Spending New Year’s Eve 1996 in an urgent treatment center wasn’t in Steve Coffman’s holiday plans.

A former Army quartermaster, Coffman usually was the picture of good health, running in marathons and countless shorter road races. Even family vacations centered on exercise. Coffman and his wife Joyce had hiked through the Tetons and across a glacier in Montana.

"It was a shocker," Coffman said. "I’d been training over the Christmas holidays, and one day, ran 10 miles with my stepdaughter. The next day, I started feeling sick and I thought maybe I’d overexerted myself."

Within a few days, Coffman, a University of Kentucky Chandler Medical Center facilities planner, knew something was seriously awry. He’d lost a substantial amount of weight, which was coupled with constant urination.

"I knew that was a bad sign," he said. "On New Year’s Eve, I finally went to the urgent treatment center. My blood sugar was over 500 milligrams per deciliter (mg/dl) and I was diagnosed with Type 1 diabetes."

If he’d gone without treatment, Coffman was at risk for going into a diabetic coma, said UK Diabetes Program Director Dennis Karounos, M.D. Normal blood sugar levels range from 80 to 100 mg/dl in people without diabetes. Diabetes is diagnosed if fasting plasma glucose exceeds 126 mg/dl.

More than five million people in the United States have this potentially fatal disease, but have not been diagnosed.

"There are two major types of diabetes," Karounos said. "Type 1 used to be considered juvenile diabetes because most people develop it by age 20. Type 2 diabetes affects 90 percent of people with the disease."

Some people have genes that predispose them to Type 1 diabetes. Coffman knew of no family diabetes history, but one year after his diagnosis, his brother also developed the disease.

Researchers at UK are studying the way the immune system is triggered in Type 1 diabetes.

"Viruses are the strongest implicated cause," Karounos said. "We’ve done research that shows exposure to German measles during pregnancy actually can increase the risk of the child having diabetes 20 to 40 fold."

The German measles virus has a protein with a similar structure to insulin secretory granule protein, Karounos said.

"The immune system thinks it’s destroying the German measles virus, but it actually destroys the insulin-producing cells -- it’s a case of mistaken identity," Karounos said.

Because the immune system destroys all of the insulin-producing cells, Type 1 diabetes patients absolutely are dependent upon insulin to sustain life.

Type 2 diabetes affects more than 180,000 Kentuckians. Risk factors are obesity, inactivity and eating a high-fat diet -- common to many lifestyles in the region.

"There also is a stronger genetic component to Type 2 diabetes -- if one identical twin has the disease, then there’s a 90 percent chance that the second twin will have it," Karounos said.

Type 2 diabetes is caused by three factors: insulin resistance, when the patient’s body becomes resistant to the effects of insulin; excessive glucose production in the liver, probably a consequence of insulin resistance; and as a result of these factors, the pancreas tries to make extra insulin to regulate blood sugar, but finally fails.

Should you be concerned?

"Fifty percent of people with Type 2 diabetes go undiagnosed. They often develop complications, such as an unhealed foot wound, fatigue, excessive urination, weight loss or numbness in hands and feet because of nerve damage," Karounos said.

Some patients are not diagnosed until another illness brings the diabetes to a physician’s attention, such as heart disease, stroke or high cholesterol. Women who have a baby of large birth weight also are at risk.

"Everyone over age 45 should have a plasma glucose drawn at a physician’s office to test for diabetes," Karounos said. "People with family members who have Type 2 diabetes or who have risk factors should be tested earlier."

There is good news for people diagnosed with either type of the disease. Five medications now are available to treat the Type 2 diabetes. Smaller insulin injection pens help individuals with Type 1 diabetes with daily insulin shots. Many new devices for monitoring blood glucose are undergoing clinical testing. But even fancy technology won’t work without good education, Karounos said.

"At the University of Kentucky, we have a diabetes education program that has been recognized by the American Diabetes Association," he said. "About 80 percent of the people completing our program have 20 percent improvement in their blood sugar control."

Coffman is one patient the program helped. "I had a hard time dealing with it at first because of my physical fitness level," he said. "I kept saying, ‘why me, why me?’"

Hard work and support from family, friends and staff helped him through the first six months of stabilization.

"Steve participated in the UK Diabetes Education Program and has kept his diabetes under excellent control, monitoring it frequently and taking insulin injections with an insulin pen," Karounos said. "He maintains an active lifestyle and has reduced his risks for long-term complications by keeping his blood glucoses under such good control."

Two years after diagnosis, Coffman keeps in prime shape with a disciplined regime of running during his lunch break six days a week and cross training with bicycling and weight lifting. He still runs races, and he and Joyce hiked to the Colorado River at the base of the Grand Canyon in 1997.

"The payoff has been tremendous," Coffman said. "I feel good almost all of the time."

Data compiled and edited by The Lane Report.
Source: University of Kentucky Chandler Medical Center.