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Diagnosis diabetes

Nearly 13-million are diagnosed. More than 5-million more have it and don't know it.

LISA GREENE
Published April 18, 2004

TAMPA - If he hadn't been dating a nurse, Rodney Biddle figures he never would have known what was wrong.

At least, not until it was too late.

When he started falling asleep at work last fall at MacDill Air Force Base, he thought his late nights on his home computer made him drowsy. When he got thirsty all the time, he guessed the water-chugging habit he picked up while working in sun-scorched Qatar as a military contractor had stuck with him.

And the tingling in his toes just had to be athlete's foot.

Biddle never thought about diabetes.

But all too soon, he would have to. He became a part of the epidemic of diabetes sweeping America.

The number of Americans now diagnosed with diabetes is about 13-million, nearly double what it was in 1990. More than 5-million more have the disease and don't know it, federal scientists say. Together, that's 6.3 percent of the population. By comparison, up to 4-million Americans have Alzheimer's disease and up to 1.5-million have Parkinson's disease.

Diabetes is a disease in which the body either fails to produce the hormone insulin or use it properly. Because insulin moves sugar into cells, the disease causes sugar to build up in the blood. As the years pass, high sugar levels can lead to a cascade of devastating complications - blindness, kidney failure, dying limbs, death.

The disease already is the sixth-leading cause of death in the United States.

But scientists expect worse. Among U.S. children born in the year 2000, says a recent federal study, the number that will someday develop diabetes: more than one in three.

The toll of a disease that already exacts a staggering cost on the American health care system is expected to keep climbing. Diabetes cost the nation more than $132-billion in 2002, according to a study by the American Diabetes Association. That could grow to $156-billion by 2010 and to $192-billion by 2020, the group says.

The rising dollars translate to a higher price in pain and disability: More people hobbling from amputated feet. More people bound to dialysis machines. More people paralyzed by sudden strokes.

More people dead.

* * *

Biddle is 37.

When he began having trouble last fall, the 6-foot-2 computer support technician weighed 234, and his exercise program had lapsed.

His favorite food group: "fried and greasy." He loved big steaks, baked potatoes, french fries. To counteract his drowsiness at work, he drank a couple of Cokes each day.

When his girlfriend suggested diabetes, he thought it was unlikely. But he went to the doctor just to be sure.

Biddle's family was out of town for Thanksgiving, so he went to the Golden Corral. He ate turkey and ham. Potatoes, sweet potatoes, bread.

The next day, he went to his doctor to get his blood test results.

At first, he wasn't too worried. Biddle didn't know much about diabetes.

Then he started to learn.

* * *

The reason for the epidemic, most scientists say, is simple.

As Americans have gotten fatter, they have gotten more diabetic.

"The problem is people are sitting there . . . the only exercise they're getting is working the video game while they're eating their supersize hamburgers and fries," said endocrinologist Tony Morrison, co-director of the Diabetes Center at the University of South Florida.

The vast majority, about 90 percent, of U.S. diabetes patients have Type 2 diabetes, in which the body doesn't make enough insulin or use the insulin it produces well. Often, as people become overweight, they become resistant to insulin, so the pancreas has to produce more to move sugar out of the bloodstream. For many diabetics, the pancreas becomes so stressed it no longer can make enough.

Some cases of Type 2 diabetes have a genetic link, and some ethnic groups, including blacks, American Indians and Asians, seem more prone to developing diabetes. Some people get the disease without being overweight, and some develop complications despite working hard to control their weight and blood sugar.

But for the most part, Type 2 cases are linked to obesity and lack of exercise, scientists say. And with Americans' waistlines wider now than ever before, people are not only getting diabetes more often, they're getting it younger. While diabetes is more likely in older people, a federal study found that diabetes rates increased by nearly 70 percent among people 30 to 39 between 1990 and 1998 and by almost 40 percent among people 40 to 49.

Those who find out early, like Biddle, have a better chance. With medicine, exercise and a healthy diet, they can control their blood sugar better and lower their risk of deadly illness.

But several Tampa Bay diabetics say their original symptoms were mild. If not for luck - a routine physical, or a friend with a diabetic relative - they might have found out years later.

For Kip Anthony, the sign was just a blister.

"It all started with a new pair of shoes," she said, "And a trip to the mall."

But when the blister wouldn't heal, the Tampa neurodiagnostic technologist visited her doctor and found out that diabetes was the reason why.

* * *

Because sugar, in the form of glucose, provides energy for the body, it goes everywhere - through blood cells, into muscle and fat cells, down to the toes and up to the eyes, deep into the kidneys.

But when something so vitally important goes bad, the consequences spread deep into the body as well.

"Our bodies are built on using glucose as a fuel," said Dr. George King, research director at Joslin Diabetes Center and professor at Harvard Medical School. "It's used by many, many pathways inside the cell. . . . Almost every aspect of the cell is going to go bad."

High levels of glucose wreak havoc in the blood vessels that carry it. When glucose damages the cells lining the blood vessels, it becomes harder for the blood vessels to distribute blood and deliver its lifegiving oxygen.

Think of the blood vessels as the body's highway, King said. Glucose damage becomes a really bad traffic jam.

In the eyes, leaking blood vessels can cause blindness. In the legs, blood vessel damage leads to amputations. In the kidneys, membranes thicken, become scarred, and can stop working.

It's not just sugar that gets too high. Many diabetics have high cholesterol and triglyceride levels, molecules in the blood that increase the risk of heart disease. They also can get nerve damage that deadens the feet and other areas.

And yet, most of the damage occurs slowly, over years, even decades.

That's why many people with Type 2 diabetes feel no symptoms and don't even know they have the disease. Others feel fine for years, then start to develop complications.

That's one reason Dr. John Malone becomes frustrated. Malone, the director of USF's pediatric diabetes program, often finds it harder to get Type 2 patients to take the disease seriously.

He thinks it's because the threat is more remote than it is for children with Type 1, which used to be known as juvenile diabetes.

If a child with Type 1 doesn't take his insulin, he can go into a diabetic coma.

"They can end up in the hospital," Malone said. "If a child with Type 2 doesn't take their Glucophage (medication), nothing changes."

Or at least nothing that they feel right away.

Jalisa Young was just 12 when she found out she had Type 2 diabetes. Jalisa, now 14, knew she was overweight. Her family history also made the disease more likely: She is at least the fourth generation to have Type 2 diabetes.

At first, the St. Petersburg teen didn't take the disease seriously. She still ate candy, mashed potatoes, french fries. Especially french fries.

"I was ready to go back to playing and stuff, with my friends," she said. "I wasn't really paying attention."

Six months later, her doctor sat Jalisa down and told her about losing "my toes and my legs and stuff." About how, if her body were a car, sugar would cause it to rust and break.

Now she watches her diet, rides her bike and walks to her best friend's house. Her mother got her sugar-free candy at Halloween. Her best friend buys sunflower seeds instead of candy when they're together, so Jalisa won't be tempted.

But sometimes the grownup worries weigh on her.

"It's hard being 14, because you miss out on a lot of stuff," she said.

* * *

Children are what makes Biddle take diabetes seriously. He is divorced and broke up a few months ago with the girlfriend who helped diagnose him. But one day, he wants to get married and have children.

And he doesn't want them to go through what he did.

Growing up, Biddle's father ran the family lumber business. He was overweight, and he smoked. He got tired in the afternoon. One day, when Biddle was 16, his father went home for a nap and never woke up.

Now, Biddle wonders if his father had diabetes and never knew.

"It terrifies me that if I don't take care of myself, I could have a heart attack in my 40s and leave a wife and kids," Biddle said. "I really want kids."

After being diagnosed, Biddle went through a panic phase. He stopped eating bread, potatoes and several other foods entirely. He ate a lot of salad and not much else. He bought a glucose meter for his brother, who doesn't have diabetes.

Then Biddle took diabetes education classes and learned more about what he could and couldn't eat. He started cooking for himself, often waking up at 5 a.m. to put food in the oven to take to work for lunch.

He learned to stick his finger at least twice a day to test his blood sugar. Most nights after work, he headed to the gym in his apartment complex. He put a punching bag in his living room for extra workouts. His weight began to fall.

Even the most routine chore had to change. A few weeks ago, he stopped by Publix and walked straight past the bakery. No more doughnuts.

Broccoli, green beans, squash. A few bananas.

"I'm not supposed to," he said. "But I'll get a few small ones."

A lot of chicken, a little steak. He has lost 14 pounds.

These days, Biddle tries to shop the edges of the store, for fresh vegetables and meat, and stay away from the high-sugar processed aisles in the center. He knows that candy and many carbohydrates, such as bread and pasta, will raise his blood sugar.

He visited the health-food section, reading labels on sugar-free salad dressings, marinades, even barbecue sauce.

A new treat to try: peanut-butter cups . . . sugar free.

* * *

That's the kind of difficult, wholesale change that diabetics have to make, Morrison said. Perhaps more than with any other disease, diabetics must shoulder daily responsibility for managing their own health.

"You're asking them to change 30, 40, 50 percent of their diet," he said. "And that's tough. To talk about it long term is really difficult to do."

Joe Passero knows that. Passero, a Lutz resident, learned in November that he has diabetes. In January, he went to USF's education class, practicing his finger-stick technique and charting each morsel of food, recording the reading of every drop of blood.

Class lectures mean learning to worry about all the things that might seem trivial: Prick the side of your finger when the tip gets sore. Don't add butter just because it's in the recipe. Floss.

Oh, and don't wear your socks too tight.

There's plenty more advice in the stacks of booklets and brochures.

"Diabetes is a paper disease," Passero joked, hefting a briefcase of handouts onto the table.

* * *

The classes have a point: to avoid the complications that haunt diabetes. As diabetes rates rise, those complications are increasing as well. Across the state, the rate of diabetics' hospitalizations rose almost 24 percent from 1997 to 2002.

In the Tampa Bay area, specialists have seen the trend.

Orthopedic surgeon Heidi Stephens treats diabetic feet, repairing them when she can and amputating when she can't. She has rescheduled her work week to add time for the constant stream of new patients.

Vascular surgeon Brad Johnson, who operates on damaged blood vessels, figures half his patients are diabetic. Seven years ago, he worked with one other surgeon. Now there are four.

Tampa nephrologist Charles Wright remembers when LifeLink first performed 100 kidney transplants in a single year, in 1988. Now LifeLink does 160 to 180 a year. But Wright, medical director of LifeLink of Florida, thinks that number will rise. Diabetics make up about one-third of the patients waiting for kidney transplants.

"You usually have had diabetes for over 10 or 15 years before kidney disease," Wright said. "The leading edge hasn't hit renal failure."

Diabetes doesn't just cause those complications, the specialists said. It also makes them harder to treat. Diabetics are more prone to heart attacks during and after surgery. Infections are more common.

If Stephens gives a patient an antibiotic to ward off infection, she first makes sure the patient doesn't have kidney damage that could get worse with the drug. And if she has to amputate someone's foot, she worries that the nerve damage common to diabetics will make fitting a prosthesis harder.

To try to avoid complications, diabetics often take several medicines - not just to control blood sugar, but also to lower cholesterol and blood pressure.

But diabetics can lower their risk by losing weight and watching their diet, generally by avoiding certain carbohydrates - such as potatoes and pasta - and limiting high-fat foods. Diabetics who lose weight, Morrison said, often can cut back on the drugs they take.

"You can control it to the point where you don't need anything," he said.

* * *

That's what Biddle banks on: that change will keep him healthy. One recent evening, he invited a co-worker, Kim Shafer, over for dinner. When Shafer ate at Biddle's last year, he made shrimp pasta alfredo.

The new menu: baked chicken, steamed veggies, salad. Shafer helped snap green beans, snacked on peanuts and hinted that a steamer like Biddle's would be a good present for her upcoming wedding.

"Now is a good time to be diabetic," she told him. "With all the Atkins-friendly stuff."

Biddle laughed.

"There's never been a better time to be diabetic!" he joked.

But it's still not easy. Biddle confessed to Shafer that the previous afternoon, he got hungry and ate some banana pudding. It sent his blood sugar soaring and left him exhausted.

Before, banana pudding was a snack. Now, it's a threat.

"I'm being forced down the nutrition road," Biddle said.

Since that evening, Biddle has stuck to his new diet. He has lost five more pounds. The other day, he was in a computer training class and saw somebody dozing off, just the way he used to do. It made him wonder how many others are out there, the diabetics who don't know it.

"There are worse things I could have," Biddle said. "I could have cancer. I'm blessed that it's something I can fight back. I can do something to take control of the situation."

- Lisa Greene covers medicine and can be reached at greene@sptimes.com

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