Diabetics gaining a friend

Michelle Swafford

Monday, Dec. 12, 2005 | 8:17 a.m.

Diabetes is an incurable disease that affects millions of Americans and more than 167,000 Nevadans. It can have brutal complications that affect the heart, eyes, kidneys, nervous system, lower limbs and gums.

COMMON SYMPTOMS

* Frequent urination * Excessive thirst * Irritability * Fatigue * Nausea and vomiting * Unusual or sudden weight loss * Increased appetite * Blurred vision * Fruity, sweet, or wine-like odor on breath * Sores that heal slowly * Dry, itchy skin * Losing the feeling in your feet or having tingling in your feet

TYPE II

The following characteristics can put a person at higher risk of developing diabetes; often Type II.

* Family history of diabetes * Had a baby weighing more than 9 pounds * Overweight * Exercise infrequently and are under the age of 65 * Consider yourself to be Hispanic, black, American Indian, Asian American or Pacific Islander

Source: National Diabetes Information Clearinghouse, Juvenile Diabetes Research Foundation, American Diabetes Association

The Las Vegas Valley's diabetes care is getting a shot in the arm, injecting higher-level care and education for the more than 167,000 Nevadans plagued with the disease.

The Joslin Diabetes Center in Boston is opening a satellite office in Las Vegas that will offer treatment, education and research in Southern Hills Hospital & Medical Center's medical offices. Joslin has 25 affiliate offices across the United States -- mostly east of the Mississippi River -- and partners with Harvard Medical School. It also has an office in Bahrain, near Saudi Arabia.

Dr. Elliott Joslin formed the first center in 1898, 24 years before insulin treatments were discovered. Today, the Joslin Diabetes Center has research and education components.

Local diabetes patients and advocates say Joslin's local center is sure to raise the bar on care in Las Vegas.

"They have such a fine standard of care," said Mylan Hawkins, executive director of the Nevada Diabetes Association. "Joslin has always been on the cutting edge of diabetes care and management. In my opinion it would be a wonderful asset to our state"

Hawkins' organization relies on grants and donations to provide resource guides, support groups, camps and emergency supplies to Nevadans with diabetes.

She said Joslin also has "extremely good resources for children."

That could be good news for 9-year-old Katie Cornett, who has had Type I diabetes since she was 3.

"When my daughter was diagnosed, there was only one doctor available," Tina Cornett said. "The more options we have, it's better for everyone."

Cornett said her daughter has been able to maintain her health through structured living.

"We're very scheduled," she said. "Everyone gets up and eats. Our lives are pretty much regimented around her. We have meals and snacks the same time every day."

When Katie was first diagnosed, her mother said, it was "devastating."

"You don't think of anything ever being wrong with your children," she said. "I remember it being very overwhelming. One year later, I was having a phone conversation while drawing up insulin because it becomes so routine."

Theresa Le Blanc-Moore, a Valley Hospital emergency room nurse and 19-year Type I diabetes patient, said Joslin could aid her care as well as the diabetic patients who visit the emergency room with complications.

"Once Joslin comes, there will be a set standard," she said. "There's definitely not a standard here. There needs to be a protocol of testing (blood sugar levels.)"

She said many of the patients in her diabetes support group and in her emergency room lack education and think it's OK to have high blood sugar levels and test those levels once a week.

It's recommended that patients check their blood sugar levels four to six times a day by pricking their finger and placing a drop of blood on a meter that measures the sugar levels.

Mike Arguello has had Type II diabetes for nearly 20 years and has felt the disease's effects. He has been switched from pills to insulin injections and had to have a heart transplant in 1999. He is now on a waiting list for another heart and new kidneys.

"I've got a 10-year-old daughter and I want to be around for her," Arguello said. "I feel that I've been blessed and given a second chance. A lot of people don't understand, when you get a second chance you have to change your life, and if you don't, you won't live very long."

Before he learned he was diabetic, Arguello said, he weighed more than 200 pounds, ate lots of carbohydrates that are common in his Hispanic culture, smoked cigarettes and drank light beer.

These days, the 62-year-old must be on a restricted renal diet, take 30 pills multiple times a day for his heart, check his blood pressure and test his blood sugar level four times a day. He then takes insulin through an insulin pump to balance his food and drink intake.

The Joslin Diabetes Center hopes to be a resource for those patients, their doctors and others in the community.

It's also probable that the Las Vegas Joslin center could recruit much-needed doctors to treat diabetes, Hare said.

Pediatric endocrinologists are in highest demand -- there are only two in Southern Nevada and one in Northern Nevada, Hawkins said.

The Las Vegas center has hired a registered dietician, registered nurse, nurse practitioner, two case managers and support staff.

While Nevada could use the extra doctors, existing primary care doctors sometimes feel threatened by Joslin centers because they fear they will lose their patients, said Dr. John Hare, director of affiliated programs for Joslin Diabetes Center and a Harvard Medical School associate professor of medicine.

"The arithmetic doesn't work, Hare said. "There are too many people with diabetes. Ninety-five percent of people with diabetes are treated by primary care physicians."

Diabetes is not limited to certain religions, genders, economic levels or races and ethnicities -- but blacks, Hispanics and American Indians are at higher risk of developing the disease.

A large Hispanic population is one of the reasons why Joslin was receptive to opening a center in Las Vegas, Hare said.

Also, Joslin was looking to expand to the West to bring comprehensive diabetes care to more people, he said.

Dr. Jim Snyder, an endocrinologist in Las Vegas who has partnered with Fremont Medical Center, approached Joslin about opening a Las Vegas center. Joslin officials were in Las Vegas this week to finalize plans for the center, which is scheduled to open Jan. 15.

"I have a passion for team care and no one does it better than Joslin -- there's no reason to reinvent the wheel," Snyder said. "The best catalyst for stimulating good care is to bring good care here."

Joslin's philosophy of care brings endocrinologists, dieticians, nurse educators, ophthalmologists, mental health workers, podiatrists and exercise specialists to one center for comprehensive care and education.

The Las Vegas Joslin Diabetes Center will operate as a franchise that receives programs, access to expertise and counseling for a fee.

The initial investment for the Las Vegas center is $250,000 for staff, rent and support services, and subsequent years of operation will cost more than $1 million, Snyder said.

The local Joslin Diabetes Center is investing in equipment for neurological assessments that test for nerve damage, eye exams that check for glaucoma and metabolic assessments to measure patients' nutrition, Snyder said.

"Diabetes education and training are services that are not reimbursed well even though they are vital to the health of patients with diabetes," Snyder said.

He said Medicare pays for 10 hours of medical training and two to three hours of nutrition education the first year and two to three hours of medical updates and one to two hours of nutrition updates in following years.

Nevada insurers will not automatically cover Joslin's services, but Snyder said he plans to negotiate with them to be included in their plans.

"That's one thing the (Joslin) affiliation can't do is guarantee coverage," Snyder said.

After six months of operation, the Las Vegas center plans to seek American Diabetes Association accreditation, Snyder said.

With or without the accreditation, the Joslin name is likely to be an asset in the Las Vegas Valley, patients and advocates say.

Michelle Swafford can be reached at 259-2326 or at swafford@lasvegassun.com.

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