Changes: add a comment on lancet reuse (9 Sept)
         add section on adhesive capsulitis (9 Oct) (thanks, Lyle and Lee)

Subject: READ THIS FIRST
========================

Copyright 1993-1995 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?
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 One Touch II?
  How can I download data from my Glucometer ™?
  Other recordkeeping software
  I’ve heard of a non-invasive bG meter — the Dream Beam?
  What’s HbA1c and what’s it mean?
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
  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 — not even 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)?
  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) ?
  How can I contact the United Network for Organ Sharing (UNOS)?
  Could you recommend some good reading?
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 tend to treat type 2 diabetics
with drugs (oral hypoglycemics) and insulin rather than taking the time to
try to get their patients to make the difficult lifestyle changes described
above. This isn’t true of all practitioners, but of many. They have good
reason for this tendency: they know all too well (often from painful personal
experience) that most type 2 patients aren’t going to make many changes
anyway, and the doctors and other practitioners don’t like wasting their time
and breath. So it’s likely to fall to friends and relatives who care deeply
to educate themselves about type 2 diabetes and do what they can to encourage
their loved one to make changes. In particular, if the doctor has left the
impression that drugs and insulin are the only treatments, make sure to
counter that impression with information about the value of exercise, diet,
and weight control.

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

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

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

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

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

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

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

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

Subject: Managing adolescence, including the adult forms
========================================================

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

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

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

              All Blood Glucose Measurements Are Good.

              There Are No Bad Blood Glucose Readings.

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

Why is it true?

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

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

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

   Child: My blood sugar is 350.
   Adult: Oh, that’s awful! You must try to be better!
      [next time]
   Child: My blood sugar is … um [to self: I must be good] 140 …
   Adult: Oh, that’s great!

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

This all happens with the best of intentions from all parties. The child is
trying to please, and is behaving in exactly the ways that elicit approval.
The adult is trying to care for the child’s health in the most natural ways.
And the result is one that neither desires.

Thus the positive mantra to replace the half-negative one above:

              All Blood Glucose Measurements Are Good.

           Responding To Blood Glucose Readings Is Good.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

An excellent
…

read more »

Changes: minor edits (23 Sept)

Subject: READ THIS FIRST
========================

Copyright 1993-1995 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?
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 One Touch II?
  How can I download data from my Glucometer ™?
  Other recordkeeping software
  I’ve heard of a non-invasive bG meter — the Dream Beam?
  What’s HbA1c and what’s it mean?
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
  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 — not even 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)?
  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) ?
  How can I contact the United Network for Organ Sharing (UNOS)?
  Could you recommend some good reading?
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". (See above for conversion to mmol/L.) This is a random error
and will not be consistent from one determination to the next. You cannot
expect to get exactly the same reading from two checks done one after the
other, nor from two meters using the same blood sample.

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

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

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

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

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 97% 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 couple of ways of reducing the cost of blood glucose monitoring.
One is to seek out the best price for the strips; large stores such as FEDCO
often have good prices, as do some mail order suppliers (see mail order
section).

A second way is to use visually read strips (Chemstrip bG and a couple of
lesser known brands) and cut them in half or even in thirds. Do the cutting
carefully with a pair of strong, *clean* scissors, and get the strips back
into the vial as quickly as possible. There have been reports that some
manufacturers claim this procedure will cause problems, but those who have
used the technique report that it works well. Visually read strips are
slightly less accurate than meters.

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

Most discussion on m.h.d of the cost of 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, it may be
worth calling the meter manufacturer and trying to persuade them to give you
a meter. If anybody has actually tried this, let us know whether or not it
worked.

As with strips, this discussion of costs applies to the US, and there has
been little discussion of meter costs outside the US on m.h.d., probably
because fewer tradeoffs are available in most countries. An Australian
correspondent notes a much narrower choice and higher cost of meters there,
but subsidized (pardon, subsidised) measurement strips. In Britain, strips
are covered by the National Health Service, but meters may be expensive.
Elsewhere? Please post.

Subject: Comparing blood glucose meters
=======================================

This section is courtesy of Lyle Hodgson <l…@world.std.com>, who found the
chart published by Hospital Center Pharmacy, got permission to reproduce it,
and entered and formatted the data. Take it, Lyle.

The following Blood Glucose Monitor Comparison Chart is published by the
Hospital Center Pharmacy (433 Brookline Ave. Boston MA 02215; reprinted here
with permission). After I mentioned it a couple weeks ago, Ed
…

read more »

> Please look at our new 200+ page website for your interest.
> Dr. George I. Traitses B.Sc.(hon.), D.C., M.Sc., C.H.N., C.C.R.D.
> Doctor of Chiropractic, Human Nutrition, Chiropractic Rehabilitation
>  Infinite Health Canada-Live Cell Evaluation-Enzyme Nutrition

Dr. Traitses:

When calling yourself a "doctor," you should make it clear that you
are a CHIROPRACTOR so we can weigh your comments and the merits of
your commercial website in light of that fact.

Thanks,

Henry

DO NOT reply to this message, at least not without removing any of the
newsgroups in your Newsgroups: line of your reader.

I have been notified from the postmaster at his site that Steve Jones:
"has been removed from this host, advised of the gross misjudgement displayed
in this posting, and disciplined for the action"

In article <4aniqc$…@post.gsfc.nasa.gov>,
   sjo…@ifmp.nasa.gov (Steve Jones) wrote:

>            Sell money making reports by mail !!
>        Make a profit of over 700% on each sale you make !!!

[remaining deleted].

In most of the groups that this message was posted to, it is against the
charter of the newsgroup to post advertisements, and as you can see the
individual has experienced the repercussions for doing so.

Cheers,
David

—
3…@qlink.queensu.ca  [David Elfstrom]  http://qlink.queensu.ca/~3dre/.