San Joaquin County among deadliest in state for diabetes

Dec. 07--Kelli McGeorge was diagnosed with Type 1 diabetes three years ago last month, after she was in a head-on collision. Doctors aren't sure whether she developed the insulin-dependent disease as a result of the accident, or if it was already developing in her system and the accident and subsequent hospital stay brought it to the forefront.

She spent one night in a hospital in Reno -- where she was living at the time -- under observation, and then went home with some bruises and pain pills.

Two days later, she was back in the hospital for emergency surgery to fix a perforated small intestine that they'd missed the first night. After two weeks recovering, she was sent home.

Her weight when she left was 128. During the next two weeks, she lost her appetite, her energy, her strength and 34 pounds. She was taken into the Lodi Memorial Hospital emergency department in a wheelchair because she was too weak to walk.

McGeorge's blood sugar was over 900; a healthy range falls between 70 and 120. After a week, she was sent home with oral medications and the diagnosis of diabetes.

Within weeks the doctor discovered her body makes no insulin and she was prescribed insulin therapy. That used to mean daily injections, but today she has an insulin pump.

"It is amazing," the Lodi resident said. "No daily shots, I just push a button and I'm good to go."

But McGeorge remembers going through a time when she felt out of control, lost in trying to understand diabetes. She was an athlete at Tokay High, and while she admits she was never a stand-out, she had learned to control and understand her body pretty well.

"I couldn't do that anymore. I couldn't even walk for more than five minutes, even with help. I just didn't have the strength," she said.

So she hopped on a stationary recumbent bicycle and started reading about diabetes. She also took a class to educate herself."Knowledge and information are what calm my fears, because diabetes does allow for a certain amount of control. You have the ability to test, and in my case dosing with insulin. But it's not exactly an exact science; there are so many factors that can throw you off, like stress or illness or exercise," she said. "It's definitely a marathon rather than a sprint, though. When I have one bad day, it's fine, I brush it off. When I have three or four in a week, I sort of freak out. Which I shouldn't do, but it happens anyway."

The Lodi resident is among a growing group of San Joaquin residents with diabetes.

There are two main types of diabetes, Type 1 and Type 2.

In the first type, a person's body basically stops producing insulin and requires insulin injections as part of a daily routine. It develops most often in children and young adults, but can appear at any age.

The second type is typically associated with older age and those who are overweight and physically inactive. While the body usually produces enough insulin, it cannot use it effectively to break down food. Patients can often control the disease through diet, but sometimes, like Type 1, an insulin regime is required.

Type 1 diabetes is an autoimmune disease that is not preventable, while Type 2 stems from lifestyle and can be prevented.

A growing concern

Today, San Joaquin County ranks among the worst in California for deaths caused by both types of diabetes, according to the California Department of Public Health.

Out of 58 counties, San Joaquin is ranked No. 53 for the highest number of all diabetes-related deaths. No. 58 has the most diabetes-related deaths. The majority of those are patients with Type 2 diabetes.

Eleven percent of the county's residents have diabetes, compared to 8 percent both statewide and nationwide.

Countywide, those rates have increased from 2003 when just 7.6 percent of residents over the age of 18 had diabetes, while the state's rate has remained constant, according to the county Public Health Services Department.

The disease ranks seventh in the top 10 causes of death in the county.

Male Hispanics have the highest rate of new diagnoses -- and it's growing.

Local health officials would like to change that with education and outreach.

Registered nurse Donna Schulz, who teaches a diabetes class at Lodi Health, blames today's lifestyles -- especially our eating habits -- for the increase in Type 2 diabetes rates.

"A lot of people eat out more than they used to," she said. "We are much more sedentary than we used to be, too, and we have more activities than are not conducive to regular eating times where people make a meal and enjoy it together."

Health officials also point to a lack of education and lack of health insurance for preventative care."It's really an epidemic," said Dr. Frank Huang, a Lodi endocrinologist. "If we don't take care of ourselves, we will miss the boat."

He added that one report claimed a third of the nation's population has undiagnosed pre-diabetes, the first warning sign for Type 2 diabetes.

Across California, there is a growing prevalence of Type 2 diabetes in adults ages 18 to 44, due to a number of issues. These include especially high rates of current tobacco use (20 percent) and heart disease (8 percent), high rates of residents without insurance (30 percent) and low rates of accessing recommended services such as eye exams.

In San Joaquin County, low rates of early pre-natal care may be contributing to a relatively high percentage of pre-term births which, in turn, puts the fetus at greater risk for diabetes later in life, according to the Public Health Services.

Other factors that contribute to developing Type 2 diabetes include blood pressure levels and smoking. Almost 30 percent of adults in San Joaquin County have high blood pressure, while more than 15 percent of county residents smoke, PHS found.

Weight has an effect, especially with developing Type 2 diabetes. Sixty-five percent of adults in San Joaquin County are overweight or obese, according to a 2011 report.

Diet, too, is a risk factor, according to Huang who treats a number of Lodi patients who eat a lot of carbohydrates and starches such as white bread, he said. Those require more insulin to break down in the body.

Although diet doesn't play a role in developing Type 1 diabetes, eating properly is key to controlling the disease, McGeorge, who has Type 1 diabetes, also watches what she eats and tries to exercise as often as she can.

She also thinks about her future -- which she hopes includes children. Insulin needs increase dramatically during pregnancy, she said.

"It's not the short-term I worry about, really. It's the long-term, the fear that I will lose my sight, or my kidneys, or worse," she said. "I'm very conscious of where my blood sugars are at on average. It's definitely a control issue with me. I deal with it by testing frequently and getting my labs done often."Other than that, she said doesn't really think about having diabetes as she goes about her daily routine -- until someone gives her a funny look for pulling her insulin pump out of her bra -- the easiest place to store it -- in public, she said.

In Lodi Health's five-county service area, health officials regular survey the top health concerns. Type 2 diabetes is among the top ailments the health system is focusing on when it comes to prevention, according to spokeswoman Carol Farron.

"As a result of that and the socio-demographics ... diabetes, heart disease, stroke and hypertension deserve the most of our attention," she said.

That is one reason for the class Schulz teaches and health fairs such as the one Lodi Health sponsored earlier this year.

The Public Health Services Department, too, is pinpointing its outreach by addressing chronic disease issues using appropriate cultural approaches, and has launched a diabetes informational website sponsored by Kaiser Permanente. It can be found at www.unitefordiabetessjc.org.

Screening important

Huang said it is important for doctors to screen at-risk patients for pre-diabetes. When a patient ends up in his office, it is usually too late to prevent the disease, but he attempts to empower the patient to live a full life by taking control of their lifestyle including diet and exercise.

"You need a support system, from a dietitian to an exercise partner. Data shows this is as good as medication," he said.

More than 90 percent of the estimated 2,000 patients Huang has seen over the last seven years have diabetes. While he said diabetes is typically genetic, the food we eat can affect it, as well.

"Food plays a role. It tastes good, and it's easy to fix, I admit it," he said of packaged meals.

He also blames the economy.

"I had one patient say she'd eat more veggies if they weren't so expensive," he said. "That's part of the problem."

It's an issue in Sacramento County, too, where Galt City Councilwoman Barbara Payne recently attended a conference on the topic on childhood obesity. That can lead to Type 2 diabetes.

Like in San Joaquin County, the fastest growing group is young Hispanic males.

"That's a large part of our community," Payne said.

She would like to see the city reach out to residents to educate them on nutrition and exercise, and is currently working with the superintendents in both Galt school districts.

McGeorge wants people to know that diabetics can eat whatever they wish; they just have to watch their portions.

"I want people who were just diagnosed to know that its not great to have diabetes, but once you get used to it, it's not that bad, either," she said. "You just have to think a little more when it comes to your health -- and really, we all should do that anyway, right?"

Contact reporter Jennifer Bonnett at [email protected].

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