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Preventable, non-curable guilt factory

Vicious cycles tough to break in preventing, coping with diabetes

Adam Olson doesn’t mince words when asked how he feels about someone refusing to prevent a disease he himself had no opportunity to prevent.

“Oh God, ... I’d give you all the money I have, for Nate to not deal with it,” Adam said. “That kind of stuff is just infuriating to me. We couldn’t control it at all.”

Adam, 43, and his 13-year-old son, Nate, both cope with type 1 diabetes every day, every time they have any food or drink. Type 1 is unpreventable. Meanwhile, type 2 cases make up about 90 percent of all diabetes diagnoses.

That’s why CGH diabetes coordinator Callie McClain is sensitive to Adam’s point of view. After all, she says she shared that bias when she began her work in diabetes about 10 years ago. But she quickly learned to put herself in the shoes of her patients.

“They come in so guilty,” McClain said. “But I think it’s important for patients to understand that it’s not always self-inflicted.”

McClain explains that there are many causes of the significant spike in type 2 diabetes’ occurrences in kids – CGH recently diagnosed a 9-year-old with the disease once referred to as adult-onset diabetes. But mostly there is a common thread: Our society is worlds apart from those of previous generations.

Like type 2 diabetes, there has been a spike in sedentary jobs in the digital age. And many modes of entertainment that didn’t exist a generation ago don’t require leaving your seat. For our youth, that’s yielded an increase of obesity in kids ages 6 to 11 from 6.5 to 19.6 percent between 1980 and 2008. In teens, it’s jumped from 5 percent to 18.1 percent.

While McClain says the greatest risk factor in type 2 diabetes is age, obesity is right on its heels. No wonder type 2 diabetes in kids rose 21 percent between 2001 and 2009. That correlation is why patients are referred to fellow CGH diabetes educator Margaret Glady and nutrition guru Bryan Frederick to lose weight.

Diet obviously is a major factor, but McClain puts a greater emphasis on simply being active.

“The activity part is huge,” McClain said. “It improves insulin sensitivity, so the insulin the patient still makes, they use better.”

She also points out that types 1 and 2 diabetes might be different diseases, but the long-term complications are the same. Also, type 1 diabetics often develop the same sort of insulin resistance type 2 sufferers have.

“It’s like a key that can’t fit the hole,” McClain said.

Another thing that types 1 and 2 share is their relationship with heart disease. In fact, as Mark Jordan of Dixon pointed out in one of this series’ videos, his cardiac issues – he had triple bypass surgery earlier this year – were masked by his diabetes.

“The significance of developing diabetes, is it’s like you’ve already had a heart attack,” McClain said. “That’s the cardiac impact. They’re not directly related to each other, but they go hand in hand. If you are told today you have diabetes, the risk of cardiac disease is astronomical.”

The window of golden opportunity is a stage called pre-diabetic. There is no cure for diabetes, but lifestyle changes during what McClain says is typically a 10-year-window of pre-diabetes could restore glucose to healthy levels.

“It’s scary to think how many people are walking around pre-diabetic,” Hewitt said.

That’s because the symptoms – fatigue, thirst and increased urination among them – are less intense during the pre-diabetic stage. And they often can be attributed to other factors. Naturally, we’re going to drink more during the summer, resulting in more trips to the bathroom. But even in the dead of winter, there’s the fear factor. So, despite the fact that Community Services provides free glucose screenings that could nip diabetes in the bud, it’s a struggle to convince people to get tested.

The pre-diabetic period is where the magic can happen. But it takes forming relationships. Bedside manner plays perhaps the biggest role in diabetes educators’ effectiveness.

“There’s no point in making them feel guilty about what’s already happened,” said McClain, who has patients who have had the disease for as many as 60 years and are complication free. “For most patients, eventually they’ll get it. When they come in here, and you see their attitude is totally different and they say to you how much better they feel, it’s very, very rewarding.” 

She typically meets with patients in 30- or 60-minute sessions.

“A lot of it is just talking about not feeling guilty,” McClain said. “It’s hard to move forward when you feel guilty, or this is something you caused, so what’s the point?

“A lot of it is just talking and building a relationship. A lot of opening up has to happen in this job. You get really close with patients.”

Many vicious cycles are at play. The fatigue diabetes causes, of course, hinders the desire and ability to be active. So, too, does guilt. Another symptom is hunger, a massive hurdle, as research shows diabetics can make significant improvement by losing 5 to 10 percent of their weight.

“And it’s not like a nagging hunger,” McClain said. “It’s like, ‘I haven’t eaten in 3 days.’ And they never feel full. The patient thinks it’s their appetite, but it’s actually a side effect of high blood sugar.”

When Olson, who works in the insurance field, sees clients with diabetes, it’s a challenge.

“Someone tells me, ‘I’m diabetic.’ And I don’t really have to ask if they’re type 1 or type 2. You can tell,” Olson said. “For them, it’s maybe just a pill, but it’s still something that could be shortening their life expectancy.”

And McClain drives home that the increase in the disease’s rate is scary.

“It should be scary,” McClain said. “But sometimes our lifestyle is so strong. The perception of change can be very hard.”

But great things can happen with change. McClain sees no reason why type 2 diabetics can’t play football or run cross country.

“It’s encouraging for them to be part of something physical,” McClain said. “If you assume the weight is there because of inactivity, and they decide they want to do something physical – like football – I would definitely encourage that, with close monitoring.

“It really isn’t the limiting disease that it was at one time. You just have to get people motivated.”

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