Surgery Worked for Him

I developed diabetes more than 20 years ago (because of my weight I assume, since it does not run in my family). I was doing so poorly that I took 150 units of NPH in the morning and 150 units at night, plus oral meds. My diabetes was never under control. This went on for many years while the doctor changed my insulin and medications, but still I was not under control.

In 2005, I had shot up to 370 pounds at  my height of 5'10". I met with doctors who suggested a bariatric bypass. I had the procedure done in September of that same year.

Since then, I have lost more than 150 pounds, and for more than a year now, I have not taken any kind of diabetes medication—no oral meds, no insulin. My blood glucose level is now 115 or less, and my A1C is never over 5.8. This is after 20 years of dealing with diabetes.

For me, having this operation was well worth it.

Stuart Fisher
Tamarac, Fla.

Editor’s Note: You can read more about gastric bypass surgery in “Slimming Surgery: Sorting Hope from Hype.”

California’s Failure

I read the article “Victory in California” (Dec. ’07, p. 47) with interest. It is terrible that children with diabetes have not been able to attend school because diabetes care was not provided. California should provide a certified school nurse in each school.

In addition to diabetes, there are many medical conditions kids have that require skilled nursing care. In the long run, this action will save money. A nurse’s salary is cheaper than the cost of hospitalizations, a parent paying for private school, or a lawsuit. Most important, the health and safety of children will be ensured. A certified school nurse would provide diabetes care and educate the staff about diabetic emergencies. A nurse can recognize the subtle signs of high or low blood glucose, and take action before an emergency evolves.

I know this works. I have had diabetes for more than 40 years. I attended New Jersey public schools and was well cared for. My parents did not have to worry. Now I am providing diabetes care to schoolchildren as a certified school nurse.

Sue Flicker, RN, BSN, CSN
Estell Manor, N.J.

Glitazone Questions

I’m confused after reading “Glitazones and Your Heart, Revisited” (Dec. ’07, p. 23). Perhaps other readers are too. How can Actos cut the risk of heart attack and stroke and not be associated with increased risk of death from heart failure or heart attack if it increases heart failure by 41 percent? What is the definition of heart failure? Since adding Glipizide to Actos and metformin, my husband’s blood sugar readings are more in control. But, seeing what “heart failure” did to my dad, I am very concerned.

Bonnie Parrish-Kell
Las Vegas, Nev.

Craig Williams, PharmD, responds: Congestive heart failure occurs when the heart doesn’t pump as well as it should, which can cause fluid back-up (inducing swelling and fluid in the lungs). A heart attack, however, is a sudden blockage of an artery supplying blood to the heart muscle.

Acute symptoms of congestive heart failure (CHF) that require hospitalization are called CHF exacerbations—the symptoms are worsened, but still exacerbations are seldom fatal (less than 5 percent of the time). Patients often fully recover.

Examples of exacerbations include acute shortness of breath with some fluid in the lungs, or ankle or leg edema (swelling). This explains how glitazones can increase the risk of heart failure, but not necessarily death from heart failure.

Drugs such as glitazones that cause mild fluid retention could reasonably be expected to increase exacerbations without affecting mortality, as long as the underlying function of the heart is still good.

Unfortunately, there is still a lot that we do not understand about these drugs. There remains some debate as to whether or not the increased rate of hospitalization for heart failure is a result of benign fluid retention (which can be caused by glitazones), or if some sort of underlying cardiac dysfunction might be at work in some people.

Calling Out Kid’s Menus

Your magazine often gives me good ideas to share with my customers who are diabetic; however, I think the article “Dinner for Two” (Dec. ’07, p. 24) needs some tweaking.

I liked most of the suggestions on how to control portion size, with the exception of the tip to “Eat like a kid” and order from the children’s menu.

If you’ve looked at a children’s menu in most restaurants, these items are usually highest in fat and come with few vegetables.

I wouldn’t recommend that diabetics order chicken nuggets, hot dogs, hamburgers, or pizza over salmon or pork.

I would encourage them to either have a clear soup or salad and an appetizer instead of an entree, or ask the server if they can order a smaller sized portion of the entree, priced accordingly.

I hope that some day more restaurants will serve better food to children.

Leah McGrath, RD, LDN
Black Mountain, N.C.

CGM, Con and Pro

I read the letter in the Dec. ’07 issue (p. 11) about one man’s success with continuous glucose monitoring systems (CGMs) and was shocked to hear of someone with a positive story.

Calibrating is the first hurdle. You cannot calibrate your system if you have just administered a bolus, if your blood glucose has gone up or down 20 to 40 points in the last 20 minutes, if you are getting ready to be active, or if you recently have eaten or are about to eat. It was extremely hard for me to find that perfect time at least twice per day.

The sensor was often inaccurate, and I lost far more sleep with it because it would go off, frequently being wrong. I never knew when I could trust the sensor and when I could not. Therefore, I was doing far more blood glucose checks than before—not fewer.

I felt my blood glucose stayed high longer than if I had not been using a CGM. Also, the sensors were uncomfortable and kept flopping around. It took longer to heal from the sensor site than from a pump site. I was so glad to get rid of the sensor. My numbers got no better and in fact, my A1C went up while I was using it.

I hope they get the bugs worked out of this product because it would be such a help if it had worked.

Denise Payne
Via the Internet

I was diagnosed with type 1 diabetes when I was 12. Last summer, I purchased a CGM, knowing that Medicare was still debating their value. I wanted to evaluate the system myself before filing a claim.

It has been a tremendous advantage in managing my blood glucose. The low and high alarms help remind me to take action to control my blood glucose levels. I have reduced my peaks and valleys by changing my bolus timing. I no longer have to get up every two hours each night to test, because the CGM will wake me if I am too high or too low. Life, and control, are better.

CGM usage, like pumping, is not for everyone. It takes a commitment, and a willingness to work with the technology, to be successful. And certainly, improvements are needed.

It would help to reduce the size of the sensors and receivers. It would help to make the sensors last longer and cost less. It would help to make them noninvasive—and it will help when Medicare and others offer coverage.

Gary R. Taylor

Via the Internet