TWIN FALLS — Dwayne Kluchesky’s symptoms developed suddenly. First, unquenchable thirst.
“I couldn’t get enough water,” the Twin Falls chaplain said.
He also lost weight dramatically, which was odd. He weighed more than 250 pounds, didn’t exercise and wasn’t dieting.
Kluchesky had seen those symptoms before, in his mother. And he was pretty certain they spelled diabetes. But he went to see his doctor anyway.
That visit six years ago confirmed his suspicions with a diagnosis of type 2 diabetes. His blood sugar level was in the 300s — far above the 80–130 that the American Diabetes Association advises before meals, and the 180 recommended for an hour or two after meals.
“Mine was super, super high,” Kluchesky said. “Since then things have changed quite a bit, but I still have a hard time keeping my blood sugar down to 150 on a regular basis.”
He’s not alone. The number of American adults diagnosed with diabetes has more than tripled in the past 20 years as the population has aged and gained weight. In Idaho, an estimated 100,000 adults lived with diabetes in 2015 and an estimated 84,000 with prediabetes.
And the cost is extraordinary.
People with diabetes have health care costs 2.3 times greater than those without diabetes. In Idaho, diabetes and prediabetes cost an estimated $1.3 billion each year and were the sixth leading cause of death in 2014. The American Diabetes Association estimates the total cost of diabetes and prediabetes in the U.S. at $322 billion.
But unlike type 1 diabetes, type 2 diabetes can be prevented or delayed by eliminating risk factors such as physical inactivity, unhealthy diets and tobacco use.
Type 1 diabetes is a chronic condition in which the pancreas produces little or no insulin. People with type 2 diabetes make insulin, but the body doesn’t use it the way it should. Prediabetes is when blood sugar is higher than normal, and if left untreated it often progresses to type 2 diabetes.
Despite that dark specter, Idaho is seeing a steady increase in overweight and obese populations, say 2015 data from the Idaho Department of Health and Welfare. The majority of Idahoans are too heavy — 35.8 percent overweight and 26.8 percent obese.
And even a diabetes diagnosis might not inspire dramatic lifestyle change.Kluchesky watches what he eats — but not always.
“It’s just the human condition,” he said. “Sometimes I want ice cream, so I eat some. In the old days, I ate a half-gallon of ice cream.”
Before his diagnosis, he’d have six or eight scoops of ice cream. Now, he’ll have just one. Usually.
He has lost 30 pounds and now weighs 223. His doctor says he should lose 20 more pounds, but Kluchesky figures it’s more like 40.
“I’m still considered obese, but I’m not morbidly obese like I was,” he said. “Ideally, I should be 170 or 175.”
Now, at 67, Kluchesky often thinks of his mother, who had type 2 diabetes and died at 69.(tncms-asset)b7da9343-3c21-5dec-a12f-a46a7b7052ee(/tncms-asset)
“They said it was congestive heart failure,” he said. “I’m just saying this, but I’m sure it was because of type 2 diabetes. When my mom had diabetes they didn’t know that much.”
At the time of her death, his mother’s feet were black from diabetic neuropathy, a type of nerve damage caused by diabetes. And she was blind due to diabetic retinopathy, a complication caused by damage to blood vessels in the eyes.
Kluchesky often wonders how much time he has left to live. He has started to lose feeling in his toes, and he can’t tell how heavy his feet are — signs of diabetic neuropathy.
“I’ve noticed in the last two years I will suddenly become out of balance,” he said, “that I have to take an extra step. My feet are in a state of numbness.”
Kluchesky’s father died at 88. He wasn’t diabetic, but he loved candy.
“I didn’t have good examples growing up,” Kluchesky said. “They’d say, ‘Eat what you want and when you want as long as you finish it all.’”
He’s paying the price now.(tncms-asset)e0e96d59-d3b0-5d8b-949c-46d229b5e2f5(/tncms-asset)
‘I was killing myself’
Jody Bruffett, 55, and Helen Rector, 65, held purple weights as they walked quickly around the Jerome Recreation Center’s track July 18.
Five days a week, to help control their diabetes, the two walk for a mile, bike for 15 minutes, then row for 10 minutes. Sometimes Bruffett takes Zumba or water aerobics classes.
But there was a time when Bruffett wouldn’t even walk down a store aisle, let alone a track. She often used a motorized cart because her knees hurt so badly.
“I was dying,” she said. “I was killing myself.”
Bruffett has type 2 diabetes. Rector, diagnosed at age 12, has type 1. The two have been friends for more than 20 years.
“I do things with Jody,” Rector said. “She looks out for me.”
Bruffett used to take insulin to control her diabetes, but now she can do it with exercise and pills. Despite exercise and weight loss, Rector still requires insulin.
Bruffett was diagnosed at 32. Attending a health fair at the rec center, she decided to have basic blood work done; the tests revealed high blood sugar.
Bruffett wasn’t completely shocked. Her mother is diabetic. Her grandfather was also diabetic, but they didn’t figure it out until he died. And with her last pregnancy, Bruffett’s blood sugar was elevated.
“It was borderline at that point,” Bruffett said. “I had been losing weight without trying, and sometimes that’s a sign also that you are becoming diabetic. I was just run-down, not having any energy.”
Bruffett finally started seeing her diabetes improve after undergoing gastric bypass surgery. Rector saw similar results after the same surgery. Both are part of a support group for people who have undergone weight loss surgery or are thinking about it.
Rector lost 60 pounds after surgery. Bruffett lost 150. She was overjoyed the first time she flew in a plane and didn’t have to use a seat belt extender.
“I had to do a lot of soul searching and investigating before,” Bruffett said. “I knew that’s what I wanted to do. You have to be mentally prepared for it. Everyone thinks surgery is the easy way out, but it’s not. You still have to follow the rules.”(tncms-asset)75a543ee-7d3d-11e7-95c5-00163ec2aa77(/tncms-asset)
Dr. Bob Korn, medical director of bariatrics at St. Luke’s Boise Medical Center, said gastric bypass surgery has been found to cure type 2 diabetes for at least a decade — the length of time cases have been tracked. Korn, a member of the American Society for Metabolic and Bariatric Surgery, specializes in laparoscopic gastric bypass, laparoscopic sleeve gastrectomy and laparoscopic gastric banding. All three reduce stomach size and help the body become more sensitive to insulin, which means patients don’t feel hungry all the time.
“We are curing approximately 60 percent of patients that come to us with type 2 diabetes,” Korn said.
The bariatrics program in Boise is the largest in the state. Seven years ago, Korn was performing less than 300 of these surgeries a year. Now, he and his colleagues do 600 a year, generally for patients 80 to 100 pounds overweight.
Nationally, gastric bypass surgeries are performed at a rate of 200,000 a year, Korn said, and have become the most common abdominal surgery. In terms of invasiveness, he said, it’s comparable to having a gallbladder out.
Why does it work?
“Obesity is the pinnacle cause of type 2 diabetes,” Korn said. “Obesity is contributing to the death of 300,000 people this year. These people have a rapid improvement of their diabetes over a few days.”
Surgery patients can go home in two days and back to work in two weeks.
Bruffett still has 15 pounds she’d like to lose, but that’s where exercise and healthy eating help.
“Do I feel good?” she said. “I feel good, and I feel healthy.”
Bruffett said her biggest pitfall is carbohydrates. “People don’t often look at the carbs in food, and they can raise your blood sugar higher than simple sugar.”
Carbohydrate counting is a way diabetics control their blood glucose. Carbohydrates affect blood glucose more than other nutrients, says the National Institute of Diabetes and Digestive and Kidney Diseases. Healthy carbohydrates include whole grains, fruits and vegetables. Unhealthy carbohydrates are often foods and drinks with added sugars.(tncms-asset)ae20e34d-8964-5cfa-bd33-504956cbd209(/tncms-asset)
Even though Bruffett lost 150 pounds, she still has to watch her carbohydrate intake.
“That’s the main thing, exercise and maintaining a good, healthy weight,” she said. “It doesn’t have to be aggressive. Just walking to the mailbox. As long as it’s movement outside your normal routine.”
For years, Bruffett worried that her son and daughter-in-law had type 2 diabetes. Her son once weighed about 400 pounds, and her daughter-in-law was around 360 pounds.
“His father and me are diabetic,” Bruffett said. “He’s 28, and there is no doubt in my mind you better do something about it. You don’t know how much damage has been done.”
The son and daughter-in-law were tested, but the results were negative. Since then, Bruffett said, they have lost more than 50 pounds each.
That’s a relief. But she still fears they might one day experience what she’s suffering.
Despite Bruffett’s lifestyle changes, diabetes had already damaged nerves in her feet. Now her feet burn. And there’s no way to repair that.(tncms-asset)35c4308f-4bd2-556d-836c-2d0e6e6fe89a(/tncms-asset)
‘Never give up’
For Pauline Patheal, 80, the motivation to lose weight came from a support group she found 35 years ago.
Patheal is a member of Take Off Pounds Sensibly, or TOPS, a noncommercial weight loss, education and support organization; it costs $34 a year to enroll. A group of 15 TOPS members meets weekly at Jerome Public Library.
“We always have a lesson,” said Patheal, who said she has wasted her time on plenty of yo-yo diets. “How to eat right and take it off sensibly. They stress exercise. We are not a diet group. We don’t go on crazy fad diets.”
Patheal attended the international TOPS convention in Little Rock, Ark., in late July with 1,700 other people. She currently weighs 140 pounds and can go 7 pounds below or 3 pounds above her current weight and still stay on target.
At her peak weight of 199, she had hardening of the arteries and pain in her legs. Her type 2 diabetes was also worse. She was so sick her husband of 61 years, Leroy, thought she was dying.
“I thought she was going to kick the bucket,” Leroy said.(tncms-asset)e020aba7-7058-5028-aedf-86c650ccce37(/tncms-asset)
Patheal slept a lot. She had diarrhea and stomachaches.
“I knew something was wrong,” she said. “And he did too.”
Patheal’s mother and grandmother also had diabetes. “They didn’t know about this stuff back then,” she said.
Even after losing the weight, Patheal still needs to control her diabetes with pills, portion control and exercise.
Patheal was one of eight women exercising July 26 at Jerome Senior Center. Sitting in chairs, the women balanced their feet on red, green and orange balls. Each placed one foot on top of the ball, raising her heels, then her toes. She put the ball between her heels and lifted both legs.
Classes at the senior center last 45 minutes with the majority spent seated. Patheal has attended for 25 years.
“It helps, but you have to be careful,” Patheal said. “You just do what you can do. Everyone does it at their own level.”
Her sugar level on July 26 was 111, she said, which is good.
“Never give up,” she said.(tncms-asset)648bfb3e-71ba-5515-b0b6-81879f519d77(/tncms-asset)
‘You need to save your life’
MaryAnn Doshier is a South Central Public Health District diabetes lifestyle coach who works primarily with physicians. She educates them on current diabetes guidelines from the Centers for Disease Control and Prevention and the American Diabetes Association. The guidelines help doctors catch people at the prediabetes stage and get it under control.
“Rather than the doctors having to take a class,” Doshier said, “we get the information and give it to the doctors for free.”
In the Magic Valley’s eight-county district, about 9.4 percent of the adult population reported having been told by doctors that they had diabetes, according to Health and Welfare’s 2015 report. None of the six other districts in Idaho had a higher rate.
The percentage of each county’s adults with diabetes, according to the CDC’s 2013 report on Idaho: Minidoka, 9.4 percent; Gooding, 8.5 percent; Cassia, 8.2 percent; Twin Falls, 7.9 percent; Lincoln, 7.8 percent; Camas, 7.5 percent; Jerome, 7.3 percent, and Blaine, 5.6 percent. In Idaho, only Oneida and Bannock counties had higher rates than Minidoka, at 9.9 percent and 9.8 percent, respectively.
“Minidoka has one of the highest in our area and in the state,” Doshier said. “They don’t know why. That is one area where we are trying to get a diabetic prevention program.”
The Idaho Department of Health and Welfare offers diabetes prevention programs in Shoshone and Gooding, and St. Luke’s Magic Valley Medical Center offers one in Twin Falls. Doshier collaborates with all three.
“I help to get them set up with certified lifestyle coaches that can teach them,” she said. “A lot of them are dietitians and nutritionists.”
Diabetes may cause cardiovascular disease, nerve damage, kidney damage, hearing problems and Alzheimer’s disease, the Mayo Clinic says.
“There definitely needs to be more people who are made aware they are in the prediabetic stage, because they can reverse it before they have diabetes,” Doshier said. “Diabeties can become very serious.”
People can stay in the prediabetes stage for an average of five years, Doshier said.
“It’s a lot easier to take care of it if you take care of it before it becomes diabetes,” she said. “’I don’t have to worry I’m only prediabetic.’ That’s the time you need to do something about it. That’s the time you need to save your life, so to speak.”(tncms-asset)74e34155-aba5-5f6e-b0fa-9ea5f14364bd(/tncms-asset)
‘I just don’t have the willpower’
On July 28, Kluchesky met a friend for breakfast. Kluchesky didn’t eat the whole grain his diabetes mentor would recommend and instead opted for the carbohydrate-heavy chicken fried steak with gravy.
He usually eats a big breakfast, a smaller lunch and next to nothing for dinner.
Instead of using sugar in his coffee, he used a substitute sweetener called Stevia. But instead of putting one packet in his drink, he poured in six.
“You know what? I like sweet stuff,” he said. “I don’t like coffee, I just like the stuff I put in it.”
Kluchesky takes two metformin a day to help regulate his type 2 diabetes.
“This is like a godsend to diabetics,” he said, pulling out a blue pillbox.
He checks his blood sugar in the morning and at night. A couple of hours after breakfast July 28, he squeezed a drop of blood onto a strip and inserted it into a small device. His blood sugar was at 189, which is high. A reading of 150 would be his goal later in the day.
Kluchesky keeps track of his blood sugar in a log book.
“This goes with me everywhere,” he said.
Sometimes his blood sugar reaches 80 — too low — and he begins sweating profusely and has tremors or shakes; he keeps a little piece of mint candy in his pocket just in case. When his sugar is high, his heart rate is fast and he feels thirsty.(tncms-asset)583857fb-dd08-520c-b4f2-d6f2f07ae42a(/tncms-asset)
In early August, he planned to have surgery on his hands for trigger finger, a musculoskeletal condition that affects the tendons and ligaments in the fingers or thumb. The digit gets stuck in a bent position, then straightens with a snap — like a trigger being pulled and released. In severe cases, the finger may become locked in a bent position.
Though gastric bypass surgery is an option, Kluchesky doesn’t see the point.
If he doesn’t eat right and exercise now, not much would change after the surgery. He doesn’t even do the small things his doctor tells him to do, like walking after eating.
One of the reasons Kluchesky doesn’t exercise: He has a degenerative disk disease in his lower spine. He used to fly fish all the time; now he can’t stand for long.
He figures plenty of other type 2 diabetics shun exercise, too.
“Maybe we’re not serious enough to do anything,” Kluchesky said. “But they just keep telling me, ‘Well, if you limit your portions, or after you eat go and walk around the block.’ I don’t do that, I got a paunch on me.
“I just don’t have the willpower to do the right thing.”