Back to Ask the Diabetes Team Questions from September 1999

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  1. How does insulin affect the feelings of hunger? My teenage daughter is experiencing constant feelings of hunger and is having real difficulty controling her appetite. (28 Sep 1999)

  2. Is it normal for IUGR [Intrauterine growth retardation] infants to have hyperglycemia at birth? Does hyperglycemia at birth indicate diabetes? (28 Sep 1999)

  3. My 3 year old son has been off insulin for about 2 1/2 months, and while we work hard to avoid high blood sugars, we are also fighting lows. Do you see hypo and hyperglycemia in children not on insulin? (28 Sep 1999)

  4. My granddaughter is 15. She was diagnosed at age 8. Every month 3 days prior to her menstrual period, she gets very sick. Throwing up, high sugars and wound up in the hospital with ketoacidosis. Will this happen every month or eventually straighten itself out? (28 Sep 1999)

  5. I am 41 years old and have had Type 1 diabetes for 18 years. Recently, I had an incident happen that I can't explain. I went to take a nap, which I've done a hundred times before with low blood sugars. The next thing I knew, I was being treated by paramedics. (28 Sep 1999)

  6. I am a 17 year old, type 1 diabetic female. I have had friends telling me that it is terrible for a diabetic to drink (alcohol). What is the additional risk to a diabetic, and how might I prepare for it? (28 Sep 1999)

  7. My four year old daughter was diagnosed one month ago. Her blood sugars are progressively going up at supper time despite the fact that I keep raising her dosage at lunch time. (28 Sep 1999)

  8. Regarding a previous question -- we are facing exactly the same situation, except that our child is going into kindergarten. Do you know if the ruling would apply to schools also, rather than daycare situations? (27 Sep 1999)

  9. My son was diagnosed four months ago. We count carbohydrates and his insulin is based on this. I want to know if I should be a little more concerned about the types of foods he eats as long as his blood sugar is under control. (27 Sep 1999)

  10. Is the sugar substitute sorbitol the same sorbitol that is produced in the body? Does it pass through the system, or is it stored? I'm worried about the long time use of this sweetener and the adverse reactions down the road with the nervous system and vision. (27 Sep 1999)

  11. Two months ago my sixteen month old nephew contracted Type 1 diabetes. The problem is that when he is sick or just doesn't feel like eating. What can you suggest? (27 Sep 1999)

  12. I have a cat with unregulated diabetes and I'm trying to acquaint myself with the territory. I've been looking up the Somogyi effect on the Internet to learn more about it. (27 Sep 1999)

  13. My 15 year old daughter recently had a fasting insulin blood test. Her father has type 1. Her insulin levels in her blood were high, around 100. My daughter has a problem with her weight and upon discussing the blood results with her doctor and a nutritionist, we were told this may be part of the problem. (27 Sep 1999)

  14. My daughter is 6 1/2 years old and was diagnosed with diabetes Type 1 2.5 years ago. She weighs 33 kilos. At her recent appointment her endocrinologist said her body is rejecting the insulin. I have never heard of this. (27 Sep 1999)

  15. Our son is thirteen and a half years old and he was diagnosed type 1 one and a half years ago. How can we be sure he is not going to have a hypo during the night? (27 Sep 1999)

  16. I have a five year old daughter who was diagnosed with diabetes at age 1. A few days ago she woke up screaming bloody murder. When I went into the room, I found that she was completely paralyzed on her right side. (27 Sep 1999)

  17. A friend has an 11 year old daughter who was diagnosed with diabetes 5 years ago. In the past two months, she has had difficulty with low blood sugar at night which has caused two seizures. Could puberty be causing any of these problems? (27 Sep 1999)

  18. My six year old son has had diabetes for three years now, and although we love his doctor and diabetes team we have recently developed a difference of opinion. Recently we started using a sliding scale of his Humalog. Our medical team is actually against this. (27 Sep 1999)

  19. I am wondering if the milk boxes (similar to juice drink boxes) would be beneficial to have on hand to bring up lows. The ones I am curious about are the ones which do not have to be refrigerated. (24 Sep 1999)

  20. Our son was diagnosed 3 1/2 months ago at the age of 2 1/2. When I check his blood sugars at meals and at bedtime, they are usually within the expected range. When I check 2 hours after a meal, the sugars are almost always high: 15 mmol or higher. Is this normal? (24 Sep 1999)

  21. What can I do to gain weight? (24 Sep 1999)

  22. Is it true that Caucasian children are more prone to develop Type 1 than Asian children? (23 Sep 1999)

  23. My 17 year old daughter is 4 months pregnant. She has seizures throughout the night. Can these seizures affect the health of the unborn baby? (23 Sep 1999)

  24. I have Type 1 diabetes and would like feedback on a deep seated itch which is under the skin and this itchiness causes me to scratch for hours. (23 Sep 1999)

  25. My ten and a half year old daughter has had Type 1 Diabetes for almost 4 years. She is now on the pump. She seems to be becoming more nervous and overly responsible in all areas of her life. How can I help her not be so nervous and worried about so much, especially with her levels etc.? (23 Sep 1999)

  26. I was diagnosed with MODY diabetes when I was 16 (I am 26 now). I have read that MODY is autosomal dominant. Can you explain this term? What are the changes of my children developing MODY? (23 Sep 1999)

  27. My son recently had strep throat and a stomach virus. As a result his sugar levels bottomed and his insulin was cut dramatically. Two weeks later his sugars and ketones are soaring. Do you have any suggestions? (20 Sep 1999)

  28. My sister-in-law currently injects insulin. I think she could benefit from an insulin pump. How does she go about obtaining one? What is the cost of such a device? (20 Sep 1999)

  29. I'm wondering about the relationship of sleep apnea to diabetes and, specifically, whether the effect of lack of sleep on the immune system could be a contributing factor in the onset of diabetes and how lack of sleep affects blood sugar levels in general. (20 Sep 1999)

  30. My 13-year-old daughter would love to be able to eat only when hungry, rather than on a schedule. She takes Humalog and NPH in the morning, Humalog at dinner, and NPH at bedtime. She isn't interested in a pump. (20 Sep 1999)

  31. Our 7 year old daughter was diagnosed with diabetes 3 months ago. She does great most of the time but recently she has a hard time with her shots.. We use the short needle but she still has problems. Is it okay to numb the area lightly with ice before giving the shot? (20 Sep 1999)

  32. My son has chronic high blood sugars in the morning (300+). I have checked him often at night (no lows) We've tried everything. How do we bring down the blood sugars in the mornings? (20 Sep 1999)

  33. In reading the literature, I noticed that asthma and allergies are also symptoms of hypoglycemia. (20 Sep 1999)

  34. My HMO and my doctor are giving me contradictory information on Rezulin. My doctor says that there are no reported cases of liver damage beyond the first 8 months on, and that the numbers of fatalities are overblown. (20 Sep 1999)

  35. I just got a test today of my 4 year old twins, one of them was rated 99 in glucose and the other 114. My mother is type 2 diabetic. I'm very afraid he is at risk of developing it so young. (20 Sep 1999)

  36. My 18 year old daughter has Type 1. Her lifestyle consists of many late nights -- everything from a prom to doing homework. She takes lispro before meals and N at bedtime. How should she handle her evening insulin and snack on these occasions? (20 Sep 1999)

  37. Is there any documentation or other professional opinions or evidence to substantiate the idea that type 2 diabetes may be brought on by acute physical trauma? (16 Sep 1999)

  38. I have a 12 year old son who has had diabetes for 2 1/2 years. His doctor recommended counseling for a possible learning disability and behavior problems. The diagnosis was depression caused by hypoglycemia and the only recourse would a lifetime of taking Prozac. (16 Sep 1999)

  39. Is there a higher rate of Type 1 diabetes developing in the off-spring of a family with a known history of alcoholism? (16 Sep 1999)

  40. What advice do you have for an active 8 year old boy (Type 1 diagnosed four years ago) who is going through a growth spurt and has blood sugars out of control? (16 Sep 1999)

  41. I am considering the insulin pump. I am 14 and was diagnosed at age 4. My primary reason for wanting the pump is to keep my blood sugar balanced. Is this the best method available for me? (16 Sep 1999)

  42. I am 24 year old and diagnosed with gestational diabetes. The local hospital does not have a neonatal ICU. My mother recommends I should ask my doctor for a referral to the closest hospital with a neonatal ICU. (16 Sep 1999)

  43. I have heard about a condition called restless leg syndrome and that it occurs in diabetics. What is RLS, what causes it, and where can I get more info on it? (14 Sep 1999)

  44. My 7 year old daughter has been diagnosed with type 1 diabetes for about 3.5 years. She is on lispro and Ultralente insulins. She says the Ultralente burns when it is injected by itself. She says it hurts less when the Ultralente is mixed with a few units of lispro (when needed). Is this common? (14 Sep 1999)

  45. Is there any connection between prematurity and type 1 diabetes? (14 Sep 1999)

  46. Is the only way to control the blood sugar by insulin or are there other ways? (14 Sep 1999)

  47. Our son is type 1, age seven, normal weight, was diagnosed two years ago. He only needs a total of ten Protaphane and two Actrapid each day. Why does he only need such a small dose? (14 Sep 1999)

  48. I have kept up with the GlucoWatch news since last year and I am very excited about it! The last thing I read, however, said that it was only for those 18 and older. (14 Sep 1999)

  49. My 7 week old daughter took part in a study at birth and was found to be a carrier of a diabetes gene marker. What environmental factors should I watch for? (14 Sep 1999)

  50. I had gestational diabetes (insulin dependant) with my first pregnancy. I am now just 6 weeks pregnant with my second and my family doctor said it is not a guarantee I will have it again. Are there any steps I can take in prevention? (14 Sep 1999)

  51. I have just been diagnosed with gestational diabetes. I was told I failed my 1 hour test, so I had to take the 3 hour test. Can you test too early? I was tested at 18 weeks. (14 Sep 1999)

  52. My husband has been a type 1 diabetic for 43 years. He is 52 years old. He has few complications. His glycohemoglobin range is 7.5. He has 3-5 reactions a week; some are severe. I want to know if this is normal. (14 Sep 1999)

  53. What pre-surgery precautions should be taken for diabetic children? (12 Sep 1999)

  54. I have a 19 month old son diabetic since birth due to partial pancreatic agenesis. I recently read that repeated hypoglycemia in infants and toddlers has been associated with learning disabilities later in life. Can you provide any further information? How do they define hypoglycemia? (12 Sep 1999)

  55. Our 12 3/4 year old son has had one mild diabetic seizure and 2 pretty full blown seizures in the past few days. Can you give us any information on why these seizures occur and how they can be prevented? (12 Sep 1999)

  56. What low blood sugar reading is considered to be low-severe versus that which is low-moderate for a young child? (12 Sep 1999)

  57. My daughter is 11 1/2 and had diabetes for 9 1/2 years. Twice within the past month she has complained of a severe headache and I have tested her blood sugar and she was somewhat low. Is it possible that these are migraine headaches? (12 Sep 1999)

  58. I have a 3 year old nephew who's father is hypoglycemic. My husband is a type 1 diabetic who takes 4 shots a day. We've taken some blood sugar counts on my nephew as per his persistent requests. To our surprise, we got some very high results. (12 Sep 1999)

  59. My son is 14 years old and is on an insulin pump. He tests 4 times/day and his tests are low. In spite of the fact that his basal rate continues to be adjusted lower to accommodate the low tests, his A1c results are higher at each three-month doctor visit. Could there be any reason why the A1c is high while the daily blood tests remain low? (12 Sep 1999)

  60. My 17 year old daughter, of Latin descent, has always had a "rusty" neck. She scrubs and scrubs and cannot get it to go away. I recently saw a special on television that indicated this could be a pre-diabetes condition. Have you ever seen any research on this condition? (12 Sep 1999)

  61. My daughter who is 5 years old was diagnosed 7 months ago with type 1. I was wondering when do children with diabetes get to start using the insulin pump? I thought it was just for adults but I guess I was wrong. (12 Sep 1999)

  62. At 4 days old, my son was diagnosed with "transient diabetes of the newborn". I have not been able to find anyone to explain to me what it is and why it happened. (12 Sep 1999)

  63. My husband takes Lente Iletin I (beef-pork) and Regular Iletin I (beef-pork), both of which are being discontinued. What type of insulin would be a compatible substitute for each? (12 Sep 1999)

  64. My daughter is 21 years old, diagnosed at age 15 with Type 1. Last year, she had four episodes in which her blood glucose went skyrocketing to over 500, and wouldn't come down. All four times she ended up being hospitalized. She has been on an insulin pump for about 6 months. A few weeks ago, she had another high blood glucose episode for no known reason. (12 Sep 1999)

  65. My niece is 8 years old. Recently, upon waking, her blood sugar was tested and found to be in the normal range. She began to get dressed for the day. The usual quick breakfast was prepared by her mother. A minute went by. She was called to eat only to be found passed out on her bed. (11 Sep 1999)

  66. I was rather happy with my life for the past 5 months. My diabetes condition was in well control and under my control. However, lately I started binge-eating again. I gained 4 kg. I was so depressed because I gained a lot of weight. I stopped injecting insulin again. What can I do? (11 Sep 1999)

  67. My 14 1/2 year old stepdaughter was diagnosed with Type 1 2 1/2 years ago. Her doctor told us this week that he thinks she might be a Type 2 diabetic due to the lack of antibodies. Her doctor stated that the "new consensus" was that about 50% percent of the children over 10 labeled at Type 1 are actually Type 2. Is it accurate? (11 Sep 1999)

  68. I'm 16 years old and type 1, diagnosed six weeks ago. In the hospital they put me on 300 grams of carbs a day, and at first I followed this diet but found that I always felt stuffed and forced to eat. Why are people telling me to stuff myself? (11 Sep 1999)

  69. How can we locate an English speaking doctor in Paris who can treat a 12-year-old type 1 (recently diagnosed) child in an emergency, especially in the month of August when many Parisians are on vacation? (11 Sep 1999)

  70. I have a child that will be going into middle school in the fall. He has type 1 diabetes and sometimes goes low when he has unplanned exercise at school. In middle school he will just have a part time nurse. He will have 9 teachers in a day. Do you have any advice for handling the situation? (9 Sep 1999)

  71. My daughter is 8 years old and was diagnosed at age 4. We both tried the pump with a placebo for 3 days. The only problem with the pump was with the insertion of the tube. This was extremely painful for her, and she refuses to consider the pump. (9 Sep 1999)

  72. I am a 35 year old insulin dependent diabetic. My wife is having a baby in several months. Is there a test that can be run to find our if my baby carries the genes or cells that can cause diabetes? (9 Sep 1999)

  73. Our 13 year old son has recently been having ups and downs with his blood sugars: high during the night and waking up in the 300's. His endocrinologist suggested Glucophage to give him better control until he starts using the pump. What are your thoughts on this? (9 Sep 1999)

  74. My 6 1/2 year old son was diagnosed with type 1 diabetes 2 1/2 years ago. He currently has moderate hypoglycemias (in the low 50's) every one out of every 5 or 6 blood glucose tests. Are the lows a concern for brain development at his age, and if not, how low of an hbA1c should we try for? (9 Sep 1999)

  75. My infant son was diagnosed with IDDM seven months ago. At that time he was in DKA. His HbA1c was 17.6. Could you tell me please the effects undiagnosed diabetes could have on the developing brain, nervous system and over-all wellness of an infant? (9 Sep 1999)

  76. I am 48 and have had Type 1 since I was 33. In March 1999 we determined the HLA antigens of my youngest son : DR2,7; DQ1,2; DR51,53. What is the possibility that my children will develop Type 1 diabetes? (9 Sep 1999)

  77. My Goddaughter is Type 1 diabetic since age 9. She is now 21. She has developed complications of neuropathy. I read that lipoic acid can help neuropathy tremendously. Why is the FDA dragging its feet in the U.S. on this megavitamin? (9 Sep 1999)

  78. My husband has been a diabetic for the past 22 years; he is now 27. He was recently diagnosed with moderate stage renal disease. What does this mean? Does this mean dialysis very soon? (9 Sep 1999)

  79. My son, age 3.5 years, was diagnosed when he was 1 year old. He suffered a very serious bout of croup 10 months prior. There is a history of diabetes in my family. I believe that although he was predisposed to diabetes, the croup sped up the onset of the diabetes. (9 Sep 1999)

  80. I am 51 years old, Type 2, non-insulin dependent, diabetic. I am very interested in the GlucoWatch monitor because of a rare condition. I would like to know if there is any way possible for me to test the monitor or become a volunteer. (9 Sep 1999)

  81. My girlfriend is 32 years old, and for 14 years has had Type 1 diabetes. She doesn't accept her situation and she has poor control. I thought that a period with another people with diabetes would help her (and me) obtain a good understanding of diabetes. (7 Sep 1999)

  82. I'm worried about my sister. I'm afraid she may be pretending to have diabetes. After our parents divorced last year (I'm 15 and my sister is 10) she has been desperate for attention. Her best friend has diabetes, so she knows a little about the disease. (7 Sep 1999)

  83. If someone was a serious drinker and did not eat proper amounts of food to compensate the low blood sugars, could their body lose control of blood sugars, leading to diabetes? (7 Sep 1999)

  84. I know that one of the complications of diabetes is nerve damage or neuropathy. Is this due to taking so many injections a day? Can so many needles damage your nerves? (7 Sep 1999)

  85. I am a 13 year old girl. My dad had extremely bad diabetes. I was wondering if I could have it now. I am always thirsty and sometimes really hungry. So, should I go get checked for diabetes or do you think its just something that will pass? (7 Sep 1999)

  86. My grandfather on my mother's side developed Type 2 diabetes when he was an adult and recently I found that my grandmother on my father's side had Type 1. My mother does not have diabetes. I have several symptoms. I have been tested for diabetes three times in three years and my doctor says I am fine. (7 Sep 1999)

  87. My 12 year son has been on the pump for 8 months. His numbers were great on injections with a 6.2 hemoglobin A1c, but since he has been on the pump his numbers have been all over the place and now has a 9.2 A1c. What do you think could be the problem? We are both very discouraged. (7 Sep 1999)

  88. While I read a great deal about Humalog being able to maintain its efficacy for up to 28 days without refrigeration, we have had at least 6 instances of Humalog "going bad" on us. The bottles usually have been open a couple of weeks, so they are not close to expiration. Is there something we are missing? (6 Sep 1999)

  89. I'm having difficulty with my toddler going hypoglycemic in the middle of the night. What products are available that would provide a slow release of sugar to help prevent hypoglycemia? (6 Sep 1999)

  90. How we can prevent hypoglycaemia? (6 Sep 1999)

  91. My 18 year old son was diagnosed with type 1 diabetes 3 weeks ago. Everywhere we look for nutrition guidance, the emphasis seems to be on how to lose weight. We would like any pointers on low carbohydrate foods that will put some weight on my son. (6 Sep 1999)

  92. I am 26 years old and was diagnosed with type 1 three months ago. For one year before that, I was taking Propecia (the hair loss pill). Could that be the reason for my diabetes? (6 Sep 1999)

  93. Is drinking Coca-Cola or other soft drinks the main cause of diabetes? (5 Sep 1999)

  94. I am 32 years old and 28 weeks pregnant with identical twin boys. I just failed my 1 hour test and I am very concerned. I have been looking everywhere for a list of foods that I should and shouldn't eat. (5 Sep 1999)

  95. Is there an insulin pen available that records the time that the last injection took place? (5 Sep 1999)

  96. I have had three appointments with my gynecologist, who, because of severe vaginal fungal infection that would not clear up, did some blood tests and tells me that I am "borderline" diabetic. What should I do to stave off the full onset of diabetes? (5 Sep 1999)

  97. Please supply details of side effects and adverse reactions to human insulin versus animal insulin. (5 Sep 1999)

  98. My daughter is a Type 1 diabetic, diagnosed at age 8, currently age 19, and on the insulin pump. The doctor wants her to lose more weight and thus recommended Glucophage. What is the history of Glucophage use with type 1 diabetics this young? (3 Sep 1999)

  99. I have had type 1 diabetes for 16 years. I am 24 now. The other morning, I "woke up" in my living room. I had a broken blood vessel in my eye, had bitten through my tongue, a couple of bruises and was very disoriented. (3 Sep 1999)

  100. My 6 year old daughter had a A1c result of 7.6. The problem is she experiences low blood sugar around 40 often. Does insulin change the results of the A1c test? (3 Sep 1999)

  101. I was recently told by a doctor specializing in diabetes that he wanted me to fast once a week, not take my insulin (70-30 40 units twice daily) on that day and to cut my meals to two a day. Never in my life have I heard of that. (3 Sep 1999)

  102. Is there any way of avoiding loss of fatty tissue around the insulin injection area? Are there areas of the body where this condition is less likely to occur? (3 Sep 1999)

  103. My husband has had diabetes since he was 12. He now has been diagnosed with lymphoma. Could these be related? (3 Sep 1999)

  104. My son, 8 years old, was diagnosed with type 1 diabetes two months ago. Two weeks ago he started having some sinus problems and we have found that his blood glucose has tended to the high side. We have increased his Humalog to 4 units and Protaphane to 9 but it does not seem to stabilise. (3 Sep 1999)

  105. My 7 year old daughter was diagnosed Type 1 seven months ago. Since that time her insulin dosages have steadily decreased to where she is currently only taking 6 units of NPH a day. Could this mean she is not truly a Type 1 or could she be a Type 1B? (3 Sep 1999)

  106. My 18 year old son has had type 1 diabetes since he was 9. Just lately, he has had more trouble recognizing low blood sugars. I know he has a beer now and then, and although I don't like it, it will probably happen. How exactly does alcohol affect the body? (3 Sep 1999)

  107. My Type 1 18 year old was recently diagnosed with hypothyroidism. After starting thyroid therapy, his blood sugars became high immediately after meals and low before the next meal. Will increasing doses of Synthroid cause increasing highs after meals? (3 Sep 1999)

  108. I have been a diabetic for 22 years and am 26 years old. Three years ago I was told they found a trace of protein in my urine. My doctor said I do not have nephropathy -- yet putting me on Zestril seems as if he is treating me for kidney disease. (2 Sep 1999)

  109. My 12 year old niece has diabetes. It's the type where she has to have shots twice a day. Her average is 190. Is this high? (2 Sep 1999)

  110. My son will be visiting his grandparents in another state soon. In order to make this a little easier for his grandparents, I am wondering it I can go ahead and load the syringes with the proper amount of NPH ahead of time. Then, all they would have to worry about measuring and adding is the Humalog. (2 Sep 1999)

  111. My 8 year old was diagnosed 3 months ago, and was previously inoculated for Hepatitis B. I have just read of a possible connection between Hepatitis B vaccinations and increased incidence of Type 1 diabetes. Has this report any validity? (2 Sep 1999)

  112. I have Type 1 Diabetes and there is no medical history of any kind in my family. I was on medications such as Prednisone (a steroid) for longer than a year. Is it possible that these medications could have triggered diabetes? (2 Sep 1999)

The Diabetes Team

Bill Jones, MD (Specialist in the management of diabetes during pregnancy, member since April 1997)
Marco Songini, MD (Italy) (Pediatric, adolescent, and adult endocrinologist and diabetologist, member since April 1997)
Larry Deeb, MD (Pediatric Endocrinologist, member since July 1998)
John Schulga, MBChB MRCGP MRCP FRCPCH (UK) (Consultant Paediatrician in childhood and adolescent diabetes and endocrinology, member since July 1999)
Stuart Brink, MD (Pediatric Endocrinologist, member since October 1999)
Matthew Brown, MD (Pediatrician and a Pediatric Diabetologist, member since January 2000)
Jim Lane, MD (Adult Endocrinologist, member since November 2000)
David Schwartz, MD (Pediatric Endocrinologist, member since May 2001)
Andrea Scaramuzza, MD (Italy) (Pediatric Endocrinologist, member since October 2003)
Linda DiMeglio, MD (Pediatric Endocrinologist)

Barb Schreiner, RN, MPH, CDE (Diabetes Nurse Specialist, member since July 2002)
Jane Seley, RN, GNP, MPH, MSN, CDE, CHES (Diabetes Nurse Practitioner, member since August 2002)
Joe Solowiejczyk, RN, MSW (Family Therapist, member since April 2010)
Linda Mackowiak, RN, MS, FNP, CDE (Diabetes Nurse Specialist)

Jill Weissberg-Benchell, PhD (Medical Psychology and Psychiatry, member since January 2000)

James Michael Schurig, MS, RD, LD, CDE (Dietitian, member since December 2000)

Exercise Physiologists
Rick Philbin, M.Ed., A.T.C., C.S.C.S (Sports Medicine, member since July 2004)

Lois Schmidt Finney, RD, MPH, CDE (DPT-1 Research Coordinator, member since July 1998)
Heather Speer, MPH, CCRC, CDE (Clinical Diabetes Research and Education Coordinator, member since July 1998)

Social Workers
Debbie Butler, CDE, MSW, LICSW (Licensed Clinical Social Worker, member since October 2004)

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