Minority Groups at Risk of Diabetes : Health: Changing lifestyles and lack of preventive care have left more minorities and immigrants afflicted with the disease, experts say.

Esther Lee remembers well the day her mother was unable to drag herself out of bed.

“She was used to working in a factory 12 hours a day and then going to English classes,” says Lee, 27, a Korean immigrant. “Then one morning she said she physically couldn’t get up.”

Korean-speaking doctors diagnosed diabetes. They told Lee’s mother to get bed rest, but she continued to work because she needed the money. Several years later, after her mother’s illness worsened, Lee saw Dr. Francis Rhie interviewed on Korean-language television.

Under Rhie’s care, Myung Lee began to improve. But not before the disease had blinded her.

Lee’s case is not uncommon in Southern California’s fast-growing immigrant and minority populations. Certain types of diabetes afflict immigrants and minorities more often than European-Americans, in part because of probable genetic predisposition, cultural differences and health care problems.

According to the American Diabetes Assn. (ADA), the number of diabetics has doubled in California since 1990--from 1.4 million to 2.8 million, or 9.3% of the population.

Nationally, 6.2% of whites suffer from diabetes, compared to 10.2% of blacks, 9.3% of Cubans, 13% of Mexicans, 13.4% of Puerto Ricans and 13.9% of Japanese-Americans, ADA figures show.

As county, state and federal lawmakers argue about cutting health-care funding, more minority residents are losing limbs, kidneys and their lives to diabetes because preventive care is unavailable to them, experts say.

“This is an urban disease,” says Rhie, president of the California affiliate of the ADA. As minorities and immigrants adapt an American lifestyle, they are susceptible to poor exercise and diet patterns that can induce problems.

“We’re dying because of our success,” Rhie says.

Diabetics are unable to metabolize sugar, leaving high levels of glucose in the blood. Like a car with a full tank of gas but no combustion, diabetes prevents the body from making the insulin necessary to get the system running.

People with the so-called non-insulin dependent diabetes are often over 30, obese and may suffer worsened symptoms during times of stress. They may require insulin for control of their symptoms.

By contrast, diabetes mellitus, or insulin-dependent diabetes, usually strikes children or young adults (commonly European-Americans) and requires daily insulin injections.

Researchers are unsure why minorities are afflicted with non-insulin dependent diabetes, but they suspect that genetics, combined with lifestyle, lead to a greater predisposition to the disease.

For instance, being 20% or more overweight is a major risk factor, Rhie says, because “the body can’t keep up with the increased need for insulin.”

Minorities also suffer more serious complications. Among diabetics in California, the ADA says, American Indians are eight times more likely than whites to develop kidney failure, Latinos are six times more likely, and African-Americans are three times more likely. (A lack of research money has prevented studies of the state’s varied Asian population, Rhie says.)

Consequently, minorities are more often hospitalized.

Caring for diabetics costs California taxpayers nearly $1.3 billion annually, according to the American Diabetes Assn. That cost could be reduced, association officials say, if money were invested in prevention, education and the training of doctors who speak other languages.

Only recently has the medical community begun reaching out to minority and immigrant residents with:

* Increased education programs.

* Public service announcements on non-English language TV and radio, and in newspapers.

* Outreach workers at English-as-a-Second-Language classes, churches and ethnic festivals. (However, for the most part, specialists speak only two languages: Spanish and Korean.)

Diabetics can live long, productive lives if the disease is controlled, Rhie says. The problem is early detection and teaching patients to adjust their diets and lifestyles.

Diabetes, says Rhie, fails to command the same attention as AIDS and other high-profile diseases, which means less research money.

“We don’t have an Easter Seal poster child. We don’t use scare tactics, so we don’t get the money,” Rhie says. “It’s staying flat.”

Six years ago, Thien Tran spent half a year trying to find a Vietnamese-speaking endocrinologist.

“Vietnamese people feel more comfortable with Vietnamese doctors because of the language barrier,” says Tran, 66, a middle-class government worker who fled Saigon in 1975.

During her search, Tran’s weight dropped from 98 pounds to 60. Small cuts were becoming infected and taking months to heal. “I was so tired, I couldn’t stand up,” she says. “My family doctor really didn’t know anything about diabetes.” The doctor prescribed vitamin injections and relaxation. Tran was almost in a diabetic coma when she insisted that her doctor admit her to the hospital.

Tran met Rhie in diabetes education classes at St. Joseph Hospital in Orange. Tran now goes to martial-arts classes for exercise, adheres to a strict diet, has three insulin shots a day and constantly monitors the sugar in her system.

Others patients are more reluctant to monitor their lifestyle and thus are less successful at controlling the disease, Rhie says. Rich, fatty and sweet foods are an integral part of the diet and culture of certain minority groups, leading to obesity and increasing the chance of diabetes.

“Controlling diabetes is frustrating, time-consuming and emotionally draining,” Rhie says. “It becomes a full-time job. Patients resent it. They ask themselves, ‘Why am I living?’

“Macho men can’t handle the thought of taking insulin shots,” Rhie says. “They think they’re done with being a man. Asian men (patients) sometimes develop an inferiority complex. They think they have a defective body, which lowers their human value.”

Tyrone D. Jones, 46, a black Panamanian who lives in Mission Viejo, lost a leg to diabetes. He had ignored the weight gain, the unquenchable thirst, the pain in his legs and arch, the bloated “sloshing around”--as he describes his symptoms--until he lapsed into a diabetic coma. “I never liked going to doctors,” he says. “I didn’t realize how dangerous the sickness was.”

Jones, who has high blood pressure and gout, also had a stressful job in Orange County’s social services department, he says, which made him neglect his health. He has been in three diabetic comas since the disease was diagnosed when he was 33.

Gout caused a sore in his arch, and diabetes-induced poor circulation prevented it from healing. After two years of infection, doctors amputated his leg from the knee down. Jones also must spend three days a week on dialysis because his kidneys have failed. “I’m supposed to be on a special diet, but I’m not following it because I’d probably starve to death,” he jokes.

Only recently has he agreed to a kidney transplant. “What if I got a woman’s kidney and started acting different? Or what if I got the kidney of a killer and started acting like that?” he says. “I had to get over all that.”

The state considers diabetes a catastrophic illness and so subsidizes the medical care for dialysis and kidney transplants of all patients, regardless of income, says Cathy Hicks, director of St. Joseph Hospital’s Renal Center.

Rarely, though, do the government or private insurers subsidize prevention or education, which, if properly handled, could greatly reduce the financial and emotional cost associated with diabetes, says Jan Wolf, manager of La Amistad de Jose, St. Joseph’s free clinic in one of Orange County’s poorest neighborhoods.

The clinic, in Garden Grove’s Buena Clinton neighborhood, serves almost exclusively Spanish-speaking patients who have no insurance and travel frequently to Mexico.

“We’ve had patients arrive in diabetic shock, which is an indication of how well our health care system works for the poor,” Wolf says sarcastically.

Sonia Paz, the clinic’s coordinator and a registered nurse, sees about 10 diabetics per month. The number would probably be higher, she says, “but we only accept people from the neighborhood,” which has between 3,500 and 5,000 residents.

With the diabetic patients, “we have to constantly educate and re-educate,” Paz says. “These people come from a different culture; they have different beliefs.”

They tend to ignore medical advice, she says: “They’ll drink little milk and honey at night or have a Coke when it’s hot. We tell them to use (sugar substitute), but when they go to Mexico, they can’t find it so they put sugar in their coffee. They come back here thinking we’re not going to notice.

“We’re serving the tip of the iceberg here,” Paz says. “We’re filling a huge need, and there’s a lot more to be done.”