The lowdown on diabetes: Are you at high risk?

• Profile: Charlie Carr, Age 54, Type 2
• Profile: Gyasi Cambridge, Age 10, Type 1
• Profile: Lucia Carvalho, Age 45, Type 1
• Profile: Shirley Garner, Age 74, Type 2
• Profile: Warner Davis, Age 75, Type 2

 

Do you have diabetes? No? Are you sure?

According to the U.S. Department of Health and Human Services, more than 18 million people in this country have diabetes, and it is estimated that at least half of them don’t even know it.

Further, some 41 million people in the United States have what is called pre-diabetes, and most are not only unaware of it, they don’t know what it is.

The term “pre-diabetes” essentially defines itself. It refers to people whose blood sugar levels are higher than normal but not yet within the range of a diabetes diagnosis. It is important to understand that those classified with pre-diabetes have already boarded the train bound for diabetes. And it’s even more important to learn how to get off that train before it reaches the station.

For people diagnosed with type 1 diabetes, the pancreas does not produce insulin, which is needed to convert glucose into energy for the body. This means glucose will build up in the bloodstream, overflow into the urine, and pass out of the body without satisfying its role as the body’s main source of fuel.

Type 2 diabetes develops when the body can’t respond properly to the insulin produced. At first, the pancreas increases the production of insulin to compensate; but at some point it falls behind, no longer able to make enough insulin to respond to food intake. Again, glucose builds up in the bloodstream and is eliminated without serving the body.

Charlie Carr
Age 54, Type 2

Charlie Carr learned the hard way what happens when you ignore your diabetes and hope it will just go away. About three years ago, he got fed up dealing with the disease he’d already lived with for 17 years: he quit taking care of himself. He started drinking sodas and eating irregularly or eating large portions of food in one sitting. He stopped exercising.

“I kind of just let it go,” he says. “I decided, ‘I want sugar, I want candy.’ I got frustrated with all the ‘Oh, you can’t eat this. You can’t do that.’ I felt the walls falling in on me.”

He ended up at Community Hospital, where he almost died.

“It really looked like I wasn’t going to make it. It changed my life. It really did,” Carr says. “I made a promise: ‘If I get out of here, I’ll do everything right.’”

When he did finally get better, Carr made good on that promise. The first thing he did was sign up for Community Hospital courses in diabetes to help educate himself. Through education, he’s been able to manage his disease without becoming frustrated with the limitations.

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Insulin resistance, another condition, means the muscle and fat cells are resisting or not using insulin properly. This results once again in an overactive pancreas that is unable to produce enough insulin to keep up with the body’s demand, causing glucose to build up in the bloodstream.

Each condition ends up the same: too much glucose in the bloodstream, without a way for the glucose-hungry cells to use it for energy. Over time, this can damage nerves, eyes, kidneys, and other organs. When blood sugar is high, your blood is thick, sticky, and sweet, and it’s harder for the heart to pump it.

In addition, damage occurs to the inner walls of the blood vessels. “It contributes to arteriosclerosis from the start,” says RoseMary O’Neil, R.N., a certified diabetes educator and the program coordinator for Community Hospital’s Diabetes Program. “It contributes to the buildup of plaque.”

Damage also occurs to the outside of the nerve cells, leading to a condition called peripheral neuropathy — numbness and tingling in the feet and legs — and to autonomic neuropathy, which “affects the whole digestive tract,” O’Neil explains. Symptoms include diarrhea, constipation, and a slow emptying of the stomach that is marked by bloating.

“Once you have the diagnosis of diabetes, you have it for life,” says Michelle Barth, clinical dietitian and certified diabetes educator for Community Hospital. “It can be controlled, but there is no cure yet. Because type 2 diabetes is an issue of lifestyle, those who start to take care of themselves, who lose weight and start exercising, can slow the progression of diabetes or delay or negate the need for insulin. But they can’t reverse the disease.”

Those with pre-diabetes have a higher risk of developing type 2 diabetes, as well as heart disease. Once called adult-onset diabetes, type 2 is now found among children and adolescents, owing largely to issues of weight and exercise. According to the Center for Chronic Disease Prevention and Health Promotion (CCD), some 151,000 people in this country below the age of 20 have diabetes.

Gyasi Cambridge
Age 10, Type 1

Gyasi Cambridge is your average basketball-playing, pizza-loving boy…who happens to have diabetes.

“It hasn’t changed him at all,” says his mother, Cheryl Cambridge of Seaside. Since being diagnosed with diabetes in November 2004, Gyasi has continued to play endless hours of basketball every day; he still wears basketball shorts everywhere he goes, and his favorite foods are still pepperoni pizza and something from the McDonald’s® menu. It’s just that now he gives himself insulin shots three times a day. And when he wants a couple of pieces of pizza from Mountain Mike’s, his favorite, he has to plan a little bit.

“I usually give myself two units of insulin for two slices of pepperoni,” says Gyasi, who has taken a series of courses on diabetes to learn how to monitor the disease himself. His advice to other kids diagnosed with diabetes? “Don’t worry about it, because it’s going to get easier,” says Gyasi, who spent six days in Community Hospital when he was first diagnosed.

Six months after his initial diagnosis, managing his diabetes has become pretty routine for Gyasi. He’s learned to schedule his meals and to make sure his drinks are sugar-free.

“Everything we do we have to check the carbs first,” his mom says. “He sees the doctor once a month, and he manages pretty well.”

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When diabetes strikes during childhood, it is routinely assumed to be type 1, formerly called juvenile-onset diabetes. In the last two decades, however, type 2 diabetes has been reported among children and adolescents with increasing frequency in this country. It is called maturity-onset diabetes in youth.

It is, according to the CCD, often hard to detect type 2 diabetes in children, and it can go undiagnosed for a long time. Children may have mild or no obvious symptoms. Further, it can be difficult to confirm whether it is type 1 or type 2 when the criteria for differentiating between the two types in children overlap. Children with type 2 diabetes can develop ketoacidosis (acid buildup in the blood), usually associated with type 1; and children with type 1 diabetes can be overweight, an observable risk factor for type 2.

“The good news about pre-diabetes,” says Barbara Quinn, clinical dietitian and certified diabetes educator for Community Hospital, “is that it is reversible. Lower your fat intake and your weight, increase your fiber, increase your activity or exercise, and you can lower your chances for developing diabetes and heart disease.”

According to the National Institutes of Health, studies have shown that people with pre-diabetes tend to go on to develop type 2 diabetes within 10 years unless they lose 5 percent to 7 percent of their body weight. The key is to make and maintain modest changes in diet and level of physical activity.

Identifying the strategies for preventing or delaying the onset of type 2 diabetes is often considerably easier than implementing them. Not unlike the often silent dilemma of high cholesterol, type 2 diabetes can be unobtrusive for a long time, offering little or no incentive to embark on the rigors of diet and exercise.

An article in Diabetes Care (January 2004) reported on two landmark studies, the Finnish study (2001) and the Diabetes Prevention Program (2002), both of which concluded that type 2 diabetes could be delayed or prevented with modest changes in weight, diet, and activity. Yet both also reported that “considerable effort from well-trained staff was needed to achieve these behavioral changes.”

Lucia Carvalho
Age 45, Type 1

She was born and raised in Portugal, but it was her father’s dream to come to America. In 1973, she followed her father and his dream. She was just 13.

That was four years after Lucia Carvalho had been diagnosed with juvenile-onset, or type 1, diabetes. And in 1993, two decades after the family had come to the United States, Lucia’s parents succumbed to the type 2 form of the disease. Her brother and sister have since been diagnosed with it, as well.

Carvalho’s parents never learned English, so she ferried them to and from their medical appointments until they died, all the while caring for her own condition. Today, Carvalho, who was born with only one kidney, undergoes dialysis three times per week. She lives in Monterey near her sister, who promised their parents she would look after Lucia in their absence.

“I deal with the dialysis the same way I deal with diabetes,” Carvalho says, “taking each day as it comes. I never talked to my mom much about it because she felt so guilty about the diabetes. So, I’ve had to learn how to survive and deal with it myself.

“I take four insulin shots a day. I tried to use the pump, but I’m blind in one eye and have a cataract in the other, so it was not easy to read. This is not an easy task. But either you learn how to deal with it day by day or you don’t get to deal with it at all.

“I tell my doctor, ‘As long as I fight and you support me, I’ll be here.’ I’ve just got to enjoy life while I can, with no regrets.”

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During the Finnish study, participants had seven group sessions with a nutritionist during the first year of intervention, followed by one session every three months thereafter, plus individualized guidance on increasing their physical activity. In the Diabetes Prevention Program, participants met with a case manager 16 times during the first six months and monthly thereafter; in addition, group courses on exercise and weight loss were offered, as were two supervised exercise sessions per week.

The dilemma revealed by the article is that, while the U.S. healthcare system is not structured to provide or reimburse for regular lifestyle counseling, better strategies are needed to help people lose weight, keep the weight off, and exercise more often.

Community Hospital has created a quarterly class for patients classified as pre-diabetic (fasting blood glucose level of 100–125 or higher). The four sessions focus on understanding diabetes and pre-diabetes, the impact of either on our lives, and effective strategies for preventing or delaying the onset of type 2 diabetes. There is a $60 fee for this series of classes.

“Weight is the symptom we usually see,” says Barth, “but there’s more. The overweight person who doesn’t exercise, eats poorly, drinks, and smokes is adding up the risk factors. In our classes, we talk about moderate exercise. We don’t talk about forbidding foods; we talk about portion control, increasing fiber, decreasing fat, and savoring our food.”

There are other risk factors besides weight and exercise, including age, a family history of diabetes, low HDL cholesterol, high triglycerides, and high blood pressure. O’Neil says, “Your genetics are the gun, but your lifestyle is the trigger.”

Shirley Garner
Age 74, Type 2

Shirley Garner has always excelled in the kitchen. It’s where she shines. She especially loves to bake — apricot cobbler, blueberry streusel, rhubarb crisp — whatever’s in season. So when she was diagnosed with diabetes about four years ago, she faced some major lifestyle changes.

“I always made a huge pan of fudge at Christmas,” Garner says, a bit wistfully. “I’ve had to put my foot down there, although there are times when I’ll still have just one piece.”

At 74, the Carmel Valley grandmother has had to cut back on the baking, change her eating habits, and hit the treadmill daily.

Garner’s diabetes has rarely caused her any discomfort. She was only tested for the disease as a precaution after she mentioned to her doctor that diabetes ran in her family. Now she’s just grateful she’s dealing with it later in life instead of in her youth, in the days before insulin.

“When we heard the term ‘diabetes’ when I was young, it was like a death sentence.”

Today, Garner is able to control her diabetes without medication. “Once you’re diagnosed,” she says, “you can go into a funk and have a huge pity party, or you can appreciate all the things you can still do.”

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Warner Davis
Age 75, Type 2

When Seaside’s Warner Davis was diagnosed with diabetes 5 or 10 years ago — he can’t really remember when — the retired veteran approached the disease much the same way he handled Vietnam. “It’s all about self-management,” he says. “It’s a stay-alive type of program. The more you know about it, the better you’re going to fare.”

Originally from Texas, Davis came to the Peninsula via Alaska in 1963, when he was first stationed at Fort Ord. From there, he was sent to Thailand, then back to Fort Ord before his tour in Vietnam. Following his final return to Fort Ord, he retired to his home in Seaside with wife Yuriko. They’ve been married 56 years.

“I wouldn’t be here talking about it if I couldn’t work with it,” he says. “But I credit the support groups for that. First off, Community Hospital has a program on diabetes where they teach you how to manage and live with the disease.

“I’m no authority on this, but if you really want to watch out for diabetes, to remain in a healthy or pre-diabetic state, I would suggest you get to your proper body weight and maintain it. Eat the proper foods, and stay away from the bad fats. Protect your heart, and it will protect your diabetes. And if you do have diabetes, above all join a support group.”

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