Taking on diabetes

Kentuckians fight to win against widespread disease

Yvonne Beam, a consumer-member of Salt River Electric, joined some 464,000 Kentuckians when she was diagnosed with Type 2 diabetes, formerly called adult-onset diabetes. 

With diabetes, the body doesn’t make enough or properly use insulin, a hormone that turns food into energy. According to a 2021 report by the state Cabinet for Health and Family Services and other agencies, 13.3% of adult Kentuckians had diabetes in 2019, almost doubling the 2000 rate and putting the state among the top 10 states in the incidence of diabetes. 

Beam was not shocked at the diagnosis and knew the seriousness. 

“I have relatives with diabetes on both sides of my family,” she says. “I felt like I was doomed. Diabetes can destroy your life.” 

The Bardstown resident, now 71, was 55 when told she had prediabetes—when blood sugar levels are above normal but not high enough to be classified as diabetes. That state report shows 11% of Kentucky adults are prediabetic. People with prediabetes can take steps to prevent or slow its progression to diabetes. 

Beam was able to stave off Type 2 diabetes for more than 11 years through lifestyle changes. (Check out the National Diabetes Prevention Program for prevention information.)

Many don’t recognize the often-subtle signs of diabetes such as thirst, hunger, very dry skin, blurry vision, numb or tingling hands or feet, fatigue and frequent urination, the latter often at night. 

Some people lose weight without trying. Virginia Jones of Berea, who has Type 2 diabetes, experienced this. 

“I was losing weight like crazy,” she says. “By the time I was diagnosed with diabetes, I was down to 112 pounds. 

I was really thirsty all the time. When I was put in the hospital, my blood sugar was 600 or 700 (normal fasting blood sugar is 99 and under). I didn’t know I had diabetes.” 

Jones’ blood sugar was so high because with diabetes, the body can’t properly process blood sugar (glucose), so it builds up in the blood. 

Besides Type 2, there are two other types: Type 1, juvenile diabetes; and gestational diabetes (diabetes while pregnant). There are also lesser-known types such as medication-induced diabetes. Type 1 is rarer and often diagnosed in childhood or adolescence, although it can appear in adults. It typically happens more suddenly, according to the American Diabetes Association. 

Taking control 

What happens after diagnosis is not precisely the same for each person. That’s why seeing a medical professional regularly is crucial—especially since diabetes is a chronic (long-lasting) disease, says Chlodys Johnstone, an associate director of education and quality services at the University of Kentucky Barnstable Brown Diabetes Center, who has been Jones’ medical provider from the start. 

“The first part of treatment is physical activity and nutrition—lifestyle changes,” Johnstone says. “If your doctor recommends medication, you still need to make the lifestyle changes.” 

Jones took Johnstone’s advice to heart and went fishing. 

“I love to fish,” Jones says, “and it is something I can do most days. I walk around the bank a mile and maybe more, walking and throwing my line and bending to bait the hook.” 

Jones also walks up and down stairs and the long driveway at her daughter’s house for exercise. A dramatic change in her diet, emphasizing moderation, has also made a big difference. 

“When I first knew I had diabetes and went to a restaurant, I would ask them to bring me a box before the food came,” she says. “I would cut everything in half and save the rest for another meal. I basically had to learn how to eat right.” 

As is the norm, Johnstone prescribed medications for Jones. Many people take oral medications such as Metformin first and then take insulin if the disease worsens or the pills do not work for them. 

Keeping track of the blood sugar level each day helps keep it from getting too far out of range. It’s not easy to keep the disease in check, in part because it can change over time, Johnstone says. 

“Your body can develop what is called insulin resistance,” she says. “Your pancreas may make insulin, but your cells may not respond appropriately. Eventually, this can damage the insulin-producing cells in the pancreas to the point they cannot keep up with your body’s needs.”

On the flip side, Johnstone says with proper diet, regular doctor visits, medication and exercise, it’s possible to put diabetes into remission.

Diabetes’ deadly companions

Dealing with diabetes can be tricky enough, but it can lead to even more devastating issues. A common one is diabetic neuropathy, a type of nerve damage that causes tingling and numbness in the feet or hands. 

“Neuropathy can limit the quality of life and be painful,” says Johnstone. “It can make people lose sensation in their feet and keep them from realizing if they are developing sores or lesions.” 

Between 20% and 40% of people with diabetes will develop chronic kidney disease; the end stage of this is renal disease. Johnston says, “Diabetes damages the filtration function of the kidneys. Dialysis or a kidney transplant are the only two treatments.”

Diabetic retinopathy, another a complication of diabetes, is caused by elevated blood sugar levels, which can result in damage to blood vessels in the retina of the eye (see sidebar).

Yeast infections are more frequent in women, and even some men, with diabetes, Johnstone says. 

Last, but certainly not least, diabetes increases the risk of heart disease.

Diabetes often runs in families. Jones’ family experienced that.

“Almost my whole family has it,” Jones says. “One brother got it in his late 20s. He had to have both legs amputated at the knees because he didn’t take care of himself and didn’t do what the doc told him. Then he got gangrene after he cut himself. Two of my three brothers died after having to be on dialysis. Fortunately, my kidneys are still good.”

Diabetes can impact the whole body, Johnstone says. “The good thing is that we have great education in our state. There are advances in terms of medications—not only to treat blood sugars but to help with associated diseases. Together, we hope these will lead to a reduction in the number of people with diabetes.” 

Diabetes and the heart: these two are not strangers  

 After being diagnosed with Type 2 diabetes, Virginia Jones of Berea found out she also had cardiovascular disease.  

“I didn’t know I had any heart problems,” she says. “I found out at my regular doctor’s office, and they sent me to the University of Kentucky. Now I have a heart doctor plus my diabetes doctor.”   

The Center for Disease Control and Prevention notes that if you have diabetes, you’re twice as likely to have heart disease or a stroke than someone who doesn’t have diabetes—and at a younger age. Further, according to the CDC, the longer you have diabetes, the more likely you are to have heart disease.  

This is because over time, high blood sugar can damage blood vessels and the nerves that control the heart. People with diabetes are also more likely to have other conditions that raise the risk for heart disease.   

The CDC says to particularly watch for these three conditions:  

• High blood pressure increases the force of blood through your arteries and can damage artery walls. Having both high blood pressure and diabetes can greatly increase your risk for heart disease.  
• Too much LDL (“bad”) cholesterol in your bloodstream can form plaque on damaged artery walls.  
• High triglycerides (a type of fat in your blood) and low HDL (“good”) cholesterol or high LDL cholesterol are thought to contribute to hardening of the arteries.

None of these conditions has symptoms. A blood pressure check and a simple blood test can determine whether LDL, HDL, and triglyceride levels are high.  

People with diabetes are also more likely to have heart failure, according to the CDC. This is a serious condition in which your heart is still beating, but it can’t pump blood well. This can lead to swelling in the legs and fluid buildup in the lungs, making it hard to breathe. Heart failure tends to get worse over time, but with early diagnosis and treatment, symptoms can be relieved and stop or delay the condition from getting worse.  

These factors can also raise your risk for heart disease:  

• Smoking.  
• Being overweight or having obesity.  
• Not getting enough physical activity.  
• Eating a diet high in saturated fat, trans fat, cholesterol, and sodium (salt).  
• Drinking too much alcohol. 

What is gestational diabetes?  

Women with no history of diabetes can develop what is called gestational diabetes when pregnant.   

“The biggest risk is that too much glucose can cause the baby to grow too quickly and have to be delivered before the baby is fully developed,” says Chlodys Johnstone, an associate director of education and quality services at the University of Kentucky Barnstable Brown Diabetes Center. “The baby may also be born hypoglycemic because it is used to having so much insulin.”  

Pre-eclampsia, a serious blood pressure condition that develops late in pregnancy, is also possible.   

The mother’s short-term health also can be in danger, Johnstone adds. If her doctor is concerned about diabetes, “additional regular screenings are good, even after the baby is born.”