Sarah Cooke listened as her aging diabetic patients vented about trying to cope with the pernicious disease.
“Guilt and denial, that’s pretty much it,” said a woman with short gray hair.
“Confused,” said another woman wearing wire-rimmed glasses. “I don’t know what I can eat and what I can’t.”
Cooke, a clinical dietitian at Loma Linda University Health Care, leads a weekly class as part of an effort to combat the diabetes crisis in Southern California, with elderly residents particularly vulnerable. Cooke recently discovered that about 70 percent of all patients who enter Loma Linda University Medical Center are diabetic.
“The important thing is to get to people shortly after they’re diagnosed and get them the resources and proper education,” she said. “A lot of people have had diabetes for a number of years, have developed complications and never had the opportunity to talk to a dietitian or take a class.”
After hearing the diabetic patients’ complaints, Cooke offers suggestions. During her nine years as a dietitian at Loma Linda, Cooke has seen an increasing number of younger patients who have pre-diabetes. She attributes this to the sodas, sugary energy and coffee drinks, and fast food that many younger people subsist on, in addition to their sedentary lifestyle.
That is translating into an onrush of suffering as these patients age, when the effects of the disease are most pronounced. Diabetes is a disease in which the body’s inability to produce any or enough of the hormone insulin causes elevated levels of glucose (or sugar) in the blood. If untreated, it can lead to hypertension, heart disease, strokes, blindness, kidney disorders, amputations and death.
Physicians anticipate the rate of diabetes among the elderly will increase sharply in the coming years. About 45 percent of all adults in the state have pre-diabetes or undiagnosed diabetes, according to a study by the UCLA Center for Health Policy Research. Up to 30 percent of those with pre-diabetes will develop Type 2 diabetes within five years.
The diabetes rate in the state has increased by 35 percent since 2001, according to the study. About 13 million adults in California have pre-diabetes or diabetes and another 2.5 million adults have already been diagnosed with the disease, totaling about 40 percent of the state’s population. Nationally, annual medical spending for people with diabetes is almost twice that for people without the disease. A person who is diagnosed with diabetes by age 40 will have lifetime medical spending that is $124,600 more than someone who is not diabetic.
Education is important in preventing and controlling diabetes, said Dr. Theodore Friedman, an endocrinologist at Martin Luther King Jr. Outpatient Center and chairman of the county Department of Health Services Endocrinology Work Group. He leads a weekly class for diabetics, most of whom are seniors, which emphasizes healthy eating and exercise. He has discovered that elderly diabetic patients are sometimes more amenable to changing their eating and unhealthy habits than younger patients, he said.
“Most of my patients say they want to lose weight,” he said. “Many are on so many medications they’re trying to reduce the number they’re taking. They really want to change, while some younger people feel they’re invincible or they’re too busy to alter their lifestyle.”
The rate of adults with diabetes in Los Angeles County (about 10 percent) is slightly higher than the state average (about 9 percent), according to the UCLA study. The county Health Department offers a number of diabetes classes, but some impoverished elderly patients don’t have transportation and can’t attend regularly. As a result, the department offers eleven classes, some in Spanish and English, posted on YouTube, ranging from nutrition suggestions to stress management to mixing insulin.
“In the past, diabetes education was more for wealthy people,” Friedman said. “Now we’re trying to educate everyone. We’re trying to get patients to get as involved as possible in managing their diabetes.”
Although experts say the diabetes rate is concerning all over Southern California, the level varies from county to county. Orange County’s rate is below the state average.
That’s the case in Riverside County, too. But next door, in San Bernardino County, the diabetes-related death rate — 32.4 per 100,000 population — is more than 50 percent higher than the state average.
Because the problem is so severe among the elderly, extensive community outreach is needed, said Dr. Kevin Codorniz of Loma Linda’s division of endocrinology, diabetes and metabolism. The classes at the Diabetes Treatment Center and at other hospitals are an important way to educate patients so they understand the disorder and change their lifestyle to avoid dangerous blood sugar levels.
Carolyn Edwards, who attended the class at Loma Linda, lives nearby in Bloomington. Edwards, 71, a retired hotel front desk manager, was diagnosed with diabetes decades ago, but never assiduously monitored her condition.
“When I was working it was easier to keep my sugar levels down because I was much more active,” she said. “But when I retired it became much more of a challenge. I had stopped fixing meals and just snacked or went to hamburger places. Then my blood sugar went crazy and my doctor suggested I take this class.”
For years Edwards had little energy and was often too weak to walk. She frequently felt so dizzy that she occasionally leaned against a wall for support and slowly slid to the floor. After two classes at the Diabetes Center, she said she has made significant changes and already feels more energetic. She now tests her blood sugar twice a day, shops and makes herself healthy dinners every night, and works out on a stationary bicycle at a gym.
Most of the people who participate in the Loma Linda class are in their fifties and older. The first class focuses on the basics of diabetes, the second on nutrition, and the third on blood sugar monitoring and reading food labels. The patients put into practice what they’ve learned and then return two months later for a final class, when their weight and blood sugar levels are tested again.
Cooke recently saw a 70-year-old patient with severe diabetes who was almost 50 pounds overweight and had a number of complications, including kidney failure and hyperten-sion. When Cooke asked the woman about her eating habits, the woman mentioned that she consumed eight tortillas. “A day?” Cooke asked. “No,” the woman said. “Each meal.”
“That meant she was eating 24 tortillas every day,” Cooke said. “The woman thought that since tortillas aren’t sweet, they wouldn’t be bad for her diabetes. She didn’t realize this was way too much carbohydrates and carbohydrates break down into sugar.”
Cooke immediately signed the woman up for a diabetes class.
Corwin writes for the Center for Health Reporting at the Leonard D. Schaeffer Center for Health Policy & Economics at the University of Southern California. Research for the story was supported by the Gary and Mary West Foundation.
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