Fighting Disease With Words : Minorities have a much higher chance of being stricken with diabetes. But education efforts in the county are beginning to make a difference in some patients’ lives.

Esther Lee remembers well the day her mother was unable to drag herself out of bed.

“She was used to working in a factory 12 hours a day and then going to English classes,” said Lee, 27, a Korean immigrant. “Then one morning she said she physically couldn’t get up.”

Korean-speaking doctors diagnosed diabetes in Esther Lee’s mother. They told her to get bed rest, but she continued to work because she needed the money. Several years later, after her mother’s illness worsened, Lee saw Dr. Francis Rhie interviewed on Korean-language television.

Under Rhie’s care, Myung Lee began to improve. But not before the disease had blinded her.

Lee’s case is not uncommon among Southern California’s fast-growing immigrant and minority populations. Certain types of diabetes afflict immigrants and minorities much more often than they do European-Americans, but only recently has the medical community begun reaching out to that population.

In Orange County for instance, a new program began this month to educate Latinos about the dangers of diabetes and the ways to control the disease.

Latinos and Asians, who together account for about one-third of Orange County’s population, each have a nearly 300% higher chance of developing the disease than European-Americans, while African-Americans report nearly a 200% higher rate, according to the American Diabetes Assn.

In California, with its growing population of minorities and immigrants, the number of diabetics has doubled since 1990, from 1.4 million to 2.8 million, or 9.3% of the population, the association reports.

As county, state and federal lawmakers argue about cutting funding for health care, more and more members of minority groups are losing limbs, kidneys and their lives to diabetes because preventive care is unavailable to them.

“This is an urban disease,” said Rhie, president of the California affiliate of the American Diabetes Assn. and one of three diabetes specialists in Orange County who speaks Korean. “We’re dying because of our success.”

People with diabetes are unable to metabolize sugar, leaving them with high levels of glucose in the blood. Like a car with a full tank of gas but no combustion, diabetes prevents the body from making the insulin necessary to get the system running.

By using conveniences that restrict exercise and by eating foods with high fat and sugar content, more and more people have developed diabetes.

Minorities are hit hardest by a type of diabetes in which the body produces insufficient amounts of insulin and use it inefficiently, said Rhie.

Researchers are unsure exactly why minorities are afflicted, but they suspect that genetics, combined with poor eating and exercise habits picked up here, lead to a greater predisposition to the disease.

Being 20% or more overweight is a major risk factor, he said, because “the body can’t keep up with the increased need for insulin.”

(Another type of diabetes, the more commonly known autoimmune disease, requires daily injections of insulin. It usually appears in childhood and more commonly afflicts European-Americans than minorities.)

Not only are minorities more prone to diabetes, but they also suffer more serious complications from the disease. Rhie said economic and cultural barriers prevent them from receiving proper medical care and education.

Among those with diabetes in California, American Indians are eight times more likely than whites to develop kidney failure, Latinos are six times more likely, and African-Americans are three times more likely. (A lack of research money has prevented studies of the state’s varied Asian population, Rhie said.)

Consequently, minorities are more often hospitalized.

Caring for diabetics cost California taxpayers nearly $1.3 billion annually, according to the American Diabetes Assn. That cost could be reduced, association officials say, if money were invested in prevention, education and training of foreign-language-speaking doctors. People with diabetes can live long, productive, normal lives if the disease is controlled, Rhie said. The problem is detecting victims early enough and teaching them to readjust diet and lifestyle to keep the diabetes in check.

Thien Tran, 66, spent six months trying tried in vain to find a Vietnamese-speaking endocrinologist.

“Vietnamese people feel more comfortable with Vietnamese doctors because of the language barrier,” she said. Tran, a middle-class government worker who fled Saigon in 1975, kept looking for a Vietnamese specialist.

The search took its toll: In 1986, Tran weighed 60 pounds, down from 98. Small cuts were becoming infected and taking months to heal. “I was so tired, I couldn’t stand up,” she said. “My family doctor really didn’t know anything about diabetes.” The doctor prescribed vitamin injections and relaxation. Tran was nearly in a diabetic coma when she insisted that her doctor admit her to the hospital.

Tran met Rhie in diabetes education classes at St. Joseph Hospital in Orange. She now goes to martial-arts classes for exercise to lower her glucose level, adheres to a strict diet, has three insulin shots per day and constantly monitors sugar in her system.

Others patients are more reluctant to monitor their lifestyle and thus less successful at controlling the disease, Rhie said. Rich, fatty and sweet foods are an integral part of the diet and culture of certain minority groups, leading to obesity and increasing the chance of inducing diabetes. “Controlling diabetes is frustrating, time-consuming and emotionally draining,” Rhie said. “It becomes a full-time job. Patients resent it. They ask themselves, ‘Why am I living?’

“Macho men can’t handle the thought of taking insulin shots,” Rhie said. “They think they’re done with being a man. Asian men (patients) sometimes develop an inferiority complex. They think they have a defective body which lowers their human value.”

Though efforts were begun three years ago in Los Angeles County to educate Latinos about the disease’s dangers, volunteers in Orange County only this month received enough funding to begin a similar outreach program.

The Orange County chapter will receive $650,000 this year for all its screening and education programs.

On June 27, at the Santa Ana Salvation Army, the local chapter of the American Diabetes Assn. will sponsor a free lunch and education seminar in Spanish.

The organization also has published public service announcements in Spanish-language newspapers and has a Spanish-speaking outreach worker who talks about diabetes in English as a Second Language classes, churches and Latin festivals such as Cinco de Mayo celebrations.

For other minority groups, though, there is still no formal outreach in Orange County, Rhie said, except for individual doctors’ efforts. (Rhie, for example, volunteers his time to do public service talk shows on Korean-language TV.)

Diabetes fails to command the same attention as AIDS and other high-profile diseases, which means less research money. “We don’t have an Easter Seal poster child. We don’t use scare tactics so we don’t get the money,” Rhie said. “It’s staying flat.”

Tyrone D. Jones, 46, a black Panamanian who lives in Mission Viejo, lost a leg to diabetes. Before that, he ignored the weight gain, the unquenchable thirst, the pain in his legs and arch, the bloated “sloshing around,” as he describes his symptoms, until he lapsed into a diabetic coma. “I never liked going to doctors,” he said. “I didn’t realize how dangerous the sickness was.”

Jones, who has high blood pressure and gout, also had a stressful job in the county’s social services department, he said, which made him neglect his health. He has been in three diabetic comas since the disease was diagnosed when he was 33. Gout caused a sore in his arch, and diabetes-induced poor circulation prevented it from healing.

After two years of infection, doctors amputated his leg from the knee down. Though Jones still works as a county appraiser and maintains good spirits, he spends three days a week on dialysis because his kidneys have failed. “I’m supposed to be on a special diet, but I’m not following it because I’d probably starve to death,” he joked.

Only recently has he accepted a forthcoming kidney transplant. “What if I got a woman’s kidney and started acting different? Or what if I got the kidney of a killer and started acting like that?” he said. “I had to get over all that.”

The state considers diabetes a catastrophic illness and so subsidizes the medical care for dialysis and kidney transplants of all patients, regardless of income, said Cathy Hicks, director of St. Joseph Hospital’s Renal Center, which has the largest dialysis unit in Orange County.

Rarely, though, do the government or private insurers subsidize prevention or education, which, if properly handled, could greatly reduce the financial and emotional cost associated with diabetes’ serious side affects, said Jan Wolf, manager of the hospital’s free clinic in one of Orange County’s poorest neighborhoods.

The clinic, called La Amistad de Jose, in Garden Grove’s Buena Clinton neighborhood, services almost exclusively Spanish-speaking patients who have no insurance and travel frequently to Mexico.

“We’ve had patients arrive in diabetic shock, which is an indication of how well our health care system works for the poor,” said Wolf. Unlike Los Angeles County, Orange County has no government-funded hospital that cares for the poor, though a network of 12 community clinics provides services to the indigent population, she said.

Sonia Paz, the clinic’s coordinator and a registered nurse, sees about 10 diabetics per month. The number would likely be higher, she said, “but we only accept people from the neighborhood,” which has between 3,500 and 5,000 people.

With the diabetic patients, “we have to constantly educate and re-educate,” Paz said. “These people come from a different culture; they have different beliefs.”

They tend to ignore medical advice, she said. “They’ll drink little milk and honey at night or have a Coke when it’s hot,” Paz said. “We tell them to use (sugar substitute), but when they go to Mexico, they can’t find it so they put sugar in their coffee. They come back here thinking we’re not going to notice.

“We’re serving the tip of the iceberg here,” Paz said as she hurried off to prepare for surgery. “We’re filling a huge need, and there’s a lot more to be done.”

Diabetes and Ethnicity

Ethnic minorities in the United States are more likely to develop diabetes than whites, according to the American Diabetes Assn. The following statistical averages, based on the 1990 Census, show the Orange County diabetic “at-risk” population also more heavily minority than the general population:

% At % of OC Ethnicity Risk Population American Indian * * Asian 16% 10.0% Latino 37% 23.4% Black 2% 2.2% White 45% 64.4% Other * * Total 100% 100%

* Less than 1%

Sources: 1990 Census, American Diabetes Assn., Orange County Department of Health Services

Researched by JANICE L. JONES / Los Angeles Times