Life With the Pump

Thanks for the "Pumped Up" article by Linda Rath in your March issue [p. 43]. I have been on an insulin pump since April 25, 1980, shortly after the pump first became available. The original pump I had was metal and weighed 1 pound. The syringe was on the outside of the pump together with two knobs, which were the controls. There was also a red light to let you know the pump was working. I had to have a cloth cover made so I could keep the red light covered in theaters and other dark places.

Without the pump—and without 46 years of my wife's great meals—I wouldn't have been able to celebrate my 70th birthday in February. I have been a diabetic since age 7, and I am in good health. Thank you to the inventors of the insulin pump for improving and extending my life.
Charles E. Cabibi, Jr., Metairie, La.

Appreciating "A Team Effort"

In April, I will celebrate my 50th anniversary as a type 1 diabetic. As I read "A Team Effort" [Reflections, March '09, p. 76], I thought about how blessed I have been with so many loved ones who have supported me over the past 50 years: my mom, my husband, my three grown children, and so many close friends—some of whom have diabetes and others who don't. Much as Mark Roberts describes in his article, their love and concern have made all the difference in my life.
Susan Downing Tazzi, Middle Village, N.Y.

I have been insulin dependent for 61 years and have been a subscriber to Diabetes Forecast for most of those years, and the March issue was special. My husband and I could relate personally to "A Team Effort." We have always been a team, and now I find I depend more on his help.

In addition, though, I'm glad to have an insulin pump. I found the "Pumped Up" article to be a good summary. For other seniors who might be thinking about the pump: Consider readability. With my declining eyesight, I find it difficult to read the pump’s screen and to look for bubbles in the insulin reservoir. 
Lois Petersen, Berrien Springs, Mich.

More on Chocolate, Please

I enjoyed Tracey Neithercott's "Virtue or Vice?" article in the March issue [p. 47]. But there's something you left out: You gave the amounts of coffee, eggs, potatoes, and wine it's OK to have, but not how much dark chocolate. 

The article says, "You're only eating a little chocolate, so make it count." Well, how much is "a little"? You also mention picking a bar with 70 to 80 percent cocoa content, and choosing chocolate coming from Venezuela, Trinidad, or Mexico. But not all chocolate bars or bags give information on cocoa content or country of origin. And not everyone can afford special chocolate-shop chocolate. The average consumer is going to buy his or her chocolate in Wal-Mart or a local grocery store.

I buy Hershey's Special Dark block chocolate (for a serving size of five blocks, or 38 grams, there are 180 calories and 12 grams of fat) or Hershey's Bliss Rich & Creamy Dark Chocolate bags (for a serving size of 43 grams, there are 200 calories and 14 grams of fat). These are usually the best price. So, how much dark chocolate can I have? 
Christine Mezzoni, Hopkinsville, Ky.

Tracey Neithercott, Associate Editor, responds: People's nutritional needs vary. Someone who is trying to shed pounds may eat a different amount of chocolate than a person trying to maintain weight and control blood glucose levels. And someone trying to lose weight who doesn't exercise will eat less than a person trying to lose weight who does exercise. Rob van Dam, PhD, assistant professor in the Department of Nutrition at the Harvard School of Public Health, says that it is reasonable to eat about a 1-inch square of dark chocolate a day, or an ounce a week. But, again, what is best for you depends on your own needs and goals.

While specialty chocolate costs more than a Hershey's bar, since you're supposed to be eating just a little, it should last awhile. You can buy Lindt chocolate in Wal-Mart or the grocery store candy aisle (it's more expensive than Hershey's, but some find it more satisfying). Lindt makes bars that are 70, 80, even 90 percent cocoa as well as bars from one country of origin, like Ecuador, Peru, or Madagascar. These bars weigh 3.5 ounces and sell for between $3.50 and $4.50. Wal-Mart also sells Ghirardelli chocolates, including a 3-ounce bar of 60 percent cocoa, and bags of Green & Black’s 70 percent dark chocolate bites.

Hershey's makes a dark chocolate bar called Cacao Reserve by Hershey's. You can buy it as 65 percent dark chocolate or choose it by country of origin. You’ll pay up to $3.29 for a 3.5-ounce bar.

Finally, the reason chocolatier Jacques Torres suggested specific countries of origin was simply for taste. The idea is that if you enjoy something richer, you don’t need as much. And if you're limiting yourself, why not eat something delicious? But if you prefer Hershey's chocolate, there's nothing wrong with that!

Eating to Burn Fat

The March 2009 issue has a research finding on page 26 that protein-packed meals, especially breakfast and lunch, seem to boost the fat-burning capacity in obese people. Please provide examples of high-protein, low-fat breakfasts and lunches.
Lloyd P. Ignacio, Kailua, Hawaii

Robyn Webb, MS, LN, responds: Here are a few suggestions for some great high-protein breakfasts: a fruit smoothie made with nonfat plain yogurt; low-fat cottage cheese and fruit; reduced-fat peanut butter spread onto whole-grain toast or an English muffin; or an egg white omelet filled with veggies and served with fruit. For lunch, try flaked tuna mixed with low-fat vinaigrette; low-fat mayonnaise with vegetables stuffed into a whole-grain pita pocket; or low-fat black bean dip sandwiched between two small whole wheat tortillas and grilled. Click here for more protein-packed breakfast ideas.

Two Votes for Recipes

In response to one of your readers who wanted fewer recipes [Mail Call, Feb. '09, p. 14], I disagree. I made two of the recipes in the Nov. '08 issue—the green bean casserole and the wild rice soup [p. 63]—and I enjoyed both of them. I also made the rutabaga and carrot hash from the Feb. '09 issue [p. 64]. I am always looking for recipes that are healthy and provide the nutritional information.

Please don't get rid of your recipe section! I believe there is room in the magazine for medical information and recipes both. We all have to eat, and eating healthfully is one of the most important treatments for diabetes.
Sue Jonas, Pulaski, Wis.

I always look forward to the recipes.  I also appreciate the format that is used for the recipes in the articles about food, because I find it easy to clip or copy them. I keep them in an envelope on my counter and choose one or two when I am making up my shopping list for the week. If we like the results, I add the recipe to my collection. Most of them are keepers!

As the wife of a diabetic, I need this resource. And frankly, because of my husband's diabetes, we are eating better than ever.
Jeanne Vaver, Sheridan, Ill.

The Editors respond: No need to worry! The recipes are here to stay.

Support for Self-Monitoring

I've worked as a rehabilitation specialist for nearly 29 years with individuals who are severely visually impaired or blind—and I'm nearly blind myself. So, when I was told 10 years ago that I had type 2 diabetes, I was really scared. I'd seen the havoc diabetes can cause and was determined not to go down that path. I vowed to take and keep control.

Daily monitoring of my blood glucose has been a major part of that.  I've learned that rice and pasta raise my blood sugar levels and exercise keeps them down. Since achieving better control, my A1C has stayed between 5.6 and 5.9. I use a talking monitor. The hardest part for me is reading information on food labels because of my vision and finding helpers to give me the information I need.

The information my meter provides guides what I do. Every diabetic person needs to work with a health care team, learn the meaning of the numbers that show up on the meter, and use that information as a guide to good control. Pricking a finger two or three times a day has to be, for me at least, something more than simply an activity to keep my doctor happy.
Nancy Johnson, Topeka, Kan.

Christy Parkin, MSN, RN, CDE, responds: Congratulations on achieving such a great level of control of your diabetes. It sounds as if the ongoing feedback from your glucose testing keeps you informed and motivated to do the things that keep you healthy.

Too often, health care providers (and insurance companies) judge the value of blood glucose monitoring simply by its application to making medication changes. Obviously, self-monitoring results do provide important information that can guide medication therapy. However, providers and insurers sometimes seem to forget how important feedback and motivation are to controlling diabetes. After all, diabetes is essentially a self-managed condition. In other words, you are the one who must shoulder most of the responsibility. Keep up the good work.

Cooking With Splenda

I read the letter from Carolyn Ruck in the Mail Call section [Feb. '09, p. 16] about the use of Splenda in recipes. She said that Splenda was causing spikes in her glucose levels. Not all Splenda is sugar free! If you buy it in packet form, it is, but if you buy Splenda Sugar Blend for baking, you will note that according to the label, it does contain sugar. When I use Splenda Sugar Blend, I also experience spikes in my blood sugar. However, when I add a packet of Splenda to tea, I don't. I eat all kinds of foods and beverages that contain Splenda that don't cause my glucose to rise.
Kim Fisher, McConnellsburg, Pa.

Teens and Managing Diabetes

I have a response to Karen Murner's letter in the April issue [p. 16] about not blaming teens for poor blood glucose control, an issue raised in a Guest Editorial by Henry Rodriguez, MD [Dec. '08, p. 11]. Unfortunately, I have to agree with Henry Rodriguez that poor adherence to a diabetes care plan is fairly common among adolescents.  I have given my son all the groundwork I can so that he can manage his diabetes correctly. However, many kids are not fortunate enough to be that connected to their parents.

Many teens just have that feeling of invincibility that we all can probably remember. I've sat down with my kids and stressed that what they do today affects their tomorrow.

My son is very responsible now. I only hope that he continues on this path of good management skills in blood glucose control. I commend Karen Murner for taking such good care of not one but two children with type 1 diabetes—and still finding time to read Diabetes Forecast. Sadly, there are many families in which parents aren't as involved in their children's diabetes management.
Christine Kucelin, Lomita, Calif.

Happy With HBOT

In the March issue, Lee Sanders, DPM, writes about hyperbaric oxygen therapy (HBOT) as a treatment for healing a foot wound [Mail Call, p. 13].

In 2006, I had HBOT because of an ulcer on my big toe brought on by my diabetes. The ulcer was medically treated for several months. While I was in the hospital, the surgeon came in to discuss amputation of that toe. I asked about oxygen therapy, which he was against. He did send me to another hospital and transferred my care to another doctor.

After 19 daily hyperbaric oxygen treatments, I'm glad to say I still have my toe. Yes, it's expensive, and you have to locate a hospital with a hyperbaric oxygen chamber. But a second opinion is always good, especially when amputation is the only other option.
Debi Matteson, Prescott, Ariz.

Diverticulitis Tip

In response to Janis McWilliams's comments on handling diverticulitis [Ask the Experts, Feb. '09, p. 15], I have one more suggestion. I was diagnosed with diverticulitis 22 years ago at age 42, and had recurring bouts that I resolved by drinking clear liquids, as recommended by my doctor. 

In the spring of 2005, these bouts started coming back to back and were getting increasingly painful. A gastrointestinal specialist wrote me a prescription and recommended that I go to the hospital when a recurrence presented itself. At about the same time, I happened to give up foods and beverages containing aspartame. That was in July 2005, and I have not had a diverticulitis attack since. The prescription drug was aspartame-coated as well.  However, I never needed to fill that prescription. Prevention proved to be worth more than a pound of cure.
Clara Gudolonis, Limerick, Pa.

Janis McWilliams, RN, MSN, CDE, BC-ADM, responds: Many people with intestinal problems notice foods that trigger symptoms for them. It is always good to avoid these foods. Aspartame is certainly an example that would fall into this category for you.

Questioning Fat and Carbs

As a type 2 diabetic, I'm mystified as to why so many of your recipes violate the basic rule of no more than 3 grams of fat and 25 grams of carbohydrate per serving. A case in point: the two recipes on page 48 of the February issue. What am I missing? Have I been misinformed all these years?
Carter Kelley, Escondido, Calif.

Sue Robbins, RD, CDE, responds: I am not familiar with the rule you describe. Generally, women with type 2 diabetes should have about 45 to 60 grams of carbohydrate per meal, and men should have 60 to 75 grams. Fat intake can vary, but a general guideline is that 30 percent of your total calories should come from fat. However, for a person who does not need to lose weight and who is choosing healthy fats, the percentage will often be higher, and that is perfectly acceptable. Of course, it is important to eat a variety of foods containing carbohydrate, protein, and fat.

The important thing to keep in mind is to control portion size so that most dishes are permissible under your meal plan. Let's face it: If you have a recipe that fits your meal plan but tastes horrible, you'll never use it again. So, it's better to find healthy meal options that you like and enjoy them in moderation.