Diabetes, Tennessee: The state is home to patients, care and research
John Anderson is shown in this April, 1979 photo wearing the prototype diabetes insulin pump. Photo Courtesy University of Memphis Libraries, Special Collections. Memphis Press-Scimitar archives. Photo by Saul Brown
Spring Hill native General Nathan Bedford Forrest was the real life version of the movie character “Machete.”
He had thirty horses shot out from under him. He killed thirty one men in hand to hand combat. He survived a point-blank shot from one of his men who he then stabbed to death saying “No damn man kills me and lives!” Union General William Sherman said he should be captured or killed “even if it takes ten thousand men and bankrupts the treasury.” He made it through the 1873 Memphis yellow fever epidemic which at the time was the worst the city had seen.
But his death finally came not from a Yankee bullet, sword or cannonball, but from something many Tennesseans of today can relate – diabetes.
In 2009 Tennessee ranked fifth in the nation for adults with diabetes mellitus (pronounced MEL it US) according to America’s Health Rankings. Center for Disease Control statistics show Hardeman County to have the highest rate in the state for people over twenty years old with some 13.1 percent of adults there with type one or two diabetes. Williamson has the lowest rate at 8.8 percent.
And it is a “protean” disease which means it affects almost all systems of the body. A diabetic is more likely to have heart disease, kidney disease and strokes than a member of the rest of the population. Peripheral artery disease can restrict blood flow to the arms and legs, increasing the chances for amputation.
John Anderson of Knoxville knows well of diabetes. The Memphis native was diagnosed in 1970 when he was six and has seen many changes.
“Rather than being scared I thought it was kind of cool that I was going to the hospital,” Anderson remembers. “It wasn’t so cool when I found out I had to take shots. The doctor also asked me what I wanted for breakfast when I was in the hospital. I said ‘Sugar Smacks.’ He said ‘I don’t think so.” The coolness began rapidly disappearing.
In the early 1970’s he says schools were not sure how to deal with diabetic children. “I remember during recess sitting in the classroom by myself drinking a Fresca – which was the only diet drink at the time- because the teachers were worried about me on the playground,” Anderson says.
Schools do much better today in understanding diabetes, but one place in Tennessee was ahead of its time in letting diabetic kids be kids.
Since the late 1950’s Just north of Chattanooga in Soddy Daisy, Tennessee Camp for Diabetic Children (TCDC) has mixed diabetes education with summer fun. The campers get to ride horses, swim, and canoe- in short- what non diabetic children remember from their summer camp experience. Medical personnel are always there and many of the counselors are themselves diabetics who know what to do in an emergency.
Another place helping diabetics live their lives to the fullest is The Church Health Center which was opened in Memphis in 1987 by Dr. Scott Morris, a physician and Methodist minister. The clinic opened to work with physicians to provide free or reduced medical, dental and vision care to the uninsured of the area. In 2001, the CHC opened the Wellness Center to provide education and a gym to keep Memphians healthy. Treating someone for diabetes or heart disease is a good thing. Not treating the same person because he or she does not have diabetes is better. Today for every dollar spent to treat, the CHC spends a dollar on prevention.
PatFriesonworks out at the Church Health Center's Wellness Center. Photo courtesy Church Health Center
Jessica Leu, registered dietician at CHC, says diabetes is an important concern for the center. Unlike most conditions, it is a disease that can often be managed to the point where drugs are not needed. “Our role is to educate patients on self-management of diabetes. We have free community classes and several physicians refer their patient to us. We give them the knowledge and tools for prevention,” she says. “Our whole site is to prevent weight gain and in that way we are there to prevent diabetes in everyone who walks through the door.”
The prevention emphasis is on type II diabetes, which is about ninety percent of diabetics. Type II is usually brought on by a combination of weight gain around the abdomen and genetics. Those with a history of diabetes in the family are at greater risk than those who don’t have that familial history.
“A majority of those who come here to learn self-management are middle aged people coming knowing “I’m not getting any younger.’ Very few of the younger are interested in self-managing their diabetes,” Leu says. “Some have beginning nerve damage in their feet and hands. They ask why they have aches and pains in their feet and that’s a scary thing.”
Leu says as far as type I diabetes, many are familiar with the term “juvenile diabetes” but that is no longer used by the medical community. “We can’t call it that anymore because about twenty five percent of all type II diabetes cases are diagnosed are in children.”
“A common question we get is ‘can I reverse my diabetes?’ And the answer is no. Once you have you have it for life,” Leu says. “With weight loss and exercise and good lifestyle choices you can manage your diabetes. But in the course of time, with a sedentary lifestyle and weight regain your old friend diabetes can come back. Diabetes is a progressive condition. Ones diabetes today won’t be diabetes in 5 years,” she says. “It’s kind of an uphill battle.”
Tennessee has also had a share of research and development. Vanderbilt in Nashville is home to Vanderbilt Diabetes Research and Training Center, constantly working on the disease.
Today many diabetics use the insulin pump. The small device is about the size of an AppleI phonein a case and the computer inside the device delivers insulin as needed. In 1979 an early prototype was tested at William Bowld (now part of Methodist- University) Hospital in Memphis under the direction of Doctors George Burghen, Abbas Kitabchi and Joseph Newton. Large and cumbersome by today’s standards, those tests led to the freedom enjoyed by may diabetics. Anderson, then fifteen, was a participant in the study along with two adults.
The diabetic insulin pump of today has changed drastically since its 1979 study in Memphis. Photo courtesy Adam Inc.
More recently, Extremity Innovations of Bartlett has been working for approval from the Food and Drug Administration to market a system created some forty years ago by a podiatrist in California to give a one-time silicon injection into the foot pads of diabetes patients. Injuries to the feet are very common in diabetics and can lead to amputation. The InnoPad system aims to cut down on those injuries and amputations.
Immediate problems come from either too much or too little glucose in the blood. The brain stores very little glucose, the fuel for our bodies, so early symptoms show in the patient’s mental status. Anderson says he sometimes first notices a fluttery feeling in his chest, then a feeling of being disoriented, hungry tired and weak. “Now it can just sneak up on me,” he says. Often food fixes the problem, but now and then it turns into an emergency.
A few times “as I am coming to, I hear the sound of an engine, ambulance techs talking and calling in a report, then I realize ‘uh oh, I’ve had an emergency!” he says. Paramedics and Emergency Medical Technicians are trained to check blood sugar in patients with an altered level of consciousness. And police are trained to know the combative, disoriented person who may appear and even have the breath of someone intoxicated could be a diabetic having a medical emergency. In most cases of low blood sugar emergency patients intravenously receive sugar the equivalent of an eight ounce Coca Cola mixed with salt water. Shortly after the glucose hits the brain, the patient generally switches from comatose to coherent in a matter of minutes.
EMS representatives from Tennessee’s four largest cities gave a diversity of answers to the question “what percentage of your calls are for diabetic emergencies” possibly due to the way they are calculated. Hamilton County EMS reported three hundred in one year out of 28,000- less than one half of one percent. Captain Mark Wilbanks of the Knoxville Fire Department, says “our 2009-2010 fiscal year we responded to 280 diabetic problem calls. This accounts for five percent of our total call volume for EMS responses. Nationally it is about four percent,” he says referring to a study on the topic. Kim Lawson, public information officer at Nashville Davidson County Fire, looked at 911 calls which came into the call center. She says about 1.3 percent come in as diabetic emergencies but a call may come in as a stroke, alcohol emergency or man down only to later to be discovered it was a diabetic emergency. In Memphis, Gary Ludwig, Deputy Fire Chief in charge of EMS, said from January 13 to October 11 out of 78, 132 EMS runs 1,392 or just fewer than two percent were for diabetic emergencies.
And that wellmay bejust part of the story. Remember the many health issues which often follow diabetics – kidney failure, heart attacks and strokes are all common reasons to call EMS.
The financial costs can be out there, too. The American Association of Kidney Patients estimates in costs $30,000 per year for dialysis.
Frustrating for Leu is seeing how many diabetes complications can be prevented. “ I remember seven years ago,” she says. “I wrote a thesis on the need for community education for diabetics. At that point only about thirty percent were being educated. Now I hear people 10 years after their diagnosis and they are learning things for the first time. It’s frustrating. They could have gotten information earlier. They could have done the right things earlier. They could have gotten their insulin schedule earlier. They could have gotten better medication.”
The old saying goes “eternal vigilance is the price of freedom.” For diabetics that is especially true. When John Anderson was diagnosed, he said some treated him like he had been handed a death sentence. Forty years later he is alive, no heart attacks, no strokes, amputations, no blindness nor is he on dialysis. But that is not due to indifference to his condition. “I’ve known people who have died not taking care of themselves. It’s an unpleasant way to go,” he says.
Lower income people are especially susceptible to lower quality food and a sedentary lifestyle which can lead to diabetes. Parenting issues are especially on Leu’s mind not only as a health care educator but also because in a few weeks she will be having a daughter to go along with her son. “I go to the grocery and I see children fed things their parents eat and the cycle is continuing,” says Leu “I have seen parents turn down requests from their children for fruit and vegetables saying ‘we don’t need that now’ when they have a cart full of Lunchables.”
It is a late fall afternoon in one of Memphis’s parks and several people are taking advantage of the fitness trail looping around about one and one half miles. An exercise station is being used giving exercise and fitness instructions. But this is not one of the better-publicized parks in town like Overton or Shelby Farms. This is Frayser Park, a community recreation area in the inner city. Here, where the diabetes risk factor is high it seems some have gotten the message that research and medicine fights diabetes, but so can a pair of walking shoes.
America’s Health Rankings on Diabeteshere
Church Health Center Wellnesshere
A Canadian study on diabetic calls and EMS found by Mark Wilbanks of the Knoxville Fire Departmenthere