Self-Monitoring Is Key

I enjoyed Christy Parkin's guest editorial, "The Great Monitoring Debate" [March '09, p. 11]. I would never want to go without self-monitoring my blood glucose.

I was diagnosed with type 2 diabetes 15 years ago at age 60, and I'm on three oral medications. I test three times, sometimes four times a day, almost every day. By testing, eating well, and exercising, I have been able to keep my A1C between 6.1 and 6.5 for more than a decade.
Ron Kerr
Fort Wayne, Ind.

Sharing in a Team Effort

Thank you so much for the Reflections article "A Team Effort" [March '09, p. 76]. As the wife of a type 1 diabetic, I often know my husband's sugar is off even before he does.

When we first started dating, I took it upon myself to learn about diabetes. If something ever happened, I wanted to know exactly what I could do to help the man I love. I can relate to the author's experiences with his wife, as I have come home from work many times to find jars of fruit or applesauce completely emptied and my husband not remembering what he had eaten.

Thank you for this story of encouragement. I read this magazine to get tips and advice for my husband, so it was very nice to see some kind words meant for me.
Stephanie German
Bloomington, Minn.

Lucky to Have Diabetes

I am moved to respond to Lynda Lynch, whose letter was published in the March issue [Mail Call, p. 12, "Relating to Reflections"]. Her daughter is having trouble dealing with her diabetes.

I have lived with diabetes for close to 36 years, and I was diagnosed when I was 5 years old. I take insulin injections and test my blood glucose several times a day. I have no complications from my diabetes. My A1C ranges from 5.7 to 6.

Ms. Lynch describes her daughter asking, "Why me?" I think most people with diabetes have asked this question. My answer is that I am lucky to have diabetes. It is a controllable disease. Look at people who have cancer, or Parkinson's, or Alzheimer's. These diseases are not under their control.

Diabetes is under our control. We have medications to help our blood sugars. We have glucose monitoring systems to help us stay healthy. Of course, we have to do our part, test ourselves, administer our medications, and watch our diet and exercise.

Her daughter is young, and relatively new to managing her diabetes. In time, she may come to the same conclusion that I have. I am lucky to have diabetes. I control my diabetes. My diabetes doesn't control me.
Allyson Kish
Metuchen, N.J.

Pre-Diabetes Is Serious

I read with interest in "Ready, Set, Stop!" [Feb. '09, p. 40] about a new way to view pre-diabetes: "Considering recent data on cardiovascular disease and retinopathy, pre-diabetes seems less like a unique condition and more like a less severe diabetes."

When I was told that I was pre-diabetic, I phoned my insurance company to see whether it would pay for a consultation with a dietitian, as I was seeking ways to reverse the progression. I was told that I must be diagnosed with diabetes before the company would pay. Of course, with no guidance or coaching, I was diagnosed with diabetes just eight months later.

Further along in the same article, I read that the Diabetes Prevention Program compared study subjects who got lifestyle intervention (diet and regular exercise) with a group that got metformin and a third group that received a placebo and lifestyle information. The intensive lifestyle intervention group had the best results. If only I had had the benefit of coaching while I was still pre-diabetic, I could have prevented the disease from advancing. I was serious and committed but lacked the information I needed.

The insurance industry could save money by coaching pre-diabetics at the outset rather than by paying for drugs once its clients are diagnosed with diabetes. It can be a complicated disease that takes ongoing education to understand. Pre-diabetics need professional help before it's too late. 
JoAnne Zoller Wagner
Pasadena, Md.

Keep the Recipes Coming

Much of the information I get for managing my type 2 diabetes comes from Diabetes Forecast, and I am grateful for all the help. I read a letter in the February issue ["A Different Kind of Diet," p. 14] in which the reader asked for fewer recipes. Please don't give up the recipes. They are of tremendous help and inspiration in keeping my diet from becoming boring.
Margaret Pelletier
Montreal, Quebec, Canada

Health Care: In Need of Change

Thank you for your article on advocacy for diabetics in the January issue ["Paving the Way to a Healthier America," p. 72]. Your article described the exact situation that I have experienced with the health care system since I graduated from college. It has been a nightmare. Once you are out of school, you do not qualify for your parents' health care coverage, and you immediately need to find a full-time job with benefits. Being self-employed or working part time is not even an option for people with diabetes. I have called numerous organizations claiming to offer group benefits, and I was still denied coverage on the basis of my diabetes as a preexisting condition.

Right now I am teaching English in the Czech Republic. I am covered under Czech health insurance, and I am also paying an unreasonable amount for COBRA coverage in the United States. In the Czech Republic, diabetic citizens receive complete coverage for their insulin pump supplies, paid for by the government. In the United States, there are numerous diabetics who are paying out of pocket for their diabetic supplies because they do not have coverage. Health care is a human right. If you have a medical condition, you have a right to treat it and not be denied your medicine or coverage.

I am hoping that the current administration takes steps to overhaul the failing and corrupt U.S. health insurance system. Otherwise, we will continue to see rising poverty, injustice, and even death among people who could have otherwise made valuable contributions to American society.
Erynn Rees
Northfield, Ohio

Hidden Heart Problems

My husband has type 2 diabetes and was experiencing severe pain under his left breast. The doctor did an electrocardiogram and blood work and scheduled a stress test, but told him that if it happened again to go straight to the emergency room.

The next time, we did, and the hospital found that 90 percent of my husband's arteries were blocked. They ended up doing a six-way bypass. The surgeon said that diabetes can mask the pain that alerts people to this heart problem.
Maxine Goldman
St. Louis

Paris Roach, MD, responds: For reasons that are not clear, people with diabetes may not experience chest pain or discomfort during an episode of angina or a heart attack. Some people have no symptoms at all, while others may have shortness of breath, nausea, vomiting, indigestion, sweating, heart palpitations, dizziness, or excessive fatigue even with normal daily activities. Many of these symptoms can be dismissed as nothing serious, but should be promptly evaluated as possible signs of coronary artery disease or an ongoing heart attack.

How About Whole Fruit?

In your article "Just Plain Water, Just Plain Safe" [Dec. '08, p. 32], you mention juices to be aware of when taking certain drugs, but what about the fruits themselves? Is it safe to eat grapefruit, apples, and oranges while taking my meds?
Darrell Gentry
Collierville, Tenn.

Craig Williams, PharmD, responds: In general, it's best to take your medicine with water, and have fruit or juice at a different time. But you don't need to forgo your daily fruit altogether.

While the new research mentioned in the article indicates that one glass of fruit juice can hinder the absorption of some medications, it doesn't take into account the effect of eating whole fruit at the same time as taking medication. Still, whole fruit is a safer way to go—one glass of fruit juice is equivalent to two to three whole fruits, so you'd have to eat a lot of fruit to get the same effect as from drinking a glass of juice.

In terms of interaction with medications, most people with diabetes would probably not have a problem with one to two glasses of juice—or four to six whole fruits—a day. If you become concerned that your medicines aren't working properly, consult your doctor or pharmacist.

Not a Game of Perfection

I agree with what David Marrero, PhD, wrote in the January Guest Editorial ["A Plan That Works for Me," p. 10]. Diabetes is not a game of perfection, and it's unlikely that people will follow rigid diet rules for a lifetime. I also believe that there is nothing that must be eliminated entirely from my diet. However, his "3-to-1" rule and conclusion that diabetes is "a game of averages" seem contrary to what I've been taught about the importance of consistency.

An abnormally high blood glucose level one third of the time, offset by an abnormally low blood glucose two thirds of the time, may result in a good average blood glucose level. However, do these lows offset the damage of the highs?
Marvin Oed
Cockeysville, Md.

David Marrero, PhD, responds: You are correct that excessively high or low blood glucose is not good and should be avoided. My "3-to-1" rule was intended to provide more flexibility for me, in terms of eating. The reason is simple, and you give it above. People with diabetes aren't likely to follow rigid diet rules for a lifetime.
It is important, however, to underscore that the "1" part of my 3-to-1 rule does not mean uncontrolled glucose surges or a total disregard for sound glucose control. You should always try to make reasoned adjustments in your therapy (i.e., insulin doses) to cover these events. Moreover, it is important to remain mindful that there are consequences to trying to cover rich food with insulin: notably weight gain and the potential for hypoglycemia. 

The 3-to-1 rule is based on the idea of consistency. I personally have found it to be a simple way to account and plan for food choices that may not be the best diabetes nutrition, while staving off the consequences of chronic high glucose. Thus, when I do divert from my more consistent (and predictable) diet, it reminds me to get back on track so that I maintain the best possible health.

Omega-3 Content

Following the long discussion of omega-3 fatty acids in the February issue ["The A-to-Z of Omega-3," p. 45] were recipes to help provide a source of omega-3 in the diet. But there was no information in those recipes telling how much omega-3 they supplied.
Lester Goss
Chandler, Ariz.

Madelyn L. Wheeler, MS, RN, CDE, FADA, CD, responds: Most people should get about 500 milligrams of omega-3 a day; people at risk for heart disease, including people with diabetes, should get between 600 milligrams and 1 gram (1,000 mg) per day. Here's the information about the omega-3 content in those recipes: A serving of ginger salmon has 1.3 g (1,300 mg) omega-3 fatty acids, a flaxseed and raisin muffin has 1.4 g (1,400 mg), and a serving of curried brown rice pilaf with walnuts has 0.5 g (500 mg).

Scholarship Opportunities

As a parent of a diabetic college student, I would like to know if you could offer some resources for scholarships that may be available to diabetic students. My daughter is a second-year student at Georgia Southern University and has done an outstanding job of keeping her blood sugar in check. She works out regularly and eats as healthfully as possible. I would appreciate any help you can give!
Alice Beckham
Ashford, Ala.

Crystal C. Jackson, associate dir­ector for government relations and advocacy, American Diabetes Association, responds: There are a few opportunities worth checking out; here are a couple for starters:
• The Diabetes Scholars Foundation awards college scholarships to high school seniors with diabetes (www.diabetesscholars.org/College.htm).
• The Donnelly Awards, established by Billie Jean King, give scholarships to two young tennis players with diabetes each year. Visit World Team Tennis at www.wtt.com for more information.
You can also check with local organizations, health associations, pharmaceutical companies, and private funds to see if they award scholarships. These can change from year to year and state to state. Seniors should look to their own high schools for privately awarded scholarships, too. I've also seen a number of college-bound students with diabetes receive community service scholarships based on service to the American Diabetes Association and other organizations.