Like the guys in the TV ads, Ken Bolster had a "going problem." He was getting up at night every two hours to go to the bathroom. Bolster thought it was his prostate, as the TV ads suggest, and waited for his annual physical exam to bring it up with his doctor.
His prostate was fine, but his blood sugar was sky high. Bolster was diagnosed with Type 2 diabetes in September. "It was a shocker to me," the Odessa resident said.
He has plenty of company. More than 20 million Americans have diabetes, and up to 95 percent of them have Type 2 diabetes, which has surged along with obesity rates. Bolster, 58, wasn't obese, but he does have a strong family history of the condition.
Type 1 diabetes develops most often in children and young adults who suddenly stop producing insulin (PDF). In Type 2, patients still produce some insulin, but it doesn't work as efficiently as it should.
Type 2 usually develops after age 45, and so it is also known as adult-onset diabetes. But as more children are becoming obese, more are developing Type 2 diabetes long before reaching adulthood.
Early symptoms can be subtle, as Bolster learned, so an estimated 10 million Americans don't even know they have diabetes.
The financial impact of diabetes is staggering — about $174 billion in 2007 in medical costs, days lost from work and early death, according to the Centers for Disease Control and Prevention.
Last week, a study in the journal Health Affairs found health costs last year related to obesity had hit nearly $150 billion, and the biggest reason was the skyrocketing rate of Type 2 diabetes.
Why is diabetes so costly? Partly because of expensive new medications, testing supplies and the many complications associated with diabetes.
"Patients need eye care, foot care, cardiac care and testing, dental care and many patients don't have insurance coverage for that," says Dr. Susan Jane Boston, an endocrinologist with Morton Plant Mease Diabetes and Endocrine Center at Mease Countryside Hospital in Safety Harbor. Some patients must choose between eating and buying medication or testing supplies, she said.
Early diagnosis can make a difference
When we eat, sugars and starches are broken down by the body into glucose. The hormone insulin removes glucose from the bloodstream, carrying it to the cells where it is used for energy. If you don't produce enough insulin, or the body doesn't use insulin properly, glucose can't get into the cells and they begin to starve. With nowhere to go, glucose builds up in the bloodstream, often with serious consequences.
Bolster had one of the most common symptoms of diabetes: frequent urination. It's the body's way of trying to get rid of all that glucose in the bloodstream. No matter how much they drink, diabetics seem to have an unquenchable thirst and can become dehydrated. Left unchecked, severe dehydration can lead to a coma, even death. That's why high blood sugar must be treated and controlled, usually for life.
Uncontrolled, it can damage nerves, particularly in the feet and lower legs, leading to amputation; it also can damage small blood vessels in the eyes, kidneys and heart, resulting in vision loss, kidney failure, heart attack and stroke.
Holly Wetz, a registered nurse and certified diabetes educator at St. Joseph's Hospital in Tampa, says early diagnosis and treatment are key to avoiding complications. But too often, people don't seek help until trouble starts.
"By the time we see them they've already lost vision, they're already on dialysis," says Wetz. "Most have had symptoms and didn't know it was diabetes."
Anyone who has a family history of diabetes needs to be screened and should be alert for symptoms of the disease.
Besides frequent urination and excessive thirst, other symptoms of Type 2 diabetes include extreme hunger with weight loss, blurred vision, nausea and vomiting, extreme weakness and fatigue, and loss of feeling in the hands or feet. Symptoms may be so mild that they're easy to dismiss as simply getting older.
Anyone can get Type 2 diabetes but those at highest risk include African-Americans, Hispanics and American Indians, those who are overweight or obese (especially with fat concentrated in the belly) and those with a family history of Type 2 diabetes. Also at risk are those who are inactive, women who had gestational diabetes during pregnancy, smokers and the elderly.
And because of the epidemic of obesity in children, Type 2 diabetes — once exclusively a disease of adults — is becoming more common in adolescents and teenagers.
Taking a proactive approach is key
Bolster, a retired hospital data processing director from upstate New York, didn't let the shock of his diagnosis last long. His doctor prescribed daily medication to get his blood sugar under control. He swore off junk food, started walking, joined a fitness center and began attending diabetes education classes.
Almost a year later, he still checks his blood sugar five times a day, but the lifestyle changes made such a difference he now needs almost no prescription medication. He says family support was critical and gives his wife and daughter a lot of credit for his success. "I'm a good soldier," he says. "I feel extremely optimistic. Having it in check makes everybody feel a whole lot better."
Irene Maher can be reached at firstname.lastname@example.org or (813) 226-3416.