by Joy Lotz Mahoney
(Alpha, DePauw University)
Like many people with diabetes, Janelle Williams Demaree, an alumna of the Gamma Mu chapter at Ball State University, never saw it coming.
Janelle knew she was at a higher risk for diabetes; the disease was prevalent in her family. Her grandmothers, mother and two uncles all had some form of the disease. A petite, athletic 28-year-old, Janelle was doing all she could to stay healthy and delay or prevent type 2 diabetes in her own life.
So, when Janelle received her diagnosis in 2005, even her doctor was surprised. Initially diagnosed with type 2 diabetes, she was later reclassified with type 1 as her pancreas slowly ended its production of insulin. With her diagnoses, Janelle’s life, as it is with all sufferers of diabetes, has changed forever.
The Silent Killer
Like many Americans, young and old, Janelle knew others who had suffered the devastating impact of diabetes. Yet she did not believe it would happen to her. Not at her age. Not with her lifestyle.
Often called the “silent killer,” diabetes is one of the fastest-growing diseases in the United States today. Nearly 26 million people have some form of the disease, and one in four of them is not yet diagnosed. At least 79 million more are at risk for type 2 diabetes, including one in three adults. One in three children born in the year 2000 or later faces a future with diabetes.
Perhaps most staggering is the fact that diabetes annually kills more people in the United States than AIDS and breast cancer combined.
What is Diabetes?
Diabetes is a chronic disease with no cure that develops when the body can no longer make or efficiently use insulin—a hormone necessary to convert the food we eat into the energy we need for daily life.
When a person eats, her food converts in the bloodstream to a form of sugar called glucose. Certain foods, such as carbohydrates, break down into more glucose than others. To process blood glucose, the pancreas releases insulin, which acts like a key to unlock the body’s cells so that glucose can enter. The cells then convert glucose to energy, and that energy is what we use for the activities of everyday life.
In a person with diabetes, the body either does not make or use insulin efficiently. When this happens, glucose levels build up in the bloodstream. When the glucose levels get high enough, they act like a toxin—damaging blood vessels and nerves and leading to complications like heart disease, stroke, kidney disease, blindness and amputations. Diabetes also can be related to other problems, including Alzheimer’s disease, depression and erectile dysfunction.
Know the Types
There are at least five types of diabetes, and each one is different. The most common forms of the disease are type 1, type 2 and gestational diabetes.
In type 1 diabetes, the pancreas stops producing insulin altogether—a condition that can quickly be fatal. Formerly known as juvenile diabetes, Type 1 diabetes is an autoimmune disorder that develops suddenly in children and adolescents, but it can also develop in adults. The causes of type 1 are nebulous, but genetics and environment both play a role. Type 1 diabetes affects approximately 5 percent of all people in the United States with diabetes. It cannot be prevented, and those who have it require artificial insulin to survive.
Type 2 diabetes—by far the most prevalent—affects approximately 95 percent of people with diabetes. In this form of the disease, the pancreas either does not produce enough insulin or the body’s cells do not use insulin efficiently. As a result, blood glucose levels can build up slowly and silently. Often, people with type 2 do not know they have the disease until they develop complications due to glucose levels that remain elevated over time.
Type 2 diabetes is sometimes preventable because it often develops due to lifestyle factors, such as being overweight and under-active. But not all people who are overweight will develop type 2 diabetes; as with all forms of diabetes, genetics plays an important role. Other risk factors include family history of type 2 diabetes; high blood pressure; having a baby weighing more than nine pounds at birth; and being African American, Latino, Native American, Asian American or a Pacific Islander. Being over the age of 45 is also a risk factor for type 2 diabetes, although this form of the disease is becoming increasingly common in children and adolescents. As a result, the term “adult-onset diabetes” has become virtually obsolete.
Approximately 79 million Americans have prediabetes, a condition that develops before type 2 in which blood glucose levels are high but have not yet crossed the diabetes threshold. People with prediabetes can often prevent or delay the onset of type 2 with lifestyle changes, such as diet and exercise, along with regular monitoring of blood glucose levels. Studies show that people with prediabetes who lose 5 percent to 10 percent of their body weight can reduce their risk for type 2 diabetes by more than 50 percent.
A third type of diabetes is gestational diabetes, which involves elevated blood glucose levels during pregnancy. A woman with gestational diabetes did not have diabetes before pregnancy and may not have it after. She must be monitored closely to preserve both her health and that of her developing baby. While the cause is not fully understood, a woman can develop gestational diabetes if her body cannot make and use all the insulin she needs for pregnancy. After pregnancy, gestational diabetes disappears but places a woman at greater risk for type 2 later in life. About 4 percent of all pregnant women develop gestational diabetes in the United States.
Additional types of diabetes include latent autoimmune diabetes in adults (LADA)—sometimes called type 1.5—and maturity-onset diabetes in the young (MODY). In LADA, the pancreas stops producing insulin over time, which can sometimes lead to an inaccurate diagnosis of type 2 early in the disease. In people with MODY, a form of type 2 diabetes develops because of a defect in a single gene. MODY is often misdiagnosed as types 1 or 2 and accounts for 1 percent to 5 percent of all diabetes cases. As with other types of diabetes, both LADA and MODY require careful management of blood glucose levels.
In any form, diabetes is a disease with serious complications and can double a person’s risk for death. But with proper management, people with diabetes can live long, productive, fulfilling lives.
Even though she knew she was at risk for diabetes, Janelle’s symptoms caught her by surprise. She had a diligent fitness routine, working out five days a week, and she was still young.
“I never thought it would happen to me; diabetes was not on my radar,” she says.
Yet Janelle had begun drinking excessive amounts of water to quench a persistent thirst—three or four bottles of water every night, which she attributed to her vigorous exercise schedule. She was going to the bathroom frequently, and she found herself eating a lot, gaining weight, and developing blurry vision. In addition, she had developed swelling in her legs, a condition that took a few doctor’s appointments to diagnose.
A blood test revealed that Janelle had a non-fasting blood glucose level of 288 milligrams per deciliter–a high number for anyone with or without diabetes.
“Diabetes never once occurred to me until I got the phone call saying my blood glucose was 288,” Janelle says.
To confirm the results, her doctor administered a fasting blood glucose test.
“The day before I did my fasting test, I went online and started reading all the symptoms, which I should have known, given how prevalent it was in my family,” Janelle says. “I suddenly realized that I had several symptoms that I didn’t know.”
Janelle’s research and her mother’s counsel prepared her for her doctor’s diagnosis of diabetes.
“I was scared. I cried a lot in the beginning,” she says. “It’s a life sentence. There’s not a cure for it.”
But Janelle had a good support system, including a strong network of Alpha Chi Omega friends, and she was willing to adapt to the changes the disease would require. She began watching her intake of carbohydrates and sugar; using medication; and, later, insulin to manage her blood glucose levels.
Not everyone who develops diabetes experiences symptoms. In people with type 1 diabetes, symptoms can be swift and profound. It is important to know the symptoms of diabetes and seek treatment right away if there is a concern.
Adapting to Life with Diabetes
Life with diabetes can be overwhelming because the disease demands constant attention from those who have it.
In addition to bearing multiple finger pricks a day to test one’s blood, a person with diabetes must learn to use a blood glucose meter and insulin or other medication. She must learn to count carbohydrates in everything she eats and plan accordingly to manage spikes or dips in blood glucose levels. Stress and illness can make blood glucose levels swing out of control, and sleep can pose a risk because blood glucose levels can drop dangerously low. Often, people with diabetes must awaken to test their blood glucose in the middle of the night and, if levels are too low, consume a fast-acting carbohydrate, such as orange juice, to boost their levels to a safe range. In short, diabetes is a 24/7 disease.
“A lot of people think it can’t happen to them,” Janelle says. “Maybe they don’t realize how big a deal diabetes is. Your whole lifestyle changes.”
For many people with diabetes, social gatherings can be challenging since it may be difficult to determine the carbohydrate content in food. When Janelle meets with family, friends and colleagues, her diabetes is always part of the meal.
“People make things special for me—low carb, sugar free,” she says. “Quantity is a huge factor. It’s not like I can never have chocolate again, but not a whole piece of cake. My portion sizes have changed.”
Management Is Key
Before Janelle married in 2006, she had a year to establish her diabetes management routine. After marriage, it wasn’t long before she and her husband, Craig, happily found themselves expecting their first child. Janelle began seeing an endocrinologist who specialized in pregnancy in order to more closely manage her diabetes.
Her insulin requirements dramatically escalated during the middle of her second trimester. Soon after, Janelle went into premature labor, a high-risk situation for both her and her baby. She was admitted to the hospital at 32 weeks, where tests revealed she also had developed preeclampsia and HELLP syndrome. Her medical team tried to calm her contractions, but the baby was ready to come. After a breathtaking delivery, Janelle and Craig met their baby boy, Parker, for the first time. Then, in a tragic turn of events, they learned that Parker had likely been born with a metabolic disease. Within a short time after his birth, their precious son Parker passed away.
Just beginning to heal from the heartbreak of losing Parker, Janelle and Craig soon discovered they were expecting again. This time, they welcomed a healthy second son, Grant, who was proactively treated for a metabolic disease upon birth. Their heartbreak from Parker’s death helped them prepare for Grant’s safe delivery. Today, Grant is a thriving 2-year-old.
Janelle’s diabetes may have played a role in Parker’s passing, although her medical team does not know for sure. But thanks to experience, her own diabetes management and the vigilance of her medical team, Janelle and Craig welcomed their third child in July—a baby sister for Grant.
Today, Janelle and her family face a hopeful future and the opportunity for a long and healthy life together.
Hope in Heartbreak
A diagnosis of diabetes or prediabetes can be difficult news, but hope lies in knowing your numbers and managing your risk for complications or, when applicable, type 2 diabetes.
If you have diabetes, it is important to work closely with your medical team to develop a personalized plan for diet; exercise; and, if necessary, insulin or other medication. A healthy diet and regular exercise can go a long way toward managing blood glucose levels in people with diabetes, as well as those specifically at risk for type 2. Today, a simple blood test known as the A1C can confirm whether you have diabetes or are at risk for type 2.
After Grant’s birth, Janelle says she was tired of checking her glucose levels, of dealing with diabetes; she had burned out. Exhausted, she spent a few months simply not checking her blood glucose—and she was honest with her endocrinologist.
“She understood completely, and she urged me to start checking,” Janelle says of her doctor. “She was very gentle, but she reminded me of the importance of my health for my family and my son. I needed to hear someone else tell me that outside of my family and friends.”
From her personal experience, Janelle, now 34, offers hope to others weary of the toll of diabetes in their own lives.
“Don’t ever stop checking your blood glucose,” Janelle says. “Go back through diabetes education; do it every couple of years. What we’re learning about diabetes changes quickly. Be open and honest with your physician. If you’re overwhelmed or tired, let your physician know that. Talk about it. A lot of people deal with it on their own. Diabetes does get tiring; it’s your life.”
Today, Janelle supports two organizations that have helped her along her journey with diabetes. A former employee of March of Dimes, she and Craig have walked and raised funds to support the organization’s research for premature birth and infant mortality. And through her work as an executive assistant at St. Vincent Hospital of Indianapolis, Janelle helped lead the American Diabetes Association’s Red Strider movement last year for its Step Out: Walk to Stop Diabetes™ in Indianapolis.
Join the Movement
Diabetes is one of the most serious medical threats to our future today, but by working together as sisters, as families, as cities and communities, we can change the future of this disease. Start by talking with your doctor about diabetes. Then, join the movement to Stop Diabetes by sharing your story at stopdiabetes.com, or act by visiting diabetes.org/stepout to get involved in your local Step Out: Walk to Stop Diabetes.
Together, we can take steps to stop diabetes once and for all.
To learn more about, volunteer with and/or give to the American Diabetes Association’s research, education and advocacy, visit diabetes.org.