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Archive-name: diabetes/faq/part1 Posting-Frequency: monthly Last-modified: 19 June 1994 Changes: New subject line and archive name (23 May) Link in the insulin pump discussion (23 May) Minor edits (23 May) Add cost comments from Britain (23 May) Add BDA contact info (23-24 May) Change .Z to .gz in TOUCH2 info (24 May) Add Followup-To: line that got lost (28 May) Add anti-failure comments to type 2 section (2 June) Add reference to Michael Wolfe's software overview (19 June) Add four sections on Online Resources (19 June) Copyright 1993-1994 by Edward Reid. Re-use beyond the fair use provisions of copyright law and convention requires the author's permission. CONTENTS ======== GENERAL Where's the FAQ? What's this newsgroup like? What is glucose? What does "bG" mean? What are mmol/L? How do I convert between mmol/L and mg/dl? What's type 1 and type 2 diabetes? Is it OK to discuss diabetes insipidus here? What is it? How about discussing hypoglycemia? BLOOD GLUCOSE MONITORING How accurate is my meter? Ouch! The cost of test strips hurts my wallet! What do meters cost? Comparing blood glucose meters (from Lyle Hodgson) How can I download data from my One Touch II? How can I download data from my Glucometer (tm)? Other recordkeeping software I've heard of a non-invasive bG meter -- the Dream Beam? What's HbA1c and what's it mean? TREATMENT My diabetic father isn't taking care of himself. What can I do? Managing adolescence, including the adult forms So-and-so eats sugar! Isn't that poison for diabetics? Insulin nomenclature Caring for insulin while travelling (not yet written) Injectors: Syringe reuse and disposal Injectors: Pens Injectors: Jets Insulin pumps Beta cell implants, pancreas transplants, future cures What's a glycemic index? How can I get a GI table for foods? I beat my wife! (and other aspects of hypoglycemia) (not yet written) Does falling blood glucose feel like hypoglycemia? Alcohol and diabetes (by Peter Stockwell) SOURCES Online resources: diabetes-related newsgroups Online resources: diabetes-related mailing lists Online resources: commercial services Online resources: FTP Where can I mail order XYZ? How can I contact the American Diabetes Association (ADA) ? How can I contact the Juvenile Diabetes Foundation (JDF) ? How can I contact the British Diabetic Association (BDA) ? Could you recommend some good reading? DCCT What is the DCCT? What are the results? Subject: Where's the FAQ? ========================= Millions of volunteers are working on drafting Periodic Informational Postings in their Copious Spare Time (tm). Needless to say, this isn't moving very quickly. If you want to volunteer to research and/or write, contact Steve Kirchoefer (swkirch@chrisco.nrl.navy.mil). This FAQ attempts to answer the questions which have been most frequently asked in misc.health.diabetes (m.h.d). This is not a complete informational posting. My only criterion for inclusion is that the topic has frequently appeared in m.h.d, either by an explicit question, or implicitly by posting a related question or a common misconception. If you obtained this article by some method other than reading m.h.d, you may wish to refer to the sections on "Online resources" for more information. An informational posting on insulin pumps is posted to m.h.d at the same time as this FAQ. See below for retrieval information. It was developed and is maintained by Jim Summers (summers@cs.utah.edu), with lots of help from Joan Stout (sasjcs@unx.sas.com). An informational posting on diabetes-related software is posted to m.h.d at the same time as this FAQ. See below for retrieval information. It was developed and is maintained by Michael Wolfe (mwolfe@wvnvms.wvnet.edu). ****** As of this writing we are in the process of submitting the software posting to news.answers. If it does not appear with this posting, please be patient. ****** Other informational postings will, we hope, appear as volunteers find the time to write them. I've used ideas and information from many people in writing this FAQ. I haven't attempted to identify them, but I thank them all. The words herein are mine unless otherwise credited. If you read this and it helps you, please let me know what part helped, and why. If you read this and can't find what you want, let me know that too. Such comments will help me and the other volunteers decide what is worth working on, and whether. You'd be surprised how little feedback we get. These documents -- the FAQ, the insulin pump discussion, and the software overview -- are available from the news.answers archives at rtfm.mit.edu. Using anonymous ftp, get the files: /pub/usenet/news.answers/diabetes/faq/part1 /pub/usenet/news.answers/diabetes/insulin-pump-disc /pub/usenet/news.answers/diabetes/software Or send an email message to mail-server@rtfm.mit.edu, subject ignored, body containing: send usenet/news.answers/diabetes/faq/part1 send usenet/news.answers/diabetes/insulin-pump-disc send usenet/news.answers/diabetes/software Note that "faq/part1" is currently the *only* part. ****** Also note that the software overview is currently being submitted. If it isn't in the rtfm archive, try again in a few days. ****** Subject: What's this newsgroup like? ==================================== Posting topics range through emotional support, treatment techniques, psychological factors, health care practices, and insurance. The atmosphere is generally a highly supportive one, and most participants believe strongly that this is an important aspect. As in other parts of the net, there are one or two regular participants who believe that it is important to question the motives and/or knowledge of anyone posting a new problem. If you find that the first response is antagonistic, please wait a few hours. Every antagonistic response will elicit a dozen sympathetic responses. Topics closely related to diabetes mellitus which do not have their own place in Usenet are welcome. Examples are diabetes insipidus, hypoglycemia, glucose intolerance, legal and employment ramifications of chronic illness, effects on family members, and so on. misc.health.diabetes tends to be inclusive of anyone who needs it. The same caveat applies here as in all newsgroups: the advice is worth what you paid for it. This applies in spades to a critical health topic such as diabetes. Never substitute informal advice for a physician's care. Advice given in m.h.d is *never* medical advice. The variety of individual responses to diabetes is exceeded only by the variety of individual responses to life. No two patients respond alike, and many respond *very* differently from others. These differences are physiological, not just psychological. They reflect not only varying responses, but the fact that diabetes itself probably has many causes, many more than the few types currently recognized (see section on types). When you read advice, realize that what works (or doesn't work) for someone else may not work (or may work) for you. When you give advice, try to remember that most advice is relative to the individual, not absolute. Recognize that you can't treat your own diabetes by a set of rules, but only by knowing how your own individual body and physiology work and by adjusting to your own mechanisms. If you obtained this article by some method other than reading Usenet, refer to the section on "Online resources: diabetes-related newsgroups" for brief information on how to obtain access to Usenet newsgroups and misc.health.diabetes in particular. The actual charter which led to the creation of the newsgroup in May 1993 follows. This charter was approved by a public vote of the Usenet readership, and is the only official statement of the scope and purpose of this newsgroup. 1. The purpose of misc.health.diabetes is to provide a forum for the discussion of issues pertaining to diabetes management, i.e.: diet, activities, medicine schedules, blood glucose control, exercise, medical breakthroughs, etc. This group addresses the issues of management of both Type I (insulin dependent) and Type II (non-insulin dependent) diabetes. Both technical discussions and general support discussions relevant to diabetes are welcome. 2. Postings to misc.health.diabetes are intended to be for discussion purposes only, and are in no way to be construed as medical advice. Diabetes is a serious medical condition requiring direct supervision by a primary health care physician. Subject: What is glucose? What does "bG" mean? ============================================== Glucose is a specific form of sugar, one of the simplest. It is the form found in the bloodstream. "Blood sugar" always refers to blood glucose, and is abbreviated bG. All bG meters are specific for glucose and will not respond to other sugars, such as fructose, sucrose, maltose and lactose. Although sucrose (table sugar) is the most common sugar in food, glucose is also common. Most fruits, fruit juices, and soft drinks contain large amounts of glucose, and many foods contain small amounts. This means that you must be very careful to clean any food residue from your fingers before drawing blood for a bG check. Since the normal level of bG is only 1g/L (=100mg/dl), it only takes a tiny speck of glucose on your finger to contaminate the sample and give you a falsely high reading. 10 *micrograms* of glucose could raise the reading enough to cause you to overreact dangerously. Subject: What are mmol/L? How do I convert between mmol/L and mg/dl? ==================================================================== mmol/L is millimoles/liter, and is the world standard unit for measuring glucose in blood. Specifically, it is the designated SI (Systeme Internationale) unit. "World standard", of course, means that mmol/L is used everywhere in the world except in the US. A mole is about 6*10^23 molecules; if you want more detail, take a chemistry course. mg/dl (milligrams/deciliter) is the traditional unit for measuring bG (blood glucose). All scientific journals are moving quickly toward using mmol/L exclusively. mg/dl won't disappear soon, and some journals now use mmol/L as the primary unit but quote mg/dl in parentheses, reflecting the large base of health care providers and researchers (not to mention patients) who are already familiar with mg/dl. Since m.h.d is an international newsgroup, it's polite to quote both figures when you can. Most discussions take place using mg/dl, and no one really expects you to pull out your calculator to compose your article. Many meters now have a switch that allows you to change between units. To convert mmol/L to mg/dl, multiply by 18. To convert mg/dl to mmol/L, divide by 18 or multiply by 0.055. And remember that reflectance meters have a 10-15% error margin at best, and that plasma readings are 15% higher than whole blood, and that capillary blood is different from venous blood. So round off to make values easier to comprehend and don't sweat the hundredths place. For example, 4.3 mmol/l converts to 77.4 mg/dl but should probably be quoted as 75 or 80. Similarly, 150 mg/dl converts to 8.3333... mmol/l but 8.3 is a reasonable quote, and even just 8 would usually convey the meaning. Actually, a table might be more useful than the raw conversion factor, since we usually talk in approximations anyway. mmol/l mg/dl interpretation ------ ----- -------------- 2.0 35 extremely low, danger of unconciousness 3.0 55 low, marginal insulin reaction 4.0 75 slightly low, first symptoms of lethargy etc. 5.5 100 mecca 5 - 6 90-110 normal preprandial in nondiabetics 8.0 150 normal postprandial in nondiabetics 10.0 180 maximum postprandial in nondiabetics 11.0 200 15.0 270 a little high to very high depending on patient 16.5 300 20.0 360 getting up there 22 400 max mg/dl for many meters and strips Preprandial = before meal Postprandial = after meal Subject: What's type 1 and type 2 diabetes? =========================================== The term diabetes mellitus comes from Greek words for "flow" and "honey", referring to the excess urinary flow that occurs when diabetes is untreated, and to the sugar in that urine. Diabetes mellitus (DM) comes in four classifications (which some will argue don't really represent the actual types very well): type 1 -- characterized by total destruction of the insulin-producing beta cells, probably by an autoimmune reaction. Onset is most common in childhood, thus the common (but now deprecated) term "juvenile-onset", but the onset up to age 40 is not uncommon and can even occur later. Patients are susceptible to DKA (diabetic ketoacidosis). There seems to be some genetic tendency, but the genetic situation is unclear. Most patients are lean. Always requires treatment by insulin. Not sex-linked. Also referred to as IDDM (insulin dependent diabetes mellitus). type 2 -- characterized by insulin resistance despite adequate insulin production. A large majority of patients are overweight at onset, and a majority are female. Most are over 40, hence the common (but now deprecated) terms "adult-onset" or "maturity-onset", but onset can occur at any age. Patients are not susceptible to DKA. There is a strong genetic tendency, but not simple inheritance. Depending on the individual, treatment may be by diet, exercise, weight loss, oral drugs which stimulate the release of insulin, or insulin injections -- and usually a combination of several of these. Also referred to as NIDDM (non-etc) *even when treated with insulin*. type 3 -- a catchall for forms not covered by the other types, including loss of the entire pancreas to trauma, cancer, alcohol abuse, or exposure to chemicals. type 4 -- gestational. Occurs in about 3% of all pregnancies as a result of insulin antagonists secreted by the placenta. It is recommended that all pregnant women receive a screening glucose tolerance test between the 24th and 28th weeks of pregnancy to detect gestational diabetes early if it occurs, as diabetes can cause serious difficulties in pregnancy. Usually requires insulin treatment. Not DKA-susceptible. Usually disappears after childbirth, but not always. Most authorities state that the typical patient is female ... About 90% of diabetes patients are type 2 (some 12 million in the US), and about 10% are type 1 (some 1 million in the US). Discussion on m.h.d tends to run about 2/3 type 1, I'd guess. This probably reflects the fact that type 1 diabetes is harder to ignore, and that type 2 seldom strikes the younger people who are more likely to have net access. Type 2 is *not* less serious. "1" and "2" are often written in Roman numerals: type I, type II. Because typography is often unclear on computer terminals, I've stuck with the Arabic numeral version. Diabetes accounts for about 5% of all health care costs in the US, some US$90 billion per year. Subject: Is it OK to discuss diabetes insipidus here? What is it? ================================================================= Diabetes insipidus (DI) results from abnormalities in the production or use (two main types) of the hormone arginine vasopressin. The excess urine flow is devoid of sugar. There are no blood glucose abnormalities, and in fact there is nothing in common with diabetes mellitus except the excess urination when untreated. Diabetes insipidus can be treated with hormone replacement (by nasal spray or injection). DI is much less common than diabetes mellitus, though a few people have discussed it on misc.health.diabetes and are reading m.h.d. Such participation is certainly welcome, but because the number of DI patients is only 1 or 2 per 10,000 population (25,000-50,000 in the US), there probably isn't a critical mass for discussion on Usenet. One possible resource for DI patients is Diabetes Insipidus and Related Diseases Network Route 2 Box 198 Creston, IA 50801 Subject: How about discussing hypoglycemia? =========================================== Sure ... To clarify: the term "hypoglycemia" is used to refer to two distinct conditions. The word just means "low blood glucose". This can occur as an insulin reaction, the result of too much injected insulin (taken to treat diabetes) compared to food intake and exercise. But low blood glucose can also be a chronic condition resulting from abnormalities of insulin secretion, and this chronic condition is also called hypoglycemia. Chronic hypoglycemia may be caused by beta cells which overreact to an increase in blood glucose (bg) by releasing too much insulin, which then causes a too-rapid drop in bG. Such a condition, called reactive hypoglycemia, is usually handled by dietary adjustments, in particular avoiding refined sugars and large meals which stimulate the overreaction. This often requires an effort in calculating the diet and monitoring bG levels that is equal to what anyone with diabetes needs. Tumors (insulinomas) can cause a steady overproduction of insulin. These generally require surgical removal. There may be other causes as well -- I haven't tried to review the field thoroughly, and I don't believe anyone claims to understand all the causes. So chronic hypoglycemia is closely related to diabetes mellitus in being a disorder of insulin production and use, and requires many of the same techniques for its treatment. The two are a natural for discussion in the same newsgroup. Which is good, since there really isn't anywhere else in Usenet at present to discuss chronic hypoglycemia. Welcome. Subject: How accurate is my meter? ================================== bG (blood glucose) meters are not as accurate as the readings you get from them imply. For example, you might think that 108 means 108 mg/dl, not 107 or 109. But in fact all meters made for home use have at least a 10-15% error under ideal conditions. Thus you should interpret "108" as "probably between 100 and 120". (See above for conversion to mmol/L.) This is a random error and will not be consistent from one determination to the next. You cannot expect to get exactly the same reading from two checks done one after the other, nor from two meters using the same blood sample. This is generally considered acceptable because variations in this range will not make a major difference in treatment decisions. For example, the difference between 100 and 120 may make no difference in how you treat yourself, or at most might make a difference of one unit of insulin. With present technology, more accurate meters would be much more expensive. This expense is only justified in research work, where such accuracy might detect small trends which could go undetected with less accurate measurements. This discussion applies to ideal conditions. The error may be increased by poor or missing calibration, temperatures outside the intended range, outdated strips, improper technique, poor timing, insufficient sample size, contamination, and probably other factors. Contamination is especially serious since it can happen so easily and is likely to result in an overdose of insulin. Glucose is found in fruits, juices, sodas, and many other foods. Even a smidgen can seriously alter a reading. When comparing meter readings with lab results, also note that plasma readings are 15% higher than whole blood, and that capillary blood gives different readings from venous blood. Visually read strips are slightly less accurate than meters, with an error rate around 20-25%. By "error rate" I mean twice the standard deviation from the mean. An error rate of 15% says that about 97% of the readings will be within 15% of the actual value. Subject: Ouch! The cost of test strips hurts my wallet! ======================================================= The cost of test strips is a complex interaction of R&D costs, manufacturing costs, marketing strategy, insurance practices, and undoubtedly other factors. You can ask on the net if you want; you'll get lots of comments but no answers. There are a couple of ways of reducing the cost of blood glucose monitoring. One is to seek out the best price for the strips; large stores such as FEDCO often have good prices, as do some mail order suppliers (see mail order section). A second way is to use visually read strips (Chemstrip bG and a couple of lesser known brands) and cut them in half or even in thirds. Do the cutting carefully with a pair of strong, *clean* scissors, and get the strips back into the vial as quickly as possible. There have been reports that some manufacturers claim this procedure will cause problems, but those who have used the technique report that it works well. Visually read strips are slightly less accurate than meters. Do *not* cut strips when using them in meters. The results will be totally incorrect. Most discussion on m.h.d of the cost of test strips has centered on the US. I'm not sure why, though a good guess is that differences in health care systems and national policies make this issue more critical to the individual patient in the US. There is no dearth of non-US participants on m.h.d. Subject: What do meters cost? ============================= The flip side of expensive test strips is that the manufacturers virtually (and sometimes literally) give away the meters to hook you on their test strips. Don't pay full price for a meter; look for discounts, rebates, and giveaways. For example, as of this writing I'm looking at a catalog that shows a Glucometer 3 for US$45, with a US$30 manufacturer's rebate *and* a US$30 trade-in allowance if you already have a competing meter -- which means you make US$15. There are similar deals on other meters. But make sure you consider the cost of strips as well as the cost of meters, and find out which your insurance will pay for. The most fully featured meters, such as the One Touch II, don't have such widely advertised deals, though you can probably find ways of getting them at discount. If you have insurance that pays for strips but not for the meter, it may be worth calling the meter manufacturer and trying to persuade them to give you a meter. If anybody has actually tried this, let us know whether or not it worked. As with strips, this discussion of costs applies to the US, and there has been little discussion of meter costs outside the US on m.h.d., probably because fewer tradeoffs are available in most countries. An Australian correspondent notes a much narrower choice and higher cost of meters there, but subsidized (pardon, subsidised) test strips. In Britain, strips are covered by the National Health Service, but meters may be expensive. Elsewhere? Please post. Subject: Comparing blood glucose meters ======================================= This section is courtesy of Lyle Hodgson <lyle@HQ.Ileaf.COM>, who found the chart published by Hospital Center Pharmacy, got permission to reproduce it, and entered and formatted the data. Take it, Lyle. The following Blood Glucose Monitor Comparison Chart is published by the Hospital Center Pharmacy (433 Brookline Ave. Boston MA 02215; reprinted here with permission). After I mentioned it a couple weeks ago, Ed encouraged me to seek the permission to post it and helped in figuring out how to format it into 80 columns, which was hell since the original was an 8.5x14" landscape with 8-point text. Note that I haven't edited anything more than to patch in some grammar where it was obviously lacking and to abbreviate the hell out of everything. I don't know what a Privacy Option is; whether the Previous Test, Last Test, and Latest Test under "Memory" are all the same thing; whether the cassette available from the Diascan manufacturer is Audio or Video; or the sizes of most of these meters. Hope you find this chart as informative as I found the hard copy. You can get your own hard copy of the original for free by calling the Hospital Center Pharmacy yourself, 1-800-824-2401. Ctrl Soln = Control Solutions. Trng Cass = training cassette available. A=audio, V=video. Power Srce= power source (wow): NR=non-replaceable Mem = memory. Number of results stored. D/T=date and time also stored. Wrty = length of warranty. Product Name/ Range Time Ctrl Trng Power Manufacturer mg/dl (sec) Soln Cass? Srce Mem Wrty Accuchek III/ 20- 120 Lo/Hi A,V 9V 20, 2 yr Boehringer- 500 alka- D/T Mannheim line Rejects inadequate sample, must wipe and time. Displays date&time. Privacy option. Companion2 20- 20 Lo/Hi Video 3V NR 10 4 yr Sensor/ 600 lith Medisense Largest display of readings. No wiping, blotting, or timing; auto start. Easy strip insertion. No cleaning. Diascan-S 10- 90 Norm/ Yes 6V J 10 2 yr Meter/ Home 600 Elev/ cell Diagnostics High The only smearable strip. Must wipe and time. Large easy-to-read display. Privacy option. Exactech 40- 30 Hi/Lo Video NR last 4 yr Companion 450 lith or Pen/ Medisense One-button operation. No wiping, blotting, or timing. Glucometer3/ 20- 60 Norm A,V mem: 300, 3 yr Miles/Ames 500 NR; D/T AA for LED display Alarm clock, meter, & logbook. Privacy option. One Touch II/ 0- 45 Norm A,V 6V J 250 3 yr Lifescan 600 cell No wiping, timing, or blotting. Signals when meter must be cleaned. One Touch 0- 45 Norm Audio 6V J prev 3 yr Basic/ 600 cell Lifescan Pen2 20- 20 Hi/Lo Video NR 10 4 yr Sensor/ 600 lith Medisense Largest display of readings. No wiping, blotting, or timing; auto start. Easy strip insertion. No cleaning. Tracer II/ 40- 120 Hi/Lo Video two 10 2 yr Boehringer- 400 3V Mannheim lith Pocket-sized monitor, smallest test strip needs less blood. Ultra/ 0- 45 Lo/ Video four 2 2 yr Home Diag- 600 Mid/ 1.5V nostics Hi "N" No timing, wiping, blotting; automatic temperatures; correction. Large easy-to-read display. Accucheck 20- 15- Lo/ Video 6V 30 3 yr Easy/ 500 60 Mid/ alka Boehringer- Hi line Mannheim Easy calibration; small drop of blood needed. No wiping, blotting. Glucometer 40- 60 Hi/ Video two latest 5 yr Elite/ 500 Norm 3V Miles/Ames lith No wiping or timing. Strip draws up amount of blood needed. *PARTNER 10- 90 Norm/ Audio "J" 10 2 yr Visually 600 Elev/ cell Impaired/ Abnorm. Home Diag. Elev Shoulder strap, durable carry case, extra battery, smearable strip. Large display earpiece. Privacy option. CheckMate/ 40- 60- Norm None two 40+ lifetime Cascade 400 90 3V D/T of pur- Medical lith chaser Built-in lancing device, 4 programmable alarms. Strips are individually foil wrapped. Lyle, happy with her Companion2 thanks Subject: How can I download data from my One Touch II? ====================================================== You can get a cable to hook the One Touch II to a PC from the meter manufacturer, LifeScan. The cable includes some electronics, not just a cable, so you probably don't want to make your own. In the US the cable is free. Elsewhere, LifeScan lets each international office set its own policy on cable distribution, and some are charging substantial fees. North American telephone numbers are: U.S.A. 1-800-227-8862 +1 408 263 9789 Canada 1-800-663-5521 elsewhere (If you have trouble locating a phone number for your international office, let me know. If this problem is recurrent, we will add the list of offices here.) LifeScan provides some software for downloading the data. According to a recent posting, it is minimal download software, and you must use other software (for example, a spreadsheet) for analysis. Vic Abell's freeware TOUCH2 (described below), by contrast, downloads and analyzes data and has received rave reviews from its users for its analysis features. And Vic posts update announcements to misc.health.diabetes. There is a shareware Windows program called Diabetics Assistant which downloads from the One Touch II, saves the data in a file, and provides various analysis and display facilities. I haven't heard from anyone who has used this program. I know it is available on America Online. No comparable Macintosh software is known to be available. However, downloading the raw data using a basic telecom program (such as Kermit or ZTerm) is feasible. The meter responds to basic simple commands. LifeScan will send you a list of the commands and responses. Call and ask for the protocol specification, or FTP it from Vic Abell (see below). Info from Vic Abell <abe@cc.purdue.edu>: TOUCH2 is Vic Abell's freeware MS-DOS/PC application for downloading and analyzing data from the LifeScan One Touch 2 blood glucose meter. TOUCH2 interfaces to the RS-232 data port of the One Touch 2, downloads the data on command, and provides a variety of analytical displays. It's available via anonymous ftp from vic.cc.purdue.edu (128.210.15.16) in /pub/touch2.zip or /pub/touch2.tar.gz, with information in /pub/touch2.README. When ftp asks for a password, you must provide your valid email address of the standard form user@domain.typ. The protocol specification is available from the same site, same directory, filename lifescan.ot2. If you do not have ftp access, you can get a copy of a TOUCH2 distribution by email by sending an email letter to: ftpmail@decwrl.dec.com In the body of the letter put: reply <your_email_reply_address> connect vic.cc.purdue.edu anonymous <your_email_address> chunksize 100000 binary uuencode get /pub/touch2.zip quit If you want touch2.tar.gz or lifescan.ot2 instead, put its name in place of touch2.zip in the "get" directive. Multiple "get"s are allowed. <your_email_address> must be in the standard form user@domain.typ. If you want btoa encoding instead of uuencoding, replace the "uuencode" line with "btoa". If you can't receive email messages of 100K bytes, change the "chunksize" line. Be patient; the server sometimes takes two or three days to process the backlog, and recently up to a week. Subject: How can I download data from my Glucometer (tm)? ========================================================= Miles Inc, makers of the Glucometer M/M+ blood glucose meters, sells a program called Glucofacts+ DMS which -- downloads and analyzes data from the meters -- stores the data in files -- produces quite a variety of statistical reports and graphs on screen or printed -- runs under MS-DOS only -- supports only the Glucometer M and M+ -- requires a nonstandard cable which is supplied with the software -- uses a proprietary interface (unlike Lifescan, Miles will not provide the specifications of the interface) -- does not provide for manual entry of data -- a Data-Link Modem available separately provides the capability of transferring data directly from the meter to a PC at the physician's office, for those lacking a home PC. -- can upload the data to the doctor's office (a Data-Link Module provides standalone capability for users without a PC) -- is *not* available in a demo version Chris Trippel of Miles (chrisg@se01.elk.miles.com) will answer questions unofficially and can email copies of a very good description, about 7K long, of Glucofacts+ DMS. You can also get information and place orders by calling 1-800-348-8100. If ordering, ask for Lloyd Bane, ask for product code 5044B, and provide the serial number from your meter. Subject: Other recordkeeping software ===================================== I searched the PC and Macintosh software libraries on America Online using the key 'diabetes' and came up with three MS-DOS programs, two Windows programs, and two Macintosh HyperCard stacks for blood glucose recordkeeping. Prices range from free to $30, or $16/yr for one of the stacks. The Control Diabetes program from Nutrisoft has received favorable mention in m.h.d; I haven't seen any of the others mentioned. The Diabetics Assistant can download from a One Touch II. CompuServe has software in the Diabetes Forum. I do not know of any FTP site which has any of these programs. If anyone can volunteer a system for this purpose, all these programs could be loaded to it. It might be worth trying to describe the programs and their sources here after reviewing the operation of each. If anyone wants to take on the project, let me know. This section could profit from some attention. Subject: I've heard of a non-invasive bG meter -- the Dream Beam? ================================================================ ***The following information is incomplete, as another company has introduced a noninvasive meter for about $8000. It has been discussed in the newsgroup. *** There is at least one development project in hot pursuit of a bG monitor which operates by shining light through flesh (through the thumbnail in one case) and analyzing the light that passes through. Glucose doesn't affect light much differently from many other substances in the body, so this is not an easy task. Some field trials have been done, but the developers have a way to go to reach acceptable accuracy. A successful product is far from guaranteed, and may be several years away if it arrives at all. One estimate is that such a meter might cost about US$1000. Assuming the per-check cost is zero, this would pay for itself in 1-2 years for many patients. Look for the insurance companies to throw up some roadblock to achieving these savings, at least in the US. Subject: What's HbA1c and what's it mean? ========================================= Hb = hemoglobin, the compound in the red blood cells that transports oxygen. A1c is a specific subtype. (The 1 is actually a subscript to the A, and the c is a subscript to the 1.) Glucose binds slowly but irreversibly to hemoglobin, forming a stable sub-sub-type which is only eliminated by the normal recycling of the red blood cells, which have a lifetime of about 90 days. In non-diabetic persons, the formation and destruction reach a steady state with about 3.0% to 6.5% of the hemoglobin being the A1c subsubtype. Since most diabetics have a higher average blood glucose (bG) level than non-diabetics, the steady state level is higher in diabetics. The HbA1c level thus is an indication of the average bG level over the past 90 days or so. Interpreting HbA1c values is tricky because several different lab tests have been introduced over the last 15 years, measuring slightly different subtypes with different limits for normal values and thus different interpretive scales. All are still in use in some places. When you get a lab result, be sure to look at what the lab considers to be the normal range. Most discussion of HbA1c values in m.h.d appears to be based on the most recent lab test, where the normal range is approximately 3-6.5%. Caveat lector. Subject: My diabetic father isn't taking care of himself. What can I do? ======================================================================== We'll assume your father has type 2 diabetes. See separate section for definition of types. Type 2 diabetics, and those who care for them, are in a difficult situation. Type 2 strikes late in life, so personal habits and patterns are already formed and solidly engrained. Yet in most cases those habits and patterns are exactly what must be changed if a newly-diagnosed diabetic is to care properly for his or her health. This is a difficult psychological problem. The cornerstones for treating type 2 diabetes are exercise, weight control, and diet. A high percentage of type 2 patients who apply these therapies assiduously can control the disease with these therapies alone, without insulin or oral hypoglycemic drugs. Naturally these are also some of the most difficult aspects of life to change. There can be no single or simple answer of how to help or encourage a particular individual find a combination of therapies which not only controls the disease but also is psychologically acceptable and which can be incorporated as a lifetime pattern. Helping depends on knowing the individual's habits, patterns, motivations, desires, likes and dislikes, and working with all the existing conditions and everything brought forward from past life. Doctors and other health care professionals tend to treat type 2 diabetics with drugs (oral hypoglycemics) and insulin rather than taking the time to try to get their patients to make the difficult lifestyle changes described above. This isn't true of all practitioners, but of many. They have good reason for this tendency: they know all too well (often from painful personal experience) that most type 2 patients aren't going to make many changes anyway, and the doctors and other practitioners don't like wasting their time and breath. So it's likely to fall to friends and relatives who care deeply to educate themselves about type 2 diabetes and do what they can to encourage their loved one to make changes. In particular, if the doctor has left the impression that drugs and insulin are the only treatments, make sure to counter that impression with information about the value of exercise, diet, and weight control. At the same time, it's important to remember that needing oral hypoglycemics and/or insulin injections as additional tools isn't failure. On the contrary, a patient who's been actively involved in self treatment already has an excellent chance of using these additional tools successfully. Those who have learned to use the exercise - weight control - diet triumvirate will also be able to utilize insulin and oral drugs as additional treatments when needed. Choose the appropriate tools and use them effectively. These treatment choices can interact in positive ways as well. Bringing blood glucose under control often increases the body's sensitivity to insulin. So ironically, using insulin may decrease the need for insulin. This is a positive change which can then be reinforced by the other, interacting treatments. You will need far more information than is appropriate for a Usenet FAQ panel. As a start, call the ADA (see ADA section), get a subscription to _Diabetes Forecast_ (see journals), and visit a university library and browse in the diabetes section in the stacks. Beyond the generalizations above, a few specifics are usually of value: Set a good example in your own life. Exercise and eat a good diet. The recommendations for diabetics are healthy choices for anyone. Share your example. Serve a tasty, low-fat diet to family and friends when they are your guests. Suggest joint activities. Suggest a walk instead of watching a ball game. Make sure your diet and activities are visibly enjoyable so your guests will accept your invitiation to join you. Subject: Managing adolescence, including the adult forms ======================================================== Adolescents have special problems in managing diabetes. These include a variety of physiological problems related to puberty and rapid growth, social problems related to growing up and the general social pressures of adolescent life, and the psychological turmoil caused by the expectations of others. I'm here today to talk about (hey, hold the eggs and tomatoes) expectations. Actually, this all applies to adults as well, though the subtle points may differ. The most important thing to remember, for the adolescent, the parent, and the health care provider, is All Blood Glucose Measurements Are Good. There Are No Bad Blood Glucose Readings. If that doesn't sound right, then please take two steps. First, learn why it is true. Then chant it like a mantra until you internalize it, so that you never give off the slightest vibes to the contrary. Why is it true? There are two kinds of adolescents (to simplify life enormously): those who rebel and those who want to please. Ironically, the rebellious are probably easier to deal with in treating diabetes. "So my blood sugar is 350, so what?" Bad? No, that's good: you know what's going on, and so does your child. The point of blood glucose measurement is to respond -- not to be good or bad -- and only with an accurate report can you and the patient respond. [Compulsory digression: 350 mg/dl = 20.0 mmol/L.] Look what can happen to the eager-to-please child: Child: My blood sugar is 350. Adult: Oh, that's awful! You must try to be better! [next time] Child: My blood sugar is ... um [to self: I must be good] 140 ... Adult: Oh, that's great! In short order, the log book looks great but the HbA1c doesn't jibe. This all happens with the best of intentions from all parties. The child is trying to please, and is behaving in exactly the ways that elicit approval. The adult is trying to care for the child's health in the most natural ways. And the result is one that neither desires. Thus the positive mantra to replace the half-negative one above: All Blood Glucose Measurements Are Good. Responding To Blood Glucose Readings Is Good. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . There is an excellent article entitled "Insulin Therapy in the Last Decade: A Pediatric Perspective", by Julio Santiago, MD, of the St. Louis Children's Hospital and the Washington University School of Medicine in St. Louis, Missouri, which appears in _Diabetes Care_, volume 16 supplement 3, December 1993, pp. 143-154. The article discusses many aspects of treating pediatric diabetes. Santiago spends several pages discussing how to establish realistic and honest approaches to self-monitoring. I highly recommend the article. Subject: So-and-so eats sugar! Isn't that poison for diabetics? =============================================================== This is asked from both sides: the non-diabetic who doesn't understand diabetes, and the diabetic who gets tired of hearing "I won't put any sugar on the table" etc etc ad nauseum. Diabetics should eat a high-quality, healthy diet very similar to that recommended for everyone. This will include some sugar, and research indicates that obtaining a moderate amount of carbohydrates in the form of sugar makes little or no difference in controlling blood glucose levels. There isn't room here to describe all the aspects of diabetes treatment that make this so. No one has suggested a really good, uniformly satisfying answer to the public know-alls who insist they know more than you do. Feel free to add to this list: That was true before insulin was isolated in 1921. Fat is more dangerous than sugar because diabetics have a three-fold higher risk of heart disease. The whole point of injecting insulin is to balance carbohydrate intake. All carbohydrates are converted to sugar in the digestive tract anyway. Subject: Insulin nomenclature ============================= The major types of insulin have both generic designations and brand names used by the manufacturers. Most of the brand names are close enough to the generic ones that the correspondence is obvious. Novo uses totally different names. In those parts of the world where Novo has most of the market, the Novo brand names are used in place of the generic names. To facilitate communication between Novo users and others, here is the correspondence: Generic Novo ------- ---- Regular Actrapid NPH Protophane Lente Monotard Ultralente Ultratard Subject: Caring for insulin while travelling ============================================ (not yet written) Subject: Injectors: Syringe reuse and disposal ============================================== Disposable syringes can be safely reused as long as you take reasonable precautions. Recap both ends between uses, and discard the syringe if dropped, dirty, or damaged (especially if the needle is bent). Discard it when it becomes uncomfortable to use. This varies a great deal, being half a dozen uses for some patients and several dozen uses for others. Comfort depends far less on sharpness than on the silicone coating applied to the needle at manufacture. Syringe disposal has proven controversial. If you want to be conservative, buy a needle clipper, get a hard plastic bottle designed for medical waste to put the syringes in, and take the full bottle to a facility approved for handling medical waste. Your doctor's office may be able to handle it for you. Intermediate positions use one of these techniques. At the least conservative, cap the needle carefully and discard in trash which will not be subject to illicit searching and possible abuse. If you have trouble capping the needle without sticking yourself, definitely get a bottle to drop the uncapped syringes in; a bleach bottle may be adequate. Local or state regulations may apply. Subject: Injectors: Pens ======================== A pen injector is a device that holds a small vial of insulin and a retractable, disposable needle, and injects an amount measured with a dial. Advantages include being compact, convenient, easy to use circumspectly in public, and accurate and simple in dose measurement. The primary disadvantage is cost. The special vials may be difficult to obtain in remote areas, but of course falling back to a standard syringe is always an option. Pens are more popular in Europe than in the US. Subject: Injectors: Jets ======================== A jet injector uses no needles, but instead squirts the substance being injected through a narrow orifice under high pressure, producing a fine stream which penetrates the skin as easily as a needle. Obviously jets are popular with anyone who is simply scared of needles, for any reason. The jet disperses the insulin more than a needle does, which probably results in faster absorption. This can be an advantage or a disadvantage, and requires careful monitoring when first used. Technique is just as important as with needles, so jets are no more appropriate than needles for small children. If a jet is used to avoid needles, equipment failure forcing a fallback to needles may be traumatic. High cost is a major factor. Subject: Insulin pumps ====================== An insulin pump provides a Continuous Subcutaneous Insulin Infusion, or CSII, via an indwelling needle or catheter. That is, a small needle (similar to those on insulin syringes) or tube is inserted through the skin and fixed in place for two or three days at a time. The external box pumps insulin through the needle steadily. Pumps don't solve all the problems of treating diabetes for two main reasons: 1) The infusion is still subcutaneous, so the insulin still must be absorbed before it can be used. Insulin from the pancreas goes directly into the bloodstream and takes effect much more quickly. 2) Current pumps are open-loop -- that is, there is no feedback from blood glucose (bG) to the pump. The patient must still self-monitor bG and program the pump. Nonetheless, many patients get much better results with a pump than from intensive therapy without a pump, and those patients tend to be extremely happy with the pump. It isn't clear at present how to decide whether a given patient should use a pump. Different studies have obtained varying results, ranging from 85% success to 85% dropout! Unfortunately, no studies seem to have been done since the mid-1980s, and it is likely that the pumps and pump therapy have become much more consistenly successful since then. A few important factors seem clear, though: 1) Motivation. A meter takes extra effort and attention. 2) Knowledge. If you aren't already familiar with intensive therapy, think more than twice before jumping for a pump. You should probably try intensive therapy with multiple injections first. 3) Treatment team. Successful users are backed by teams of physicians and educators who are experienced *with pumps*. Don't try a pump on your own (the manufacturers won't let you anyway), and don't try it with inexperienced providers -- these are recipes for unnecessary failure. 4) Funding. Pumps represent a nontrivial capital outlay. If you don't have insurance or other public programs that will pay for the pump, you will need personal financial resources. Most or all pump manufacturers allow a trial period, so you can try a pump without financial risk. You will probably know fairly soon whether you want to continue with the pump. A long discussion about many aspects of pumps is posted monthly at the same time as this FAQ. See the section "Where's the FAQ?" for retrieval information. The insulin pump discussion was developed and is maintained by Jim Summers (summers@cs.utah.edu), with lots of help from Joan Stout (sasjcs@unx.sas.com). Subject: Beta cell implants, pancreas transplants, future cures =============================================================== Beta cells can be isolated and implanted, requiring only outpatient surgery. But foreign beta cells are quickly rejected without immunosuppressant drugs. Even with the recent advances in drugs, especially cyclosporin, using immunosuppressants is much more dangerous than living with diabetes. As a result, beta cell implantation is not currently used to treat diabetes. Current research is investigating two general methods of implanting beta cells without the use of immunosuppressant drugs. The first (immunoisolation) encapsulates the beta cells within a barrier so that nutrients, glucose, and insulin can pass freely through the barrier but the proteins which provoke the immune response, and the cells which respond, cannot pass. The second (immunoalteration) involves altering the proteins on the surface of the cells which provoke the immune response. The first human trial began earlier in 1993 on immunoisolated beta cells, and human trials may begin late in 1993 on immunoaltered beta cells. Don't expect these treatments to be available on a standard basis any time soon. I've been reading about this research for nearly 15 years, and the results are always just around the corner. Serious problems remain to be solved: safety of the immunoisolated implants, long-term survival, ability to use beta cells from non-human species, perfection of both techniques -- all these must be resolved before beta cell implantation moves beyond the experimental stage. Other problems will likely be encountered along the way, since this is cutting edge medical research. I'll be surprised if it gets out of the lab before the year 2000; 2010 is probably a better guess. And it may fail -- it's always possible that unsolvable problems will yet arise. Finally, it's not yet clear that even completely normal bG profiles will cure all the problems of type 1 diabetes. Some may be related to the autoimmune reaction that is the immediate cause of diabetes. This question cannot be answered until it is possible to normalize bG levels for a period of many years. Whole pancreas transplants have the same rejection problems as beta cell implants, and also require major surgery. For these reasons, whole pancreas transplants have only been used 1) in desparate cases in medical schools with exceptional capabilities, and 2) in conjunction with kidney transplants. Kidney transplants are (relatively) common in diabetics with advanced complications. A kidney recipient is taking immunosuppressant drugs anyway, and the same surgery that implants the kidney can stick in a pancreas with little extra effort or trauma. As a result, the double transplant is now recommended, at least for consideration, for any diabetic patient who requires a kidney transplant. The only disadvantage would seem to be that the pancreas donor must be dead; whereas a living kidney donor is feasible. However, at some organ banks the double transplants get in a different queue, and in some cases the queue for double transplants may be shorter. This will not be true in all cases and may depend on whether the double transplant is considered experimental at that institution. It is worth investigating which choice would get quicker results. Also note that these treatments apply only to type 1 diabetes. Type 2 diabetes is the result of insulin resistance or other forms of improper use of insulin within the body, not an absolute lack of insulin. Type 2 patients have normal beta cells. There is no treatment of comparable promise on the horizon for type 2 diabetes. Subject: What's a glycemic index? How can I get a GI table for foods? ===================================================================== The glycemic index, or GI, is a measure of how a given food affects blood glucose (bG). Some complex carbohydrates affect bG much more drastically than others, and some (such as white bread) even more than sugar. This was quite a surprise when the research was first published around 1980 [[[[[need to check date]]]]]. The problem with using the GI extensively in diet is that it is not additive. That is, different foods interact to produce a combined GI that cannot easily be predicted from the separate GIs. For example, a baked potato has a very high GI (one of the famous, unexpected examples), but adding butter to it lowers the GI greatly. Research is continuing, and eventually it may be possible to predict the GI of a complete meal. For now, the important thing is to understand that foods may affect your bG profile in ways that you wouldn't expect from categorizations such as "simple sugar" and "complex carbohydrate". Build your knowledge about your own response to different foods and meals by monitoring and keeping records, and avoid assumptions. There have been requests for GI tables on m.h.d. To my knowledge, none is available in electronic form. Subject: I beat my wife! (and other aspects of hypoglycemia) ============================================================ (not yet written) Subject: Does falling blood glucose feel like hypoglycemia? =========================================================== Sometimes. Symptoms of hypoglycemia are divided into the adrenergic and the neuroglycopenic. Adrenergic responses are caused by increased activity of the autonomic nervous system and may be triggered by a rapid fall in blood glucose (bG) or by low absolute bG levels; symptoms include weakness sweating tachycardia palpitations tremor nervousness irritability (sound familiar?) tingling of mouth and fingers hunger nausea or vomiting (unusual) The autonomic nervous system activity also causes the secretion of epinephrine, glucagon, cortisol and growth hormone. The first two are secreted rapidly and eliminated rapidly. The second two are secreted slowly and remain active for 4-6 hours, and may cause reactive hyperglycemia. Neuroglycopenic responses are caused by decreased activity of the central nervous system and are triggered only by low absolute bG levels; symptoms include headache hypothermia visual disturbances mental dullness confusion amnesia seizures coma The above information is from Mayer Davidson's _Diabetes Mellitus: Diagnosis and Treatment_. Remember, as always, that individual responses vary greatly. The exact set of symptoms encountered will vary. It's not impossible that some of the symptoms will fall in the other category for some individuals. Subject: Alcohol and Diabetes ============================= This section provided by Peter Stockwell (peter@sanger.otago.ac.nz). Having diabetes does not prevent the consumption of alcoholic drinks, but there are some considerations: - Alcohol can metabolised to produce energy and so has dietary consequences. - Alcohol promotes the uptake of blood glucose into liver glycogen causing a drop in bG. - Many alcoholic drinks contain sugar, particularly mixed drinks. - The symptoms of drunkenness and hypoglycaemia are similar - alcohol may mask the effects of a hypo. - Diabetics must remain sober enough to care for themselves (perform injections on schedule, etc). - Excess alcohol consumption can cause increased serum triglycerides. Few difficulties arise if following points are observed. Acceptable in moderation: - Red wines. - Dry or medium-dry white wines. - Dry sherries. - Dry light beers (lagers, light ales fermented with low residual sugar). - Spirits (whiskey, gin, vodka, etc) with "diet" mixers. Use with extreme caution due to high sugar content: - Sweet wines or sherries. - Ports. - Heavy or dark sweetened beers (stout, porters, etc which have high residual sugar). - Wine coolers. - Spirits with normal mixers. - Cocktails. - Liqueurs. Use with extreme caution due to very high alcohol concentration: - Neat (undiluted) spirits. General rules: - Simple drinks (wine, beer) are more reliable than complex mixed drinks, especially in company where you have less control over the contents or concentration. - Drink with or after food to avoid hypo problems. - Approach anything with caution if you are in doubt. - Low alcohol beers are not necessarily preferred - many of them are rather sweet. - Alcohol provides about 7 cal/g of food energy. Some is lost in the urine, but most is converted by the liver into forms which can be used for energy elsewhere in the body or stored as fat. Clearly these succinct rules are simplified and there are exceptions to them (for example, there are dry ports) but they are intended as a general guide. I make no attempt to define the term moderation, this will depend on the individual. Subject: Online resources: diabetes-related newsgroups ====================================================== On the Usenet, the misc.health.diabetes newsgroup carries most of the messages related to diabetes. Volume runs about 20-25 articles/day. Suppose you obtained this FAQ by some method other than by reading m.h.d and you want to participate. If you already have access to Usenet news, just subscribe to misc.health.diabetes; the exact method depends on the software used at your site, so you should inquire locally for details. If you do not have access to Usenet news, inquire locally about obtaining such access. The key words are "I want to participate in the Usenet newsgroup misc.health.diabetes". Usenet is available at most colleges and universities, many companies, some of the large commercial services (including Delphi, Netcom, America Online, world.std.com, the WELL), many smaller local services, most Freenet systems, and many locally run BBSs. Some of these have selective news feeds, and you will have to ask them to get misc.health.diabetes before you can subscribe via their system. m.h.d is not gatewayed to any mailing list, and to my knowledge is not archived anywhere. Other Usenet newsgroups which might be relevant are rec.food and its subgroups the sci.med hierarchy bit.listserv.transplant (only available at a few sites -- see the description below of the TRNSPLNT list) Subject: Online resources: diabetes-related mailing lists ========================================================= Three public electronic mailing lists have diabetes-related content. The major one is the DIABETIC list, which carries about 60-80 messages/day. Its charter is to be "a support and information group for diabetics". The overall flavor and atmosphere are different from the m.h.d newsgroup, so if you find that you are uncomfortable with one, try the other. If you subscribe to the DIABETIC list, be prepared for the large volume of messages. If you have not dealt with this volume of email before, it will be quite disconcerting to see so many messages appear in your personal mailbox, and I advise that you consider one of the following methods to avoid being overwhelmed: -- set up a mailbox (aka userid, account, screen name) separate from your normal personal mailbox in which to receive the mailing list. You will have to ask locally whether this is possible on your system. -- convert to the digest as soon as you have subscribed. The digest option collects all messages for a day into a single large message, sent at midnight (in California) each night. Convert to digest form by sending a message addressed to the listserv (see below) with a message body containing set diabetic mail digest DIABETES is a low volume mailing list intended as "a technical discussion for researchers". However, it is clear that most of the few participants are not researchers, and the content is poorly focussed. It carries one or two messages/day. TRNSPLNT is a low volume mailing list for discussion of organ transplants. It carries 5-6 messages/day. It is relevant to diabetes because complications of diabetes often lead to kidney transplants. TRNSPLNT is gatewayed with the newsgroup bit.listserv.transplant, which is available at the few Usenet sites which carry the bit.* hierarchy of newsgroups. To subscribe to the mailing list in the first column, send a message to the email address in the second column (or to the alternate if given) containing the command in the third column. Note that Firstname Lastname is your real name, such as John Doe. The listserv software will use the email address in your message header for your subscription. If you have trouble sending email to the listserv, or if you receive no response, then you will need the help of someone at your site. DIABETIC listserv@pccvm.bitnet subscribe diabetic Firstname Lastname DIABETES listserv@irlearn.bitnet subscribe diabetes Firstname Lastname listserv@irlearn.ucd.ie TRNSPLNT listserv@wuvmd.bitnet subscribe trnsplnt Firstname Lastname listserv@wuvmd.wustl.edu Subject: Online resources: commercial services ============================================== Compuserve (CIS) has a very active Diabetes Forum. I am not aware of any other commercial service that has an area focussed on diabetes. Subject: Online resources: FTP ============================== Demon Internet Services, a UK service provider, has donated FTP space for diabetes-related materials due to the urging and coordination of Ian Preece (ianp@dktower.demon.co.uk). This cooperative endeavor was launched with an empty directory in June 1994, and depends on the efforts of all of us to populate that directory with useful materials. Appropriate materials include software (freeware, shareware, demos), tables of data and information, news and research articles (with permission please), periodic postings from the newsgroups and mailing lists, and any other information files. Short guide: anonymous ftp to ftp.demon.co.uk, directory /pub/diabetes. A few pointers for those not familiar with ftp follow. However, if you do not know how to invoke ftp at all, please ask locally. FTP to: ftp.demon.co.uk Log in as: anonymous Password: <your email address> (please give your true address) Commands: cd /pub/diabetes gets to the diabetes directory dir lists contents binary prepare to xfer binary files ascii prepare to xfer text files get <filename> xfer file to your system To submit: cd /incoming do before put put <filename> xfer file to Demon ftp dir <then send email to ianp@dktower.demon.co.uk telling him about the file you have submitted> Subject: Where can I mail order XYZ? ==================================== XYZ is most often test strips, especially for those who don't live near discount pharmacies. Mail order prices are not always lower than local prices. Remember that there is an advantage to going to a single pharmacist for all your drugs, if that pharmacist is knowledgeable about interactions and tracks all the drugs you use. Adjustments will be slower if you mail order. Never mail order unless you are certain about what you need. That said, here's a list of mail order firms specializing in diabetes supplies. Aside from the one listed below, I've not heard of any outside the US, perhaps because the health care systems elsewhere don't encourage the practice. Some of these advertise in _Diabetes Forecast_ (see section on journals). This list is presented with no recommendations, pro or con. Each issue of _Diabetes Forecast_ also contains a column summarizing recommendations for ordering health supplies by mail. Chronimed 1-800-477-6540 or +1 612 546 1146 Source International 1-800-237-6696 Diabetic Warehouse 1-800-995-4308 Hospital Center Pharmacy 1-800-824-2401 (part of the Joslin Diabetes Ctr) Diabetic Care Center 1-800-633-7167 Diabetic Express 1-800-338-4656 The Sugar Substitute 1-800-435-1992 Diabetic Promotions 1-800-433-1477 Thriftee Home Diabetes Care 1-800-847-4383 National Diabetic Pharmacies 1-800-467-8546 in Canada: Diabetes Specialty Shop 1-800-465-3336 (Canada) Subject: How can I contact the American Diabetes Association (ADA) ? ==================================================================== The ADA has local offices in many cities. Check your local phone book first. To contact the national organization, call 1-800-232-3472 or +1 703 549 1500. This will reach all departments. The ADA offers aid to diabetic patients, books, and journals ranging from general to research. They maintain lists of physicians with special interest and/or training in diabetes. New patients and their families needing advice are encouraged to call. They may be able to help in dealing with bureaucratic problems. Subject: How can I contact the Juvenile Diabetes Foundation (JDF) ? =================================================================== Check your phone book for a local office, or call 1-800-533-2873. (It has been pointed out to me that the JDF provides many services and support. I need more information to include here.) Subject: How can I contact the British Diabetic Association (BDA) ? =================================================================== The British Diabetic Association 10 Queen Anne Street London W1M 0BD Telephone 071-323-1531 (+44-71-323-1531) The BDA produces a bi-monthly magazine for members called "Balance". Membership is UKP 12 a year. Subject: Could you recommend some good reading? =============================================== You mean to curl up with on the sofa? Oh, diabetes ... OK. My favorite book is Mayer Davidson's _Diabetes Mellitus: Diagnosis and Treatment_. Though written as a medical text, anyone willing to plow through an occasional dense passage and keep a dictionary handy will have no trouble with it. (See below about medical terminology.) Being written by a single person, it is much better focussed than the "committee" books which are so common. And it's extraordinarily cheap for medical books, US$25 in 1989. Eventually we may have a full list of a variety of books. You'll have to make do with the above until someone volunteers to put it together. Any university library will have a large number of books on diabetes, and they will be grouped together on the shelves. Go and browse. The rest of what I have to talk about is periodicals. _Diabetes Interview_ is a monthly newsletter emphasizing interviews with famous researchers and patients, with some other tips and news and humor and a minimum of advertising. It's a small business endeavor. Lyle Hodgson (lyle@world.std.com) and others recommend it strongly. One year, US$14; two years, US$24 (probably more outside the US). Their address: 3715 Balboa Street, San Francisco, CA 94121. Use Visa or MC and call 415-387-4002. _Diabetes Self-Management_ is a bimonthly costing US$12/yr. Write 150 West 22nd St, New York NY 10011, or in the US call 800-234-0923. According to Richard Simpson <rsimps1@gl.umbc.edu>, who recommends it, the magazine has a reading and 'interest' level close to the average population -- more like 'people' magazine than 'Scientific American.' It contains diet advice, basic terminology, health warnings. Naturally, it is loaded with insulin, etc. ads. It seems very middle-of-the-road -- no miracle cures or herb remedies! Everything else I have to recommend comes from the ADA (see section on ADA). Here's what the ADA says about its own publications: _Diabetes_ -- the world's most-cited journal of basic diabetes research brings you the latest findings from the world's top scientists. _Diabetes Care_ -- the premier journal of clinical diabetes research and treatment. _Diabetes Care_ keeps you current with original research reports, commentaries, and reviews. _Diabetes Reviews_ -- the comprehensive but concise review articles in ADA's newest journal are a convenient way for the busy clinician to keep up-to-date on what's truly new in research. _Diabetes Spectrum_ -- translates research into practice for nurses, dietitians, and other health-care professionals involved in patient education and counseling. _Clinical Diabetes_ -- For the primary-care physician as well as other health-care professionals, this newsletter offers articles and abstracts highlighting recent advances in diabetes treatment. _Diabetes Forecast_ -- ADA's magazine for patients and their families features advice on diet, exercise, and other lifestyle changes, plus the latest developments in new technology and research. It is a valuable tool for patient education. Now for my own opinions. _Diabetes Forecast_ is the mass market magazine, intended to be readable by most educated diabetics. For US$24/year you can hardly go wrong. DF may seem low-level to those who've been to graduate school -- I'd guess it's written at a 10th-12th grade level. But it contains an extraordinary amount of useful information and is excellent at promoting self-care and a positive self-image for persons with diabetes. If you aren't reading DF, subscribe now. No excuses accepted. The remaining journals are of interest if you want to follow what is new and under investigation in medical practice and research. The journals vary in difficulty of reading. Though some knowledge of statistics and chemistry helps, a general acquaintance with scientific method is perhaps more important, and a smattering of familiarity with medical terminology helps most. Luckily, medical terminology is basically simple -- it mostly consists of putting together roots and affixes to make specific terms. Learn a few dozen roots and you can make out most of it. Try to have a dictionary at hand at first. _Diabetes Care_ publishes papers on clinical research. I find many of the papers to be interesting and applicable to my own management. _Diabetes_ is the ADA's journal primarily for basic research. Some of the articles are interesting, but they run much more toward biochemistry and mechanisms of metabolism. As important as basic research is, few of the reports say little of value directly to patients. _Diabetes Spectrum_ is the ADA journal most oriented toward health care practitioners. It consists of reprints of important articles (sometimes several on a topic) and summaries of related articles, plus original commentaries from other authors. As such, it provides a broad overview of topics for readers who don't have time to track down lots of separate original articles. If you only have time to read one technical publication, _Diabetes Spectrum_ is probably the best choice. The ADA has a multiplicity of price structures for nonmembers, regular members, and professional members. I don't have a list of all the options, and I'm not sure I'd want to reproduce it here if I did -- I haven't figured it all out myself. A basic regular membership with _Diabetes Forecast_ is US$24/year (in the US, I don't know the cost outside the US). The ADA takes checks, money orders, Visa, Mastercard and American Excess. Phone numbers 1-800-232-3472 +1 703 549 1500 +1 703 549 6995 fax or write American Diabetes Association Subscription Services 1660 Duke Street Alexandria, VA 22314 USA Subject: What is the DCCT? What are the results? ================================================ The DCCT was a large multi-center trial involving over 1400 volunteer patients with type 1 diabetes. It began in 1983, ramped up to full speed by 1989, and ended early in 1993 when the investigators felt the results were clear. The volunteers were all undergoing "standard" treatment when they were recruited, meaning one or two injections per day. They were randomly assigned to two groups. One group continued as before. The other group received intensive treatment aimed at achieving blood glucose (bG) profiles as close as possible to normal. The intensive treatment involved multiple bG checks per day, multiple injections and/or an insulin pump, and access to and regular consultation with a team of treatment experts. The results show that the intensive treatment group did indeed achieve bG levels closer to normal, and that they experienced far fewer diabetic complications. In particular, patients who maintained HbA1c levels around 7% appear to be much better off than those whose HbA1c hovers around 9%. (See caveats in the section on HbA1c.) Though it is not possible to separate the effects of all the aspects of the intensive treatment, it is reasonable to believe that lowering average bG is effective even in isolation from the other aspects of the intensive treatment. In its position statement, the ADA says Patients should aim for the best level of glucose control they can achieve without placing themselves at undue risk for hypoglycemia or other hazards associated with tight control. Though type 2 patients were not included in the study, it is generally believed that the results showing the benefits of tight control apply to type 2 patients as well. The entire position statement is recommended reading. -- Edward Reid ed@titipu.resun.com (normal) PO Box 378 Edward_Reid@acm.org (forwarding) Greensboro FL reide@freenet.fsu.edu (seldom checked)