Voice of the Diabetic

Voice of the Diabetic, published quarterly, is the national magazine of the Diabetes Action Network of the National Federation of the Blind. It is read by those interested in all aspects of diabetes and blindness. We show diabetics that they have options regardless of complications. We know that positive attitudes are contagious.

Send news items, change of address notices, and other magazine correspondence to: Voice of the Diabetic, 1800 Johnson Street, Baltimore, Maryland 21230; phone: (410) 296-7760; e-mail: editor@diabetes.nfb.org

Find us on the World Wide Web at: www.nfb.org and click on Publications.

Note: The information and advice contained in Voice of the Diabetic are for educational purposes, and are not intended to take the place of personal instruction provided by your physician, or by your health care team. Discuss any changes in your treatment with the appropriate health professionals.

Voice of the Diabetic

Eileen Rivera Ley

Director of Publishing

Elizabeth Lunt

Editor

Suzanne Shaffer

Art Director

Ed Bryant

Editor Emeritus

Gail Brashers-Krug

Director, Special Projects

Ann S. Williams

Contributing Editor

Tom Rivera Ley

Technology Writer

Cover Photo: Ed Bryant standing with an award plaque from the Diabetes Action Network of the National Federation of the Blind. It reads: “Award of Gratitude, Ed Bryant, Editor, Voice of the Diabetic, 21 Years of Distinguished, Dedicated Leadership and Service to the Diabetes Action Network, July 3, 2006, NFB Convention, Dallas, TX.”

Photograph courtesy of Vicki Palmer.

Voice of the Diabetic is published quarterly by the Diabetes Action Network (DAN) of the National Federation of the Blind (NFB). It is read by over 320,000 diabetics and their care-givers who know that with the right information and support, no diabetic has to feel helpless or hopeless, regardless of medical complications. Voice of the Diabetic is available in print, audio, and e-mail versions and is the only magazine that focuses specifically on making life with diabetic complications a lot less complicated.

Voice of the Diabetic: Educate, Empower, Inspire.

Voice of the Diabetic

1800 Johnson Street

Baltimore, MD 21230; phone: (410) 296-7760

www.nfb.org, click on publications

E-mail:

News items: editor@diabetes.nfb.org

Subscriptions & change of address: subscribe@diabetes.nfb.org

To distribute free copies: distribute@diabetes.nfb.org

To advertise: ads@diabetes.nfb.org

Note: The information and advice contained in Voice of the Diabetic are for educational purposes, and are not intended to take the place of personal instruction provided by your physician or by your health care team. Discuss any changes in your treatment with the appropriate health professionals.

Inside This Issue

FEATURE:

Ed Bryant’s Vision Gave Us Our Voice

by Elizabeth Lunt

Diabetes and Heart Health

by Paula S. Yutzy, RN, BSPA, CDE

Don’t Ignore Erectile Dysfunction: It’s Treatable!

by Ed Bryant

Tackling Trans Fats

by Lynn Baillif, MS, RD, LN, CDE

If Blindness Comes

The Unofficial Guide to Low Vision Services

by Eileen Rivera Ley

Pumps Are Possible Even If You Can’t See Them

by Tom Rivera Ley

National Federation of the Blind Annual Convention

Letter to Our Leaders

Tribute to Ed Bryant

by Gary Wunder, President, NFB Missouri

Book Review: The Ultimate Guide to Accurate Carb Counting

Healthy Home Cooking

by Healthy Exchanges

Resource Roundup

Voice of the Diabetic Subscription Form

[PHOTO/CAPTION: Ed at his desk with the Voice. Photo courtesy of Vicki Palmer]

[PHOTO/CAPTION: Betty Walker, Karen Mayry, Ed Bryant, Carol Anderson and Delores Olson—Diabetes Action Network officers at the National Federation of the Blind annual convention, Phoenix, Arizona, July 1987]

[PULL OUT QUOTES: “Life is not hopeless if you have diabetes and blindness is not synonymous with inability. You can always find a way.” — Ed Bryant

“His dedication and commitment are magnificent and unflagging.”

— Dr. Marc Maurer, President, National Federation of the Blind]

Ed Bryant’s Vision Gave Us Our Voice

by Elizabeth Lunt

After 21 years as volunteer editor of Voice of the Diabetic, Ed Bryant has retired. It’s been a labor of love, and his project has grown beyond his wildest dreams. In 1986, he sent out 600 copies of the brand-new newsletter to rehabilitation agencies for distribution. When he retired in 2006, over 320,000 copies were going out each quarter to subscribers and through volunteer distributors to health care facilities, community centers and anywhere people need help managing their diabetes. “It just took off like a rocket,” Ed says. The Voice has been soaring ever since—thanks to Ed’s diligence, dedication and determination to get the word out to fellow diabetics.

Ed, now 62, was diagnosed with diabetes when he was 14. He had perfect vision until he was 30. He was working as the national manager for a portrait photography business when he realized that he was asking his secretary to take dictation on tasks he had always done himself. By the time he made it to an ophthalmologist he had almost no vision in one eye and the other was going fast. The diagnosis: diabetic retinopathy. Although an operation restored vision in one eye, he lost that one about a year later when a friend accidentally poked him. All of a sudden, he was blind. “Of course it was a shock” he recalls. After a pause he adds cheerfully: “The vision was gone, but you have to keep moving in life.”

And move he did, right to a chapter meeting of the Columbia, Missouri, National Federation of the Blind (NFB). Ed had grown up in Columbia and returned from St. Louis when he lost his vision. Gary Wunder, president of the Missouri NFB, recounted in a tribute speech in February, 2007 (see p. 17) that although Ed’s career had been “snatched away,” Ed did not despair where others would have. Gary recalls that Ed’s response to his sudden blindness was: “There are coping skills out there and I’ll learn them.” Once Ed started learning, he was unstoppable.

Ed was learning to manage his diabetes without vision, but it “irked him to no end” that his mother had to come over and draw his week’s supply of insulin. “It was ridiculous,” he says, a trace of impatience still in his voice. Refusing to rely on his mother, Ed set about inventing an insulin-dispensing device that he could use himself. The first version, which his father and brother made for him in a woodshop, was “big and bulky,” but it worked. Today, he uses the Count-a-Dose (available through the NFB) and says he hasn’t found anything better.

Ed is the first to admit that he did not manage his diabetes as well as he could have when he was young. He thinks better control might have prevented some of his complications. But even if you are careful, he says, diabetes can be “mean, nasty and insidious.” Ed firmly believes that people need support to stay with their self-management, which is why he helped to get the Diabetes Action Network (DAN) going and stayed with the Voice for so long. They’re great projects for the NFB, he says, because “there are so many myths in the public about the blindness part of it”—and because so many people lose vision from diabetes.

The link between diabetes and vision loss is why Ed found so much support from within the NFB. “His visionary and devoted leadership in developing and editing the Voice of the Diabetic for years is a true testament to his commitment and care for diabetics throughout the country,” says Dr. Joanne Wilson, Executive Director of Affiliate Action at the NFB. “Ed’s contribution to this important program of the Federation has been second to none. He is one of our most valued leaders.”

Ed’s vision to help people with diabetes became the Voice. In 1985, DAN was brand new, but Ed wanted to spread the word that “life is not hopeless if you have diabetes, and blindness is not synonymous with inability.” He suggested to DAN founder Karen Mayry that they start a newsletter. “Great,” he remembers her saying. “You’re the editor.” And Voice of the Diabetic was born.

Over the years Ed found inspiration in his work from the many voices of his fellow diabetics. He took hundreds of calls and got hundreds of letters. He remembers one woman in particular whose doctor told her that she was going blind and that she would have to stay home and let her husband do everything for her. She called Ed to tell him she knew better than that doctor—from reading the Voice. That’s why he continued; so he could make sure people living with diabetes would know they have options. The NFB is full of people who prove this every day, he points out. “They get to where they want to go,” he says. “You can always find a way.”

But Ed is realistic about the fight. With diabetes, he knows, it can be long and hard. Another reader he recalls was from Argentina and was only able to get dialysis when she visited the U.S. She eventually died because the care in her own country was so poor. Ed was shocked that “she was literally dying and could not get help or service.” Her fate renewed his determination to show people that “here in the U.S. we have the resources,” he says. “People [can] continue to live and enjoy life and take care of their diabetes.”

Many readers wrote and called Ed over the years to thank him for his determination. And NFB and DAN executives sing his praises. “His dedication and commitment are magnificent and unflagging,” states Dr. Marc Maurer, president of the NFB. Tom Rivera Ley, a former DAN president, believes that Ed’s work on the Voice will have a positive impact on people for years to come. “You could only accomplish something that great with true passion,” says Tom, “and Ed has passion for educating people with diabetes.”

Indeed, Ed volunteers at a summer camp for diabetic children where he shows them how to inject their insulin and helps them learn self-management. He also leads by example—his own diabetes is now in good control. Three times a week he goes to a gym where he uses a variety of exercise machines to keep fit. He monitors his diet carefully to keep his blood sugar down. “I tell people to cheat in moderation,” Ed says with a chuckle, “maybe one piece of pie instead of a chocolate cake.” For the most part, he says, he’s doing very well.

So what’s next for Ed? He still writes for the Voice and speaks to people who call for support. He spends time with Gail, his wife of 24 years. He’s developed an interest in Civil War artifacts and just had a large display case built for his home. Gary Wunder has invited Ed to help enlarge the Missouri NFB. Many people want a piece of Ed’s time. One thing is certain: We at the Voice have a tough act to follow. Thank you, Ed.

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Diabetes and Heart Health

by Paula S. Yutzy, RN, BSPA, CDE

Two out of three diabetics will die from a heart attack or stroke, which means cardiovascular disease is more likely to kill you than any other complication of diabetes. I was dismayed to learn that in a recent survey of people with diabetes, many did not even identify cardiovascular disease as a complication of diabetes. Yet your risk, just by having diabetes, is very high. You need to know how to stay on top of this threat to your health. Understanding your test results for what I call the “Three Musketeers” of cardiovascular disease is a must for all diabetics and their caregivers. I encourage you to find a way to be physically active and watch your diet as well. These steps will help you reduce your risks from cardiovascular

disease.

The Three Musketeers

I call these three factors the “Three Musketeers” because where you find one, you often find the others. You need to know them by their descriptions and their numbers.

High Blood Sugar

You know that you need to pay attention to the amount of glucose in your blood. The A1c test indicates your average blood sugar level over the preceding two or three months. The name comes from the fact that the component of blood to which sugar sticks, and can therefore be measured, is called hemoglobin A1c. High blood sugar is generally regarded as an A1c of over 6.5 percent. The American Diabetes Association states the A1c goal for most diabetics is under 7 percent and under 6 percent, if possible, without significant hypoglycemia. Consult your health care provider for an individual goal.

High Blood Pressure

High blood pressure causes stress on blood vessels and contributes to damage that also leads to kidney failure and retinopathy. People with diabetes should be treated to achieve a systolic blood pressure under 130 mmHg and a diastolic blood pressure under 80 mmHg. Many people are on blood pressure medicine, but are not reaching these targets. They should check their own blood pressure with a sphygmomanometer (blood pressure machine) at different times of the day. Automatic and talking sphygmomanometers are available. If you get one of your own, take it to the doctor’s visit with you and have its accuracy verified by comparing the reading to what the doctor gets. Some people have what we refer to as “white coat syndrome” meaning they have an increase in their blood pressure when it is checked at the doctor’s office, but not at home. Keep a record of what you get at home and show it to the doctor when you go to your visit.

High Cholesterol

The cholesterol test measures three types of fats, or lipids, in your blood. You get high cholesterol in two ways: inherit it in your genes if it’s in your family health history, and from the fat in meats, egg yolks and dairy products that you eat.

The most dangerous type of blood fat is the low-density-lipoprotein (LDL). This is often called “bad” cholesterol, because it accumulates in blood vessels and clogs them. High-density-lipoprotein (HDL) is the “good” kind of cholesterol that actually works to remove LDL from the blood. Triglycerides are storage and energy fats, and are the most common fat cells in your body. I frequently see diabetics who have high LDL and triglycerides, and low HDL. This combination increases the risk of cardiovascular disease, and is one you should strive to avoid.

Medications and Diet

There are several medications that can be used to lower the LDL. Statins (e.g. Lipitor, Zocor) are frequently perscribed. Some people have bad reactions to these and get muscle pain or cramping; if this happens to you, notify your doctor immediately. You may need to change to another type of cholesterol medication.

I am amazed by the many people with diabetes who take expensive medication to lower their blood fats and at the same time eat lots of fatty food which raise their blood fats! Every day in my practice I seem to run into someone on cholesterol medicine who eats eggs, sausage and biscuits with butter for breakfast and a burger and fries for lunch or dinner. If you do this you are defeating the efforts of the medication to lower blood fats by choosing to eat these foods.

I am also surprised that many people (frequently men) do not recognize fatty food for what it is. I have devised a simple solution: Put the food on a napkin and walk away. After five minutes, if you see a grease spot on the napkin that food has too much fat and you should choose something else to eat.

Exercise

You should discuss your exercise plans with your doctor before you begin. If you have not had a stress test, ask if your doctor thinks you should. The stress test allows the doctor to see how your heart is working during exercise and can identify problems before they become serious.

Once exercise is considered safe, you now have to decide what kind of exercise you can

do. You will begin slowly and gradually increase your activity. You might go to a gym or get a recumbent bike or stepper for use at home. Chair dancing is good for those who have mobility problems. Put on your favorite music (can’t be a waltz!), sit in a chair without arms and dance with your arms to the music. Move your legs to the beat if you like. You will be surprised how much exercise this can be.

I remember a patient I had years ago. She was a tiny lady of about 70. I described chair dancing to her and encouraged her to try it. When she came back, she told me that she and her 93-year-old mother would sit in the kitchen each morning and “chair dance to the oldies”! They laughed and had a great time. I can just see them in the kitchen dancing and giggling together. She reported that they had not had such fun for a long time.

When you exercise you should warm up for five minutes by stretching and easing into your activity. Bike, walk, swim (or whatever you have chosen) slowly at first. Then increase your speed. An easy way of judging your pace is this: If you can talk while you exercise you are going the right speed. If you can sing “Happy Birthday” you are not going fast enough, and if you can’t get words out, slow down! Some people like to count their pulse, but I think this is easier.

Start exercise sessions with five minutes warm up. Then do five minutes going faster. As you get in the exercise habit, increase the middle exercise time slowly by two to three minutes every few days, until your complete exercise period is at least 30 minutes. This should include cooling down for five minutes by going slower to give your heart time to slow down too.

The Three Musketeers are also known as the ABC’s. Do you know your ABC’s? A is for A1c, B is for Blood Pressure and C is for Cholesterol (see inside heart). The ABC’s are manageable, but I see many who are not managing them as well as they could. A recent report said that only 37 percent of people with diabetes had an A1c under 7 percent, only 36 percent had blood pressure under 130/80 and only 48 percent had total cholesterol under 200 mg/dL. Only 7.3 percent had all three in the control range!

You can improve this situation and decrease the effects of cardiovascular disease. Until we do, two of every three people with diabetes will die of a cardiovascular event. Although heart disease and stroke are the leading causes of death in people with diabetes, they are preventable if you have your ABC’s in control. Keep the Three Musketeers away!

Diabetes ABC’s

A1c under 6.5% or 7%

Blood Pressure under 130/80 mmHg.

Cholesterol, Total under 200 mg/dL

HDL over 40 mg/dL for men and 50 mg/dL for women

LDL under 100 mg/dL, under 70 mg/dL is preferred

Triglycerides under 150 mg/dl

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[PHOTO/DESCRIPTION: A couple embraces]

Don’t Ignore Erectile Dysfuntion: It’s Treatable!

by Ed Bryant

If you are a man with diabetes, we’ve got good news and bad news about your sex life.

The bad news: Men with diabetes are three times more likely to report having problems with sex than non-diabetic men. The most common sexual problem is Erectile Dysfunction, or ED, sometimes called impotence. Even worse, because ED is such a private issue, many men feel embarrassed to discuss the problem with their doctor, or even their partner, so the problem is never addressed.

The good news: ED is one of the most treatable complications of diabetes. In fact, over 95 percent of cases can be successfully treated. With proven treatments available, diabetic men with ED have options. It isn’t something you—or your partner—should have to live with.

What ED Is—and What It Isn’t

ED means the repeated inability to achieve or sustain an erection sufficient for sexual intercourse. Although sexual vigor generally declines with age, a man who is healthy, physically and emotionally, should be able to produce erections, and enjoy sexual intercourse, regardless of his age. ED is not an inevitable part of the aging process.

ED does not mean:

• An occasional failure to achieve an erection. The adage is true: It really does happen to everyone. All men experience occasional difficulties with erection, usually related to fatigue, illness, alcohol or drug use, or stress. It isn’t fun, but it is totally normal.

• Diminished interest in sex. ED occurs when a man is interested in sex, but still cannot achieve or maintain an erection. Many men with diabetes also experience a decreased sex drive, often as a result of hormone imbalances or depression. Decreased sex drive is quite treatable, but it is treated differently from ED.

• Problems with ejaculation. Such problems often indicate a structural problem with the penis. The most common treatment is surgical.

How Diabetes Causes ED

Human sexual response requires several different body functions to work properly and together: nerves, blood vessels, hormones, and psyche. Unfortunately, diabetes—and even the treatment for diabetes—can affect many of these functions.

• Nerves: One of the most common complications of diabetes is neuropathy, or nerve damage. Erection is a function of the parasympathetic nervous system, but orgasm and ejaculation are controlled by the sympathetic system. Neuropathy to either system can cause ED.

• Blood Vessels: Diabetes damages blood vessels, especially the smallest blood vessels such as those in the penis. Diabetes can also cause heart disease and other circulatory problems. Proper blood flow is absolutely crucial to achieving erection. “Erection is a hydraulic phenomenon that occurs involuntarily,” says Arturo Rolla, MD, of Harvard University School of Medicine. “Nobody can will an erection!” Anything that limits or impairs blood flow can interfere with the ability to achieve an erection, no matter how strong one’s sexual desire.

• Hormones: Diabetes often causes kidney disease, and kidney disease, in turn, can cause chemical changes in the type and amount of hormones one’s body secretes, including the hormones involved in sexual response.

• Psyche: Psychological issues can cause a diminished sex drive, but they can also lead to ED even when sex drive is fine. ED can follow major life changes, stressful events, relationship difficulties, or even the fear of ED itself. The physiological changes associated with fear can themselves cause ED!

• Medications: About 25 percent of ED cases are caused by drugs. Many medications, including common medicines prescribed for diabetes and its complications, can cause ED. The most common offenders are blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug). In addition, over-the-counter medications, including certain eye drops and nose drops, have been associated with ED. That does not mean you should stop taking these medications! Rather, you should discuss them with your doctor to determine whether a different dosage, an alternate medicine, or additional treatments will resolve the ED.

Treatments for ED

ED is easily and successfully treated! If your sex drive is unaffected, but you experience problems achieving or sustaining erection for a period of four to five weeks, you may have ED. Talk to your doctor immediately. Don’t delay—erectile dysfunction doesn’t “just go away!” Additionally, ED could be a sign of a serious, even life-threatening complication, such as congestive heart failure or kidney disease. Ignoring your ED because it’s embarrassing could jeopardize your health.

Most men seek treatment from their family doctor, who may or may not be familiar with the range of treatment options. A specialist may be a better choice. Specialists include urologists and doctors practicing at ED treatment centers.

A thorough physical exam and medical history, along with certain laboratory tests, can help your doctor determine what is causing ED, and then choose an appropriate treatment. The most common treatments for ED fall into four categories: medications, external mechanical devices, counseling, and surgery.

Medications:

Oral medicines: The best known ED medications are the Big Three: Viagra (sildenafil citrate, made by Pfizer, Inc.), Levitra (vardenafil HCl, made by Bayer and GlaxoSmithKline), and Cialis (tadalafil, made by Eli Lilly). The three are chemically very similar, and all have proven very effective. Because they are effective, convenient, and relatively inexpensive (about nine dollars per pill), these medicines have become the treatment of choice for most men experiencing ED.

The main difference among the three is in how long they last. Viagra is supposed to work for between 30 minutes and four hours; Levitra for 30 minutes to two hours, and Cialis for up to 36 hours. In addition, Viagra is slightly less effective if taken with food; Viagra can also cause temporary abnormalities of color vision.

In some cases, however, these drugs may be unsuitable for patients with heart disease. If you are considering one of these drugs and you have heart disease, as many diabetics do, be sure to tell your doctor. In rare cases, the pills may create “priapism,” a prolonged and painful erection lasting six hours or more (although reversible with prompt medical attention).

Topical medicines: When the problem is insufficient blood flow, vasodilators (such as nitroglycerine ointment) can be applied to the penis to increase penile blood flow and improve erections. The main side effect of nitroglycerine ointment is that it may give the partner headaches. To prevent this, the man should use a condom.

Penile Injection Medication: This is just what it sounds like. Injected at home directly into the penis, the medication alprostadil produces erection by relaxing certain muscles, increasing blood flow into the penis and restricting outflow. Although some sources report an 80 percent success rate, the therapy has disadvantages, such as risks of infection, pain, and scarring—fibrosis—in the penis, and it may also cause priapism. A popular version of this medication is Upjohn Corporation’s Caverject. The MUSE System, by VIVUS, involves the same medicine (a pellet of alprostadil) applied with an eye-dropper-like applicator, directly into the urethra.

External Mechanical Devices:

This category of treatments includes external vacuum therapies: devices that go around the penis and produce erections by increasing the flow of blood in, while constricting the flow out. Such devices imitate a natural erection, and do not interfere with orgasm. External vacuum therapy mechanisms are approximately 95 percent successful in causing and sustaining an erection. All are portable, and costs range between $200-$500, covered under most insurance plans and Medicare Part B.

The vacuum constriction device consists of a vacuum cylinder, various sizes of tension rings, and a vacuum pump, either hand-operated or electric. The penis is placed in a cylinder to which a tension ring is attached. Air is evacuated from the cylinder by means of the pump, creating a vacuum, which produces the erection. The cylinder is removed, leaving the tension ring at the base of the penis to maintain the erection.

Vacuum therapy devices have a few disadvantages. One must interrupt foreplay to use them. You must use the correct-size tension ring and remove it, to prevent penile bruising, after sustaining the erection for 30 minutes. Initial use may produce some soreness. Such devices may be unsuitable for men with certain bleeding disorders. In general, vacuum constriction devices are successful in management of long-term ED.

“Rejoyn” is an inexpensive, nonprescription alternative to the vacuum-actuated devices. Described by its manufacturer as a “support sleeve,” it does not “cause” an erection, but rather supports the flaccid penis as if it were erect (one wears it under a condom).

Counseling:

The great majority of ED cases in diabetic men have a physical cause, such as neuropathy or circulatory problems. In some cases, however, the cause of ED is psychological, including depression, guilt, or anxiety. With a thorough exam, the doctor should be able to determine whether the ED is psychological or physical in nature. If the cause is psychological, your doctor may refer you to a psychiatrist, psychologist, sex therapist, or marital counselor. Do not view such a diagnosis as an insult. Most psychologically-based ED is easily and successfully treated.

Surgery:

There are two kinds of surgery for ED: one involves implantation of a penile prosthesis; the other attempts vascular reconstruction. Expert opinion about surgical implants has changed during recent years; today, surgery is no longer so widely recommended. There are many less-invasive and less-expensive options, and surgery should be considered only as a last resort.

The obvious risks are the same that accompany any surgery: infection, pain, bleeding, and scarring. If for some reason the prosthesis or parts become damaged or dislocated, surgical removal may be necessary. With a general success rate of about 90 percent, any of the devices will restore erections, but they will not affect sexual desire, ejaculation, or orgasm.

Prostheses: Many different types of penile prostheses are available, in three categories: rods, inflatable prostheses, and self-contained prostheses. Semi-rigid or malleable rods are the simplest and least expensive of all. Their main disadvantage is that the penis remains constantly erect, which may cause problems with concealment.

Inflatable prostheses are complex mechanical devices that imitate the natural process of erection. Parts are inserted surgically into the penis and scrotum, and activated by squeezing. When erection is no longer desired, a valve on the pump is pressed, and the penis becomes flaccid. Self-contained single-unit prostheses are similar to the inflatable types, but more compact. The entire device is implanted into the penis. When erection is desired, the unit is activated by either squeezing or bending, depending on which of the two types of self-contained prostheses is used.

Vascular Reconstructive Surgery corrects defects in penile blood vessels. The surgeon may reconstruct the arterial blood supply, or remove veins when the cause is due to leakage. Less than five percent of men with ED may benefit from vascular surgery.

Preventing ED

Like all diabetic complications, ED can occur even when you have followed your doctor’s advice and carefully managed your diabetes. Also like all diabetes complications, ED is less likely to occur with good blood sugar control. Poorly controlled diabetes and high cholesterol increase the chances of vascular complications, which may lead to ED or other circulatory problems. In addition, regular smoking and alcohol use can contribute to ED.

You are not alone; others have faced these difficulties. ED is treatable; you do have options!

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Tackling Trans Fats

by Lynn Baillif, MS, RD, LN, CDE

You may have heard that trans fats are going to be banned in certain states and cities as a public health measure. The following will help you understand what these fats are and why you should minimize them in your diet.

What are trans fats?

Trans fats are manufactured by adding hydrogen to liquid vegetable oil. The result is a product that is solid at room temperature. You may have seen the terms “hydrogenated” or “partially hydrogenated” on food labels. This means the product contains trans fat.

How do trans fats affect my health?

We used to believe that trans fats were a heart-healthy alternative to saturated (animal) fats. Years ago you may have been encouraged to switch from stick butter to stick margarine. However, a growing body of scientific evidence has shown that this is untrue. Trans fats increase the risk of heart disease by raising LDL (“bad”) cholesterol and lowering HDL (“good”) cholesterol thus changing the ratio of HDL to LDL in the body. The Harvard School of Public Health estimates that 30,000 premature cardiovascular deaths per year could be prevented by replacing trans fats in the food supply with liquid vegetable oil (unsaturated fat).

Why are trans fats used in food?

Trans fats were developed in the early 1900s as a low-cost alternative to butter. They are frequently used in packaged food products because of their extended shelf life. This means the cookies, crackers and chips in your cabinet will last longer without becoming rancid. If you look around your kitchen you may find vegetable shortening (like Crisco) and stick margarine, which are both high in trans fats. They have a longer shelf life than butter, which contains no trans fat. You can keep the can of vegetable shortening on your shelf for 1 year. Margarine will keep in your refrigerator for six months compared to one to three months for butter.

What foods have trans fats?

Although stick margarine is high in trans fat, its use accounts for only one-third of the trans fat intake in the American diet. The vast majority of the trans fat we eat comes from fast food, commercial baked goods and other prepared foods. For example, a donut has approximately three grams of trans fat and a large order of french fries has approximately seven grams of trans fat. So you can see how easy it is for you to consume the eight grams of trans fat each day that is the average intake for Americans.

How do I know if there are trans fats in foods I buy at the grocery store?

As of January 1, 2006, the Food and Drug Administration has required manufacturers to include trans fat on the nutrition facts label. You will find it listed underneath total fat. Products can be labeled as zero grams of trans fat if they contain less than .5 grams trans fat per serving. So, you may see partially hydrogenated oil on the ingredient list even though the label states zero grams of trans fat. In such a case, be careful. If you eat a large amount of the product your trans fat intake can add up.

Can I continue to eat trans fats?

According to the American Diabetes Association 2007 Nutrition Recommendations and Interventions for Diabetes, you should minimize your consumption of trans fats. Although there are trace amounts of trans fats which occur naturally in beef and dairy products, there is no need to avoid these foods since the amounts they contain are

negligible.

Should I use margarine or butter?

The answer depends on how often you use it and for what purpose. If you rarely use butter or margarine, having whichever you prefer is fine. Otherwise, it is a good idea to explore this question. Light butter has less unhealthy animal fat than stick butter while tub margarine has less trans fat than stick margarine. As a spread, tub margarine with water or liquid vegetable oil as the first listed ingredient or labeled as “no trans fat” is a wise choice. If your goal is to prevent food from sticking to a pan while cooking or baking you can use a vegetable oil cooking spray or nonstick pans so you do not need to use butter or margarine. When flavoring vegetables, potatoes, popcorn or other foods, try a butter-flavored powder like Butter Buds. It contains no fat. If you prefer the flavor of butter in your homemade baked goods, try using half light butter and half regular butter for the fat in the recipe. You can also decrease the fat in the recipe by one-third without changing the texture of the finished product. Another option when baking is to use a fruit puree (applesauce, mashed banana or baby food prunes) to replace up to three-quarters of the fat in the recipe. But remember this will increase the carbohydrate content of the finished product.

What else can I do to avoid trans fats?

When dining out, ask what type of fat is used in preparing your food. Some establishments are making an effort to reduce their use of trans fats. For example, McDonald’s now uses an oil for cooking french fries that contains no trans fats. Marriott International has undertaken a company wide program to rid its hotel restaurants of trans fats without compromising food quality. However, it is important to remember that even if fried foods and baked goods are made without trans fats, they are still often high in total fat content. We will talk about how to manage your overall fat intake in a future column.

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IF BLINDNESS COMES…

Welcome to the Voice’s newest feature. If Blindness Comes is a special pull-out section on diabetes and vision loss, printed in a larger font. If you know someone living with diabetes and vision loss, please pull this section out and share it.

This issue of If Blindness Comes...is sponsored by a generous educational grant from GlaxoSmithKline.

[PHOTO/Description: A man uses a magnifier to read a notice.]

The Unofficial Guide to Low Vision Services

by Eileen Rivera Ley

Many people with diabetes experience some vision loss, and getting help can be confusing. For some, the loss comes from retinopathy; for others the culprit may be macular degeneration or glaucoma. While causes and severity vary, the solution may be the same—low vision services. There are excellent resources for people who are neither fully blind nor fully sighted, and I hope the following will answer your questions about them.

Q: What exactly is low vision?

A: You have low vision if your best corrected visual acuity is 20/70 or less. You are not “legally blind” until visual acuity drops to 20/200 or less. (Incidentally, someone who has no vision is also “legally blind.”) But those numbers don’t tell the whole story. Visual field loss and blind spots have profound effects on vision. For example, a blind spot obscuring your central field can make reading regular print nearly impossible, even if your visual acuity is 20/20. Specially trained low-vision optometrists will evaluate functional vision beyond visual acuity.

Q: Who uses low-vision services?

A: Anyone with deteriorating or permanently damaged vision. The typical patient is a senior with macular degeneration—the main cause of blindness. Since diabetes is the second-leading cause of blindness, however, low vision practitioners see many people with diabetes. They therefore know that diabetes self-management goals like measuring insulin and reading your meter are as important as reading your bills, price tags, or computer.

Q: Who provides low-vision services?

A: Optometrists. They spend four years learning about the eye, lenses and visual function, and some get extra training in low-vision services; they will know the most about prescribing specialized low-vision lenses and devices. Ophthalmologists are medical doctors who specialize in the health of the eye; they examine all parts of your eyes, prescribe medications, and do surgery. Many can test you for lenses and give you a prescription for glasses, but optometrists are the optical experts. You need to see both specialists: your optometrist to help you cope with your low vision and your ophthalmologist for your eye disease.

Q: What are the goals of low-vision services?

A: You and your practitioner will determine these together. What is most important to you? Checking a price tag in the store, studying a road map, reading the nutrition label, sorting mail, looking up a phone number, and viewing a theatrical performance are the types of things you might ask about. Finding the right low-vision tools will take time. Usually, the specialist will explore the optical alternatives first by assessing reading, writing, distance viewing, mobility, and lighting options.

Q: What is the Best Way to Work with My Low-Vision Specialist?

A: Ask questions, and make sure your specialist knows you want to hear all the options. Sometimes low vision specialists feel pressured to recommend only visual solutions because they know how much you want to see. Ask them to recommend anything they think will help you function best, whether their recommendation makes use of your eyes, your ears, or your sense of touch.

Q: How Difficult is Reading with Magnification?

A: You may need a variety of magnification devices to accomplish your goals, as they tend to be task-specific. In prescribing a reading device, the practitioner must balance the tradeoffs among magnification levels, fields-of-view, and working distance. The stronger magnifiers require you to be one inch from the lens, a less-than-comfortable position for sustained reading. Powerful magnifiers also tend to have a small field-of-view and can enlarge only a few characters at a time. These constraints may reduce reading speed.

A trained low vision specialist will systematically evaluate your reading by measuring speed and accuracy at different print sizes and documenting the print size of the last good reading. Then the specialist will select a magnification system that converts actual print size to the size you can see most clearly.

Endurance is perhaps the most important factor in determining an optimal reading system. Rarely will a low-vision device enable you to curl up comfortably with a book and read for hours. If the only way you can read unaided is by holding a book up to your nose, chances are that the reading system will become more cumbersome and inadequate as time progresses. This is true even when your visual condition is reported as stable.

Q: What are Low Vision Recommendations?

A: Low vision optometrists will provide you with a shopping list of choices, usually ranging in price and effectiveness, that they think will help you the most with your pre-determined goals. They should explain the pros and cons of specific systems and introduce non-visual options as needed. If you don’t understand, ask questions. If information is missing, ask questions. For example, you may be offered lighting advice for your home, but will need to ask about a plan for times when lighting is not in your control. The low vision optometrist should be realistic about the ease of use, practicality, and comfort level of a prescribed device.

If you have progressive retinopathy you may find low-vision services frustrating, because prescribed devices may quickly become ineffective as your condition gets worse. In such cases, you should evaluate whether your time and resources might be better spent in refining non-visual skills such as typing, Braille, and cane travel.

Q: How Can I Be a Wise Consumer of Low Vision Services?

A: Think about your needs, and insist on getting help. The fact that vision enhancement is technically feasible doesn’t automatically make it a good idea. Ask yourself if a low-vision optical system will meet your needs at home and at work. Consider the ergonomics (working conditions) of a device. Will using the device give you a headache, back pain, or eye strain? Understand the field-of-view limitations and necessary lighting conditions. Consider portability. Will you need training to use the device? Ask about the usefulness of the device as vision fluctuates, a common complaint of people with diabetes. Selecting low-vision devices is highly individual. During your comprehensive low vision evaluation, ask your provider to lend you a device to test at home (this may not always be feasible).

Also consider economics. For example, telescopic lenses are a big-ticket low-vision device and they definitely work. Many people with low vision keep a telescope handy for occasional spotting tasks, but they are expensive. Is the investment warranted? How much benefit will you gain from the device compared to the cost? Are there community resources that might assist with the cost? Sometimes state vocational rehabilitation services and groups like the Lions Clubs can help.

Keep in mind that visual goals change as technology changes, so plan to return to the low-vision center every few years to see what’s new. You may be pleasantly surprised, as I was when I first saw the hand-held CCTV (electronic magnification) products.

Part of being a satisfied consumer is to understand your own needs and limitations, as well as the available options. Keep traditional low-vision solutions in perspective; many low-vision people never learn to make the most of their other senses, so they cling to their visual solutions, reducing overall efficiency. If you are significantly visually impaired or are legally blind, consider non-visual techniques for reading, such as audio books. Even if non-visual strategies are your second choice today, familiarity with them will serve as an excellent resource in later years. Having a full range of alternative techniques is always your best bet.

You can learn more about your options and meet others with diabetes and low vision by contacting the Affiliate Action Office of the National Federation of the Blind, at (410) 659-9314.

The NFB Diabetes Action Network (NFB DAN) will hold its annual meeting July 2, 2007, in Atlanta, Georgia. The NFB DAN, which publishes Voice of the Diabetic, is a peer support and action group for diabetics experiencing complications of their illness. The annual meeting will be held in conjunction with the annual convention of the National Federation of the Blind.

The NFB DAN meeting promises to be exciting and informative. This year’s theme is “Lose to Gain.” “We all know that we should lose weight, but most people don’t know that taking off just a few pounds can really improve your diabetes management,” noted NFB DAN president Lois Williams. Glenda Somerville, a Certified Diabetes Educator, will be the featured speaker, providing practical advice about losing weight and managing diabetes.

In addition, the Voice of the Diabetic team will discuss recent changes in the magazine and their plans for even more improvement over the coming year. Voice Director of Publishing Eileen Rivera Ley encourages all readers to attend: “We love hearing from our readers! Help us make the Voice great. There’s lots of fun to be had. It’s wonderful to see other diabetics who are thriving, despite complications, with the support and encouragement of fellow travelers. I hope to meet you there!”

The NFB DAN Meeting will be held in Atlanta, Georgia, on Monday, July 2, 2007, at the Marriott Marquis Hotel, 265 Peachtree Center Avenue. For registration information, contact the NFB DAN at (410) 659-9314 or on the web at www.nfb.org/voice. For reservations at the Marriott Marquis, call (888) 218-5399.

Optical Devices

Reading glasses

Magnifiers

Telescopes

Binoculars

Electronic Magnifiers (CCTVs)

Computer magnification software

Non-Optical Devices

Bold line paper

Felt tip markers

Large-print books

Jumbo-print playing cards

Adapted board games

Large checkbook and registers

Non-Visual Devices

Talking and Braille watches

Talking blood glucose meters

Talking thermometers

Books on Tape

Self threading needles

Talking calculators and clocks

Computer screen readers

Long white canes

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Pumps Are Possible Even If You Can’t See Them

by Tom Rivera Ley

Have new designs made insulin pumps more accessible to those of us who cannot depend on our sight to read their small screens? The answer is a resounding no. Should blind and visually impaired diabetics avoid using pumps? Again: a resounding no.

The number of pump users has grown from around 10,000 in1990 to an estimated 250,000 users worldwide in 2006. Competition in this exploding market has been good for consumers, sparking advances in pump technology and ease of use. Some are even kid friendly. Kid friendly, you ask? Yes. Many school-age children with type 1 diabetes now use insulin pumps by themselves. In an effort to target this life-long market, manufacturers have focused on smaller size and hip new colors and patterns. And pediatric endocrinologists are now prescribing pumps for parents to use with their diabetic children who are as young as two years old.

New features include:

• Lots of stylish colors

• Smaller size

• Wizards to assist in calculating the mealtime bolus

• Wizards to assist in calculating a high blood sugar correction bolus

• Added safety features, such as waterproofing

• Ease-of-use enhancements, such as menu-driven programming

But Voice of the Diabetic readers may recall numerous articles over the past decade outlining the inaccessible features of these devices. Unfortunately, even with all of these useful (or cosmetic) advances, pump manufacturers continue to ignore our voices pleading for an accessible pump.

Almost all pumps on the market today offer a way to administer a mealtime or correction bolus accurately without seeing the pump screen, but this is no advancement from a decade ago, as insulin pumps in the 1990’s also had this feature. What’s worse, nearly all of the new advances in convenience and safety, such as the bolus wizards, variable bolus deliveries and more powerful basal features are completely inaccessible without the ability to read the pump screen.

I am greatly disappointed as each new insulin pump comes to market without addressing the accessibility issue. But the good news is that the new models are no less accessible than the old. If you want to take advantage of the unique benefits of an insulin pump over a multiple daily injection (MDI) regimen, you can, with very little sighted help at first.

I am totally blind and have used an insulin pump successfully for nearly a decade. It offers greater control in preventing low blood sugar and added convenience when I’m on the go. Also, the pump is the only way I can match my basal insulin delivery to the peaks and valleys caused by the Prednisone I take daily. I do need sighted assistance to set the time/date, preferences and basal profiles. But once I have set those, I manage daily operation without assistance. This includes bolus administration, changing the batteries, and replacing insulin and infusion sets. I am very happy with my pump and plan to continue using it. I must assure you, however, that as soon as a manufacturer decides to make a truly accessible insulin pump, I will immediately change to that pump and will announce it boldly and loudly to all diabetics I know.

I am confident that sooner or later, and hopefully sooner, a company will produce an accessible insulin pump. It is the right thing to do, and it is the smart business thing to do as well. The National Eye Institute (NEI) states that 40 to 45 percent of diagnosed diabetics have some level of diabetic retinopathy. Furthermore, diabetics are living longer and healthier lives than ever. So even if diabetic retinopathy were not an issue, glaucoma, cataracts and age-related macular degeneration will be. And the fact is that nearly all pump users would benefit in some way from pumps that you don’t have to see to use. Turning on a light is not always convenient or desired, and poor lighting abounds. Pulling out your pump is not always physically or socially convenient. Many diabetics experience fluctuating vision: fine one day, relatively poor the next. Most pump users encounter one or more of these circumstances routinely, and all would benefit from an accessible pump.

So, which company will finally listen to our voices and make the smart business decision? Who will create a fully accessible pump? Only time will tell, but the first producer stands to reap rich harvests of loyal new customers, good will, positive press, and competitive advantage. Until then, I will make do with my semi-accessible model, which does allow for good self-management while I wait!

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National Federation of the Blind Annual Convention

In addition, the Voice of the Diabetic team will discuss recent changes in the magazine and their plans for even more improvement over the coming year. Voice Director of Publishing Eileen Rivera Ley encourages all readers to attend: “We love hearing from our readers! Help us make the Voice great. There’s lots of fun to be had. It’s wonderful to see other diabetics who are thriving, despite complications, with the support and encouragement of fellow travelers. I hope to meet you there!”

Will you need dialysis in Atlanta?

If so, have your home dialysis unit contact a unit in Atlanta well in advance. You can work with your social worker or unit coordinator for reservations. Information on dialysis centers in every state is available at 1-866-889-6019 or at www.dialysisfinder.com. Remember, you must have a transient patient packet and completed physician's statement when you arrive for dialysis.

Diabetes Action Network Annual Meeting

Featuring:

• “Lose to Gain” theme

• Information about the latest technologies for diabetes management

• An extensive exhibit hall

• Special recognition for anyone whose A1c is less than seven for our “Less Than Seven by 7/07” initiative

• A chance to connect with other diabetics experiencing complications

• The annual election of NFB DAN officers

NFB Convention is Really a Reunion

by Anil Lewis

As I was growing up, the third Sunday in August was always rejuvenating because my extended family from around the country came to my grandmother's little house in Woodville, Georgia, for our family reunion.

Fortunately for me I have another extended family, and from June 30 through July 6, 2007, approximately 3,000 of my sisters, brothers, aunts, uncles, nieces, nephews, and cousins will be attending the largest family reunion of blind people in the country. Most refer to this week of fun and fellowship as the annual convention of the National Federation of the Blind!

This year Tour Day falls on Independence Day, Wednesday, July 4, and there is so much to do in Atlanta! The Marriott Marquis is only a few blocks from Centennial Park, which is sure to have an outstanding Independence Day celebration. Also the Georgia Aquarium and the new Coca-Cola Museum are in walking distance of the hotel. Conventioneers will be a short MARTA train ride away from Underground Atlanta or Lenox Square, which, in addition to being a wonderful shopping experience, will provide an entertaining atmosphere on the holiday. The Georgia affiliate is arranging transportation for those who would like to visit the Martin Luther King Jr. historic site or the Carter Center Library.

Even as we make plans to have a grand old time, we must remember the real reason for the reunion. A full agenda of presentations will cover an array of issues that are important to the nation's blind. Our national-office staff will no doubt have a mix of training sessions on advocacy, self-determination, and strategies for collective action that will educate and empower. The convention provides a real opportunity to remind ourselves and others about the true potential of the blind. I can't wait to see y'all in Atlanta.

Join us in Atlanta!

June 30 - July 6

To register, visit www.nfb.org or call the NFB at 410-659-9314.

The 2007 convention of the National Federation of the Blind will take place in Atlanta, Georgia, at the Marriott Marquis Hotel at 265 Peachtree Center Avenue, Atlanta, Georgia 30303. For room reservations call (404) 521-0000 or 888-218-5399.

The Marriott has several excellent restaurants and features indoor and outdoor pools, solarium, health club, whirlpool, and sauna. Convention room rates are: singles/doubles, $61; triples/quads, $66 per night, plus a 15 percent sales tax. The hotel is accepting

reservations now. A $60-per-room deposit is required. Fifty percent of the deposit will be refunded if you cancel your reservation before June 1, 2007. The other 50 percent is not refundable.

Rooms will be available on a first-come, first-served basis but the special rates will not be available after June 1, 2007.

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Letter to Our Leaders

Drs. Maurer & Wilson:

I am a current member of the National Federation of the Blind here in the wonderful state of Nebraska. I was recently diagnosed with type 2 diabetes, and began treatment including medication, diet changes and exercise. Upon discovering that checking my blood sugar would be a regular thing, I joined the Diabetes Action Network (DAN) and the diabetes talk list on NFBnet.

Let me tell you what I have gained in just a short time of involvement with this wonderful group of people:

1. Information:

Carb counting was new territory for me; planning balanced meals a new frontier. I knew I needed a map (of sorts) for navigating this new territory. The people on the diabetes list referred me to articles from Voice of the Diabetic that had the very information I needed for planning meals, among other things. I found articles on finger-sticking techniques (for doing the blood sugar checks on a glucometer) and even dealing with stress. There is a wealth of information to be found in Voice of the Diabetic, and I’ve only scratched the surface.

2. Support:

I admit, despite knowing that diabetes is in my family, I took the diagnosis very hard. Upon joining the diabetes talk list, I found immediately a network of people who (because of their love, encouragement, camaraderie, understanding and so much else) is more aptly described as a family...much like the Federation as a whole. In fact, I’ll go so far as to say that the DAN is a family within the Federation family. I say this because they have shown love and support and affirmed me at times I felt afraid (especially of the finger sticking), and reminded me that it’s okay to be afraid, but it’s what you do with that fear—how you handle that fear—that matters. I…wish that I… [could] meet these people in person and give each and every one of them the biggest bear hug my six foot frame would allow.

Thank you for taking the time to read this. I felt it important for you to know just what the Diabetes Action Network and Voice of the Diabetic means to someone like me.

Sincerely,

Alan Wheeler

Editor’s notes: Dr. Marc Maurer is President of the National Federation of the Blind; Dr. Joanne Wilson is Executive Director for Affiliate Action. To join the National Federation of the Blind/Diabetes Action Network chat list via the World Wide Web, visit http://www.nfbnet.org/mailman/listinfo/diabetes-talk or, via email, send a message with subject or body ‘help’ to diabetes-talk-request@nfbnet.org. You can reach the person managing the list at diabetes-talk-owner@nfbnet.org.

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Tribute to Ed Bryant

February 10, 2007

by Gary Wunder, President NFB Missouri

People come to blindness in different ways—some by birth, some by accident, some by age, but many by medical conditions we can’t yet prevent. Not only do people come to blindness differently, but they react to it differently as well. Some view it as a tragedy which soon becomes their reason to have someone else do all of the work which should be theirs. Others come to think of blindness as a disadvantage but one they can use to their benefit: “I’m blind; I can stay home; this misfortune, as bad as it is, has given me a life-long income, so I’ll enjoy the internet, my music, I’ll become an expert on Ebay.” Again, the message is the same: “I’ll let someone else take care of me.”

Ed, as much as anyone, had these options. Not only did blindness take his vision, but it took his livelihood. I know blind people who enjoy photography, but I don’t know any blind photographers, and this is the profession blindness snatched away from our friend.

So, how did he react? He looked at blindness and said: “There are coping skills out there and I’ll learn them.” He looked at the source of his blindness, diabetes, and again he said: “There are coping skills out there and I’ll learn them.” What he did next is the reason we’re here today. He didn’t stop with learning and inventing skills—he decided to share them. Share them with his family and friends? No, not Ed—our friend decided if he had skills to share, he’d share them with the world, and what better way to do that than through the written word?

In his quest for a partner to help in this sharing, Ed found an ally in the National Federation of the Blind, and together they started a publication which has been the voice of hope for many who feared their lives were over. Through Ed’s voice, and the voices of hundreds of his fellow travelers, people have learned that blindness and diabetes don’t have to mean living in a nursing home or forever depending on someone else to draw and administer medication, fix meals, do laundry, and carry on all the life activities many of us take for granted.

To the man who could have retired 20 years ago and considered himself deserving of pity and care, we today come to say “Thank you for charting a different course.” To the man who has taught so many to use a needle, and who has needled so many of us, diabetics or not, to do more than we would otherwise do, we meet here today to tell you how much you mean to all of us.

And now that much of your work is over in starting and running the publication so aptly named The Voice, I come to recruit you for yet another Federation task—help us grow the NFB of Missouri in the same way you have helped to grow the Diabetes Action Network. You deserve the right to retire but we hope that you'll pass on that, as you did once before, and start another phase of changing what it means to be blind.

Members of the NFB in Columbia, Missouri, gave a party to honor Ed Bryant on February 10, 2007. Gary Wunder, president of the NFB of Missouri, delivered this speech at the event.

Book Review: The Ultimate Guide to Accurate Carb Counting

If you administer mealtime insulin, being off by 10 or 15 carbs can make a difference. But carb calculations can be complicated. Does “sugar free” mean “no carbs”? How does fiber content affect carb count? What is the glycemic index, anyway? And how does that exchange list work?

Gary Scheiner, type 1 diabetic and certified diabetes educator, answers these questions and many others in his new book, The Ultimate Guide to Accurate Carb Counting. Scheiner writes with a witty and engaging style that makes reading a pleasure as he takes an in-depth look at all aspects and theories behind carb counting. He explains how to understand food labels, make estimates for unlabelled foods, and cope with eating out. Four “Tool Kits” entitled: Exchange Lists, Carbohydrate Factors, Glycemic Index Values and Carb Listings (for 2,500 foods) round out the excellent information in this very useful book. Scheiner makes a sometimes-complicated subject as simple as pie (apple, small slice = 46 carbs).

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Healthy Home Cooking

by Healthy Exchanges

Hi! Thanks for joining us in the kitchen again, where the cooking is easy and the food is both healthy and tasty! Enjoy!

Are you trying to reduce your sodium intake? Good for you; you’re doing the right thing. Lowering your sodium will help drop your blood pressure and benefit your cardiovascular system. On average, you should consume less than 2,300mg of sodium per day. Foods with 200mg of sodium or more per serving are considered high-sodium, foods with less than 140mg per serving are low-sodium.

Here are some foods that you may not have thought of as high-sodium foods.

Deli meat: 1oz – 396mg or more

Packaged pudding mix: 1/2 cup serving made with milk – 470mg

Ketchup: 1 tablespoon – 167mg

Soy sauce: 1 tablespoon – 1029mg

Canned soup: 1 cup – 1000mg

Chili: 1 cup – 1200mg

TV Dinner: 1150mg

Pizza: 1 slice – 900mg

To help maintain a low salt intake try some of the following tips:

Don’t use salt at the table, and reduce the salt used in food preparation. Try 1/2 teaspoon when recipes call for 1 teaspoon. Many cakes and desserts can be prepared without adding salt. Use herbs and spices for flavoring meats and vegetables instead of salt. If you prefer a pre-mixed spice blend make sure it does not include salt. Avoid salty foods such as processed meats (deli), pickles, soy sauce, salted nuts, chips and other snack foods.

Three more salt-reducing quick tips to keep in mind in the kitchen: Don’t add salt to dried beans before you cook them as it will prevent them from getting soft. Don’t salt meat or a roast as you’re browning it. Salt draws out moisture so it will stay more moist if you leave salt out of the process. And finally: If you mistakenly add too much salt to a dish you’re preparing, drop in a potato and continue cooking. The potato will help to absorb the extra salt.

Now for our Recipe Low-Salt Makeovers:

MP of IA sent this recipe to be revised from a 50’s recipe into a recipe of today, using the great food items that are now available in the grocery store.

CONGEALED AMBROSIA SALAD

1 (4-serving) package JELL-O sugar-free orange gelatin

1/2 cup Splenda Granular

1 cup boiling water

1 (8-oz) can crushed pineapple, packed in fruit juice, undrained

1/2 cup no-fat sour cream

1/2 teaspoon coconut extract

1 (11-oz) can mandarin oranges, rinsed and drained

1 (8-oz) can pineapple tidbits, packed in fruit juice, drained

1/4 cup flaked coconut

1/4 cup chopped pecans

In a large bowl, combine dry gelatin, Splenda, and boiling water. Mix well to dissolve gelatin. Refrigerate for 15 minutes. Stir in undrained crushed pineapple, sour cream, and coconut extract. Add mandarin oranges, pineapple tidbits, coconut, and pecans. Mix well to combine. Spread mixture into an 8-by-8-inch dish. Refrigerate until firm, about 3 hours. Cut into 8 servings.

Serves 8 – Each serving equals: 101 Calories, 3g Fat, 1g Protein, 15g Carb, 60mg Sodium, 29mg Calcium, 1g FiberDiabetic Exchanges: 1 Fruit, 1 Fat

Carb Choices: 1

MS of OH, sent in a great way to serve chicken.

CHICKEN SALAD ORIENTAL

1/3 cup Land O Lakes no-fat sour cream

1 (8-oz) can pineapple tidbits, packed in fruit juice, drained and 2 tablespoons liquid reserved

1/2 teaspoon ground ginger

2 cups diced cooked chicken breast

1 (8-oz) can sliced water chestnuts, rinsed, drained and coarsely chopped

2 tablespoons sliced green onion

4 lettuce leaves

1/4 cup slivered almonds

In a large bowl, combine sour cream, reserved pineapple juice, and ginger. Add chicken, pineapple, water chestnuts, and onion. Mix well to combine. Cover and refrigerate for at least 15 minutes. For each serving, place 1 lettuce leaf on a plate, spoon about 1 cup chicken mixture on lettuce, and sprinkle 1 tablespoon almonds over top. HINT: If you don’t have leftovers, purchase a chunk of cooked chicken breast from your local deli.

Serves 4 – Each serving equals: 242 Calories, 6g Fat, 25g Protein, 22g Carb, 89mg Sodium, 68mg Calcium, 4g Fiber Diabetic Exchanges: 3 Meat, 1/2 Fruit, 1/2 Fat, 1/2 Vegetable

Carb Choices: 1 1/2

We hope you enjoyed our time together in the kitchen. Remember, if you’d like us to revise one of your family favorites so it’s healthier, send your request to: Healthy Exchanges, PO Box 80, DeWitt, IA 52742. Also, be sure to visit our Web site at www.healthyexchanges.com for more “common folk” healthy recipes to try. Until next time…

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Resource Roundup

Note: Resources mentioned below do not imply endorsement by the Diabetes Action Network of the NFB.

The National Kidney Foundation can assist diabetics

The National Kidney Foundation (NKF) publishes a variety of informational materials about diabetes and chronic kidney disease. The NKF also provides resources and support for those undergoing dialysis or kidney transplants. The NKF seeks to prevent kidney and urinary tract diseases, improve the health and well-being of individuals and families affected by these diseases, and increase the availability of all organs for transplantation. For more information, call the NKF at (800) 622-9010, or go to www.kidney.org.

Bilingual Talking Glucose Meter

The Prodigy Autocode delivers clear, audible readings in both English and Spanish, is affordable and fits in your pocket. No coding is necessary and you’ll have results in six seconds. You may be eligible for a free meter! Call toll free: (866) 540-4815.

Talking microwave

Bravo to Hamilton Beach for their Talking Microwave (Product # 87106 and #87108). This machine is available at retail stores such as Walmart and Best Buy for under $100, a remarkable achievement considering that most of its predecessor talking microwaves averaged well over $300.

Amazing new reading device that talks

The new Kurzweil–National Federation of the Blind reader is a portable hand-held device that talks! Simply position over documents, nutritional labels, book pages, recipes, etc. and the tool will read the contents aloud. The retail price of this revolutionary new product is $3,495 but for a limited time the NFB is offering a $200 discount. A new feature enables the reader to identify paper money. For more information or to order, call (877) 708-1724 or to go www.nfb.org.

Accessible Glucose Meter

The new Advocate is compact, it talks, and its display is clear and bright. The meter uses capillary action, touchable test strips and tests across a 20mg/di range, with a tiny blood sample. Contact the retailer: Diabetic Support Program, 3381 Fairlane Farms Road, Wellington, FL 33414; telephone: (800) 990-9826 www.prescriptionsplus.com.

A wealth of information at one site

DiabetesXChange.org is a new online clearinghouse for promising initiatives in diabetes care, prevention and management in the U.S. Whether it’s a small community-based initiative, university-sponsored effort, corporate wellness program or large government project, visit the Web site to learn more.

Help for Diabetic Amputees

The mission of The Amputee Coalition of America (ACA) is to reach out to people with limb loss and to empower them through education, support and advocacy. This includes access to, and delivery of, information, quality care, appropriate devices, reimbursement, and the services required to lead fulfilling lives. The ACA publishes InMotion,

a magazine that addresses topics of interest to amputees and their families. The ACA toll-free hotline provides answers and resources for people who have experienced the loss of a limb. In addition, the organization develops and distributes booklets, video tapes,

and fact sheets to enhance the knowledge and coping skills of people affected by amputation. To contact the ACA, call (888) AMP-KNOW (888-267-5669), or check out the Web site at www.amputee-coalition.org.

Talking health-monitoring devices

You can buy a number of useful medical tools, such as the Lo-Dose Count-A-Dose tactile insulin syringe-filling tool, a talking blood pressure cuff, a talking digital thermometer, and a talking prescription bottle reader. Prices are reasonable, and in some cases the lowest anywhere. Enhance your independence and health! Contact the NFB’s Independence Market at telephone: (410) 659-9314 (select option 4 from the voice menu); Web site: www.nfb.org.

Low Vision Tools

The NFB Independence Market has many useful assistance aids for low vision individuals. If you need assorted magnifiers, low-vision felt-tip pens or large-print items such as address books, calendars or check registers, you will find them among the useful items in the market. Contact the NFB’s Independence Market at telephone: (410) 659-9314 (select option 4 from the voice menu); Web site: www.nfb.org.

Full Service Diabetes Supplier

Access Diabetic Supply promises free glucose monitors, delivery, and in-home training in the use of blood glucose testing devices. Your private insurance is welcome, and they accept Medicare, too. Check them out online: www.diabeticsupply.com or call: (800) 285-1430.

Read the Paper by PHONE with NFB-NEWSLINE®

NFB-NEWSLINE® makes daily newspapers and magazines accessible by phone. Users listen to the news via synthesized voice. No computer is needed and it is FREE! New feature: national television listings! To subscribe contact: NFB-NEWSLINE®, 1800 Johnson Street, Baltimore, MD 21230; telephone: (866) 504-7300.

Diabetes Supplies

American Diabetic Supply, Inc., will ship your diabetes supplies to your door. They handle all insurance claims and provide free delivery. Those with Medicare and/or private insurance (no HMOs) may receive supplies at no further cost. For information, contact: American Diabetic Supply, Inc., telephone: (800) 453-9033, ext. 611; Web site: www.americandiabeticsupply.com.

Flying With Insulin or Supplies?

Terrorist activity has caused the United States Transportation Safety Authority, the TSA, to limit carry-ons. What about insulin, glucose tablets, and other diabetic supplies?

Passengers may bring insulin on board as long as the prescription label matches the name of the traveler. For more details go to: www.tsa.gov.

NOTE: www.diabetesandtravel.com also contains useful advice for diabetic travelers, for example, how to manage time zone changes.

Support for Self-Management—and a Free Meter

Liberty Medical can help Medicare patients with low-cost supplies delivered to your door. They also offer healthcare professionals on the telephone and reminders when you may need refills. Call (800) 786-9835 to ask about your free meter.

Attention Voice Readers!

We will be sending out a survey to randomly-selected Voice readers soon. If you get one, please fill it out and mail it back. Tell us what you want to read about! Tell what you think would make Voice of the Diabetic more useful to you!

Your opinions are vital to our continued success.

Thank you!

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March for Independence

Join our Voice of the Diabetic Team, as we March for Independence this summer!

Voice readers, writers, staff and supporters will come together to participate in the National Federation of the Blind’s March for Independence, in Atlanta, Georgia, on July 3, 2007 at sunrise. Can’t be there with us in Atlanta? Join us in spirit by sponsoring a marcher. To learn more, call the NFB at (410) 659-9314, extension 2406, or visit us on the Web at www.marchforindependence.org.

Health Article

Senin, 01 September 2014