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The Honolulu Advertiser
Posted on: Thursday, September 11, 2008

DIABETES DAY 5: PREVENTION
You can save your own life by taking control of it

Photo gallery: Keeping diabetes at bay

By Dan Nakaso
Advertiser Staff Writer

Hawaii news photo - The Honolulu Advertiser

Natividad Prescott, 76, has a history of diabetes but no longer needs to take daily insulin injections because she controls the disease through diet and physical activity.

BRUCE ASATO | The Honolulu Advertiser

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TODAY’S PRIMER


Type 2 risk factors

• Over age 45
• Overweight or obese
• Family member with diabetes
• Asian American, Pacific islander, Alaska native, American Indian, African American, Hispanic
• Gestational diabetes or gave birth to a baby weighing more than 9 pounds
• High blood pressure
• HDL cholesterol —“good” cholesterol— levels below 35 mg/dl, or triglyceride levels above 250 mg/dl
• Exercise less than three times a week
• History of cardiovascular disease
• Impaired glucose tolerance or
impaired fasting glucose at previous testing
• Clinical conditions associated with insulin resistance, such as acanthosis nigricans
• For women, polycystic ovary syndrome, also called PCOS.
Lowering your risk

• Reach and maintain a reasonable body weight
• Make wise food choices
• Be physically active every day
• Lower blood pressure and cholesterol levels
• Take prescribed medicines
Source: National Diabetes Information Clearinghouse Resources


DEATHS

Diabetes was the seventh-leading cause of death listed on U.S. death certificates in 2006. This ranking is based on the 72,507 death certificates in 2006 in which diabetes was listed as the underlying cause of death. According to death certificate reports, diabetes contributed to a total of 233,619 deaths in 2005, the latest year for which data on contributing causes of death are available.

Diabetes is likely to be underreported as a cause of death. Studies have found that only about 35 percent to 40 percent of decedents with diabetes had it listed anywhere on the death certificate and only about 10 percent to 15 percent had it listed as the underlying cause of death.

Overall, the risk for death among diabetics is about twice that of other people of similar age.
Source: U.S. Centers for Disease Control and Prevention

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Hawaii news photo - The Honolulu Advertiser

Larry Lands, 56, has had type 1 diabetes for 46 years. He hooks himself up to the dialysis machine in his bedroom every night. For exercise, he put in an “endless pool” system where he swims laps against the current.

GREGORY YAMAMOTO | The Honolulu Advertiser

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Hawaii news photo - The Honolulu Advertiser

Tennis regulars, from left, Natividad Prescott, 76; Harry Mau, 72; Nova McKenzie, 70; and Roy Nashiro, 59, “high five” each other after their morning match at Wai'anae Regional Park. Many of the regulars have physical ailments that motivate them to exercise regularly to stay healthy.

BRUCE ASATO | The Honolulu Advertiser

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NANAKULI — Overweight and resigned to whatever fate lay before her as a diabetes sufferer, Natividad "Natty" Prescott is convinced that her life was only saved by the love of a good man.

At the age of 69, Prescott had given up trying to manage the type 2 diabetes she had lived with for 40 years, even though she was a retired nurse who knew better. Not even the pleas of her daughter or two granddaughters to lose weight, eat right and manage her insulin made a difference.

"I was hard-headed," she said.

Then eight years ago, she returned home from the Sacramento area for her Leilehua High School 50th reunion and caught the eye of former Mules quarterback Bill Prescott, who changed her life.

After a few dates, Bill proposed in December 2000 and days later mustered up the courage to add a condition:

"He said, 'I'd like to live a long, long time with you,' " Natty remembered. " 'If you don't take care of yourself, I may lose you in a matter of five years. God willing, maybe we can have a 25th anniversary.' That's when I opened my eyes."

It's always up to patients to decide whether to control their diabetes or let their diabetes control them, said Natty's primary care physician, Dr. Ben Chun of Kaiser Permanente's Nanaikeola Clinic in Nanakuli.

"The main difference between her and people who don't take care of themselves is she's the one in charge," Chun said. "We have a diabetes care team but she said, 'These people are here to help me, but I have to do it myself.' "

It's that kind of attitude that 56-year-old Larry Lands believes has allowed him to keep his eyesight and left foot.

He was 10 years old when he was diagnosed with type 1 diabetes, the same disease that killed Lands' father at the age of 50.

"I've worked my backside off all my life," Lands said. "I love my life. I love being here. I can tell my life story and make people laugh or tell my life story and make people cry. I prefer to make people laugh."

His Kaiser Permanente primary care physician, Dr. Paul Laderta of the Waipi'o clinic, calls Lands' case "one of the more severe cases of diabetes type 1 I've seen."

"To Larry's credit, he's also one of the best patients when it comes to managing his disease," Laderta said. "Larry is one of those patients who takes total control of his care. Larry has done his homework and asks the right questions. Attitude is very, very important. Patients with the best attitudes who take control of their disease do much better."

MALIGN NEGLECT

That was hardly how Natty Prescott dealt with her diabetes most of her life.

She was born Natividad Luna because she was born on Dec. 26, 1931, in a Del Monte pineapple field of the old Camp 84.

In high school, the girl known as Natty reached barely 5 feet tall and weighed maybe 95 pounds — "just your skinny Filipino girl," she said.

By statehood in 1959, Natty had become a nurse in the Sacramento area. Her sister was dying of cancer, and her marriage of 35 years was falling apart.

"I couldn't take it," she said. "I believe extreme stress set it off, because diabetes doesn't run in my family."

Her weight shot up to 152 pounds. She was thirsty and tired and felt the constant need to urinate.

"Oh, God, I could still eat," Natty said. "I was eating all the time. Even being a nurse, you never think you have diabetes yourself. Don't ask me why, but it was the farthest thing from my mind. I just thought something was wrong."

By the time she went to a Kaiser emergency room, "I was sick, throwing up, confused and sweating all the time. When they said the word diabetes, I didn't like it one bit. I've seen people with diabetes, and I was scared. 'It can happen to someone else, but not me.' That was the attitude I had. I thought at the time, 'I'm going to get over it,' even though I knew there was no cure."

After her sister died in 1960, Natty did not manage her insulin and also developed shingles — from all of the stress, she thinks.

"I gave up taking care of myself," she said. "I was living alone and just didn't care."

Where her blood glucose levels should have been somewhere around 100 milligrams per deciliter, Natty's regularly zoomed from 300 to 500.

"I just didn't care," she said. "So I didn't take care of myself. They told me exercise, diet, medication, but those things didn't sink in. I didn't care how I looked. I didn't care to lose weight. A lot of people were plump, and I was just one of them. For 40 years, I just got by."

A GOOD INFLUENCE

Then the old high school quarterback sat next to her at the Leilehua reunion.

"In high school, he was this quiet, laid-back person," Natty said. "He was very popular with everybody, and the girls were in love with him, because he was very handsome. How come I didn't go goo-goo over him? He's half haole, half Hawaiian and I only dated Japanese boys, because they had cars and they could afford a carnation lei."

By their reunion, Bill had retired from the Army as a sergeant first class and a subsequent career as head operator at the Chevron refinery.

After a couple of dates, Natty returned home to California while Bill stayed behind in Nanakuli, secretly reading up on diabetes.

"When I came back and I'd pig out, he'd say, 'You shouldn't be eating this and that,' " Natty said. "He was nagging me, and I should have dropped him. 'Who are you to tell me? It's my life. It's not yours.' But he was serious because he knew he was going to marry me. He knew what he wanted, and he went after it. He became my conscience. I was so used to eating cake and ice cream, and when we went out on a date, he'd just take it away from me. He said, 'It's poisoning your body.' If I had left him and stayed fat, I would have been a bilateral amputee by now."

And when Bill told Natty that she had to lose weight and eat better following his proposal, "I could hear the sincerity in his voice because he meant well and he cared," Natty said.

'I WILL TRY'

They were married in May 2001 at the Ko Olina Resort & Marina.

"When you're 69 years old, what are you going to do? Wait another 10 years?" Natty said. "I said, 'I will try.' That's when I started seeing my doctors seriously. I don't think I would have lasted 76 years if it wasn't for him."

She gave up her beloved Coke — "I was addicted to it" — cut way down on ice cream and cake and her favorite carbs, like french fries.

For the last four years, she's been totally weaned of her twice-daily insulin injections and now takes insulin pills.

She also plays tennis three times a week and has her weight back down to 110 pounds.

"I promised God I would be good," Natty said.

"Her story is a great inspiration," Dr. Chun said. "She had doctors telling her for years to take care of herself, but it took somebody else to say they care for her. And that's what did it for her. It was inside her to begin with. That's the message to everyone: That power to change lies within everybody."

A STRATEGY FOR LIFE

For most of his life, Lands has always looked to his own power.

Lands' sister, who is one year older, also was diagnosed at age 10.

"They tell me that I'm in the last two-tenths of 1 percent that are still above ground at this point," Lands said. "If my sister and I both make it just four more years, we'll become only the second siblings in history to make 50 years as type 1 diabetics."

When he was a child, Lands had to boil water to sterilize his insulin needles, which were injected via glass syringes. Where diabetes sufferers now can test their glucose levels on the spot and get instant results, Lands and his sister had to go to the hospital and wait 24 hours for their results.

"In other words, it was totally, completely useless information for taking care of yourself," he said.

Lands was only slightly better off than his father, who was diagnosed with type 1 diabetes during World War II after spending three days on a troop train eating nothing but candy bars.

"That's when his diabetes showed up in full force," Lands said. "There was very little knowledge about diabetes in that day and age."

He died at age 50 when Lands was in junior high school. And when Lands made his 50th birthday, "it was a gigantic milestone. When I was born, the average lifespan for a type 1 diabetic was about 14 years."

'IT'S GOOD TO SEE YOU'

Lands has fought to keep up a positive attitude despite several medical scares.

Eight years ago, he underwent quadruple bypass surgery. Six years ago, he developed a blister while stepping off a treadmill that ended up infecting the bone behind his left little toe.

Impaired circulation that's so common among those with diabetes meant that Lands couldn't feel pain in his foot, and problems piled up for four long years.

"It didn't actually hurt because I can walk on a completely bloody foot and I won't feel it," he said.

His condition worsened to the point that doctors wanted to amputate his foot, "but I was too stubborn for that," Lands said.

Over a 15-year period, Lands also underwent 10 eye surgeries.

"When I say it's good to see you, I really mean it's good to see you," Lands said.

During the day, he stays in shape by swimming against the blast of an "endless pool" in his Royal Kunia backyard. At night, Lands connects himself to a peritoneal dialysis machine in his bedroom.

"Diabetes crushes some people and inspires others," Lands said. "I didn't have any control over the hand that was dealt me. The only thing I could control was the way I played my hand."

Reach Dan Nakaso at dnakaso@honoluluadvertiser.com.