Editor’s note: This story is part of an occasional series on top community health issues, as identified by the Ozarks Health Commission.
IN-DEPTH |
Weldon Farrar needed months, and help, to build a routine that allowed him to manage his diabetic condition. From cutting cheesecake out of his diet to accepting that what he had would be with him forever, there were major hurdles to clear.
The first was coming to grips with a diabetic diagnosis, a challenge a growing number of residents in and around Springfield are facing.
“It’s been difficult,” he said. “But I’m used to it. I can handle it now.”
And still, he said, there have been a handful of worst-case scenarios brought on by his condition during the two decades he’s had it. Once, he was driving down Highway 60 when his blood sugar bottomed out. None of his familiar advance warning signs — sweatiness, shakiness, anxiety — presented, and his vision began to double.
Headlights came at him in fours. Farrar pulled off the highway, ate some emergency Tootsie Rolls he had in the truck and emerged from a brief, but dangerous, daze.
“My consciousness was coming back, but I had no idea where I was,” he said. “Because I didn’t remember how I got there. It was just weird.”
Such is life with diabetes, where even someone like Farrar, who now meticulously monitors his food intake to keep his blood sugar levels balanced, can still get blindsided.
“The thing I hate about it is, I do have to do it,” he said. “And before, I never had a problem. I thought, ‘Well, I could go out in the wild and survive.’ And now I’m not one of those that can do that. I have to have my medications and my insulin. So that’s kind of hard to accept that. But it’s just part of life.”
What is diabetes?
Diabetes affects how a person’s body turns food into energy, according to the Centers for Disease Control and Prevention. It is a chronic, incurable health condition, but it’s one that can be mitigated by a healthy diet, active life and/or medication. The medication can come at a steep price. In 2020, 3.26 million Medicare patients spent over $1 billion out of pocket on insulin.
Insulin is naturally produced in the pancreas, and the CDC describes it as a key to “let blood sugar into your body’s cells for use as energy.” The body of a person with diabetes either can’t produce or can’t use insulin as others can. It means higher levels of blood sugar stay in the bloodstream, which can lead to heart disease, loss of vision and kidney disease, according to the CDC.
On the rise locally, diabetes is targeted as top 3 public health issue
Managing diabetes is becoming part of more and more lives in and around Springfield. Its prevalence has increased by about 30 percent since the Ozarks Health Commission released a 2019 report that assesses the top health issues facing the Springfield area, which includes Greene, Christian and Webster counties.
Why care? Diabetes is more prevalent in the Springfield area (Greene, Christian and Webster counties) than in all but two of seven Southwest Missouri counties tracked by the Ozarks Health Commission, according to the most recent CDC data included in the 2022 Regional Health Assessment report. And with locally high rates of obesity and other health and diet issues, you, or someone you know, may be at risk.
About 11.2 percent of residents in the three-county area have Type 1 or Type 2 diabetes, according to the 2022 report, released last spring. That percentage is higher than the broader seven-county Ozarks area, which is higher than the state, which is higher than the U.S. average.
The recent increase led top health officials here to move diabetes into its list of the top three public health concerns in the region.
The Community Health Assessment report serves as a starting point for the health care community to target ways to address the selected issues over the coming years, and that deliberation continues. While diabetes has ranked high in previous health assessment reports, it had never been one of the top three priorities until the latest report was released.
Diabetes can be brought on earlier or more difficult to manage due to poor physical health and obesity, and Springfield isn’t lacking in either category. About 31.8 percent of Springfield region residents are obese and 14.1 percent are in poor physical health, according to the report. Both numbers come close to aligning with Missouri’s overall rates, which are both higher than national averages.
When public health leaders gathered at the Springfield Art Museum last spring to explain the selection of the tri-county area’s top issues, Brandi Bowers avoided all the supporting data to justify the focus on diabetes. Instead, she described how diabetic conditions affect the day-to-day lives of patients she works with in her role as head pharmacist at the MSU Care Clinic.
“Your family notices it, your kids notice it, your coworkers notice it,” Bowers said in a follow-up interview. “And it’s because your physical health is not quite where it needs to be that day for whatever reason. Then, of course, that’s going to impact your mental health.”
‘Something’s wrong’
Whether it shows up early in life (type 1 diabetes, typically) or develops over time (type 2, which is by far the more prevalent of the two), diabetes wreaks havoc on the process of turning food into energy. And that in turn, Bowers said, affects everything — relationships, work, motivation.
Farrar first noticed health issues in 2004, at a point in his life when he was in great shape. He was 40 and working at Bass Pro’s Wonders of Wildlife, a job that involved diving to clean tanks that housed creatures like an alligator snapping turtle.
When he wasn’t swimming, he was handling snakes. Kids would ask if the 6-foot kingsnake wrapped around him was poisonous, and he’d joke that he probably should have checked before the show. When he wasn’t at work, he was often canoeing or doing something else outdoorsy. But he started to notice exhaustion set in as soon as his shifts ended.
Before working at Bass Pro, he’d gotten his EMT license. Between that and having a grandmother with diabetes, he knew that chronic fatigue was a symptom, and he told his doctor as much during a routine physical. His blood pressure was high, which concerned his doctor, and Farrar got a prescription for that. But after his doctor measured his fasting blood sugar level at 112 mg/dL, Farrar said he was nonplussed.
“He said: ‘That’s not too bad, but it’s kind of high for fasting. It’s considered prediabetic,’” Farrar recalled. “He says: ‘We’ll wait three months, and we’ll test you again.’ Well, during that three months, it progressed a lot.”
Farrar would go home from work, eat dinner and collapse. He would only get up to use the bathroom — three times a night. Over time, he noticed his wetsuit didn’t fit like normal. It was loose. At the next appointment, Farrar said his doctor was more focused on how the new blood pressure medication was working.
“And he was ready to show me out the door,” Farrar said. “And he goes, ‘I wouldn’t worry about the prediabetic (issue); people can be prediabetic for years.’ And I said, ‘No.’ I said, ‘Something’s wrong.’ I said I have all the symptoms. And I said I didn’t realize I’d lost so much weight until your nurse just weighed me, and I went from 185 to 165 in just a few months. He looked and said, ‘Yeah, you have lost weight. We’ll do a test.’ And then he did it, and it was 300 (mg/dL). That’s when I knew for sure.”
Farrar, now on Medicare, is doing well. He has access to medication and has developed methods to manage diabetes that work for him. He keeps mini PayDay candy bars in his truck to avoid incidents like the one on Highway 60. The sugar and protein in the chocolate and peanut candy bar provide a balanced response to a sugar crash, he said. He learned a lot of his strategies from the team at the MSU Care Clinic, he said during an interview there last year.
The clinic, located on the Missouri State University campus, provides primary health care services for uninsured, low-income patients ages 18-64. About a quarter of the patients are diabetic, said Bowers, who is a clinical assistant professor at the University of Missouri-Kansas City’s School of Pharmacy at MSU. It’s a condition that disproportionately affects low-income communities, and over a fifth of Springfield’s population lives below the poverty line, according to Census figures.
Stigma that people with diabetes ‘did something wrong’
“The (stigma is) that diabetes only happens in this space where someone has neglected — willfully neglected — their food choices, and their exercise routine and their body. When in reality, diabetes is really multifactorial, and just painting it that black and white takes out the humanity of the thing, which is that some people can’t access those things,” Bowers said. “The idea that diabetes is because you did something wrong — whatever that may be — and that because you’ve now done this wrong thing, you’re being punished with whatever therapy you need, I think is the biggest stigma associated with it.”
Bowers and Jaime Gnau, the clinic’s dietetics instructor, team up to offer patients medicinal and nutritional advice during the same visits. Since the pandemic, when a person with diabetes said he wasn’t able to go to the grocery store to get healthy food, the clinic has partnered with Ozarks Food Harvest to offer take home boxes, complete with recipes.
The clinic, run by Mercy, provides care, supplies and medication to patients for free. Last year it also added a behavioral specialist intern from Burrell Behavioral Health. Bowers said the goal is to provide a lot of opportunities to remove barriers to care for patients during a medical appointment, an event when people are often seeking to learn about and improve their health.
“Our patients will very frequently say that you, the clinic, or my provider, has done so much for me, and we always respond with, ‘You’ve done all the work,’” Bowers said. “We’ve just given you the tools. And it’s very, very fulfilling to be able to give people the tools they need to do the work, because so many of our patients want to be healthy. But they just can’t identify — even if they can name the barrier — they can’t identify a way around the barrier.”
Farrar said the clinic helped him at a time when he was in-between jobs and uninsured. He first went there after losing a job in the spring of 2017. With no insurance or income, he needed help to get medication.
“This place was a godsend because I don’t know what I would have done,” he said. “I could not be without my medication. It’s just something you have to have when you have diabetes, and high blood pressure, so this place really helped me a lot. I’m very grateful to them.”
In the process of getting help from the care team, Farrar said he also found direction.
They told him to start a journal of what he ate every day. For someone who used to eat whatever he wanted and work it off, it was a seismic behavior change.
“It has helped me tremendously, it really has, mostly because ever since I found that I had diabetes, I had a negative attitude,” he said. “I hated it. But I wasn’t really keeping on top of it. And so I had a bad attitude about it. But when Jaime and Brandi started talking to me about ways of trying to control it, I started taking their advice, I started keeping a log of what I was eating, trying to keep track of the carbs and also other medications and stuff.
“And then I started seeing some results. And I thought, well, I guess I can do this. And now it’s to the point where I don’t keep a log. I just keep track in my head of what I eat. And I keep track of the carbs of whatever I’ve eaten. I check carbs on everything.”
But it took a while to get there. Asked what his initial reaction to the diagnosis was, he said he was devastated.
“Something was wrong with me that I couldn’t take a pill to get rid of,” he said. “It really bothered me quite a bit.”
Bridging gaps between people and resources
Diabetes runs in Glenda Brandon’s family, and the longtime CoxHealth employee said it cost her late aunt her eyesight and decades of life. Her older sister has it too, and she has combated it with rigid focus.
She walks three miles every day no matter the weather — half in the morning, half at night. When they get together for dinner, Brandon said a “buddy system” is in effect to make sure she limits her French fries to two or three before it’s back to salad. She can tell when her blood sugar level is running high or low, Brandon said, and she’s always got peanut butter and medication with her in case of emergency. “She’s so driven and conscious with it,” Brandon said.
Family members who have struggled with diabetes and family members who have sacrificed because of it both inspire Brandon, 59, to get regular checkups and bloodwork done and exercise three times a week.
“I make sure that my numbers are not going the wrong directions, because I am conscious that this is not one of the things I want,” Brandon said after attending a workshop called The Truth About Sugar. “Because it affects too, too many things.”
Brandon said she attended the meeting on behalf of parishioners with diabetes who worship with her at God’s House of Glory. She said bringing more events like the workshop to churches and community centers across Springfield could put healthy habits on more radars before diabetic conditions develop, or before people learn their diagnosis. According to the CDC, one in three Americans has prediabetes, and about 80 percent of that third of the population doesn’t know it yet. And Black Americans are 60 percent more likely to be diagnosed with diabetes when they visit their doctor, and over twice as likely to need a lower limb amputated as a result of having diabetes.
The Jan. 21 workshop at the Holland Building was led by Melesha Bailey, owner of Love 4 Life Wellness and a founder of the SpringMO Black Wellness Initiative. Bailey said she helped create the group last year to get more of Springfield’s Black residents to prioritize their health care.
Asked what Springfield’s public health community could do to help improve diabetes rates here, she advocated for support of outreach programs that meet Springfield’s diabetic populations where they are to help them. Springfield has community gardens, trails and health workshops among its resources, Bailey said. However, she added, “A lot of times, people don’t know that these resources exist. And another thing is, if you don’t see people like yourself in these facilities, a lot of times Black people don’t want to go to the doctor. They don’t feel heard and they don’t feel respected.
“You’ve got to be able to find people that look like you, that speak like you, that can pour into you. And I think that’s where resources need to be.”
Bailey, who is also the wellness director at the Ozark Regional YMCA, said she got serious about her health six or seven years ago. Diagnosed with fibromyalgia, Bailey said one of her coping mechanisms to deal with the chronic pain was processed, sugary food.
“It was like a medicine to me,” she said, an addictive one. It was omnipresent in her diet, she told the full conference room, and was likely a far greater part of theirs than they realized. Bailey said she got her wake-up call when her doctor told her she was prediabetic.
“And I’m like, ‘No, I’m not going to let myself die by what I put in my mouth,’” Bailey said. “From that point on is when I made a decision that I can do this. And I made a decision that I’m not going down that road. I just refuse.”
She enrolled in an online health coaching certification program, she said, to learn how to take care of herself. After finding success for herself, she started her health coaching business, and expected to help coach people who wanted to lose weight. She’s found instead that many of her clients in Springfield primarily want help managing their diabetic conditions.
“And it’s hard,” she said. “Because it’s a mindset thing. You’re telling people, ‘(You) can’t eat cookies, and can’t eat candy.’ But the goal is to give people better alternatives and tell people, ‘If you keep doing this, you’re going to be on medication.’ You give them the reality. You can start losing toes. You could start getting your legs amputated. And so sometimes when people are shocked with the realities of what could happen, then they’re like, ‘Okay, I don’t want to do that.’”
Springfield City Councilmember Monica Horton, who represents the city’s northwest side, attended the event and told Bailey and the group that awareness efforts like the workshop are “huge components” of educating and helping some of the Springfield residents most affected by diabetes. Horton, who has a prediabetic condition, said she is all too familiar with the experience of finding out a relative’s blood sugar levels were “through the roof” during checkups. Seeing so many family members have diabetes, and cope with it, can sometimes create a false sense of security.
“Well, so and so has had it for so long, and it’s in my blood, right?” she said. “So therefore, maybe this is something that we just supposed to live with.”
Fatalism is a shared trait among many of Bailey’s clients with diabetes, she said
Bailey tells her clients that their genetic predispositions don’t mean they have to get diabetes too. Nor does it mean they have to suffer from it or die because of it, she said. For people with diabetes or any chronic illness, Bailey’s challenge is “to help them to change their mindset about who they are, what they mean to this world, and that they can be better and that they don’t have to be sick,” she said.
“Sometimes it’s really hard.”
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