Testing on the Trail

I'm 73 years old, have had type 1 diabetes for more than 35 years, and have been on an insulin pump for 10 of those.

I wanted to share with you this picture of me horseback riding in the Sun River Wildlife Management Area in the Rocky Mountain Front landscape of Montana. I'm on a trail ride with a group from the Triple J Wilderness Ranch in Augusta, Mont., and here I have stopped to check my blood sugar.

I rode for up to four hours per day for five days, despite the complications I've had from diabetes, including neuropathy below my knees and the triple bypass I had 11 years ago.

I thought this picture would give hope and inspiration to other people with diabetes as we struggle with this disease.
Gemma Rettmann, Eugene, Ore.

Success Stories

I was born on March 26, 1942, and diagnosed with type 1 diabetes two days later. The registered nurse in the nursery noticed that I was not too responsive, so she took a litmus strip and patted it on my wet diaper. The strip turned dark green!

At the time, urine testing was the means of testing your diabetes control. Insulin was either a pork or beef long-acting insulin. I used a 40-unit vial, one injection a day. The American Diabetes Association was then only a fledgling group for physicians, and my parents were at a loss about how to feed this diabetic infant. The registered dietitian at the hospital communicated with the baby formula companies to determine an appropriate calorie range. These were difficult times for my parents, but they managed.

Growing up presented additional challenges, of course, but my diabetes has never been my crutch. I went to college and graduate school. I have experienced no complications, thanks to my excellent control of my diabetes. I have written diabetic cookbooks and appeared on TV and radio as an example of successfully surviving the challenges of living with type 1 diabetes. The Joslin Diabetes Center gave me a 50-year award, and in 2015, I will proudly receive my 75-year award.

Has it been hard? You bet! Can you succeed? Yes, by persevering each day, thinking about what you eat, and exercising daily. I owe my success to my excellent medical training and to a true understanding of what uncontrolled diabetes will do to a person's life.
Barbara Susan Borrell, PhD, RD, MS, MBA, Orlando, Fla.

Last year I sent in a letter inquiring about diabetic marathoners and how they trained for their success [Mail Call, March '09, p. 13]. Tracey Neithercott's article "Success!" [Dec. '08, p. 61] about runner Jerry Nairn and his training program was very inspiring, and the advice was worthwhile. 

I wanted to follow up to let you know that I just completed my first sprint triathlon. What a thrill! It was hard swimming in a lake with 800 other competitors, then biking 10 miles, and running 3 miles, but I overcame the obstacles and accomplished my goal. I am hooked! I love my fitness level now and my blood sugar control. I am more aware of my body and I am taking care of it.

I truly appreciate the "Success!" article, as it led me to believe that I could dream.
Dena Linda, Houston

Good Things for Free

In reading your October issue, I noticed that the article "10 Ways to Save a Buck and Improve Your Health" [p. 44] neglected to mention the three hours of diabetes medical nutrition therapy that all Medicare beneficiaries can receive if they are diagnosed with diabetes. 

This is an especially great benefit to the aging population, an increasing number of whom have type 2 diabetes. As a registered dietitian Medicare provider, I see many patients benefit from this covered service. The benefit usually figures into an initial one-hour visit and four 30-minute follow-up visits: a total of five visits to a dietitian in the first year of diagnosis. In subsequent years, two hours—or four 30-minute follow-up visits—of nutrition therapy are covered. This benefit was introduced several years ago and provides a big cost savings to people with diabetes.
Lise Gloede, RD, CDE, President, Virginia Dietetic Association, Arlington, Va.

Unavoidable Complications

I take issue with the global statement "Neuropathy can be prevented with good blood glucose control" made in your article about gastroparesis, "Feeling Full" [Oct. '09, p. 39]. This is not the first time I have read statements like this in diabetes articles. The use of "can be" makes me angry; this is misleading and incorrect. "Neuropathy may be prevented" or "blood glucose control may reduce your chances of getting neuropathy" would be more accurate. As a member of the National Neuropathy Association, I have learned that avoiding neuropathy is not as simple as controlling your blood glucose.
I started experiencing symptoms of neuropathy 18 years ago. I was tested for diabetes on a regular basis. The tests came back negative for eight years; the following year, I was diagnosed. Since then, I have never had an A1C higher than 6. My fasting blood glucose levels are normal, and always have been.

Regardless of my good blood glucose control, my neuropathy is extremely progressive. I have been told that there are exceptions to the assurances that blood glucose control can prevent complications, and that I am one of those exceptions. I don't think it is fair to your readers to publish articles with blanket statements like this one.
Rhonda Schmidt, Dayton, Ohio

Belinda Childs, MN, ARNP, BC-ADM, CDE, responds: You are right that neuropathy—nerve damage that affects the feet, legs, or hands—isn't only caused by poor blood glucose control. There are other causes of neuropathy besides diabetes that should be ruled out by your doctor, including some chemotherapy agents, other medications, endocrine disorders like thyroid disease, traumatic injury, alcohol, and some autoimmune diseases. For most people with diabetes, however, neuropathy is a result of high blood glucose levels. Numerous research studies show that achieving good blood glucose, blood pressure, and cholesterol levels will reduce a person’s risk for complications from diabetes. But even if your control is good on average, mild elevations of blood glucose may still lead to neuropathy.

Unfortunately, current treatments do not enable people to achieve normal blood glucose levels 100 percent of the time. Nevertheless, it is important to continue to strive for good diabetes control to reduce your risk. Be sure to talk to your health care provider or educator about the best times to test your blood glucose.

Searing Pork Chops

I tried a recipe in the November issue, Pork Chops Stuffed With Apples and Dates [p. 63]. After searing the chops 7 to 8 minutes on each side, should they be placed in the oven? If so, at what temperature and for how long? They definitely do not get done on the inside in that length of time or even twice the time.
Edith LePere, Lakeland, Fla.

Robyn Webb, MS, LN, Food Editor, responds: If you want to cook the pork chops longer than the time indicated, put the chops on a baking sheet lined with parchment paper, and cover the chops with another piece of parchment, which keeps the moisture in. Bake at 350 degrees until the chops reach desired doneness.

Diabetes and Special Diets

I read your article about managing a diet with ulcerative colitis and diabetes [Ask the Experts, March '09, p. 17] and agree completely that it is difficult. I know from personal experience that if your diet is severely limited because of acute irritable bowel syndrome (IBS), then the remaining foods that are gentle on the stomach tend to be high in carbs and fats. Could IBS and the diet it requires increase one's risk for diabetes?
Duanne Cole, The Dalles, Ore.

Christy L. Parkin, MSN, RN, CDE, responds: There doesn't seem to be any research that indicates a relationship between irritable bowel syndrome and diabetes, or colitis and diabetes. It's true, though, that managing a diet with both diabetes and one of these digestive conditions can be very difficult.
IBS in people with diabetes is a complicated issue that can be hard to diagnose, because people with diabetes can experience autonomic nerve damage in the gut as a result of diabetes itself. This is why it's important to see an endocrinologist and a gastrointestinal specialist to treat your specific condition. You should also see a dietitian who has experience with both diabetes and IBS to help you with meal planning. As with any diet, you need to watch portion sizes and calories.