Jan 5, 2003 By Josh Krysak 12 min read

Editor’s note: This story is the first in a two-part series examining the growing incidence of diabetes in Fayette County. For Doreen Bugai, Sept. 18, 1994, is a day she will never forget.

The Connellsville woman had been battling what she thought were gallbladder pains for three straight days. The night before that fateful morning, Bugai had called her mother, who had had her gallbladder removed, and asked her how to combat the pain. She told her daughter to drink vinegar water.

“On that particular day, it was a Sunday, and my daughter and I went to visit a friend,” Bugai said. She and her daughter never made the visit.

Bugai, who had convinced herself she was just having gallbladder pains, had been having a heart attack for three days, but the symptoms had been masked, elusive.

For many diabetics, there is no chest pain.

“We have silent heart attacks,” Bugai said.

That event was a turning point for the 47-year-old Brownsville native. Since that day, she has never really recovered.

“From that point on, I just went downhill,” she said. “I’ve had every complication that goes with diabetes, except amputation.”

According to the Centers for Disease Control, 17 million Americans have diabetes, and 1 million diabetics are diagnosed each year. In 1999, diabetes caused 19 percent of all deaths in the United States, and it is now the sixth-leading cause of death. According to local experts, Fayette County has a higher incidence of diabetes than the rest of the state and a greater risk of complications associated with the disease.

“Across the country, it is increasing,” said Dr. Tim Jackson, an endocrinologist and the only diabetes specialist in Fayette County. “It’s at epidemic proportions across the country because obesity is.”

Sue Shearer, the diabetes educator for Fayette Home Care, agrees.

“In America, in general, diabetes is growing in large amounts. Fayette County, in particular, is really hit hard,” she said.

Bugai, who was diagnosed in 1980, is one of those who have been hit hardest by the disease. “At first, I didn’t realize what diabetes actually did to the body,” she said.

Now, she knows all too well.

She has suffered with neuropathy, internal bleeding and severe stomach and vision problems. She has undergone numerous surgeries and can only watch as insurance companies wage war over a new pancreas that is simply waiting for her.

“Right now, the insurance companies are battling it out because they think that the pancreas is not a need,” she said. She is optimistic, though, as recently she received positive signs from insurance representatives that she will receive the donor organ.

“By the grace of God it will be settled. I put everything in his hands.”

On the frontline

The pancreas is the frontline for the disease. Located behind the stomach, the organ produces a naturally occurring hormone, insulin, that helps the body use glucose for energy. When the pancreas produces little or no insulin, the body is unable to properly use energy from food. Blood sugar levels are elevated and early symptoms of the disease begin to appear: weight loss or gain, thirst, frequent urination and fatigue.

When Bugai was diagnosed she had been losing weight, almost 60 pounds, but she thought it was because of her new diet: She was drinking a gallon of water a day. The other symptoms were there, but she thought they were the result of stress from her job and the death of her brother the year before.

“I just thought it was all those things, because diabetes does not run in our family,” she said.

After she got to the point where she could no longer function, she was diagnosed with Type 1 diabetes.

Diabetes is classified into two main categories: Type 1, or insulin dependent, and Type 2, or non-insulin dependant. In Type 1, the pancreas produces little or no insulin, and injections of insulin are needed to replenish the body’s supply. In Type 2, the body produces some insulin, but it does not work very well and the diabetic must make changes in diet and exercise to compensate.

Doctors said that for Bugai, the disease was brought on by the shock of losing her brother. At first, Bugai, like many other diabetics, could not differentiate between health problems caused by the disease and those caused by the medications. She said she was allergic to beef and pork insulin and had to work her way through the various treatments until she became more stable.

Bugai, who worked at California University of Pennsylvania in child care, had to quit her job because she was too sick to perform, and she eventually had to give up most of her active life for a life she now dedicates almost completely to diabetes.

“When I go out of the house, you should see the big bag I carry: my machine, my monitor, my insulin, all those things,” she said. “People will say, ‘Doreen, don’t you get tired of carrying that stuff?’ Well, it has become a way of life after 20 years.”

Bugai’s “way of life” is the way of many in the area. Tina Dills, a friend of Bugai’s who is also a Type 1 diabetic, sympathizes with her.

“I get depressed because I don’t want to deal with it,” she said. “There are days when you just don’t feel good.”

Dills, 30, was diagnosed when she went for a routine physical for her driver’s permit. She was just 17. Her life has never been the same. The things she once loved are now memories. “I used to love to do counted cross stitching. I used to love to go bowling with my friends. I can’t do it anymore.”

Who’s to help?

Both Bugai and Dills complain that a lack of knowledge, at least in the beginning, caused additional problems.

Bugai said doctors often prescribed pills without ever explaining what they were for or how to take them properly. Bugai now takes 20 prescriptions a day, in addition to her insulin.

She has educated herself over the years and now works to help diabetics across southwestern Pennsylvania learn how to take better care of themselves. She attends all the seminars and lectures she can find and even goes as far as filling out the addresses of diabetic friends on surveys for free literature. Doing so makes her feel like she is helping. She just keeps fighting.

Dills said she too is working to take better care of herself, but due to poor insurance coverage, she can afford her medications only if the doctor can give her samples. She said she buys her own insulin, almost $200 a month, but after that, she is at the mercy of the system. She is covered under the insurance of her husband, Scott, who works at Uniontown Hospital.

Both Dills and Bugai said that while they think diabetes educators like Shearer really help, the county is in desperate need of a full-time diabetes specialist.

Shearer agrees.

“It is a big problem,” she said. “A full-time doctor would really help us. The doctors here are already overworked.”

Barbara Girod, vice president of clinical services at Greene County Memorial Hospital, said that while Jackson serves Greene County four days a week and Fayette County one day a week, it is not enough.

She said diabetic education programs like the one Shearer works with are helpful. Greene County Memorial used to have one, but Girod said it closed last year for financial reasons.

Despite the lack of doctors, Bugai said she goes to different doctors three or four times a week. Dills, conversely, admits she does not go to enough. “I honestly don’t take care of myself like I should, because I get frustrated,” she said.

She said her dedication is sporadic at best, and she often misses her doctor appointments.

On the home front

While doctors for area diabetics are few and far between, the battle continues on the home front every day. Just walking, spending time with friends and family and basic living become struggles.

Bugai said she checks her blood-sugar level about 14 times a day. Routinely, she needs a cortisone injection just to walk, but then she has to deal with the side effects. Cortisone wreaks havoc on a diabetic body. “Every day is a challenge.”

She said simple things like eating and exercise are now obstacles. When she first was diagnosed, she said, she did a lot of diet trading – exchanging foods that are restricted or forbidden in the diabetic diet for extra insulin – two extra cups of mashed potatoes for five extra units of insulin. Now she knows better.

“I used to wait for my kids to have some candy, or I would have a low-blood-sugar attack so I could get a bite of it, but now I realize this is the kind of food everybody should be eating.”

For Dills, the diet aspect of diabetes is one of the toughest battles.

“I go on binges. I don’t eat all day long. I know I don’t eat the right way, but I didn’t used to care for sweets and now I crave them,” she said.

While she admits she struggles with the diabetic diet and is overweight, she is upset by the way society perceives her and diabetics. She said that people will comment on the red streaks and blotches on her legs or her blackening ankles, all of which are complications from the disease. She is saddened by the superficiality of it all.

“People really look at my legs, and it is embarrassing if I wear shorts or a dress,” she said. “So many people ask me, ‘Ewhh, what is that?’ including adults. It has caused a lot of depression.”

She and Bugai attend counseling to help them cope with the struggles.

While battles over diet and exercise are inescapable for diabetics, other problems arise.

Dills admits that she does not have a good marriage and thinks that diabetes is partly to blame. She said she has been seeing a psychiatrist about her difficulties but hasn’t had any breakthroughs yet.

“I always feel that when I tell him that I don’t feel good, that he doesn’t believe me,” she said. “I feel like a chronic complainer, but I really don’t feel good.”

Bugai also said that stress from the disease can cause relationship problems. She is now divorced.

Marriage problems are not unusual in diabetic relationships. A recent study by Penn State University examined how married couples respond when one partner is diagnosed. The study, which focused primarily on dietary changes for non-insulin-dependent diabetics, found that in most cases the diabetic was totally responsible for dietary alterations.

“The most common is when the diabetic takes all the responsibility upon themselves,” said Lynne Brown, associate professor of food science. The study also found that stress factors in the marriage increase and past conflicts often are revisited.

“If there had been conflict in the past about weight control, especially if it was a male diabetic who had had insensitivity toward the weight problems of the wife, this can lead to sabotage,” Brown said.

She noted that the couples either come to an understanding about the disease or experience varying degrees of conflict.

“Many times, if one member of a couple is diabetic, both will need to change food choices and negotiate diet adjustments that are satisfactory,” Brown said. “Lots aren’t able to do that. In couples where the non-diabetic plans the diet, dietary rules can feel imposed. The diabetic resents this, and the diet doesn’t last or the non-diabetic spouse burns out.”

Internal, external conflict

Conflict is the norm for a diabetic. Bugai experiences internal conflict every time she looks at her 4-year-old granddaughter, Haley. Bugai said her daughter Tamara and her granddaughter come to visit every Sunday, and it is then that Bugai hates diabetes the most. It is on those days that she tries to forget about the disease around which her life has become completely centered, and it is then that she realizes how much her life has changed.

“It’s hard. There are some days I just cry. I’m not the person I used to be. I was always a go-getter and worked very hard. At one time I worked four jobs. It is very hard to accept. Sometimes I just feel useless,” she said.

But it is the recognition that little Haley has already been faced with the harsh reality of life that truly saddens Bugai. She said her granddaughter already knows about blood-sugar tests and how grandma is often too tired to even see her. Haley has become a soldier, too.

“It has become a way of life for her, also,” she said.

Dills also has to face the saddening reality of being unable to do the things she wants with her 6-year-old son, Scott.

“It makes it tough, because there are times I just don’t want to do anything, and that takes away from him,” she said. “It breaks my heart to break his heart.”

Bugai said that although there are many heartbreaks along the way, she will continue to wage war over her body, her life and her future. She said that although she didn’t ask for diabetes, she will accept the disease and recognize the gifts it has brought in to her life and the reality it has made her face and understand.

“It seems that all I talk about, all I seem to focus on, is this diabetes. This is my life. This is every day. It has changed me tremendously and I know God has a purpose for it. I know it is going to be OK.”