In my work as a consultant, I encounter people from all walks of life, and sometimes I interact with patients while working on DME assignments. Having owned my own DME, I find myself out of the habit of assisting patients with questions about equipment.

While concluding a JCAHO implementation project in Coral Springs, Fla, I was standing behind the counter with Mark Salpeter, vice president of operations for Plaza Medical Supply, reviewing for their unannounced accreditation survey, when a female patient in her early 70s (I'll call her Flora) walked in and announced that she had been diagnosed with diabetes years ago. At the time, she thought her doctors were lying, so she refused treatment and avoided routine blood testing and medications.

She started explaining her lifestyle and eating habits when I finally asked, "Why are you avoiding treatment?" and she answered, "Because I feel fine and I don't trust doctors—they make things worse."

She went on telling us that she intended to live until she was 100 years old, and Brooklyn, Fla, was the perfect place for her retirement. Mark and I immediately expressed our concern for her health and explained that not respecting diabetes was certainly not the way to reach 100 years old. In fact, the disease can be a death sentence when unmanaged.

However, with regular testing of blood sugar, a proper diet, and the necessary insulin therapy, one can survive this disease long-term. The support of friends and family also is an important factor in managing this disease.

IN DENIAL

Like millions of Americans diagnosed with diabetes, Flora was in denial and unwilling to accept that eating habits developed over a lifetime would require, in some cases, a drastic change to keep the disease in check. Additionally, the active management of the disease is a full-time job requiring dedication, commitment, and consistency. Those who do not accept responsibility for their health put themselves and their families under great stress as health steadily declines until death arrives—usually within 10 years of diagnosis—when the disease is not respected for the killer it is. The process of deterioration is slow, but the disease is deliberate and the results are irreversible.

"My doctor says I may have diabetes," Flora said, and Mark replied, "Either you do or you don't, and if your medical test came back positive for diabetes, then you have it, so let me show you some of the products we have for you and how they work."

He asked if she had ever tested her blood sugar, and she stated, "It's been years," so I explained that testing her blood sugar levels daily was critical to her long-term survival, and why use of insulin pills, injections, or inhalants was not discretionary if she wanted to live to be 100. High glucose levels in the blood over time may cause irreparable nerve damage, blindness, wound development on the feet and hands, prolonged healing issues, kidney failure, impotence, and possible amputation.

A PERSONAL LOSS

I have firsthand knowledge of the power of this disease and what it can do to patients if ignored. You see, I recently lost a close family member to diabetes. I watched him, his wife, and his son suffer as the disease destroyed his bright and beautiful life—taking him from us at 37 years old. So with permission from his wife, Mary Toliver, I will convey the impact that diabetes had on the life of my late cousin, the Reverend Paul Toliver of Bakersfield, Calif. He was a young man with many hopes and dreams, but his life was cut short by denial, neglect, and a lack of respect for diabetes.

DENIAL IN 1991 (THE BEGINNING)

Paul was diagnosed with diabetes in 1991. A few days after applying some hair texturizer, he noticed that he was developing a sore on his head that became red, swollen, and painful to the touch. He thought he had left the chemicals on too long, causing a burn to develop, which is not uncommon with texturizer use. However, his fiancee, Mary, convinced him to go to the emergency department immediately because it did not look like any texturizer burn she had ever seen. In fact, it was much more serious.

Physicians immediately admitted him to the hospital, fearing that the sore would not heal properly and might lead to his skull being exposed due to rapidly dying scalp tissues. To actively manage the healing process, they gave him hyperbaric treatments and a diagnosis of diabetes and obesity.

Ted Jones, Jr

While still lying in a hospital bed on a reduced fat diet, Paul asked Mary to bring him a fish filet sandwich from McDonald's. Out of love and wanting to comfort her fiance, she got him the sandwich—despite his swollen head and face from the infection that had set in.

When Paul's blood sugar was initially tested, it was near 720, although it should have been in a range of 70 to 120. There was no doubt in the minds of the physicians that Paul had diabetes, which was likely preventing the wound on his head from healing.

He was released 2 weeks later with his head bandaged and a prescription for glyburide, diabetic test strips, lancets, and a glucometer (blood glucose test meter) to measure his blood sugar. That same year, Paul and Mary were married in Paul's father's church in Bakersfield. And the congregation prepared a feast of foods that would make your jaw drop.

After the wedding, Paul continued to deny the disease, the treatments, and the tests—and most importantly, he did not watch his diet. Paul ate barbecue, candy, bacon, doughnuts, honey buns, sweet potato pie, rice, potatoes, and cheese (on everything), and no trip to Los Angeles was complete without stopping at Fatburger to get the chili cheeseburger and a side of steak fries.

DENIAL 1992 (SLUGGISH)

Six months after Paul and Mary were married, Paul went on insulin injections in conjunction with the glyburide, but his blood testing remained inconsistent as was his diet. Eventually, he reverted back to the same junk food that made him sluggish all the time. Finally, doctors told him there was nothing they could do for him unless he controlled his diet.

DENIAL 1993 (INSULIN ABUSE)

Mary consistently urged Paul to take his insulin and all of his medicines as directed. Out of love, she persisted, which caused strain in the marriage. His addiction to food, however, was stronger than his will to diet and exercise.

Paul learned some new ways to control the side effects of overeating from another diabetic who Paul noticed could eat anything he wanted—seemingly without the side effects of high blood sugar. If Paul wanted sweets, he ate what he wanted and then took a little more insulin. This turned out to be a bad idea over time, and his body responded with vision problems, neuropathy (a condition in which the blood vessels that supply the nerves are damaged), and, eventually, partial amputations of his hands and feet.

In 2000, Paul's kidneys failed, and he was placed on dialysis indefinitely. Marital fights ensued because Paul gave in to his cravings for ice cream, sodas, and other sweets. This was heartbreaking for Mary because she knew that these foods were killing him.

ACQUIESCENCE 2000 (KIDNEY FAILURE)

On August 17, 2002, Paul became ill due to renal failure, which required trips to the dialysis center three times a week, 4 hours each treatment, and daily hyperbaric treatments at UCLA for wound care for several weeks. Paul did not respect the disease until neuropathy claimed three fingers on his left hand, one finger on his right hand, and his left leg below his knee, and began affecting his right foot before his death. Additionally, the continuous dialysis treatments affected the circulation in his arms and hands, contributing to the loss of circulation to the fingers of both the right and left hands.

In 2005, Paul suffered a cardiac arrest and seizures during a dialysis treatment, and bit through his tongue. He went into a coma, and 3 weeks later Paul died from total system failure.

My cousin did not die in vain, and I hope his story will help some of the 20.8 million American (7% of our population) who have diabetes. According to the American Diabetes Association, however, more than one third of the 20.8 million do not even know they have the disease. I urge you to share this story with your diabetes supply customers, in hopes that they will understand the severity of the disease and treat it with the respect that it deserves. n

Thedford (Ted) Jones, Jr, is president, CEO, and cofounder of The Intelligent Business Network Inc (TheIBNetwork), Burbank, Calif, a health care consulting firm providing turnkey solutions for Joint Commission accreditation, policy and procedure development, financial management, and information technology. Jones has a degree in health care administration and experience in the areas of accreditation, managed care contracting, accounts receivable management, cash acceleration, and information technology architecture. He can be reached at .