July 08, 1997|By Diana K. Sugg | Diana K. Sugg,SUN STAFF
Squinting at the nightly news last week, Pat Parrish found herself moving closer to the television. The announcer was describing new guidelines for diabetes -- including screening that would have caught her disease earlier, keeping her vision from being blurred, her feet from being gnarled, her kidneys from being damaged.
For years, even as her physician dismissed a few high blood-sugar tests, the disease was quietly eating away at Parrish's nerves and organs. The Columbia woman, 60, was stunned to learn that 8 million Americans were in the same predicament.
They all have diabetes and don't know it.
The guidelines, endorsed June 23 by the American Diabetes Association and soon to be adopted by the World Health Organization, urge that adults 45 and older be screened annually and, if normal, retested at three-year in tervals. The cutoff point of a common blood-sugar test that indicates who is diabetic and who is not has been lowered.
Experts believe these changes, the first in nearly 20 years, will pick up roughly a quarter of the country's undiagnosed diabetics and prevent needless disability and death.
But if millions are to be diagnosed and others are to get good care, society must still address thorny underlying issues.
Diabetes is widely ignored despite its human and financial toll. The public dismisses it, many still using the phrase "I have a touch of sugar." Primary-care physicians are often too busy to look for and treat the condition. Many insurance companies won't pay for the basic equipment and education diabetics need.
"If we had an infectious disease that caused as much blindness, amputation, kidney failure and heart attacks as diabetes, and it was occurring at this type of rate, we would have the most aggressive, well-funded eradication program that the world has ever known," said Dr. James R. Gavin III, chair of the committee that developed the guidelines and a senior scientific officer at the Howard Hughes Medical Institute in Chevy Chase.
Four myths
For generations, four myths have persisted about diabetes: that it's rare, that it's not serious, that little can be done and that the only place the little can be done is the doctor's office or the hospital.
Science has debunked all these. Yet diabetes still doesn't get much respect. Some physicians call it the Rodney Dangerfield of chronic disease.
The number of cases of diabetes has tripled over the last three decades to 16 million. It's among the most costly of diseases, sucking up 15 percent of every health care dollar. Its sprawling reach pulls in everyone from kindergartners to retirees. It can make people act like drunks or fall into comas. It can turn a foot blister into a wound that won't heal. It blinds. It kills three times as many women every year as breast cancer.
All this begins with the affected person feeling nothing more than perhaps a little thirsty or a bit tired. But inside the body, a critical system has gone awry.
Glucose, or blood sugar, is released into the bloodstream after a meal. But to fuel the cells, the sugar must get into them. A hormone called insulin acts as a key to open the cells and let in the glucose.
In children and teens who develop Type 1 diabetes, there isn't enough insulin to unlock the cells.
But 90 percent of people with the disease have Type 2 diabetes, which most often develops after age 40. In this kind, the body doesn't properly use the insulin it makes.
In both types, the glucose builds up in the bloodstream, making it thick and syrupy. Some glucose overflows into the urine and is passed out. The body loses its main source of energy.
Complications and death
Physicians now know that high levels of blood sugar will lead to complications, even death, over time. But with training and tools -- including diet, exercise, insulin and other medication -- diabetics can lead a healthy life. Many don't even need to be on insulin.
The tragedy is that so much suffering could be avoided. Studies show half of amputations and kidney disease could be prevented. In Maryland in 1994, the most recent year for which figures are available, that translates into 810 amputations and 2,335 cases of kidney disease, and about $41 million in hospital costs.
But cases typically take seven to eight years to be diagnosed.
The result is a quiet epidemic. And people like Pat Parrish.
"I have always had access to excellent health care. I've always been insured through my husband," Parrish said. "There should be no excuse."
Twice over several years, her doctor mentioned that her blood sugar was high but assured her not to worry, that nothing needed to be done. Then, in 1988, when she was 51, she began feeling exhausted and losing weight. Eventually, she developed a bladder infection so severe it landed her in the hospital. The physician realized she had diabetes.
