Battling diabetes

2006-04-10

Bloomington Hospital's Diabetes Care Center served more than 1,200 people in 2005.  Nearly one third of the roughly 20.8 million Americans with diabetes - some 6.2 million people - do not know they have the disease. Since 1990 the prevalence of diabetes in Indiana has risen from 5.7 to 7.4 percent.

In a national television ad, Patti LaBelle says, "I have diabetes; diabetes doesn't have me."  That statement conveys the attitude underlying everything that's said and done atBloomington Hospital's Diabetes Care Center.

The center helps diabetic patients manage their disease - thus reducing the likelihood they will suffer blindness, heart disease, stroke, kidney disease or limb amputations.

That's a good thing, because diabetes is the leading cause of blindness, kidney disease and limb amputations in the U.S., and more than doubles the risk of stroke and heart disease among adults.

"These are all potential problems associated with uncontrolled diabetes," said Barbara Murray, the center's full-time dietitian. "Controlled diabetes is much less dangerous."

The Diabetes Care Center, in the Star Center at 220 W. Allen St., is in its third home. When it was first established in 1996 in the hospital's emergency department, it had no full-time staff.

Now it has five part-time nurses, one full-time and two part-time dietitians, and two receptionists.

All its nurses and dietitians are certified diabetes educators by the National Certification Board for Diabetes Educators.

Numbers on the rise
The center has helped a burgeoning number of patients in recent years. In 1998 it served 200 patients; in 2005 it served 1,222.  Its monthly support group has grown from an average of 6 to 8 people in 2000 to 25 today.

Dr. Philip Behn, medical director of the Diabetes Care Center , said these growing numbers reflect an increase in the incidence of diabetes in the nine-county area served by Bloomington Hospital .  "There certainly has been a regional increase in incidence, but it's difficult to give numbers," Behn said. "That's because with the development of better drugs over the past decade, more primary care doctors are treating diabetes themselves."

Whatever the increase is, it parallels a mushrooming number of people in Indiana being diagnosed with diabetes. Since 1990 the prevalence of diabetes in the U.S. has risen from 4.9 percent of the adult population to 6.7 percent, but from 5.7 to 7.4 percent in Indiana.

And from 1980 through 2004, the number of Americans with diabetes more than doubled - from 5.8 million to 14.7 million. Eidemiologists predict that by 2050 the incidence of diabetes in the U.S. will double, and economists project the total cost of diabetes (including health-care costs and lost wages) will rise from $132 billion in 2002 to $192 billion in 2020.

Why the increase? Put simply, Americans are eating too much and exercising too little, a deadly combination that puts them at risk for developing the fastest-growing diabetes - Type 2.

Type 2 diabetes is the most common form of diabetes, accounting for 90 to 95 percent of all diagnosed cases. Though it most often develops in middle-aged and older adults, it's increasingly being diagnosed in children and adolescents - prompting doctors to no longer call it "adult onset" diabetes, as they once did.

The increase in young people with Type 2 diabetes is blamed largely on poor eating and exercising habits. The Indiana State Department of Health says nearly 85 percent of American children and adolescents with Type 2 diabetes were either overweight or obese at diagnosis.

"It's a very worrisome phenomenon," Behn said. "Young people tend to be less active and consume too many calories by drinking soft drinks and eating fast food."

Type 1 diabetes, which used to be called "juvenile onset" or "insulin dependent" diabetes, usually strikes children and young adults.

It accounts for only 5 to 10 percent of all diagnosed cases of diabetes, and occurs when the body's immune system destroys the cells in the pancreas that make insulin.

Because their bodies produce little or no insulin, people with Type 1 diabetes must take insulin daily through injections or an insulin pump to survive.

Improved treatments In the past decade, scientists have made great strides in treating diabetes. "Today's diabetic patients are getting better treatment, doing better self-management, and living longer," Behn said.

In 1995, there was only a handful of insulin and oral medications designed to control diabetes, Behn said. "Since then we've seen four to five new classes of oral medications, with one or two new ones that should be on the market within a few years," he said. "We've also seen at least five new types of insulin that are less prone to cause hypoglycemia (a low level of blood sugar) and weight gain."

Behn said one new injectable medication - exenatide - not only secrets insulin in the same manner that a healthy body would, but decreases a person's appetite, often causing weight loss.

Behn said several new insulin pump devices, worn on the belt or under the clothing, allow insulin to be continuously infused into the bloodstream.

"You have to adjust the insulin infusion rate at meal times or times of physical activity, so using the pump requires a lot of education," he said. "But they have improved our ability to treat diabetes with less hypoglycemia."

Better education
The diabetic care center offers a variety of education classes - such as a class for pregnant women with diabetes - as well as individual sessions with a nurse or dietitian.

Patients learn, among other things, that if they have too many low-blood-sugar episodes, their bodies will eventually stop giving them warning signs (perspiration, shakiness) until they are close to passing out. "If your blood sugar gets dangerously low you can go into diabetic coma, where you have a seizure or pass out," said Teresa Fender, a registered nurse and diabetes educator at the center. "Those episodes kill brain cells that can never recover."

The American Diabetes Association recommends that every diabetic receive self-management education such as that provided at the center.

Behn emphatically agrees.

"I could not work without the diabetes educators at this center, which I feel rivals any center in the country," he said. "They are critical in helping patients practice good diabetes care."

Listen to an expert

People who have a child or teenager with Type 1 diabetes are invited to hear a talk by Samuel Wentworth, a pediatric endocrinologist, from 7 to 8 p.m. May 15 in Bloomington Hospital's Wegmiller Auditorium.

The talk will be preceded by a vendor display from 6 to 7 p.m. The event is free, and light refreshments will be served. For more information call (812) 353-9258.