Facing a higher threat of diabetes,
many Latinos are fighting a
silent battle

By Cristina García
Adelante staff writer

The lights are low; a multicolored strobe throws colors over the floor. Couples dance the bachata, cumbia, and salsa. The beat reverberates through the room. It is in his body; it courses through his fingers, and explodes through a guitar into Latin rhythms. It came from his Caribbean heritage and was refined through universities in North Carolina and New York. It is raw talent; it is passion.
For the dancers on the floor, there are no outward signs that in his body lurks what has, in the United States, become a silent killer.

Not without warning
“I could drink tomato juices — six of them — and the thirst would be there. It was terrible: water, water, water,” said Alfredo Jiménez, 48, a native Salvadoran and leader of the band Del Alma.

EMILY SCHWARZE/Adelante Alfredo Jiménez performs with Del Alma on April 4 at La Casa Grande. Del Alma performs at the restaurant off Clark Lane most Sunday nights. The rigorous care and expensive treatments required by his condition have been a setback, but his music is still going strong.

Jiménez did not yet realize that he had joined the ranks of some 5.2 million people in the United States who are living with the disease but have yet to be diagnosed. For Latinos, the threat of diabetes is 50 percent greater than it is for whites of a similar age.
What brought the disease out into the open a few months ago was a bout with diabetic ketoacidosis, an acute life-threatening medical condition: His body was burning up fat and muscle for energy.
Jiménez was urinating away all his calories, so he did not have enough insulin to use food.
“I was exhausted,” Jiménez said. “I felt like death was coming to me, but I had no idea what it was.” A close friend took Jiménez to the hospital. He was immediately placed on intravenous insulin.
“I was accepting death: That is how serious it was,” Jiménez said. Doctors told him he could have gone into a diabetic coma. When he was admitted to the hospital, his blood-sugar level was 570 — high, but not unusual for a newly diagnosed diabetic. Jiménez now tries to keep it between 80 and 90.
Jiménez experienced other warning signs. He had bruises that just would not heal, periods of blurred vision and excessive weight loss. He was urinating frequently. He also has diabetes in his family.
“I remember my father deteriorating,” Jiménez said. “I didn’t want to know I had diabetes; I didn’t want to know I had something my father had.” This denial very nearly cost Jiménez his life.

More info Click here to learn more about recognizing and treating diabetes www.adelanteonline.com

What’s in a name?
The pancreas produces insulin, which is necessary for the body to use food. For the 13 million people in the United States diagnosed as diabetics, however, there is either little or no production of insulin, or insulin does not have an effect at the cellular level. Delbert Howard, a clinical nurse specialist and diabetes educator at Columbia’s Cosmopolitan International Diabetes Center who helps manage Jiménez’s diabetes, compares insulin to a key. For Type 2 diabetes, the key — or insulin — is present, but it will not fit into the receptor sites on the body’s cells. For Type 1 diabetics like Jiménez, there is either no key or only a partial key.
“All your body’s cells have receptor sites on them for insulin to attach,” Howard said. Insulin has to attach to the receptor site in order to facilitate the movement of glucose, or sugar, from the blood stream into the body’s cells, where it can be used for energy or stored up as fat.

Alfredo JimÉnez “Diabetes is not cancer: I’m aware of that, but if you don’t do things right, you will die.” Alfredo JimÉnez leader of the band Del Alma and a diabetic www.adelanteonline.com

Type 1 diabetes, previously called juvenile diabetes, accounts for only 5 to 10 percent of all diagnosed cases. Genetics and environmental factors are at play in this form. Type 1 usually affects children and young adults — although, as in Jiménez’s case, the disease can strike at any age.
In appearance, Type 2 diabetes looks very similar to Type 1; however, the risk factors are different and prevention is possible. Type 2 is associated with older age, obesity, family history of diabetes, physical inactivity, and race/ethnicity.
What puts some ethnic groups at a higher risk is not known for certain. Elena Rios, CEO of the National Hispanic Medical Association, speaks of a genetic predisposition to the disease that may have its root in the native population of the Americas. Dolores Arce-Kaptain, director of Alianzas, an outreach and extension program though University of Missouri-Kansas City, reminds Latinos to watch out for certain important risk factors. The Latin American culture has a fairly healthy cuisine, she says. That tends to change, however, when immigrants make their lives in the United States.
“At home they ate fresh fruits and vegetables and walked a lot. They come here and become sedentary,” Arce-Kaptain said. “Their diet really starts to change.”
Rios says the first generations of Latin American immigrants to the United States are usually healthier.
“They have healthier habits,” Rios said. “They are used to eating food cooked themselves; it’s less processed.” It is when the sedentary lifestyle sets in and the diet changes that the predisposition seems to kick in. Low-income Latinos also have a greater chance for developing diabetes. Rios says it is harder for those with limited income to make choices at the grocery store that foster good health.
“They usually buy white bread instead of wheat bread, white rice instead of brown; all those simple carbohydrates add up,” Rios said.
Beyond the higher risk factors, aspects of Latino culture may work against conventional medicine.

Alfredo JimÉnez “The doctors are there to coach me with this disease. They’ll tell me what to do, and then I’m on my own; ultimately, it’s up to me.” Alfredo JimÉnez leader of the band Del Alma and a diabetic www.adelanteonline.com

“There’s a feeling among Hispanics that you don’t go to the doctor unless you’re really sick, like on your death bed,” Rios said. She explained a religious aspect as well. Latinos, especially Catholics, can have a fatalistic attitude.
“It’s like if you have cancer, it’s God’s will, that’s your fate, your destiny, and you don’t need to go to a doctor to die,” Rios said.
Even for those who are ready to seek care, it’s often difficult to find a way to pay for it. According to the Commonwealth Fund, as many as 80 percent of low-income Hispanics were uninsured at some point from 1996-1999, even though they were more likely than other groups to have stable employment.
Access to health care can decrease the risk of diabetes. Health-care professionals are often able to help patients make changes — to diet and exercise, for example — that can prevent or slow down the onset of diabetes. And for those who have been diagnosed with the disease, health care is critical; without it, the risk of life-threatening complications increases. Blindness and loss of limbs are two of the many complications that are more likely to occur if cases are not managed.

A new way of life
“A lot of people with diabetes have to go through some sort of grieving process.” Howard said. “You’re going to have to give up some things in order to have a better life in the future.”
Jiménez is still dealing with the logistics of his diabetes. He must deal with mounting medical bills. He also needs to learn to juggle his treatment plan with his personal life, a new baby, a new job and his ongoing work as a musician.
“When I found out, I cried for three days in a row,” Jiménez said. “I couldn’t believe I had it.”

Items that diabetics may carry in a portable treatment kit, from left to right: a bottle of insulin, a lancet to stick a finger for blood, a glucose meter to test the level of insulin in the blood and a syringe for injecting insulin.

Now he has had time to reflect. A new daughter, Valentina, has also forced him to slow down and take life more seriously. Things with the band have changed. They are not playing as many gigs and are taking on less stressful jobs like DJing. He wants things to be like they were before, but he realizes he needs time to organize.
“Diabetes is not cancer: I’m aware of that,” Jiménez said. “But if you don’t do things right, you will die.”
He used to be able to stay up late, sit for hours at all-night diners ordering freely from the menu. He used to be able to sleep in late, walk barefoot. Now there is a schedule, a routine. Around 9 a.m., he needs to have showered. Cleanliness for diabetics is very important, as they are more susceptible to infection, which can lead to amputation. He needs to eat breakfast, but it cannot be just anything. He also needs to check his blood sugar and inject himself with insulin three times a day.
“Sometimes I get a little embarrassed when I have to tell my friends, ‘Before we can go to lunch, I have to do this,’” Jiménez said, pointing to his kit containing his insulin and supplies to check blood sugar levels.
According to Howard, routines vary for each diabetic and might change multiple times during one’s life.
“People revert back. They do a whole lot of things at first, then after awhile, they slack off,” Howard said. “It’s a waxing and waning situation sometimes.”
Change may come at a cost. Without insurance, Jiménez does not have the resources to pay for the medical bills and costly supplies. He credits the Centro Latino with getting him through the crisis, but he doesn’t know how he’s going to manage in the long run.
“I’m getting bills that add up to $12,000,” Jiménez said. “I just don’t have the money.”

Preventing complications
Jiménez has not yet experienced any complications relating to his diabetes, but for the Chávez family, the threat is all too familiar.
Frederick Chávez was a family man — he was one of seven children and had seven children of his own. He had a work ethic his son Randy is proud of, and hopes to pass on to his children. Ten years before Frederick Chávez died, he was diagnosed with Type 2 diabetes. Chávez says his father took oral medications and made attempts to keep his diabetes under control, but eventually kidney failure forced him to start dialysis.
“My dad was a large man. When he retired, he started to put a little excess weight on,” Chávez said. “That is when he found out he had elevated blood sugars.”
Kidney damage is just one of the complications that diabetes can bring on.

LAURA ELIZABETH POHL/Adelante Delbert Howard, nurse clinician at the Cosmopolitan International Diabetes and Endocrinology Center, 1 Hospital Drive, teaches diabetes basics to newly diagnosed patients. The center offers two diabetes education sessions each week, from 1 p.m. to 4 p.m. Mondays and 2 p.m. to 5 p.m. Wednesdays.

Heart disease is the leading cause of diabetes-related death. Adults with diabetes have heart disease death rates up to four times higher than adults without diabetes, according to the Centers for Disease Control and Prevention. High blood pressure, dental disease, and nervous system disease — which can lead to amputations of the legs and feet — are also more prevalent in adults with diabetes. Diabetes is the leading cause of new cases of blindness in adults aged 20 to 74. Poorly controlled diabetes before conception and during the first trimester can cause major birth defects.
For the Latino population, rates of diabetes-related complications are higher.
When his father started to question some of the possible side effects for the medications he was taking, Randy Chávez started to go with him to his appointments. His father did not feel comfortable discussing certain things with his doctors, he recalls.
“He was this big Mexican man; he worked hard all of his life and didn’t want anybody to think that he could ever be hurt,” Chávez said.
According to the American Diabetes Association, patient education is critical.
“Developing a trusting relationship with your care providers is crucial,” Howard said.
At Cosmopolitan International Diabetes Center, a class called “Managing Your Diabetes” is considered an important part of the diabetes treatment plan. Jiménez went though the class after he was diagnosed and agrees with Howard.
“The doctors are there to coach me with this disease,” Jiménez said. “They’ll tell me what to do, and then I’m on my own; ultimately, it’s up to me.”
Patients first meet one-on-one with the nurse educator and dietitian. Research is ongoing, but continuing education remains the best way to deal with diabetes.
Jiménez worries about the future for Valentina, since he knows the disease can be inherited. But he’s hopeful that things will be different for her.
“I probably won’t be alive, but I can see the future,” Jiménez said. “One day they will be able to reverse diabetes.”

Diabetes facts

Risk factors for Type 2

• Obesity
• Family history of diabetes
• Physical inactivity
• Impaired sugar metabolism
• Race/ethnicity
• Older age

Symptoms
Some or none of the following symptoms may appear — each case is unique. If you suspect you may have diabetes, you should seek testing.

• Frequent urination
• Excessive thirst
• Unexplained weight loss
• Extreme hunger
• Sudden vision changes
• Tingling or numbness in hands or feet
• Feeling very tired much of the time
• Very dry skin
• Sores that are slow to heal
• More infections than usual

Source: Centers for Disease Control and Prevention

For more information
American Diabetes Association: www.diabetes.org *
Centers for Disease Control: www.cdc.gov/diabetes
1-877-CDC-DIAB
Take Diabetes to Heart: www.takediabetestoheart.com
1-800-307-7113*
Call or go on-line to receive a free Spanish cookbook containing diabetes-friendly recipes.
NDEP — Federally funded program, leading source of care and prevention information: www.ndep.nih.gov; 1-800-438-5383*
Call or go online to receive a free copy of Movimiento, a CD with Latin rhythms that promotes exercise.

*available in both Spanish and English

Where to go for testing
COLUMBIA
Family Health Center
The Resource Center
1500 Vandiver Drive, Suite 110
Columbia, MO 65202
(573) 214-2314
8 a.m. – 5 p.m. Monday through Friday
5:30 p.m. – 7:30 p.m. Monday and Thursday
Centro Latino
Parkade Center
601 Business Loop 70 W. Suite 208
Columbia, MO, 65203
(573) 449-9442

JEFFERSON CITY
Capital Region Diabetes Management Center
1432 Southwest Blvd.
Jefferson City, MO 65109
(573) 632-5090
8 a.m. to 9 a.m. second and fourth Friday of the month
Eight-hour fast recommended

SEDALIA/MARSHALL
Pettis County Health Center
911 East 16th St.
Sedalia, MO 65301
(660) 827-1130
8:30 a.m. – 4:30 p.m. Monday through Friday

— Cristina García