Diabetes: Delaware's Billion-dollar crisis Margie Fishman and Jen Rini, The News Journal 1:01 p.m. EDT April 23, 2016 Diabetes (Photo: Jason Minto, The News Journal)
Delaware has a $1 billion time bomb strapped to its back. It's called Type 2 diabetes.
Today, one in three Delawareans has higher-than-normal blood sugar levels because they can't efficiently produce and use insulin. Left unchecked, prediabetes and full-blown Type 2 diabetes can disrupt every organ system in the body, leading to blindness, amputated limbs, heart disease, stroke and kidney failure.
Type 2 diabetes, linked to excess weight and a sedentary lifestyle, disproportionately impacts minorities and the poor.
"It's like a tornado," said Carrie Holmes, a Dover diabetes educator. "It just keeps getting bigger and bigger."
After nearly losing a foot to gangrene, Sharon Childress, of Seaford, can't ignore the signs of a “sugar shake” when her blood sugar levels plummet and convulsions rattle deep in the center of her chest.
Childress developed gestational diabetes when she was pregnant in 1975. More than two decades later, in 1997, she was diagnosed with Type 2 diabetes.
“I really keep an eye on it because I don’t want to lose my eyesight I don’t want to lose my feet,” explained the 59-year-old. “I want to live today. And you can live with diabetes."
Not only can you live with diabetes; if caught early enough, life-altering changes can be avoided. That's not the case with most chronic diseases. And it all starts with a simple blood test.
Once diagnosed, patients willing to overhaul their diet and exercise regimens can lower high blood sugar, high cholesterol and high blood pressure. Yet roughly a quarter of those who have diabetes don't even know they have it.
The average person is diagnosed with Type 2 five to seven years after living with prediabetes, according to Christiana endocrinologist James Lenhard. Some patients experience no symptoms warning them of trouble ahead.
Faced with an aging population and widening waistlines, Delaware spends more on diabetes than either heart disease or cancer. The cost is a staggering $1.1 billion a year — the second-highest health care expenditure behind mental health — for screening, treatment, lost worker productivity and death. The national tab is more than $245 billion, threatening to bankrupt Medicare if current trends continue.
Nearly half of American adults have diabetes or prediabetes, according to a startling study published last year in the Journal of the American Medical Association. And those statistics don't include the growing number of teens diagnosed with prediabetes, who don't yet qualify as Type 2 diabetics.
Being overweight is the number one risk factor for youth. Children from African American, Hispanic, Asian and Native American families are twice as likely to develop diabetes as those from Caucasian families.
Delaware deals with diabetes dilemma
Type 2 used to be a disease associated with forty-somethings and retirees, said C.J. Jones, associate executive director for the Delaware Diabetes Coalition.
"In the last 10 to 15 years, the age keeps coming down lower," she said. "It scares the living daylights out of me."
The demand for diabetes treatment has spawned a more than $24 billion global insulin industry, with some brands raising their prices by 160 percent over the last five years. Patients, meanwhile, must bankroll a growing list of medications and supplies while negotiating higher insurance premiums and deductibles.
"It's an insidious disease," said Marianne Carter, a Delaware State University dietitian. "If it's not under control, the complications can be devastating."
Blame an aging population, spiraling obesity rates, behavioral economics, children sequestering themselves indoors to blow up virtual worlds, infrequent blood tests, or the absence of a coordinated outreach campaign.
Or just blame being set in your ways.
Type 1 diabetes is an autoimmune response typically diagnosed in children. But the more prevalent Type 2 is driving the uptick in cases. The nation's overall diabetes rate has more than doubled over the past two decades in tandem with the obesity rate. Today, diabetes is the seventh-leading cause of death in the U.S.
The News Journal spent months interviewing people on the front lines of diabetes education, including doctors, local and national public health experts, community advocates and nutritionists. We also talked to Delawareans with prediabetes and Type 2 diabetes who radically changed their way of life to stop the disease in its tracks.
National data show that prediabetics who lost 5 to 10 percent of their body weight and exercised regularly lowered their risk of developing Type 2 diabetes by nearly 60 percent. Those who only took medicine lowered their risk by 31 percent.
Yet, in the race to contain an epidemic, prevention is a relatively new area of focus for state and national public health officials. It takes years to test programs to prove their efficacy, along with navigating the complex web of insurers, physicians, advocacy groups, federal regulators and legislators, according to Ann Albright, who heads the Division of Diabetes Translation for the Centers for Disease Control and Prevention.
"If this were a drug, it would already be in people's hands," she said.
Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you are more likely to have heart disease or stroke.
DIABETES
NERVE DAMAGE
Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction.
DIABETES
KIDNEY DAMAGE
The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
DIABETES
EYE DAMAGE (RETINOPATHY)
Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
DIABETES
FOOT ISSUES
Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation.
DIABETES
SKIN CONDITIONS
Diabetes leaves people more susceptible to bacterial and fungal infections.
DIABETES
DIABETIC KETOACIDOSIS
Diabetic Ketoacidosis is a serious condition that can lead to diabetic coma or even death.
When cells don't get the glucose or sugar they need for energy, the body begins to burn fat for energy, which produces ketones. Ketones are chemicals that the body creates when it breaks down fat to use for energy.
The body does this when it doesn't have enough insulin to use glucose, the body's normal source of energy. When ketones build up in the blood, they make it more acidic. They are a warning sign that your diabetes is out of control or that you are getting sick.
DIABETES
HEARING PROBLEMS
Hearing problems are more common in people with diabetes.
DIABETES
ALZHEIMER'S DISEASE
Type 2 diabetes may increase the risk of Alzheimer's disease. The poorer your blood sugar control, the greater the risk appears to be. Although there are theories as to how these disorders might be connected, none has yet been proved.
CHAPTER 2
After an infected hair follicle nearly killed him, Gary Stumpf doubled down on managing his Type 2 diabetes.
The Dover retiree had a family history of the disease, but that didn't stop him from scarfing down two orders of McDonald's hash browns for breakfast or a Wendy's hamburger for lunch.
Diagnosed with Type 2 more than two decades ago, Stumpf's real complications began with what masqueraded as a nasty flu in 1998.
Doctors advised him to rest for a week. The next day, Stumpf noticed swelling the size of a grapefruit in the scrotum area around his testicles.
He was diagnosed with Fournier's gangrene, an extremely rare condition caused by an infection in the genital region that destroys the body's tissues. People with diabetes are at higher risk of contracting the disease, because high blood sugar impedes blood circulation, making it harder for the body to repair sores and wounds.
“In the last 10 to 15 years, the age keeps coming down lower. It scares the living daylights out of me.”
C.J. JONES, DELAWARE DIABETES COALITION
Type 2 diabetes is a chronic, progressive condition that affects the pancreas, an organ roughly the size of a hand. The pancreas makes enzymes that aid digestion and insulin, a hormone that helps the body store or break down sugar, or glucose, from the food we eat and convert it to energy.
Excess weight, eating habits and genetics play a role in how quickly the disease progresses. Being overweight, particularly in the midsection, interferes with the body's ability to break down glucose in the blood, hamstringing the pancreas.
That's why many people with diabetes, like Stumpf, must take multiple oral prescriptions and shoot themselves with insulin several times a day to lower their sugar levels.
Dover resident Gary Stumpf points at bananas during a diabetes care program tour at the Dover Acme grocery store on April 9. Stumpf was diagnosed with Type 2 diabetes more than two decades ago. (Photo: JASON MINTO/THE NEWS JOURNAL)
During his first month in the hospital, Stumpf recalled submitting to 24 major surgeries and laborious, painful cleanings to remove all the dead skin from his gangrene.
"I was given a 10 percent chance to survive," the 65-year-old remembers. It took him nearly five months to relearn to walk and breathe on his own, followed by three months of in-home nursing care.
Since that time, the former U.S. Department of Defense analyst has faithfully tracked what he eats, and his weight has dropped to 266 pounds from a high of 415 pounds.
With ritualistic precision, Stumpf needle-pricks his middle finger, squeezes a drop onto a plastic matchstick and shoves it into his glucose meter. Bleep. The screen flashed 131 (milligrams per deciliter) on a recent weekday. Normal is 70 to 100.
“I figured it would be high,” Stumpf said, immediately regretting the patty melt he ate for lunch.
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