Dallas, TX – [Ambient sound of hyperbaric chamber]
Bill Zeeble, KERA 90.1 Reporter: 16 million people in this country have diabetes. While two-thirds know it, the rest - five and a half million - don't. It's called "the silent killer."
Margaret Eckerd, insurance employee and diabetic: I was just discovered to have the diabetes.
Zeeble: Margaret Eckerd's getting ready to slide into a hyperbaric chamber doctors say will help her foot wound heal. Until a few weeks ago, when she saw her doctor, she had no idea why her toes had puffed up.
Eckerd: I had swelling of the feet. I also have high blood pressure. It runs in my mother's side of the family. My sister has diabetes. I didn't pay attention to some of the symptoms and go see a doctor.
Zeeble: Two weeks ago, Eckerd's little toe was amputated. Diabetes is the leading cause - by a long shot - for this last-chance surgical procedure. Eckerd is now among 56,000 new amputees a year in this country. Unfortunately, her case is too typical, according to Hilda Guerra, who works in a diabetes clinic in Starr County, along the Texas-Mexico border
Hilda Guerra, Office Manager, Starr County diabetes clinic: It seems to me people don't really pay attention to long-term complications until it actually knocks on their door.
Zeeble: Now, Eckerd is answering the door.
Eckerd: They put me on a diet of 1800 calories per day. I'm going to a class this week to learn how to eat better. To recognize what I can have and what I can't have, and what moderations. I'm taking insulin in the morning, two different kinds, and insulin in the evening. I'm taking a high blood pressure medication. I'm on multi-vitamin
Zeeble: Eckerd is what's called a Type 2 diabetic, like 90-95% of those with the disease. Even though she's injecting insulin to control the disease, her body still makes the hormone. Type 1's produce no insulin, and must inject it to survive. Insulin converts sugars - carbohydrates - for energy, whether those sugars come from donuts and Ding-Dongs or the healthier brown rice, beans, and bananas. Because Margaret Eckerd is overweight and relatively inactive, her insulin isn't used efficiently. So her blood sugars occasionally rise several hundred percent outside the normal range. Craig Hanis, a genetics professor and diabetes researcher at the University of Texas Health Science Center in Houston, says complications like Eckerd's usually appear after years of inadequate care.
Craig Hanis, Professor of Human Genetics at the University of Texas Health Science Center: It's the leading cause of blindness in adults; leads to kidney failure, leads to loss of feeling in periphery. Those things don't happen overnight.
Zeeble: Hanis is driving to Rio Grande City, in Starr County, along the state's southern border. There's a higher incidence of diabetics in Starr than in any of the state's 254 counties.
Hanis: There's good evidence to suggest the things that'll predict who'll develop those complications, it depends on what they were doing two, three, four and five years ago. Most people don't think about how this meal will effect my health five years from now. So it's a very difficult disease in that regard to make changes.
Zeeble: Hanis has been trekking to Rio Grande City for 19 years, trying to find out why the incidence of diabetes - and the price its residents pay - are so high. The county's death rate from diabetes is three times higher than anywhere else in Texas. At first, Hanis says some scientists thought it might be the water along the border, because diabetes rates were high in surrounding counties as well. Then Hanis and others considered the near 100% Mexican-American population.
Hanis: Laredo showed similar results. Later it was shown in Colorado, Mexican-Americans have high rates of diabetes, and also in New Mexico. So everywhere Mexican-Americans were looked at, they had high rates of diabetes. That was the first clue of what was going on.
Zeeble: But, Hanis wondered, "Why Mexican-Americans, in particular?" He figured genes must play a big role and started looking at the history of the local population. Today's Mexican-Americans, says Hanis, are a mix of Spanish and Native American ancestry. In fact, Native Americans, specifically the Pima Indian tribe of Arizona, have the highest rate of diabetes in the world.
Hanis: We were able to show approximately 30% of the contemporary gene pool is Native American derived. And 70%, Spanish derived. It was a simple argument that if genes were important for diabetes, and you're receiving a large proportion of your genes from the Native American population that has high rates of diabetes, then the frequency of diabetes in Mexican-Americans should be proportional, based on how much Native American ancestry there was. It turned out that explained the data really well.
Zeeble: Back in 1981, Hanis says that wasn't obvious.
Hanis: To give you an idea of how much things have changed genetically, we very carefully collected the blood samples. We saved the plasma, saved the red cells, threw away the white cells. And the reason we threw away the white cells is no one knew what to do with them. The only thing in them might be DNA. And we don't throw samples away anymore. [He laughs.]
Zeeble: In fact, genetic research is among the hottest areas for diabetes investigators seeking new treatments for the disease. Some leading U.S. labs can be found at the University of Texas Southwestern Medical Center here in Dallas, and the National Institutes of Health in Phoenix. Yet, says Hanis, genes explain only part of the diabetes problem among Hispanics and Native Americans. The ballooning growth of Type 2 diabetes nationwide is also blamed on the ever-increasing number of obese adults and children.
Larry Deeb, Pediatric Endocrinologist: We're faced with an epidemic of obesity.
Zeeble: Larry Deeb is a pediatric endocrinologist in Tallahassee, Florida.
Deeb: No doubt about it. It's rampant in Americans, children, starting very young.
Zeeble: Deeb says medical instructions to exercise and diet often fail, even though both can cure Type 2 diabetes. Fewer fat cells (eliminated by dieting) and a higher metabolism (prompted by exercise) will dramatically improve insulin efficiency in most cases. But eating better and exercising are easier said than done, as anyone who's ever tried will testify. Just ask Hilda Guerra, office manager at the Starr County clinic that Craig Hanis opened nearly 20 years ago. She has Type 2 diabetes.
Hilda Guerra, Office Manager, Starr County diabetes clinic, and diabetic: It's hard to admit you have a disease. You're knowledgeable, and yet you're not doing anything about it. It's just hard to admit. Like, I know I'm overweight, and I don't do anything about it. I wish I could. I dream about it constantly. But, you know, wanting to do it and actually doing it are two different things. I believe there's a key that would motivate individuals to do that change, but if you know what the key is, let me know, ?cause I certainly don't know it.
Zeeble: In the case of Type 2 children, whose numbers have unexpectedly soared in the past decade, not even the threat of insulin shots have worked, according to Larry Deeb and other pediatricians. At the international American Diabetes Association conference in San Antonio this year, Deeb led a discussion among several hundred pediatricians on the topic of Type 2 children. It prompted Los Angeles diabetes physician Francine Kauffman to blast school policies that have cut physical education and installed vending machines.
Francine Kauffman, Pediatric Endocrinologist: We gotta demand getting back P.E. and getting that junk out of school. I mean, maybe that's not going to be the answer to the problem, but it's certainly going to be some impact. If we can't do something in everyone's family, then I think at least as a community or nation, we oughta make some impact on this. Rather than roll over and then take a really public health approach to this and say, "It's over, guys. I don't care how much money the school gets. Selling someone a Slurpee and a Snickers bar for breakfast. It's just over." And demand, and I think we've got the power somewhere. [Ambient sound of applause.]
Zeeble: Frustrated diabetes doctors like Kauffman know such an activist approach will be a long, tough, battle because she knows she's fighting human nature. Teenagers usually don't think about long-term health effects. But Kauffman warns something better change.
Kauffman: If we don't address this now, we're looking at a generation of people who'll bankrupt the entire system. These will be 35 and 45 year-old people with cardiovascular disease, disabled, and no workforce in America.
Zeeble: Researchers in the field share Kauffman's fears and say they too are scared for the future of children with diabetes, and an over-burdened health care system. For KERA 90.1, I'm Bill Zeeble.