Admiring Randy Jackson

Thank you to Randy Jackson for "keeping it real" for people with type 2 diabetes [Feb. '09, p. 51]. As a fellow participant in the I Know Diabetes campaign sponsored by the American Heart Association, I can attest to his selfless dedication to educating people about the important connection between diabetes and cardiovascular disease. Besides being a great judge on American Idol, he is a very nice man who is reaching out to his "peeps" and telling them it is OK to back away from the buffet table and get familiar with portion control and the treadmill. I applaud Randy for using his popularity to help remove roadblocks for people trying to manage and control type 2 diabetes.
Barbara Johnson
Chanhassen, Minn.

Keeping Infusion Sets in Place

In the November issue, one of your readers wrote that she has trouble keeping her infusion sets in while riding her motorcycle [Ask the Experts, p. 20]. I am a mother of two diabetic sons (ages 8 and 11) and have used many different infusion sets over the past four years. I absolutely love the Cleo infusion sets because my children don't have to see the needle while waiting to change their sites.

I had the same problem with getting the infusion sets to stick and have the solution: After you have inserted the set, keep the insertion device on for three to five seconds before attempting to remove it. Before removing it, gently rock the purple insertion device back and forth about five or six times. Then, during the last rock, gently tilt the cartridge to the side. The set will stay in, and the insertion device can be thrown out. Do not pull straight up because that takes the site out. Works every time!
Alice A. Williams
Kansas City, Mo.

I have been using the pump for about a year and have been using IV Prep antiseptic wipe, manufactured by Smith & Nephew. It has about 70 percent alcohol but feels sticky when applied to the area where you want to insert the infusion set. I have never once had my insertion come out. I take showers with the insertion set in with no problem, and I change it every two to three days.
Judy Levine
Queens, N.Y.

Before Choosing a Pump

I just read your January issue "2009 Resource Guide" and have a suggestion. When comparing insulin pumps, people with diabetes should also consider customer service. It's as important a part of a supply company as the service department is in an automobile dealership. Things to consider would be:

Does the company have a Web site where you can get information about alarms and how to work through them (i.e., for those times you are unable to call the company)? How long does the after-hours support phone number at the insulin pump company ring before someone answers? Does the person who answers the phone know anything about insulin pumps, or is the call taken by an answering service? If the number leads to an answering service, what is the average length of time before a representative of the insulin pump company calls back? If the insulin pump company has to send a replacement part, how does it send it—overnight or by regular mail? Is there a charge for overnight shipments?

These items came to mind recently when part of my insulin pump malfunctioned while I was on a cruise. The e-mail I sent to the company didn't get through because the company's e-mail system was not working. I called the insulin pump company twice about the problem I had. Both times the phone rang five to six times, and then it went to an answering service. Eventually I found out that a piece of my pump was defective and that the company would have to send me a replacement part, which seven days later still had not arrived. I find this to be very poor customer service. 

For someone considering getting an insulin pump, the manufacturer's customer service should be a factor in the decision.
Meshell Lavina
Plano, Texas

Temperature Ranges for Meters

I use your annual Resource Guide (Jan. '09, p. 31) to learn about new products and to compare the products I currently use with others that might work better for me. I was disappointed to see that the section on glucose monitoring did not include temperature ranges in which the monitors work most effectively. 

I enjoy hiking and backpacking, and I need a meter that will operate in temperatures outside what is typically found in the home. I have become accustomed to putting my meter in my sleeping bag overnight, to protect it from the cold, which makes it immediately operational in the morning. There have been times, however, when I have had to warm the meter for a period of time before it would operate. I believe that including a column showing the operational temperature ranges of meters would be very helpful to your readership. 
JoAnn Launt
Cooperstown, N.Y.

The Editors respond: Most blood glucose monitors operate within a wide temperature range. For example, representatives say that Wal-Mart's ReliOn Ultima meter should be operated in temperatures between 50 and 122 degrees Fahrenheit, and Diagnostic Devices meters and test strips operate from 50 to 104 degrees. Home Diagnostics TRUE products operate between 50 and 104 degrees.

A Supplement Fan

I would like to add something to the answer supplied by Craig Williams, PharmD, in the January Ask the Experts column ["Is Glucosamine Safe for Me?" p. 16].

I am a diabetic, and several years ago I couldn't tie my shoes, nor could I walk across the floor very easily, before I started to take a supplement containing glucosamine. However, since taking this supplement every day, I can now easily bend my knees, and I can walk without any difficulty.

The downside is that the medication did increase my blood sugar, but that was easily remedied by taking a bit more insulin. I would highly recommend this to anyone who is having joint problems.
Lola Volpe
North Hollywood, Calif.

Craig Williams, PharmD, responds: Data from blinded, controlled research studies don't support the effectiveness of these supplements. However, there are many case reports similar to Ms. Volpe's in which people have experienced success taking supplements like this. The main point to remember for anyone taking glucosamine or similar supplements is that blood glucose elevations should be minor, and are often easily handled as long as monitoring is ongoing.

Reading Up on Diabetes

I noticed in your January issue that you had an article ["Handbook for Health," p. 75] about a recently published book for people with diabetes. I think this is a great item to have in the magazine. There are a lot of books out there about diabetes, and it is hard to tell if a certain book will have what you are looking for. I hope this will be a regular feature each month.

I also always look forward to the Resource Guide. It is one of the ways I find out about new products for diabetes care. 
Richard Kern
Claremore, Okla.

Give Teens Some Credit

I could hardly believe the sentence highlighted from the Guest Editorial in the December 2008 issue [p. 11]: "Poor adherence to diabetes management is an obstacle to successful intensive treatment in adolescents and young adults with type 1 diabetes."

As the mother of two teenage type 1 diabetics, I was outraged. How dare you assume that "poor adherence" is to blame? The age group you describe includes 15- to 24-year-olds. This encompasses, for many young adults, the period of puberty, high school, and college. Don't you think that maybe those factors make it more difficult to achieve success?  Speaking of "success," did these test subjects make it through to their 25th year and beyond? If so, let’s not consider them unsuccessful. They maneuvered through adolescence and young adulthood and are still taking care of themselves every day.

My teens use insulin pumps, have A1Cs between 5.5 and 7.5 on a consistent basis, and serve as excellent role models for three younger children in our community who also have type 1. They are independent in their diabetes management and need only a few reminders during stressful times to maximize their care.

It is very disheartening to read articles that assume "poor adherence" is to blame for lack of success.
Karen Murner
Versailles, Ky.

Henry Rodriguez, MD, responds: Unfortunately, despite the efforts of caring and invested parents, adolescents and young adults not uncommonly suffer from "diabetes fatigue." Young adults with type 1 diabetes must not only cope with the typical stresses associated with establishing their own identity and independence, but they must do so within the constraints imposed by their disease. They're also faced with the challenges of fitting in with their peers. Poor adherence to a diabetes care plan is not infrequently the result of these obstacles.

Kids like yours who are working hard to maintain good glucose control should be commended for this accomplishment, and are lucky to both be personally capable and to be growing up in a supportive home. I wish that all of our patients were so fortunate.

The incidence of what we in the  medical profession call "poor adherence" to a diabetes care plan is unfortunately fairly common among adolescents and young adults with type 1 diabetes. Those of us engaged in assisting these young people in the management of their diabetes do not view this as a failure on the part of them and their families. We view poor adherence as a reflection of the challenges that they face and of the need to develop better approaches to assist them. It's a subject of intense study, through which we hope to better understand this transition period for adolescents, and better assist families in their journey through it.

Avandia and Bone Density

Last spring I was walking with friends on a flat, smooth sidewalk when I felt my ankle turn. I fell, landing mostly on my right knee and right hand. Although I experienced only a little pain, I apparently had severe damage, including a slight fracture of the left ankle (which may have caused the fall), a broken right kneecap, and a completely shattered right shoulder. The orthopedic surgeon was surprised at the amount of damage inflicted by a simple fall.

Several months later I had my regular visit with my diabetes doctor and told him of my fall. He immediately took me off Avandia, which I had taken for more than 10 years, having been one of those who tested the drug for several years before it was approved. He told me that people taking Avandia and Actos in long-term trials had begun to experience  fractures, especially older women, and especially in the hands, feet, and upper arms.

I write this to warn others taking either of these drugs to have bone density tests done and to be sure to take the recommended dose of calcium and perhaps Fosamax if suggested by your doctor.
Jane M. Tripp
West Grove, Pa.

The Editors respond: Ms. Tripp is correct that Avandia and Actos have been shown to be linked to fractures in women. Treatment with rosiglitazone (Avandia) and pioglitazone (Actos) may decrease bone density and increase the risk for fractures in women. Therefore, these agents may not be the best choice for women with low bone density or who are otherwise at increased risk for fracture.

My Diabetes, My Responsibility

Your December 2008 article "Surviving the Holidays" [p. 35] contained some good information on how to keep one’s diet under control. But I strongly disagree with the recommendation to ask a host to make special dishes to accommodate someone with diabetes.

It is hard enough for someone to host a get-together, and I would never put additional stress on a friend or family member to provide foods that fit into my diabetes diet. What if every guest made a similar request?  No one would ever want to host a get-together again. 

It is my diabetes and my responsibility to eat correctly, no matter what type of food is served.
Ellen Burleson
Canyon Lake, Texas

Congrats from Canada

Way to go for 60 years of Diabetes Forecast! I found out about the magazine just after I found out I was diabetic, in February 2007. It has been a learning experience the past two years. The magazine gives me some new information that I might not otherwise get here in Canada. Keep up the good work.
Shelly Jardine
Vancouver, B.C., Canada