VOICE OF THE DIABETIC

A SUPPORT AND INFORMATION NETWORK

The Diabetics Division of the National Federation of the Blind

Volume 10, No. 3

Summer Edition 1995

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                            FREE!    FREE!

     Voice of the Diabetic is offered absolutely free to any 
interested person upon request.  Readers may receive the
publication in print, on audio cassette for the blind, or in both 
formats.  To begin receiving the Voice, please complete the 
subscription form (or a facsimile) on page 19 and mail it to the 
editorial office.

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     Voice of the Diabetic is a national publication of the
Diabetics Division of the National Federation of the Blind.  It is 
read by those interested in all aspects of blindness and diabetes.  We 
show diabetics that they have options regardless of the ramifications
they may have had. We have a positive philosophy and know that
positive attitudes are contagious!

     News items, change of address notices and other magazine 
correspondence should be sent to:

Ed Bryant, Editor
Voice of the Diabetic
811 Cherry Street, Suite 309
Columbia, MO 65201-4892
Phone:  (314) 875-8911

c1995 The Diabetics Division of the National Federation of the
Blind. 
ISSN 1041-8490

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Inside This Issue

Update:  Non-invasive glucose monitors
     by J.R. Wu

Finding the tools he can live by

Metformin -- good news for type II's
     by Janet Blodgett, M.D.
Experimental drug may prevent adult diabetes

Social Security, SSI, and Medicare facts for 1995
     by James Gashel

Dialogs about diabetic dynamos:  Scholarship available for IDDM 
Diabetics
     by Debra Frank, M.S., M.S.

Double transplant:  A two-year drama
     by Marie R. Verrastro

Ask the Doctor
     by Wesley W. Wilson, M.D.

What insulin manufacturers say about vial design change
     by Ed Bryant

To dog or not to dog
     by Ed and Toni Eames

Nutritious eating made easy

Recipe corner

What you always wanted to know but didn't know where to ask
(Resource List)

Food for thought

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Update:  Non-invasive Glucose Monitors

by J.R. Wu

[Photo:  Portrait.  Caption:  J.R. Wu]

     No more needles is the motto for approximately 44 companies who
are researching better blood glucose monitoring techniques.  The
new non-invasive technology, some ten years in the making,
requires no finger pricks, giving diabetics an easy, painless way
to check and control their blood-sugar levels more frequently,
thus avoiding or minimizing long-term organ damage.

     The monitors under development use a beam of light shined through
the skin to measure blood glucose levels. Near infrared
spectroscopy (NIR), dubbed the "Dream Beam" by Futrex Inc., one
company researching this technology, can determine the chemical
makeup of an object by analyzing the signal changes in the
wavelengths of light after it has passed through the object. By
measuring the glucose-emitted signals, the concentration of sugar
levels can be determined. However, glucose accounts for only
1/1000 of the mass of blood, making it hard to measure the
wavelengths absorbed by glucose which are also absorbed by othermore sizable
bodily components such as water and fat. The trick
then is to focus on those specific wavelengths that, although
weakly absorbed by glucose, are even less captured by surrounding
tissue.

     When non-invasive monitors hit the market, they will cost several
thousand dollars. For diabetics who test glucose three times a
day, the yearly cost for equipment, such as a glucometer and
accessories, is estimated at $1,050.

     In the forefront of the monitor race is Biocontrol Technology,
Inc., based in Indiana, PA. They were the first company to submit
an application to the Food and Drug Administration for approval.
The glucometer, called Diasensor 1000, uses NIR technology to
measure glucose levels. If approved, the meter will be marketed
to individuals due to its strict calibration requirements. It
cannot be used in a clinic or hospital setting and will need to
be recalibrated periodically at a Biocontrol office. Diasensor
1000 is an 11"x18.5"x11" machine that is not as portable as
current smaller meters and will be priced near $8,000.

     Another non-invasive technology being developed by the University
of California, San Francisco and Cygnus Therapeutic Corporation
in Redwood City, CA, has nothing to do with light. Rather, they
measure sugar levels transdermally with a GlucoWatch. The
process, called reverse iontophoresis, uses a steady electrical
current to extract glucose molecules out of the body. Originally,
this electrotransport was used to deliver drugs transdermally by
enlarging the pores to allow large drug molecules to enter the
skin. This non-invasive monitor would include a GlucoPad that
adheres to the skin. It is placed on the back of the GlucoWatch
that can measure and read sugar levels. Cygnus envisions that the
pad would be replaced daily while the watch would allow for
continuous monitoring of glucose levels. The transdermal concept
has been considered by pharmaceutical giants like Eli Lilly,
Becton Dickinson and the Alza Corporation.

     Non-invasive monitoring techniques are not limited just to the
skin. Other methods measure the concentration of light shined
through the eyeball or emanating from glucose. The enthusiasm for
this new technology is witnessed in the number of companies
involved in the research and the varied methods they come up
with. Yet, companies also withdraw because of failed attempts to
perfect a machine. Consequently, non-invasive glucometers may not
be marketable for several more years. No one knows.
The Centers for Disease Control estimates each year 15,000 to
39,000 people become blind from diabetes. When a monitor is
approved by the FDA, company representatives say that voice
synthesizers may become an accessory.

     Until then, accuracy, accessibility, and affordability are
important details that still need to be worked out. Reliability
and accuracy in the no-prick meter will be vital to prevent any
complications and calibration techniques for use in a general
setting still have to be refined. The glucose monitoring marketis worth
approximately 1.5 billion dollars and demand for the new
meters will be high. Companies involved in the research are aware
of the immense financial profit to be gained if they are the
first to come out with a non-invasive monitor. However, if
affordability can't be guaranteed, the monitors won't benefit
anyone - consumers or manufacturers. Listed below are some of the
companies engaged in the non-invasive blood glucose monitor
research:

Americare Transtech, Inc., Miami, FL
Bayer Corporation, Diagnostics Division, Tarrytown, NY
Biotronics Technology, Inc., Waukesha, WI
Biocontrol Technology, Inc., Indiana, PA
     affiliate - Diasense, Inc., Pittsburgh, PA
Boston Advanced Technology, Boston, MA
Cedars Sinai Medical Center, Los Angeles, CA
Cygnus Therapeutic Systems, Redwood City, CA
Futrex, Inc., Gaithersburg, MD
LifeScan, Inc., Milpitas, CA
Medisense, Inc., Waltham, MA
Sandia National Laboratories, Albuquerque, NM
University of Iowa, Iowa City, IA
Worchester Polytechnical Institute, Worchester, MA

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Finding The Tools He Can Live By

     From the Editor:  This story by Alana Hanson was adapted from the
Mesabi Daily News, December 11, 1994. Ken Carstens has served in
a leadership position for the Diabetics Division of the National
Federation of the Blind. He and his wife Linda always lend
helping hands to anyone in need.

     Ken and Linda Carstens of Virginia, Minnesota have filled their
home with furniture and wood decorator items which they made by
hand. Items include: book shelves, deacon's benches, domed
trunks, doll furniture, toy boxes, and decorative tables. Having
operated their in-home wood shop for the past 15 years, they
enjoy spending most of their days in the basement workroom. Both
Ken and Linda are skilled in using power tools to craft handmade
items of wood.

     Thirty years ago, Ken began losing eyesight due to complications
of diabetes. He had to stop farming and find another occupation.
For several years Ken and Linda helped operate a coffee shop at
their local county courthouse. Eventually, the Carstens left the
shop after deciding to try other kinds of work. However, they
remained in the area because they liked northern Minnesota and
the Mesabi Range.

     "Ken has always liked working with wood," said Linda Carstens.
They had a few tools and when a friend brought a toy box over for
them to repair, they fixed it and thought they'd like to try to
make one. It sold right away and they made another, and anotheruntil they were
in business for themselves.

     "Now, we make all sorts of chests," commented Ken. To enable them
to do different kinds of work, they expanded their tool and
equipment collection. The Carstens use a lot of patterns, or jigs
to make the more popular items.

     Blindness is not Ken's only complication of diabetes. With a
kidney donated by his sister, Ruby Thielke, Ken has undergone
transplant surgery. (Editor's note: Ken has had a kidney
transplant for more than 19 years!) Having had both legs
amputated at the knee, Ken sits in a modified wheel chair which
he cut down for ease of movement.

     Keeping his tools arranged on a shelf at hand level under the
table, Ken is able to find needed items quickly. His ruler is
notched at appropriate places at the inch and its subdivisions.
Each mark is a different length so he can determine which is
which. To cut a board to the right length, Carstens fits the
ruler slot at the length where he wants to make a cut. After
making sure the safety shield is on, he starts the machine and
saws the wood by pushing it toward the blade.

     Commenting that her husband has learned to adapt his skills,
"It's worked out," Linda said, "he's pruned his fingers once or
twice," but he has never had anything worse happen. 

     Ken said that his wife has come a long way using the machinery,
particularly since she was unfamiliar with the various pieces of
equipment before they began the business. "Now, she's as good as
anyone," he said.

     "I've had a lot of people ask me to train low-vision people on
power tools," said Ken. "But anyone who has any sight at all
would try to use it, of course. I just go by touch, sound, and
smell." 
     
     The Carstens do most of the work as a team. While one is occupied
using a machine, the other operates another piece of equipment,
or sands wood. After the wood is cut and sanded one member of the
team holds while the other fastens the item with screws. Linda
said that it is easier to put in screws than nails. "Phillips
screws are especially easy to put in with an electric drill." 

     At various times during the year, the Carstens show their unique,
handmade decorator items and pieces of furniture at craft shows
and fairs. People who buy items crafted by the Carstens not only
gain a quality piece of furniture or a unique decorator item, but
also learn that blindness is not synonymous with inability.

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Metformin - Good News For Type II's

by Janet Blodgett, M.D.
     Dr. Janet Blodgett is an Assistant Professor of Medicine in the
Division of Diabetes at the University of Texas Health Science
Center at San Antonio.

     If you were diagnosed as having type II diabetes, you have
probably been exercising regularly and watching what you eat. To
help further control your diabetes, your doctor may have
prescribed pills that seem to do the trick, but oral diabetes
medicine has some unpleasant side effects and may not work
forever. Your only other choice, injecting insulin, is something
you would like to avoid for as long as possible. Don't you wish
there was another option? Well, now there is.

     A drug called metformin, which received Food and Drug
Administration approval late December of 1994, is expected to
have a major impact on the treatment of type II
(non-insulin-dependent) diabetes. Metformin effectively controls
blood glucose levels without the side effects of the diabetic
drugs that are available now. So if you are currently treating
your diabetes with pills or with diet and exercise alone, this
new medication may work well for you.

What Is Metformin?
     Metformin has actually been around for about 30 years in Europe
and 20 years in Canada. It belongs to a class of antidiabetic
drugs called biguanides. These agents were developed in the 1920s
and were originally available in the United States. However,
complications resulting primarily from phenformin, a related, but
less effective drug, tarnished the reputation of all the
biguanides and the class of drugs was pulled from the market in
1977. Now, after three decades of safe and effective use, the
Food and Drug Administration retested metformin and approved it
for use alone and in combination with sulfonylureas, the
traditional oral diabetes medicine in use long before the
approval of metformin. Metformin is manufactured and distributed
by Bristol-Myers Squibb under the brand name Glucophage.

     Normally, insulin works like a key to unlock a passage into the
cells so that glucose can enter and be used for fuel. But with
type II diabetes, your cells are resistant to insulin, so they
cannot effectively process your blood glucose. Rather than
flooding your bloodstream with extra insulin to overwhelm the
less-than-hospitable receptors on your body's cells, metformin
works by sensitizing your cells to insulin's effects. Thus, the
receptors work more efficiently so you can process glucose using
the insulin that your body already makes. As a result, you can
lower both your blood glucose levels and circulating insulin
levels, which protects the blood vessels throughout your body.

     In addition, metformin has a number of secondary benefits over
currently available pharmacologic treatments. Metformin lowers
the levels of triglycerides and other fatty blood components,
and, in many people, works as an appetite suppressant. These
traits further reduce insulin resistance and improve triglycerideand
cholesterol levels, thus keeping blood glucose levels in
check while reducing the risk of heart disease and other
complications. This aspect of metformin makes it a welcome
addition to the repertoire of diabetes treatments.

The Old Order
     Right now there are several ways to improve your insulin
sensitivity. Sometimes, losing weight and changing your diet and
exercise habits will help. However, most people with type II
diabetes need to take oral medicine and eventually insulin
injections to maintain normal blood glucose levels.

     Although highly effective in improving blood glucose and
triglyceride levels, a regimen of increased exercise, improved
diet, and weight loss alone is rarely successful in treating
diabetes over the long term. Indeed, few people achieve their
ideal body weight through diet and exercise and those who do lose
weight often gain it right back.

     So people with type II diabetes often need to use some sort of
pharmacological therapy to manage their diabetes. Currently,
there are two types of drug therapies available: oral agents
called sulfonylureas and insulin injections.

     Sulfonylureas work primarily by stimulating the pancreas to
produce more insulin so that cells will be more likely to process
the glucose coursing through the bloodstream. This therapy also
increases the number of insulin receptors on the cell surface.
Both of these effects result in lower glucose levels. Currently,
if you cannot take oral agents, or if they stop working, the next
step is to take insulin, either alone or in combination with the
oral agents.

     Unfortunately, both sulfonylureas and injected insulin have
several counterproductive side effects. Oral agents generally
become less effective over time because the overworked pancreas
eventually becomes exhausted and burns out. When this happens,
people must begin taking insulin injections.

     Furthermore, both therapies promote weigh gain because they allow
you to absorb calories from blood glucose that would otherwise
spill out in your urine. This weight gain can worsen insulin
resistance and increase the risk of heart disease.

     In addition, it is not healthy to have too much insulin flowing
through your system. High levels of insulin, or hyperinsulinemia,
is known to contribute to the development of atherosclerosis, or
hardening of the arteries. Severe vascular disease, particularly
coronary artery disease, is the most common cause of
hospitalization and death for people with type II diabetes. So,
it's a good idea to try to avoid any therapies that worsen this
condition. Insulin and oral agents can also promote hypoglycemia,
so you always have to be on the alert for such reactions.

Why Use Metformin?     The introduction of metformin is an exciting prospect
since it
addresses many of the limitations of the other therapies.

     Most important, metformin sensitizes the tissues in your body to
the effects of the insulin your body makes without stimulating
your pancreas to make more insulin. Because metformin does not
affect the action of your pancreas, taking the drug does not
cause pancreatic exhaustion, which is the reason that
sulfonylureas eventually stop working. Furthermore, you won't
have super-high levels of insulin in your bloodstream, as people
with type II diabetes tend to have when they use just
sulfonylureas or insulin.

     In addition, metformin can lower levels of triglycerides and
other fatty blood components. Since heart disease is a problem
for many people who have type II diabetes, this is a welcome
bonus.

     Metformin can also act as an appetite suppressant, thus promoting
weight loss and improving insulin sensitivity and cardiovascular
health.

     Another side effect connected with insulin and sulfonylurea
therapies is hypoglycemia. Metformin alone does not cause
hypoglycemia because it does not raise your circulating insulin
level the way other medications do. Of course, if you take
metformin in combination with sulfonylureas, you will still need
to watch out for hypoglycemia.

Is Metformin For You?
     Metformin is an exciting alternative for many people with type II
diabetes. It may be a good choice for you if you are currently
controlling your diabetes with diet and exercise alone or if you
are now taking a sulfonylurea.

     Taken alone, metformin will allow your body to make better use of
your own insulin. If you take metformin in combination with a
sulfonylurea, you can achieve a collaborative effect. The
sulfonylurea makes your pancreas produce more insulin while the
metformin makes your tissues use that insulin better. These
methods are in many ways superior to existing treatments.

     If you are already taking insulin, chances are that metformin
will not be a good choice for you, since you probably don't
produce enough insulin naturally or with the help of
sulfonylureas. Metformin has not been approved for use with
insulin. It is also important to note that people with kidney
disease cannot use metformin since they may experience more
serious side effects than other users.

     Of course, like all drugs, metformin does have some side effects,
most notably gastrointestinal discomfort. About 10% to 30% of
users experience loss of appetite, nausea, stomach discomfort,
and diarrhea. However, these symptoms are temporary and disappear
over time. Also, they can be lessened or alleviated by loweringthe dose.

     A rare, but serious side effect is a toxic condition called
lactic acidosis. It occurs when your tissues are not getting
enough oxygen to survive. Although the risk of developing lactic
acidosis from metformin is much lower than from the other
biguanides, people with kidney disease are at the greatest risk
of experiencing this side effect. Thus, physicians in the United
States will be given specific guidelines for selecting patients
who can safely use the drug.

The Next Step
     Metformin is not just another oral agent. Rather, it is an
exciting drug that should have a major impact on the treatment of
type II diabetes. Whether you use it alone or with sulfonylureas,
it can keep your blood glucose levels steady while lowering your
levels of circulating insulin and triglycerides, thereby reducing
your risks of heart disease. And it does all this with fewer side
effects than other available treatments. So see your doctor to
find out if metformin is the right treatment for you.

     (Note: This article appeared in Diabetes Self-Management, March/
April 1995. Reprinted with permission.)

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Experimental Drug May Prevent Adult Diabetes

     An experimental drug may help ward off adult diabetes, which
afflicts about five percent of all Americans, a study suggests.

     The medicine, troglitazone, is being developed as a treatment for
people who already have diabetes, but the new study raises the
possibility it might also be useful for those who are at high
risk of the disease.

     Currently, the only known way to prevent adult diabetes is by
losing weight and exercising more.

     The drug helps the body use insulin more efficiently. As a
result, levels of insulin and sugar in the blood go down.
However, the study is preliminary and does not prove that
lowering blood sugar levels with the drug prevents diabetes.

     Doctors from the University of California at San Diego tested the
drug on overweight people who had high blood sugar levels but
were not considered diabetic. Such people are at high risk of
adult, or type II, diabetes which is more common than the variety
that strikes during childhood.

     In an editorial published with the study, Dr. Harry Keen of Guy's
Hospital in London said the potential for a drug treatment is too
great to be ignored.

     But he added, "Medical moralists will despair that
pharmacologicinventiveness may now allow people to become even fatter and
lazier without having to face their metabolic nemesis."

     The research, conducted by Dr. John Nolan and others, was
published in the New England Journal of Medicine.

     Doctors experimented on 18 people. Half got troglitazone, while
the rest got dummy pills, for 12 weeks.

     A condition called insulin resistance is an important underlying
factor in adult diabetes. They body needs insulin to absorb
sugar. Some people make even more insulin than normal, but their
bodies do not use it properly, so sugar levels in their
bloodstreams rise too high.

     All the study participants had insulin resistance. After taking
troglitazone, their insulin levels fell 41 percent and their
sugar levels also declined significantly.

     (NOTE: This article appeared in the News-Press, North Ft. Meyers,
FL.)

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Social Security, SSI, and Medicare Facts For 1995

by James Gashel

[Photo:  portrait.  Caption:  James Gashel]

     This article appeared in the Braille Monitor January 1995,
published by the National Federation of the Blind.

     From the Monitor Editor: James Gashel is the National Federation
of the Blind's Director of Governmental Affairs.

     The beginning of each year brings with it annual adjustments in
Social Security programs. The changes include new tax rates,
higher exempt earnings amounts, Social Security and SSI
cost-of-living increases, and changes in deductible and
co-insurance requirements under Medicare. Here are the new facts
for 1995:

     FICA and Self-Employment Tax Rates: The FICA tax rate for
employees and their employers remains at 7.65%. This rate
includes payments to the Old Age, Survivors, and Disability
Insurance (OASDI) Trust Fund of 6.2% and an additional 1.45%
payment to the Hospital Insurance (HI) Trust Fund, from which
payments under Medicare are made. Self-employed persons continue
to pay a Social Security tax of 15.3%. This includes 12.4% which
is paid to the OASDI trust fund and 2.9% which is paid to the HI
trust fund.

     Ceiling on Earnings Subject to Tax: During 1994 the ceiling on
taxable earnings for contributions to the OASDI trust fund was$60,600. The
taxable income ceiling for contributions to the
OASDI trust fund during 1995 is $61,200. As was true in 1994,
there is no ceiling on earnings that are subject to the HI trust
fund tax contribution of 1.45% for employees or 2.9% for
self-employed persons.

     Quarters of Coverage: Eligibility for retirement, survivors, and
disability insurance benefits is based in large part on the
number of quarters of coverage earned by any individual during
periods of work. Anyone may earn up to four quarters of coverage
during a single year. During 1994 a Social Security quarter of
coverage was credited for earnings of $620 in any calendar
quarter. Anyone who earned $2,480 for the year (regardless of
when the earnings occurred during the year) was given four
quarters of coverage. In 1995 a Social Security quarter of
coverage will be credited for earnings of $630 during a calendar
quarter. Four quarters can be earned with annual earnings of
$2,520.

     Exempt Earnings: The earnings exemption for blind people
receiving Social Security Disability Insurance (SSDI) benefits is
the same as the exempt amount for individuals age sixty-five
through sixty-nine who receive Social Security retirement
benefits. The monthly exempt amount in 1994 was $930 of gross
earned income. During 1995 the exempt amount will be $940.
Technically, this exemption is referred to as an amount of
monthly gross earnings which does not show "substantial gainful
activity." Earnings of $940 or more per month before taxes for a
blind SSDI beneficiary in 1995 will show substantial gainful
activity after subtracting any unearned (or subsidy) income and
applying any deductions for impairment-related work expenses.

     Social Security Benefit Amounts for 1995: All Social Security
benefits (including retirement, survivors', disability, and
dependents' benefits) are increased by 2.8% beginning with the
checks received in January, 1995. The exact dollar increase for
any individual will depend upon the amount being paid.

     Standard SSI Benefit Increase: Beginning January, 1995, the
federal payment amounts for SSI individuals and couples are as
follows: individuals, $458 per month; couples, $687 per month.
These amounts are increased from individuals, $446 per month;
couples, $669 per month.

     Medicare Deductibles and Co-insurance: Medicare Part A coverage
provides hospital insurance to most Social Security
beneficiaries. The co-insurance payment is the charge that the
hospital makes to a Medicare beneficiary for any hospital stay.
Medicare then pays the hospital charges above the beneficiary's
co-insurance amount.

     The Part A co-insurance amount charged for hospital services
within a benefit period of not longer than sixty days was $696
during 1994 and is increased to $716 during 1995. Beginning with
the sixty-first day through the ninetieth day, there is a dailyco-insurance
amount of $179 per day, up from $174 in 1994. Each
Medicare beneficiary has sixty "reserve days" for hospital
services provided within a benefit period longer than ninety
days. The co-insurance amount to be paid during each reserve day
is $358, up from $348 in 1994.

     Part A of Medicare pays all covered charges for services in a
skilled nursing facility for the first twenty days within a
benefit period. Beginning with the twenty-first day through the
one hundredth day within a benefit period, the Part A
co-insurance amount for services received in a skilled nursing
facility is $89.50 per day.

     For most beneficiaries there is no monthly premium charge for
Medicare Part A coverage. Persons who become ineligible for
Social Security Disability Insurance cash benefits can continue
to receive Medicare Part A coverage premium-free for thirty-nine
months following the end of a trial work period. After that time
the individual may purchase Part A coverage. The premium rate for
this coverage during 1995 is $261 per month. During 1995 this
premium rate is reduced by 30% for individuals who have earned at
least thirty quarters of coverage under Social Security covered
employment. For such individuals the monthly premium rate for
purchasing Medicare Part A coverage during 1995 will be $183.

     The Medicare Part B (medical insurance) deductible remains at
$100 in 1995. This is an annual deductible amount. The Medicare
Part B basic monthly premium rate will increase from $41.10
charged to each beneficiary and withheld from Social Security
checks during 1994 to $46.10 per month during 1995. Medicare Part
B coverage may be continued for persons who complete a trial work
period and become ineligible to receive Social Security
Disability Insurance cash benefits. This monthly premium rate is
$46.10, the same amount paid by Social Security beneficiaries
through withholding from their monthly Social Security checks.

     Programs Which Help with Medicare Deductibles and Premiums:
Low-income Medicare beneficiaries may qualify for help with
payments. Assistance is available through two programs - QMB
(Qualified Medicare Beneficiary program) and SLMB (Specified
Low-income Medicare Beneficiary program).

     Under the QMB program states are required to pay the Medicare
Part A (Hospital Insurance) and Part B (Medical Insurance)
premiums, deductibles, and coinsurance expenses for Medicare
beneficiaries who meet the program's income and resource
requirements. Under the SLMB program states pay only the full
Medicare Part B monthly premium ($46.10 in 1995). Eligibility for
the SLMB program may be retroactive for up to three calendar
months.

     Both programs are administered by the Health Care Financing
Administration (HCFA) in conjunction with the states. The rules
vary from state to state; but, in general:
     An individual may qualify for the QMB program if his or her
     income is near the national poverty level, approximately $7,596
     annually for an individual (about $633 per month) and $10,080
     annually for a family of two (or $840 per month). These amounts
     apply for residents of forty-eight of the fifty states and the
     District of Columbia. In Alaska the income threshold used to
     define poverty is approximately $9,444 annually for an individual
     ($787 per month) and $12,540 annually for a family of two ($1,045
     per month). In Hawaii the income threshold used to define poverty
     is approximately $8,712 annually ($726 per month) for an
     individual and $11,556 annually ($963 per month) for a family of
     two. For the SLMB program annual income must be 110 percent or
     less of the national poverty levels. Under both programs $20 in
     monthly income is not counted toward the limit. Resources - such
     as bank accounts or stocks - may not exceed $4,000 for one person
     or $6,000 for a family of two. (Resources generally are things
     you own. However, not everything is counted: the house you live
     in, for example, doesn't count, and, in some circumstances, your
     car may not count either.)

     Here's an idea of what the QMB program provides in 1995. Under
Part A the hospital insurance deductibles are $716 for the first
sixty days of a hospital stay and $179 per day for days sixty-one
through ninety in the hospital. However, to qualify for help
under the QMB program, you must file an application. If you think
you qualify but you have not filed for Medicare Part A, contact
Social Security to find out if you need to file an application.
Further information about filing for Medicare is available from
your local Social Security office or Social Security's toll-free
number, (800) 772-1213.

     Remember, only your state can decide if you're eligible for help
from the QMB or SLMB program. So, if you're elderly or disabled,
have low income and very limited assets, and are a Medicare
beneficiary, contact your state or local welfare or social
service agency to apply. For more information about either
program, call HCFA's toll-free telephone number, (800) 638-6833. 

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Dialogs About Diabetic Dynamos: Scholarship Available For IDDM
Diabetics

by Debra Frank, M.S., M.S.

[Photo:  portrait.  Caption:  Debra Frank, M.S., M.S.]

     Debra Frank holds Masters of Science degrees in Recreation
Therapy and Exercise Physiology. She is a member of the American
Association of Diabetes Educators (AADE), the International
Diabetic Athlete Association (IDAA) and is on the medical
advisory board of the Juvenile Diabetes Foundation International
(JDFI) Nassau/Suffolk, New York Chapter. As an active athlete
with IDDM she shares both her personal and professional
experiences with Voice of the Diabetic. She hopes to motivate andeducate
others to live rather than merely exist.

Summer, Sun, Sweat and Sport

     It's summer time and the living should be easy. Having IDDM in
hot and humid climates can make an individual tired and
lethargic. Many of us choose to be less active during this season
to avoid sudden insulin reactions caused by heat and quick
changes in body temperature. There is good reason to be cautious
exercising during extreme heat conditions. But there is no reason
not to exercise if you're properly prepared. Others choose
activities such as swimming, bicycling, tennis, softball,
race-walking, or golf rather than remaining indoors taking a
fitness class or sitting on a stationary bicycle. Most of these
activities involve groups of people and have no set time
schedule. Therefore, to prevent unnecessary reactions or
complications, carry a portable cooler with plenty of water,
insulin and syringes, a blood sugar monitoring kit and strips,
juice or your favorite emergency glucose source, and healthy
snacks. Additionally, protect your head and eyes. The sun plays
tricks on the eyes and diabetics should be cautious when outside.
Anyone who is on anti-rejection drugs, antibiotics or any
prescription medication should be extra careful. The exaggerated
sensitivity and photosynthetic reaction of sun can be extremely
dangerous to the dermatome (skin) because of these drugs. Wear
light-colored, cotton clothing and bring sun block. Also,
remember to wear comfortable shoes, or sneakers, and cotton socks
when possible. Carrying baby powder to avoid chafing and
irritation during hot weather is also a smart idea. Now you're
probably more prepared than anyone else for that daily walk in
the park or summer company picnic and softball game.

The Angelo Centano
Golf Scholarship

     Join in the 'Spirit of Sport' and win a $500 scholarship. Write a
300 to 600 word essay telling us why you feel you should earn the
1995 Angelo Centano Golf Scholarship. Since Angelo's untimely
death in 1992, his friends at the Elmont Knights of Columbus, his
family, and the Nassau/Suffolk Juvenile Diabetes Foundation have
been hosting a golf fundraiser in Angelo's memory. This year's
Angelo Centano Golf Tournament is scheduled for early September
1995. One of the event committee members suggested that some of
the money be awarded as a scholarship to a person who has IDDM.
What good is raising millions in search of a cure(s) when many of
us have already fallen victim to the reality of diabetes and its
complications? We are already living lives against the odds while
awaiting miracle cures.

     If you feel you want to buy a tandem bicycle so you and a friend
or family member can enjoy riding together, or you want to go to
the next IDAA meeting, or you want to hire a coach to train you
for the swimming events at the 1996 Para Olympics in Atlanta, or
you have any other special desire which you feel winning this
scholarship will help you achieve, pick up your pen, sit down atyour computer
or send in a cassette. GO FOR IT! You just might
win!

     From the Editor: Debra Frank encourages blind diabetics to submit
essays. Entries should reflect any activity good for physical
health and positive living. Incidentally, a typed, double-spaced
submission would be approx. 11/2 to three pages long.

     All essays should be labeled "Golf Scholarship Essay 1995" and
sent directly to the Voice of the Diabetic. Please have your
submissions in by October 31, 1995. The winner will be chosen by
a committee and announced in the Voice, Spring 1996 issue. We
look forward to reading and hearing from you in the near future.
Remember our IDAA motto, "I Run On Insulin!" For more information
on the scholarship contact: Ed Bryant, editor, Voice of the
Diabetic, 811 Cherry St., Suite 309, Columbia, MO 65201;
telephone: (314) 875-8911.

+++++++++++++++++++++++++++++++++++++++

Double Transplant: A Two-year Drama

by Marie R. Verrastro

     I was sitting on an emergency room cot when a young intern
hurried past. "How are you feeling?" he asked, then added, "I
guess you wouldn't be here if you felt very good."

     "Actually," I replied, "I'm probably the only one here who feels
this great. I just got a call. I'm here for a double transplant!"

     So began the most exciting, frightening ride of my 27-year-old
life. The story began several months earlier, in January 1993,
when my kidney was failing and my nephrologist informed me that I
would be an excellent candidate for a kidney transplant. He also
brought up the possibility of doing a two for one deal: receiving
a pancreas as well as a kidney.

     Once the plan was formulated, I launched headlong into a flurry
of medical activity between January and May. This entailed taking
just about every medical test known to mankind in order to ensure
my only medical problems were diabetes and kidney failure. The
long list of tests included a gynecological exam, an upper and
lower GI series, a stress test for my heart, a hepatitis
vaccination and many blood tests to check everything from AIDS to
exact blood type.

     The tests were not painful, but I waited on pins and needles for
each result. Before a transplant can be performed, all current
health problems must be "fixed" so the transplant will have a
healthy environment in which to survive. Each positive result
brought me one step closer to my hopeful goal.

     After all the results of my tests were in, I was ready for the
final phase of this drama. The scene was University Hospital inCincinnati,
Ohio. There wasn't a cast of thousands, but it felt
like it. Present for the big interview were: Dr. R. Munda,
Professor of Surgery, Dr. R. First, Professor of Medicine, Dr. H.
Hariharan, Assistant Professor of Medicine, Ann Demmy, RN,
Pancreas Transplant Coordinator, Linda Page, MSW, LISW, Renal
Social Worker, Kay Bonnar, Administrative Assistant, my husband
Richard and myself. We discussed financial matters and the
support network I would have from friends and family, but the
bottom line was plain and simple: Was I strong and healthy enough
to successfully endure the rigors of adding two new organs to my
body?

     The doctors reviewed my case while Richard and I tried not to
bite our nails with anxiety. No one wanted to discourage us, but
everyone in the room wanted to present the most realistic picture
of the operation. We were educated in the operational procedure
itself, the medicines I would need to take and their various side
effects. When all participants were satisfied with our answers,
the big decision was made. I received a clean bill of health and
completed the paperwork to be listed as an organ donor recipient.

     I was given a beeper, that electrical lifeline to the doctor's
office, in August, about the same time I started hemodialysis.
Richard and I knew we might have to wait a year or longer for the
right match, so we settled in for the interim.

     Much to our surprise, we received the expectant phone call just
two months later on a cool October midnight. Anne phoned to let
me know they had a donor. "Come to the emergency room as soon as
you can," she said. I did two things. I phoned my parents in New
York and I showered and washed my hair. Who knew when I would be
doing this by myself again? Richard had to laugh. "At least you
have your priorities straight during this critical time," he
said.

     So, this is how I came to be sitting in the emergency room at 2
AM in such good spirits. Anxiously, Richard kissed me good-bye
and took up his position in the waiting room, as I was wheeled
into the operating room. The last thing I remember thinking was,
"This is what I've been waiting for, but what, oh, what have I
taken on?"

     Updating Richard periodically, the doctors emerged after six
hours with the news. Everything went well and the transplant was
successful. My creatinan, one measure of kidney function, was .9
and my blood sugar was less than 100, both well within normal
range. I was taken to the intensive care unit with my three
kidneys and two pancreases. It was an odd arrangement: I had a
kidney in my abdomen and a pancreas hooked up to my bladder. Who
can believe the surprises of modern medicine?

     I thought the actual operation was going to be the hard part, but
boy, was I wrong. The transplant story had just begun.

     I stayed in ICU for two days, most of which I don't remember. Myparents
kept vigil and were in charge of alerting the rest of the
family and friends of my status. Richard was there also, though
he was not as comfortable with the medical environment as my mom,
who was a nurse. I had tubes, catheters and lines going
everywhere and I'm sure I made a pretty gruesome picture.

     When I was moved to 6 West, the transplant wing of the hospital,
things became different. Each day the transplant team made rounds
and evaluated my case. I was now taking the three medicines I
would take for the rest of my life: cyclosporine, prednisone and
imuran. These would suppress my immune system and prevent my body
from rejecting the new organs. The next ten days brought changes
and challenges. My medicine doses were fine tuned each day and I
slowly began to recover. I was determined to get strong and was
encouraged to take walks in the hall. Because of the placement of
the pancreas and also the need for a moist environment for the
new organs, dehydration was a constant worry. I started eating
solid foods and, believe it or not, I started a daily ritual of
trying to drink between four to five liters of fluid a day. It
became a game because Richard would count the number of empty
fruit punch quarts on the window sill when he visited.

     All was going well and the team thought I'd be ready to go home
soon. But, like 95 percent of double transplant patients, I
suffered my first rejection. The doctors performed a biopsy on my
kidney and started a fantastic new anti-rejection medicine called
OKT3. Fantastic because it turned the rejection around. Not so
fantastic were its side effects: nausea, vomiting, headaches and
flu-like symptoms. But, it did its job and after a three-week
stay, I was now on my own.

     Well, not exactly on my own. In the following weeks I went to the
clinic every Monday, Wednesday and Friday. With my immune system
compromised I was a target for every germ in the air. The next
six months were critical. During each visit, I was weighed, gave
a urine specimen and took a blood test. The the same doctors who
had been involved in the original operation evaluated my numbers
and made adjustments to my daily routine. Since being at the
clinic three times a week for several hours, I began to make
friends. We commiserated when the numbers were bad and cheered
each other on when the numbers were positive.

     How can I describe the next three months? It was like the
Matterhorn at Disneyland. Thank goodness I had the transplant
team, my friends, family and Richard on the ride with me. As
determined as I was to get well, I still had a rocky road to
travel. I suffered two more rejections severe enough to put me
back in the hospital for several weeks throughout December and
January. Also, I was still very weak and spent most of my time
sleeping and reading.

     However, March was the turning point. Finally, after the coldest,
snowiest Cincinnati winter in recent history, spring was around
the corner. I had not been in the hospital for over a month and
had begun to ride my exercise bike to get some strength back. Myclinic visits
were now spaced to once every two weeks and I
wanted to get out and see the world.

     A big help was the return of my dog Shelby, who had been staying
in Morristown, New Jersey throughout this time. Once back, we
started taking long walks several times a day. The sun felt good
and it was terrific to get out and exercise.

     Things were really looking up. I reached my six-month anniversary
in April, and Richard and I felt we could breathe a little
easier. Richard began to feel more comfortable leaving me to my
own pursuits.

     I had a slight set-back in May, though more emotional than
physical. I was hospitalized for a minor stomach virus, but some
of the side effects of the prednisone when I was on high doses
were horrible. I gained ten pounds, had a horrible case of acne
and was growing hair everywhere. One day Richard teasingly said
he was going to braid my back hair and I burst into tears. The
doctors took care of the stomach problem and I found a counselor
who helped me cope with my new life.

     I made it to my one-year anniversary in October. The team
celebrated in their usual style with a few more medical tests
that monitored whether the pancreas transplant would stave off
some of the diabetic complications.

     Now, it is January, two years later. What a difference. I've lost
ten pounds, my skin is clear and I'm beardless. I've adjusted to
a life without insulin and blood sugar swings. Visiting the
clinic about every six weeks, I have more energy and strength
than I can remember in a long time. I get out and walk about an
hour a day. I've also begun to do some public speaking and am
taking an interest in the production department at a local radio
station. Though I'm free from insulin and food-related time
schedules, I still rely on my good habits picked up from being a
diabetic for 17 years. I'm hoping that my diet and exercise
routines will help my transplant last a good long time.

+++++++++++++++++++++++++++++++++++++++

Ask the Doctor

by Wesley W. Wilson, M.D.

     NOTE: If you have any questions for "Ask the Doctor," please send
them to the Voice editorial office. The only questions Dr. Wilson
will be able to answer are the ones used in this column. 

     Wesley Wilson, M.D. is an Internal Medicine practitioner at the
Western Montana Clinic in Missoula, Montana. Dr. Wilson was
diagnosed with type I diabetes in 1956, during his second year of
medical school.

     Q: For five years I've worked hard to control my diabetes, butunexpected
high and low blood sugars are frustrating,
particularly when I have insulin reactions for no reason that I
can understand. I've heard of insulin pumps and I wonder if pump
therapy could improve my diabetic control. What is your opinion?

     A: I'm guilty of usually answering questions such as yours with a
strong maybe and that is my answer again. I will try to provide
an answer based on my own investigation and personal experience
with pump therapy. I have used insulin for about 40 years and
pump therapy for the last year and a half. Pump therapy provides
both benefits and problems. I should emphasize that this reply
deals only with type I diabetes.

     First, a brief discussion of insulin therapy. Both multiple
injection therapy (of intermediate duration and rapid acting
insulin) and pump therapy are designed to provide a low rate of
insulin that should keep the blood sugar level relatively
constant. Then extra doses of insulin are timed and taken to
prevent high blood sugars after meals. The base rate or basal
rate and bolus doses (extra insulin taken to cover meals) are
terminology of pump therapy.

     Multiple injection insulin therapy usually uses a combination of
several doses of rapid acting insulin, Regular, and longer acting
insulin, NPH or Lente. Both are taken before breakfast and
dinner, with the longer acting insulin taken in smaller doses
before dinner and then again at bedtime to prevent a rise in
blood sugar during the early morning hours. This mixture provides
some degree of a basal insulin plus a bump in insulin activity
during meal times. This type of therapy is widely used and
usually gives reasonably good blood sugar control.

     It seems to me, however, that there are two major problems with
it. All insulins, especially the longer-acting ones, seem to be
irregularly absorbed. Research has shown that up to 40% more or
less rapid absorption of insulin from shot to shot can occur. It
is my opinion that the more slowly absorbed insulins, such as
Lente or NPH, tend to show a greater degree of variation in rate
of absorption than does the more rapidly absorbed Regular type
insulin. This variability in insulin absorption and action is a
major factor in the unexpected, but frequently seen, wide swings
in blood sugar levels. One day there is good control of blood
sugar, but another day with seemingly identical factors the blood
sugar may be unexpectedly high or low, or both at different times
during the day. This fluctuation in insulin action causes a great
deal of unpredictability in blood sugar levels.

     Another problem with multiple dose insulin therapy is its
dependency upon slowly absorbed insulin. Unfortunately, blood
sugar levels change with different types of physical activity.
Anyone who depends upon insulin injections is well aware that
increases in insulin absorption often seem to occur with
increased physical activity and muscle use. As they increase
physical activity, individuals without diabetes rapidly drop
their insulin levels, and with maximum exertion very littleinsulin can be
detected in the blood. Insulin absorbs more
quickly during physical activity, while at the same time the body
needs less insulin. For diabetics, this fact poses a double risk
for hypoglycemia.

     A third problem with multiple dose insulin injection therapy is
related to the duration of insulin action. All the current
insulins require 20 to 30 minutes to become available for
absorption and action. Even the rapid-acting insulins must be
given 20 or 30 minutes prior to a meal. The main problem is
related to intermediate-acting insulin. When a mixture of
intermediate-acting and Regular insulin is given before
breakfast, it often peaks in one to two hours followed by another
peak four to six hours after the injection, requiring the person
taking the insulin to eat promptly at noon. Many persons who are
taking an intermediate duration insulin in the morning feel as
though they are being held hostage by their morning dose of
insulin. 

     Now that we have looked at problems with the most usual form of
insulin therapy - multiple dose injection - the question is can
pump therapy avoid some of the problems and improve life?

     Insulin pump therapy uses only Regular insulin. For most
individuals, only the abdominal wall is used as an injection
site. This single location and type of insulin minimize, but do
not entirely avoid, the variability of insulin absorption and
activity. Also, since no slowly absorbed insulin, such as NPH or
Lente, is used with pump therapy, the need to eat at a specific
time is much less a factor.

     Furthermore, if an unusually large or small amount of exertion is
encountered or can be expected, with pump therapy the basal rate
can be adjusted prior to meals, even if the meal is at an unusual
time. Remember that the insulin already injected will continue to
act for some hours, so an adjustment of dosage does not cause an
immediate change in insulin action. Again, you must predict in
advance when a meal is to be expected so the bolus may be taken
20 or 30 minutes prior to the meal. If marked exertion is to be
undertaken, the basal rate can readily be reduced an hour or two
before the change in physical activity and then adjusted back up
afterwards to hopefully keep the blood sugar on a reasonably
stable level. 

     After this complex discussion, it seems worthwhile to point out
that the main advantage of pump therapy for myself and for many
of my patients is reasonable control of blood sugar with much
greater flexibility of lifestyle. Please notice I did not say
pump therapy can provide better control than standard insulin
programs. Current pumps only do what the wearer tells them to do.
A pump which adjusts insulin dose according to blood sugar level
or meal size is not yet available. However, a great deal of
research is being done to find an implantable glucose sensor
capable of measuring blood sugar levels. When that device is
available, an automated, artificial, pancreas-type insulin pumpwill be
available and should simplify diabetic management.

     The disadvantages of pump therapy are many and for that reason
anyone who considers a change to pump therapy must choose
carefully. Pump therapy is expensive. Even if insurance covers
most of that expense, many diabetes management experts are
cautious about recommending pump therapy. 

     Pump therapy brings increased risk of infection at the needle
site. The needle remains in place for two or three days and
infections, sometimes severe, certainly may occur. Meticulous
care seems the best way to minimize these problems.

     Some people dislike the concept of being attached to a small box
by a length of plastic tubing all the time and for them it does
represent a significant problem in lifestyle.

     In addition, some aggravations of pump therapy include: blocked
tubing, injury to the pump, wearing out of batteries, the need to
carry extra sets of tubing, injection sets, and always needing to
have a backup unit containing standard insulin. I realize many
readers of Voice of the Diabetic have visual impairment, which
also represents a significant problem for pump therapy. (Editor's
Note: The Disetronic H-TRON V100 insulin pump incorporates both
audio and tactile cues, and is used successfully by blind
diabetics. For further information, contact Disetronic Medical
Systems at 1-800-688-4578.)

     In conclusion, I feel that pump therapy is worth serious
consideration if flexibility in meal times and activity levels
with continued careful control of blood sugar seems worth the
trade off of expense, inconvenience, and risk of infection. The
insulin pump requires a lot of work by both patient and
physician. Remember, the pump does nothing by itself, only what
the wearer tells it to do. So it requires a great deal of
attention to detail on the part of the person with diabetes
attempting pump therapy.

     I would be very interested to hear comments from other insulin
pump users, particularly anyone with impaired vision.

+++++++++++++++++++++++++++++++++++++++

What Insulin Manufacturers Say About Vial Design Change

by Ed Bryant

[Photo:  portrait.  Caption:  Ed Bryant]

     Our Diabetics Division has lobbied more than three years for
modifications in insulin vial design. Currently, all insulins are
packaged in identical cylindrical vials, a practice which makes
non-visual identification of containers impossible.

     In a meeting with the Food and Drug Administration (FDA), the two insulin
manufacturers, Eli Lilly and Company and Novo Nordisk
Pharmaceuticals Inc., agreed to color code vial labels. Color
coding is of course not adequate for thousands of blind diabetics
and most individuals with diminished visual acuity. Additionally,
there are diabetics who experience fluctuating vision or who are
color blind. 

     It is logical that insulin containers have sufficient tactile
coding for identification by the blind and those losing vision.
If vials were differentiated by shape and labels had
distinguishable tactile cues, blind diabetics could independently
handle their insulin needs. These men and women would have the
basic human dignity of being able to self-manage their diabetes.
Knowing they could handle their own health requirements, they
would be more likely to seek employment. They would not be
limited to job opportunities near home. Some would no longer need
the services of visiting nurses just to draw insulin, and could
save approximately $150 per month. Often these services are paid
for by Medicare and/or Medicaid.

     Good metabolic control matters. For many this means increased
insulin injection frequency. Tight control is good but it places
diabetics at more risk for hypoglycemia. Low blood sugar
reactions can mean injury, hospitalization, and even death.
Individuals should not draw insulin when disoriented, whether due
to low blood glucose or other distraction, but unfortunately some
do. If vials were differentiated by shape, errors would be
minimized.

     During previous meetings between the FDA and insulin industry,
the blind were excluded from the planning process. The
insupportable, antiquated myth about the blind needing to have
everything done for them still exists. It is well documented that
blind individuals can self-manage their diabetes by using
adaptive equipment to independently draw insulin(s), test blood
sugars, etc. THEY CANNOT SAFELY DISPENSE INSULIN, A CRITICAL
STEP, IF ALL CONTAINERS ARE THE SAME.

     Years ago, the FDA made insulin manufacturers change vial shapes.
Before this ruling, some insulins had been packaged in containers
having either a rounded top cross-section, a square cross-section
or a hexagonal cross-section. The agency was concerned that there
were too many vial shapes on the market. This mandate was
probably well-intentioned on the government's part, but
unfortunately enough research wasn't done. Simply put, the
federal agency DID NOT check with blind consumers!

     We need this regulation changed! To expedite such changes in
federal law, formal application to alter the regulations must
come from the insulin manufacturers, who will have to agree on
standardized vial marking(s). Once a specific amendment is
requested (to the relevant section in the code of federal
regulations) from the FDA, Health and Human Services and the
Office of Management and Budget will commence regulatory review.
     I find it interesting that the insulin industry and/or the FDA
may not really be interested in modifying vial configuration for
consumer safety. In the past when one consumer wrote to Novo
Nordisk (not Eli Lilly) about this matter, the company's response
was that the FDA should be contacted for help in the tactile
marking of insulin vials. The same person also received
correspondence from an FDA consumer safety officer who wrote, "We
can only suggest that your group and possibly others contact the
insulin manufacturers to urge them to alter their packaging." Not
to mention the apparent buck passing on both sides, I wonder why
the FDA, which is mandated to be vigilant with drugs and their
containers for consumer safety, would advise people making
obviously good suggestions to seek help from the insulin
industry? The FDA knows full well the dangers if the wrong type
or amount of insulin is administered. I FIND IT ASTONISHING THAT
THIS FEDERAL AGENCY HAS NOT INTERVENED TO HELP ENSURE THE SAFETY
OF THOUSANDS OF DIABETICS.

     In a letter dated July 11, 1994, Dr. Solomon Sobel, M.D., FDA
Director, Division of Metabolism and Endocrine Drug Studies, said
the National Federation of the Blind would be invited to a
meeting of organizations, associations, and the insulin
manufacturers. Months later I received a copy of correspondence
Dr. Sobel had sent to a consumer regarding insulin vial shapes.
The letter stated that following a meeting with associations
there would be another meeting with Eli Lilly and Novo Nordisk to
determine what changes would be feasible. My written response on
April 7, 1995, to Dr. Sobel said in part: "Why would the FDA not
want consumers, organizations, and the insulin industry to
discuss possible modifications together? Why wouldn't the FDA
moderate the meeting? If the goal is to move toward solution of
this problem, more would be accomplished if all groups are
represented. Does the FDA and/or the insulin manufacturers not
want all aggregations to meet together? It seems judicious and in
fact logical that ALL concerned meet to discuss the issue." AS OF
PRESS TIME JUNE 16, NO RESPONSE HAD BEEN RECEIVED FROM DR.
SOLOMON SOBEL OF THE FDA.

     CONSENSUS IS UNANIMOUS-INSULIN SHOULD BE PACKAGED IN DIFFERENTLY
SHAPED CONTAINERS. The cost of changing vial design would not be
prohibitively high. Mr. William Gierke, Manager of Pharmaceutical
Package Engineering, Eli Lilly and Company, said on May 6, 1992,
"As much insulin as we make, cost of the molding would perhaps be
up front quite a bit. But per product it would probably round
off. I don't think the extra cost would really be a factor."

     Eli Lilly and Novo Nordisk always seem enthusiastic about helping
insulin-dependent diabetics in any way possible. They are always
willing to work with diabetes educators to improve services to
insulin users. Nevertheless, readers should also be cognizant
that the industry has a huge vested interest in insulin. Profits
each year are in the multi-million dollar range.

     Movement toward solution sometimes comes slowly, but action
should be expected. Instead of remaining noncommittal and
duckingresponsibility, the FDA and the insulin industry should resolve
this consumer hazard. If the insulin industry proposes vial shape
changes to the FDA, the agency is required to respond. I decided
to write to both insulin manufacturers, hoping to bring the
insulin vial issue to fruition. Are the companies really willing
to initiate vial shape change? Incidentally, the insulin industry
is fully aware that container design change would benefit the
sighted as well as the blind. 

Lilly Responds to Letter 
     In December 1994, I met with Lilly representatives, who brought
prototype designs for my review and input. It was obvious they
were working toward a method of identifying insulins by touch.

     When Eli Lilly received my May 9 letter regarding vial design
change, they responded promptly via telephone and letter (letter
appended below). Their reply was positive and they are working
toward a solution. Mr. Timothy Button, Marketing Associate with
Lilly, phoned June 1 regarding my letter. He said that to learn
more about the needs of blind diabetics, he would attend the
National Federation of the Blind Annual Convention in Chicago.
There Mr. Button will host a meeting with consumers to discuss
insulin vial change.

     He said Lilly has something very promising on the drawing board,
but because it involves patents, he could not divulge what it is.
He said that in 1996, Lilly will have a product available to help
diabetics distinguish different types of insulins.

     Until then, Mr. Button said, Lilly is looking for a temporary
solution and will probably make a test run of 2000 to 3000 sets
of devices that could be attached to the bottom of vials, to aid
tactile identification. This would be a temporary solution, he
said, until they can get their permanent design onto their
manufacturing lines.

     Cost effectiveness is important for any marketing plan,
especially if it crosses international borders. Mr. Button said
his company has a global perspective because Lilly has 17
world-wide sites where insulin is produced or has a contract
relationship with an insulin producer. As stated above, a Lilly
engineer said the cost of changing insulin vial shapes should not
substantially alter the cost of production. Besides, there is
more involved than how cheaply insulin can be produced. Vial
shape change would substantially improve the safety factor, a
major concern for blind as well as sighted diabetics.

     Lilly is exploring the possibilities of vial shape change.
However, the FDA requires "stability testing" on anything the
manufacturers do that affects the primary containers holding
insulin. The industry must prove to the FDA that the insulin will
not be affected in any way by container shape changes. The entire
process could perhaps take two to five years.

     Mr. Button said Lilly was willing to work with Novo Nordisk inchanging
vial designs. It is absolutely clear that Eli Lilly and
Company is striving to help customers. They know diabetic
retinopathy and neuropathy can affect all diabetics at some point
in their lives. Lilly is to be commended for realizing this and
working toward a solution. 

Novo Nordisk Finally Responds
     In January 1995, I met with Novo Nordisk representatives and
discussed the need for change in insulin vial design. They had
not yet developed any prototypes or solutions. Mr. Jim Smart,
Senior Vice President of Marketing, said in an April 26th letter
to me that Novo Nordisk is "continuing to explore possibilities
at their Denmark headquarters."

     On June 7, Mr. Alan W. Scobie, Novo Nordisk's Director of Medical
Marketing, responded to my May 9 letter (both are reprinted
below). His letter was distant, guarded, and noncommittal. I have
been in contact with both insulin manufacturers for several years
now, and while Lilly is an active participant in the search for a
solution, Novo Nordisk is still on the sidelines. As such, they
are in danger of being left behind.

     Novo Nordisk is a huge international organization with many
layers of management. My "contact person" within the company has
changed many times, and things always seem to be "just getting
underway." Perhaps they will note Lilly's offer "to work with
Novo Nordisk in changing insulin vial designs" (as stated by Mr.
Timothy Button, above) and finally join the process.

     The following letter was sent to both insulin manufacturers on
May 9. (The letter to Lilly made reference to prototypes
presented at their December meeting - otherwise the letters are
identical.)

May 9, 1995

Jim Smart
Senior Vice President, Marketing
Novo Nordisk Pharmaceuticals Inc.
Princeton, NJ 

Dear Mr. Smart:
     What is the status of Novo Nordisk's work toward finding a
solution so insulin vials can be identified tactually by blind or
visually impaired diabetics? Discussing possibilities for
container and/or label design change on January 10, 1995, I
appreciated you and Mr. Cugini meeting with me. You had no
prototypes of tactile markings, so I assumed work toward a
solution had not yet begun. Your April 25 letter said in part
that you are continuing to explore possibilities with your
product development team in Denmark. It has been four months
since we met, and I cannot help but wonder if this issue has been
given any priority?

     I have been contacted by MANY health professionals and consumers wanting
to know what insulin manufacturers are doing to make the
containers tactually identifiable. Episodes of hypoglycemia,
hospitalization, and even death will be minimized if vials can be
identified by touch. Years ago, insulin containers were of
different designs, so why not join forces with Eli Lilly and work
toward getting vials of different shapes re-established in the
Code of Federal Regulations? It would help so many!

     Dr. Solomon Sobel, FDA, Director, Division of Metabolism and
Endocrine Drug Studies, wrote July 11, 1994 that the National
Federation of the Blind, other organizations, and insulin
manufacturers would meet and discuss ways to accommodate blind
diabetics. In a February 27, 1995 letter to a consumer, Dr. Sobel
stated that associations would meet to discuss possible
modifications blind persons would find useful, and in a separate
meeting, the FDA would present ideas to the insulin
manufacturers. More would be accomplished if ALL interested
parties met together for discussion. It is logical and judicious
to have an open meeting. QUESTION: DO YOU KNOW WHY THE FDA IS
PLANNING SEPARATE MEETINGS WHICH WOULD PREVENT DIRECT QUESTIONS
AND SUGGESTIONS TO THE INSULIN INDUSTRY?

     WILL NOVO NORDISK PHARMACEUTICALS INC. PRIORITIZE GETTING INSULIN
PACKAGED IN DIFFERENTLY SHAPED CONTAINERS? AS YOU KNOW, THE FDA
WILL CONSIDER ANY DESIGNS INSULIN MANUFACTURERS SUBMIT. ARE YOU
WILLING TO DO THIS SO THIS ISSUE REACHES FRUITION?

     While my primary interest is insulin users in the United States,
you obviously view insulin from a global marketing perspective.
By producing vials in different shapes, humans worldwide would
benefit.

     Voice of the Diabetic readers and many others want to know what
the insulin industry is doing to correct this vexing problem. I
AWAIT YOUR RESPONSE TO THE ABOVE.

Yours truly,
Ed Bryant
President
Diabetics Division
National Federation of the Blind

* * * * * *

The following was Novo Nordisk's response:

June 7, 1995

Mr. Ed Bryant, President
Diabetics Division
National Federation of the Blind

Dear Mr. Bryant,
     We acknowledge receipt of your letter of 9 May 95.
     Several meetings have been held to discuss the issue of tactile
coding of our vials as an aid to blind or visually impaired
persons with diabetes. Numerous options have been identified that
will require extensive investigation to ensure that they will not
only be feasible from a production and safety standpoint but also
will meet the needs of the greatest number of affected
individuals.

     You mentioned in your letter that the FDA was undertaking an
initiative to explore this issue and that they would be
contacting manufacturers. We are contacting the FDA to determine
their intentions in this regard and to ensure that we participate
in the discussions.

     Please be assured that we at Novo Nordisk Pharmaceuticals Inc.
are putting substantial energy into this issue and that we are
desirous of reaching a solution that addresses the needs of all
parties involved.

     Thank you for your letter. I will contact you again when I have
further information.

Sincerely,
Alan W. Scobie
Director, Medical Marketing
Novo Nordisk Pharmaceuticals Inc.
Princeton, NJ

* * * * * *

     The following was Lilly's response to my letter. Mr. Button also
phoned me, on June 1 and June 9, to further clarify details.

May 31, 1995

Mr. Ed Bryant, President
Diabetics Division
National Federation of the Blind

Dear Mr. Bryant:
     Thank you for your letter dated May 9, I apologize for tardiness
in responding. Since we met last December in Columbia, Missouri
along with Dr. Jerry Buhler and Robert Porter of Lilly, we have
been aggressively exploring options that might meet the challenge
of providing blind and visually impaired people with diabetes
with the ability to independently identify insulin vials.

     Please be assured that meeting the needs of our customers is a
priority for Lilly and the need for vial identification for the
blind and visually impaired is currently an unmet need for those
people with diabetes. We are working on this challenge and have
some promising options in development. Lilly plans to test these
concepts with a diverse group of blind and visually impaired
people with diabetes to determine their utility, appropriateness
and acceptability. We hope that you will assist us in theseefforts.

     In the upcoming months, Lilly is making plans to attend key
meetings to share information and gather more customer input. As
part of this commitment, I will be attending the annual
convention for the National Federation of the Blind in Chicago to
learn more about how people who are blind or visually impaired
independently manage diabetes.

     Thank you for your continued interest and efforts, and please do
not hesitate to call me at anytime to talk about our progress to
date.

Sincerely,
Timothy H. Button
Marketing Associate, Global Diabetes Care
Eli Lilly and Company
Indianapolis, IN

* * * * * *
 
     The following are samples of letters to: Dr. David A. Kessler,
Commissioner, Food and Drug Administration, 5600 Fishers Lane,
Rockville, MD 20857. These Voice readers made their thoughts
known!

March 20,1995 

Dear Dr. Kessler:
     By now, I am sure that you have received much correspondence in
support of the National Federation of the Blind proposal to
require tactile marking on insulin vials indicating the various
types of insulin. You can add this letter to that body of
correspondence.

     I have been a diabetic for 43 years. That makes me old enough to
have experienced the days of U40 and U80 strength insulins. Those
insulins were packaged in varied vials indicating the type of
insulin contained in the vial. Regular insulin was packaged in a
round vial. NPH insulin was in a rectangular vial. The three
types of Lente insulin were all packaged in the same round vial
with octagonal vial shoulders. As a sighted diabetic, I found
this packaging helpful, but when I became blind, those packaging
differences became crucial. I was most alarmed when the advent of
U100 insulin brought with it the elimination of the different
vial shapes in favor of a round vial for all types of insulin.

     As a blind diabetic, I learned to adapt by producing my own
homemade labels and placing the two different types of insulin I
was using in different parts of my refrigerator and I was
consistently good at using these alternative techniques. However,
I had no control over the information provided by the pharmacy
where I bought my insulin. They once told me that my Regular
insulin was Lente. The next injection resulted in a nearly fatal
episode of hypoglycemia. Since then, I have often wondered howmany times this
was happening to other diabetics.

     A return to varied vial shapes is absolutely essential. It is the
only way by which blind diabetics can be assured of getting and
using the products they intend to use. I shudder to think of the
consequences of failing to recognize this problem and acting to
correct it. Please do so as quickly as possible.

Sincerely, 
Donovan Cooper
Burbank, CA

* * * * * *

May 5, 1995

Dear Dr. Kessler:
     I work with a large population of elderly diabetic patients, many
with poor visual acuity, as an RN and Certified Diabetes Educator
for a Home Health Care Service. I recently became aware of the
amazingly simple idea of changing the shape of insulin vials to
provide tactile cues to the patient of which type of insulin they
are drawing up. I strongly support this idea.

Thank you,
Lois Hollingsworth, RN, CDE
Nurse's House Call
Hooper Holmes, Inc.
Akron, OH

* * * * * *

May 7, 1995

Dear Dr. Kessler:
     I am writing to express my personal support for needed changes in
insulin packaging. I wholeheartedly embrace the National
Federation of the Blind's campaign to incorporate tactile cues in
insulin vial packaging. As an insulin treated diabetic with
sight, I know only too well the importance of proper insulin
administration and the possibly fatal effects of improper
administration. I urge you to take action on the recommendations
given you by the above association.

     I have also written to Eli Lilly and Company, as well as Norvo
Nordisk Pharmaceuticals.

Sincerely,
Kathleen Kimberling, RN, BA
Member of American Association of Diabetes Educators
Moorpark, CA

* * * * * *

May 8, 1995
Dear Dr. Kessler:
     I am an allied health professional who manages a hospital-based
diabetes management center. Over 1,000 inpatients and outpatients
with diabetes utilize our services annually. Many of these 1,000
individuals with diabetes suffer from impaired vision.

     I am extremely concerned that the FDA still has not intervened in
the dangerous practice of insulin manufacturers supplying all
U-100 insulins (R, N, & L) in identical vials.

     Please consider the fact that diabetes is the leading cause of
blindness in people ages 25-74. It makes no sense to me that the
FDA has not mandated tactile packaging of insulin.

     Dr. Kessler, there are simply too many blind or visually impaired
diabetics drawing their own insulin - several times daily - for
this potentially fatal discriminatory situation to go
unrectified. I implore you to lead the FDA to mandate that
insulin manufacturers package their products for tactile
recognition.

     I look forward to a response from you in this regard.

Sincerely,
Nancy White, RN
Program Director
Coliseum Diabetes Management Center
Macon, GA

* * * * * *

May 9, 1995

Dear Dr. Kessler:
     I am writing in support of the Diabetics Division of the National
Federation of the Blind's request for the insulin package change.
I believe that the incorporation of standardized, nonvisual cues
into insulin vial packaging is important and essential for the
protection of many diabetics.

     As an educator, I am aware of many diabetics who have taken the
wrong insulin because of a mix up with the vials. The majority of
these patients were not blind.

     Once again I wish to encourage the package/vial change for
insulin.

Sincerely,
Stacia R. Pickard, RD, LD, CDE
Diabetes Support Center
Jacksonville, FL

* * * * * *
May 9, 1995

Dr. Kessler:
     I am a pharmacist with specialized training in the care and
management of patients with diabetes mellitus. I would like to
express my concern regarding the packaging of insulin. Presently,
all insulin products (within a manufacturer's product line) are
packaged in identical vials. This makes the identification of the
different types of insulin extremely difficult for patients with
visual impairments. As you are aware, patients with diabetes are
frequently blind or visually impaired.

     I hope the FDA will consider a policy whereby insulins (e.g.,
Regular, NPH, Lente) are packaged in different shaped vials, have
colored coded labels, and use permanent tactile cues that enable
visually impaired persons to correctly identify the type of
insulin. I fully support the efforts of the National Federation
of the Blind in this endeavor.

Sincerely,
Stuart T. Haines, Pharm.D., CDE
Assistant Professor
University of Maryland
Baltimore, MD

* * * * * *

May 12, 1995

RE: Packaging of insulin needs to include permanent tactile cues

     I agree with those who are promoting the packaging of insulin in
containers that contain permanent tactile cues. This is important
not just for blind individuals with diabetes, but for all
individuals who are handling insulin containers. We who are
sighted also may make mistakes, and differently shaped containers
will help everyone.

Sincerely,
Judith Tomer, RD, CDE
University of Michigan Medical Center
Ann Arbor, MI  n

+++++++++++++++++++++++++++++++++++++++

     If you or a friend would like to remember the Diabetics
Division of the National Federation of the Blind in your will, you can 
do so by employing the following language:

     "I give, devise, and bequeath unto the Diabetics Division of
the National Federation of the Blind, 1800 Johnson Street, Baltimore,
Maryland 21230, a District of Columbia nonprofit corporation, the
sum of $______________" (or "______________ percent of my net estate"
or "the following stocks and bonds: _______________") to be used for
its worthy purposes on behalf of blind persons."
+++++++++++++++++++++++++++++++++++++++

To Dog Or Not To Dog

By Ed and Toni Eames

[Photo:  portrait, 2 people.  Caption:  Ed and Toni Eames, pictured
with their dogs and cats.]

     From the Editor: Ed and Toni Eames are active members of the
National Federation of the Blind (NFB). Toni is president and Ed
is treasurer of the NFB of California, Fresno Chapter.

Ed Eames says:

     Unlike my wife Toni who became acquainted with guide dogs while
in her twenties, my adventure with guide dogs began much later in
life. In fact, my relationship with Toni was based upon my
romance with guide dogs.

     When I was diagnosed at age 42 with retinitis pigmentosa in 1972,
I was informed that I would need a white cane or a guide dog in
the not too distant future. This stunning prediction caught me
totally off-guard because I was on my way to participate in my
weekly poker game at the Temple University Faculty Club. Unable
to comprehend the news, I played poker and had the biggest
winning night ever!

     The ophthalmologist advised me not to change jobs because it
would be easier getting around in a familiar environment while my
sight deteriorated. However, his recommendation was a little
late. I had previously decided to leave my position on the
faculty at Temple University in Philadelphia and had already
accepted a position as professor of anthropology at Baruch
College in New York City. I continued residing in Philadelphia
even though my travels between these two cities involved a
complicated commute. Still trying to use my limited residual
vision, twice I experienced terror and trauma when I fell off the
subway platform onto the tracks. Looking back, surviving those
two accidents seems miraculous.

     As the ophthalmologist had predicted, my sight deteriorated and I
learned to use a white cane. In the 1980-1981 academic year I
took a sabbatical, got a research grant and went to India to do
anthropological field work. Sidewalks in India's cities are rare
and pedestrians share the roadway with bicycles, bicycle-driven
rickshaws, bullock carts, cows, cars and buses. Under these
conditions, my white cane lost much of its effectiveness as a
mobility aid. I felt compelled to rely on sighted guides as my
safest and most effective mobility tools.

     I had never owned a pet and did not consider myself a dog lover.
However, in the course of rehabilitation I had met several guide
dog users and was impressed with their confidence and ability toget around.
When I returned home from India, the first thing I
did was apply for a guide dog. Although my ex-wife was even less
enthusiastic than I about dogs, at least, she recognized my need
for a safer and more effective mobility aid.

     I spent the month of August 1981 at the Seeing Eye in Morristown,
New Jersey, training with my black Labrador, Perrier. Thinking
only about having a more effective mobility aid, I had no inkling
the impact the dog would have on my life.

     Three days after completing the training, Perrier and I began our
commute from Philadelphia to New York. Following the same route I
had used for years, I was amazed at the ease with which Perrier
guided me on and off trains, subways and buses. He handled the
streets of New York as if born to the task. My colleagues at
Baruch welcomed Perrier, and students seemed more relaxed about
my blindness with a dog in the classroom. I'm not sure how much
anthropology Perrier learned by attending my classes because he
slept noisily through most of them. For that matter, I wonder the
same thing about most of my students but, at least, they had the
good manners not to snore!

     My increased feelings of independence and self-reliance became a
sore point with my ex-wife. Although she did not mind my need to
care for Perrier - feeding, providing water, daily outings for
relief and occasional visits to the vet, she did resent the
attention he drew when he accompanied us to restaurants,
theaters, religious services and the homes of friends. She saw no
need for Perrier's presence when she could assume the guiding
role. In contrast, my children and grandchildren readily
incorporated him as a member of the family. 

     Professors are always seeking new areas of interest for research
and publication and I was no different. As my relationship with
Perrier blossomed, I became intrigued with the guide dog/blind
person partnership. Questions began churning in my mind. Why do
some people opt for partnership with guide dogs? On what basis do
people select particular training programs? Does having a guide
dog help or hinder employment prospects? How do training programs
select canine and student applicants? What are the advantages and
disadvantages of working with guide dogs? Obviously, these
burning issues required immediate research and could only be
adequately addressed in a book. My research brought me
face-to-face with a variety of blindness-related issues which
pushed me toward the assumption of an advocacy role. I discovered
the National Federation of the Blind and became an activist. My
ex-wife, a very private person, became increasingly uncomfortable
with my outspoken advocacy role. For many of us who go blind in
middle age, life may seem to be a never-ending tragedy. However,
most of us get past that stage and, with proper training in the
techniques of blindness, resume active and productive lives. For
me, becoming blind was a turning point. It led to getting
Perrier, researching my book on guide dogs and, ultimately, to
meeting Toni. Initially, she was a consultant on the book, then
co-author, and eventually became my wife. At our wedding in June1987, Perrier
was ring bearer and Toni's guide, Ivy, was maid of
honor.

     It was fun living and traveling with two dogs. Although I had
never considered myself an animal person, I had no difficulty
becoming part of a family consisting of dogs and cats. After Toni
and I married, I took early retirement and we moved to Fresno,
California. Over the next few years we became itinerant educators
and writers.

     Unfortunately, Perrier had to be euthanized two years after our
move to California. My feeling that Perrier was magic and
irreplaceable is shared by many of those who have lost their
first partners in independence. The transition to a successor dog
is usually emotionally wrenching. When I began working with Kirby
at Guide Dogs of the Desert in Palm Springs, California, I
compared him unfavorably with Perrier. Perrier's guiding style
was confident, but Kirby's was cautious. However, Kirby was far
more outgoing and his exuberance and joy of life soon endeared
this lovable Golden Retriever to me and all who met him.

     Although Kirby's short working life was spent in Fresno, a small
and laid back city located in the agricultural belt of
California, he was equally at ease in our travels to New York,
San Francisco, Philadelphia and Boston. Like Ivy, he earned an
AKC Companion Dog Excellent title. However, his major claim to
fame occurred after the amputation of his left front leg as a
result of bone cancer. His rehabilitation and resumption of work
as my guide was an historic event. Everyone who saw his
un-Golden-like tail continuously waving over his back realized
this enthusiastic dog took pride in his work. His heroism and
devotion to duty was recognized by the California Veterinary
Medical Association. In September 1994, he was posthumously
inaugurated into the CVMA Animal Hall of Fame.

     My grief at the loss of Kirby exceeded the feelings I had when
Perrier was euthanized. At least Perrier had a full working life
of eight years, but Kirby was euthanized after only
four-and-a-half years of our partnership. At the end of July 1994
I went to Rochester, Michigan, to train with Jake, a 21-month-old
Golden Retriever. At the time of this writing, we've been home a
few months and I still call him Kirby about half the time. Jake,
trained at Leader Dogs for the Blind, is a sensitive and bright
dog. In contrast to Kirby's exuberance, Jake is quiet and mellow.
Although I still miss Kirby, Jake is nudging his way into my
heart and will become a beloved companion as well as a partner in
independence.

     At Leader, I joined 24 other students who were in training. Of
these 24 individuals, seven were diabetics. Four of the seven
were training with a guide dog for the first time and the other
three were retrainees. Special dietary provisions were made for
the seven diabetic students. They had an additional snack at
night, were given special meals and received snacks to take with
them during the morning and afternoon training sessions. At leasttwo trainers
were in residence at all times. They were familiar
with first aid techniques and were sensitive to the needs of
people with diabetes. During my third night in the dorm, a
student went into diabetic shock. Unable to administer to this
student's needs, the trainers on duty called 911 and an emergency
crew arrived within a short time. She was taken to the hospital
where she regained control of her blood sugar. The next morning
she returned to school. Like the other six diabetic members of
the class, she completed the course and is now home working with
her canine partner.

     In the last few years, Leader Dogs has developed a cooperative
relationship with a nearby kidney dialysis unit. Several students
on dialysis have completed the Leader program. Community
volunteers or trainers transport the students to and from the
unit. The time needed for treatment is worked into the training
schedule. Brad Scott, Director of Training, has observed that
only two or three students a year fall into this category. As
long as accommodations can be made for individuals on dialysis,
Leader will work with them.

Toni Eames says:

     Regardless of my mother's admonition to be cautious, I was the
kind of kid who had to pet every animal I could get my hands on.
With limited vision, my infatuation with furry things led to some
embarrassing moments. On several occasions, I reached out to
cuddle what I perceived to be an animal, only to discover a fur
collar on a coat or the head of a crawling child.

     My love affair with dogs began at age five when my family
acquired Ginger, our pet dog. He remained part of our family
until his death during my freshman year in college. Two years
later, during my senior year, I moved from the college dorm into
my own apartment. Before obtaining furniture, I rushed to the
nearest humane society and found a new canine companion. Loki, a
Shepherd-Terrier cross, was a spoiled brat until Charm, my first
guide dog, entered the family. Being teamed with a guide dog
stimulated my interest in becoming an outstanding dog handler.
With my newly-acquired skills, I transformed Loki into a
well-mannered pet.

     Even though I'd been a dog devotee for years, I waited until I
had graduated from college before seeking partnership with a
guide dog because I had picked up many negative attitudes toward
canine partners which permeated the blindness system. When I was
a youngster participating in recreational activities at the New
York Lighthouse, I encountered guide dog users, but none took the
time to discuss the benefits of working with dogs. I was
horrified when one of those adults told me that guide dogs could
never be petted or played with, not even by their blind partners.
This and other myths were never dispelled by teachers, camp and
rehab counselors, and others including my mobility instructor.
Like most blind kids growing up in the '50s, my training with a
white cane did not begin until I was 16. Although theprofessionals said I was
a competent cane user, I never felt
comfortable with it. I felt insecure, vulnerable and very much
alone. Perpetuating the myths, my mobility instructor failed to
discuss the reality of working with a guide dog. As an
undergraduate college freshman in 1961, I discovered that school
policy prohibited guide dogs from living with blind students in
the dormitory. As I look back, I cannot believe how
unsophisticated I was about guide dogs.

     When I was in my early twenties, I met a woman my age who was
playing with her dog in the basement of the Lighthouse. Then, I
realized that guide dogs could be both friends and pets. She and
I began spending time together and became good friends. Through
her, I met several other guide dog users. I was continuously
amazed by the working abilities of their dogs. They stopped at
curbs, located subway stairs, avoided obstacles, negotiated
crowds, guided their partners to empty tables inside busy,
popular restaurants.

     One day, another friend and I arranged to meet at the Port
Authority bus terminal, one of the busiest, noisiest, and most
complicated transportation hubs in the city. I was astonished by
his dog's skill in locating the ticket booth, the stairs to the
upper level and the bus departure gate. He explained these
abilities weren't feats of a miracle dog, but responses of a
well-trained guide dog who had mastered a familiar route. After
that trip, I was ready to trade my cane for a furry mobility
device.

     In March 1967 I spent a month at Guiding Eyes for the Blind in
Yorktown Heights, New York, training with a Golden Retriever
named Charm. Developing my partnership with this Golden girl was
one of the most significant turning points in my life. That
September I began graduate school at Hunter College in the heart
of New York City. I could not believe how tension-free traveling
had become. With Charm as my guide, we used subways and buses,
walked along unfamiliar streets, negotiated crowded thoroughfares
and found our way to lecture halls, classrooms and the library. I
was thrilled when Charm and I breezed through the Port Authority
bus terminal with the same ease and proficiency demonstrated
several months earlier by my friend and his dog.

     When I received my Master's degree, Charm was an integral partner
in my search for a job. Like many blind people, I ran into
employment discrimination. With my furry friend as emotional
support, job interviews were less scary. On my way home from
these ordeals, I discussed my impressions with Charm before
phoning my human friend to talk about my latest interview.

     Charm shared the joy of my first job as rehabilitation counselor
at a state psychiatric hospital. In fact, she was one of the
reasons I was offered the job. My supervisor recognized the
therapeutic impact of a dog on the lives of mentally ill patients
long before there was documented evidence of this fact.
     Charm's impact on my life was revolutionary. B.C. (Before Charm),
I lacked confidence and had difficulty advocating on my own
behalf. A.D. (After Dog), I became self-assured and spoke out for
my rights. Charm became my alter ego. I took inordinate joy in
her accomplishments and was acutely embarrassed by her mistakes.
I had no intention of allowing school authorities, restaurant
owners, theater managers and taxi drivers to deny access to my
well-behaved, well-trained canine companion. Instead of reducing
me to tears, phrases such as "Get that dog out of here" and "No
dogs allowed" made me angry enough to fight such rampant
discrimination. Backed by state white cane/guide dog laws and the
federal Americans with Disabilities Act, my guides and I have
been able to go to nearly all places open to the public.

     Charm's death in 1977 left my life in turmoil. I had never
experienced such a devastating loss. Charm's successor, a Golden
Retriever named Flicka, was so different in temperament that it
took months to learn to love her. Charm was calm and gentle, but
Flicka was rough and energetic. They both had the impeccable
manners of a professional guide in harness, but when not on duty,
Flicka was a dynamo. For the seven years of our working
partnership, Flicka and I lived and worked in New York.

     In contrast to my first two guides, Ivy, my third Golden, split
her working career between New York and California. I met Ed and
after we were married, we decided to move. Just before her fifth
birthday, Ivy gave up the hectic life of a New York City commuter
for the routine suburban life in a small California city.
Memories of subway travel, incessantly honking car horns and
congested sidewalks are revived when we visit New York. Our
relatively sedentary daily routines have been punctuated by
exciting and busy trips to Israel, Bermuda, Canada, Mexico and
more than 20 states.

     All three of my Golden girls have successfully competed in
American Kennel Club obedience trials. In fact, Ivy became the
first guide dog to obtain the intermediate level title of
"Companion Dog Excellent." They have all been good will
ambassadors for the guide dog movement with their impeccable
public behavior and outstanding performance as guides. People are
attracted to dogs and feel more comfortable speaking with those
of us partnered with guide dogs. I enjoy these unsolicited
contacts and have met and have become friends with many
interesting people through the canine connection.

     Ivy has earned her place in California history by helping to
change the law. Now, privately trained guide dogs have the same
access rights as those trained at guide dog schools. Ivy received
her greatest award in 1993 when she was bestowed with the coveted
title of the "Delta Society Guide Dog of the Year." Along with Ed
and Kirby, his guide dog, she and I were flown to New York where
we appeared on local and national news shows.

     Having passed her twelfth birthday, Ivy's step is slower and more
labored; she is on medication to alleviate the pain of arthritis.She has lost
sight in her right eye and is not a good candidate
for cataract surgery. Our time together as working partners is
limited. She will soon be retired and will spend her days
lounging at home while her successor steps proudly into her paw
prints.

Ed and Toni Eames reflect:

     We are committed to using guide dogs as our preferred mobility
aid. Our dogs are such vital elements in our lives that the mere
thought of being without them is distressing. Regardless of the
cause of blindness, we believe guide dogs would be of great
benefit to many of our blind peers.

     Because diabetes is the single, most reported cause of blindness
in the United States, all guide dog schools welcome applications
from diabetics. Dietary and other accommodations facilitate the
completion of training courses by diabetics.

     Currently, 14 programs in the United States train guide dogs and
their blind or visually impaired partners. All receive financial
support from the public through donations, grants and estate
bequests. The dogs, equipment and training are furnished free, or
at minimal cost, to applicants selected for training.

     Full details about the programs and the the impact of guide dogs
on the lives of their partners are contained in the revision of
our book, A Guide to Guide Dog Schools. The book is available in
standard print or computer disk at a cost of $10 including
handling and shipping. Make check(s) payable to Disabled on the
Go (DOG) and send the order to Ed Eames, 3376 North Wishon,
Fresno, CA 93704-4832. If ordering a computer disk, please
specify size. The cassette and Braille versions are currently in
production by the National Library Service and will be available
in the near future through your local NLS branch. To contact us,
write to Toni and Ed Eames, 3376 North Wishon, Fresno, CA
93704-4832, or call (209) 224-0544.

+++++++++++++++++++++++++++++++++++++++

Nutritious Eating Made Easy

[Figure:  food pyramid from top to bottom:  Fats, Oils & Sweets (use 
sparingly) on top; Milk, Yogurt, & Cheese Group (2-3 servings); Meat, 
Poultry, Fish, Dry Beans, Eggs & Nuts Group (2-3 servings); Fruit 
Group (2-4 servings); Vegetable Group (3-5 servings); and Bread, 
Cereal, Rice & Pasta Group (6-11 servings).]

     Eating a balanced and nutritious diet can seem impossible at
times. And while many people have become more conscious of the
amount of fat they eat in their diet, they sometimes forget that
low-fat doesn't necessarily mean low-calorie. "These people have
fallen in that fat trap," says Tina Watson, a registered
dietitian at University Hospital and Clinics. "The secret is to
eat a balanced diet using the food pyramid as your guide."
     Watson offers these simple tips to limit total fat, saturated fat
and cholesterol in your diet while increasing complex
carbohydrates and fibers.

The Food Guide Pyramid

     Cereals, grains, fruits and vegetables should be the focal point
of your meals and snacks. Here are some ways to add them to your
diet and create healthy eating habits.

     1.  Put fruit that doesn't need refrigeration where you can see
it. Make a habit of grabbing a few pieces on your way out the
door.

     2.  Keep carrots or other raw vegetables in your briefcase.

     3.  Keep dried fruits in your desk for snacks.

     4.  Give a healthy gift for the holidays and other special
occasions by filling a bright basket with fruits and/or
vegetables. Welcome spring with a basket of strawberries, papaya,
pineapple, green peas and asparagus and accent with daffodils,
bows and limes or lemons.

     5.  Nibble on spears of fruit such as strawberries, grapes and
pineapple chunks on small skewers or cocktail sticks. Serve with
low-fat or nonfat vanilla or lemon yogurt.

     6.  Top melon wedges with a small scoop of fruit sorbet or
sherbet.

     7.  Microwave small winter squash halves stuffed with apples,
raisins and spices. Serve with fish or poultry.

     8.  Serve lots of shredded carrots, cabbage, lettuce and peppers
with traditional Mexican tacos, burritos and enchiladas. Have
plenty of fresh salsa on hand and serve with low-fat tortilla
chips.

     9.  Drink fruit or vegetable juice instead of grabbing a can of
soda. Try individual servings of 100 percent juice such as V-8,
tomato, orange, pineapple and grapefruit juice.

     10.  Try adding thin slices of banana to pancake batter. Top with
fresh or frozen strawberries that have been microwaved until hot.
Garnish with light whipped topping.

     11.  Spread reduced-fat or nonfat cream cheese on reduced-fat or
nonfat crackers. Garnish with sun-dried tomatoes, cucumber slices
and pimento or smoked salmon and dill.

     12.  Bake apple, pear and banana pieces along with raisins, dried
apricots and powdered cinnamon for a wonderful fruit dish.
     13.  Marinate red and yellow pepper pieces, onion slices, baby
carrots and whole mushrooms in reduced-sodium soy sauce, ginger
and one to two teaspoons of olive oil. Gently cook and serve over
brown rice.

     14.  Saute onions, mushrooms and red pepper in a small amount of
diet margarine. Add this mixture to prepared wild rice, barley or
couscous.

Recipe Makeovers

     Baking cakes, pies, cookies and muffins for both special
occasions and everyday eating can weaken the strongest resolve to
eat healthfully. But you can bake your cake and eat it, too, by
following some of these suggestions.

     15.  Replace oil, butter or margarine with an equal amount of
applesauce. This works well with box cake mixes, cakes made from
scratch, brownies and zucchini bread. For each half-cup of oil
replaced with applesauce, 907 fat calories are saved.

     16.  Replace oil with half applesauce and half milk (nonfat or
skim milk is best). This alternative is useful if the oil in your
recipe is the only liquid.

     17.  Replace regular margarine, shortening or butter with diet
margarine. This will reduce fat calories by half, a savings of
400 calories per half-cup.

     18.  Replace shortening, butter or margarine with liquid oil.
Although this will not reduce calories, it will reduce
cholesterol-raising saturated fat.

     19.  Replace regular cheese with low-fat cheese. To qualify as
low in fat, cheese should have fewer than five grams of fat per
ounce.

     20.  Replace heavy cream with evaporated skim milk.

     21.  Replace sour cream with plain yogurt or fat-free sour cream.

     22.  Replace a traditional pie crust with a graham cracker crust.

     23.  Reduce sugar by 25 percent. For example, instead of one cup
of sugar, use three-quarters of a cup. This change does not
significantly alter the taste of most recipes, especially if you
increase the amount of sweet spices such as cinnamon, nutmeg and
vanilla.

     24.  Reduce nuts by half.

     25.  Reduce chocolate chips by 25 to 50 percent. Chocolate chips
should be called chocolate fat bits: a cup of semisweet chocolate
chips has about 912 calories, and 49 percent of those calories
are from fat.
     26.  Use two egg whites in place of one whole egg.

     27.  Replace at least half of the white flour with whole-wheat
flour. This will increase the amount of fiber and nutrients.

Healthy Snacking

     Eating between meals is a way of life these days as people rush
from activity to activity. The challenge is to find healthful
snacks that fit into a busy lifestyle. Try these tips.

     28.  Prepare a pot of soup or meatless chili and invite everyone
to help themselves.

     29.  Place covered bowls of low-fat snacks such as dried fruits
or pretzels around eating areas for easy access.

     30.  Bake a batch of moist, low-fat muffins to be enjoyed
throughout the day. When you use whole grains and fruits in the
recipe, you pack in needed vitamins and minerals as well.

     31.  Keep on hand quick pizza fixings such as English muffins,
tomato sauce and skim-milk cheese.

     32.  When traveling, take along mini-bagels spread with low-sugar
fruit spread or peanut butter and jelly sandwich halves. You also
can bring along frozen turkey or lean roast beef sandwiches and
eat them en route after they defrost.

     (NOTE: Reprinted from Caring magazine, a University of
Missouri-Columbia Hospital and Clinics publication.)

+++++++++++++++++++++++++++++++++++++++

Recipe Corner

Fruit-Milk Dessert
(a pudding and pie filling)

from Sandra Nebergall
of Chattanooga, TN

[Photo:  portrait.  Caption:  Sandra Nebergall]

Sandra and her husband Peter, enjoy this tasty sweet often.

1 package sugar-free Jell-O
1 8 oz. fortifier yogurt
1 16 oz. tin unsweetened fruit or fruit cocktail (optional)

     Follow first stage of directions for Jell-O preparation (mix
package contents with one cup boiling water), then refrigerate
until cool ("preset stage"; approx. 30 minutes).
     Next, place yogurt in deep mixing bowl, blend Jell-O with yogurt,
mixing thoroughly. If you will be adding fruit, do it now. Allow
mixture to set, in refrigerator (approx. 1.5 hours).

     If you will be using tinned fruit, first drain off and discard
the juices. Many fresh fruits would work as well, but DO NOT use
fresh pineapple - it will cause the Jell-O to not set. Tinned
pineapple is OK. Choose compatible fruit flavors, i.e., raspberry
Jell-O with raspberry yogurt, orange Jell-O with lemon yogurt,
cherry Jell-O with vanilla yogurt.

     Yield: 4 servings; Calories: 80; Protein: 2g; Fat: 0g;
Carbohydrates: 18g; Sodium: 40mg; Diabetic Exchanges: 1 starch.


Spicy Shrimp

     NOTE: To receive one free set of "Around the World With Butter
Buds" recipe cards, please contact: Butter Buds, P.O. Box 140,
Dept. ATW, Great Neck, NY 11021; telephone: 1-800-231-1123.

1 packet Butter Buds Mix, liquefied
2 tablespoons minced fresh parsley
1 1/2 teaspoons cajun seasoning
1 tablespoon olive oil
1 large garlic clove, minced
1 pound jumbo shrimp, peeled and deveined (about 24 shrimp)

     Preheat oven to 400 F. In a medium bowl, combine all ingredients
except shrimp. Add shrimp and toss to coat. Cover and refrigerate
one hour. Transfer shrimp and the marinade to a baking dish large
enough to hold the shrimp in a single layer. Bake 10 minutes, or
until cooked through. Do not overcook. Serve hot or at room
temperature with toothpicks.

     Yield: 12 servings; Per serving (2 shrimp): 45 calories, 7g
protein, 1g carbohydrate, 1g fat, 1g saturated fat, 65 mg
cholesterol, 185 mg sodium; Diabetic exchanges: 1 lean meat.

Variation:  Shrimp-Vegetable Medley

     To serve as a main dish, after refrigeration stir four cups
assorted raw vegetables (such as small whole mushrooms, bell
peppers and zucchinni chunks) into shrimp. Bake as directed.

     Yield: 6 servings; Per serving (4 shrimp with vegetables): 170
calories, 20g protein, 11g carbohydrate, 5g fat, 1g saturated
fat, 195mg cholesterol, 553mg sodium; Diabetic exchanges: 2
vegetable, 2 lean meat.

     Thanks to the Cosmopolitan International Diabetes Center,
Columbia, MO, for the following recipes.


Zero Salad Dressing
8 ounce can tomato sauce
2 tbsp. vinegar
1 tbsp. Worcestershire sauce
1 tsp. sugar (or 1/2 packet sugar substitute)
1 tsp. dried onion
1 tsp. horseradish
1/2 tsp. salt (optional)
2 drops Tabasco sauce

     Combine all ingredients and mix well.

     Yield: 20 (1 tbsp.) servings; Calories: 5; Diabetic Exchanges:
free.


L.E.A.N. for Life Soup

3 10-ounce cans beef bouillon
3 10-ounce cans water
2 cups tomato or V-8 juice
1/4 cup chopped onion
1 cup green beans, canned
1 cup shredded cabbage (optional)
1/2 cup sliced canned mushrooms, drained
1/2 cup green pepper, chopped
2 tbsp. lemon juice
1 cup chopped celery
Pepper to taste

     Combine all ingredients above. Simmer until vegetables and soup
is of desired consistency. If desired, add more water.

     Yield: 12 servings; Per 1 cup serving: Calories 20, Fat 0mg,
Sodium 520mg, Cholesterol 0mg; Diabetic Exchanges: free.

     Tip: for a heartier soup, add one can kidney beans and a package
of frozen mixed vegetables. This would provide: 75 calories,
703mg sodium, 0g fat, 0mg cholesterol and 1 starch/bread
exchange.

+++++++++++++++++++++++++++++++++++++++

What You Always Wanted To Know But Didn't Know Where To Ask

(Resource list)

     Inclusion of materials in this publication is for information
only and does not imply endorsement by the Diabetics Division of
the NFB.

Diabetes Education Video

     The Best of Living with Diabetes Television Video Series is a new
video explaining the basics about diabetes. Produced by CNBC andLifetime
television medical correspondent Pat Gallagher, this
73-minute video is a compilation of 100 episodes of the
newsmagazine television show, "Living With Diabetes."

     This video explains type I and type II diabetes, weight loss,
exercise, cholesterol, high blood pressure, neuropathy, foot
care, eye disease, kidney disease, and proper disposal of
syringes. It can be ordered by calling 1-800-433-2469 for Visa,
MasterCard, Discover orders or send a check made payable to
"Medicool" for $12.95 plus $3 shipping and handling to: Medicool,
Inc., 23762 Madison Street, Torrance, CA 90505.


Rover Seeing Aid

     The Rover Seeing Aid is a new device that may be helpful to the
blind. This lightweight sensor mounts on a person's wrist and,
with a few waves of the hand, the brain can assemble a complete
picture of its surroundings through tactile feedback.

     The Rover Seeing Aid, released by the Possibilities Company in
Columbia, Missouri, is priced under $100. It comes with a
no-risk, 30-day home trial, and a one-year warranty. A 20%
discount will be given if ordered before Sept. 30, 1995. For more
information call: 1-800-566-3333.


Finger Skin Cream

     Diabetics who suffer from sore, cracked or calloused fingers
because of frequent use of blood lancets for glucose monitoring
may find new relief.

     Formulated For Fingers, a new skin cream by Can-Am Care
Corporation, features the Australian Tea Tree Oil as a
moisturizing and soothing ingredient. 

     This cream, packaged in four-ounce squeezable bottles, is priced
at $9.99. For more information contact: Can-Am Corporation,
Cimetra Industrial Park, Box 98, Chazy, NY 12921-0098; telephone:
1-800-461-7448.


The Insulcap

     Draw insulin safely and with less waste using the Insulcap. It
fits on any insulin bottle and allows the syringe to be inserted
until it stops automatically in the right position. Users would
need some sight to correctly insert the needle in the device
slot. You don't have to hold the bottle in place or fear the
needle bending. The caps are color coded in orange or blue to
distinguish different types of insulin. The orange caps also have
guides on them as tactile cues. Not only is recovering hard to
reach insulin easier, but Insulcaps are also reusable.
     Contact your pharmacist or medical supplier to obtain Insulcaps
or for more information write or call: Diabetic Insulcap, Inc.,
P.O. Box 34347, Las Vegas, NV 89133-4347; telephone: (702)
363-0426; fax: (702) 363-0427.


Book for Diabetics Now on Cassette 

     Living With Diabetic Complications: A Survival Guide for Patients
by a Patient by Judy Curtis is now available on audiocassette
through the National Library Service for the Blind and Physically
Handicapped. 

     The print version of the 294-page book was reviewed in the Voice
(Vol. 8, No. 2) by Ed Bryant, editor, who had this to say about
it: "This informative publication ... lets diabetics know they
are not alone ... It not only explains what can happen and why,
but also provides treatment options and other important
resources. It further elaborates on the emotional and social
aspects of living with complications ... It is loaded with
information pertinent for all type I and type II diabetics, as
well as anyone interested in diabetes." 

     Ask for it by catalog number RC36956 when ordering an
audiocassette. For further information, contact the National
Library Service for the Blind and Physically Handicapped at
telephone: 1-800-424-8567. To order it in print, send $15.95
(check or money order) to: Outreach Enterprises, 2309 SW 1st
Ave., Suite 1842, Portland, OR 97201.


Foot Cleanser and Conditioner

     Clean and condition your feet without the use of water. That is
what the new product Apply & Dry Foot Cleanser and Conditioner by
IGI, Inc. is offering. Ingredients in the liquid gel are
activated when massaged into the skin. The resulting foam will
trap the dirt and lift it away from the skin, allowing it to be
toweled off, leaving the skin clean without drying it out. Apply
& Dry is available in 12-oz. bottles or single-use packets. It is
only available through drug stores. For further information
contact Jack Sullivan, director of sales and marketing at
1-800-531-9092.


Diabetic Meal Planning Made Easy!

     Thirty different breakfasts, lunches and dinners all for diabetic
needs - and it's not a cookbook.

     Diabetic Meal Planning Made Easy! is a complete 30-day meal plan
based on the American Diabetes Association's food exchange
system. It offers a variety of food and snack ideas.

     Author Marilyn White developed the meal-planning guide to helpdiabetics
realize that they can eat well on their prescribed
diets and avoid serious reaction problems.

     Diabetic Meal Planning Made Easy! is available from L & M
Enterprises, Box 4352 D, Shreveport, LA 71134 for $9.95 postage
paid.


Diabetes Literature

     The following came from the Spring/Summer 1995 catalog called the
Diabetic Reader. To order the tapes and/or books contact: Prana
Publications, 5623 Matilija Ave., Van Nuys, CA 91401; telephone:
1-800-735-7726; fax: (818) 786-7359. Checks, money orders or
MasterCard, Visa or Discover cards accepted. A $19 minimum with
credit card orders.

     1. New Nutritional Guidelines for a New Day in Diabetes Care:
Most Commonly Asked Diet Questions (#A12) by Betty Brackenridge,
MS, RD, CDE, is a 60-minute audiocassette.

     Confused by the big changes in diet for diabetics announced in
the 1994 ADA Nutritional Guidelines? (Who isn't?!) Betty
Brackenridge, former president of The American Association of
Diabetes Educators answers such questions as: "What do you mean
there's no more 'diabetic diet?'" "What do you mean I can eat
sugar?" "What do you mean I don't need to be my 'ideal' weight?'"
And she continues with a segment on other most commonly asked
diet questions. The book costs $11.95 plus $3.25 handling.

     2. The Diabetic's Book: All Your Questions Answered (#B08) by
June Biermann and Barbara Toohey is a 233-page paperback book
that gives information to people who are diagnosed with diabetes.
The book also has a supplement on weight loss. It costs $12.95
plus handling.

     3. Convenience Food Facts (#B52) by Arlene Monk, RD, is a
456-page paperback reference book on over 1,500 popular brand
name products plus diabetically oriented ones. The book also
gives facts about calories, carbohydrates, fat, cholesterol and
exchanges. It costs $10.95 plus handling.


Diabetes Curriculum Book

     The American Association of Diabetes Educators is offering a
reference text on state-of-the-art diabetes education. A Core
Curriculum for Diabetes Education, Second Edition, written by
experts in the field, provides comprehensive knowledge about
diabetes care. It can be an important source of information for
rehabilitation teachers who do not have easy access to diabetes
educators in their areas or who work with many diabetics, or for
anyone who is preparing for the Certified Diabetes Educator
examination. Cost for members is $60 and for nonmembers is $85.
To order contact: AADE, 444 North Michigan Ave., Suite 1240,Chicago, IL
60611-3901; telephone: (312) 644-2233.

+++++++++++++++++++++++++++++++++++++++
     
Food For Thought

     We invite blurbs and tidbit articles for inclusion in this
column. Materials received may be edited and used as space
permits. Products and services included in this column are for
information only and do not imply endorsement by the Diabetics
Division of the NFB.

Drug Slows Kidney Damage

     For many type I insulin-dependent diabetics, good control of
glucose levels and blood pressure can help to keep kidneys
healthy, though it cannot prevent kidney damage. No drug can
prevent this from occurring. However, in a study published by the
New England Journal of Medicine, a prescription drug named
Capoten (captotril) has been proven to slow the progression of
diabetic nephropathy. 

     A group of people with type I insulin-dependent diabetes and
signs of kidney disease such as high levels of protein in their
urine and damage to the small blood vessels in their eyes, were
given the drug for an average of three years. Results showed that
kidney damage progressed more slowly for some patients who
received Capoten.

     Only a doctor can prescribe the drug because it has side effects
such as swelling of the face, rash, cough and stomach upset.
Also, it should not be taken by pregnant women. For more
information on Capoten, contact your doctor, pharmacist or
diabetes educator or call: 1-800-993-8993.


Windows From the Keyboard

     We have been asked to announce: Windows from the Keyboard is a
Braille guide to show how to use your keyboard instead of a
mouse. The book includes Quick-Reference Keystroke Command Charts
for Windows 3.1 and Word For Windows, Ami Pro for Windows,
WordPerfect for Windows, Quartro Pro for Windows, Excel for
Windows, and Lotus 1-2-3 for Windows.

     Four volumes in Braille cost $16.95. Order from National Braille
Press, 88 St. Stephen Street, Boston, MA 02115; telephone: (617)
266-6160.


Screen Magnification Software

     We have been asked to announce: The computer company Ai Squared
has announced the release of the new ZoomText 5.0 product line.
The new product includes ZoomText for Windows 5.0, ZoomText forDOS 4.5, and
ZoomText Plus 5.0 (for Windows and DOS). Designed
specifically for the visually impaired, ZoomText magnifies the
display of all software, including word processors, spreadsheets,
databases, and online services.

     Using ZoomText 5.0, the screen can be magnified in power ranging
from 2x to 16x. The display can be moved in and moved out at the
touch of a button. ZoomText for Windows and ZoomText for DOS
retail for $395. ZoomText Plus retails for $595. For information
contact: Ai Squared, P.O. Box 669, Manchester Center, VT
05255-0669; telephone: (802) 362-3612; fax: (802) 362-1670.


The following is from Kay McCoy, a nurse in Drake, CO.

     "The art of medicine consists of amusing the patient while nature
cures the disease."

- Voltaire

     "The art of nursing consists of caring for and about a person
until and after health has been restored or suffering ended."

- Kay McCoy


Diabetic Health Insurance

     We have been asked to announce: Lifestyles Marketing Group, Inc.
offers a health insurance product that can be purchased by
diabetics. Coverage can be adjusted to fit each individual's
budget and needs. The policies even include coverage for diabetes
after a six-month waiting period. Additionally, Lifestyles offers
a Heart Attack and Heart Surgery Indemnity policy which entitles
the owner of the policy to collect up to a $50,000 lump sum
payment. Diabetics can qualify for this coverage even if they
have high blood pressure provided that they have not previously
been diagnosed with a heart disease, had a heart attack or heart
surgery.

     For information about these and other products please call
Michael Kronick or Jamie Woolard at 1-800-899-0606.


New Lancet 

     We have been asked to announce: The Cleanlet 25 is a new lancet
designed to minimize discomfort from finger punctures, such as
callusing and bruising. It utilizes a small 25 gauge needle,
rather than the 21 or 23 gauge sizes most other lancets have.
Note, a 21 gauge lancet occupies approximately 21/2 times the
volume of a 25 gauge needle. The Cleanlet also has a cap which
can be snapped over the needle after use to minimize accidental
sticks.
     Special offer: Consumers may receive 25 free Cleanlet 25 lancets
when you call and give the name and order number from the box of
lancets you are currently using. Ask for the samples department.
For information contact: Gainor Medical, P.O. Box 353, McDonough,
GA 30253; telephone: 1-800-825-8282.


Large Print Dictionary Needed

     We have been asked to announce: Vincent P. Fisher, who is legally
blind, is in need of a large print dictionary to aid him in his
reading. He wrote to the Voice asking for help because he is in a
corrections unit and without income. To donate a dictionary or
make suggestions please contact him at: HSU/#194532, P.O. Box 351
WCI, Waupun, WI 53963.


Herbal Healing With Horse Chestnuts

     (To Voice readers: The following tidbit has not been clinically
proven to work, but you might find the information interesting.)

     Eight years ago, a woman lost her vision because of diabetic
retinopathy. She consulted nine specialists and even underwent
laser therapy in futile attempts to restore vision. Then, on a
trip to Europe with her husband, a specialist suggested that they
collect the hulls from the nuts of a horse chestnut tree that had
seven fingered leaves. They were to use the hulls to prepare a
tea. The specialist said that after about two months of drinking
the tea, the blood vessels should quit hemorrhaging and therefore
make surgery possible. The advice rang true and the woman's
vision was restored in an operation after she began drinking the
tea. She was able to read newsprint and drive, if she had wanted
to.

     Apparently, the tea stopped the bleeding from diabetic
retinopathy. A horse chestnut tree is different from a chestnut
tree. It has seven leaflets, but sometimes there are only five.
The specialist stressed that only the seven fingered leaves are
to be used and that the tea must be made with the hulls from the
horse chestnut tree. Its scientific name is Aesculus and the
species is called Hippocastanum. The tree grows predominantly in
the north and northeast, but has been found as far south as mid
Arkansas, the Carolinas, Virginia, and even in the mountainous
areas of California.


Humor

     The following was received from Betty Walker, a federationist
from Missouri:


     Spongecake: Dessert made from ingredients borrowed from
neighbors.

     Keep your words soft and sweet, you never know when you'll have
to eat them.


Insulin Shot Reminder

     We have been asked to announce: If you forget whether or not you
have taken your insulin shot, there is a new product called the
"Insulin Shot Forget Me Not" system to help you remember. This
wallet-shaped, portable system consists of a cloth holder divided
into seven sections for each day of the week. There are four
pockets for each section. At the beginning of the week, load one
to four alcohol swabs in the pockets coinciding with the number
of shots taken each day and you're set for the week. 

     Cloth holder colors are available in teal green, royal blue, plum
pink and red orange. The cost of the "Insulin Shot Forget Me Not"
is $19 plus $1 shipping. Please allow four to six weeks for
delivery. Order from: Olin Fimreite, 1840 Sheila Blvd.,
Whitehall, WI 54773; telephone: (715) 538-4045.


Large Type Textbooks

     We have been asked to announce: The American Printing House for
the Blind (APH) is offering over 500 new textbook titles in large
type in their Early Start Program. Book subjects include
economics, environmental science, health, literature, math,
music, psychology and many more. Pricing is 25 cents per page,
including binding and all titles are available for purchase with
Federal Quota Funds.

     APH titles are also in the on-line database CARL ET AL that lists
materials accessible to visually-impaired people. Listings
include Braille books, large type books, music scores, sound
recordings, software programs and tactile graphics from over 200
agencies across North America. CARL ET AL costs $7.50 per month,
plus $0.25 per minute after the first hour of connect time.
Customers can search for books, communicate with agencies through
electronic mail and order from APH on CARL ET AL. To obtain a
catalog, subscribe to CARL ET AL, or for more information
contact: Resource Services, American Printing House for the
Blind, P.O. Box 6085, Louisville, KY 40206-0085; telephone:
1-800-223-1839.


Protein Causes Blindness 

     An important discovery that may eventually make the difference
between sight and blindness for many thousands of people was
announced by a research team in Boston.

     Based on pioneering experiments in animals, the researchers
haveidentified a protein that stimulates the abnormal growth of tiny
blood vessels in the eye.

     The leakage of blood from the new capillaries gradually destroys
the retina, the eye's light-sensing organ, and causes the form of
blindness called diabetic retinopathy. Striking 25,000 to 50,000
Americans annually, it is the most common form of blindness in
young adults, most of them with insulin-dependent diabetes.
Similar abnormal blood vessel growth is also seen in other eye
disorders such as age-related macular degeneration and
neovascular glaucoma, and the research might eventually apply to
them, also.

     Now, the new research shows for the first time that the levels of
a protein, a hormone-like growth factor called vascular
endothelial growth factor, or VEGF, correlate closely with the
extent of damage done to the eye in monkeys, suggesting it is
responsible for the abnormal growth of new blood vessels.

     The team also suspects that such abnormal growth can be blocked,
and that the retina might be saved. Drugs that may fill that role
are already being studied.

     The discovery was reported by ophthalmologists Joan Miller,
Anthony Adamis, and 10 co-workers at the Massachusetts Eye and
Ear Infirmary, Children's Hospital and Beth Israel Hospital, all
in Boston. Their work is based on more than 30 years of research
on blood vessel growth conducted by Dr. Judah Folkman, at
Children's Hospital.

     A full report on the new research is to be published in the
American Journal of Pathology. Other reports, highlighting
results from human studies that are now underway, will be
published soon, Adamis said.

     In fact, preliminary results of studies of the amounts of the
growth factor in the eyes of diabetics compared with
non-diabetics "indicate that VEGF is significantly elevated in
patients" with diabetic retinopathy, the team reported. If
confirmed, treatments aimed at blocking growth factor production,
or its action, in the eye could be useful.
"Studies with neutralizing antibodies suggest that such an
approach is feasible," they wrote.

     According to Dr. Martin Wand, an ophthalmologist in private
practice in Hartford, Conn., who has followed the experiments
closely, they are "really phenomenal work." If the results hold
up, he added, "then for the first time they have something they
can block" to prevent eye damage. "You can see the pieces of the
puzzle coming together."

     (Note: This article appeared in the Duluth News-Tribune September
7, 1994, Duluth, MN.)

Helen Keller Speaks Through Miss America

     We have been asked to announce: Helen Keller and Miss America
have teamed up this year to help deaf-blind youths and adults. 

     Heather Whitestone, the first woman with a disability to be
crowned Miss America 1995, leads the Helen Keller National
Center's (HKNC) 1995 Deaf-Blind Awareness Campaign. She wants to
inspire deaf-blind people with her message of "face your
obstacles, work hard and build a support team."

     The Awareness Campaign begins in June, the month of Keller's
birthdate, and continues throughout the year. Citizens, agencies
and organizations are encouraged to plan state and local
activities, especially during the week of June 25 to July 1. 

     The HKNC is a nonprofit program providing comprehensive
rehabilitation and personal adjustment training, job preparation
and placement for all Americans who are deaf-blind. For more
information contact: Helen Keller National Center, 111 Middle
Neck Road, Sands Point, NY 11050; telephone: 1-800-255-0411 ext.
275.


Braille/Print Greeting Cards

     We have been asked to announce: Tessa Creations is offering
Braille/ print greeting cards for $1.00 per card with envelope.
They do custom printing and have a wide variety of topics to
select from. For a limited time, the cards are offered on a buy
one get one free basis. For more details contact: TESSA
Creations, 14139 Western Avenue, Suite 211, Blue Island, IL
60406; telephone: (708) 396-1937.


Push Instead of Pull

     Sometimes when a person has dexterity problems, it is difficult
to remove the strip holder from the One Touch meter for cleaning.
In the Spring 1995 issue of the The Adaptive Monitor, a
newsletter published by the Visually Impaired Persons Specialty
Practice Group, American Association of Diabetes Educators,
Marilyn Teasley, RN, CDE, of Cleveland advises that, instead of
pulling, pushing the holder may be more effective. The meter
should be turned so the window end is facing the user, with the
thumbs placed on the small bumps in the corners of the strip
holder. The user can then press and push the strip holder out.


Sense-Sations

     This appeared in the New Hampshire Federationist, Spring 1995
issue published by the National Federation of the Blind of New
Hampshire. 
     Sense-Sations offers a selection of magnifiers and Braille
watches. They also have magazine listings from Recorded
Periodicals.

     Write to them at: 919 Walnut St., Philadelphia, PA 19107.


Diabetes, Complications, Options

     The Diabetics Division of the National Federation of the Blind
has a pamphlet titled "Diabetes, Complications, Options," which
explains our outreach programs. Full of essential information, it
reaches out to anyone concerned with diabetes and its
ramifications.

     Unlimited free copies are available to all interested parties.
The pamphlet is great for libraries, pharmacies, physicians'
offices, seminars, hospitals and so on. "Diabetes, Complications,
Options" may be ordered from: National Federation of the Blind,
Materials Center, 1800 Johnson Street, Baltimore, MD 21230;
telephone: (410) 659-9314.


Jewish Braille Books

     We have been asked to announce: Menachem Shaingarten has produced
a collection of Jewish Braille books. They include pamphlets and
essays on the Chassidic movement and its interpretation of
Biblical verses based on talks of the Lubavitcher Rebbe.
Children's books are also available that depict Jewish history,
from 10th centruy Constantinople to the German ghetto of the
Middle Ages, from life under the Cossacks to the Enlightenment of
the 19th century. The books can be borrowed from the Jewish
Braille Institute, 110 E. 30th St., New York, NY 10016, or they
can be purchased through Rabbi Chitrik, 732 Eastern Parkway,
Brooklyn, NY 11213. 


Diet May Reduce Dialysis Deaths

     We have been asked to announce: Researchers at Johns Hopkins
Medical Institutions have found that a very-low-protein diet
before kidney dialysis may reduce patient deaths by three-fourths
during the first two years of dialysis.

     Earlier studies have indicated a very-low-protein diet produces
normal, rather than low, levels of bloodstream protein. This diet
eliminates a part of the high-protein foods that is difficult for
kidney patients to metabolize properly.

     However, Josef Coresh, M.D., Ph.D., a Hopkins epidemiologist and
author of the study warned, "This is a small study [of 44
patients], so there's a fair amount of imprecision involved."

     If similar reduction in deaths occur in a broader, morerepresentative
population, the diet may become an important tool
for prolonging the lives of dialysis patients.


New Company

     We have been asked to announce: IRIS Avenews is a new company
with the mission of providing daily living information (such as
the ingredients on food and medication packages, ads for store
sales, instructions and warranties for products) in various
formats, mostly on cassette. They have prepared a survey on tape
to find out what information people need and are also running a
couple of contests. One is poetry about information and one is
writing fiction to add to a story already started. For more
information contact: Independent Reading, Information Services,
2255 North Main Street #108-292, Longmont, CO 80501; Internet
address: iris1@boulder.earthnet.net


Voice Distributors Needed

     Since the Voice is now offered free, our Diabetics Division will
provide extra copies to anyone wanting to help spread the word.
We will gladly send from five to five hundred-plus copies each
quarter to be used as free literature. Medical facilities can
order as needed for patients. Individuals can usually place
copies of the Voice in libraries, pharmacies, hospitals, doctors'
offices, or other public locations.

     Diabetes education is essential. Anyone who distributes the Voice
will be helping people with diabetes, and their families, to
learn about the disease and its ramifications; to learn that they
have options; and that their world is far greater than whatever
"limits" may be imposed by the disease. If you would like to help
spread the word by distributing the publication, please contact:
Voice of the Diabetic, 811 Cherry Street, Suite 309, Columbia, MO
65201; telephone: (314) 875-8911.

+++++++++++++++++++++++++++++++++++++++

Board Members

    The Diabetics Division of the National Federation of the
Blind

Ed Bryant, President/Editor
     Columbia, MO

Janet Lee, Vice-President
     Cedar, MN

Bill Parker, Vice-President
     Norfolk, VA

John Yark, Treasurer     Stamford, CT

Tom Ley, Secretary
     Baltimore, MD

+++++++++++++++++++++++++++++++++++++++

Advertisers

     Effective advertising doesn't scream at its audience.  It 
persuades.  It sells.  The key to cost-effective advertising is
making your voice heard where an audience is already listening.  Voice
of the Diabetic, circulation 114,000+, offers such an outlet.  Make 
your voice heard.  For advertising information contact:

     Voice of the Diabetic
     Ed Bryant, Editor
     811 Cherry Street, Suite 309
     Columbia, MO 65201-4892
     (314) 875-8911

+++++++++++++++++++++++++++++++++++++++

Subscription/Donation Form

     The Voice of the Diabetic is a quarterly magazine
published by the Diabetics Division of the National Federation of the 
Blind (NFB) for anyone interested in diabetes, especially diabetics 
who are blind or losing vision. It is an outreach publication 
emphasizing good diabetes control, diet and independence.

     Donations are gladly accepted and appreciated. Contributions
are not only tax deductible but are needed to keep the Voice and the
Diabetics Division moving forward to help people with all aspects
of diabetes.

     Members of the NFB Diabetics Division enjoy priority
services and unique benefits such as a continuous free subscription to 
the Voice, automatic access to committees covering all aspects of 
diabetes, free counseling concerning all facets of blindness and 
diabetes as well as access to diabetics who have experienced 
complications.

     The Voice is free to any interested person upon request.
Each subscription costs the Diabetics Division approximately $20 per
year.  To help defray publication expenses, members are invited, and 
nonmembers are requested, to cover the subscription cost.

To begin receiving the Voice, please check one:

[  ]   I would like to become a member of the NFB Diabetics
Division and receive the Voice of the Diabetic. (Members are entitled 
to special membership benefits.)

[  ]   I would like to receive the Voice of the Diabetic as a nonmember.
(Nonmembers are encouraged to pay the institutional
rate of $20/one year; $35/two years; $50/three years.)

Send the Voice in (check one):

[  ]   print   [  ]   cassette tape for the blind and physically
                       handicapped
[  ]   both (recorded at slower-than-standard speed of 15/16 IPS)

Optionally check this box:

[  ]   I would like to make (or add) a tax-deductible
contribution of $ ___________ to The Diabetics Division of NFB.

Please print clearly

Name     ____________________________________________________________

Address  ____________________________________________________________

City _______________________________  State _______  Zip ___________

Telephone ( _____ ) _______ - _______________

Send this form or a facsimile to:

Voice of the Diabetic, 811 Cherry St., Suite 309, Columbia, MO
65201

Please make all checks payable to:

NATIONAL FEDERATION OF THE BLIND
