Subject: diabetes FAQ: general (part 1 of 5)
Supersedes: <diabetes/faq/part1_827207059@rtfm.mit.edu>
Date: 1 Apr 1996 18:12:00 GMT
Summary: Discusses questions which have been asked frequently in
         misc.health.diabetes. Likely to be of interest to anyone who has
         diabetes or a friend or relative with diabetes or other blood
         glucose disorder.
X-Last-Updated: 1996/03/08

Posting-Frequency: biweekly
Last-modified: 8 Mar 1996

Changes: add comments about conversion factors from Joao Magalhaes (4 Feb)
         fix spelling of S.I. (8 Mar)

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

Copyright 1993-1996 by Edward Reid. Re-use beyond the fair use provisions
of copyright law and convention requires the author's permission.

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

Subject: Table of Contents
==========================

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

Subject: 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. If you obtained this article by
some method other than reading m.h.d, you may wish to refer to the sections
on "Online resources" for more information.

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.

An informational posting on insulin pumps 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 Jim Summers <summers@cs.utah.edu>.

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 Michael Wolfe <mwolfe@wvnvms.wvnet.edu>.

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.

These documents -- the FAQ, the insulin pump discussion, and the software
overview -- are available from the news.answers archives at rtfm.mit.edu.
Using anonymous ftp, get the files:

   /pub/usenet/news.answers/diabetes/faq/part1
   /pub/usenet/news.answers/diabetes/faq/part2
   /pub/usenet/news.answers/diabetes/faq/part3
   /pub/usenet/news.answers/diabetes/faq/part4
   /pub/usenet/news.answers/diabetes/faq/part5
   /pub/usenet/news.answers/diabetes/insulin-pump-disc
   /pub/usenet/news.answers/diabetes/software

Or send an email message to mail-server@rtfm.mit.edu, subject ignored, body
containing:

   send usenet/news.answers/diabetes/faq/part1
   send usenet/news.answers/diabetes/faq/part2
   send usenet/news.answers/diabetes/faq/part3
   send usenet/news.answers/diabetes/faq/part4
   send usenet/news.answers/diabetes/faq/part5
   send usenet/news.answers/diabetes/insulin-pump-disc
   send usenet/news.answers/diabetes/software

If you are using the World Wide Web (aka WWW, W3, lynx, Mosaic, Netscape),
you can reach a WWW-formatted version of the FAQ and other documents via the
URL

   http://www.cis.ohio-state.edu/hypertext/faq/usenet/diabetes/top.html
or
   http://www.smartpages.com/faqs/diabetes/top.html

Both of these have been badly out of date through much of late 1995. The OSU
server is running but not being supported and may disappear without warning.
SmartPages is supposed to be the new site but is not updating FAQs. Until
this situation is resolved, you are better off retrieving the complete FAQ
files from the reliably up-to-date copies at

   ftp://rtfm.mit.edu/pub/usenet/news.answers/diabetes/

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 <betsyb@vms.cis.pitt.edu> 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 psychological. They reflect not only varying
responses, but the fact that diabetes itself probably has many causes, many
more than the few types currently recognized (see section on types). When you
read advice, realize that what works (or doesn't work) for someone else may
not work (or may work) for you. When you give advice, try to remember that
most advice is relative to the individual, not absolute. Recognize that you
can't treat your own diabetes by a set of rules, but only by knowing how your
own individual body and physiology work and by adjusting to your own
mechanisms.

Subject: Abuse of the newsgroup
===============================

As mentioned above, a few participants believe that name-calling and abusive
language are more effective than polite discussion, support and interchange
of information. They are wrong, and the vast majority of participants support
a more civilized and polite view of humanity. Since misc.health.diabetes is
unmoderated, we all have to live together.

A few m.h.d. participants have received abusive email. Some are afraid to
expose such abuse, having been told that email must always be private.
However, abusive email is no more deserving of privacy than obscene phone
calls or threatening letters. There is no authority to which you can report
abusive email (unless it contains an actual threat, in which can you may be
justified in contacting a law enforcement agency). Steve Kirchoefer
<swkirch@chrisco.nrl.navy.mil> is willing to try to mediate problems with
email. Though Steve has no official authority, he has experience in dealing
with problems on the net and may be able to help clear up such problems. Send
him complete copies of any abusive email.

Subject: The newsgroup charter
==============================

The actual charter which led to the creation of the newsgroup in May 1993
follows. This charter was proposed by Steve Kirchoefer
<swkirch@chrisco.nrl.navy.mil> and approved by a public vote of the Usenet
readership, and is the official statement of the scope and purpose of this
newsgroup.

  1. The purpose of misc.health.diabetes is to provide a forum for the
     discussion of issues pertaining to diabetes management, i.e.: diet,
     activities, medicine schedules, blood glucose control, exercise, medical
     breakthroughs, etc.  This group addresses the issues of management of
     both Type I (insulin dependent) and Type II (non-insulin dependent)
     diabetes.  Both technical discussions and general support discussions
     relevant to diabetes are welcome.

  2. Postings to misc.health.diabetes are intended to be for discussion
     purposes only, and are in no way to be construed as medical advice.
     Diabetes is a serious medical condition requiring direct supervision
     by a primary health care physician.  

Subject: Newsgroup posting guidelines
=====================================

The following posting guidelines were adopted by a vote of m.h.d participants
in September 1994.

Posting guidelines for misc.health.diabetes:

Postings to misc.health.diabetes should be compliant with the standards 
for all material posted to Usenet.  The following articles may be found 
in news.announce.newusers, and should be reviewed by all posters:

-Emily Postnews Answers Your Questions on Netiquette
-Answers to Frequently Asked Questions about Usenet
-A Primer on How to Work With the Usenet Community
-Rules for posting to Usenet
-What is Usenet?

Posting to misc.health.diabetes should be compliant with the group charter,
[which is in the previous section].

In addition to the above, the following guidelines are emphasized as
particularly relevant for contributions to misc.health.diabetes:

-No personal attacks or insults.  Avoid argumentative debates.  Responses
 should concentrate on the issues presented.

-No private discussions.  Take private discussions to email.  When in
 doubt, use email.

-Edit responses to avoid unnecessary inclusions of earlier postings.

-Edit subject lines as necessary to remain consistent with the topic.

-Support factual statements with your sources.  If you can not recall the
 source, then say so.  Do not imply authority which you can not actually
 support.

Additional information can be found in the general FAQ posted periodically
to this group.

Subject: What is glucose? What does "bG" mean?
==============================================

Glucose is a specific form of sugar, one of the simplest. It is the form
found in the bloodstream. "Blood sugar" always refers to blood glucose, and
is abbreviated bG. All bG meters are specific for glucose and will not
respond to other sugars, such as fructose, sucrose, maltose and lactose.

Although sucrose (table sugar) is the most common sugar in food, glucose is
also common. Most fruits, fruit juices, and soft drinks contain large amounts
of glucose, and many foods contain small amounts. This means that you must be
very careful to clean any food residue from your fingers before drawing blood
for a bG check. Since the normal level of bG is only 1g/L (=100mg/dl), it
only takes a tiny speck of glucose on your finger to contaminate the sample
and give you a falsely high reading. 10 *micrograms* of glucose could raise
the reading enough to cause you to overreact dangerously.

Subject: What are mmol/L? How do I convert between mmol/L and mg/dl?
====================================================================

mmol/L is millimoles/liter, and is the world standard unit for measuring
glucose in blood. Specifically, it is the designated SI (Systeme
International) unit. "World standard", of course, means that mmol/L is used
everywhere in the world except in the US. A mole is about 6*10^23 molecules;
if you want more detail, take a chemistry course.

mg/dl (milligrams/deciliter) is the traditional unit for measuring bG (blood
glucose). All scientific journals are moving quickly toward using mmol/L
exclusively. mg/dl won't disappear soon, and some journals now use mmol/L as
the primary unit but quote mg/dl in parentheses, reflecting the large base of
health care providers and researchers (not to mention patients) who are
already familiar with mg/dl.

Since m.h.d is an international newsgroup, it's polite to quote both figures
when you can. Most discussions take place using mg/dl, and no one really
expects you to pull out your calculator to compose your article. However, if
you don't quote both units, it's inevitable that many readers will have to
pull out their calculators to read it.

Many meters now have a switch that allows you to change between units.

To convert mmol/L to mg/dl (of glucose), multiply by 18.

To convert mg/dl to mmol/L (of glucose), divide by 18 or multiply by 0.055.

These factors are specific for glucose, because they depend on the mass of
one molecule. The conversion factors are different for other substances.

And remember that reflectance meters have a 10-15% error margin at best, and
that plasma readings are 15% higher than whole blood, and that capillary
blood is different from venous blood.  So round off to make values easier to
comprehend and don't sweat the hundredths place.  For example, 4.3 mmol/l
converts to 77.4 mg/dl but should probably be quoted as 75 or 80.  Similarly,
150 mg/dl converts to 8.3333... mmol/l but 8.3 is a reasonable quote, and
even just 8 would usually convey the meaning.

Actually, a table might be more useful than the raw conversion factor, since
we usually talk in approximations anyway.

   mmol/l     mg/dl     interpretation
   ------     -----     --------------
     2.0        35      extremely low, danger of unconciousness
     3.0        55      low, marginal insulin reaction
     4.0        75      slightly low, first symptoms of lethargy etc.
     5.5       100      mecca
    5 - 6     90-110    normal preprandial in nondiabetics
     8.0       150      normal postprandial in nondiabetics
    10.0       180      maximum postprandial in nondiabetics
    11.0       200      
    15.0       270      a little high to very high depending on patient
    16.5       300
    20.0       360      getting up there
    22         400      max mg/dl for many meters and strips

Preprandial  = before meal
Postprandial = after meal

Subject: What is c-peptide? What do c-peptide levels mean?
==========================================================

Thanks to Andrew Torres <andym@kuhub.cc.ukans.edu> for this section.

C-peptide blood levels can indicate whether or not a person is producing
insulin and roughly how much.

Insulin is initially synthesized in the form of proinsulin.  In this form the
alpha and beta chains of active insulin are linked by a third polypeptide
chain called the connecting peptide, or c-peptide, for short. Because both
insulin and c-peptide molecules are secreted, for every molecule of insulin
in the blood, there is one of c-peptide. Therefore, levels of c-peptide in
the blood can be measured and used as an indicator of insulin production in
those cases where exogenous insulin (from injection) is present and mixed
with endogenous insulin (that produced by the body) a situation that would
make meaningless a measurement of insulin itself. The c-peptide test can also
be used to help assess if high blood glucose is due to reduced insulin
production or to reduced glucose intake by the cells. 

There is little or no c-peptide in blood of Type I diabetics, and c-peptide
levels in Type II diabetics can be reduced or normal. The concentrations of
c-peptide in non-diabetics are on the order of 0.5-3.0 ng/ml.  

Subject: What's type 1 and type 2 diabetes, and gestational diabetes?
=====================================================================

The term diabetes mellitus comes from Greek words for "flow" and "honey",
referring to the excess urinary flow that occurs when diabetes is untreated,
and to the sugar in that urine.

Diabetes mellitus (DM) comes in four classifications (which some will argue
don't really represent the actual types very well):

   type 1 -- characterized by total destruction of the insulin-producing beta
             cells, probably by an autoimmune reaction. Onset is most common
             in childhood, thus the common (but now deprecated) term
             "juvenile-onset", but the onset up to age 40 is not uncommon and
             can even occur later. Patients are susceptible to DKA (diabetic
             ketoacidosis). There seems to be some genetic tendency, but the
             genetic situation is unclear. Most patients are lean. Always
             requires treatment by insulin. Not sex-linked. Also referred to
             as IDDM (insulin dependent diabetes mellitus).

   type 2 -- characterized by insulin resistance despite adequate insulin
             production. A large majority of patients are overweight at onset,
             and a majority are female. Most are over 40, hence the common
             (but now deprecated) terms "adult-onset" or "maturity-onset", but
             onset can occur at any age. Patients are not susceptible to DKA
             (diabetic ketoacidosis). There is a strong genetic tendency, but
             not simple inheritance. Depending on the individual, treatment
             may be by diet, exercise, weight loss, oral drugs which stimulate
             the release of insulin, or insulin injections -- and usually a
             combination of several of these. Also referred to as NIDDM (non
             insulin dependent diabetes mellitus) *even when treated with
             insulin*.

   type 3 -- a catchall for forms not covered by the other types,
             including loss of the entire pancreas to trauma, cancer,
             alcohol abuse, or exposure to chemicals.

   type 4 -- gestational. Occurs in about 3% of all pregnancies as a result of
             insulin antagonists secreted by the placenta. It is recommended
             that all pregnant women receive a screening glucose tolerance
             test (GTT) between the 24th and 28th weeks of pregnancy to detect
             gestational diabetes early if it occurs, as diabetes can cause
             serious difficulties in pregnancy. Usually requires insulin
             treatment. Not susceptible to DKA (diabetic ketoacidosis).
             Usually disappears after childbirth, but about 40% of patients
             develop type 2 diabetes within five years. Most authorities state
             that the typical patient is female ...

These terms are not used entirely consistently. Some doctors will refer to
any diabetic using insulin as type 1, and will refer to the early onset of
type 1 diabetes as type 2 until insulin therapy is required. This usage does
not fit with most modern usage as described above (type 1 is beta cell
destruction, type 2 is insulin resistance). The situation is complicated by
the fact that early in the course of the disease it can be difficult to
determine which type is occuring, especially for patients in their 30's, the
age when the onset of both types is common.

Different patients respond very differently to what is categorized above as
the same disease. The root causes of all forms of diabetes are not
understood, and are likely more complex and varied than the simple categories
show. Type 1 diabetes likely has a few root causes, and type 2 diabetes
probably has a larger number of root causes.

There are also well documented reports of cases of diabetes with unexplained
combinations of syndromes from types 1 and 2. These are sometimes referred to
as "type 1-1/2", and the reasons are not understood.

The classification above is not completely standard, and other classifications
exist.

About 90% of diabetes patients are type 2 (some 12 million in the US), and
about 10% are type 1 (some 1 million in the US). Discussion on m.h.d tends to
run about 2/3 type 1, I'd guess. This probably reflects the fact that type 1
diabetes is harder to ignore, and that type 2 seldom strikes the younger
people who are more likely to have net access. Type 2 is *not* less serious.

"1" and "2" are often written in Roman numerals: type I, type II. Because
typography is often unclear on computer terminals, I've stuck with the Arabic
numeral version.

Diabetes accounts for about 5% of all health care costs in the US, some
US$90 billion per year.

Subject: Is it OK to discuss diabetes insipidus here? What is it?
=================================================================

Diabetes insipidus (DI) results from abnormalities in the production or use
(two main types) of the hormone arginine vasopressin. The main symptom is
excessive thirst and massive urination. The excess urine flow is devoid of
sugar. There are no blood glucose abnormalities, and in fact there is nothing
in common with diabetes mellitus except the excess urination when untreated.
Diabetes insipidus can be treated with hormone replacement (by nasal spray or
injection). DI is much less common than diabetes mellitus, though a few
people have discussed it on misc.health.diabetes and are reading m.h.d. Such
participation is certainly welcome, but because the number of DI patients is
only 1 or 2 per 10,000 population (25,000-50,000 in the US), there probably
isn't a critical mass for discussion on Usenet. A support newsletter is
published by

    Diabetes Insipidus and Related Diseases Network
    Route 2 Box 198
    Creston, IA 50801

Subject: How about discussing hypoglycemia?
===========================================

Sure ...

To clarify: the term "hypoglycemia" is used to refer to two distinct
conditions. The word just means "low blood glucose". This can occur as an
insulin reaction, the result of too much injected insulin (taken to treat
diabetes) compared to food intake and exercise. But low blood glucose can
also be a chronic condition resulting from abnormalities of insulin
secretion, and this chronic condition is also called hypoglycemia.

Chronic hypoglycemia may be caused by beta cells which overreact to an
increase in blood glucose (bg) by releasing too much insulin, which then
causes a too-rapid drop in bG. Such a condition, called reactive
hypoglycemia, is usually handled by dietary adjustments, in particular
avoiding refined sugars and large meals which stimulate the overreaction.
This often requires an effort in calculating the diet and monitoring bG
levels that is equal to what anyone with diabetes needs.

Tumors (insulinomas) can cause a steady overproduction of insulin. These
generally require surgical removal.

There are other causes as well. Mayer Davidson discusses some in his book
(see the section Could you recommend some good reading?). I don't believe
anyone claims to understand all the causes.

So chronic hypoglycemia is closely related to diabetes mellitus in being a
disorder of insulin production and use, and requires many of the same
techniques for its treatment. The two are a natural for discussion in the
same newsgroup. Which is good, since there really isn't anywhere else in
Usenet at present to discuss chronic hypoglycemia. Welcome.

Subject: Who did this?
======================
-- 
Edward Reid          ed@titipu.resun.com
PO Box 378           reide@freenet.tlh.fl.us
Greensboro FL 32330

On the World Wide Web:

  mailto:ed@titipu.resun.com

