Bruce Balch handles the tiny, sharp lancets with expertise in his insurance office.
He has been testing his blood about eight times daily for the past five years, since he was diagnosed with diabetes at age 45.
Balch dashes the notion that only overweight people get diabetes.
He was a nationally competitive triathlete at the time of his diagnosis. He still is.
He’s raced against Lance Armstrong, competed in Ironman events, earned the distinction of national champion in USA Triathlon’s 2012 Duathlon National Championship and qualified for a major event in China last year.
Balch took a break from triathlons after his diagnosis, but returned to competition precisely because of diabetes.
"It kind of ticked me off more than anything," he said of the unexpected disease.
LACK OF AWARENESS
There are many misconceptions about diabetes. For instance, studies show that most people think diabetes is serious but not life-threatening.
"That couldn’t be further from the truth," said Tracie Patten, market manager-Nevada for the American Diabetes Association.
Diabetes affects the body’s ability to change food into energy, causing blood sugar levels to spike. The disease impedes everything from thought processes to pumping blood.
"How do you keep this disease from taking over all your organs?" Patten asked. "Which is what it does. It’s the leading cause of heart attacks, stroke, kidney failure, blindness and amputation."
She describes the disease as an "epidemic," affecting 200,000 Nevadans. The association says 25.6 million Americans have diabetes. The disease is likely to affect another 79 million Americans in the next 10 years. And, it’s a greater killer in the United States than breast cancer and AIDS combined.
Moreover, in November, the association cited a study by the Centers for Disease Control and Prevention projecting that the number of youths with Type 2 diabetes in the United States will surge by 49 percent during the next 40 years, possibly even quadrupling. Those with Type 1 diabetes are projected to climb by 23 percent, possibly tripling.
Researchers have linked Type 1 (formerly associated with children, or "juvenile diabetes") to autoimmune issues, while Type 2 relates to genetic tendencies as well as obesity, especially among Hispanic, African-American, Native American and Asian populations.
Type 1 diabetes ultimately requires a lifelong dependence on injected or pumped insulin. While diet and exercise can help a person living with Type 1, diet, exercise and medication are mainstays of control for Type 2 diabetes.
The local tide of Type 2 cases is rising, said Dr. Lubna Ahmad, a Las Vegas endocrinologist in practice for 14 years.
"We’re seeing more and more people developing diabetes at a younger age," she said.
She’s also seen a wave of prediabetes, in which blood glucose levels are elevated but not yet high enough to indicate actual diabetes. And, she’s noticed a large population of people unaware that they even have Type 2 diabetes.
That unaware group, she said, is larger in Nevada than what she’s seen elsewhere. Disease awareness, dietary awareness, healthful lifestyles – much of it seems to vanish into Nevada’s thin air.
"What I saw in New York City is, people would walk," she said.
Add to that lack of awareness a general confusion about diabetes, whether it’s the mistaken belief that Type 1 can turn into Type 2, what to eat or where exactly some adults fall between the two types.
"Eighty-five percent of those living with Type 1 diabetes are adults," noted Marcela Arroyave, outreach manager for the Juvenile Diabetes Research Foundation’s Nevada chapter. She herself lives with Type 1, having been diagnosed when she was 14.
FALLING BETWEEN THE CRACKS
Balch’s doctor explained to him that his diabetes was more like a "1.5."
Balch’s fall-between-the-cracks of Type 1 and Type 2, is called LADA, latent autoimmune diabetes in adults, said Dr. Fred Toffel, an endocrinologist practicing in Las Vegas since 1984, and the medical director of the Diabetes Treatment Center at Desert Springs Hospital.
"It presents like Type 2," he said. "It’s not a rapid onset disease as we see in children with Type 1 diabetes. Often they’re given pills, and the pills may even work for a couple of months, maybe up to a year. Then the pills fail. You look at the person and they tend to look a little different than the typical person with Type 2 diabetes. They tend not to be as heavy."
Toffel said they also tend not to have high blood sugar. But they do need insulin and are treated essentially within a year or two of diagnosis as a Type 1 patient.
"One point five" could also mean something else, Toffel added. "That’s why I don’t like using that term. It could be a patient who has true Type 1 diabetes but also has the genetics to get Type 2 diabetes, so they have metabolic syndrome, too. So here you have somebody with Type 1 diabetes who has all the cholesterol and blood pressure problems that people with Type 2 get, and are obese or overweight."
For Balch, the onset of diabetes was as cryptic as his diagnosis.
"I was out riding and all of a sudden I realized that the street signs were fuzzy," he recalled. He chalked it up to age and got glasses. Then came fatigue, along with losing weight and the "classic peeing, drinking."
"I’m like, I’m 45," he said. "I’d been going hard. And when I mean training, I’m training with all my biker buddies, hard-core stuff, going 200-plus miles a week and really pushing it."
When taking a break didn’t work, frustration drove him to other solutions, even changing his bike. Several months later, he suspected allergies, and had a corticosteroid shot – not the best move, he said, if you have diabetes.
The shot landed him in the hospital, where the mystery was solved. Balch, who also is a husband, father, church elder and testicular cancer survivor, took the scare as a wake-up call to revamp his diet.
"I think I’m in better condition now and healthier as somebody with diabetes than I was as an athlete who didn’t know," he said.
Mike Hildebrand, who was diagnosed with Type 2 diabetes in May 2010, agrees about the wake-up call. Once a nearly 400-pound self-styled "big boy" who rode scooters in the supermarket, Hildebrand lost about 110 pounds. Within a year, he also met the woman of his dreams and had a baby. Now he’s training for the 65-mile bike-racing leg of the American Diabetes Association’s "Tour de Cure" event April 27 at M Resort.
"It was more a lot of depression and not liking who I was at the time," he said of the timeline leading up to his diagnosis. "Emotional eating and compensating. You stop caring until you wake up."
He’d already noticed disturbing conditions that included frequent urination, a pounding headache keeping him awake at night, asthmatic symptoms and the loss of feeling in his lower legs, which had turned an ashy gray color. But his wake-up call came when he realized in the Hallmark store that his son, the skinny swimmer visiting from Salt Lake City, was embarrassed by him.
The diagnosis felt like a dirty secret at first.
"There’s a lot of shame involved," Hildebrand said. "Because I knew that Type 1 diabetes was something you were born with, it was a legitimate disease. And in my mind Type 2 diabetes was something you did to yourself."
Swearing off the supermarket scooter, he changed his diet and lost 20 pounds – just enough to enable him to work out. Within a few months, he noticed his gray "stumps" transforming back into legs with normal color and feeling.
Ahmad said there’s been plenty of good Type 2 diabetes news in the past five years, with the advent of incretin-based therapies, including drugs such as Byetta and Januvia.
"Previously when we didn’t have these drugs, we would actually use medications until (the patient’s) pancreas burned out, and then put them on insulin," she explained. "Now our treatment has changed so when you see this same person walk through the door, we put them on medications to try to preserve their pancreatic (function) as long as we can."
As for high-tech, high-convenience paraphernalia that make coping with both types of diabetes easier, there’s a seemingly endless stream of smartphone apps, blood glucose meters, monitors and pumps. That includes meters with audio capability for people with vision problems, and meters for high-temperature and low-temperature climates.
The American Diabetes Association’s Patten said some of those gadgets can make the difference between a physician plan based on a week of readings, and one based on a more accurate month-at-a-glance. The result can be a patient who feels drastically better.
The upcoming year may also bring a longer-acting, more predictable new insulin, helping reduce overnight hypoglycemia, Toffel added.
He also suspects insurance companies will start paying for continuous glucose monitoring systems for home use.
Moreover, an artificial pancreas is in the works – aiming for tighter responses to blood sugar changes, and a major improvement in the quality of life for people with Type 1 diabetes.
Beyond modern medicine and technology, diet and exercise remain pillars of necessity, experts say. Some say that diet and exercise alone can even help head off Type 2 diabetes. People who have the disease can use lifestyle changes to reduce their medication, and in some cases, control Type 2 without medication.
"The statistic is that 90 percent of Type 2 diabetes cases can be reversed through diet and exercise if caught early enough," Patten said.
Ahmad said, "I do have a few patients who, they do know how to control their disease with just what they do."
Toffel recommends a progressive exercise program as simple as walking, with physician approval. He also suggests using small plates and eating mindfully.
"Eat slower. I think one of the big problems we have, and it’s getting worse with our time constraints, is we’re fast eaters. We don’t give our brain the time to realize that we’re full."
Ahmad, a yoga practitioner who adheres to a strict diet, believes prevention is the best medicine.
"In medical school, if you don’t learn that, you haven’t really learned," she said.