|Ocala, FL -
January 11, 2013|
Published in Ocala.com on Friday, January 11, 2013 at 12:04 p.m.
Clara Kiss, left, gets a blood sugar test as she visits with registered nurse Heatherann Cundiff at the Munroe Regional Medical Center Diabetes Healthways office in Ocala.
Every sign pointed to Dennis being in good health. At least that’s the way Dennis saw it.
And losing more than a dozen pounds in a couple of weeks without effort was an added blessing, Dennis thought.
But that was before he went unconscious working outside and was rushed to the hospital by a co-worker. When he came to, his diagnosis was the last he expected to hear and his doctor didn’t sugarcoat it.
“I wasn’t in the hospital more than two, three hours before (he) told me. ‘We know what your problem is. You have diabetes,’” Dennis said.
“As first I was in shock. Then depression set in,” said Dennis, who didn’t want his last name used for this story. “I had friends that were diabetic. They had all sorts of problems, a couple of toes lost. I didn’t want that.”
Dennis’ revelation that he had Type 2 diabetes occurred 25 years ago. Thousands of insulin shots and a few heart stents later, Dennis thinks he’s fared pretty well.
The news wasn’t the death sentence he originally thought.
“I play golf regularly,” said the 64-year-old retired government worker. “I work out. I do normal things that everyone does.”
Although Dennis has suffered from heart problems linked to diabetes, he attributes much of his otherwise healthy life to area organizations like Diabetes Healthways, part of Munroe Regional Medical Center, where he meets with support groups and learns about the disease.
The University of Florida/IFAS Marion County Extension Service will also begin this month a series of classes to help diabetics learn and control the medical issues related to the illness.
“If you don’t come to one-on-one (meetings) you’re missing out on support and the support of friends and family is important,” Dennis said. “I don’t think you can learn what you get at these meetings off the Internet.”
About 90 percent of diabetics have type 2 diabetes like Dennis.
Type 2, formerly called adult onset diabetes, involves a complicated medical condition by which a person’s cells doesn’t adequately absorb insulin in order to accept glucose, the sugar the body uses a fuel.
During early stages of type 2 diabetes, the pancreas still produces normal levels of insulin, but with time that production level diminishes. In most cases, the diabetic will eventually have to inject themselves with insulin to make up for that lost insulin production.
Affecting the cells’ ability to absorb insulin are a number of factors, including the weight of the diabetic, said Diane Thompson, director of Diabetes Healthways. The more fat cells the diabetic has, the more difficult muscle cells have of absorbing the insulin they need.
Due to complications of the disease, many diabetics can suffer from a myriad of medical problems that lead to heart problems, kidney and circulatory failure and vision loss.
Type 1 diabetes, formerly called juvenile onset diabetes, occurs typically before the age of 20. With type 1 diabetes, cells in the pancreas that produce insulin are destroyed by the diabetic’s own immune system and, as a result, always need injected insulin.
As a result of decreased insulin production, both type 1 and type 2 diabetics are constantly faced with the decision of how much insulin to inject to balance the glucose they get from meals.
Typically, the ideal blood sugar level before a meal is 80 mg/dL – 110 mg/dL.
When Dennis was taken to the hospital, his sugar level was six times higher than normal.
The onset of the disease is typically gradual.
“You have diabetes for about 10 years before it’s diagnosed if you don’t see a physician regularly,” Thompson said.
By the time someone is diagnosed, their body is producing about 50 percent less insulin than it should. That number drops between 1 percent and 4 percent each year after that, Thompson said.
Dennis is not alone: An estimated 10 percent of Marion County adults in 2009 were diabetic, according to the federal Centers for Disease Control and Prevention. That was up from 7.8 percent in 2004.
One CDC study estimated that currently as many as 14.5 percent of adults in the county could be diabetic.
That growth of diabetes isn’t unique to Marion County. In Florida, 10.1 percent of people had diabetes in 2010, according to the CDC.
Thompson offers a series of diabetes classes and one-on-one sessions at Diabetes Healthways. She talks with clients about diet, physical activity, insulin needs and monitoring and addressing physical problems associated with the disease.
Thompson describes balancing a person’s insulin needs like walking a tightrope, because every diabetic is different with their own lifestyles and medical issues.
Thompson’s class sessions total 10 hours and are paid for by most insurance companies.
Thompson said the predominate factors in type 2 diabetes is genetic predisposition, obesity and physical inactivity.
Thompson said she wasn’t surprised that the number of adult onset diabetes was on the rise. More people are getting heavier and less active.
Her prediction is that the percentage of adult, type 2 diabetics will only increase.
“If you really want to see the wave of the future, look at the pediatric population. It’s frightening,” Thompson said. “It’s now that 8-, 9-year-olds have type 2 diabetes.”
A decade ago, that was almost unheard of, she said, but as children become more sedentary, children get heavier.
CDC maps showing cases of obesity are synonymous with maps showing high concentrations of diabetes in the United States.
Another problem is the rising cost of healthy foods. “When you’re on a set income, people will ask, ‘Am I going to eat healthy or am I going to keep the lights on?’” Thompson said.
Thompson’s office gets between 75 and 100 doctors’ referrals per month. Between 35 percent and 40 percent actually come.
Doctors and insurance companies are seeing the importance of such centers that counsel patients. Studies show that as many as 30 percent of hospital patients are there because of complications due to diabetes.
But as hard as people try to determine how much insulin they need to inject, it’s still little more than an educated estimate.
In the long run, injecting insulin is not as accurate as a healthy pancreas producing just the right amount and healthy cells willing to absorb it along with the glucose.
Many type 2 diabetics who once were able to control their sugar levels with oral medicines, diet and exercise eventually have to start using injectable insulin and more strictly monitor their glucose levels. And in time, the disease takes its toll for many diabetics, causing heart, eye, organ and circulation problems, Thompson said.
But Thompson said that’s where agencies offering diabetes classing are again helpful. Qualified staff help diabetics better understand how insulin injections help and how to better monitor for related health problems.
Colombian-born Clara Kiss, 76, learned she was diabetic in 1986 as she was caring for her diabetic mother and aunt.
As a lark, she tested her own sugar level. It was nearly four times higher than it should have been.
“I was scared to death and called the doctor immediately,” Kiss said.
Kiss went to the Diabetes Healthway earlier this week. Her blood sugar levels were becoming erratically too high. Less than a year ago, after decades of controlling her diabetes with diet and exercise, she had to start injecting insulin.
But she admits her diet and her exercise routine have taken a backseat to taking care of her husband, who suffers from amyotrophic lateral sclerosis, commonly called Lou Gehrig’s disease.
“Now I’m really nervous ...that I’ll have some kind of problems with my kidneys, my eyes, my feet,” she said.
She doesn’t eat at regular intervals now that she must care for her husband.
She takes insulin shots three times per day in addition to taking oral medications, but her tests show that her glucose levels are already too high in the mornings and after meals.
Heather Cundiff, a registered nurse at Diabetes Healthways, counsels Kiss that stress also contributes to high sugar levels.
Kiss said when she learned that her diabetes had become bad enough to warrant injected insulin, she was frightened. But Cundiff countered: “Insulin doesn’t hurt you; glucose hurts you.”
Kiss will return to the center to be counseled about her diet.
Kiss has also felt the opposite extreme of glucose highs.
In some cases, without property food intake, diabetics can also suffer glucose lows. That can easily result in unconsciousness and death, Cundiff said.
It can be complicated and that’s why extensive education sessions are needed, Cundiff said.
“Well-controlled diabetes leads to a healthy, happy life,” Cundiff said. “If it’s poorly controlled, diabetes leads to complications. Diabetes is a lot of work.”
Dennis urges diabetics to contact others with the same disease, get educated and join support groups.
“You have to know there are other people out there like you,” he said.
And he advises not to worry about the health issues that many diabetics will eventually suffer.
Citing his own condition, Dennis said, “That’s 10 years down the road. I live for today...You can’t worry about that kind of stuff.”