Diabetes is a nationwide health epidemic, and Nevada is not immune to the disease’s impact. According to the American Diabetes Association, nearly 300,000 Nevadans have diabetes, 75,000 of whom are undiagnosed. Recent projections place the number of diabetic Nevadans at more than 600,000 by 2030. This is a sobering number and a reminder that we as medical professionals need to invest time and energy to adequately educate the growing diabetic population.
At Volunteers in Medicine of Southern Nevada, a nonprofit that provides free health care services to uninsured and low-income individuals and families, 17.3 percent of our adult patients are diabetic. VMSN provides patients with all of their medications — including insulin, blood sugar monitors and strips — free of charge, but that is only a small piece of diabetes management. Physicians must formulate an extensive and customized treatment program, but it is ultimately the responsibility of the patients to follow the program and incorporate sweeping lifestyle changes into their daily lives.
At VMSN, we explain the basic science of diabetes and what can happen if complications arise: vision and limb loss, increased risk of heart disease, nerve damage and dental issues. I inform newly diagnosed patients that having diabetes is No. 1 cause of nontraumatic amputations, blindness with diabetic retinopathy and dialysis treatments as a result of kidney damage. It is a tough conversation to have, but patients must understand diabetes’ impact on long-term health.
Most patients struggle with the diagnosis and what it means for their future health. The question of “why me” is often followed by “what should I do?” Informing people that they won’t live a full and productive life without proper care is especially jarring.
To ensure patients take their diagnosis seriously, it’s pivotal to find something that motivates the patient. Family is often the great spark. Many of our patients work multiple jobs to provide for their families and struggle to put food on the table. They cannot afford to become seriously ill and miss work. When you live paycheck to paycheck and don’t have luxuries such as paid vacation, good health is essential to survival.
It’s important to remember that 180-degree lifestyle changes do not happen overnight. Diabetics must invest wholeheartedly in the treatment process.
The multiple doctors’ visits and flood of treatment advice can be overwhelming for any diabetic. In a free nonprofit clinic, one of our great challenges is overcoming patients’ lack of health literacy, which is the ability to comprehend information about the human body in order to make sensible health decisions. According to the U.S. Department of Health and Human Services, only 12 percent of Americans have proficient health literacy, while individuals deemed to have below basic health literacy are more likely to be uninsured and unhealthy. VMSN treated more than 2,600 individuals last year, many of whom lack the health literacy and nutritional knowledge to maintain a diabetes treatment program without significant physician intervention.
Nutrition is key to diabetes maintenance, but is not the same for every patient. Physicians must learn about cultural tendencies and then find options that work for the patient. We tailor each nutritional plan to the person’s cultural background, dietary habits and severity of the diagnosis. Whole grains (brown rice), sweet potatoes, fish and fresh vegetables are examples of diabetic superfoods that can be utilized across a wide spectrum of dietary and cultural preferences. As the International Diabetes Federation recently noted: “Prescribing a diet outside of the cultural norm was persistently associated with participants’ feeling that the diet was difficult to incorporate into the family’s eating patterns or with social interactions.”
Of course, treatment and diabetes management is easier with an early diagnosis. A later diagnosis often means the side effects are already evident, whether it’s the need for limb amputation or deteriorating vision. But if diagnosed early enough, diabetes is not a death sentence. It is, however a health crisis that needs constant care and regulation. The diagnosis is step one in a lifelong battle. From diet and medication to constant monitoring of blood glucose levels, it’s a steep learning curve, especially for those with low health literacy. But with the right treatment plan, and a willingness to tackle the disease head on, diabetics can live a long and happy life.
Dr. Rebecca Edgeworth is the medical director at Volunteers in Medicine of Southern Nevada.