Daniel Robinson knew it was only a matter of time before he was diagnosed with something. With a 72-year-old father who suffers from hypertension and type 2 diabetes and a 65-year-old mother with arthritis, illness didn’t just feel likely, it seemed imminent.
But he never imagined it would come at age 22. It was October 2014, just months shy of his graduation from the University of Florida. He was playing basketball, and something felt wrong. “I was really dehydrated, and my legs started to cramp. But I was joking at the time, like, ‘I’m not LeBron [James]. I can play through my cramps,’” Robinson says.
His pain persisted and, eventually, his legs locked up on him. A friend drove them back to his apartment since Robinson couldn’t climb the stairs to his own dorm room. He called his parents, who urged him to see a doctor. His thoughts haunted him: Could it be multiple sclerosis? What if it didn’t get better? A nurse at the clinic he visited the next day told him he looked too fit for diabetes but tested him anyway.
Two days later, she called back with the bad news.
“You’re diabetic,” he recalls the nurse saying. “And I responded, ‘OK, excellent.’ She asked, ‘Why are you happy?’ I said, ‘Because I don’t have multiple sclerosis. I’ll take it.’”
What Robinson experienced is far more common than most people are aware. Although diabetes is broadly associated with those who are older or who lead unhealthy lifestyles with little exercise and lots of junk food, many young, active adults are diagnosed with forms of the disease that lifestyle choices can’t prevent. And African-Americans are disproportionately affected, nearly two times more likely to have diabetes than Whites, according to the American Diabetes Association (ADA). Fortunately, however, as Robinson found out, an early diagnosis and advances in medical treatment mean young diabetics can still lead long, active lives.
Another blood test revealed that Robinson was a type 1 diabetic. In this form of the disease, white blood cells attack the beta cells in the pancreas responsible for producing insulin, which then don’t produce enough of the hormone to keep the body energized throughout the day. Type 1 only accounts for 5 percent of adult diabetes cases, according to the Centers for Disease Control and Prevention (CDC). In 2012, the American Diabetes Association found that approximately 29 million Americans (8 million of whom are undiagnosed) were living with some form of diabetes, and about 13 percent of those diagnosed were African-American. Of those 29 million, about 1.25 million had type 1. A study by the CDC predicts that the number of youth with type 2 will increase by 49 percent over the next 40 years; type 1 cases among youth are expected to rise by 23 percent. By 2050, according to U.S. Census Bureau predictions, minorities from lower-income families will make up about half of all type 1 cases.
That only exacerbates a problem that’s as much economic as it is physical.
“The most annoying thing is that insulin costs an arm and a leg, and it’s a pain that I have to deal with,” Robinson says. The insulin he needs to stay healthy runs $350 a month, even with health insurance. But being diagnosed just before he graduated softened the blow because he already had a job lined up after graduation and knew he’d be able to afford his medication. “I didn’t have a job in college. It’s not like I would have let my parents pay for it, either.”
Life After Diagnosis
Matt Petersen, managing director of medical information at the ADA, says costs certainly play a significant role in the fight against diabetes. The Food and Drug Administration doesn’t allow generic insulin, he says, so there isn’t a supercheap version of the drug. But there are older, lower-priced versions sold at stores such as Walmart, for example. The older types of the hormone don’t work in as wide a range as the newer formulas, Petersen says, however, “they all work very well but in various kinds of ways. The main way that they work differently from each other is how fast they start acting and how long they act.”
Robinson is on a basal-bolus insulin injection regimen, a method of treatment combining long-lasting and fast-acting medications to control glucose levels. Per his prescription, Robinson takes a basal injection when he wakes up or before he goes to bed. The basal (long-lasting) insulin provides a constant source of the hormone all day that converts blood sugar into energy. He takes the bolus (fast-acting) insulin, which he says takes about 30 to 60 minutes to kick in, before every meal. “If I plan to have a meal with pasta, bread or a lot of starches, I’d just bolus more before that meal. But I’m cheap,” Robinson says jokingly, “and it costs less to cut out pasta, rice and forms of bread than it does to buy insulin more often.”
According to Petersen, the newer and more expensive insulin medications act even faster than the ones Robinson currently takes. Diabetics could take a newer version of the bolus injection just five to 10 minutes before they decide to eat to help control glucose levels. This works well, he says, with the frenetic lives of adults and older children who have more variable schedules. “All the insulin we’ve had for the past 20 or 30 years, including the ones that don’t cost much, are still available and can be a good solution for people with a limited amount of money to spend on medication,” Petersen explains.
What Is Diabetes?
Here is a breakdown of the three main kinds of the disease:
• Type 1
Also known as juvenile diabetes, type 1 affects only 5 percent of the 29 million people living with the disease. With this form of diabetes, the body does not produce insulin, the hormone that converts sugar and starches into energy. Type 1 diabetics use insulin injections and other treatments to manage the disease.
• Type 2
This is the most common form of diabetes, and the one for which African-Americans and other minorities are the most at risk. With this type, the body does not utilize insulin properly, and the pancreas makes more than enough of the hormone to make up for improper use. But over time, the body can’t continue to produce enough insulin to control blood glucose levels, so the sugar builds up in the blood instead of properly going into the cells. The eyes, kidneys, nerves and heart could be affected. Weight loss and exercise can prevent or delay a diagnosis. Diabetics can eat healthily and exercise to control their blood glucose outside of prescribed medications or insulin.
When women who are not already diabetic develop high blood glucose during their pregnancies, this condition is known as gestational diabetes. It is unclear exactly what causes it, but some believe hormones from the placenta block the action of the mother’s insulin, making it difficult for her body to process it correctly. This leads to high levels of glucose in the blood (a condition known as hyperglycemia) because the sugar cannot be converted to energy without insulin. Although it’s not guaranteed, some doctors say eating foods high in fiber and low in fat and calories, along with exercise, can prevent gestational diabetes. This form of the disease can be treated with insulin injections or oral blood sugar control medications.