Diabetes difficult disease to diagnose
Editor’s note: This story is the second in a two-part series examining the growing incidence of diabetes in Fayette County.Diabetes, which affects 17 million Americans, is a disease everyone has heard of but no one, except the dedicated diabetic, truly understands. And according to local experts, the disease has reached unprecedented levels across the country, especially in Pennsylvania, and local diabetics actually know very little about the disease. It is often casually attributed to heredity and is classified in conventional wisdom as a not-so-serious disease.
This view is a misconception that has led to higher incident rates and poor personal care, according to Dr. Tim Jackson, an endocrinologist working in Fayette and Greene counties.
“Everyone sees people with diabetes who don’t take care of themselves, and it doesn’t seem to hurt them in the short term,” said Jackson. “Across the country it is increasing. It is epidemic across the country because obesity is.”
He said diabetics often don’t recognize the serious health problems that complications from the disease can create.
“Diabetes is an abnormality of the metabolic paneling of glucose due to inadequate insulin or no insulin,” Jackson said. “It results in injury, destruction or illness in the vascular walls.”
Experts say the disease begins in the pancreas, where insulin, a naturally occurring hormone that helps the body use glucose for energy, is insufficient or not produced at all. This defect causes blood glucose levels to be too high. Cells to make energy cannot use the glucose in the bloodstream. Instead, the glucose collects in the blood, eventually leading to high glucose levels and diabetes.
According to the American Diabetes Association, the two most common types of diabetes, insulin dependent and non-insulin dependent, affect different people in different ways.
Type 1 diabetes usually occurs in children and young adults, but it can affect anyone. The disease is caused when the pancreas stops making insulin or makes only a tiny amount.
In Type 2 diabetes, the pancreas produces some insulin, but the body does not use the hormone well. Type 2 occurs most often in adults.
According to Sue Shearer, diabetes educator for Fayette Home Care, the body then tries to rid itself of the excess glucose, causing a plethora of complications.
“When there are high levels of sugar in the bloodstream, the body’s defense mechanism is to get rid of the sugar it is not using, so it tries to excrete it,” Shearer said.
This process causes thirst, dehydration, kidney problems, hypertension and even ketoacidosis, the buildup of keytones in the blood, which is life threatening. She said other complications are caused by a change in the consistency of the blood.
“When the sugars are always too high, the blood gets sticky,” Shearer said. The result is a plaque buildup in the veins and arteries that causes restricted blood flow, circulation difficulty and feet problems.
“Diabetics are at risk of heart attack, stroke, blindness, kidney failure, nerve disease and amputation,” Jackson said. “Obesity and inactivity just make the complications worse.”
The disease can be diagnosed through routine blood tests and is often associated with symptoms of frequent urination, thirst and fatigue.
But, Barbara Girod, vice president of clinical services at Greene County Memorial Hospital, thinks the disease can be hard to diagnose at first.
“Diabetes can be a very insidious disease,” she said. “You cannot even know you have it until you are sick.”
While doctors often cannot pinpoint a specific trigger for the disease, in many cases they say a poor diet and lifestyle lead to its onset. Jackson said these factors have allowed the disease to go basically unchecked in Fayette County and throughout the country.
“Some patients are very compliant and some don’t do well at all. They don’t want to hear that they have a chronic condition that makes them change their diet, increase their activity and change their lifestyle,” he said.
Girod said she sees diabetes beginning to affect more and more children, something she also thinks reflects the nation’s lifestyle.
“It is not only an increase in the adult population, but we are seeing an increase in younger children now. It is partly because of diet, partly because of exercise habits.”
According to a recent Pennsylvania Health Care Cost Containment Council study, hospitalizations continue to rise across the state and especially in Fayette County, which was 23.8 percent above the statewide percentage. Nationally, the disease is costing $98 billion annually, according to an American Diabetes Association report. The report also found the risk of death rate to be two times higher in people diagnosed with diabetes. All the figures represent what Shearer calls a lifestyle problem.
“What causes diabetes is our lifestyle. We have gone from very active, hard-working lives to people being laid off, the ability to use transit rather than walking and of course a poorer diet,” she said.
“When I was growing up, if we went to McDonald’s once in two or three months, that was a big treat. Now, we do it every day. Instead of going out and riding the bikes and playing hide and go seek and tag, what kids are doing is sitting inside and playing video games. They are not getting any exercise.”
Jackson and Shearer also attribute the high incident rate in Fayette County to economic factors. Fayette County is one of the most depressed counties in the state.
“People who are less employed, less insured, less educated are likely to eat worse, be less aware and, because they can’t afford it, less focused on preventative care,” Jackson said. “Being poor, in study after study, results in less care. Socioeconomic status, associated with education, and health care often result in less preventative care.”
Shearer said money can be traced to the problems in the diabetic diet. While some great new products are made specifically for diabetics, they are usually more expensive: “Low-fat products are usually 50 cents to $1 more expensive, and diabetic products like drinks and sugar-free puddings, they are more expensive as well.”
While the disease is linked to the poor, Girod thinks it is also linked to the rich. She said she sees the disease growing in America because of the wide spectrum of economic statuses across the country. The poor eat poorly, and the rich still eat poorly in some cases and are often more sedentary, she said.
The local experts agree that the first step in winning the battle over diabetes is a change of lifestyle. Without better diets and more exercise, the figures most likely will continue to rise, they said.
“People need to eat right and get out off the couch and exercise,” Shearer said.