CommunityHealth tackles diabetes epidemic with medicine, education

For Paulino Carmona, the wake-up call came in 1986 when pieces of his teeth started breaking off.

The 58-year-old Chicago resident knew he had diabetes, and his dental problems were only one of the signs that his condition had spiraled out of control. Since then, Carmona has regained control of his disease, with a little help from CommunityHealth. The non-profit health center serves all of Chicago, but draws many of its clients from the Humboldt Park area, a community experiencing diabetes rates of epidemic proportions.

The predominantly Latino neighborhood has a diabetes mortality rate more than twice that of the rest of Chicago, and nearly three times that of the United States. The overall U.S. diabetes mortality rate is 25 deaths per 100,000 people. In Chicago the rate is higher: 31 per 100,000. But in Humboldt Park, it stands at 68 deaths per 100,000 people.

CommunityHealth, is located on the south end of the Humboldt Park neighborhood and provides free health care to approximately 6,300 uninsured patients annually. Although CommunityHealth, which opened in 1993, offers 21 specialty services, diabetes is one of the most common conditions it treats.

All diabetes is not created equal, however. There are two kinds of diabetes. One of those—type 1—is often genetic and only affects 5 percent of diabetics. The other 95 percent have type 2, which is what doctors at CommunityHealth most frequently encounter.

When patients are diagnosed with type 2 diabetes, it means that their pancreas is not producing enough of the hormone insulin, or else that their cells aren’t processing the insulin properly. In type 1, the pancreas makes no insulin whatsoever.

Insulin is responsible for taking sugars out of the blood, breaking them down into glucose and transporting the glucose to the body’s cells to use for energy. A type 2 diabetic doesn’t have enough insulin to remove sugar from the blood and thus has insufficient glucose going into cells.

Diabetics take medication and are required to monitor their blood sugar level several times a day. Sometimes, but not always, they also have to self-administer insulin shots.

Health costs for diabetics are three times that of non-diabetics, according to Dr. Bruce Blacker, who has been volunteering at CommunityHealth for four years and also practices at St. Joseph Hospital.

Early type 2 diabetes is an often-silent disease, says Blacker. For every diabetic patient the health center treats, he estimates that there are many more entirely unaware that they may have pre-diabetes.

“A lot of people have no idea [they have diabetes],” Blacker said. “The classic symptoms are peeing too much, they’re very thirsty, they’re losing weight. It’s very common to see that presentation.”

Although the causes of type 2 diabetes aren’t all known, weight, lifestyle and genetics all play a role, Blacker said. But besides the loss of energy associated with the disease, diabetes brings with it a host of other health complications.

“The key thing is the relationship of diabetes to all these other problems,” Blacker said. Diabetes can cause high blood pressure, gout, high cholesterol and polycystic ovary disease, to name a few. It is the leading cause of blindness, can lead to dental problems, such as Carmona’s, and can result in such poor circulation that limbs have to be amputated.

The statistics paint a dire picture of diabetes in Humboldt Park, and for as long as CommunityHealth has been around the disease has been a problem. “We’ve always seen a huge proportion of patients [with diabetes],” Blacker said.

The center’s outreach and education programs have grown remarkably in the past year. Only 18 months ago, CommunityHealth offered infrequent diabetes classes, held only in Spanish. Today, there are diabetes education classes, nutrition classes and exercise classes, among others, all conducted in English, Spanish and Polish.

The diabetes education classes run in four weekly sessions and cover everything from “diabetes 101” to nutrition, stress relief and exercise, according to Anna Blankenberger, CommunityHealth’s health education coordinator.

“Diabetes is a disease that can be controlled,” she said. “That’s one thing we really try to emphasize with our patients: it’s something you can take control over if you make some lifestyle changes.”

The classes also focus on empowerment and encouraging patients to understand their medications and their disease.

“[These classes are] not supplemental, but are an integral part in their health care,” Blankenberger said. To encourage patients to come, those who attend every class are given a free glucometer and a six-month supply of testing strips, and Blankenberger is working on offering other incentives. “Of course, not everyone has the time to come to an additional health education class. But for our diabetic patients, it’s essential.”

Carmona is a living testament to the efficacy of the classes. Two months ago, after 24 years of living with diabetes, he was told that his blood sugar levels were too high and he might have to go on insulin.

Spurred into action, he went through CommunityHealth’s diabetes classes and got his blood sugar back under control. “They told me about the tortillas,” he said. “Now I only eat one a day. Before I ate three or four for lunch, and four or five for dinner.” Carmona now monitors his diet and his carbohydrate intake—which is affected by carb-rich tortillas—knowing that a meal high in carbohydrates will immediately raise his blood sugar.

“I’m happy that I’ve found persons who take care of me.”