DIABETES: the invisible epidemic
Sedentary lifestyle often speeds up deterioration of life
BY J. PHIL GALEWITZ Cox News Service
Tom Watts survived rocket attacks almost every week during his 14 months of Marine Corps duty in Vietnam.

But the Jensen Beach, Fla., resident lost his right leg in 2005 to something quieter than combat, yet no less deadly.

Diabetes.

It is a disease that accounts for eight of every 10 amputations conducted each year at the Veterans Affairs Medical Center in Riviera Beach, Fla. And it is a condition that has reached epidemic proportions in the United States and Florida.

"You can't beat this disease," said Watts, 60, a slender man who believes he contracted diabetes through Agent Orange exposure. "It keeps eating away at you."

It's the same illness for which the federal government spends 12 percent of its total health budget each year, a disease that threatens for the first time in a century to create a generation of children who will not outlive their parents.

Nearly 21 million Americans - about 7 percent of the population - have diabetes. That's double the number of patients since 1980, and experts expect that number to double again by 2050.

PHOTO BY J. GWENDOLYNNE BERRY / COX NEWS SERVICE "I thought I would be OK because my blood glucose was under control," Bob Wesch recalls after he developed a blister on his toe. Three days later, the blister began turning red, and the wound got infected. Ultimately, the 62-year-old Hobe Sound, Fla., man had to have his leg amputated.

Most of these people have type 2 diabetes, and the alarming increase in the number of cases is tied to the poor eating habits and increasingly sedentary lifestyle of Americans. The epidemic increasingly affects children, whose obesity rates have climbed significantly. The business of caring for diabetics - from special shoes to kidney dialysis - is exploding.

Diabetes is not to be underestimated. There's no cure, and complications include heart failure, stroke and blindness.

Yet more than 6 million people are walking around with diabetes and don't know they have it.

For health care professionals, diabetes is a source of unending frustration. How can a disease that ravages the body so greatly grow at such a fast rate, as though invisible to society at large?

"This is an epidemic," said Florida Health Secretary and Surgeon General Ana Viamonte Ros.

"It's not as sensational as bird flu and Ebola," she added, "but it certainly impacts a large part of our communities, and it is in our hands to change the trend."

David Sager, who heads the prosthetics and orthotics lab at the VA, said many of his patients "did not take care of themselves when they were younger, and we are dealing with the consequences."

"We all think, 'It will never happen to me,'" Sager said. "I don't think the general public has any idea how pervasive diabetes is."

Diabetes mellitus, as it is formally known, is the sixth-leading cause of death in the United States, though studies show most Americans are confused about just what it is.

The explanation begins with the way the body operates. The fuel for its cells, the thing that makes them run and keeps us alive, is glucose, a type of sugar. The body breaks down the food we eat to get glucose and feeds the cells by using insulin, a hormone manufactured by the pancreas.

Diabetes is a chronic disease in which the body either doesn't make enough insulin or is resistant to it, leading to excess sugar in the blood.

The effect of too much sugar in the blood is, over the long term, catastrophic. Without being able to enter the cells, the glucose causes arteries to weaken, which affects organs throughout the body.

Type 2 is biggest threat

There are two primary types of diabetes.

Type 1, most often diagnosed in children and young adults, occurs when the pancreas fails to produce insulin. Without insulin, glucose builds up in the blood rather than entering cells, where it is needed for fuel.

But the form of diabetes responsible for the epidemic is type 2. With this version, the body either does not produce enough insulin to properly regulate blood sugar or does not respond well to the insulin that is produced. Being overweight increases the diabetes risk because it interferes with the body's ability to use insulin.

About 90 percent of all diabetes cases diagnosed in the United States are type 2, which used to be called adult-onset diabetes until it started showing up in children in the 1990s.

People often have no idea they even have the disease because the initial symptoms, such as frequent urination or extreme thirst, are easy to dismiss. As a result, diabetes can lurk silently until vision problems begin or its victims suffer a heart attack or stroke.

Orrin Adler, 67, worked for a computer company in New York before moving to Boca Raton, Fla. His diabetes was diagnosed in 1990, when he was 50. The same year, he had an angioplasty. In 1991, he had bypass surgery.

In 2003, he had a stroke. Today, he deals with neuropathy - nerve damage - which periodically leaves him with no feeling in his feet. His kidneys also are starting to fail.

"It's a disease where you don't feel sick until it's too late," he said.

Because most people with diabetes die of heart attacks, strokes or kidney disease, the underlying condition often gets no mention on death certificates or obituaries.

Diabetes is the sixth-leading cause of death in Florida. But if you counted the cases of diabetes-caused heart attacks and strokes, it would spring to No. 3, behind heart disease and cancer.

"Diabetes is in epidemic proportions," said Dr. Jack Waterman, a Palm Beach Gardens, Fla., kidney specialist. Most of his patients have diabetes.

"It's a shame," Waterman said. "This is a very treatable illness that can largely be prevented by changes in lifestyle."

Diabetes also exacts a huge cost on patients because of the price of everything from test strips for glucose meters to drugs to hospitalizations. The average annual health cost for diabetics is $13,621, compared with $5,956 for those without diabetes.

Although diabetes has no cure, researchers in the past decade have discovered that people can dramatically reduce their risk of getting the disease. But most Americans can't swallow the advice: Lose weight, exercise more and stick to a low-fat diet.

"People are often in denial," said Gail Starr, a Palm Beach Gardens, Fla., certified diabetes educator. "A lot of people have diabetes in their families and can see what happens if it's not controlled. But there is denial. They think that it's not so bad and it's not going to hurt me."

When Susan Perez's type 2 diabetes was diagnosed in October 2006, her doctor prescribed four medicines - two for diabetes and two for high blood pressure.

Perez got the point: She had to lose weight to save her life.

"A light went on in my head that said, 'These foods for you are poison, and you can't eat them anymore,' " said Perez, 59, of Hobe Sound, Fla.

She followed a 1,500-calorie-a-day diet recommended by a nutritionist, went to diabetes classes at Martin Memorial Medical Center, cut out ice cream and chocolate - and lost 80 pounds. Today, she can control her diabetes through diet alone, and the only medication she needs is for high blood pressure, at half the prior dose.

"Finding out I had diabetes saved my life because I wouldn't have changed my diet otherwise," Perez says. "I may have diabetes, but diabetes isn't gonna have me."

A changing identity

Not long ago, diabetes was seen as a disease of late middle age or advanced age. Today, largely because the percentage of obese Americans is higher, it's increasingly common for people in their 30s and 40s to develop the disease. That has increased the likelihood that people will face complications earlier as well.

In the past 20 years, while U.S. death rates for the big killers - cancer and heart disease - have declined, the death rate from diabetes has increased 45 percent. Even after adjusting for the aging population, the diabetes death rate in Florida has jumped 39 percent since 1984.

Nationally, one in three people born after 2000 can expect to develop diabetes during their lifetime. For blacks and Hispanics, it's one in two.

Living with diabetes isn't easy. Diabetics are told to exercise to keep blood sugar levels down, but even walking can cause problems.

Bob Wesch, 62, of Hobe Sound developed a blister on his left pinkie toe from walking around his neighborhood. Because he has diabetes, it didn't heal.

"I thought I would be OK because my blood glucose was under control," he recalls thinking after he developed the blister. But three days later, it began turning red, and that's when he sought help.

The wound got infected and, because of his impaired circulation, would not heal. He had to get his foot amputated in September 2006 - the same month his wife, Janet, died of cancer.

"It's a terrible disease," said Wesch, whose diabetes was diagnosed in 1992, when he was 47.

Diabetics who lose one leg have a 50 percent chance of losing their second leg within five years.

Just getting the message out about healthy living is a David-and-Goliath struggle considering all the advertisements for fast food in American culture, plus the couch-potato lifestyle induced by the Internet and video games.

The federal government this year will spend $3.9 billion on prevention and health promotion related to diabetes - a fraction compared with treatment costs.

Florida's Health Department's Diabetes Prevention and Control Program has a sixperson staff and a $666,000 budget. That's less than what McDonald's spends on advertising in one day.

"At the rate diabetes is growing, this will bankrupt the American health care system. There's no doubt in my mind," said Larry Deeb, a Tallahassee, Fla., physician who is president of medicine and science for the American Diabetes Association.

Marci Sloane, a diabetes educator at JFK Medical Center in Atlantis, Fla., said the challenge is not just educating the public but getting the medical profession to take it seriously. Too often, she said, doctors tell patients they have "borderline" diabetes, and as a result, their patients aren't motivated to change lifestyles.

"The epidemic is huge," said Dr. Barry Horowitz, a West Palm Beach, Fla., endocrinologist. "You see it every day in our practices. People are coming in droves."

Attacking the body's organs

Dr. Michael Marks, a retinal specialist in Palm Beach Gardens, sees the effects of diabetes in his patients. New drugs have reduced the number of diabetics going blind, but still many patients have vision loss. Other side effects include torn retinas and glaucoma.

"Diabetes is an insidious, difficult problem because it affects so many organs, particularly some at the same time," he said.

Diabetics can reduce their risk of complications by making sure they get regular eye, foot and blood glucose screenings. But most diabetics don't follow the advice.

Nationally, just over half of diabetics regularly test their blood sugar, according to the U.S. Centers for Disease Control and Prevention in Atlanta.

"There is a disconnect about the seriousness about diabetes," said Ann Albright, CDC director of the division of diabetes translation.

"Diabetes is a big problem now, and it will get worse before it gets better," Albright said. "If we do not wake up and see what's ahead of us, we have no one to blame but ourselves.

"The human suffering and economic costs will be enormous."