Odds are high in South Carolina that, at this very moment, one of your friends or family members is living with a serious disease - and doesn't even know it.
At last count, nearly people (or of the Palmetto State's adult population) had been diagnosed with diabetes. Another of South Carolina's adult population had been diagnosed with pre-diabetes.
As high as those figures are, the key word in each sentence is "diagnosed" - meaning these are just the cases we know about. The actual number is likely much higher, with another adult South Carolinians estimated to be living with the disease and yet "unaware" of it, according to Diabetes Free SC.
"Diabetes is often an asymptomatic disease until it becomes pretty severe; people can go years without knowing they have it," said Anthony Schwab, MD, an internal medicine physician with the Columbia Medical Group. "It doesn't really have a lot of significant symptoms like some other diseases do."
Dr. Schwab sees the impact of this hidden killer every day at his practice - which is part of the care network at Lexington Medical Center, an award-winning Midlands-area hospital system.
"It may be something where people just have to go pee a little bit more than normal - or are a little bit more thirsty than normal," Dr. Schwab said. "People will usually chalk that up to the heat or they'll say 'I've just been drinking more water, so I'm peeing more.' It can be very subtle. So the actual number is probably higher."
November is Diabetes Awareness Month, making this the ideal time to take a closer look at this serious disease.
The numbers associated with this epidemic are truly staggering. Diabetes is the seventh-leading cause of death in South Carolina, and it disproportionately impacts black patients - who are more likely to die from it than whites. One in every ten emergency room visits in our state is diabetes related. While cost estimates are dated, as of 2017 total direct medical expenses related to diabetes topped annually. Another in losses were attributed to missed work, according to data (.pdf) from the American Diabetes Association (ADA).
Regardless of which measurement you use - loss of life, physical suffering or financial impact - diabetes is wreaking havoc across our state.
Here's the saddest part of this story: In many cases, these pernicious impacts are either preventable or treatable. First, though, let's start with the basics. Let's consider what's happening inside the body when diabetes goes undiagnosed.
"Two different processes are going on most of the time," said Dr. Schwab. "First, your body is usually just not able to produce enough of a hormone called insulin, which helps regulate your blood sugar. And then your body just doesn't respond as well to the insulin anymore, either. That's because you've probably had high sugar levels in your blood for so long. It's almost desensitized to it."
As diabetes slowly worsens, the damage it causes within the body increases.
"Over time, diabetes damages the blood vessels - and you see that come up in the form of heart disease, kidney disease and other serious conditions," Dr. Schwab said. "Diabetes is the leading cause of kidney failure along with contributions from hypertension. It can also cause issues with blood pressure because of the damage to the blood vessels. It puts you at risk for strokes as well as blindness because it also affects your eyes."
While these symptoms are noticeable once they hit, the key to effective treatment is noticing them before they hit - before they can cause irreversible damage or death.
"Diabetes does a lot of damage silently, which is why people need to get screened early," Dr. Schwab added. "The earlier we catch it, the better we can prevent these problems from occurring down the line."
Age and obesity can also factor into someone developing diabetes - and heredity plays an extremely important role, too.
"If you have a strong family history of it, even if you have a very healthy lifestyle you're still at an increased risk of developing it later in life," Dr. Schwab warned. "It's a process that happens over time, where your body is just not able to produce enough insulin and then it develops that resistance. So that happens at different rates for different people. And that often has to do with genetic predisposition, but it's also pretty heavily tied to lifestyle as well."
For those with diabetes, the combination of newer medications - and healthier choices - can work wonders.
"I've seen people prevent the development of diabetes with lifestyle changes as well," Dr. Schwab said. "Everybody associates diabetes with eating ice cream or candy or sodas or sweet teas. But a lot of times, it involves eating things that you don't think about - like bread, rice, pasta, and very carb-heavy foods that aren't sweet."
Being prescribed the proper medication is also critical to tackling the disease.
"An oral medication, like metformin, is very helpful in treatment," Dr. Schwab said. "It's probably the most common one. It's just a pill you take once or twice a day and it helps with the insulin resistance part and helps control those blood sugars."
While medicines are helpful, Dr. Schwab emphasized the biggest thing people can do is make those lifestyle changes - including increasing their daily physical activity.
"Being active - even if it's just walking for 20 to 30 minutes a day - starting small helps," he said. "And then making those dietary changes where you don't have to get rid of everything, but you do have to cut back. It's kind of that 'everything-in-moderation' approach. Those are all things that can help prevent diabetes."
J. Mark Powell is an award-winning former TV journalist, government communications veteran, and a political consultant. He is also an author and an avid Civil War enthusiast. Got a tip or a story idea for Mark? Email him at [email protected].