Live well with diabetes

WARREN — Diabetes used to be a Southern thing. The Centers for Disease Control and Prevention shows that the “diabetes belt” is working its way north and is climbing up the eastern border counties of Ohio.

Lifestyle is the biggest contributing factor, local doctors say.

“We don’t walk. We eat fast food. We use machines for everything. (Processed food is) cheap, it’s easy, we eat more,” Dr. Kruti Shah, Steward Medical Group endocrinologist, said. “All we do is watch TV and look at our phones.”

Dr. Raj Seetharaman, an eye surgeon from Bazetta, said, “We need to cook at home and know what we put in it.”

Shah and Seetharaman were two of the speakers at the first Trumbull Regional Medical Center “Living Well with Diabetes” free seminar last month at Leo’s Ristorante in Howland. More than 160 people attended, about three times what the hospital initially anticipated. The plan is to offer quarterly seminars.

“I was surprised by the level of interest in the public,” Seetharaman said. “Step 1, if they’re interested, they can fix the problem.”

Ron Bierman, president of Trumbull Regional Medical Center, said, “People in Trumbull County have significantly higher rates of diabetes and pre-diabetes than the state average. It’s one of the diseases that’s so prevalent and can lead to many other things. We thought maybe we can do something with education.”

“We have a lot of diabetics out there,” Linda Tominey, Trumbull Regional diabetes coordinator and nurse educator, said. “We need to start taking better care of our community.”


About 12 percent of Trumbull County residents are diabetic, well above the national average of 8 percent and the state average of 10 percent, Tominey said.

The CDC considers states with a 9.5 percent and higher rate as being in the diabetes belt. Traditionally, that was southeastern states — Mississippi, Louisiana, Alabama, Arkansas, Georgia, Tennessee, Kentucky and West Virginia — largely because of diet.

Gestational diabetes — diabetes that happens in pregnancy — used to occur in 2 percent of pregnancies. Now the national average is 8 percent, Tominey said.

Diabetes is the sixth-leading cause of death in the United States, Bierman said. Diabetics are twice as likely to have heart disease or a stroke. Diabetes is the leading cause of kidney failure, lower limb amputations and adult onset blindness.

At one point, a review of the statistics of heart patients at Trumbull Regional discovered that 80 percent of them also had diabetes, Tominey said.

“There is not a single system it does not affect,” Tominey said.

“Belly fat is important,” she said. “A waistline of more than 40 inches for men and more than 35 inches for women puts too much stress on the system regardless of genetics and puts them at risk of Type 2 diabetes, stroke and heart disease, among other problems.”

There are no symptoms of pre-diabetes. By the time you have symptoms, you have it, he said.


“Diabetes can exacerbate all other problems,” Shah said.

Diabetes is a disease in which levels of blood glucose, or blood sugar — which comes from foods — are too high. Too much sugar in the blood for long periods can damage the vessels that supply blood to vital organs.

The body produces natural insulin, a hormone secreted by the pancreas. Insulin helps turn blood sugar into energy, and helps store glucose in muscles, fat cells and the liver to be used later when needed. When the body does not make enough insulin, the balance is thrown off and the circulatory system and organs it feeds are put at risk. Blood vessels, particularly small blood vessels, are damaged over time.

“Diabetes is a disease of the small blood vessels. So any organ that has lots of small blood vessels doing the work are affected,” Seetharaman said. Eyes and kidneys are two of the most-affected organs.

The common types of diabetes are Type 1, Type 2 and gestational. Type 2, once known as adult diabetes, is the most common. Type 1, which used to be known as juvenile diabetes, is better known now as rapid-onset diabetes. More and more adults are getting it, and more kids have Type 2, the slow-onset kind, primarily because of obesity, Tominey said.

The recommended age to begin screening for diabetes now is age 9, Shah said.

“Screenings are really important,” Tominey said.

Symptoms of diabetes include increased thirst, frequent urination, extreme hunger, weight loss, fatigue, blurred vision, slow-healing sores and frequent infections.


“The biggest cause of blindness, not just in the U.S., but in most industrialized countries, is diabetes,” Seetharaman said. It’s the top cause of blindness in working-age populations.

“It’s a very big problem,” he said. “It’s why governments of many countries pour so much money into diabetes research. It affects working-age populations disportionately.”

It is why eye examinations are so important, he said.

“There are no signs or symptoms to look for early on,” Seetharaman said. “People will say they don’t feel any pressure in their eyes. They won’t. It’s when it’s too late that they feel it.

“The same thing with diabetic retinopathy. You can walk around (with it) for years and not know anything is wrong. People in the early stages can see fine. But that’s when we need to see it. It can’t be reversed (when caught too late).”

Glaucoma often is a complication of diabetes.

Early symptoms that something is going wrong include floaters, blurriness, dark areas of vision and difficulty perceiving colors.

“People should know that it’s very important for diabetics to get a dilated eye exam at least once a year,” Seetharaman said. “Unless a dilated exam is performed, they cannot see the extent of damage.”

He said he’s surprised the number of patients he will see in their 60s and 70s who say they never went to a place where their eyes were dilated for an eye exam. Some of the vision care chains are geared more toward selling glasses, not examining eyes for diseases, he said.


“If you are diagnosed with diabetes, you still can have a good quality of life if you do what the family doctor says, what the eye doctor says, even what the dentist says,” Tominey said.

Shah said, “The main thing is to see your doctor, get a physical exam, eat as healthily as possible and exercise. Things that can contribute are stress, lack of sleep, weight gain, family history and ethnicity.”

The most important thing is to keep the A1C under control. An A1C test reflects average blood glucose levels over the past three months.

The normal range for the hemoglobin A1C level is between 4 and 5.6 percent. Levels between 5.7 and 6.4 percent put a person at pre-diabetic stage. Levels of 6.5 percent or higher are diabetic.

The most common treatment is daily insulin injections when blood glucose levels cannot be controlled by diet, weight loss, exercise and oral medications.

At the “Living Well with Diabetes” seminar, Tominey let people know they don’t need a doctor’s referral to call the diabetes education center at Trumbull Regional Medical Center.

“You can call me directly. I get calls every day,” she said. The number is 330-841-9689.

The center holds certifications for both in-patient and outpatient care, including demonstrations of injection equipment and other tools, tips on diabetes control and other follow-up information.

The motto, Tominey said, is, “Prevent it, detect it, treat it.”