5 Responses to “misc.health.diabetes software”

1. admin says:

   September 1 at 10:26 am

   Archive-name: diabetes/insulin-pump-disc
   Posting-Frequency: biweekly
   Last-modified: 21 May 2003
   

   I have dropped the insulin pump discussion which was posted for many
   years, since it was totally out of date. If there’s someone around who
   would like to take on the task of writing a new pump FAQ, let me know —
   personally I don’t know enough about pumps to do it without a lot of new
   research. Ideally a pump FAQ should be based on questions actually asked
   or discussed on misc.health.diabetes, and should focus on principles
   rather than on models so that it doesn’t go out of date quickly.

   I thank Jim Summers, who produced the two versions of the pump FAQ which
   have been posted to mhd. If anyone knows where he is, please let me know
   — his old email address at utah.edu bounces.

   Edward Reid
2. admin says:

   September 1 at 10:26 am

   Archive-name: diabetes/faq/part2
   Posting-Frequency: biweekly
   Last-modified: 30 April 2003
   

   Changes: see part 1 of the FAQ for a list of changes to all parts.

   ——————————

   Subject: READ THIS FIRST

   Copyright 1993-2003 by Edward Reid. Re-use beyond the fair use provisions
   of copyright law and convention requires the author’s permission.

   Advice given in m.h.d is *never* medical advice. That includes this FAQ.
   Never substitute advice from the net for a physician’s care. Diabetes is a
   critical health topic and you should always consult your physician or
   personally understand the ramifications before taking any therapeutic action
   based on advice found here or elsewhere on the net.

   ——————————

   Subject: Table of Contents

   INTRODUCTION (found in all parts)
     READ THIS FIRST
     Table of Contents
   GENERAL (found in part 1)
     Where’s the FAQ?
     What’s this newsgroup like?
     Abuse of the newsgroup
     The newsgroup charter
     Newsgroup posting guidelines
     What is glucose? What does "bG" mean?
     What are mmol/L? How do I convert between mmol/L and mg/dl?
     What is c-peptide? What do c-peptide levels mean?
     What’s type 1 and type 2 diabetes?
     Is it OK to discuss diabetes insipidus here? What is it?
     How about discussing hypoglycemia?
     Helping with the diagnosis (DM or hypoglycemia) and waiting
     Exercise and insulin
   BLOOD GLUCOSE MONITORING (found in part 2)
     How accurate is my meter?
     Ouch! The cost of blood glucose measurement strips hurts my wallet!
     What do meters cost?
     Comparing blood glucose meters
     How can I download data from my meter?
     I’ve heard of a non-invasive bG meter — the Dream Beam?
     What’s HbA1c and what’s it mean?
     Why is interpreting HbA1c values tricky?
     Who determined the HbA1c reaction rates and the consequences?
     HbA1c by mail
     Why is my morning bg high? What are dawn phenomenon, rebound,
       and Somogyi effect?
   TREATMENT (found in part 3)
     My diabetic father isn’t taking care of himself. What can I do?
     Managing adolescence, including the adult forms
     So-and-so eats sugar! Isn’t that poison for diabetics?
     Insulin nomenclature
     What is Humalog / LysPro / lispro / ultrafast insulin?
     Travelling with insulin
     Injectors: Syringe and lancet reuse and disposal
     Injectors: Pens
     Injectors: Jets
     Insulin pumps
     Type 1 cures — beta cell implants
     Type 1 cures — pancreas transplants
     Type 2 cures — barely a dream
     What’s a glycemic index? How can I get a GI table for foods?
     Should I take a chromium supplement?
     I beat my wife! (and other aspects of hypoglycemia) (not yet written)
     Does falling blood glucose feel like hypoglycemia?
     Alcohol and diabetes
     Necrobiosis lipoidica diabeticorum
     Has anybody heard of frozen shoulder (adhesive capsulitis)?
     Gastroparesis
     Extreme insulin resistance
     What is pycnogenol? Where and how is it sold?
     What claims do the sales pitches make for pycnogenol?
     What’s the real published scientific knowledge about pycnogenol?
     How reliable is the literature cited by the pycnogenol ads?
     What’s the bottom line on pycnogenol?
     Pycnogenol references
   SOURCES (found in part 4)
     Online resources: diabetes-related newsgroups
     Online resources: diabetes-related mailing lists
     Online resources: commercial services
     Online resources: FTP
     Online resources: World Wide Web
     Online resources: other
     Where can I mail order XYZ?
     How can I contact the American Diabetes Association (ADA) ?
     How can I contact the Juvenile Diabetes Foundation (JDF) ?
     How can I contact the British Diabetic Association (BDA) ?
     How can I contact the Canadian Diabetes Association (CDA) ?
     What about diabetes organizations outside North America?
     How can I contact the United Network for Organ Sharing (UNOS)?
     Could you recommend some good reading?
     Could you recommend some good magazines?
   RESEARCH (found in part 5)
     What is the DCCT? What are the results?
     More details about the DCCT
     DCCT philosophy: what did it really show?
   IN CLOSING  (found in all parts)
     Who did this?

   ——————————

   Subject: How accurate is my meter?

   bG (blood glucose) meters are not as accurate as the readings you get from
   them imply. For example, you might think that 108 means 108 mg/dl, not 107 or
   109. But in fact all meters made for home use have at least a 10-15% error
   under ideal conditions. Thus you should interpret "108" as "probably between
   100 and 120". (Similar considerations apply if you measure in units of
   mmol/L.) This is a random error and will not be consistent from one
   determination to the next. You cannot expect to get exactly the same reading
   from two checks done one after the other, nor from two meters using the same
   blood sample.

   This is generally considered acceptable because variations in this range will
   not make a major difference in treatment decisions. For example, the
   difference between 100 and 120 may make no difference in how you treat
   yourself, or at most might make a difference of one unit of insulin. With
   present technology, more accurate meters would be much more expensive. This
   expense is only justified in research work, where such accuracy might detect
   small trends which could go undetected with less accurate measurements.

   This discussion applies to ideal conditions. The error may be increased by
   poor or missing calibration, temperatures outside the intended range,
   outdated strips, improper technique, poor timing, insufficient sample size,
   contamination, and probably other factors. Contamination is especially
   serious since it can happen so easily and is likely to result in an overdose
   of insulin. Glucose is found in fruits, juices, sodas, and many other foods.
   Even a smidgen can seriously alter a reading.

   When comparing meter readings with lab results, also note that plasma readings
   are 15% higher than whole blood, and that capillary blood gives different
   readings from venous blood.

   Visually read strips are slightly less accurate than meters, with an error
   rate around 20-25%.

   For some meters, strips are available from manufacturers other than the meter
   manufacturer. Some m.h.d. readers have compared the strips side-by-side and
   found those from one manufacturer to read consistently lower than the strips
   from another. The differences are not likely to make a significant difference
   in your treatment, but are large enough to be noticeable and possibly
   confusing. For this reason it is not a good idea to change strip
   manufacturers without comparing the readings from one with the readings from
   the other.

   I’ve seen no such direct comparison of meters, but the possibility exists that
   some meters might read consistently lower than others. Be careful when
   changing meters.

   By "error rate" I mean twice the standard deviation from the mean. An error
   rate of 15% says that about 95% of the readings will be within 15% of the
   actual value.

   ——————————

   Subject: Ouch! The cost of blood glucose measurement strips hurts my wallet!

   The cost of blood glucose measurement strips is a complex interaction
   of R&D costs, manufacturing costs, marketing strategy, insurance
   practices, and undoubtedly other factors. You can ask on the net if you
   want; you’ll get lots of comments but no answers.

   There are a few of ways of reducing the cost of blood glucose
   monitoring.

   One is to seek out the best price for the strips; large stores such as
   FEDCO often have good prices, as do some mail order suppliers (see mail
   order section).

   A second way is to choose a meter with lower cost strips. Your health
   care team may be familiar with and prefer a particular meter, but it’s
   not likely that they considered cost in making their choice. If you
   insist that you need a lower cost system, they should be willing to
   work with you. All meters now on the market are adequately accurate for
   home use.

   A third way is to use visually read strips (Chemstrip bG and a couple of
   lesser known brands) and cut them in half or even in thirds. Do the
   cutting carefully with a pair of strong, *clean* scissors, and get the
   strips back into the vial as quickly as possible. Some manufacturers
   claim this procedure will cause problems, but those who have used the
   technique report that it works well. Visually read strips are slightly
   less accurate than meters. However, as of 1998, prices on visually read
   strips are relatively high, and you will have to consider whether the
   projected savings are worth the time to cut strips and the loss of the
   convenience which meters give.

   Do *not* cut strips when using them in meters. The results will be
   totally incorrect.

   Most discussion on m.h.d of the cost of blood glucose measurement strips
   has centered on the US. I’m not sure why, though a good guess is that
   differences in health care systems and national policies make this
   issue more critical to the individual patient in the US. There is no
   dearth of non-US participants on m.h.d.

   ——————————

   Subject: What do meters cost?

   The flip side of expensive blood glucose measurement strips is that
   the manufacturers virtually (and sometimes literally) give away the
   meters to hook you on their strips. Don’t pay full price for a
   meter; look for discounts, rebates, and giveaways. For example, as
   of this writing I’m looking at a catalog that shows a Glucometer 3
   for US$45, with a US$30 manufacturer’s rebate *and* a US$30 trade-in
   allowance if you already have a competing meter — which means you
   make US$15. There are similar deals on other meters.

   But make sure you consider the cost of strips as well as the cost of
   meters, and find out which your insurance will pay for. The most
   fully featured meters, such as the One Touch II, don’t have such
   widely advertised deals, though you can probably find ways of
   getting them at discount.

   If you have insurance that pays for strips but not for the meter,
   you should not have to pay anything for the meter. If it’s worth the
   time to you, call the meter manufacturers’ customer service
   departments
   …

   read more »
3. admin says:

   September 1 at 10:26 am

   Archive-name: diabetes/faq/part4
   Posting-Frequency: biweekly
   Last-modified: 30 April 2003
   

   Changes: see part 1 of the FAQ for a list of changes to all parts.

   ——————————

   Subject: READ THIS FIRST

   Copyright 1993-2003 by Edward Reid. Re-use beyond the fair use provisions
   of copyright law and convention requires the author’s permission.

   Advice given in m.h.d is *never* medical advice. That includes this FAQ.
   Never substitute advice from the net for a physician’s care. Diabetes is a
   critical health topic and you should always consult your physician or
   personally understand the ramifications before taking any therapeutic action
   based on advice found here or elsewhere on the net.

   ——————————

   Subject: Table of Contents

   INTRODUCTION (found in all parts)
     READ THIS FIRST
     Table of Contents
   GENERAL (found in part 1)
     Where’s the FAQ?
     What’s this newsgroup like?
     Abuse of the newsgroup
     The newsgroup charter
     Newsgroup posting guidelines
     What is glucose? What does "bG" mean?
     What are mmol/L? How do I convert between mmol/L and mg/dl?
     What is c-peptide? What do c-peptide levels mean?
     What’s type 1 and type 2 diabetes?
     Is it OK to discuss diabetes insipidus here? What is it?
     How about discussing hypoglycemia?
     Helping with the diagnosis (DM or hypoglycemia) and waiting
     Exercise and insulin
   BLOOD GLUCOSE MONITORING (found in part 2)
     How accurate is my meter?
     Ouch! The cost of blood glucose measurement strips hurts my wallet!
     What do meters cost?
     Comparing blood glucose meters
     How can I download data from my meter?
     I’ve heard of a non-invasive bG meter — the Dream Beam?
     What’s HbA1c and what’s it mean?
     Why is interpreting HbA1c values tricky?
     Who determined the HbA1c reaction rates and the consequences?
     HbA1c by mail
     Why is my morning bg high? What are dawn phenomenon, rebound,
       and Somogyi effect?
   TREATMENT (found in part 3)
     My diabetic father isn’t taking care of himself. What can I do?
     Managing adolescence, including the adult forms
     So-and-so eats sugar! Isn’t that poison for diabetics?
     Insulin nomenclature
     What is Humalog / LysPro / lispro / ultrafast insulin?
     Travelling with insulin
     Injectors: Syringe and lancet reuse and disposal
     Injectors: Pens
     Injectors: Jets
     Insulin pumps
     Type 1 cures — beta cell implants
     Type 1 cures — pancreas transplants
     Type 2 cures — barely a dream
     What’s a glycemic index? How can I get a GI table for foods?
     Should I take a chromium supplement?
     I beat my wife! (and other aspects of hypoglycemia) (not yet written)
     Does falling blood glucose feel like hypoglycemia?
     Alcohol and diabetes
     Necrobiosis lipoidica diabeticorum
     Has anybody heard of frozen shoulder (adhesive capsulitis)?
     Gastroparesis
     Extreme insulin resistance
     What is pycnogenol? Where and how is it sold?
     What claims do the sales pitches make for pycnogenol?
     What’s the real published scientific knowledge about pycnogenol?
     How reliable is the literature cited by the pycnogenol ads?
     What’s the bottom line on pycnogenol?
     Pycnogenol references
   SOURCES (found in part 4)
     Online resources: diabetes-related newsgroups
     Online resources: diabetes-related mailing lists
     Online resources: commercial services
     Online resources: FTP
     Online resources: World Wide Web
     Online resources: other
     Where can I mail order XYZ?
     How can I contact the American Diabetes Association (ADA) ?
     How can I contact the Juvenile Diabetes Foundation (JDF) ?
     How can I contact the British Diabetic Association (BDA) ?
     How can I contact the Canadian Diabetes Association (CDA) ?
     What about diabetes organizations outside North America?
     How can I contact the United Network for Organ Sharing (UNOS)?
     Could you recommend some good reading?
     Could you recommend some good magazines?
   RESEARCH (found in part 5)
     What is the DCCT? What are the results?
     More details about the DCCT
     DCCT philosophy: what did it really show?
   IN CLOSING  (found in all parts)
     Who did this?

   ——————————

   Subject: Online resources: diabetes-related newsgroups

   On the Usenet, the misc.health.diabetes newsgroup carries most of the
   messages related to diabetes. Volume runs about 200-250 articles/day. Suppose
   you obtained this FAQ by some method other than by reading m.h.d and you want
   to participate. If you already have access to Usenet news, just subscribe to
   misc.health.diabetes; the exact method depends on the software used at your
   site, so you should inquire locally for details. If you do not have access to
   Usenet news, inquire locally about obtaining such access. The key words are
   "I want to participate in the Usenet newsgroup misc.health.diabetes". Usenet
   is available at most colleges and universities, many companies, all of the
   large commercial services (including Delphi, Netcom, America Online,
   Compuserve, Prodigy), many smaller local services, most Freenet systems,
   and many locally run BBSs. Some of these have selective news feeds, and you
   will have to ask them to get misc.health.diabetes before you can subscribe
   via their system.

   m.h.d is not gatewayed to any mailing list, and to my knowledge is not
   archived anywhere as such. However, DejaNews has all of Usenet from March
   1995 to present online and available to the public, and plans to extend the
   scope farther into the past. You can create a filter specifying only the
   newsgroup you want, and then search for key words. See

      http://www.dejanews.com

   Another newsgroup, alt.support.diabetes.kids, has a much smaller volume of
   articles, about 2-3 per day. Being in the alt.* hierarchy of newsgroups, its
   propagation is somewhat restricted compared to misc.health.diabetes. To
   obtain access, follow the same instructions as for m.h.d, above.

   Other Usenet newsgroups which might be relevant are

       rec.food and its subgroups
       the sci.med hierarchy
       the alt.support hierarchy, especially alt.support.diet
       bit.listserv.transplant (only available at sites that carry bit.* —
                                see the description below of the TRNSPLNT list)

   ——————————

   Subject: Online resources: diabetes-related mailing lists

   Several public electronic mailing lists have diabetes-related content. The
   main alternative to a newsgroup is the DIABETIC list, which carries about
   60-80 messages/day. Its charter is to be "a support and information group for
   diabetics". The overall flavor and atmosphere are different from the m.h.d
   newsgroup, so if you find that you are uncomfortable with one, try the other.
   If you subscribe to the DIABETIC list, be prepared for the large volume of
   messages. If you have not dealt with this volume of email before, it will be
   quite disconcerting to see so many messages appear in your personal mailbox,
   and I advise that you consider one of the following methods to avoid being
   overwhelmed:

       — set up a mailbox (aka userid, account, screen name) separate from
          your normal personal mailbox in which to receive the mailing list.
          You will have to ask locally whether this is possible on your system.
          You may also be able to use your mail program to filter mailing list
          messages into a separate mailbox.

       — convert to the digest as soon as you have subscribed. The digest
          option collects messages into large postings called digests (a misuse
          of the word, as all messages are included in their entirety). This
          digest is sent daily, or when its size passes a limit (currently 2000
          lines). Convert to digest form by sending a message addressed to the
          listserv (see below) with a message body containing

              set diabetic mail digest

   TYPE_ONE is a low to moderate volume mailing list for discussion of type 1
   diabetes, intended primarily as a support group. It carries about 10
   messages/day. There is no digest option. If you get any error messages from
   "majordomo", be sure to write directly to the list owner,
   jamyers(AT)netcom.com, as sometimes the software at netcom prevents him from
   replying directly.

   DIABETES-EHLB started as an Electronic HighLights Bulletin to distribute
   information presented at the ADA conference in June 1996. It was carried
   forward as a moderated mailing list. The moderator plans to try to keep
   discussions focussed on specific topics.

   TRNSPLNT is a low volume mailing list for discussion of organ transplants. It
   carries about 10 messages/day. It is relevant to diabetes because
   complications of diabetes often lead to kidney transplants. TRNSPLNT is
   gatewayed with the newsgroup bit.listserv.transplant, which is available at
   Usenet sites which carry the bit.* hierarchy of newsgroups.

   DIABETES-NEWS is a one-way list provided by _Diabetes Interview_ magazine. It
   provides a sample, one article per week, from the printed magazine. See the
   section on "Could you recommend some good magazines?" for more information
   about the printed magazine.

   AUTOIMMUNE is a moderated, low volume list carrying technical information
   about research on autoimmune disorders, including type 1 diabetes.

   HYPO is a moderate volume mailing list for support and information on
   hypoglycemia (as a medical condition as opposed to an insulin reaction).

   To subscribe to the mailing list in the first column, send a message to the
   email address in the second column (or to the alternate if given) containing
   the command in the third column. Note that Firstname Lastname is your real
   name, such as John Doe. The listserv software will use the email address in
   your message header for your subscription. If you have trouble sending email
   to the listserv, or if you receive no response, then you will need the help
   of someone at your site.

     DIABETIC   listserv(AT)lehigh.edu     subscribe diabetic Firstname Lastname

     TYPE_ONE   listserv(AT)netcom.com     subscribe type_one

     DIABETES-EHLB
                listserv(AT)shrsys.hslc.org subscribe diabetes-ehlb Fstnm Lstnm

     TRNSPLNT  
   …

   read more »
4. admin says:

   September 1 at 10:26 am

   Archive-name: diabetes/faq/part3
   Posting-Frequency: biweekly
   Last-modified: 15 October 2002
   

   Changes: see part 1 of the FAQ for a list of changes to all parts.

   ——————————

   Subject: READ THIS FIRST

   Copyright 1993-2003 by Edward Reid. Re-use beyond the fair use provisions
   of copyright law and convention requires the author’s permission.

   Advice given in m.h.d is *never* medical advice. That includes this FAQ.
   Never substitute advice from the net for a physician’s care. Diabetes is a
   critical health topic and you should always consult your physician or
   personally understand the ramifications before taking any therapeutic action
   based on advice found here or elsewhere on the net.

   ——————————

   Subject: Table of Contents

   INTRODUCTION (found in all parts)
     READ THIS FIRST
     Table of Contents
   GENERAL (found in part 1)
     Where’s the FAQ?
     What’s this newsgroup like?
     Abuse of the newsgroup
     The newsgroup charter
     Newsgroup posting guidelines
     What is glucose? What does "bG" mean?
     What are mmol/L? How do I convert between mmol/L and mg/dl?
     What is c-peptide? What do c-peptide levels mean?
     What’s type 1 and type 2 diabetes?
     Is it OK to discuss diabetes insipidus here? What is it?
     How about discussing hypoglycemia?
     Helping with the diagnosis (DM or hypoglycemia) and waiting
     Exercise and insulin
   BLOOD GLUCOSE MONITORING (found in part 2)
     How accurate is my meter?
     Ouch! The cost of blood glucose measurement strips hurts my wallet!
     What do meters cost?
     Comparing blood glucose meters
     How can I download data from my meter?
     I’ve heard of a non-invasive bG meter — the Dream Beam?
     What’s HbA1c and what’s it mean?
     Why is interpreting HbA1c values tricky?
     Who determined the HbA1c reaction rates and the consequences?
     HbA1c by mail
     Why is my morning bg high? What are dawn phenomenon, rebound,
       and Somogyi effect?
   TREATMENT (found in part 3)
     My diabetic father isn’t taking care of himself. What can I do?
     Managing adolescence, including the adult forms
     So-and-so eats sugar! Isn’t that poison for diabetics?
     Insulin nomenclature
     What is Humalog / LysPro / lispro / ultrafast insulin?
     Travelling with insulin
     Injectors: Syringe and lancet reuse and disposal
     Injectors: Pens
     Injectors: Jets
     Insulin pumps
     Type 1 cures — beta cell implants
     Type 1 cures — pancreas transplants
     Type 2 cures — barely a dream
     What’s a glycemic index? How can I get a GI table for foods?
     Should I take a chromium supplement?
     I beat my wife! (and other aspects of hypoglycemia) (not yet written)
     Does falling blood glucose feel like hypoglycemia?
     Alcohol and diabetes
     Necrobiosis lipoidica diabeticorum
     Has anybody heard of frozen shoulder (adhesive capsulitis)?
     Gastroparesis
     Extreme insulin resistance
     What is pycnogenol? Where and how is it sold?
     What claims do the sales pitches make for pycnogenol?
     What’s the real published scientific knowledge about pycnogenol?
     How reliable is the literature cited by the pycnogenol ads?
     What’s the bottom line on pycnogenol?
     Pycnogenol references
   SOURCES (found in part 4)
     Online resources: diabetes-related newsgroups
     Online resources: diabetes-related mailing lists
     Online resources: commercial services
     Online resources: FTP
     Online resources: World Wide Web
     Online resources: other
     Where can I mail order XYZ?
     How can I contact the American Diabetes Association (ADA) ?
     How can I contact the Juvenile Diabetes Foundation (JDF) ?
     How can I contact the British Diabetic Association (BDA) ?
     How can I contact the Canadian Diabetes Association (CDA) ?
     What about diabetes organizations outside North America?
     How can I contact the United Network for Organ Sharing (UNOS)?
     Could you recommend some good reading?
     Could you recommend some good magazines?
   RESEARCH (found in part 5)
     What is the DCCT? What are the results?
     More details about the DCCT
     DCCT philosophy: what did it really show?
   IN CLOSING  (found in all parts)
     Who did this?

   ——————————

   Subject: My diabetic father isn’t taking care of himself. What can I do?

   We’ll assume your father has type 2 diabetes. See separate section for
   definition of types.

   Type 2 diabetics, and those who care for them, are in a difficult situation.
   Type 2 strikes late in life, so personal habits and patterns are already
   formed and solidly engrained. Yet in most cases those habits and patterns are
   exactly what must be changed if a newly-diagnosed diabetic is to care
   properly for his or her health. This is a difficult psychological problem.

   The cornerstones for treating type 2 diabetes are exercise, weight control,
   and diet. A high percentage of type 2 patients who apply these therapies
   assiduously can control the disease with these therapies alone, without
   insulin or oral hypoglycemic drugs. Naturally these are also some of the most
   difficult aspects of life to change. There can be no single or simple answer
   of how to help or encourage a particular individual find a combination of
   therapies which not only controls the disease but also is psychologically
   acceptable and which can be incorporated as a lifetime pattern. Helping
   depends on knowing the individual’s habits, patterns, motivations, desires,
   likes and dislikes, and working with all the existing conditions and
   everything brought forward from past life.

   Doctors and other health care professionals have a choice in treating
   patients with type 2 diabetes. They can prescribe drugs (oral hypoglycemics)
   and insulin, or they can try to get their patients to make the difficult
   lifestyle changes described above. (Many patients need both.) The latter
   effort is time consuming and often frustrating, as doctors too often see
   patients failing to make any change at all.

   Friends and family can help by learning about type 2 diabetes, and doing what
   you can to encourage your loved one to make diet and lifestyle changes. If
   this supports the plan a treatment team is urging the patient to follow, you
   will add your support for difficult changes. If the doctor (or the whole
   treatment team) falls down on the educational and motivational structure, you
   can fill in some of the gaps. Your effort is well spent in either case.

   In particular, if a doctor has left the impression that drugs and insulin are
   the only treatments, make sure to counter that impression with information
   about the value of exercise, diet, and weight control.

   At the same time, it’s important to remember that needing oral hypoglycemics
   and/or insulin injections as additional tools isn’t failure. On the contrary,
   a patient who’s been actively involved in self treatment already has an
   excellent chance of using these additional tools successfully. Those who have
   learned to use the exercise – weight control – diet triumvirate will also be
   able to utilize insulin and oral drugs as additional treatments when needed.
   Choose the appropriate tools and use them effectively.

   These treatment choices can interact in positive ways as well. Bringing blood
   glucose under control often increases the body’s sensitivity to insulin. So
   ironically, using insulin may decrease the need for insulin. This is a
   positive change which can then be reinforced by the other, interacting
   treatments.

   You will need far more information than is appropriate for a Usenet FAQ
   panel. As a start, call the ADA (see ADA section), get a subscription to
   _Diabetes Forecast_ (see journals), and visit a university library and browse
   in the diabetes section in the stacks.

   Beyond the generalizations above, a few specifics are usually of value:

      Set a good example in your own life. Exercise and eat a good diet.
      The recommendations for diabetics are healthy choices for anyone.

      Share your example. Serve a tasty, low-fat diet to family and friends
      when they are your guests.

      Suggest joint activities. Suggest a walk instead of watching a
      ball game.

      Make sure your diet and activities are visibly enjoyable so your
      guests will accept your invitiation to join you.

   ——————————

   Subject: Managing adolescence, including the adult forms

   Adolescents have special problems in managing diabetes. These include a
   variety of physiological problems related to puberty and rapid growth, social
   problems related to growing up and the general social pressures of adolescent
   life, and the psychological turmoil caused by the expectations of others. I’m
   here today to talk about (hey, hold the eggs and tomatoes) expectations.

   Actually, this all applies to adults as well, though the subtle points may
   differ.

   The most important thing to remember, for the adolescent, the parent, and the
   health care provider, is

                 All Blood Glucose Measurements Are Good.

                 There Are No Bad Blood Glucose Readings.

   If that doesn’t sound right, then please take two steps. First, learn why it
   is true. Then chant it like a mantra until you internalize it, so that you
   never give off the slightest vibes to the contrary.

   Why is it true?

   There are two kinds of adolescents (to simplify life enormously): those who
   rebel and those who want to please. Ironically, the rebellious are probably
   easier to deal with in treating diabetes. "So my blood sugar is 350, so
   what?" Bad? No, that’s good: you know what’s going on, and so does your
   child. The point of blood glucose measurement is to respond — not to be good
   or bad — and only with an accurate report can you and the patient respond.

     [Compulsory digression: 350 mg/dl = 20.0 mmol/L.]

   Look what can happen to the eager-to-please child:

      Child: My blood sugar is 350.
      Adult: Oh, that’s awful! You must try to be better!

         [next time:]

      Child: My blood sugar is … um [to self: I must be good] 140 …
      Adult: Oh, that’s great!

   In short order, the log book looks great but the HbA1c doesn’t jibe.

   This all happens with the best of intentions from all parties. The child is
   trying to
   …

   read more »
5. admin says:

   September 1 at 10:26 am

   Archive-name: diabetes/faq/part5
   Posting-Frequency: biweekly
   Last-modified: 22 June 2002
   

   Changes: see part 1 of the FAQ for a list of changes to all parts.

   ——————————

   Subject: READ THIS FIRST

   Copyright 1993-2003 by Edward Reid. Re-use beyond the fair use provisions
   of copyright law and convention requires the author’s permission.

   Advice given in m.h.d is *never* medical advice. That includes this FAQ.
   Never substitute advice from the net for a physician’s care. Diabetes is a
   critical health topic and you should always consult your physician or
   personally understand the ramifications before taking any therapeutic action
   based on advice found here or elsewhere on the net.

   ——————————

   Subject: Table of Contents

   INTRODUCTION (found in all parts)
     READ THIS FIRST
     Table of Contents
   GENERAL (found in part 1)
     Where’s the FAQ?
     What’s this newsgroup like?
     Abuse of the newsgroup
     The newsgroup charter
     Newsgroup posting guidelines
     What is glucose? What does "bG" mean?
     What are mmol/L? How do I convert between mmol/L and mg/dl?
     What is c-peptide? What do c-peptide levels mean?
     What’s type 1 and type 2 diabetes?
     Is it OK to discuss diabetes insipidus here? What is it?
     How about discussing hypoglycemia?
     Helping with the diagnosis (DM or hypoglycemia) and waiting
     Exercise and insulin
   BLOOD GLUCOSE MONITORING (found in part 2)
     How accurate is my meter?
     Ouch! The cost of blood glucose measurement strips hurts my wallet!
     What do meters cost?
     Comparing blood glucose meters
     How can I download data from my meter?
     I’ve heard of a non-invasive bG meter — the Dream Beam?
     What’s HbA1c and what’s it mean?
     Why is interpreting HbA1c values tricky?
     Who determined the HbA1c reaction rates and the consequences?
     HbA1c by mail
     Why is my morning bg high? What are dawn phenomenon, rebound,
       and Somogyi effect?
   TREATMENT (found in part 3)
     My diabetic father isn’t taking care of himself. What can I do?
     Managing adolescence, including the adult forms
     So-and-so eats sugar! Isn’t that poison for diabetics?
     Insulin nomenclature
     What is Humalog / LysPro / lispro / ultrafast insulin?
     Travelling with insulin
     Injectors: Syringe and lancet reuse and disposal
     Injectors: Pens
     Injectors: Jets
     Insulin pumps
     Type 1 cures — beta cell implants
     Type 1 cures — pancreas transplants
     Type 2 cures — barely a dream
     What’s a glycemic index? How can I get a GI table for foods?
     Should I take a chromium supplement?
     I beat my wife! (and other aspects of hypoglycemia) (not yet written)
     Does falling blood glucose feel like hypoglycemia?
     Alcohol and diabetes
     Necrobiosis lipoidica diabeticorum
     Has anybody heard of frozen shoulder (adhesive capsulitis)?
     Gastroparesis
     Extreme insulin resistance
     What is pycnogenol? Where and how is it sold?
     What claims do the sales pitches make for pycnogenol?
     What’s the real published scientific knowledge about pycnogenol?
     How reliable is the literature cited by the pycnogenol ads?
     What’s the bottom line on pycnogenol?
     Pycnogenol references
   SOURCES (found in part 4)
     Online resources: diabetes-related newsgroups
     Online resources: diabetes-related mailing lists
     Online resources: commercial services
     Online resources: FTP
     Online resources: World Wide Web
     Online resources: other
     Where can I mail order XYZ?
     How can I contact the American Diabetes Association (ADA) ?
     How can I contact the Juvenile Diabetes Foundation (JDF) ?
     How can I contact the British Diabetic Association (BDA) ?
     How can I contact the Canadian Diabetes Association (CDA) ?
     What about diabetes organizations outside North America?
     How can I contact the United Network for Organ Sharing (UNOS)?
     Could you recommend some good reading?
     Could you recommend some good magazines?
   RESEARCH (found in part 5)
     What is the DCCT? What are the results?
     More details about the DCCT
     DCCT philosophy: what did it really show?
   IN CLOSING  (found in all parts)
     Who did this?

   ——————————

   Subject: What is the DCCT? What are the results?

   The Diabetes Control and Complications Trial was a large multi-center
   trial involving over 1400 volunteer patients with type 1 diabetes. It
   began in 1983, ramped up to full speed by 1989, and ended early in 1993
   when the investigators felt the results were clear. The volunteers were
   all undergoing "standard" treatment when they were recruited, meaning
   one or two injections per day. They were randomly assigned to two
   groups. One group continued as before. The other group received
   intensive treatment aimed at achieving blood glucose (bG) profiles as
   close as possible to normal. The intensive treatment involved multiple
   bG checks per day, multiple injections and/or an insulin pump, and
   access to and regular consultation with a team of treatment experts.

   It is particularly important to note that intensive treatment was
   defined as a collaborative effort involving the patient and a skilled
   team of health care professionals. It was not defined by particular
   techniques, although certain techniques were typically used. The
   frequent consultations and availability of a professional team were
   critical components of intensive therapy.

   The results show that the intensive treatment group did indeed achieve
   bG levels closer to normal, and that they experienced far fewer
   diabetic complications though also more hypoglycemia. In particular,
   patients who maintained HbA1c levels around 7% appear to be much better
   off than those whose HbA1c hovers around 9%. (See caveats in the
   section on HbA1c.) Though it is not possible to separate the effects of
   all the aspects of the intensive treatment, it is reasonable to believe
   that lowering average bG may be effective even in isolation from the
   other aspects of the intensive treatment. In its position statement,
   the ADA says

      Patients should aim for the best level of glucose control they can
      achieve without placing themselves at undue risk for hypoglycemia or
      other hazards associated with tight control.

   Though type 2 patients were not included in the study, it is generally
   believed that the results showing the benefits of tight control apply
   to type 2 patients as well.

   The entire position statement was published in most of the ADA’s
   publications (see "could you recommend some good reading") in the
   summer and fall of 1993.

   The formal report detailing the results was published in The New England
   Journal of Medicine, aka NEJM, of September 30,1993 (v 329 pp 977-986).
   The following discussion is based on that article.

   Several DCCT subjects participate in m.h.d and are willing to answer
   questions related to the personal aspects of DCCT participation.

   ——————————

   Subject: More details about the DCCT

   The study placed subjects into two cohorts, primary prevention or
   secondary intervention, depending on duration of diabetes and existing
   complications — the primary prevention cohort were those with
   essentially no complications.

   Specifically: all subjects met these criteria:

       Insulin dependent as evidenced by deficient C-peptide secretion
       Age 13 to 39 years at entry to the study
       No hypertension, hypercholesterolemia, severe diabetic complications,
           or other severe medical conditions
       Meet the criteria for one of the cohorts

   and were separated into the two cohorts by these criteria:

                                 Primary          Secondary
                                Prevention       Intervention
                                 Cohort            Cohort

       Duration of IDDM        1-5 yrs           1-15 yrs
       Retinopathy             none detectable   very mild to moderate
                                                     nonproliferative
       Urinary albumin         < 40 mg / 24 hr   < 200 mg / 24 hr

   Within each cohort, the subjects were randomly assigned to either
   conventional therapy or intensive therapy. Thus the study compared
   intensive to conventional therapy in two different cohorts. The two
   questions the study was mainly designed to answer were

     1) Will intensive therapy prevent the development of diabetic
        retinopathy in patients with no retinopathy (primary
        prevention), and
     2) Will intensive therapy affect the progression of early
        retinopathy (secondary intervention)?

   Conventional therapy included one or two injections per day, daily self
   monitoring of blood or urine glucose, education, quarterly
   consultations, and intensive therapy during pregnancy. Intensive
   therapy included three or more daily injections or an insulin pump, bG
   monitoring at least 4x/day, adjustment of insulin dosage for bG level
   and food and exercise, monthly personal consultations and more frequent
   phone consultations.

   To simplify a lot, the DCCT showed the following changes in the
   intensive therapy groups compared to the conventional therapy groups.
   Note that ‘-’ shows a decrease, ‘+’ shows an increase, in the number of
   patients affected. Patients were judged as affected or not based on
   binary criteria, so the results only say how many subjects were
   affected, not how severely those subjects were affected.

   Intensive therapy compared to conventional therapy:

                                   Primary                    Secondary
     Complication                 Prevention    Combined     Intervention
     ————                 ———-    ——–     ————
     Retinopathy(*)                 – 75%                       – 55%
     Nephropathy(*)                 – 35%                       – 45%
     Neuropathy(*)                  - 70%                       – 55%
     Hypoglycemia(*)                              +200%
     Weight gain(*)                               + 33%
     Hypercholesterolemia(*)                      - 35%

   (*) This brief table begs many questions about what exactly was
   measured and how. For more details, read the paper.

   There were no detectable differences on several measures:
   …

   read more »