Know Your Enemy

By Christina E. Rodriguez

Photo: Jillian Sipkins

Alberto Morales was a healthy 24-year-old in 1978. He had nothing to worry about, until one day he developed a rash on his back.

He went to the doctor, who couldn’t determine what was wrong. Several blood tests later, Morales found he had type 2 diabetes, that he had become insulin-resistant (a condition linked to the rash) and that, in order to live with this disease, he needed to change his lifestyle.

They told me I had to go to classes to find out about the food I could eat. Basically, when it came down to it, they told me to stay away from sugar,” explained Morales, now 55. “But everything we eat turns into sugar later on anyway, so you can’t fight it. All you can do is [watch] how much you eat and what you eat.”

After experimenting with different medications, the Chicago resident is now taking three pills — two to control his blood glucose levels and one for his cholesterol.

pillsinside1“They’ve tried different types of medication because sometimes it’s too strong and I break out in something else, so they have to lower it. That’s all I’ve been on, pills,” he said. “Whether I take them all the time, that’s a different story.”

Type 2 diabetes is associated with aging and is easier to expect as people get older, says Dr. Enrique Caballero, an endocrinologist at Joslin Diabetes Center, a research, care and education institution affiliated with Harvard Medical School. However, this disease transcends age. According to the National Diabetes Education Program, 10.4 percent of Latinos ages 20 or older have been diagnosed with diabetes.

“It’s a shock when you’re in your 30s and 40s. It’s difficult to accept at any age,” he said. “Many people have it but don’t know it.” According to the Joslin Diabetes Center, 10 percent of all Latinos have type 2 diabetes, yet one-third of them have gone undiagnosed. Sometimes it takes five to 10 years to see symptoms of the disease.

The American Diabetes Association defines diabetes as a “disease in which the body does not produce or properly use insulin.”

Dr. Caballero explains the function of sugar and insulin in the body as a lock-and-key relationship. In the human body, cells need sugar to survive and work properly. Insulin, a hormone produced by the pancreas, plays the role of the key that the sugar needs to open the lock and enter the cells.

Insulin allows our bodies to use that sugar properly, giving us energy. When the insulin is no longer produced (as in type 1 diabetes, also known as insulin-dependent diabetes mellitus) or does not work properly within our cells (as in type 2), sugar collects in the body and is released through our urine. Because of this the kidneys are strained, which may lead to a decrease in kidney function and end-stage renal disease, according to, a Web site aimed at diabetics. This can end up being life-threatening with the only treatment options being regular dialysis or a kidney transplant.

People with type 2 diabetes do not produce enough insulin or are insulin-resistant, meaning that insulin does bind to the cells, but is not used properly to convert sugar, starches and other food into energy.

According to, type 2 diabetes has a strong hereditary component.

Morales is one of nine children, seven of whom are diabetic, as were his parents. His mother – like one of his brothers – lost her eyesight and ended up going on dialysis.

“She [took] medication for years,” Morales said. “Eventually, it just took her. ”

Extensive clinical research has found that type 2 diabetes affects Latinos, African-Americans and Native Americans more than it does non-Hispanic whites, according to the Agency for Healthcare Research and Quality.

Latinos are particularly at risk because they tend to eat a diet high on carbohydrates and fats and do minimal amounts of exercise. According to the Centers for Disease Control and Prevention, only 45 percent of Latino adults engage in at least some leisure-time physical activity, compared to 49.3 percent of blacks and 65.7 percent of whites.

Dr. Caballero blamed those tendencies on “a combination of genetics and lifestyle factors.”

There are many consequences to not taking diabetes seriously. For example, cardiovascular disease is the No. 1 cause of death among diabetics. Other diabetes complications can include blindness and amputations.

Morales is losing his sight rapidly because of the complications that came with not taking his medication. He has glaucoma in both eyes, which forced him to leave his job as a production manager in October 2008.

“Right now, I can’t see anyone unless they’re really up close. I never thought that would happen,” he said thoughtfully. “They told me that I had to take care of myself and that the first thing to go would be my feet. And you don’t think about it, they tell you about it but it doesn’t sink in until something really happens, and for me it wasn’t my feet, it was my eyes.”

But, as Dr. Caballero points out, “This doesn’t need to happen if you take care of your blood sugar.”

Checking your blood sugar before meals is important to know how insulin is reacting within the body. Type 2 diabetics usually are put on prescription insulin pills that need to be taken daily. These controls blood glucose levels by allowing sugar to enter the cells as it would normally do. If medication is not taken as prescribed, blood sugar levels go up (a condition called hyperglycemia) and can affect all other organs, causing long-term complications.

Diabetics who take their illness seriously and learn to live with the disease can live healthy lives. “Diabetes is a disease that can be controlled, as opposed to other diseases where there is little to do. It requires will power to change your lifestyle, but it is worthwhile,” Dr. Caballero said. “It’s a great investment because the quality of life will be better. Diabetes is not a limit anymore.”

Step 1: Learn About Diabetes
Diabetes means that your blood glucose (blood sugar) is too high. Educate yourself about the two main types of diabetes.

Step 2: Know Your ABCs
Talk to your health care team about how to manage your ABCs: A1C (blood glucose or sugar), blood pressure and cholesterol. This will help lower your chances of having a heart attack, stroke, blindness or other diabetes-related problems.

Step 3: Manage Your Diabetes

Many people avoid the long-term problems of diabetes by taking care of themselves. Work with your health care team to reach your ABC goals.

Step 4: Get Routine Care
See your health care team at least twice a year to find and treat any problems early. Ask what steps you can take to reach your goals.
Source: National Diabetes Education Program (

Preventive measures can be taken even if you are not diabetic:
The American Diabetes Association says the two main factors that help prevent and manage diabetes are diet and exercise.
Baking or broiling is better than frying, and eating vegetables is healthier than cookies or candy. Cutting down on processed sugars is another healthy plus.
A minimum of 30 minutes of exercise a day can do a lot of good for people with or without diabetes. Cleaning your house or doing yard work – whatever will speed up your heart rate – are great examples of physical activity.

First published by Cafe Media.

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