Archive-name: diabetes/faq/part1
Posting-Frequency: biweekly
Last-modified: 30 May 2010 (excludes change list and Table of Contents)
Changes: add aspartame topic in research section (14 July 2005)
fix Avogadro's number (15 Dec 2006)
correct U of Louisville link (10 March 2009)
add a point to the mg/dl vs mmol/l table (27 Feb 2010)
clarify conversion section (30 May 2010)
------------------------------
Subject: READ THIS FIRST
Copyright 1993-2010 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?
Is aspartame dangerous?
IN CLOSING (found in all parts)
Who did this?
------------------------------
Subject: Where's the FAQ?
This FAQ attempts to answer the questions which have been most frequently
asked in misc.health.diabetes (m.h.d). This is not a complete informational
posting. My only criterion for inclusion is that the topic has frequently
appeared in m.h.d, either by an explicit question, or implicitly by posting a
related question or a common misconception.
This FAQ is posted biweekly to the Usenet newsgroup misc.health.diabetes.
If you obtained this article by some method other than reading Usenet,
refer to the section on "Online resources: diabetes-related newsgroups"
for brief information on how to obtain access to Usenet newsgroups and
misc.health.diabetes in particular.
Feel free to make copies of this FAQ for your personal use or for a friend or
relative, including to share with health care providers. If you want to make
this FAQ available to others on an ongoing basis (for example, on a BBS),
please do *not* post or copy the entire FAQ. Instead, post only this section,
entitled "Where's the FAQ?". This will enable others always to retrieve the
most recent version.
I have removed the outdated informational posting on insulin pumps.
An informational posting on diabetes-related software is posted to m.h.d at
the same time as this FAQ. See below for retrieval information. It was
developed and is maintained by Rick Mendosa <mendosa(AT)mendosa.com>.
I've used ideas and information from many people in writing this FAQ. With a
few exceptions I haven't attempted to identify them, but I thank them all.
The words herein are mine unless otherwise credited.
If you read this and it helps you, please let me know what part helped, and
why. If you read this and can't find what you want, let me know that too.
Such comments will help me decide what is worth working on, and whether.
You'd be surprised how little feedback I get. If you are reading this on the
newsgroup, just reply to this article. If you found this on the web, send
email to <edw...@paleo.org.SPAMNOT>.
These documents -- the FAQ and the software overview -- are available
from the news.answers archives at rtfm.mit.edu. Using anonymous ftp, get
the files:
Unfortunately, faqs.org has not updated reliably for the past several
years, so rtfm.mit.edu is the best source for the latest version.
------------------------------
Subject: What's this newsgroup like?
Posting topics range through emotional support, treatment techniques,
psychological factors, health care practices, and insurance. We talk about
our problems, frustrations, depressions and complications to find out how
others handle the same issues and for mutual support. The atmosphere is
generally a highly supportive one, and most participants believe strongly
that this is an important aspect. As in other parts of the net, there are one
or two regular participants who believe that it is important to question the
motives and/or knowledge of anyone posting a new problem. If you find that
the first response is antagonistic, please wait a few hours. Every
antagonistic response will elicit a dozen sympathetic responses.
Meta-topics include discussions of how to best convey health information on
the Usenet, ethical treatment of other participants, what topics and
information are appropriate for m.h.d, where to find diabetes information,
and what the newsgroup should be like.
Betsy Butler says eloquently:
The positive posts of people who are in great control are very
motivating, but it is also helpful to hear from people who don't find
it so easy. I'm sure there are a lot of people who struggle to keep
control. The people who are having trouble also need to know that there
are others who struggle, and that they are not alone. It can be very
intimidating, and a blow to self-esteem for people to suggest that if
you would just do X, Y and Z, you will be in control. There are 100s of
factors to balance, and I think people need to be reassured that "yes,
it's hard to balance so many things, many of which can't be measured or
that don't act predictably."
Topics closely related to diabetes mellitus which do not have their own place
in Usenet are welcome. Examples are diabetes insipidus, hypoglycemia, glucose
intolerance, legal and employment ramifications of chronic illness, effects
on family members, how family members can best provide support, and so on.
misc.health.diabetes tends to be inclusive of anyone who needs it.
The same caveat applies here as in all newsgroups: the advice is worth what
you paid for it. This applies in spades to a critical health topic such as
diabetes. Never substitute informal advice for a physician's care. Advice
given in m.h.d is *never* medical advice.
The variety of individual responses to diabetes is exceeded only by the
variety of individual responses to life. No two patients respond alike, and
many respond *very* differently from others. These differences are
physiological, not just
...
Archive-name: diabetes/faq/part5
Posting-Frequency: biweekly
Last-modified: 14 July 2005
Changes: see part 1 of the FAQ for a list of changes to all parts.
------------------------------
Subject: READ THIS FIRST
Copyright 1993-2005 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?
Is aspartame dangerous?
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:
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:
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 1993-2005 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?
Is aspartame dangerous?
IN CLOSING (found in all parts)
Who did this?
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
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)
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
...
Archive-name: diabetes/faq/part2
Posting-Frequency: biweekly
Last-modified: 9 December 2007
Changes: see part 1 of the FAQ for a list of changes to all parts.
------------------------------
Subject: READ THIS FIRST
Copyright 1993-2007 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?
Is aspartame dangerous?
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
Costco often have good prices, as do some online order suppliers.
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, so if you are getting strips under insurance, you are
generally safe in using the preferred brand under your plan.
At one time, you could use visually read strips (such as Chemstrip bG)
and cut them in half. This type of strip has mostly disappeared from the
market as of 2007 and the prices on any remaining is high, so this is no
longer a viable option.
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. There is even a brand of strips which
includes a basic meter in the top of each vial; the price is OK and as
far as I know the accuracy is as good as any.
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 don't have such widely advertised deals, though you can probably
find ways of getting them at discount. Decide whether you need a meter
with a lot of extra features or just a basic one. As of 2007, even most
basic meters allow you to download results into a computer.
If you have insurance that pays for strips but not for the meter, you
should not have to pay anything for the meter. Most like it will be
provided to you so that you can use the preferred strips. If not, and if
it's worth the time to you, call the meter manufacturers' customer
service
...
Archive-name: diabetes/faq/part3
Posting-Frequency: biweekly
Last-modified: 10 March 2009
Changes: see part 1 of the FAQ for a list of changes to all parts.
------------------------------
Subject: READ THIS FIRST
Copyright 1993-2009 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?
Is aspartame dangerous?
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:
