All

patients accepted for the test received "risk factor

modification": help with smoking cessation, appropriate exercise,

and diet.



  Findings of the BARI study were reviewed on September 13, 1995,

by the Data and Safety Monitoring Board, a panel of PTCA experts,

cardiovascular surgeons, clinical cardiologists, biostatistics

experts and ethics specialists. The Board concluded that the

differential results of the two treatments, and the unfavorable

mortality for diabetics on insulin or oral hypoglycemics, were

unlikely to be due to chance. The Board recommended to the

National institutes of Health that physicians, other health

professionals, and the public be promptly informed of the

results.



  In summary: The BARI study was a careful comparison of the

results of two medical procedures frequently used in response to

multiple coronary artery disease. Many "endpoints" were

investigated, including: Patients' anginal status, number of

diseased vessels, functional status, quality of life, gender,

age, race, and presence/absence of diabetes. Although the study

considered many issues, its findings for diabetics were

particularly significant. The study strongly suggests that if you

are diabetic, using insulin or oral hypoglycemic agents

(sulfonylureas), and you suffer from multiple coronary artery

disease, and if you are at the point of needing a first

revascularization, you will probably fare better with CABG,

bypass surgery, than with PTCA, balloon angioplasty, as an

initial treatment.



  Anyone who has evidence of coronary artery disease, with or

without a prior PTCA or CABG, needs, under close physician

monitoring, to aggressively reduce known risk factors, such as

smoking cessation, appropriate control of blood pressure and

serum cholesterol, and needs to achieve optimal control of their

diabetes.



  [From the Editor: I've had bypass surgery. Several doctors have

told me the best way to determine if you have coronary artery

disease is with a "routine exercise treadmill test." While you

work out, electrical instruments measure your heart rate, heart

rhythm, EKG, and blood pressure, and the doctor will note any

other symptom you may have. Added together, all the test data

give a good picture of the state of your heart.



  You can have a normal pulse, and significant coronary artery

disease. Diabetics (and non-diabetics) can have normal EKGs, too,

even in the early stages of a heart attack. One physician told

me: "the absence of electrocardiographic abnormalities does not

preclude the presence of significant heart disease."



  My doctors said that if you have multiple risk factors, like

cholesterol, hypertension, smoking, cardiac arrhythmia ("heart

murmur"), or a family history of heart trouble (another is the

presence of diabetes), you ought to have periodic treadmill

checks, to see how your heart is doing. If you've had diabetes

for 20 years (IDDM or NIDDM) you could benefit from this test. If

heart disease is discovered soon enough, medical intervention can

make a difference.]



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





                        My New Lifestyle



                      by Frederick R. Claus



[Photo: portrait; Caption: Frederick R. Claus]



  My decision to lose weight was a long time coming. I had looked

at those new and "fad" diets, and even tried some of them. It did

not take me long to realize they were not for me--I could not

regulate my life to a piece of paper with food listed on it.



  This bothered me quite a bit, but for me momentous life-

changing decisions just don't come when I try to force them. So I

just quit trying to push the issue. As usual, I had it "working

down inside" and after some time it came to me that what I needed

was not a new diet; what I needed was a new life-style. So I set

about developing one... In fact it is still under development,

and probably will always be!



  One of the things that came to me was that first I needed to be

more flexible. At age 61, one tends to become "locked in" to a

lot of things. This I changed. I am presently causing great

concern to my kids and grand-kids. They now fear for my sanity.

It is the old "Grampa ain't what he always was" syndrome, and

some of them do not know how to handle the changes.



  I examined the way I was living. My wife died back in February

of 1994, and since then I had been merely existing. My meals were

taken where I was, while I was doing whatever. I was a junk food

junkie.



  I talked about my feelings with a very dear friend, last July,

and she gave me some pointers on how she looked at healthy

eating. I began to look more closely at the food on the grocery

store shelves. I began buying the "Healthy Choice" brand of foods

for my breakfast and supper meals, and I quit buying "fast food"

junk such as burgers and fries.



  My meals now consist of:



BREAKFAST: Bowl of Healthy Choice multi-grain cereal, non-fat

milk, and black coffee.



LUNCH: A Garden Salad from Wendy's (or the like) with one

prepackaged dressing, and a Diet Pepsi. (I do not like Coke.)



SNACK WHEN I GET HOME FROM WORK: Usually two hard boiled eggs

and/or an apple.



SUPPER: One of the frozen Healthy Choice prepackaged meals that

just has to be popped into the microwave for a few minutes.

Usually for dessert, I have some low-fat ice cream.



  Recently I have begun to expand my choices for supper. I now

buy codfish, skinless chicken breasts, crabmeat, turkey, and

vegetables such as okra, lima beans, asparagus, broccoli, and

peas. I eat stir-fry vegetables and prepackaged salads. I cook

the fresh things in between the frozen meals as I feel like it.



  And, of course, I have a ribeye steak and baked potato every

once in a while. As you can see my "diet" is very flexible. I

hate regimentation.



  There are times when I do not stick to my diet. I sometimes go

ahead and eat things I know are detrimental to my health. This

Friday I have a dinner date with some friends and depending on

what strikes me on the menu, I may just eat something like a

"Kentucky Hot Brown," which is turkey, ham, bacon, toast, tomato,

SMOTHERED in a very thick rich cheese sauce. (Here's to

flexibility!)



  Oh yes! Another thing I have done is give up hard liquor

entirely. That is probably the biggest difference my kids see in

me. They are used to "dad" sipping away at his "toddies" all

weekend long, and on holidays. But no more--and they find that

strange. I do have a beer now and then, and kinda over-imbibe on

my spring and fall fishing trips with the guys. But for the most

part I leave alcohol alone.



  My exercise is mostly limited to my stationary bike. I "ride"

it in the mornings before work and afternoons right after work

for 15 minutes a session. When I started, I had all I could do to

stay on it for five minutes. It took me about three weeks to get

to 10 minutes and then about three more to get to 15. It has a

little read-out thing that tells me the distance I ride, the

calories I burn, the time I am on it, and the speed I am

pedaling.



  At first I was pedaling at about 8.5 to 9 mph. That has

increased slowly, and now I am comfortably up to a little over 11

mph. In a 15-minute workout, I now travel 2.7 miles, and burn a

little over 110 calories.



  When I began I had enough natural padding on my rear so that

the seat was not uncomfortable. As I grow more fit, I find the

seat getting harder and harder on my butt. I wear sweat pants for

"riding," but one of the secretaries at work recommended I get

regular bike-riding pants to reduce the abrasion problems I am

now having with the seat. She wears them, and she rides hers for

an HOUR every day! I am not looking forward to an hour on that

thing!



  I use a stopwatch to check my heart rate while I am on my bike.

I find it runs around 125 to 130 or so after I have been riding

for five minutes, then it holds fairly steady. Every once in a

while I just go nuts and pedal like a fool, cranking the speed up

to about 12 miles per hour, but I do not hold it there for long,

and it does not seem to adversely affect my heart rate.



  I hope the above has been helpful to you. I probably ought to

tell you that the real incentive for me doing all this is because

I am in love and want to be healthy and live a long time, and

grow very old with the woman I hope to marry in the not too

distant future. I love my darling!



  (From the Editor: Quitting hard liquor improves diabetes

control. "Healthy Choice" frozen meals have the diabetic

exchanges posted on the package. But beware of "fat-free" ice

cream--it isn't SUGAR-free, and it certainly isn't FREE FOOD!

When eating anything high in fat and/or sugar, remember to

"indulge in moderation!")



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





                 Dialogs About Diabetic Dynamos



                         by Debra Frank



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



[Photo: portrait; Caption: Debra Frank]



Cross-Country Skiing



  Although this is the Summer Edition of the 1996 VOICE OF THE

DIABETIC, it's never too early to plan for winter sports. Some of

us, even now, are not quite finished with our snow adventures. In

fact many of us travel the planet, in search of snow and fun. For

the cross-country skier, blind or sighted, "following the snow"

can be a tricky situation, especially if you live in Texas, and

the coldest temperature you are accustomed to is 40 degrees

Fahrenheit! But Linda Moores, from Houston, Texas, has picked up

sports she can enjoy year round. If she has the urge and

opportunity to go sailing, she just might join the gang heading

for New Zealand this year as she did in 1991. But in 1989 she was

introduced to "Ski For Light" (SFL), a program for blind or

mobility-impaired individuals interested in cross-country, or

"Nordic" skiing.



  The SFL program is simple and safe, and allows tremendous

freedom. Participants use conventional skiing gear, and are

untethered, on their own. They set their own pace, and travel at

a speed comfortable to them. A sighted guide is nearby, but only

to warn skiers who drift off the prepared track.



  1995 marked the 20th year of SFL. Many of the participants at

this winter's SFL gathering in South Dakota reflected back on

what they had discovered over the years. One, Annemarie Cooke,

said, "My first hesitant strides on cross country skis five years

ago became one of the most life-changing experiences of my adult

life!"



  Ron and Jo Farra, co-chairs of the Nordic committee for the

North American Ski Journalist Association, have been advocating

and promoting Nordic/cross country skiing for individuals with

disabilities for decades. "Whether they want to compete in the

ParaOlympics or Special Olympics, or they just want to go out and

have some real fun and get fit, Nordic skiing is a safe, truly

full body conditioning activity. Anyone who wants to learn can be

instructed, and if necessary, adaptive equipment will be

provided" says Ron.



  Like many outdoor sports enthusiasts, the Farras try everything

available to them for recreation. They agree Nordic skiing's cost

and relaxed atmosphere are very appealing to families, seniors,

people with orthopedic weaknesses, folks afraid of heights, and

blind individuals like Linda Moores.



  Over the years, Nordic skiing has seen a resurgence of

popularity within the American population. Much of this rebirth

stems from increased interest in the environment, awareness of

overall wellness and health benefits, and the true convenience of

the sport. For a diabetic, the opportunity to participate in such

a terrific low-impact, highly aerobic and muscle-strengthening

activity, allowing the freedom to roam the snow-covered trails at

one's own pace, is truly a gift of nature and God.



  As Linda describes it, "I am able to travel with my companions

at a pace I enjoy, and I am able to slow down and stop whenever I

need. I carry a pack with all my diabetic necessities and there's

room enough for a full course meal to boot!! Cross county skiing

is truly refreshing. The ultimate invigorating sport--it allows

me to burn lots of calories while having lots of fun!"



  When there's an abundance of snow you can get up and

go...anywhere, if you have your own skis. Unfortunately, weather

and snow conditions are not always favorable or reliable for the

ideal Nordic outing. So one must get up and go to where the snow

is abundant. For Linda that might mean going back to New Zealand

for a summer excursion. She'll be touring the thousands of

kilometers of pristine snow--and if I'm lucky she will ask me to

join her. That sounds like a plan to me! Two diabetic females go

a "walkabout" on cross country skis during the heat of the New

York and Texas summers. We may never come back. See you between

the snow flakes!



  For more information on Nordic Skiing contact Jo and Ron Farra:

(518) 584-2256; for more information on "Ski For Light" contact:

(612) 827-3232.



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





                      Diabetic Ketoacidosis



  Dorland's Medical Dictionary defines ketoacidosis as an acid

condition of the blood marked by the presence of ketones, as in

diabetic ketoacidosis (DKA). This dangerous condition can occur

in individuals who have had very high blood sugars

(hyperglycemia) for an extended period of time.



  Remembering that insulin allows the body to digest and utilize

glucose, an untreated type I diabetic with long-term high blood

sugar is literally starving to death, no matter how much food he

or she may consume. Without the means to process the glucose so

overabundant in the blood, the body begins consuming stored fat

and muscle. When the body begins burning its stored reserves,

ketones are produced. Ketone production is normal, especially

during exercise or weight-loss dieting, but the healthy body

excretes the ketones it produces, so there is no harmful buildup.

Diabetes, however, changes the rules.



  The prolonged high blood glucose of untreated IDDM impairs the

kidneys' normal ability to excrete ketones. Serious problems

follow, when unexcreted ketones, products of fat and muscle

metabolization, build up in blood already saturated with sugars.

Such condition can cause diabetic coma, and without immediate

medical intervention, can cause death.



  Although anorexics, hunger strikers, and people marooned for

long periods without food or water, or facing dehydrating

illness, can experience ketosis (ketone buildup in the blood),

DKA, the one-two punch combination of ketosis and high blood

acidity from sustained elevated blood glucose, is particularly

deadly to the diabetic. Ketoacidosis takes time to develop, and

is one more solid argument for tight control and frequent blood

glucose monitoring. If you are ill, or know your sugars have been

running over 240 for some time, you should test your urine for

the presence of ketones. When in doubt, test (several urine-tests

for ketones are available), and remember to keep your health care

team informed. Take care of yourself!



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





                    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.





                     Sugar Free Marketplace



      Not quite everything for sale at the Sugar Free Marketplace

          is good for the diabetic diet. They also sell

          cookbooks, books about diabetes, and diabetic socks.

          The edible products they list, according to the

          catalog, are all made without refined sugar, corn

          syrup, honey or molasses.



      For more information about the many food products offered

          by the Sugar Free Marketplace, or their non-food

          product lines, or for a free copy of their catalog,

          contact: Sugar Free Marketplace, 6710 N. University

          Drive, Tamarac, FL 33321; telephone: 1-800-726-6191.





                          New Magazine



      "Vision Enhancement" is a new quarterly publication

          promising relevant information for both consumers and

          professionals in the vision-impaired community. It

          contains articles on current medical research, the

          latest technological aids, tips on dealing with vision

          loss, and the newest books, magazines and videos of

          interest to the vision-impaired. The magazine is

          formatted in large print, audiocassette, and computer

          disk (with a Braille-translated file for accessibility

          by deaf-blind computer users), and costs (in the U.S.):

          $20 for one year; $35 for two year; $50 for three year

          subscription. Single copies are $6.50 each. Contact:

          Vision World Wide, Inc., 5707 Brockton Drive, #302,

          Indianapolis, IN 46220-5481; telephone: 1-800-431-5481;

          e-mail: patprice@aol.com





                      Diabetes Information



      Through its HealthShare division, the Cleveland Clinic, an

          academic medical center, now offers the following:

          "Diabetes: Your Questions Answered" (booklet), priced

          at $4.95; "Your Diabetes Guide" (manual), priced at

          $24.95; and "Taking Charge of Your Diabetes"

          (videotape), priced at $19.95. All three are available

          as a package, at the price of $44.90. Contact:

          HealthShare, The Cleveland Clinic Foundation, 9500

          Euclid Ave, KK11, Cleveland, OH 44195-5020; telephone:

          1-800-238-6750.





                   New 1995 Food Exchange List



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

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



      This update, the result of a joint effort of the American

          Diabetes Association and the American Dietetic

          Association, reflects the new emphasis on total

          carbohydrate intake, rather than restricting specific

          sugar types. Users should find its new orientation

          simpler, and its meal plans vastly more flexible. In

          its new form, the Exchange List will continue to play a

          pivotal role in dietary self-management of diabetes.



      To purchase, make tax deductible checks payable to:

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

          cassette $2. Order from: National Federation of the

          Blind, Materials Center, 1800 Johnson Street,

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





                         Greeting Cards



      The Iffin Group, a North Carolina-based graphic design

          studio, has just released a series of greeting cards

          for the blind and their families and friends. Created

          by blind artist Mickey Cabe, the cards, called

          "hAndrew," have both visual and embossed elements. The

          cards, which cover a range of selections, have verses

          printed in both Braille and ink. More cards will be

          available in the near future. For information, contact:

          The Iffin Group, PO Box 8847, Asheville, NC 28814;

          telephone: (704) 684-6176.





                          Diabetes Kits



      "Do Your Level Best" is an information kit for both type I

          and type II diabetics, published by the National

          Institute of Diabetes, Digestive, and Kidney Diseases

          (NIDDK). The kit contains a 60-page easy to read

          booklet, and is free upon request. Contact Jere Suter

          at NIDDK; telephone: 1-800-438-5383.



      "Feet Can Last a Lifetime" is the title of two kits, one

          professional, one for patients, available from the

          National Diabetes Outreach Program, part of the NIDDK.

          The professional kit includes two videotapes, a

          5.07/10g monofilament used for peripheral neuropathy

          diagnosis, reprints of journal articles, a doorknob

          reminder card, and a button. Cost is $15 per kit, for

          shipping and handling; quantities of the patient kit

          are available free of charge. Contact NIDDK; telephone:

          1-800-438-5383.





                      Dex-4 Glucose Tablets



      Sold in pharmacies and supermarkets nationwide, Dex-4

          glucose tablets come in lemon, raspberry, orange and

          grape. Each fruit-flavored, easy to chew glucose tablet

          contains four grams of fast-acting carbohydrate, with

          no fat, sodium, caffeine, or cholesterol, and only 17

          calories. These value-priced tablets are available in

          tubes of 10 tablets or economy size bottles of 50. For

          further information, contact your pharmacist or Can-Am

          Care Corporation, Cimetra Industrial Park, Box 98,

          Chazy, NY 12921-0098; telephone: 1-800-461-7448.





                     Blood Collector-Dropper



      Developed for diabetics with unsteady hands and those who

          are blind or losing vision, the new Smart Dot Blood

          Collector-Dropper places the droplet for a glucose

          reading from Lifescan's One Touch II or One Touch Basic

          meter. With a 30-day money-back guarantee, it costs

          $10.95 plus $3.50 shipping and handling. Visa,

          Mastercharge, Discover and AMEX are accepted. To order,

          contact Smart Dot, 2655 West Central Ave., Toledo, Ohio

          43606; telephone: 1-800-984-1137.





                       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.





                      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.





                         Pocket Manuals



      Two inexpensive new pocket reference guides offer portable

          advice to the diabetic. The first, "Charting: The

          Systematic Approach to Achieving Control," by Janice L.

          Roth, RN, BSN, CDE, shows both type I and type II

          diabetics how to analyze their body's responses to

          diet, exercise, and medication, and how to create a

          personalized systematic program for diabetes control.

          Price is $3.95.



      "Eating Out: Your Guide to More Enjoyable Dining," by Hope

          S. Warshaw, RD, CDE, provides tips for eating in all

          kinds of restaurants, without fear of weight gain or

          uncontrolled rise in blood sugar. The book provides

          general guidelines for healthy eating, and shows how to

          select appetizing meals that still meet your diet

          requirements, even in pizza parlors and sub shops.

          Price is $4.95.



      There is a shipping charge of $1.50 per book. Order from:

          "Diabetes Self-Management," Book Division, 150 West

          22nd Street, New York, NY 10011.





                        Diabetes Supplies



      Medi-Mail, inc., of Naples, Florida, is a new, small

          diabetes supply company offering a high level of

          customer service. They bill Medicare and secondary

          insurance carriers, accept assignment, and carry

          sometimes-hard-to-find items like Diascan test strips.

          They carry diabetes literature and information, and all

          their employees have received instruction from diabetes

          educators. For information, contact: Medi-Mail, Inc.,

          1594 Northgate Drive, Naples, FL 33942; telephone:

          1-800-883-9146.



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





                 A New Approach To Heart Disease



                         by Robin McRee



[Photo: portrait; Caption: Robin McRee]



      In a day when the Centers for Disease Control reports that

          diabetics are two to three times more likely to die

          from cardiovascular disease than are non-diabetics, any

          therapy providing lower cholesterol levels and reduced

          fatty deposits in arteries is worth checking into.

          While preliminary animal tests are expected to last two

          or more years for the new heart drug, APO-A1 Milano,

          the time has come to ask if there is something which

          can be started today. The resounding answer is Yes!



      The Preventive Medicine Research Institute, of Sausalito,

          California, in a report recently published in the

          journal "Lancet," showed that meditation and yoga, when

          used in conjunction with a lowfat diet, can actually

          reverse heart disease.



      Recognizing the connection between workplace stress and

          heart disease, some businesses have incorporated

          stress-reduction programs into their daily routine.

          Symmetrix, a consulting firm in Lexington,

          Massachusetts, started one such after its workers

          participated in a program with an instructor from

          Harvard's Mind/Body Medical Institute, where they were

          taught relaxation and meditation techniques. One

          diabetic worker noticed a big health benefit: His

          insulin requirements dropped 15% after using the

          relaxation techniques for only three weeks.



      In July of 1992, Mutual of Omaha, America's largest family

          insurer, became the first to cover the $3500 cost of a

          12-week program of diet, exercise, and stress

          management. Their program was developed by Dean Ornish,

          MD, director of PMRI, who refers to it as a "reversal

          program." Participants eat a vegetarian diet in which

          10% of total calories come from fat, exercise

          moderately, practice managing their stress through

          meditation and yoga, and take part in support groups to

          help them stick with their new lifestyle changes.



      In three studies over the past 17 years, both privately-

          funded and by the National Institutes of Health, Dr.

          Ornish's program has proved it doesn't just slow down

          heart disease, but can in fact reverse it. So my

          question is this: Why sit idle waiting for a new heart

          drug when healing can begin today?



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





                 The Culture Of Misunderstanding



            (An Open Letter To The People At The Top)



                   by Peter J. Nebergall, PhD



      A person's conception of his role, capacities, and

          appropriate behavior, is part of his culture. It is

          learned behavior, enculturated, picked up from parents

          and peers. His attitude toward the capacities of others

          is equally part of his culture. Assimilated early, it

          becomes part of his character, the standard by which

          new information is judged.



      He may be taught that a black skin is a badge of

          inferiority, or that a white cane is a symbol of

          inability. In his culture, such views are

          "appropriate," and he is in conformity with his fellows

          to hold them. But consensus, while a sign of agreement,

          is no guarantor of accuracy--and if his views limit

          others from the full realization of their capacities,

          such consensus cannot be seen as beneficial to the

          culture as a whole.



      There are still peoples today who view disability as a

          reflection on an individual's ancestry, or as

          punishment for sin. In some of these groups the very

          existence of a family member who is "not whole" is an

          insult to the family--so these folks keep their

          disabled out of sight, out of mind, or worse. But what

          of the "civilized" world? To what degree are our

          interactions, and those of our fellows, predisposed by

          inappropriate attitudes assimilated long ago? And for

          those of us in positions of power and public policy,

          how many of our decisions are shaped by old ideas of

          inappropriateness, inferiority, and inability?



      If I am raised to believe that person A, by definition,

          cannot do job X, I am not likely to spend much time

          working on ways to provide him or her the means to do

          so--because, by definition, members of that group

          can't. If I am a racist, and I think a group is stupid,

          I am not likely to worry about their lack of management

          opportunities--as by definition they are not qualified

          to hold them. If I have been taught that blindness =

          clientage, a lifetime of subservience to sighted

          custodians, I am not likely to look with favor on

          alternative interpretations. And, who cares what these

          affected groups think--if I think this way, if I was

          raised to believe this, I will resist change--because

          my beliefs are part of my culture.



      So what does it take to change the culture of

          misunderstanding? First, we all need to confront our

          own cognitive maps. What do we believe? What are our

          convictions about the abilities of others? Everything

          must be on the table, so we can really learn what we

          think. I am convinced that a great many people whose

          viewpoints drive others to tears and fury are genuinely

          unaware of the faulty premises upon which their views

          are based.



      Let us become aware. Let us open our eyes to the facts, to

          the achievements of those we used to think couldn't

          handle the mainstream. When we become aware of each

          others' abilities, we will stop inflicting upon them

          our old ideas of inappropriateness, inferiority, and

          inability. This is our urgent responsibility.



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





                        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.





                       New Insulin Update



      On February 29, Eli Lilly and Company's new Humalog insulin

          (generic name Lispro) was unanimously recommended for

          marketing clearance by an advisory panel of the U.S.

          Food and Drug Administration. All that remains is for

          the FDA to settle the administrative details, such as

          the specifics of labeling and packaging. Final approval

          should come some time this year.



      This new quick-acting insulin is very different from past

          formulations, and the FDA review panel recommended that

          Humalog initially be available only by prescription.

          Traditional "R" insulins start to act about 30 minutes

          after injection (different people will react at

          different rates) and peaks in about 3.5 hours. Humalog

          starts up in 10 to 15 minutes, and peaks in one hour,

          much more like the insulin secreted by the healthy

          pancreas of a non-diabetic.





                           Hot Insulin



      Summer brings hours of fun, at the beach, the park, the

          mall, or wherever, and you may find yourself carrying

          extra insulin. That's a good idea, but remember that

          insulin is very sensitive to extremes of temperature.

          Remember last time you got in your car after a day in

          the summer sun? It was an OVEN.



      A closed car in the summer sun can get up to 140 degrees

          Fahrenheit--hot enough to kill your dog, and hot enough

          to cause physical changes in the insulin you left in

          the glove compartment.



      How hot is "too hot?" A good rule is, if it's too hot for

          you, don't leave your insulin there. If you let that

          insulin get hot, and then use it, you may find it isn't

          working, and your sugars are going up fast! Exposure to

          freezing, or to high humidity, can also damage your

          insulin. Be prepared to replace doubtful insulin--it's

          cheaper than an ambulance call.





                       NFB on the Internet



      The National Federation of the Blind has a homepage on the

          World Wide Web. At this website you can learn more

          about our organization and its services, or review our

          national publications. From the homepage, you can also

          access VOICE OF THE DIABETIC.



      To get to the NFB homepage, enter the following address at

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

          VOICE from the NFB homepage, follow the link for

          "diabetes," and then the link for VOICE OF THE

          DIABETIC.





                  Choosing Finger-Lancing Sites



      The Diabetes Control and Complications Trial ushered in the

          era of "tight control," with multiple injections and

          LOTS of blood-glucose testing. People are sticking

          their fingers more often, and to avoid sore fingers,

          calluses, etc., it is necessary to rotate test sites.

          How do you keep track of where you should put the

          lancet next?



      Ann S. Williams, MSN, RN, CDE, herself a type II diabetic,

          chooses her test sites by day of the week and time of

          day. Her left index finger is for Monday, left middle

          finger for Tuesday, left ring finger for Wednesday,

          etc. On each finger, the side toward the thumb,

          opposite the base of the fingernail, is for fasting,

          the other side opposite the base of the fingernail is

          for suppertime, and the same side, opposite the middle

          of the fingernail, is for bedtime. Any extra tests are

          done in the area around the top of the fingernail.



      She writes: "By using this method, you end up lancing the

          same site only once a week. I like doing it this way

          because I have such a hard time remembering where I

          last lanced, and this way I can figure out where I am

          supposed to be by day of the week and time of day...but

          when I wake up and can't remember what day of the week

          it is, I am in trouble."





                 Diabetes Information on the Web



      Tom Baccanti, owner of "The Outpost," a World Wide Web site

          for the blind, announces a new, very comprehensive,

          resource page for diabetics. Packed with cross-links to

          major diabetes information providers, it joins his many

          other pages keyed to major issues about blindness. He

          invites readers to: "Please use this page and let me

          know if there is anything you can't find there, and I

          will hunt it up for you."



      Access "The Outpost" at http://www.deltanet.com/users/tdb.





                       Medicare Question:



      Q: Why do some doctors send bills only to Medicare and not

          to secondary insurance? Some doctors send to both. This

          is very confusing and always takes longer to work

          things out.



      A: The government requires doctors to submit claims to

          Medicare for you. The government does not, however,

          require doctors to send claims to secondary insurance.

          Medicare does forward some claims to Medigap insurers

          or crossover companies. If you have secondary

          insurance, your doctor should include this information

          on the claim. If it is a company we forward claims to,

          Medicare will send the proper information to your other

          insurance.



      (From "Beneficiary News," Vol. 5, No. 1, Spring 1996,

          published by

Medicare.)





                    "A Touch of Sugar"...or?



      Too many folks, both health professionals and patients,

          diminish the seriousness of type II diabetes, calling

          it just "a touch of sugar." Such description encourages

          inaction, and discourages the diabetic from adopting

          appropriate measures to deal with his or her

          hyperglycemia. It also misses a major point: Excess

          sugar in the blood (uncontrolled high blood glucose) is

          acidic, destructive, and behaves much like a poison. So

          let us imagine a different scenario--would anyone

          deprecate the threat posed by "a touch of arsenic?"



      Of course that statement is ridiculous...or is it? If blood

          glucose tests reveal an abnormally high level of sugar

          in your blood, you need to take appropriate measures to

          get it under control and keep it there, just as if you

          caught someone feeding you arsenic, you'd make them

          stop, NOW!



      So laugh at the old fogies who still talk about "a touch of

          sugar," and keep your blood glucose under the best

          possible control. It's worth it.





                              Fat!



      When nutrition is discussed today, the topic of fat seems

          to be at the center of the discussion. The reason is

          simple; high fat diets have been linked to health

          problems and weight gain.



Where's the Fat?



      When we think of fat, we think of things like salad

          dressing and butter. But there is fat in almost all

          foods. Some you can see, like the fat on meat, but some

          is hidden, as in cheese, chocolate, and baked goods.



What's Wrong with Fat?



      Fat is high in calories. Eating fat can make your body

          produce more cholesterol, a waxy substance that can

          build up in the blood. Fatty deposits then build up in

          the arteries, blocking normal blood flow. (Editor's

          Note: This is especially true for diabetics!) A low fat

          diet can help keep your blood vessels open, and may

          also help to prevent colon, prostate, and breast

          cancer. Too much fat in the blood seems to inhibit the

          body's ability to protect itself from damage.



Not All Fats are Created Equal!



      Cholesterol levels can be lowered, and your risk of heart

          disease reduced, by cutting back your intake of fats.

          There are two classes of fats, and one is more harmful

          to your health than the other. Cholesterol and

          saturated fats are the hardest on your health.



      Saturated fats include butter, coconut and palm oil, and

          the fat in meat and cheese. These fats raise blood

          cholesterol. Total saturated fat is shown on the

          nutrition label. Try to eat as little saturated fat as

          possible.



      Unsaturated fats include olive, canola, corn, and sunflower

          oils, and the fat in nuts, olives, and avocados. These

          fats are not as bad as the saturated ones, but they're

          still high in calories, so use them sparingly.



How much Fat?



      Keep the total amount of fat (shown on the food label in

          grams) within the following ranges:



      Men: To maintain weight, no more than 60-90 grams daily. To

          lose weight: 40-60 grams daily.



      Women: To maintain weight: 40-70 grams daily. To lose

          weight: 25-40 grams daily.



      No more than 20-30% of your total calories should come from

          fat. You need to watch both type and total amount you

          eat.



      (Thanks to Boone County Council on Aging, Columbia, MO, for

          this information.)





                          The Lemon Law



      In June of 1995 Missouri joined the ranks of states

          providing one-year warranty and "lemon" protection to

          purchasers of certain assistive devices used by persons

          with disabilities. The law defines an "assistive

          device" as: "Any device used by a person with a

          disability to assist in performing a major life

          activity...including, but not limited to,

          motorized/manual wheelchairs, scooters, hearing aids,

          telecommunication devices, speech synthesizers,

          scanners, and other devices which enable a person with

          a disability to see, hear, or maneuver.



      To qualify as a "lemon," an assistive device must undergo

          repair for a substantial defect four times within the

          one-year warranty, or must be out of service for at

          least 30 days of the warranty period. The defect must

          be of the device itself and not the result of consumer

          abuse.



      As the Americans with Disabilities Act (ADA) defines

          diabetes as a disability, Missouri's new "lemon law"

          may shortly be extended to diabetes self-management

          equipment such as glucometers. When it does, or when

          other states join in extending this broad protection to

          the disabled, VOICE OF THE DIABETIC will report it.





                        Diabetes Hotline



      The Lifescan Tele-Library offers recorded diabetes

          information in English or Spanish. Subjects covered

          include symptoms, complications, and ways to manage the

          disease. To access this resource: call 1-800-847-7226.





                            Glaucoma



      Glaucoma is an increase in fluid pressure inside the eye.

          It can quickly bring about optic nerve damage and loss

          of vision. Glaucoma occurs twice as frequently among

          diabetics as among non-diabetics. If caught early,

          glaucoma is treatable, but no medical procedure can

          restore what is already lost.



      The National Eye Institute urges you to get your eyes

          examined, through dilated pupils, every year. Do not

          wait until the onset of vision difficulties to get your

          eyes examined! For more information contact: National

          Eye Health Education Program, 20/20 Vision Place,

          Bethesda, MD 20892-3655; telephone: (301) 496-5248.





                         Internet Access



      We have been asked to announce: National Braille Press

          announces release of COMMO, an internet access program

          that works well with speech and Braille. COMMO is a

          shareware program, priced at $40 ($30 for students).

          Free evaluation copies are available on some electronic

          bulletin boards.



      National Braille Press has also prepared a reference card,

          in Braille, for users of COMMO. The card is priced at

          $5. For information, or to order, contact: National

          Braille Press, 88 St. Stephen Street, Boston, MA 02115;

          telephone: (617) 266-6160.





                   What is Diabetes Insipidus?



      As if the types and terms of diabetes mellitus were not

          enough to remember, there is an unrelated medical

          condition also called "diabetes." This is diabetes

          insipidus.



      Diabetes insipidus (DI) results from the body's inability

          to properly retain and concentrate urine, so the

          kidneys just keep flushing it out. The word "diabetes"

          in this case refers to the very rapid flow of water

          through and out of the body. The sufferer's urine is

          almost colorless and odorless. Unlike the more common

          diabetes mellitus, this condition does not alter blood

          glucose levels.



      The cause of this incontinence is in the pituitary gland,

          located in the brain. Normally the pituitary secretes a

          hormone called vasopressin, which acts on the kidneys

          to retain water, allowing concentration of urine. If

          this hormone is absent or in short supply ("central

          cranial DI"), or if the kidneys fail to respond to its

          commands ("nephrogenic DI"), large volumes of dilute

          urine will be passed.



      Although the impact of diabetes insipidus is benign

          (provided one ingests enough fluid to replace urinary

          losses), such is not always possible. When a person

          with DI is unable to ingest sufficient fluids, severe

          dehydration can result.



      Central cranial DI can be treated with DDADP (desmopressin

          acetate antidiuretic replacement therapy), administered

          by nasal spray.



      Diabetes insipidus is fairly rare, and is unrelated to

          diabetes mellitus, but one can have both conditions. Of

          course men who have unexplained urinary incontinence

          should consult their doctor, as prostate difficulties

          can cause some of the same symptoms.





                  Free Diabetes Alert Necklace



      The Diabetes Wellness Network offers free medical emergency

          necklaces for diabetics. The necklace reads: "I have

          Diabetes--please test my blood before treating me," and

          may help save your life. Part of the Diabetes Research

          and Wellness Foundation, the medical jewelry program is

          100% free to diabetics. For information contact:

          Diabetes Wellness Network, PO Box 3837, Merrifield, VA

          22116-3837.





                            New Study



      MiniMed, Inc., of Sylmar, CA, a maker of insulin pumps, is

          currently testing a new type of blood glucose monitor.

          Where current monitors require a "finger-stick" and

          blood sample for each measurement, and provide only

          intermittent readings, the new sensor, inserted under

          the skin, would provide a continuous readout. Minimed

          plans for the glucose measurement data to be displayed

          on a pocketable or wristwatch-sized device, which will

          contain alarms for "too low" and "too high." Clinical

          trials of the new device are scheduled to start late

          this year, and if all goes well, the device may be

          available in 1998.



      VOICE OF THE DIABETIC will report on the results of

          clinical trials as they become available.





                      Sports for the Blind



      BLINDSPORT is a new e-mail list dealing specifically with

          sports for the blind. Topics may range from

          announcements of upcoming tournaments, how to make

          sports more accessible to the blind, results of

          tournaments and events, sports training camps, and any

          other related topics.



      To subscribe, send e-mail to: jmeddaugh@cris.com, stating

          that you want to subscribe to the BLINDSPORT list. This

          is not a LISTSERV address, so do not send LISTSERV

          commands. Be sure to state the name of the list that

          you are subscribing to, as several lists are run

          through this same address.





                        Syringe Disposal



      We have been asked to announce: The B-D Home Sharps

          Container provides a safe and convenient receptacle for

          disposal of used insulin syringes and lancets. This

          1.5-quart leak-proof container holds 70 to 100

          syringes, helping to protect the user and the

          environment. Suggested retail price is $2.22 each. B-D

          also offers the Safe-Clip needle remover, which safely

          removes the needles from used syringes prior to

          disposal. Suggested retail price is $3.10.



      For further information, contact your pharmacist or Becton

          Dickinson Consumer Services, One Becton Drive, Franklin

          Lakes, NJ 07417-1883; telephone: 1-800-237-4554.





                         Renal Self Test



      Doctors have known for some time that the presence of

          protein in the urine is a warning sign, and may

          indicate kidney problems. You can take this test

          yourself--first thing in the morning, before any

          physical exercise. If you get positive results two out

          of three times, call your doctor.



      Miles, Inc. (now Bayer) makes a product called "Albustix,"

          which works much like the old urinalysis glucose test

          strips--only it tests for protein. Priced at $39.69 (at

          Walgreens), the product is available from Bayer

          Corporation, Diagnostics Division, Elkhart, IN 46515;

          telephone: 1-800-348-8100.





                 New Program For Blind Diabetics



      The Colorado Center for the Blind announces a new program

          for blind diabetics and those losing vision.

          Recognizing that blind diabetics face a unique set of

          challenges, the Center's new three-month intensive

          program (offered four times a year, and you don't have

          to live in Colorado) will focus on further development

          of skills and attitudes necessary for full

          participation in the mainstream.



      For the first six weeks, participants will attend classes

          covering: Medical implications of diabetes, adjustment

          to blindness, planning for the future, creating a

          healthy lifestyle, and strategies for setting and

          achieving personal and vocational goals. Both medical

          professionals and blind diabetics will offer

          presentations.



      In the second segment of the program, individual

          participants will work, in their own home environment,

          with members of the Center staff, translating lessons

          learned into practice, and implementing their goals for

          community and vocational involvement.



      Regardless of ramifications, blind diabetics can draw their

          own insulin, test blood glucose, and perform all the

          other tasks of independent diabetes self-management.

          They are not alone. The techniques and technologies are

          there; programs like this one can help provide the

          necessary knowledge and positive attitudes.



      For information contact: Diane McGeorge, Program

          Coordinator, The Colorado Center for the Blind, 1830

          South Acoma Street, Denver, CO 80223-3606; telephone:

          1-800-401-4632 or (303) 778-1130.



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





                          Board Members



      The Diabetics Division of the National Federation of the

          Bind. (You may contact these leaders through our

          Editorial Office.)



President: Tom Ley, Baltimore, MD



First Vice-President: Ed Bryant, Columbia, MO



Second Vice-President: Janet Lee, Cedar, MN



Treasurer: John Yark, Stamford, CT



Secretary: Sandie Addy, Prescott Valley, AZ



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





                        What's Coming Up!



      The next issue of the VOICE will include: ways to prevail

          over impotence, information about the glycosylated

          hemoglobin (A1c) test, and many other personal and

          newsworthy stories.



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





                           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 142,000+, offers such an outlet. Make your

          voice heard. For advertising information contact: VOICE

          OF THE DIABETIC, Ed Bryant, Editor, 811 Cherry Street,

          Suite 309, Columbia, MO 65201-4892; phone: (573)

          875-8911



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





                   SUBSCRIPTION/DONATION FORM



      The VOICE OF THE DIABETIC is a free quarterly news magazine

          published by the Diabetics Division of the National

          Federation of the Blind (NFB) for anyone interested in

          diabetes, especially diabetics who are blind or are

          losing vision. An outreach publication, it emphasizes

          good diabetes control, proper diet, independence, and

          positive outlook.



      Donations are gladly accepted and appreciated.

          Contributions are not only tax deductible; they are

          needed to keep the VOICE and the Diabetics Division

          moving forward; helping people with all aspects of

          diabetes.



      Members of the NFB Diabetics Division enjoy priority

          services and unique benefits such as a continuous free

          subscription to the VOICE, automatic access to

          committees covering all aspects of diabetes, free

          counseling concerning all facets of blindness and

          diabetes, as well as access to diabetics who have

          experienced complications.



      The VOICE is free to any interested person upon request.

          Each subscription costs the Diabetics Division

          approximately $20 per year. To help defray publication

          expenses, members are invited, and nonmembers are

          encouraged, to cover the subscription cost.



      To begin receiving the VOICE, please check one:



[ ] I would like to become a member of the NFB Diabetics Division

    and receive the VOICE OF THE DIABETIC. (Members are entitled

    to special benefits.)



[ ] I would like to receive the VOICE OF THE DIABETIC as a

    nonmember. (Nonmembers are encouraged to pay the

    institutional rate of $20/one year; $35/two years; $50/three

    years.)



Send the VOICE in (check one):



[ ] print



[ ] cassette tape for the blind and physically handicapped

    (recorded at

slower-than-standard speed of 15/16 IPS)



[ ] both



Optionally check this box:



[ ] I would like to make (or add) a tax-deductible contribution

    of $__________ to the Diabetics Division of the NFB.



Please print clearly



Name: __________________________________________________



Address: _________________________________________________



__________________________________________________



City: ______________________ State: _______ Zip: __________



Telephone: ( )________________________



Send this form or a facsimile to:



Voice of the Diabetic

811 Cherry Street, Suite 309

Columbia, MO 65201



Please make all checks payable to:



NATIONAL FEDERATION OF THE BLIND



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



End of VOICE OF THE DIABETIC, Vol. 11, No. 3, Summer 1996 Edition















































































