Half a dozen diabetes patients gathered in a classroom uptown one recent morning to discuss why keeping blood sugar levels between 70 and 150 is so vital.
The Naomi Berrie Diabetes Center at Columbia University Medical Center offers diabetes education classes, along with nutrition counseling and other programs, for a community beset with diabetes. “We are here like a GPS,” educator Martin Ovalles told the class. “We guide you where to go.”
Some who attended were among the estimated 10.7 percent of residents in Harlem, East Harlem, Washington Heights and Inwood with diabetes, compared to the city’s average of 9.7 percent, according to the city health department. A health department survey released last year shows that diabetes disproportionately affects low-income neighborhoods, as well as black and Hispanic populations, all characteristic of uptown neighborhoods.
Uptown residents also face several additional risk factors for the disease, which some public health experts are calling a nationwide epidemic: poor diet, obesity, heredity and sedentary lifestyles.
Vanessa Castillo, a patient at the center, was shocked when her doctor diagnosed her, at 14, with Type 2 diabetes. “I was like me? Diabetes?,”recalled Castillo, now 22,. “For me, it was an old people’s disease.”
Her disease was discovered when she consulted a doctor about darkened skin around her neck, a condition known as acanthosis nigricans that is an indicator of diabetes.
Education is at the core of the problem, said nurse Patricia Kringas, also a research coordinator and certified diabetes educator at the Berrie Center.
“Diabetes is a disease of management,” she said.
Type 1 diabetes occurs when the pancreas produces an insufficient amount of the insulin hormone, which regulates blood sugar in the body. Insulin resistance occurs with Type 2 diabetes, whereby the body is unable to process glucose to be metabolized for energy, Kringas explained.
With childhood obesity rates rising, Type 2 is no longer seen only in older adults. “Now more and more, you are finding it with younger people,” Kringas said.
Genetics also plays a role, she added. In Castillo’s family, her mother and several of her aunts have the disease, and two grandparents died from complications of diabetes.
Poor diet choices are another major contributing factor.
About 60 percent of the patients that nutritionist Ericka Arrecis sees at the Berrie Center are uptown residents. Many are of Dominican background and eat high-carbohydrate diets, she said, including starchy cassava, a traditional mainstay of Dominican cuisine. That makes healthy eating challenging.
But misperceptions about the disease and its management, and about which foods contain the right types of carbohydrates for diabetics, are widespread, Berrie staff members said, particularly among immigrant populations. Some patients mistakenly believe that diabetes results from eating a lot of sugar or that being heavier means being healthy.
In fact, Ovalles said that his own mother, who lives in the Dominican Republic, complains that his sons, 9 and 11, are too thin; she asks him to send them to her for the summer so she can help them gain weight.
But even when patients understand how to manage the disease, Arrecis says, they complain about the cost of healthier foods, and about being unable to afford fresh vegetables or whole grains. “The diabetic diet is more expensive,” she acknowledged.
Castillo and her family frequently deal with this issue. “You just take whatever is cheaper,” she said of her family’s shopping habits. “Usually the cheaper stuff is the fattier food.”
Experts agree that socioeconomic factors contribute to the problem. “Diabetes to me is to me one more manifestation of social and economic inequity,” said Marilyn Aguirre-Molina, a professor of public health at the City University of New York..
Some families find it more convenient and economical to pick up dinner from the McDonald’s dollar menu rather than locate a grocery store that provides nutritious and affordable choices, she said. Uptown, “The food sources are atrocious,” Aguirre-Molina added. “They have lots of fast food, which I called fields of fat.”
According to a report from the East and Central Harlem District Public Health Office, two in three food stores in those neighborhoods are bodegas, many of which don’t offer healthy foods. For example, leafy green vegetables are available in just three percent of bodegas there, compared to 20 percent on the Upper East Side. “There has to be ways of bringing in supermarkets and other stores,” Aguirre-Molina said.
Furthermore, uptown neighborhoods are not conducive to physical activity, she added, especially when parents are concerned for their children’s safety.“Playgrounds in some of these areas are a disaster,”she said.
One uptown neighborhood responding to the growing problem is East Harlem, which Mt. Sinai School of Medicine researcher Euny Lee calls the epicenter of diabetes and obesity in the city.
Lee is the project manager of a study called the East Harlem Partnership for Diabetes Prevention, started to help pre-diabetic adults from developing full blown diabetes. Pre-diabetes occurs when people have higher than normal blood glucose levels that aren’t high enough to be classified as diabetes.
A participatory research program, the project involves several uptown community organizations in organizing workshops designed to help participants lose weight. “We’re trying to see if the workshops are a successful way of preventing diabetes,” Lee said.
While she said she can’t provide conclusive data from the study, still in progress, Lee has noticed a trend in participants’ ages. “Participants that we screen are a younger cohort,” she said. “It’s not like they are senior citizens.”
Other city programs include the Healthy Bodegas Initiative, which encourages shopkeepers to provide healthier foods like fruits, vegetables and low-fat milk in exchange for help with advertising and permits to sell on sidewalks.
Castillo, learning about her disease, still struggles to eat well and remain active, she said.
Her blood sugar is higher than it should be and she also suffers from high blood pressure. Her doctor recently prescribed insulin injections, a prospect she is nervous about because she is afraid of needles.
“I don’t like pain,” she said.
Still, Castillo said she can’t complain because she has not felt ill since being diagnosed. Her goal, she said, is to get her diabetes under control.