Efforts on Rise to Track, Treat Latinos’ High Risk of Diabetes : Health: Pediatrician leads study of more than a dozen Ventura County children who have the adult form of the disease. It usually does not develop until age 30 or over.

After 17 years as a diabetes specialist, physician Naomi Neufeld was familiar with a potentially fatal form of the disease that is common in adults.

Then, she discovered the adult-type diabetes in a 10-year-old Ventura boy, the first time she had ever heard of a child stricken by the disease that usually develops at age 30 or older.

Since that diagnosis two years ago, Neufeld has found more than a dozen Latino children in Ventura County with the adult-onset diabetes. Unlike those with the usual childhood diabetes, those with the adult type require very little insulin to stabilize their blood sugar.

Working with physicians from a county-run pediatric clinic in Ventura, Neufeld had expanded her search, examining blood samples from high school students across the county. Her medical sleuthing aims to determine the breadth of the adult type in children and figure out who is most susceptible to the disease.

“So far we have found it only among Latinos,” said Neufeld, a pediatrician based at Cedars-Sinai Medical Center in Los Angeles. “I’m out to find out why, to understand the genetics and to see if we can prevent it.”

The study is just one example of growing efforts in the county to track down and treat Latinos with diabetes and to educate Latinos at risk of getting the disease.

Nationwide, Latinos are twice as likely to have diabetes as whites, according to the American Diabetes Assn. Inadequate medical care, high-fat diets, language barriers and, possibly, genetic makeup, contribute to the high rate among Latinos, health officials say.

While Latinos comprise only about a quarter of Ventura County’s population, they make up half of the county’s estimated 60,000 diabetics, according to the association.

Based on nationwide studies conducted by the diabetes association, at least half of all diabetics in the county have not been treated and many are unaware they have the disease.

“People don’t realize that diabetes is a big problem and Latinos are particularly vulnerable,” said Lenore Gabel, director of the association’s Ventura County chapter. “Unless we address that, it’s just going to get worse.”

Diabetes strikes when the body fails to convert the sugar in food into energy. The sugar collects in the blood and urine, stalling body functions. Symptoms include increased appetite, excessive thirst, fatigue, weight loss, nausea and frequent urination.

Left untreated, diabetes can lead to blindness, kidney disease, loss of limbs and, in severe cases, death.

The most common type of diabetes usually shows up in overweight adults. Exercise and a restricted diet usually control the adult form of the disease. In extreme cases, insulin, a sugar-converting hormone lacking in diabetics, may be used to help control the disease.

Nationwide, one in seven Latinos suffers from non-insulin-dependent diabetes, compared to about one in 20 whites, the association said.

Often, diabetes sufferers end up in the hospital with complications that could have been avoided through early treatment, said county health officer Larry Dodds.

Diabetics accounted for about 7% of hospital stays countywide from January to June of 1992, Dodds said. Many of those patients were also treated for other illnesses such as heart disease or strokes, Dodds said.

“Diabetes takes a heavy toll on the system,” Dodds said. “Diabetics are much more likely to have heart-related problems.”

By treating diabetics early and getting them on proper diet and exercise programs, fewer end up in the hospital, resulting in reductions of medical costs, Dodds said.

To work toward that end, the Ventura County Medical Center recently opened a weekly diabetes clinic to reach patients who would not seek treatment unless they are extremely ill. The clinic has a bilingual nurse and instruction pamphlets printed in Spanish for its predominantly Latino clientele.

John Stauffer, the physician who oversees the county clinic, said he believes the clinic has helped reduce the number of diabetics who end up in the hospital.

“We’re seeing people early and often,” Stauffer said. “We’re giving them the ongoing care they need to stay healthy and out of the hospital.”

One common problem, Stauffer said, is that they lapse in taking their medication or take it incorrectly.

“They have to test their own blood sugar and give themselves shots,” Stauffer said. “It’s a complicated process and sometimes people do it wrong or get frustrated and just don’t bother doing it at all.”

The clinic provides a convenient way for Stauffer to more closely monitor patients, he said.

Manuel Medina, a 49-year-old factory worker whose diabetes has worsened since his illness was diagnosed seven years ago, came to the clinic on a recent afternoon to learn how to give himself insulin shots.

“I’m glad the clinic is here,” Medina said. “Before, I would just wait until I was really sick and go to the hospital. Now I know I can come here.”

In another effort to control the disease, a new county program sends field nurses to the homes of women who develop the disease while pregnant.

“We decided that this is a top concern,” said public health nurse Kay Maloney, who helped arrange state funding for the program. “It is very, very necessary to reach these women.”

Gestational diabetes occurs in the last three months of pregnancy. Left untreated, it can kill the baby. Although the disease usually disappears after the mother gives birth, it increases the risk that she may again develop diabetes later in life.

Since the program began last fall, 43 women have been treated, 33 of them Latino, said program coordinator Diane Visencio. All gave birth to healthy babies with the help of the program, Visencio said.

“These women are poor and have their hands full just trying to get food on the table,” Visencio said. “By going into their environment the nurses are able to help women who would otherwise be putting their pregnancies in danger.”

One such woman is Consuelo Duenas, a 32-year-old domestic worker in Oxnard whose fear of hospitals kept her from seeking medical attention. Duenas said she lost her last child to gestational diabetes. Now six months pregnant, Duenas’ blood sugar levels hover at three times the norm.

About a month ago, Duenas began feeling the same symptoms that occurred during her last pregnancy. “I felt very weak and heavy,” she said. “I was always thirsty.”

Through the gestational diabetes program, Duenas’ condition is closely monitored by hospital staff. Every other week a field nurse visits her at home to make sure she is taking her medicine and avoiding fatty foods such as refried beans.

Four times a day Duenas pricks her finger, drawing blood to measure her blood sugar level and twice a day she gives herself a shot of insulin.

“I don’t like to ask questions or talk to a doctor about how I feel,” Duenas said. “But when the nurse comes to my house I feel more comfortable.”

Government funds for programs like the one for pregnant mothers are slow in coming, Maloney said. “We’re lucky to even have this program,” she said. “We wish we could do more.”

In Santa Paula, a federal grant allowed the county to survey the health needs of Latinos.

The $40,000 study, conducted in January and February by the county’s Public Health Department, found that although 48% of those surveyed said they had diabetes only 13% listed the disease as a top health concern.

“If there was any question about it before, this shows that there is a real need for early intervention and diabetes education,” said Carlene Maggio, a senior health educator who conducted the survey.

But the survey’s findings won’t have much impact unless area health officials can come up with funding to carry out its goals, Maggio said.

“We don’t have the resources to start some sort of intensive screening and education program,” Maggio said, “and if we did then we’d probably have to tell all these people who come for help, ‘Oh, sorry, we don’t have the services or facilities to handle this.’ ”

Gloria Chinea, a health educator at St. John’s Regional Medical Center in Oxnard, is trying to solve the problem by reaching potential diabetics before they develop the disease.

Chinea holds monthly diabetes education workshops in Spanish at churches and community centers in La Colonia and other predominantly Latino neighborhoods around the county.

“Instead of waiting for people to come to us, we are trying to reach into the community,” Chinea said. “We need to stop risky behavior before the disease takes hold.”

Chinea uses plastic food models to illustrate which sweet, fatty and fried foods can raise the risk of diabetes.

“It is important to talk about foods people actually eat,” Chinea said. “How many tortillas can I have? How much avocado? How much menudo? Otherwise, you are not going to do any good.”

Chinea also works closely with the local chapter of the American Diabetes Assn., often calling on volunteers to help her counsel patients with diabetics.

Joe and Mona Black, whose 14-year-old daughter Sandra was found to have diabetes two years ago, are among Chinea’s most valued volunteers.

“They have been through it, so people really value their advice,” Chinea said.

“Sometimes people are in such shock they don’t do the things that will keep their diabetes from getting worse,” Mona Black said. “We try to show them that as a diabetic if you are careful you can live a normal life.”

The Blacks often attend Latino health fairs, administering diabetes tests and offering on-site counseling.

“Even at the health fairs we find people who are unaware that they have high blood sugar,” Joe Black said. “The terrible thing to realize is that there are so many people who are walking time bombs and don’t even know it.”

FYI: * For more information on diabetes education and counseling, call: the American Diabetes Assn.’s Ventura chapter, 987-1323; Ventura County gestational diabetes program, 652-5914; St. John’s Regional Medical Center’s diabetes education program, 988-2660; Ventura County Medical Center’s diabetes clinic, 652-6045.