By Aaron Collins

Justin Conner was thirsty, urinating a lot, hungry a lot, tired a lot. His skin seemed drier than normal. He noticed over months, perhaps longer—he couldn’t recall when the symptoms started—that he had been craving sweets, although he had not preferred them much in the past. Because he had no family history of diabetes, he had no context, no ready answer for why he was experiencing such unusual symptoms. And besides, his thoughts were often so fuzzy, and he felt too disoriented to sort it all out. He became somewhat accustomed to feeling not all that well, to feeling light-headed.

Then, one July day after returning to work from a lunch break on his job at a food processing plant, he felt much dizzier than usual, the office began to spin, and he passed out. His coworkers called 911. Fortunately, he was seated at his desk, or a fall from blacking out could have added to his injury.

Conner’s blood glucose had long been soaring out of control, unbeknownst to him. In addition to his hyperglycemia, the explanation for what his body experienced that July day turned out to be a something he had never heard of, but a term that is well known to diabetics and the health care professionals who treat them: Diabetic Ketoacidosis, or DKA. Like nearly 5.7 million other Americans—one in four who have the disease—Conner was an undiagnosed diabetic.

The problem with DKA is that blood sugar gets too high, and the blood becomes too acidic, causing cellular damage. Left unchecked, DKA can lead to coma or death.

The ambulance arrived soon after Conner (whose name is changed to protect his confidentiality) lost consciousness. The acid (ketone) had built up significantly in his bloodstream, which caused his near-fatal close call and led to Conner being diagnosed with type 2 diabetes, in which a person’s cells fail to use insulin properly to transport blood sugar into them for nourishment.

Fortunately Conner’s condition was caught in time.

Once more commonly called adult-onset diabetes, the insulin resistance of type 2 diabetes mellitus afflicts nearly 90% of the 24 million people in the U.S. with diabetes. Type 1 diabetes is far less common, a condition in which the body simply does not produce enough insulin. In addition to Conner’s symptoms, manifestations of hyperglycemia include nausea or vomiting, deep or rapid breathing, and fruity-smelling breath.

According to Dori Louie-Kai, M.S., R.D., C.D.E., program manager with Community Medical Centers’ Diabetes Care Center in Fresno, Conner’s case is all too common. Louie-Kai says the best course is to prevent onset in the first place, well before such emergency treatment becomes necessary. “Most people don’t know the symptoms of diabetes and are in denial that they can prevent diabetes or its complications by changing their lifestyle,” says Louie-Kai. “We must educate the American population that this is a rising epidemic that can be prevented.”

Because onset for type 2 diabetes is gradual, a person may not notice the continual increase in blood glucose over time. Our bodies adjust and we may not feel the change until detectable symptoms of diabetes become evident, so prevention and screening are essential.

Ironically, blood sugar is an essential end product of digestion, typically derived from carbohydrate sources. But the excess glucose experienced by diabetics can quickly turn deadly. That glucose is our fuel source, providing the energy for our body to function. It is stored (as glycogen) in our liver, muscle, and fat tissue—in the liver and muscle as a product that can be converted back into glucose when we skip a meal or are stressed and need fuel, and in our fat tissue so we have adequate stores to break down in case we don’t eat for days.

Louie-Kai says that knowing your diabetes risk is essential to prevention. “This country super sizes everything. Our sedentary lifestyle and fast food restaurants increase our incidence of diabetes. We have many modern conveniences and don’t get regular physical activity,” she says, adding, “People who are overweight, physically inactive, (have a) family history of diabetes, had gestational diabetes during pregnancy, or had a baby weighing nine pounds or greater are at a higher risk factor.” It is not uncommon for someone to have had diabetes for ten years before becoming aware of the condition, often due to these lifestyle factors.

Furthermore, authorities note, symptoms that are evident may be incorrectly explained away. Thirst and hunger are common experiences among non-diabetics and have lots of other explanations. “So do headaches, blurred vision, sexual dysfunction, tingling of the extremities, sores that won’t heal, yeast or bladder infections, and difficulty with concentration,” Louie-Kai points out. Too much or too little caffeine? Advancing age? Adult onset ADD? There are so many ways to dismiss or misdiagnose, if a person notices her diabetes symptoms at all.

Once accurately diagnosed, much of what a diabetic can do to manage the disease is exactly what a healthy person can do to stave off its onset. Here are just a few proactive lifestyle changes you can make—before you must, should diabetes develop:

Consistency with meals and snacks. Eat at a fairly regular time. Do not skip meals and be conscious of the amount you eat with an eye on how much physical activity you plan to undertake.

Daily physical activity. Regular activity and a physical exercise regimen are more important than ever, given how sedentary most of us have become. The more computer and TV hours spent, the less active we are, and that means we are not processing blood glucose efficiently. As that ability decreases, type 2 diabetes can manifest and worsen.

Alcohol intake. As with everything, moderation is the key. Limiting alcohol consumption can stave off the onset of diabetes. But for the diabetic, alcohol is not the best choice to quench thirst. Not only is alcohol a carbohydrate source, mixed drinks are often full of soda, fruit juices, or sweetened mixes. Some diabetes medications cannot be safely taken with alcohol. An alcoholic drink may be taken with a meal on occasion, if planned. However, diabetics should discuss this in advance with their health care provider.

Glucose monitoring. It’s the rare person who is aware of his blood pressure, but even fewer know their blood glucose level. Glucose monitoring offers key information for diabetes prevention. But for diagnosed diabetics, this knowledge is mandatory. Those on diabetes medications or insulin must test glucose levels numerous times throughout the day, typically before and after each meal. Glucose monitoring provides the level at that moment. Unless a person tests frequently they have no idea if their blood glucose is on its way up, down, or is stable. Glucose monitoring allows a person to make the best choices with regards to physical activity and food, and also indicates if or when their health care provider needs to adjust their diabetes medications.

Support groups and walking clubs. The lifestyle shifts for those with diabetes are major, if they are to manage the disease before the myriad related symptoms occur—such as heart, liver, kidney, and eye disease. “For many, the change to healthier habits is unmanageable without the support and camaraderie of others in the same boat,” says Lydia Navarro, who teaches within a program that is sponsored by Visalia’s Kaweah Delta Medical Center Community Outreach Department. Her classes focus on ways to control and live with diabetes. There are groups conducted in both English and Spanish.

The importance of support groups cannot be overestimated, says one participant in attendance at a recent meeting. “If not for this group, I would no longer be living,” she said. The temptation to engage in negative behaviors is too tempting without peer support, she added.

Sick day management plan. While it is important to maintain a positive outlook and plan to remain healthy, it is also necessary to prepare in advance for the illnesses that can result from hyperglycemia. Infections can result from and also be the cause of the hyperglycemia. Diabetics must learn to cope with these and have a plan. Family members, friends, and coworkers can be key to successful management of these health complications in advance of their appearance.

Silent witness. Diabetics should always have some kind of identification on their bodies at all times. An ID bracelet or other wearable emblem (the blue circle on white field is an international symbol of diabetes) will let emergency personnel know and can speak for you should you lose consciousness.

For more information, check out www.diabetes.org, just one among many authoritative sources online. But most importantly, if you have any of the symptoms or have a family history of diabetes, contact your health care provider, or dial 911 if any of the above severe symptoms are evident.

AIDING IN A DIABETIC EMERGENCY

Would you know what to do if someone near you went into a diabetic distress or coma? You should, because millions of people around the world have this disease.

First, remember and recognize the symptoms, because diabetics often become disoriented, irritable, or aggressive and cannot always explain to you what they are experiencing. Look for:

• shallow breathing and rapid pulse,

• cold, sweaty, or pale skin, and

• shaking, staggering, or inarticulate communication.

Second, if you see someone with these symptoms:

• look for the bracelet, pendant, or other indicator that a person has diabetes,

• assess the situation and call for medical help,

• place an unconscious person in the straightened recovery position if she has slumped unconscious in an awkward way,

• monitor pulse and breathing,

• find any diabetes medication that is on the person, or, if he remains conscious at all, ask him if he has medication on hand, and

• if the person is conscious or semi-conscious but too confused to understand what is needed, offer something sweet to eat or drink, because sugar often helps.

If you encounter someone experiencing a diabetic emergency, remembering these steps can save lives.

Infobox: Hypoglycemia:

Hypoglycemia is when blood sugar drops too low, and can be just as problematic as its opposite, hyperglycemia. Symptoms of hypoglycemia include lack of coordination, shakiness or weakness, dizziness, headache, confusion, and double vision. At its worst, hypoglycemia can cause convulsions or loss of consciousness. When in doubt, a trip to the emergency department may be in order.

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