Wednesday, November 9, 2005

National diabetes awareness month

Argen Duncan El Defensor Chieftain Reporter

About one in 11 New Mexico adults has diabetes, and children are more frequently developing a form of the disease they didn't get 15 to 20 years ago, a Socorro nurse diabetes educator said.

Nurse Jan Tarr said diabetes is an epidemic in the United States, with its prevalence increasing by 14 percent in the past two years.

New Mexico Department of Health statistics estimate that of the 115,000 New Mexicans with diabetes, 37,000 don't know they have it.

Dr. Robert Markwell, a general practitioner at Socorro Medical Associates, said Socorro might have a slightly higher rate of diabetes than the national average because of its ethnic composition. Hispanic people and American Indians are genetically pre-disposed to the condition, he said.

New Mexico's rate is 5.7 percent of people age 18 and older, compared to 7.2 percent for the country, according to the Centers for Disease Control.

According to the state health department, diabetes increases the risk of cardiovascular disease and stroke. It is also the leading cause of non-traumatic amputations in the feet and legs, blindness in 20- to 74-year-olds and kidney failure, according to the department.

Markwell said diabetics often have high amounts of fat in their blood and high blood pressure.

The cost of medical care, lost productivity and premature death due to diabetes in New Mexico in 2002 was more than $1 billion, according to the American Diabetes Association.

Two forms of diabetes exist. Type I diabetes affects 5 percent of diabetes patients. Their bodies do not produce insulin because the cells that make it in the pancreas have died.

Insulin, produced in the pancreas, is a hormone essential for turning starches and sugars from food into energy.

Markwell said Type I seems to be related to genetics, possible viruses and unknown causes more than to diet and exercise.

Tarr said exercise helps Type I diabetics, and added those individuals are often more careful than Type II patients about how many carbohydrates they eat and giving themselves insulin based on that amount.

The 95 percent of diabetics with Type II have bodies that produce too little insulin.

Tarr said development of Type II diabetes is strongly correlated with lack of exercise and weight gain. She also said if a person has a history of decades of always overeating, the pancreas stops functioning properly because it can't keep up with food consumption.

Markwell spoke of Type II having genetic factors as well.

He also said doctors are not very successful motivating patients to properly manage diabetes.

"Our biggest frustration, I think, is so many people don't seem to take it seriously and do what they need to do," he said.

Nyleen Troxel-Stowe of Socorro had Type I diabetes for 30 years before receiving pancreas and kidney transplants last year. She was diagnosed at age 6.

"I think you can adjust to it easier as a kid," she said.

She grew up restricting her diet and learning to give herself insulin shots. She had problems with leaking blood vessels in her eyes and neuropathy, nerve problems, in her feet when she was 19 years old. The neuropathy continued to some extent.

"The one thing I was lucky on: I never had any circulation problems," she said, adding such difficulties can lead to infection and amputation.

At age 25, she got an insulin pump, which gave her insulin in small amounts throughout the day. Troxel-Stowe said she thinks this is the biggest advancement she's seen because it is the closest thing to a functioning pancreas besides the organ.

She said she had to count the carbohydrates in her meals and giver herself insulin accordingly. Figuring the amount was often complicated, she said.

Before her transplant, she began having severe bouts of low blood sugar because of insulin sensitivity. People around her had to give her shots to bring the sugar level up if she began acting strangely, and she could no longer travel alone.

The transplant cured her diabetes.

"I have tons less to worry about, and I'm living a normal life for the first time since I was a little kid," she said.

Troxel Stowe said she can't thank the family of wildlife biologist John Paul Taylor Jr. enough for directly donating his organs after he died of complications from a stroke last year.

For Type II diabetes, studies show exercising is a "strong drug" in preventing or delaying it, Tarr said. She said walking 30 minutes a day, five days a week greatly helps, even if the 30 minutes is accumulated at different times during the day.

"We're a nation, and we don't exercise; we don't move enough," she said.

Although she hears many reasons not to exercise, she sees people with busy schedules and physical problems walking, Tarr said.

"They just erase the barriers in their mind and are out there moving," she said.

Tarr said diabetes is progressive.

In early stages of Type II, people can typically manage the condition with careful choice of food and exercise. Weight loss is helpful but hard to achieve, and so not counted on, she said.

If diet and exercise don't help, patients can take three categories of pills to help them use insulin more effectively. She said the next step is taking insulin, which most patients with Type II need eventually.

However, Tarr said some people can handle their diabetes for years with exercise and food management. She defined food management as limiting calories, stopping weight gain and knowing what a carbohydrate is and how to budget the consumption of it.

"So it's not always this one-way path to where people need insulin," she said.

Tarr said health care providers are seeing Type II in children now, whereas 15 or 20 years ago, the only cases of childhood diabetes were Type I. Weight gain predisposes children to Type II.

With the onset of diabetes at a young age, children may see related problems in their 20s or 30s instead of much later in life. This presents huge health care costs and is awful to face, Tarr said.

However, she said people can manage the condition.

"It's not diabetes that hurts people," she said. "It's uncontrolled blood sugar."

People can bring their blood sugar very close to normal levels and have a very good chance of a healthy life, she said.

Parents with children at risk for developing diabetes should make sure the children get exercise, possibly signing them up for activities such as sports or Boys and Girls Club, Tarr said. She said they should also watch the calories children eat and make them aware of healthy food choices.

She offered encouragement to parents whose children already have diabetes.

"Know this can be a positive impact in your life," she said, adding the condition can help the whole family eat better.

Tarr said new medications and forms of insulin are being developed and more support is available now than in the past.

Barbara Jenkins, who lives near Socorro, is raising a granddaughter with Type I diabetes. Dezeree, now almost 9, was diagnosed at 19 months old.

"You have to be on your toes all the time," Jenkins said.

Dezeree is an unusual case because she is sensitive to insulin, and so has to take it in small amounts, a minimum of five shots a day, Jenkins said.

"She doesn't remember what it was like not to be diabetic, and it's part of her life," Jenkins said.

She is aware of her food restrictions and complies with them despite disappointment sometimes, Jenkins said.

Because Type I diabetes is an immunodeficiency disease, when Dezeree gets sick, she is very ill and has trouble getting better, Jenkins said.

Socorro Consolidated Schools officials had to make special arrangements to treat her condition at school, Jenkins said. Also, if she has incorrect levels of blood sugar, she has trouble focusing and retaining information, besides other problems.

Still, Jenkins said the condition is manageable.

"She's a very happy, healthy girl," she said. "To look at her, you'd never know she has a life-threatening illness."

aduncan@dchieftain.com

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