Diabetics Take Course of Action

Carlos Paz, 45, is a diabetic. Since being diagnosed five years ago, he has tried his best to regulate his blood sugar levels, desperate to avoid the daily insulin shots he will need if the disease progresses.

This year, Paz got some much-needed guidance at a Pacoima clinic, where he found full-service care for the disease.

A nutritionist worked with the short-order cook to change his diet. “No tortillas,” he said. “Only rice.” Classes taught by a registered nurse educated Paz about the disease. Medications and blood tests were provided, with fees based on one’s ability to pay.

The program, run by MEND (Meet Each Need with Dignity), is a joint effort with Los Angeles County Department of Health Services and the year-old San Fernando Valley chapter of the American Diabetes Assn.

MEND, which serves a largely low-income Latino clientele, began the program in the spring to target that population, nearly twice as likely as Anglos to have the disease.

Run on a shoestring budget with donated medicine and a volunteer medical staff, the program has treated more than 100 low-income diabetics who have no health insurance.

The clinic’s approach coincides with a new emphasis in the county Department of Health Services, where the recently appointed director of public health has made treatment and prevention of chronic disease a top priority.

On Tuesday, the department for the first time will ask for $950,000 from the county Board of Supervisors to fund this effort.

“The health department has traditionally done a good job in containing and combating contagious disease,” said Jonathan Fielding, county public health director. “Now we have a great opportunity to reduce the overall toll of chronic diseases.”

Before the MEND program began, Paz and his nine diabetic classmates were largely on their own. Among the more than 2 million adults without medical insurance in Los Angeles County, they faced long waits at the county hospital and little access to comprehensive care.

For Beverly Crutcher, 58, the program was “God’s gift.” The Van Nuys woman, whose mother died at 57 one week after being diagnosed with diabetes, said before MEND she had begun to despair.

“I didn’t have insurance and no one would take me. If I paid for all my medications, they would cost more than I make in a month,” she said.

She knew what could happen without medical care.

“I could go blind. My kidneys could go. I could lose my hearing, have a leg cut off,” she said.

Diabetes occurs when the pancreas fails to produce sufficient insulin. If untreated, the condition can result in blindness, renal failure, heart attacks, stroke and amputation of limbs, among other complications.

The disease costs progressively more to treat as the symptoms worsen. In 1997, the American Diabetes Assn. estimated that diabetes cost more than $98 billion nationwide in medical fees, lost wages and “good services lost due to premature mortality.”

Among Mexican Americans and Puerto Ricans 45 and older, as many as one in four have the disease, more than three times the incidence of diabetes in the general population, according to the ADA. Like Latinos, older African American women also have a 25% chance of developing adult-onset, or Type II, diabetes.

While diabetes can often be controlled through exercise and diet, one-third of the nearly 16 million Americans with the disease don’t even know they have it, medical specialists say.

An effort was begun last year in the San Fernando Valley to reach the undiagnosed. The Valley’s American Diabetes Assn. chapter, in cooperation with the county Department of Health Services, has screened more than 2,000 residents for the disease, raised more than $90,000, distributed educational materials to tens of thousands and started four support groups for diabetics.

But the chapter’s president, general practitioner Keith Richman, said there is much more to do.

Early detection and treatment have become priorities for public health officials.

“If you look at the national numbers on diabetes, we probably have somewhere in the range of 120,000 diabetics in the Valley. Probably a third to a half do not know they have diabetes,” Richman said.

Many specialists expect that number to grow. One study presented at the ADA Scientific Sessions this month in Chicago found a dramatic increase in the rate of diabetes in the last 10 years, blaming a decline in physical activity, high-fat diets and increased obesity.

Identifying those most at risk might save lives, as well as reduce medical bills, health officials say.

Reaching out to the community seems to be working at MEND.

Leticia Martinez, a registered nurse who teaches a series of classes on diabetes, said many who attend seemed hesitant at first. But with only one session of the current class left, she said her students, nearly all of whom speak primarily Spanish, have proved able learners.

One student has been able to stop taking diabetes medication after changing her diet and losing weight. More importantly, her class now seems to understand the importance of vigilance, Martinez said.

Stepping onto the scale in the clinic hallway, Maria Del Gado learned she had gained three pounds in the last month.

“That’s not good,” said Audrey Triplett, the health services coordinator who helped establish the program. “You need to lose weight, not gain.”

Del Gado, an Arleta resident who volunteers in MEND’s clothing center three times a week, has fingers so calloused from work, the nurse can’t coax blood from them. The blood comes instead from her arm. This news, at least is better--her blood sugar levels are down.

“Good,” Triplett said. “Bueno. Bueno.”

Fielding said the early results of the MEND program are encouraging.

“I think the MEND program is really important,” said Fielding, who would like to see similar efforts countywide.

But prevention is as important as treatment, he said. How would Carlos Paz be doing today, Fielding wondered, if he had had information about diabetes sooner?

“The real question is 15 years ago did he know he was likely to get this disease? Did he know what he could do to prevent it or slow it down?” Fielding asked. “Those are the types of things everyone needs to have access to.”