[Nfbkabs] FW: The Voice of the Diabetic, Summer 2007

[Shannon Caldwell]

	FYI 
For those of you who are diabetic or live with others who are diabetic. 
Shannon Caldwell 


-----Original Message-----
From: voice-of-diabetic at nfbcal.org [mailto:voice-of-diabetic at nfbcal.org] On
Behalf Of Brian Buhrow
Sent: Friday, June 15, 2007 12:50 AM
To: Multiple recipients of list
Subject: The Voice of the Diabetic, Summer 2007



                            Voice of the Diabetic


              Vol. 22, No. 3               Summer Edition 2007

Voice of the Diabetic, published quarterly, is the national magazine of the
Diabetes Action Network of the National Federation of the Blind.  It is
read by those interested in all aspects of diabetes and blindness.  We show
diabetics that they have options regardless of complications.  We know that
positive attitudes are contagious.

Send news items, change of address notices, and other magazine
correspondence to:  Voice of the Diabetic, 1800 Johnson Street, Baltimore,
Maryland 21230; phone: (410) 296-7760; e-mail: editor at diabetes.nfb.org

Find us on the World Wide Web at: www.nfb.org and click on Publications.

Copyright 2006 Diabetes Action Network, National Federation of the Blind.
ISSN 1041-8490

Note:  The information and advice contained in Voice of the Diabetic are
for educational purposes, and are not intended to take the place of
personal instruction provided by your physician, or by your health care
team.  Discuss any changes in your treatment with the appropriate health
professionals.


Voice of the Diabetic


Eileen Rivera Ley
Director of Publishing

Elizabeth Lunt
Editor

Suzanne Shaffer
Art Director

Ed Bryant
Editor Emeritus

Gail Brashers-Krug
Director, Special Projects

Ann S. Williams
Contributing Editor

Tom Rivera Ley
Technology Editor

Cover Photo: Annette Gordon, who went blind from diabetic retinopathy, was
afraid to leave the house. Now she teaches others how to cope with being
blind.


Voice of the Diabetic is the only national publication that focuses on
making life with diabetic complications less complicated.  Published
quarterly by the NFB Diabetes Action Network (DAN), Voice of the Diabetic
has a circulation of 320,000 copies.  Since 1985, diabetic consumers,
families and health care providers have been returning to the Voice for
insight and inspiration. Voice of the Diabetic is available in print, four-
track audio cassette, e-mail and on the Web at www.nfb.org/voice.

Our Mission: The NFB Diabetes Action Network educates, empowers, and
inspires people living with diabetes and its complications. We share the
Federation's "can-do" philosophy through Voice of the Diabetic magazine,
volunteer peer support, and advocacy for accessible diabetes technology.
Together, we challenge one another to live our best and fullest lives.

Voice of the Diabetic
1800 Johnson Street, Baltimore, MD 21230;
phone: (410) 296-7760  +  www.nfb.org/voice

e-mail:
News items: editor at diabetes.nfb.org
Subscriptions & change of address: subscribe at diabetes.nfb.org
To distribute free copies: distribute at diabetes.nfb.org
To advertise: ads at diabetes.nfb.org

Note: The information and advice contained in Voice of the Diabetic are for
educational purposes and are not intended to take the place of personal
instruction provided by your physician or by your health care team. Discuss
any changes in your treatment with the appropriate health professionals.

Copyright 2007 Diabetes Action Network, National Federation of the Blind.
ISSN 1041-8490



Inside This Issue


FEATURE:
Annette Gordon Loses Vision but Gains Confidence
by Elizabeth Lunt

The Give and Take of Effective Communication
by Ann S. Williams

Pumper's Voice: A Pumping Primer
by Gary Scheiner

Letters: Health Care Professionals Sing our Praises!

Confusion and Panic Surround Avandia News

If Blindness Comes

Winning Strategies for Tracking Medicine
When Vision is Failing
by Eileen Rivera Ley

New, Inexpensive Treatment for Retinopathy and Macular Degeneration May Be
on the Horizon
by Gail Brashers-Krug

FDA Rejects Promising Diabetic Retinopathy Drug
by Gail Brashers-Krug

Coping with Vision Loss? NFB-Linking Individuals to a Network of Knowledge

Help Create Exciting Web Resource Where Do Blind Diabetics Work?

NFB Participates in Campaign to Raise
Awareness of Diabetic Complications

Free and Discounted Medication
by Karen Wrightson

Take Care of Your Teeth

Healthy Home Cooking Summer Favorites
by Healthy Exchanges

Book Nook

Resource Roundup

Get Moving: Exercise With Complications
by Dino Paul Pierce

Voice of the Diabetic Subscription Form






[PHOTO/CAPTION: Annette teaching Braille]
[PHOTO/CAPTION: Annette teaching a kitchen class.  In order to graduate
from the BISM training program, pupils are required to cook a meal for 20-
30 people.]

Annette Gordon Loses Vision but Gains Confidence

by Elizabeth Lunt

Annette Gordon says that for nearly twenty years, she managed her diabetes
the same way many Americans do: "I ignored it," she explains, with a warm,
rich chuckle that evokes her native Trinidad. "Big mistake."

Neglecting her diabetes cost Annette her vision and her teeth (see related
story p. __). Now 61, she wants to make sure that others don't make the
same mistake. "The doctors kept trying to talk to me about the diabetes,
but I felt fine," she says. "I thought there couldn't be anything really
wrong with me."  Annette chuckles again. "I'm going to shout it from the
housetop," she adds, "what a fool I was!"

Her first experience with diabetes was as a young pregnant woman. Her
doctor told her she had gestational diabetes-a form of diabetes that is the
result of pregnancy hormones. It usually goes away once the baby is
delivered, but her doctor told her she should watch out because women with
gestational diabetes are more likely to develop type 2 diabetes later.
Annette ignored him. She felt fine, and she had young children to care for.


Years later, during a routine exam, Annette discovered that the first
doctor's prediction had come true. She had type 2, and her new doctor
warned her to manage it. She ignored him, too. Again, she felt fine. One
more doctor in her native Trinidad even told her he would not clear her for
employment-a condition of getting a job there-until she dealt with it.

She didn't.

She says she doesn't understand what she was thinking then, but notes that
she was consumed with taking care of four children and didn't have much
money. "Poverty is a sad thing. You just want to do the best you can do for
your children, not being aware that you need help for yourself" she offers,
still trying to see how she could have ignored her diabetes for so long.
She focused on getting her children to the point of self-sufficiency and
didn't feel sick anyway.

Finally, when she was 45, she noticed problems with her eyes and her teeth
and jaw began to ache. She never connected either ailment with the
diabetes. By then she was living in the U.S., and she went to a new doctor.
 He explained to her that even though she couldn't feel her diabetes, it
was harming her. Her uncontrolled blood sugar was damaging her eyes and her
gums, and causing her teeth to loosen. She took her medicine -"when I
remembered," she says -but neglected her diet and did not exercise. Her
vision and dental problems got worse, but "everything happened gradually"
and she didn't worry about her health.

Eventually, her eye problems turned into legal blindness. The doctor told
her it was diabetic retinopathy.  "I didn't even want to go out on my sun
porch," she recalls.  She was terrified and felt trapped in the house.  "I
thought my life was over," Annette says with a sigh. "I really did."

But Annette's life was far from over.  Through the National Federation of
the Blind (NFB), her daughter found a skills program at Blind Industries
and Services of Maryland (BISM). At first, Annette wasn't interested. When
her daughter took her to the first
interview for the program, she "was mentally kicking and screaming," she
says with a laugh.

She joined the skills program to get out of the house, but she refused to
carry the white cane because then everyone would see that she was blind. "I
was in denial.even though I was falling down and risking my life every time
I crossed the street," she confesses now.

Gradually Annette realized that she had a lot in common with people in the
program, and she was inspired by her blind instructors. "It gave me back a
lot of courage," she recalls. "Here were all these people just like me
going places, involved in things."  She became determined.

She decided to take on the more advanced life-skills training class, a
rigorous eight month program spent learning Braille, mobility, and kitchen
skills, among others.  She resolved to "work my darndest, and I did." In
the middle of the program, she had to leave and go to Trinidad for three
months to care for her ill mother and to help her daughter, who was having
her first baby.

In Trinidad, she was amazed at how much she could do. "You do not lose your
natural instincts," she says. "The baby didn't know I was blind." She
managed to cook and care for her mother and her newborn grandson, and
returned to the U.S. to complete her program. "You have to cook a meal for
20 to 30 people to graduate and I made dinner for 33" she recalls proudly.

Now Annette is working at BISM where she teaches Braille to seniors and
makes home visits to help them cope with their blindness. She says she
knows how they feel, since she was there herself; people get depressed when
they have to change their lives and learn new ways without vision.

But Annette tells them that her own blindness also brought blessings and
"opened up a bigger world for me," she says.  She has done things as a
blind person that she never expected to do even when she had 20/20 vision.
She learned to use a computer during her life skills course and now, she
says, "I use it for everything!" Overcoming her fear and learning so much
has given her a new confidence.  She describes herself as "more assertive"
and sure that she can handle any challenge.  "No more sniveling and crying
for me!" she exclaims proudly.

"I played around with diabetes for years and ignored it" Annette admits,
but she is
now serious about her self-management and says she is "fighting tooth and
nail." She takes her medicine and watches her blood sugar and diet. What's
really working, she reports, is exercise. Her vision loss hasn't slowed her
down; she walks as much as possible and says that she gets "really nice
numbers" after a stint on the stationary bicycle.

Annette isn't just active when she's exercising-she was recently selected
to be the NFB spokesperson in a national education campaign about the
complications of diabetes
(see related story p. __). She is proud that she is helping to get the word
out. "I'm loud" she jokes, "When people hear me, they know it's Annette!"
She's putting her voice to good use at NFB advocacy and outreach events as
well, and loves being a part of the organization. "I've never had so much
fun in my life since I've been involved with the NFB and BISM" she says.
And they're thrilled to have her, too.


Additional reporting for this article was contributed by Gail Brashers-Krug



[PHOTO/DESCRIPTION: A man and woman sit with their backs to us. The woman
has her arm around the man's back and appears to be comforting him.]

[PHOTO/DESCRIPTION: A senior couple having a serious discussion beside a
peaceful pond.]

The Give and Take of Effective Communication

by Ann S. Williams, PhD, RN, CDE

Whether you have diabetes or not, being able to both express yourself and
understand the
people you care about-the give and take of communication-are essential to
building satisfying and mutually supportive relationships.

But if you have diabetes complications, communication skills are even more
important, as they often stir up strong emotions for everyone involved.
This article will discuss three true stories about diabetes complications
and communication problems.  (The names and a few details have been changed
to keep everyone anonymous.)

Each of these stories involves two people who care a lot about each other
and need support and help from each other. The people with diabetes are
dealing with new complications and their feelings about them. However, they
are not talking about these feelings, so they are unable to receive the
support and help they need in ways that matter. Effective communication is
the strongest way they can begin to change that.

In a process of giving (or talking) and receiving (or listening), you can
begin to build a bridge to understanding. The following few paragraphs
describe some simple guidelines for talking with and listening to someone
you care about.  Such guidelines are especially helpful for people who need
to communicate about strong emotions, such as the fear and anxiety that
often accompany diabetes complications.

Talking about Feelings: Making "I" Statements

An "I" statement is a way to open a conversation by explaining how you feel
about something. It has 3 parts:

1.  Describing the situation (very briefly)

2.  Naming the feeling

3.  Explaining the effect on you

Usually, an "I" statement takes the form, "When ( 1 ), I feel ( 2 ) because
( 3 ).  Even though this seems like something of a formula, using it will
allow you to begin talking openly about emotionally intense subjects.

Consider the following story:

Lucinda has had type 1 diabetes for 22 of her 23 years.  Last year, she
graduated from college, got her first professional job, and became engaged
to a young man she has known for 5 years.  Her ophthalmologist recently
told her that she has proliferative retinopathy and has scheduled laser
surgery for next week.  Lucinda remembers that her grandmother and aunt
were both blind from diabetes near the end of their lives and she is afraid
she will soon be blind herself.  She does not want to worry her fiancé, so
although she has mentioned the surgery to him, she called it "no big
thing," and has not discussed her fears.

Lucinda's situation is an excellent opportunity to use "I" statements to
help her communicate. She might say to her fiancé: "Ever since my doctor
told me I have to have laser surgery I feel frightened, because I think I
might go blind." By doing this, she opens communication with her fiancé and
can gain valuable support from him as she copes with her eye surgery.

Now consider this true story:

Clarence and John have been friends for about 35 years.  Both are in their
mid-40s now.  Clarence has had type 2 diabetes for 14 years, although he
has not paid much attention to it.  John says he knows a lot about
diabetes, since he helped to care for his grandmother, who had diabetes and
eventually died of kidney failure. John is worried about his friend because
he has noticed that Clarence seems to eat whatever he wants.  When Clarence
mentioned to John that his doctor had told him that he has some early signs
of kidney disease, John decided to give his friend advice about his diet
whenever they eat together. Clarence does not like this, and has tried to
laugh it off.  John has responded by becoming more insistent.

When you make "I" statements, talk about your own feelings but avoid
accusations about the other person.  For example, if Clarence said to John,
"You're insulting me," or if John said to Clarence, "You're being self-
destructive," they will probably respond to each other defensively.  That
conversation is likely to end in an argument.

Notice the difference when Clarence and John focus on how they feel and use
"I" statements.  Clarence could say to John, "When you tell me what to eat,
I feel put down, because I'm an adult and I can make my own decisions."
In turn, John could say to Clarence, "Since you told me you might have
kidney disease, I feel worried. I'm afraid that you could get very sick and
need dialysis, like my grandmother."

Of course, when people are talking about complicated, emotionally intense
topics, making "I" statements is only the beginning of the conversation.
Take this true story, for example:

Sue and Leonard have been married for 38 years and both have type 2
diabetes.  Recently, Leonard has had difficulty achieving an erection.  He
still feels attracted to Sue and wants to be able to have sex.  He feels
embarrassed and has stopped approaching Sue sexually.

Sue has mixed feelings about this.  While she misses the closeness of sex
with her husband, and feels she is to blame for their lack of an active sex
life, she also knows she has gained weight and is showing signs of aging.
She worries that she is no longer attractive to Leonard.  At the same time
she is somewhat relieved because for the last several years she has had
difficulty feeling sexually aroused.  In fact, sex has been occasionally
unpleasant and even painful for her.  Neither she nor Leonard has spoken to
the other about their troubled sex life.

Sue and Leonard have a range of complex feelings about their situation. But
if one of them could begin a conversation about their lack of sexual
intimacy with an "I" statement, they could help each other to see that they
can work on the problem together.

Listening to Feelings: Active Listening

Of course both people must actively participate to have a conversation.
While your partner opens with an "I" statement, you can help the
communication by using active listening.  This is a two-step process:
First, listen carefully, giving the speaker your full attention. Do this
without thinking of your answer while the other person is speaking.  Then
let your companion know what you have heard.  Acknowledge the emotions you
noticed, then re-phrase or summarize the message without judgment. Active
listening helps communication in two major ways.  First, you confirm that
you have understood what someone has told you.  Second, the other person
learns that you have been listening carefully.

For example, if Leonard began a conversation with Sue by making "I"
statements about his difficulty achieving an erection, he might be feeling
vulnerable and nervous.  But Sue has strong feelings about her own sexual
problems, so she might only half-listen while thinking about what she wants
to say.  If she responds to Leonard with her own point of view or turns her
hurt feelings of rejection into an accusation, Leonard will probably
respond defensively, even angrily.  Then Leonard's attempt to talk about a
difficult subject could easily lead to an argument.

Imagine how different this conversation can be if Sue uses active
listening. She knows she will have a chance to express her point of view,
so she can lay aside her own feelings and responses while Leonard explains
his difficulties and desires. When Leonard pauses, Sue could say something
like, "I can see that you feel frustrated about this."  This simple
statement would go a long way towards helping Leonard feel understood by
his wife.  And for Sue, acknowledging Leonard's feelings will help her see
that the problem is not hers alone.

Next, Sue could summarize what Leonard has said to her, for example: "I
hear you saying that you are upset that sex is physically difficult for
you, but you still want to have sex with me."  By listening carefully and
paraphrasing what Leonard said, Sue is learning that her assumptions and
fears about her attractiveness to Leonard are not true.

Now that Leonard has spoken and Sue has let him know that she heard what he
was saying, Sue might choose to respond by using "I" statements to explain
her feelings and experiences.  If Leonard uses active listening to let Sue
know that he hears both her emotional tone and the content of what she
says, they will have a good basis for understanding each other.

"I" statements and active listening will help Sue and Leonard begin to
discuss their problem.  In fact, "I" statements and active listening would
be helpful to Clarence and John, to Lucinda and her fiancé, and to you and
your family members and close friends.  With strong skills for expressing
your concerns and hearing and understanding the concerns of the people you
care about-the give and take of communication-you
will lay a strong foundation for satisfying, mutually supportive
relationships.


Pumper's Voice: A Pumping Primer
Consider the pros, cons and function of insulin infusion pumps

by Gary Scheiner, MS, CDE

More than 100,000 people in the United States use insulin pumps.  Why have
so many abandoned their trusty syringes and made the switch?  And why isn't
everyone using them? Should you consider using one? Nothing sparks more
debate among insulin users than the concept of pumps vs. shots.

How does a pump work?

The pump is a beeper-sized device that contains a cartridge filled with
fast-acting insulin. It mimics your pancreas by releasing small amounts of
rapid-acting insulin every few minutes.  This is called basal insulin, and
is designed to match the glucose released by the liver, thus keeping the
blood sugar level steady between meals and during sleep. When you eat, you
program the pump (with the touch of a button) to deliver a larger
additional dose of insulin right away.  This is called an insulin bolus,
and is designed to match the carbohydrate level in the food.

Who should consider a pump?

All of you with Type 1 and those Type 2s who produce little or none of your
own insulin can consider a pump. You will need the ability to press a few
buttons with confidence, and should be prepared to test blood sugar levels
at least four times every day and learn how to count carbohydrates to
properly set the bolus levels. You'll need to keep good written records of
blood sugars, insulin doses, the carbohydrates you eat, and physical
activity.

You will also need to have adequate insurance to use an insulin pump or be
prepared to pay for it yourself; they cost around $6,000, and the supplies
that go with them cost $1,000 to $2,000 a year.  Luckily, most private
medical insurance (including Medicare) now cover them.

Pump pros & cons

Before you jump to the pump, take a look at both the plusses and minuses.
Based on my 10 years' experience using shots, 12 years' on the pump and
feedback from over a thousand patients on both forms of therapy, I present
some benefits:

1. More stable blood sugars.  Reductions in HbA1c are common in those whose
readings are often high on shots.  There are also fewer "high to low" and
"low to high" swings.

2. Fewer low blood sugars.  By using only fast-acting insulin, there is no
long-acting insulin peaking when you're not eating.  This makes pump
therapy a good choice if you have frequent lows or an inability to detect
low blood sugars.

3. A more flexible lifestyle.  Raise your hand if you can eat, sleep and
exercise at the same times every day. It's tough, right? The pump lets you
choose your own schedule.

4. Dosing accuracy.  You'll get a bolus calculator that helps you determine
mealtime doses based on carb intake, blood glucose levels, and the amount
of insulin still active from previous boluses.

5. Precise dosing within tenths or twentieths of a unit.

6. Convenience.  You don't have to draw up syringes every time you need
insulin; just reach to your side and press a few buttons.

7. No Shots.  You change the pump's infusion set just two or three times a
week-no more discomfort from multiple daily insulin injections.

8. Easy adjustments for life's little circumstances.  You can adjust the
pump's basal rate to permit good blood sugar control for things like
illness, seasonal sports, restaurant food and menstruation.

9. Weight Control.  Eat what and when you choose; snacks are not required
when you use a pump.

10.  Novelty.  The "high-techness" of the pump can add a dimension of
excitement and fun to one's diabetes care.

 and some drawbacks:

1. Cost.  Although most insurance plans cover insulin pumps and supplies,
there are often
co-pays and deductibles.

2. A learning curve.  Don't expect good control right away.  It may take
you a few months to get the basal and bolus doses regulated and adjust to
using the pump.

3. Inconvenience.  Wearing the pump around the clock, even during sleep,
can become awkward once in a while.

4. Technical Difficulties.  As a mechanical device, pumps are prone to
occasional infusion set clogs, power failures, computer glitches and damage
due to typical wear and tear.

5. Skin Problems. Your skin can become irritated from the infusion set
adhesive.

6. Ketosis.  The absence of long-acting insulin with pump use can present a
problem if insulin delivery is interrupted for more than a few hours.  Very
high blood sugar can occur, and ketones may appear in the bloodstream and
urine.

7. Infusion Set Changes.  You must change your infusion set every couple of
days. This 3-10 minute procedure involves numerous steps and can be
momentarily painful or traumatic for the novice pump user.

The next step

Discuss this decision with your doctor-it's an important one for you and
your family. If your doctor is not familiar with insulin pumps or dismisses
them as being a "waste of time," consider finding a diabetes specialist who
is familiar with pump therapy.  Ideally, find a doctor who invites your
input and works with diabetes educators who can assist you with your pre-
pump education and post-pump blood sugar management.  If this is not
available to you, feel free to contact my office for additional resources
or direct support.

Insulin pump manufacturers and distributors offer information on their web
sites so you can learn more as you make your decision.  Find out if there
are insulin pump support groups in your area; they are excellent forums for
meeting pump users and finding out about their experiences.

Editor's note:  Gary Scheiner is a Certified Diabetes Educator with a
private practice specializing in intensive diabetes management for children
and adults.  He has had type 1 diabetes for 22 years and has used an
insulin pump for the past 12.  He offers his services via phone and the
Internet to clients throughout the world.  For questions or more
information, you may contact him at gary at integrateddiabetes.com, or call
877-735-3648.

[PHOTO/DESCRIPTION: A gold medal with a number one engraved in it.]


Letters: Health Care Professionals Sing our Praises!


Dear Ms. Ley,

I just wanted to take this opportunity to compliment you on the fine job
you did with your "Unofficial Guide to Low Vision Services."  The need for
a continuum of care for low vision patients can't be stressed enough. I so
often hear patients saying that their physicians told them "nothing else
can be done."  Of course, they are referring [only] to medical treatment,
[and] aren't offering the patients any further direction. We are able to
have these patients reading, watching TV, playing cards, and participating
in so many other activities again and they can't understand why they
weren't informed of the availability of low vision services by their
doctors. I commend you for your efforts.

Warmest Regards,

Marc Jay Gannon, OD, FAAO
Director, Low Vision Institute
Ft. Lauderdale, Florida

To the Editor:

I would like to commend you for the excellent article on erectile
dysfunction in the spring 2007 edition. It is one of the most thorough and
well-written articles that I have seen on this subject, which often does
not get the attention it warrants. I am wondering if it is possible to get
permission to make copies of this article for my patients, and, if so, is
it available in a format that would be easier to photocopy?

Thank you,
Chris Hayes, RN, CDE
Cigna Healthcare
Tempe, AZ


Editor's Note: Articles from Voice of the Diabetic are available on our Web
site at www.nfb.org/voice.



Confusion and Panic Surround Avandia News


On May 21, 2007, the New England Journal of Medicine published one study
suggesting that Avandia, one of the most common type 2 diabetes
medications, may increase the risk of heart attack by 43 percent.  Minutes
later, the panic began.

Newspapers like the Wall Street Journal, the New York Times, and the
Washington Post covered the story prominently. Some articles wrongly
asserted that Avandia had been proven to cause heart attacks, and U.S. News
and World Report even went so far as to recommend that diabetics "suspend
use" of Avandia until more research is complete.

More importantly, diabetics began to worry. Help lines and e-mail chat
lists were flooded with questions. Fortunately, the Food and Drug
Administration (FDA) published a response to help educate the public on the
issue.  Here are the FDA's answers to some common questions:

What is this new study, and how is it different from other studies?
The article in the New England Journal of Medicine does not contain any new
tests or trials. Instead, it describes a meta-analysis, also called a
"pooled analysis," of 42 different studies that had already been conducted
by different researchers at different institutions.
Researchers at the Cleveland Clinic looked at these 42 studies, lumped all
their findings together, and analyzed them. Their statistical analysis
concluded that type 2 diabetics taking Avandia had a 43 percent greater
risk of heart attack than diabetics who did not take Avandia.

But even the authors of this "pooled analysis" caution that it has
"important limitations," and that a pooled analysis "is always considered
less convincing" than large, prospective drug trials. As the FDA pointed
out, each of the 42 studies included was different. They were designed to
study different things, such as the effect on blood glucose, or weight
loss, or kidney function; none was designed to study the risk of heart
attack. In some studies, participants were on Avandia alone; in others,
they took Avandia in combination with insulin or metformin or other drugs.
Some studies featured participants with a history of heart attacks and
cardiovascular disease, while others did not. As some doctors have pointed
out, lumping the studies together is not like comparing apples to apples;
it is more like comparing apples to fruit salad.

Prior studies of Avandia had found no increased risk of heart attack. The
two largest long-term, double-blind clinical trials, called ADOPT and
DREAM, found no increased risk of heart attack from Avandia. But these
studies had important limitations as well: neither was specifically
designed to determine the risk of cardiovascular problems. ADOPT, published
in 2006 in the New England Journal of Medicine, was designed to determine
whether Avandia successfully controlled glucose levels in newly diagnosed
diabetics.  DREAM was designed to find out whether Avandia could delay the
onset of diabetes in people who were at risk for developing the disease.

So, does Avandia cause heart attacks?
We don't know yet. Prior studies of Avandia had found no increased risk of
heart attack. The new "pooled analysis" found a significantly increased
risk. In essence, the findings are in conflict. As the FDA notes, taken in
this context, the risk of heart attack "remains unclear."

Even the possibility of an increased risk, however, is cause for concern.
Diabetics are already at greatly increased risk for heart attacks and other
cardiovascular complications, just because of their diabetes. If one of the
major medications for diabetes creates an even greater risk of heart
attack, it could be disastrous. The FDA and Congress have rightly called
for research to determine whether such a risk exists.

The only way to answer the question definitively is to undertake a long-
term, rigorously controlled clinical trial specifically designed to
determine whether Avandia increases the risk of heart attack. Fortunately,
RECORD, a five-year study involving more than 4,400 participants, and
specifically designed to determine the risk of heart attack, is already
underway in Europe. The trial is scheduled to be completed in 2008.

Should I stop taking Avandia?
Everyone agrees that you should not stop taking a medicine without talking
to your doctor. It is especially dangerous to stop treating your diabetes.
Uncontrolled diabetes increases your risk for all kinds of health problems
including heart disease, kidney disease, nerve problems, amputation, and
blindness.

If you are taking Avandia, especially if you have a history of heart
disease, you should talk to your doctor right away to determine whether to
make any changes in your medication. And whatever your doctor decides,
please follow his or her instructions to the letter.



IF BLINDNESS COMES.
Welcome to If Blindness Comes, a special pull-out section on diabetes and
vision loss printed in a larger font.  If you know someone living with
diabetes and vision loss, please pull this section out and share it.
[PHOTO/DESCRIPTION: A pill bottle with a large 'E' written on the top with
a marker.]

[PHOTO/DESCRIPTION: A daily pill box.]

Winning Strategies for Tracking Medicine
When Vision is Failing

by Eileen Rivera Ley

If you are new to blindness, you may feel nervous about how you will manage
your medicines on your own. Fear not! There are methods you can use to make
sure you know just which ones are which. You may be surprised to learn that
many blind people identify pills by their shape, size, texture, smell, and
even the rattle they make.  Nevertheless, as more prescriptions are added
and generics prescribed, distinguishing pills using these conventional non-
visual techniques may become more difficult.  Thankfully, imagination and
ingenuity are limitless, and blind people continue to find ways to manage
their medications safely and independently through a variety of low vision,
no vision, low-tech and high-tech options.  The key is to develop your own
system, then stick to it.

You can Manage on Your Own-With a System

NFB Chapter President Peggy Cowgill, who has been legally blind all her
life, is an independent living specialist for the Disability Resource
Center in Alamogordo, NM and works with people to make sure they can manage
medications whether or not they can see them.  Peggy suggests marking the
lids of each prescription and over-the-counter medication, and stresses the
importance of creating symbols which can be read right side up or upside-
down. She recommends using Liquid Tactile Markers available through the NFB
Independence Market, (410) 659-9314 ($4 plus shipping and handling-Product
Code AIL40M).  This product is similar to, but more durable than, a puffy
fabric marker (Note:  Dries in 24 hours).

Peggy uses the following system:  For Tylenol (acetaminophen) she makes a
big X on the cap (she stores aspirin in a different room to prevent mix-
ups). She uses a single dot for medicines she takes once per day, a dot and
line for medicines she takes both in the morning and at night, and a single
line for nighttime-only medication.

For easy scanning, Peggy recommends keeping medicine bottles in a flat
bottomed basket, the type you find at the dollar store, so that the marked
caps can be face up at all times. Ziplocs also work well, especially when
traveling.

Creating your System

When creating a system for marking the medicine, you should have symbols
for the dose and time to be taken. For example you might use dots to
indicate the dose and dashes to represent the time of day.  More elaborate
systems may indicate the name of the medicine and the name of the person
taking the medicine. Make a system which works whether or not you are
wearing your glasses or contacts and whether or not you are having a good
eye day.

Many blind people use rubber bands to mark their medications.  Use high
quality rubber bands or ponytail holders for this, as a broken or
accidentally moved band will cause system failure!  Perhaps placing some
clear packing tape over the rubber bands will add to the stability and
protect the bands from breaking.

Be creative! Glue different-shaped buttons to the container or string beads
onto elastic and put them around the bottle neck.  Buttons might indicate
the number of pills and rubber bands in different places on the bottle can
identify when or how many times per day you should take the medicine.  For
example, if you need to take the pill once in the morning and once at night
you can wrap two rubber bands around the bottle, one securely along the top
of the bottle and the other near the base.  If you need to take two pills
each time, you can glue two buttons onto the cap of the bottle that has the
rubber bands.  Rubber bands also work well on insulin bottles.  If you have
two kinds of insulin, you can place a rubber band around one to distinguish
it from the other.

Managing Meds for More than One Person

In my home we have four people, and each takes a number of medicines.  In
addition to marking the medicines, I store them in different rooms as a
secondary precaution.  I also use different sized bottles for each of the
people in my family. If a refill comes in a different style bottle and
threatens to disturb my system I simply transfer the pills and discard the
new bottle. I also mark the initials of the user on the label.

Sharpie brand markers are a great help if you have stable, usable vision.
Since I have some limited vision, I use these permanent, waterproof markers
to mark both the bottoms and tops of our white medication bottles with the
first initial of the medicine. At first, I only marked the cap, but then
discovered that some caps are interchangeable, even on different sized
bottles. So as a back up, I began marking the bottom of the bottles as
well. I would then put the initials of the person taking the medicine in
jumbo print on the label.  I write the first initial of the medication on
the bottom of the bottle.  If the plastic was a dark color, I simply added
a piece of duct tape and wrote over that.   On the side of the label, I use
the marker to denote the dose, quantity over frequency, for example #2/3x
or #1/1x. You can use the tactile marker for the same system if you can't
see.

Memory Minders

Whether you are just very busy or just plain forgetful, you may need a way
of making sure you take your medicines.  Some people I know keep a log or
mark the calendar. Others find the classic 7-day pill sorter box keeps them
on track.  One Voice reader reports that she flips her bottles over after
taking her morning medicines then realigns them after taking her evening
dose.

Braille Labels

Braille readers use a sticky clear tape called Dymotape (also available at
the NFB Independence Market) to create custom Braille labels.  You need not
be fluent in Braille to use these labels.  In fact, marking your meds with
a few Braille numbers and letters may be an ideal way to integrate it into
your daily life.  Just this year, our mail order pharmacy, MedcoByMail,
began shipping our meds with Braille labels so my husband could identify
his countless post-transplant medicines on his own. Check with your
pharmacy to see if they can do this for you.

Talking Rx Readers

Joyce Kane, Diabetes Action Network Board Member and local NFB chapter
president, was a beta tester for a talking prescription reader developed by
a pharmacist in Connecticut. The Talking Prescription Readers, manufactured
by the Millennium Compliance Corporation, cost $15 each and are available
through the NFB Independence Market (# AIM27T). These reusable readers
attach to the bottom of most standard sized pill bottles. The device allows
you or a pharmacist to record up to a minute of detailed instructions and
precautions on its digital recording chip (in any language). Joyce has been
very happy with this method and told me "once I started using the readers,
all of a sudden I had my independence back. I could manage my meds on my
own."

To Sort or Not to Sort

Many people, even those with perfect vision, use medication dispensers with
daily compartments. Some pill boxes come divided for mornings, noon,
evenings and night, and pre-sorting medicines into these boxes can save
time and can also help those with limited dexterity.  And if you take lots
of medicines, the sorter will save you the time of opening and closing
countless bottles.

With a few adaptations, you need not be at the mercy of sighted help to
fill your pill sorters. You can fill them yourself. Some people use two
different sorters, one for morning and one for evening. Find a creative way
to distinguish one from the other. To enhance your flexibility, splurge for
a few extra sorters and organize your entire month of medicines at once.

Keep Information Handy for Sighted Helpers

If your markings make reading the original labels difficult, keep notes or
a chart of your medicines on a pad for doctor visits and emergencies. If
you use a computer, create a spreadsheet with the pertinent data. Note
cards work particularly well since they are easy to carry and update as
needed.

A Final Note on Safety

Donna Goodman, a blind pharmacist, uses Ziploc plastic bags to separate her
once-a-day and twice-a-day medicines.  She urges fellow low-vision and
blind diabetics to be proactive about medicines because anyone can make a
mistake, and mistakes can be dangerous.  When the doctor writes you a new
prescription, insist that he or she read it aloud and ask if there are
special instructions for taking the medication.  When you get your medicine
from the pharmacy or mail order company, have someone read you the labels
to verify that you got the proper medicine in the proper dose. If, upon
inspection, you notice that your pills look or feel like a different shape
or size, don't be shy. Pick up the phone and ask.  By doing so you may
avert a medication error and even save your life.


New, Inexpensive Treatment for Retinopathy and Macular Degeneration May Be
on the Horizon

by Gail Brashers-Krug

Researchers are finding that two related drugs can stop and even reverse
vision loss caused by diabetic retinopathy and age-related macular
degeneration (also called AMD), the two leading causes of blindness in
America.   The two drugs, Lucentis and its chemically similar cousin, a
cancer drug called Avastin, are produced by San Francisco-based
pharmaceutical Genentech.  But one of them-Avastin-is much less expensive.


Genentech's two drugs, Lucentis and Avastin, work by stopping the growth of
new blood vessels.  Both are injected directly into the eye, which is a lot
less painful than it sounds.  Both drugs target wet AMD and proliferative
diabetic retinopathy-the forms of the diseases that lead to severe loss of
vision, eventually leading to total blindness.  Both diseases occur when
lots of tiny blood vessels begin growing uncontrollably around the retina,
which contains the light-sensitive cells essential to vision.  By stopping
the growth of new blood vessels and sometimes even destroying some of the
excess blood vessels, Lucentis and Avastin can stop wet AMD and
proliferative diabetic retinopathy in their tracks.

Lucentis Offers Dramatic Success
Only one of the drugs, Lucentis, is approved by the FDA for use in treating
AMD.  Approved for use last June, Lucentis has already become the treatment
of choice for wet AMD.  Lucentis not only stops AMD in many patients, it
also reverses the damage, dramatically improving vision in most cases.

Although the FDA has not yet approved Lucentis for treating proliferative
diabetic retinopathy, the drug is proving extremely effective in clinical
studies.  Recently researchers at the Johns Hopkins Wilmer Eye Institute
began treating 10 patients, all with early stages of proliferative diabetic
retinopathy, with Lucentis injections.  After several months of treatment,
all 10 patients experienced vision improvement of at least two lines on a
standard eye chart.  In fact, patients saw dramatic improvements after just
one week, according to study investigator and ophthalmology professor Peter
Campochiaro, M.D.
Lucentis vs. Avastin: What's the Difference?
There is no question that Lucentis is an effective treatment for AMD.  So
why are researchers looking for alternatives to Lucentis?  The problem with
Lucentis is its cost.  A single dose of the drug costs more than $2,000,
whereas a single injectible dose of Avastin costs about $150.  Even the
typical Medicare copayment of 20 percent, or $400, is more than twice as
costly as the full price of an injection of Avastin.

Chemically, Lucentis and Avastin are very similar.  Lucentis is a small
fragment of the much-larger Avastin molecule.  To be effective, the drugs
must penetrate the tiny vessels of the retina.  Genentech researchers
originally thought the large Avastin molecule would be too big to do so.
But doctors across the country are finding that, when injected directly
into the eye, Avastin does its job and reverses the growth of new blood
vessels.

The success of Avastin in treating AMD is well documented.  Doctors across
the country widely use Avastin to treat AMD with great success.  Less is
known about Avastin's effectiveness in treating diabetic retinopathy, but
medical researchers in Birmingham, Alabama, recently reported that Avastin
totally reversed early-stage diabetic retinopathy in only three weeks in a
very small study.

The question is whether Avastin, the cheaper drug, is just as safe and
effective as Lucentis.  Avastin's manufacturer, Genentech, has no plans to
find out.  Genentech officials say that they spent millions developing
Lucentis as a macular degeneration treatment, and in funding clinical
trials proving the drug's safety and effectiveness.  Therefore, Genentech
officials say they have no intention of also funding clinical trials for
Avastin to treat eye diseases, now that Lucentis has FDA approval.

Instead, the National Eye Institute (NEI) officials announced in October
2006 that they will pay for trials to compare effectiveness and safety of
the two drugs as treatment for AMD.  So far, the NEI researchers do not
plan to study treatment of diabetic retinopathy by the two drugs. They
expect to publish results in 2009.

Off-Label Use
Although the FDA has only approved Avastin for treatment of cancer, it can
still be legally used to treat eye diseases.  Once a drug is approved by
the FDA, physicians may use it "off-label"-that is, for conditions other
than the one it was approved for-if they are well-informed about the
product, base its use on firm scientific method and sound medical evidence,
and maintain records of its use and effects.  As a result, ophthalmologists
around the country are using Avastin "off-label" to treat AMD and diabetic
retinopathy.


FDA Rejects Promising Diabetic Retinopathy Drug

by Gail Brashers-Krug

Just when it seemed that a medication to prevent diabetic retinopathy was
on the horizon, the Food and Drug Administration has ruled that the Eli
Lilly drug Arxxant (ruboxistaurin mesylate) must undergo three more years
of clinical trials before approval.

The ruling was a blow to Lilly and to millions of diabetics with
retinopathy.  According to the National Eye Institute, between 40 and 45
percent of all diabetics have some degree of retinopathy-that is, damage to
the tiny blood vessels in the eye caused by high blood sugar levels.
Retinopathy ultimately causes not only vision loss, but eventually total
blindness.  In fact, diabetes is the leading cause of blindness in working-
age adults, and approximately 20,000 Americans each year become blind as a
result of diabetes.

The new Lilly drug would have been the first oral medication to fight
retinopathy.  It works by inhibiting the enzyme that causes damage to the
tiny blood vessels in the eye, and could stop eye damage in its tracks.
Early studies were promising and seemed to represent progress in the fight
against retinopathy.

At this point, Arxxant's fate is not clear.  Lilly has invested ten years
and untold millions of dollars developing the drug.  The three-year
clinical study required by the FDA will cost Lilly several million dollars
more.  Lilly is considering its options including conducting clinical
trials, seeking new investors, or scrapping the project entirely.  Many
industry observers had expected Arxxant to be a potential money-maker for
Lilly, possibly earning more than a billion dollars by 2010 as the number
of Americans with diabetes continues to skyrocket.

The primary treatment for diabetic retinopathy is still laser surgery,
although good diabetes self-management can slow or stop its progress.  If
you have not had a thorough eye exam in the last year, please schedule one.
 You may already have retinopathy, even if it is not yet interfering with
your vision.  The only way to detect it is with a thorough eye exam. Your
eye doctor can help you take steps to protect your vision.


Coping with Vision Loss? National Federation of the Blind-
Linking Individuals to a Network of Knowledge

Are you a diabetic experiencing noticeable vision loss? Are you having
trouble reading print, getting around independently or administering your
own medications?  Would you benefit from connecting with others who can
offer you information on managing diabetes and on adjusting to low vision?
If so, then you need to learn about NFB-LINK!

NFB-LINK is the National Federation of the Blind's one-of-a-kind, online
mentoring resource. Through this program, individuals seeking information
about visual impairments will be matched with experienced blind mentors
leading successful and independent lives. With just a quick visit to
www.nfblink.org, you can sign up and get a mentor who is ready to answer
all of your blindness-related questions such as "how
can I check my own blood sugar?" or "how can I read my mail?"  NFB-LINK
offers you the support and guidance you need to live an active and
independent life while coping with low vision.

Blindness need not be a barrier to living a fulfilling life. Learn how to
enjoy your hobbies, pursue educational endeavors, explore employment
options and feel comfortable with your low vision. Join NFB-LINK and locate
your link to success! For additional information about this program,
contact Rosy Carranza via e-mail at rcarranza at nfb.org, or by calling 410-
659-9314, ext. 2283.


Help Create Exciting Web Resource
Where Do Blind Diabetics Work?

There is never enough good information out there on the employability of
the blind.  The NFB Writers' Division is creating a new web resource about
jobs to be hosted on the NFB's Jernigan Institute Web site.

Our target audiences include:

+ Individual blind and visually impaired people exploring career options
(first job seekers or career changers)
+ Employers considering hiring blind people
+ Professionals providing Vocational and Career Counseling
+ Families wondering what the future holds for their blind or visually
impaired child
+ Others learning about the potential of blind people

We need you to accomplish this goal. We are collecting as many job
descriptions as possible.  We know that not all blind people do the same
job in the same way.

How Can I Help?
Help us create the most impressive complete job resource on the web.  Fill
out a form and get your blind and visually impaired friends to do the same.

But I am not totally blind...

We know that vision loss affects employment even if a person is not totally
blind.  If you have a visual deficit which requires you to use some
alternative techniques to carry out you job duties, then you are eligible
to contribute to this effort.

But I am not working now...
That is fine, tell us about the job you did and how you did it.

How about past careers?
You can fill out a form for each job you have held as a blind person; this
way we can build a very complete database.

Send your story in print, on tape,
in Braille or via e-mail to:
Robert Leslie Newman
504 S 57th Street
Omaha, NE 68106
E-mail: newmanrl at cox.net

Note:  If you are open to being contacted, consider registering with NFB-
LINK; this innovative program pairs blind individuals seeking information
or advice with experienced Federationists able to mentor them.  (See
accompanying article on previous page.)

Where Do The Blind Work?
Job Description Form
To complete this form online go to:
www.nfb.org/voice/work or www.nfb.voice.jobdescform.org
Note:  Total answer not to exceed 1,000 words.

1.  What is your name and job title?

2.  What do you do on the job?

3.  Describe your blindness.  What adaptations do you use at work?  Note:
Consider naming the condition or briefly describe it your way.  Otherwise
briefly describe it your way.  As for the adaptations, describe the common
sense strategies as well as the more formal low vision and/or non-visual
methods and/or equipment you use.

4. What training, education, experience and certifications are required to
do this job, and where would you get them?

5. What helped you succeed in your career?  Did you have a mentor or peer
support or consumer/advocacy group?


NFB Participates in Campaign to Raise Awareness of Diabetic Complications


The National Federation of the Blind, along with several other groups that
advocate on behalf of diabetics and their health care providers, launched a
nationwide informational campaign designed to raise awareness of
complications of diabetes, including vision loss.  Unveiled in April, the
campaign aims to help diabetics manage their diabetes effectively despite
their complications, and to help delay or prevent the onset of further
complications.

The campaign focused on "The State of Diabetes Complications in America," a
newly released report that analyzed national health data from the Centers
for Disease Control and Prevention (CDC).   The report finds that three out
of five diabetics in America suffer from at least one serious complication
of the disease, such as vision loss, amputation, kidney failure, or heart
disease.  Moreover, one in ten diabetics experiences two or more
complications.

The findings constitute a "significant wake-up call," said Willard Manning,
a University of Chicago health economist who worked on the report.  Many
diabetics are not aware that they are at increased risk of kidney failure,
blindness, amputation, and heart attack because of their disease.  Many
also do not know that once they experience a single complication, they are
at even greater risk for developing a second, third or fourth.  Good
diabetes management, however, can often delay or even prevent the onset of
further complications.

"The report should also serve as a wake-up call to the diabetes industry,"
said Eileen Rivera Ley, Director of Diabetes Initiatives for the National
Federation of the Blind.  "It shows that most diabetics are experiencing
complications, so the industry needs to develop products and technologies
that are accessible to people with complications, such as vision loss or
amputation."  Ley pointed out that many diabetes technologies, such as
insulin pumps, cannot be fully used by the visually impaired.

Annette Gordon wants to be a part of the wake-up call (see related story on
pages 2-3).  Gordon, 61, and a member of the National Federation of the
Blind in Maryland, ignored her diabetes for nearly 20 years, until it cost
her both her vision and her teeth (see related story on page 17).  She
wants to make sure other diabetics don't make her mistake.  "I'm going to
shout it from the housetop!" she says with a smile.  Gordon also wants to
make sure diabetics know that life isn't over when you lose your vision.
Since she took a life-skills course for visually impaired people, Gordon
says she has newfound confidence, and can do more now than before she lost
her vision.  "Blindness opened up a bigger world for me," she notes.

"The State of Diabetes Complications in America" report was sponsored by
the American Association of Clinical Endocrinologists (AACE), along with
the NFB, the National Kidney Foundation (NKF), the Amputee Coalition of
America (ACA) and Mended Hearts.


For more information, check out: www.stateofdiabetes.com



Free and Discounted Medication

by Karen Wrightson

What would you do if your insurance lapsed and you found yourself unable to
get your medications? It can be a scary situation, but there are several
resources available.

You can search the Internet or ask your pharmacy which pharmaceutical
company makes your medicine. Once you know that, a visit to their Web sites
should provide guidance for prescription assistance. Some offer reduced
cost or free medicine for a time.
For example, Pfizer's Web site has a link for Pfizer's Helpful Answers.
Once you click on Pfizer's Helpful Answers, you will be given three choices
such as "I am a patient or helping a patient and do not have prescription
drug coverage." They then ask you to tell them a little about yourself and
the Pfizer drugs you take. Drop down menus and yes/no questions such as:
"What is your annual salary? What state you live in?" will follow, and then
some about the drugs you take. When this information is processed, you are
given telephone numbers for programs in your area. Pfizer (www.pfizer.com)
programs include Pfizer Pfriends, (866) 776-3700, and Connection to Care
(866) 776-3700.

There are other programs such as Partnership for Prescription Assistance
(888) 477-2669. Many states offer pharmacy assistance programs.  For
example, Maryland's MedBank is available online at www.medbank.org. You can
check online to see if your state has something similar.

Program officers determine medication assistance by evaluating factors such
as your salary, how many are in your household, and whether you have any
prescription insurance at all. You must include a copy of your previous
year's income tax return and a 90 day prescription from your doctor when
you send in your completed application. Unfortunately, it takes about three
weeks to obtain your medicine after your application package is received by
the pharmaceutical assistance program. Due to this delay, you may want to
try to get samples of your medicine from your doctor. Or your doctor may be
able to give you vouchers for free medication by making an appointment with
the pharmaceutical company's representative.

If you are approved for reduced-cost or free medication, it will be sent to
your doctor. The amount will vary; Pfizer sends a three month supply. If
additional financial information is required by the pharmaceutical company
you will be notified by mail.

Many chronic diseases require medication to stay healthy regardless of your
financial or insurance situation. It is good to know there are free
prescription resources available.


Take Care of Your Teeth

Diabetes can reduce your body's ability to fight off infection, and if you
have high glucose levels in your blood, that can increase the bacteria in
your mouth. This combination means your gums are at risk for infection and
then gum disease. When your gums are infected, your teeth can loosen and
fall out. This is what happened to Annette Gordon, who now wears a full set
of dentures (see related story on pages 2-3). "My teeth became so loose I
could reach into my mouth and pull them out" she recalls.

To avoid this happening to you, keep a tight watch on your blood glucose
levels, brush your teeth at least twice a day or after every meal, and
floss regularly. Tell your dentist that you have diabetes and what
medications you take. Make sure to go for a professional cleaning and check
up at least twice a year.

The American Dental Association says the signs of gum disease are:

+  gums that bleed when you brush your teeth
+  red, swollen or tender gums
+  gums that have pulled away from the teeth
+  bad breath that doesn't go away
+  pus between your teeth and gums
+  loose teeth
+  a change in the way your teeth fit together when you bite
+  a change in the fit of partial dentures

If you have any of these symptoms, see your dentist immediately. You may be
referred to a periodontist, a specially-trained dentist who treats gum
disease.


[PHOTO/DESCRIPTION:  Bowls of macaroni and potato salad on a picnic table.]

Healthy Home Cooking
Summer Favorites

by Healthy Exchanges

Hi!  Thanks for joining us in the kitchen again, where the cooking is easy
and the food is both healthy and tasty!   Enjoy!

It's time to pack up the coolers and fire up the grill for those summertime
picnics and barbeques.  Summer is prime time for contamination and food-
borne illnesses, but with planning and organization you can avoid these and
enjoy foods that travel well and are good for you.

Summer food tips:
Defrost fish, meat and poultry thoroughly so it will cook more evenly on
the grill.  Thaw securely wrapped food in cold water or the refrigerator.

Pack your cooler properly.
Use an insulated cooler and well-wrapped ice or freezer packs to keep it at
or below 40F.

Wrap food for safety. Before you put raw meat, fish, and poultry in your
cooler, separate them in tightly sealed plastic containers or zippered
plastic bags.  Never mix raw and
cooked foods.

Make sure your hands are clean. Use hand sanitizer if soap and water are
not available.

Bring extra plastic containers and store leftovers in the cooler
immediately after eating. No need to waste food.

You have managed to take off a few pounds and have gotten more serious
about controlling your diabetes, right? Your next concern is how to choose
the right foods at that temptation-filled summer picnic, potluck or family
reunion.

Remember your priorities: You're going to gather with family and friends.
What do you really crave from that over-laden table? In your mind, divide
the food into three distinct categories:

First is the healthy food.  It's more than fresh fruit or vegetables.
Maybe there's some thinly-sliced lean ham or roast beef, or a pasta salad
that doesn't look like it's drowning in mayonnaise. What about a slice of
homemade bread?

Second is the "anytime & anywhere" food.  These are foods that really
aren't special because you can have them any time. Potato chips, baked
beans and store-bought cookies-Why bother?

Third is "memory" food. When you think of home, what foods come to mind?
These are your "memory" foods.  You'll want to taste those to enjoy the
sentimental nature of the gathering.

Choose the bulk of your meal from the healthy category.  Skip over the
"anytime & anywhere" foods.  Select two or three of the "memory" foods, and
take just a taste of each. Then find a nice location far away from the food
table to enjoy your meal. Start by eating the healthy foods and savor the
"memory" foods last.  When you finish, get involved in catching up with
your friends and family.  If you decide to "walk off your meal" you
certainly won't be going alone; there is always someone who also needs that
walk and it's a great time to talk.

Here are a couple of recipes that will travel well with you to the picnic
as long as you follow the hints for packing your cooler and storing your
food.

Picnic Macaroni Salad

3 cups cold cooked elbow macaroni, rinsed and drained
3/4 cup shredded Kraft reduced-fat Cheddar cheese
1 full cup (6 ounces) diced extra-lean fat-free ham
1/4 cup chopped onion
3/4 cup chopped celery
1 cup chopped fresh tomato
1/4 cup sweet pickle relish
1/2 cup Kraft fat-free mayonnaise
1 teaspoon prepared yellow mustard
1/4 teaspoon black pepper

In a large bowl, combine macaroni, Cheddar cheese, ham, onion, celery, and
tomatoes.  In a small bowl, combine pickle relish, mayonnaise, mustard and
black pepper.  Add mayonnaise mixture to macaroni mixture.  Mix well to
combine.  Cover and refrigerate for at least 30 minutes.  Gently stir again
just before serving.

Hint: 2 1/2 cups uncooked macaroni usually cooks to about 3 cups.

Serves 6 (1 full cup) - Each serving equals:
204 Calories, 4 gm Fat, 12 gm Protein, 30 gm Carbohydrate, 644 mg Sodium,
119 mg Calcium, 2 gm Fiber
Diabetic Exchanges: 1 1/2 Starch, 1 Meat, 1 Vegetable
Carb Choices: 2

Peach Patchwork Cobbler

1 (4-serving) package JELL-O sugar-free vanilla cook-and-serve
   pudding mix
1 (4-serving) package JELL-O sugar-free lemon gelatin
1 1/4 cups water
3 cups (6 medium) peeled and sliced fresh peaches
1 (7.5-ounce) can Pillsbury refrigerated buttermilk biscuits
1/2 teaspoon ground nutmeg
2 tablespoons Splenda Granular

Preheat oven to 350 degrees.  Spray an 8-by-8-inch baking dish with butter-
flavored cooking spray.  In a large skillet, combine dry pudding mix, dry
gelatin, and water.  Cook over medium heat, stirring constantly, until
mixture thickens and starts to boil.  Remove from heat.  Stir in peaches.
Set aside to slightly cool.  Meanwhile, separate biscuits and cut each
biscuit into 4 pieces.  Gently fold biscuit pieces into peach mixture.
Pour mixture into prepared baking dish.  In a small bowl, combine nutmeg
and Splenda.  Evenly sprinkle mixture over top.  Bake for 45 minutes.
Place baking dish on a wire rack and allow to cool.  Cut into 6 servings.

Hint: Good served cold with 1 tablespoon Cool Whip Lite or warm with 1/4
cup sugar and fat-free ice cream.  If using either, be sure to count the
few additional calories.

Serves 6 - Each serving equals:
145 Calories, 1 gm Fat, 4 gm Protein, 30 gm Carbs,
417 mg Sodium, 5 mg Calcium, 3 gm Fiber
Diabetic Exchanges: 1 Starch, 1 Fruit
Carb Choices: 2

We hope you enjoyed our time together in the kitchen.  Remember, if you'd
like us to revise one of your family favorites so it's healthier, send your
request to: Healthy Exchanges PO Box 80, DeWitt, IA 52742.  Also, be sure
to visit our Web site at www.healthyexchanges.com for more "common folk"
healthy recipes to try.

Until next time . . ..
Book Nook

If you plan to leave home this summer, you'll want to get a copy of The
Diabetes Travel Guide, 2nd Edition by Davida F. Kruger (American Diabetes
Association, 2006). The sub-title, "how to travel with diabetes-anywhere in
the world" sums up the very useful contents. Inside you'll find advice for
all aspects of travel, from preparation and packing right through to coping
with an illness on your trip.

Along the way Ms. Kruger covers how to: manage your medicines through
interruptions in routine or time-zone changes; choose the right foods when
eating away from home; prepare for taking different modes of
transportation, and handle increased physical demands on your body. Helpful
boxes and tables provide planning tips and easy reference throughout the
book. A list of phrases you might need, such as "May I please have some
sugar or fruit juice or Coke?" and "Where may I buy medicine?" is at the
back in Spanish, German, French, Italian, Russian, Japanese, and Chinese.
Ms. Kruger points out that not only can you learn or read out these
phrases, you can also carry a copy to show people if you need help.

An especially interesting chapter called "Planning for Special Situations"
describes how to prepare for adventures like scuba diving, high-altitude
hiking, and camping in the wilderness. As Ms. Kruger says, "You can travel
wherever you want to go. There's no reason diabetes should keep you from
doing anything you want to do."  So take a trip through this handy and
informative book before you leave home and then make it your travel
companion. Bon voyage!



Resource Roundup
Note: Resources mentioned below do not imply endorsement by the Diabetes
Action Network of the NFB.


The following are insulin pump companies. Check the company Web site or
call for information, resources and possible support groups.
Animas Corporation
(manufacturer of the IR-2020 Insulin Pump)
(877) 937-7867
www.animascorp.com

Disetronic Medical Systems, Inc.
(manufacturer of the Accu-Chek Spirit Insulin Pump)
(800) 280-7801
www.disetronic-usa.com

Insulet
(manufacturer of the OmniPod Insulin Pump)
(800) 591-3455
www.myomnipod.com

Medtronic/MiniMed, Inc.
(manufacturers of the 522 and 722 Insulin Pumps)
(800) 440-7867
www.minimed.com

Smiths Medical
(manufacturer of the Deltec Cozmo Insulin Pump)
(800) 426-2448
www.delteccozmo.com


The National Kidney Foundation can assist diabetics
The National Kidney Foundation (NKF) publishes a variety of informational
materials about diabetes and chronic kidney disease.  The NKF also provides
resources and support for those undergoing dialysis or kidney transplants.
The NKF seeks to prevent kidney and urinary tract diseases, improve the
health and well-being of individuals and families affected by these
diseases, and increase the availability of all organs for transplantation.
For more information, call the NKF at (800) 622-9010, or go to
www.kidney.org.

Bilingual Talking Glucose Meter
The Prodigy Autocode delivers clear, audible readings in both English and
Spanish, is affordable and fits in your pocket. No coding is necessary and
you'll have results in six seconds. You may be eligible for a free meter!
Call toll free: (866) 540-4815.

Talking microwave
Bravo to Hamilton Beach for their Talking Microwave (Product # 87106 and
#87108). This machine is available at retail stores such as Walmart and
Best Buy for under $100, a remarkable achievement considering that most of
its predecessor talking microwaves averaged well over $300.

Amazing new reading device that talks
The new Kurzweil-National Federation of the Blind Reader is a portable hand-
held device that talks! Simply position over documents, nutritional labels,
book pages, recipes, etc. and the tool will read the contents aloud. The
retail price of this revolutionary new product is $3,495 but for a limited
time the NFB is offering a $200 discount. A new feature enables the reader
to identify paper money. For more information or to order, call (877) 708-
1724 or go to www.nfb.org.

Accessible Glucose Meter
The new Advocate is compact, it talks, and its display is clear and bright.
The meter uses capillary action, touchable test strips and tests across a
20mg/di range, with a tiny blood sample. Contact the retailer: Diabetic
Support Program, 3381 Fairlane Farms Road, Wellington, FL 33414; telephone:
(800) 990-9826; www.prescriptionsplus.com.

A wealth of information at one site
DiabetesXChange.org is a new online clearinghouse for promising initiatives
in diabetes care, prevention and management in the U.S. Whether it's a
small community-based initiative, university-sponsored effort, corporate
wellness program or large government project, visit the Web site to learn
more.

Help for Diabetic Amputees
The mission of The Amputee Coalition of America (ACA) is to reach out to
people with limb loss and to empower them through education, support and
advocacy. This includes access to, and delivery of, information, quality
care, appropriate devices, reimbursement, and the services required to lead
fulfilling lives. The ACA publishes InMotion,
a magazine that addresses topics of interest to amputees and their
families.  The ACA toll-free hotline provides answers and resources for
people who have experienced the loss of a limb.  In addition, the
organization develops and distributes booklets, video tapes,
and fact sheets to enhance the knowledge and coping skills of people
affected by amputation. To contact the ACA, call (888) AMP-KNOW (888-267-
5669), or check out the Web site at www.amputee-coalition.org.

Talking health-monitoring devices
You can buy a number of useful medical tools, such as the Lo-Dose Count-A-
Dose tactile insulin syringe-filling tool, a talking blood pressure cuff, a
talking digital thermometer, and a talking prescription bottle reader.
Prices are reasonable, and in some cases the lowest anywhere. Enhance your
independence and health! Contact the NFB's Independence Market at
telephone: (410) 659-9314 (select option 4 from the voice menu); Web site:
www.nfb.org.

Low Vision Tools
The NFB Independence Market has many useful assistance aids for low vision
individuals. If you need assorted magnifiers, low-vision felt-tip pens or
large-print items such as address books, calendars or check registers, you
will find them among the useful items in the market. Contact the NFB's
Independence Market at telephone: (410) 659-9314 (select option 4 from the
voice menu); Web site: www.nfb.org.

www.mendosa.com
"Diabetes is a disease that perhaps more than any other depends much more
on the patient than on the doctor." So begins the Web site of David
Mendosa, a freelance writer who has written hundreds of articles about
diabetes and everything related to it, and is diabetic himself. There are
links to all of his writings, plus resources that he has found by scouring
the Web for a wealth of diabetes information. www.mendosa.com

Full Service Diabetes Supplier
Access Diabetic Supply promises free glucose monitors, delivery, and in-
home training in the use of blood glucose testing devices.  Your private
insurance is welcome, and they accept Medicare, too. Check them out online:
 www.diabeticsupply.com or call: (800) 285-1430.

Read the Paper by PHONE with NFB-NEWSLINE®
NFB-NEWSLINE® makes daily newspapers and magazines accessible by phone.
Users listen to the news via synthesized voice. No computer is needed and
it is FREE! New feature: national television listings! To subscribe
contact: NFB-NEWSLINE®, 1800 Johnson Street, Baltimore, MD 21230;
telephone: (866) 504-7300.

Diabetes Supplies
American Diabetic Supply, Inc., will ship your diabetes supplies to your
door.  They handle all insurance claims and provide free delivery.  Those
with Medicare and/or private insurance (no HMOs) may receive supplies at no
further cost.  For information, contact:  American Diabetic Supply, Inc.,
telephone: (800) 453-9033, ext. 611; Web site:
www.americandiabeticsupply.com.

Flying With Insulin or Supplies?
Terrorist activity has caused the United States Transportation Safety
Authority, the TSA, to limit carry-ons.  What about insulin, glucose
tablets, and other diabetic supplies?  Passengers may bring insulin on
board as long as the prescription label matches the name of the traveler.
For more details go to: www.tsa.gov.

NOTE: www.diabetesandtravel.com also contains useful advice for diabetic
travelers, for example, how to manage time zone changes.

Free Diabetes Identification Necklace!

The Diabetes Research and Wellness Foundation (DRWF) is an organization
whose stated mission is "to help find the cure for diabetes and until that
goal is achieved, to provide the care needed to combat the detrimental and
life-threatening complications of this terrible disease." The Foundation
offers a wealth of free information covering all aspects of diabetes, which
you can order from www.diabeteswellness.net  or by calling the diabetes
helpline at 1-800-941-4635.

DRWF is offering free identification necklaces for any diabetic who
contacts the Foundation. This identification is key when you are unable to
speak for yourself in an emergency, and reads:  "I Have Diabetes, Please
Test My Blood Before Treating Me."

To order, mail your self-addressed, stamped ($0.41) request including your
name and address to the address below OR order online and be charged a
$2.95 shipping & handling fee.

FREE Diabetes Necklace
5151 Wisconsin Avenue, NW
Suite 420
Washington, DC 20016

If you are a health care professional and would like to receive a supply of
necklaces for distribution to patients please call us at 202-298-9211 or e-
mail us at
diabeteswellness at diabeteswellness.net to discuss your requirement.


[PHOTO/DESCRIPTION: An older couple walks together on a forest path.]

Get Moving: Exercising with Complications

by Dino Paul Pierce CFT, CPT, RD, CDE

Different diabetic complications may require different modifications to
your exercise routine, but if you can move you can still be active.  The
following are some general guidelines for safe physical activity with
diabetic complications.

Cardiac Complications:  If you have cardiac complications, such as heart
disease, you should have an evaluation to measure your blood flow, heart
rate, and blood pressure during exercise.  Your doctor can then recommend
the length and intensity of your exercise sessions.  If you are not sure if
you have cardiac disease, you should have a stress test.  If a stress test
is not available, you should follow a low-intensity program.  You should
definitely obtain the stress test if you are older than 35, have had type 2
diabetes for 10 or more years, have had type 1 diabetes for 15 or more
years, or have any additional cardiac risk factors.

Peripheral Vascular Disease (PVD):  PVD means poor circulation in your
legs.  The following are symptoms of PVD: cold feet, weak pulse in feet,
numbness and tingling, weakness in the legs, burning or aching in the feet
and toes, slow-healing leg and foot sores, and discoloration in the leg
down to the toes.  These occur because the lower leg muscles are deprived
of oxygen and nutrient-rich blood.  PVD is a risk factor for cardiovascular
disease (CVD).  If you experience these symptoms or have PVD you should be
evaluated for CVD before exercising (1,2).

Retinopathy:  Retinopathy, or eye damage, can be either "mild" or "severe,"
and either "proliferative" or "non-proliferative."  Non-proliferative
diabetic retinopathy occurs when the blood vessels in the eye leak fluid
into the retina causing blurred vision.  Proliferative retinopathy is
present when the new, fragile blood vessels begin to bleed, which can cause
scarring and vision loss.  Either type of retinopathy will impose
restrictions on your exercise program, as described below (1,3).

+  No diabetic retinopathy: you can participate in any form of exercise,
and you should have an eye exam yearly.

+  Mild, non-proliferative retinopathy: you can also participate in any
form of exercise, but you should get your eyes examined every six to 12
months.

+  Moderate, non-proliferative retinopathy: you can participate in most
exercises, with the exception of power lifting and other exercise that
would cause a valsalva maneuver, which is increased chest and abdominal
pressure by exhaling against a sealed mouth.  Furthermore, you should have
an eye exam every four to six months.

+  Severe, non-proliferative retinopathy: you can participate in most
exercises, but you want to avoid power lifting, valsalva maneuvers, and
active jarring exercises like boxing. Additionally, you should have an eye
exam every two to four months (1,4).

+  Proliferative retinopathy: it may surprise you to learn that there are
several exercises that are safe and highly recommended even for those with
proliferative retinopathy.  If you enjoy swimming, walking, low-impact
aerobics, riding a stationary bike, or low impact endurance exercises, you
can go ahead!  On the other hand, you will want to avoid heavy weight
lifting, jogging, high-impact aerobics, racquetball, tennis, and even
playing strenuous wind instruments, which require a valsalva.  In addition,
you should have an eye exam every one to two months(1).

Nephropathy (kidney disease):  Nephropathy is a risk factor and possible
indicator of CVD.  Therefore, patients with protein in their urine should
have an examination to assess the heart.  If you have high levels of
protein in your urine, you should avoid high-intensity and strenuous
exercise programs(1).

Peripheral Neuropathy:  Peripheral neuropathy is loss of feeling in the
hands and feet.  This can be especially dangerous if you cannot detect
injuries or pain in your feet.  To avoid injury, limit weight-bearing,
repetitive exercises, such as running, prolonged walking, and step
exercisers all of which can lead to foot ulcers.  Recommended exercises for
patients with sensory loss are swimming, bike riding, rowing machines,
chair exercises/arm chair fitness, elastic or resistance band arm and leg
exercises,
and other non-weight-bearing exercises (1,5).

Gastroparesis:  Gastroparesis is one of the least commonly discussed
complications of diabetes.  Also called delayed gastric emptying,
gastroparesis means that the stomach takes too long to empty its contents.
It occurs when nerves to the digestive tract are damaged or stop working.
As a result, the muscles of the stomach and intestines do not work
normally, and the movement of food is slowed or stopped.

Diabetics balance diet, insulin, oral medications, and exercise throughout
the day to achieve optimal blood sugar levels.  Gastroparesis
unpredictability is a new factor in the already difficult equation.  The
gut might function properly, not at all, or at a very delayed rate (5).  If
you have gastroparesis, you may be much more likely to have highs and lows.
 It is therefore even more important to check your blood sugar before,
during, and after exercise.


Conclusion

If you can move, you can exercise and improve your health.  No matter what
your complications, you can and should exercise. I encourage you to have a
physical and a stress test, and start being a little more active.
Remember, you cannot change the past, but you can be healthier today than
you were yesterday.


REFERENCES

1.  Pendergrass M, Lynch CC, Myers E, Blake S. Exercise and diabetes. The
University of Louisiana at Monroe School of Pharmacy Diabetes Series. 2004:
P6.

2.  Advocate Health Care.  Exercise can help control a common circulatory
problem. Available at:
http://www.advocatehealth.com/system/info/library/sam/040801.html.

3.  Medline Plus. Medical Encyclopedia. Diabetic retinopathy.  Avaliable
at: http:// www.nlm.nih.gov/medlineplus/ency/article/001212.htm.

4.  Nason ET, Rehabworks. Valsalva's Maneuver.  Available at:
http://rehabworks.ksc.nasa.gov /education/topics/valsalva.php.

5. American Diabetes Association. Diabetes and gastroparesis.  Available
at: http://www.diabetes.org/type-2-diabetes/Gastroparesis.jsp.

6.  American Diabetes Association. Physical activity/exercise and diabetes.
Diabetes Care. 2004, 27:S58-S62.


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