Insulin: Best Choice for Me

I just wanted to thank you for the article on insulin in the August issue (“Embracing Insulin,” p. 45). I recently started on insulin, and before I did, I had the same fears most people with type 2 seem to have about it. I couldn’t have been more mistaken! Insulin gives me far more precise control than oral meds ever did (and that’s important to me because my A1C went from 8.4 to 6.4 in less than a year). The injections are almost painless, and traveling with insulin is not the huge production I worried about. I hope others who are concerned about the injections or feel that going on insulin will somehow mean they have failed will read your article and take heart. Instead of trying to push our bodies to their limits to produce more insulin on our own with oral meds, we should all allow ourselves to relax.

Marte Brengle

Burbank, Calif.

Ice Cream Passes the Test

Your August issue had reviews of several varieties of ice cream (“All About Ice Cream,” p. 61), and the tester’s comments were quite positive for the two flavors of Edy’s Slow Churned No Sugar Added ice cream. Readers may want to know that the same ice cream is sold in the western portion of the United States under the brand name “Dreyer’s.” I tried the Dreyer’s Slow Churned No Sugar Added Mint Chocolate Chip, and I agree that it’s very good.

Nicholas Lubofsky

Englewood, Colo.

Before reading your article, I spent some time at a local grocery store trying to determine if sugar-free or fat-free ice cream would be best for me and my diabetes. I noticed you followed the article with two recipes, one using fat-free ice cream and one using sugar free. Is one better than the other?

Kathi Oler

Cape Coral, Fla.

Sue Robbins, RD, CDE, responds: They are all pretty good choices, and that was the main point of the article. The one that is rated lowest by the tester for taste is probably the best choice in terms of diabetes management, as it is the lowest calorie, with no fat, and is low in carbohydrate. However, if you don’t like it, you are not going to eat it. Generally, if you’ve met with your dietitian, you will have a meal plan that allows for a certain amount of carbohydrate in meals and snacks. I frequently give my patients a target amount of saturated fat and total fat per day as well. Once you have that, you can make a choice based on your preference and personal plan.

Complication Combo

The article “A Common Complication Combo” (July ’08, p. 23) intrigued me since I had just completed a stress test (I was recently diagnosed with diabetes) and there was no ankle-brachial index conducted.

Curious, I contacted my physician, who informed me such ratios were not protocol because they did not change the treatment regimen, including losing weight, controlling my diet, exercising, and taking meds.

Did I miss something? Surely you had a reason to devote a whole page to the article. How is that information useful? I am sure the majority of your readers are regular people with diabetes and not academics. Don’t you owe us information we can actually use and incorporate into our lives?

Barry A. Smith

Danville, Calif.

Paris Roach, MD, responds: In every issue of Diabetes Forecast, we publish information about new studies to keep readers abreast of what’s going on in diabetes research. Research studies may not immediately apply to patient care until the results are verified by additional studies. The study you refer to involved testing with the ankle-brachial index (ABI) as a means of detecting a serious diabetes complication, peripheral arterial disease (PAD), in people with type 2 diabetes and kidney disease.

Testing the ABI is indeed recommended in certain situations. The American Diabetes Association recommends ABI testing when symptoms of PAD (for example, leg cramps that occur when walking but stop at rest) are present. Also, a panel of experts convened by ADA suggested that all patients over 50 and those under 50 who have other PAD risk factors should be screened as well. So you can see, in different individual cases, and based on different recommendations, ABI testing could be informative. The results can alert patients and care providers to the presence of vascular disease and prompt attention to risk factors for heart attack and stroke. See “A Better Test” in the Oct. ’08 issue, p. 34, for more news on ABI testing.

Steering Clear of Trans Fats

The article “Sourcing Senior Moments” in the Aug. ’08 issue (p. 72) states, “Stay away from trans fats, the ‘bad fats’ that are often found in deep fryers and margarine tubs.” In fact, trans fats are not found in the soft, whipped margarine that comes in tubs. They are found in solid stick margarines. Misinformation
like this is a prime reason why many people I speak with think the saturated-fat-laden butter they are consuming is “better” for their arteries.

Karen Ertel, RD, CDN

Syracuse, N.Y.

Sue Robbins, RD, CDE, responds: You are right that stick margarine has much more trans fat than tub margarine. However, there may be a small amount of trans fat in tub margarine as well, if the ingredient label lists partially hydrogenated oil as an ingredient—even if the amount of trans fat is indicated to be 0.
 

Only Way to Know: Use a Meter

My son’s endocrinologist emphasized to us that the only way to truly know a person’s blood glucose is by checking it with a meter. The way she put it was that she treats many diabetic patients, and even she cannot tell what a person’s blood glucose level is just by looking at the person. The research in the article “A Sense of Where They Are: Children, Parents, and Lows” (June ’08, p. 30) reinforces this concept. However, I did not feel that the article emphasized the point enough. I was alarmed that a parent would attempt to treat a child’s suspected high without actually checking the number. As was pointed out in the article, high blood glucose can mimic low blood glucose. It seems to me the best way to close the article would be to reinforce the practice of testing the blood glucose for any suspected high or low and then treating accordingly. (If, for some reason, a meter is not readily available, it is, of course, appropriate to treat a suspected low immediately and then check as soon as possible with the meter.) 

The value of this research is to further support the practice of checking blood glucose with a meter. This research is a great source for anyone attempting to educate caregivers and institutions about the importance of blood glucose testing. Incorrect guesses of blood glucose values can have disastrous consequences.

Mary Lynn Price

Rockville, Md.

Get Out ... and Learn Martial Arts

I enjoyed your article on exercise (“Get Out!” Aug. ’08, p. 49), but I was disappointed that I didn’t see a reference to martial arts training. In September 2005, when I was 59, I started training in Tang Soo Do, a Korean form of karate. Now I am on track to test for my promotion to black belt in the spring of 2009.
I train hard at least three times a week, in a varied workout that includes strength and flexibility training as well as cardiovascular conditioning. I also stretch my mental capacity in memorizing a complex series of techniques. Since I started karate, my blood sugar has been very stable, and my blood pressure and cholesterol levels have improved dramatically. All my doctors are very impressed!

Susan LaGrande

Wappingers Falls, N.Y.

Tips for Travel with Insulin

As noted in Jan McWilliams’s reply to the August issue’s Ask the Experts question (“Freezing Insulin; Injection Changes,” p. 16), it is always wise to check the condition of the insulin frequently when traveling.

It’s my practice to carry my insulin vials with me for standard morning, evening, and bedtime injections when I am traveling. My favorite device for carrying the vials is the Frio wallet, which can be set up simply by soaking it in water for a few minutes. I give it a little boost by letting it sit in the fridge (not the freezer) overnight. I have kept the vials cool in this device for more than 2 weeks with occasional re-chilling in a hotel ice bucket. (Just don’t soak it too long or the chemical inside swells so much the wallet is hard to close.)

In addition to the vials, I carry an insulin pen for those occasions when I am away from my hotel or ship’s cabin, since I frequently inject before lunch or dinner. The pen goes with me on shore excursions and bus tours. I have been amazed and pleased to find how well the insulin holds up despite being in my pocket in the hot sun (during June in Rome, for example) all day long.

David W. Weiss

Charlottesville, Va.

Problem with Mail-Order Insulin

I’ve had type 1 diabetes since age 19, and I’m now almost 77. I was recently forced by my prescription drug insurer to accept mail-order shipments of my insulin: a 90-day supply. Insulin manufacturers require that their insulin be kept at 36° to 46°F. Shippers are not complying with these refrigeration requirements. The two insulin packages I’ve received so far arrived at 65° and 85°F. My experience with these careless shipping practices is with a drug supplier contracted by my former employer (I’m now retired) to provide me with prescription drugs. The supplier puts just one frozen gel-pack and a little insulation in a box with my insulin and ships the package 2-day UPS. I live in Texas, and by the time the package arrives, having been carried around in a hot truck for 2 days, it is well above the required temperature. UPS just drops the package at my door and, if I am not at home at the time, the package sits in 100°F-plus weather until I get home.

Both the manufacturer of my insulin and my physician have advised me to not use such degraded insulin. But the shipping company claims that insulin is okay at 86°F. Has anyone else experienced this problem? I think ADA should make the U.S. Food and Drug Administration aware of the problem and call for Congress to make the shippers comply.

G.A. Danner

Montgomery, Texas

Paris Roach, MD, responds: Mail-order insulin should be packaged and stored according to the manufacturer’s recommendations during shipment, which is typically by overnight courier. If you believe that your insulin has been exposed to temperatures outside the manufacturer’s recommendations, demand a new shipment. As a general rule, if the cold pack is still cold at the time you open your package, the insulin should be okay. If the cold pack feels warm, do not use the insulin, and call for a new shipment. One mail-order pharmacy I spoke with informed me that if you advise them at the time your insulin is ordered that you would like to be notified when the shipment leaves their pharmacy, they will call you so you can look for your insulin to arrive the next day.

Times Are Changing

I am 36 years old and have had type 1 diabetes for 16 years now. I was diagnosed while attending Sam Houston State University. At the time of my diagnosis, it was also time for my spring semester finals. I had been hospitalized, and my vision was temporarily very blurry. I was unable to read or see to drive for 2 weeks or so. I had contacted my teachers and asked them for accommodations due to my lack of vision. All but one of my professors allowed me to take my grade as it stood. That one professor told me that if I did not show up for the final, I would fail her class. I was devastated, because I was an “A” student, and I knew I would not be able to read the exam.

My doctor called the professor, but I still had to take the exam. I was able to leave the hospital for 2 hours while my husband drove me to take the final. To this day I am still not sure if I read the exam correctly or wrote on the lines. I did get an “A” in the class.

After reading the story about the current catcher on the Sam Houston State University baseball team (“In It to Win It,” Sept. ’08, p. 46) I can tell things have changed. I hope schools everywhere become more knowledgeable about diabetes and realize how serious it can be.

Chrissie Benoit

Rayne, La.

Muffins with Whole Grains

Your Carrot Apricot Power Muffins (Sept. ’08, p. 55) recipe looks really yummy. However, I’m trying very hard  to stay with whole grains, so I wonder if there is any good substitute for the white flour this recipe calls for. If so, would using the substitution require other changes to the recipe?

Darla Broberg

Portland, Ore.

Robyn Webb, MS, LN, responds: I would recommend whole-wheat pastry flour, and just see if you need to add a tad more moisture to the recipe so the muffins don’t come out dry.