Doctor’s fight against diabetes is personal

When he was 15 and attending junior high in Los Angeles, Steve Edelman was often reprimanded for falling asleep in class; then he’d have to make a beeline to the restroom to urinate, and finally to a drinking fountain to try to satisfy an unquenchable thirst.

Plus, he had scrapes and sores that took forever to heal, his vision became blurred, he lost weight and was continually tired, often tumbling into bed immediately after school and not waking up until the next morning. Finally, Edelman ended up in intensive care, and he was diagnosed with type 1 diabetes - something that later determined his life direction.

When Edelman became a doctor, he opted to specialize in the care and treatment of patients with diabetes, a treatable disease with no known cure that has grown to epidemic proportions in the U.S.

Several weeks ago, Edelman, now 53 and a local resident, was presented with the American Diabetes Association’s 2009 “Outstanding Educator in Diabetes Award” at the ADA’s 69th Scientific Sessions in New Orleans. He was the first medical doctor ever to receive the award.

Edelman, a diabetic for 39 years, is a professor of medicine at UCSD, director of the Diabetes Care Clinic at the VA Medical Center and founder/director of the nonprofit Taking Control of Your Diabetes (TCOYD) in Del Mar.

His message to anyone who will listen is: It’s never too late to take control of your diabetes, even if you already have complications.

Initially, Edelman spent a lot of time and energy trying to educate primary care physicians on the latest and best ways to care for patients with diabetes. He organized conferences, gave lectures and published articles.

“The problem was,” he said, “it took many years for the information to be translated into clinical usage.
“I witnessed many situations in which terrible complications due to diabetes could have been avoided by simple tests performed at the right time along with correct therapy.”

Today, he is still spreading the word at 11 major TCOYD conferences annually across the U.S., on a Web site, in newsletters, and on TV. He’s directed his message not only to doctors, but, perhaps even more importantly, to patients and their families.

“I truly believe that the most efficient and effective way to improve diabetes care in this country and around the world is to educate and motivate people living with diabetes to take a more active role in their health care,” he said.

Self-advocating, knowledgeable patients able to communicate effectively with their doctors are the keys to improved diabetes care and treatment, Edelman insists.

Edelman was born in Hollywood, Calif., and raised in Los Angeles, and as a child, wanted to become a dentist like his family dentist who let him select toys from a treasure chest. But after he was diagnosed with “juvenile” type 1 diabetes and became an expert at pricking his fingers for testing his blood sugar several times a day and giving himself insulin injections, he decided to study medicine.

Nothing came easy, though.

“I didn’t have very good study habits in high school, but when I went to UCLA as an undergraduate, I spent probably 16 hours a day either at class or in the library because I was the kind of guy who had to study five hours to get an ‘A,’ and I might not even get an ‘A,’ compared to someone who may study two hours and get a higher grade than I would. I really wanted to be a doctor.”

He completed his undergraduate degree in biology and master’s in physiology at UCLA, then went on to earn his medical degree at the University of California, Davis, in 1982, followed by a residency in internal medicine at UCLA - San Fernando, a clinical fellowship in diabetes and metabolism at The Joslin Clinic in Boston, a research fellowship in endocrinology and metabolism at The Lahey Clinic in Burlington, Mass., and an additional research fellowship in diabetes and metabolism at UCSD.

It was at the Joslin Clinic in Boston that he met his future wife, Dr. Ingrid Kruse, who was training to be a podiatrist specializing in the treatment of diabetes-caused foot problems. They have been married now for 22 years and have two daughters.

Edelman was recruited back to UCSD, where earlier he had a research fellowship, and the UCSD-affiliated Veterans Affairs Hospital, in 1991 after a brief stint in a private practice in Portland, Oregon.

“I didn’t like private practice,” he said. “All the managed care stuff was starting to come in and I didn’t like it because I couldn’t treat patients the way I was trained. I couldn’t give them the best care possible.”

Even today, a pet peeve of Edelman is the way health insurance companies, focused on their bottom lines, create obstacles that prevent diabetes patients from getting proper medications or devices or even “getting to a caregiver who is up to snuff on diabetes.”

“I spend 25 percent of my time fighting insurance companies to get my patients the things they need,” he said. “It’s so frustrating.”

But, he added, “If patients are constructive and persistent, they can usually get what they want 85 percent of the time. The insurance companies rely on people giving up.”

There are two main types of diabetes: juvenile or type 1, which results from the body’s failure to produce insulin, the hormone required to turn sugar and other foods into energy; and type 2, more prevalent in adults, which results from an insulin deficiency or the body’s inability to use insulin effectively.

Both types are treatable with laboratory-produced insulin and, in early-diagnosed cases of type 2, with oral medications until their effectiveness wears off.

The American Diabetes Association reports that in 2009 an estimated 23.6 million children and adults (7.8 percent of the population) have diabetes and an additional 57 million Americans have pre-diabetes.

Type 1 diabetes, which predominantly occurs before the age of 20, results from antibodies inexplicably attacking and destroying the pancreas, the internal organ near the stomach that produces insulin. “When that happens, you have to be on insulin for the rest of your life,” Edelman said. The cause of type 1 is not entirely known, but, for some [genetic, viral or environmental] reason, antibodies are produced that mistakenly identify the pancreas as a foreign body that must be destroyed. Only about 10 percent of all diabetics in the U.S. have type 1.

Persons with type 2 or adult-onset diabetes are commonly overweight and have high blood pressure and abnormal cholesterol levels at the time of diagnosis.
It is often diagnosed in certain ethnic groups such as African Americans, Native Americans, Asian Americans, Pacific Islanders and Hispanics.

“The incidence and prevalence of type 2 diabetes is skyrocketing around the world because if you have the genetic susceptibility for type 2, there are a couple of things that really bring it out: sedentary life style and obesity,” Edelman said. “And because our society is getting heavier and less active, that’s the main reason why we’re seeing such a huge increase. Over 6,000 people a day in the United States are diagnosed with diabetes.”

Complications from either type can be serious, such as cardiovascular disease, foot diseases sometimes ending in amputation, chronic renal failure, nerve damage and retinal damage that can lead to blindness.

In his own case, Edelman said early years of poor control and not receiving appropriate treatment resulted in several diabetic complications.

In his book, Taking Control of Your Diabetes, he revealed: “I have … an advanced form of diabetic eye disease and I have received extensive laser surgery to both eyes to stabilize the problem. I have diabetic kidney disease [resulting in] high blood pressure for which I take three different medications to control the situation. I also have some manifestations of diabetic neuropathy [slight numbness in my feet] and problems with my stomach [gastroparesis].

“The good news is that I sought out good diabetes specialists, such as doctors Mayer Davidson and Richard Berkson, and started to receive the appropriate treatments to minimize and slow down the progression of these complications.”

Edelman endorses the idea of universal health care, but cautions, “It has to be done in a different way than has been attempted in other countries if it’s going to be successful.”

In drafting such a plan, he would hope the federal government would investigate the systems used in other countries to determine what works and what doesn’t and would seek input from doctors at universities and the general medicine doctors “in the trenches.”

More information on TCOYD is available at www.tcoyd.org or at the TCOYD’s Del Mar office, 1110 Camino Del Mar, Suite “B”; Tel. (858) 755-5683 or (800) 998-2693; Membership in TCOYD is $20 annually.

Tags: Arthur Lightbourn, Diabetes Care Clinic, Dr. Steve Edelman, juvenile diabetes, SDNN, Stevel Edelman, Taking Control of Your Diabetes, type 2 diabetes, type diabetes

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