because so little is known. I encourage more research in this area of
diabetic complications. Keep up the
Sheryl L. Bellamy
Insulin at Altitude
• I am confused by “Flight Plan”
[Nov ’ 11, p. 24] and how decreases in
pressure when flying on an airplane
produce air bubbles, causing the
pump to deliver too much insulin.
I’ve found that if there are air
bubbles in the infusion set, insulin
is not delivered and my blood sugar
goes high. Even when I travel at high
altitudes, I have to increase my pump
rates every time. Which is right?
FoUntAin vALLEY, CALiF.
Associate Editor Erika Gebel, PhD,
responds: Your summary of the study’s
findings are correct, but they apply only
to air bubbles that form in pumps as a
result of changes in air pressure during
flights. If the bubbles in your tubing
have another cause, insulin delivery
could be hampered, raising glucose levels. As for your need for more insulin at
higher elevations, some research suggests that being at high altitudes
induces insulin resistance.
?Ask the Experts How Can I Find an Endocrinologist? How do you find an endocrinologist when you need an answer to a diabetes problem that other doctors cannot provide? My
internist recently sent a referral to yet another endocrinologist
and, after a month, there has been no response.
When I have tried to find an endocrinologist before, the first
thing I am asked is whether I am on Medicare. My reply in the
affirmative has always been my last contact with that
endocrinologist. What can I do?
WhAt to Kno W: Our best guess is that there are 5,000
practicing endocrinologists in the United States and more than
25 million people with diabetes. This effectively means that there
is one endocrinologist for every 5,000 people with diabetes. As
you can imagine, this demand for diabetes services far exceeds
what any single endocrinologist can offer, because the average
physician can usually handle no more than 500 to 750 people
with this disease in his or her practice.
R. MACK hARRELL, MD, FACp, FACE, RESponDS
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Questions about diabetes? Call the American Diabetes
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