LaJaya Jenkins, a cherubic ten-year-old who loves math and milk chocolate, is having a hard time getting the figures on her blood sugar. It's a Sunday morning in September, and she is hunched over a glass-top table in her family's tidy Oakland apartment. The small gray monitor she's using doesn't seem to be cooperating. Since being diagnosed in August with "adult-onset" diabetes, LaJaya has had to test her blood sugar six to eight times a day, so she's well attuned to the various things that can go wrong. She repositions the small paper strip dotted with her blood and pushes a button on the monitor again. "Error," she says softly a moment later.
"Clean your hands," calls her mother, Lavinia Jenkins, from the kitchen where she's boiling water for instant oatmeal and finishing up a batch of bacon LaJaya started frying ten minutes ago. Lavinia, 29, hears every word her three children say even around corners or through walls. "My hands are clean, Mama," counters LaJaya, knowing even as the words pop out that she is lying. Her fingers are still shiny with grease from placing the strips of bacon in the skillet. She slides off the chair, its black vinyl cushion cracked to expose white stuffing, and ambles to the bathroom. She stands about five-foot-three, weighs 172 pounds, and looks like a smaller version of her mother.
LaJaya comes back in seconds, wiping her hands on her star-stamped blue shorts, fingers nimble as she plops back into the chair. Without hesitation she picks up the lancet -- a simple, mostly plastic device -- and pricks a finger. She touches the bead of blood to a new testing strip and inserts the strip into the monitor, sighing with relief ten seconds later when it reads 104, well within her healthy range of 80 to 130. Next, she plunges a skinny needle into a tiny jar of insulin and sucks up twenty units, then holds it up and flicks it a few times with an index finger to kill off any bubbles before sinking it into her right thigh. She doesn't flinch. She slowly presses the black plunger and watches the colorless liquid vanish. A box of two hundred orange-capped needles is stashed a few feet away in the hallway closet.
"Sometimes it, like, stings," LaJaya says afterward. "At night it's easier." Occasionally her mother delivers the injections in a pain-free stretch of skin beneath an armpit that's hard for her daughter to reach on her own, but mostly LaJaya injects herself. "Some mornings be so crazy that you don't be ready for it," Lavinia says of her daughter's daily schedule of tests and shots. "It's like you be waking up from a dream or something."
Before LaJaya's August 2003 diagnosis and eight-day stay at Children's Hospital in Oakland, she had no idea that the disconcerting symptoms she'd experienced over the past few years had anything to do with an actual illness, much less one that could kill her. She had heard of diabetes -- a boy in her class last year had it and injected himself at lunchtime -- but LaJaya assumed that her eyes were blurry because she needed glasses, or because she was tired, which seemed lately to be more and more often. In fact, her vision problem was her body's first warning about diabetes, an imbalance of the body's blood sugar that damages small blood vessels, including those in the retinas. Diabetes is the leading cause of blindness among adults, instigating as many as 24,000 new cases each year. It also is the sixth leading cause of death in the United States; its complications claim 200,000 lives annually.
LaJaya's blurry vision and dizziness came well in advance of her diagnosis. Such prediabetes, where the blood sugar is elevated and other risk factors are present but the disease itself hasn't fully developed, can last for several years. And not everyone with prediabetes acquires the full-blown disease -- weight loss and exercise can prevent or delay its onset by lowering a body's blood-sugar level.
So LaJaya didn't know why she got dizzy when she stood up, or why she was so thirsty all the time. She certainly didn't think it had anything to do with being overweight. She knew she was big, sure, but when she looked around she saw plenty of big people: her mother, her mother's fiancé, her fifth-grade teacher. Being large just seemed normal.
Lavinia wishes that her daughter's primary-care physician, whom LaJaya has seen annually since birth, had warned them about the consequences of childhood weight gain. The doctor always said LaJaya needed to lose weight -- the mother concedes that she could, too -- but he never mentioned the risk of diabetes or tested his young patient for it, Lavinia complains. If he'd been better informed he might have; blacks and Latinos are genetically more likely than whites to develop diabetes. Researchers haven't been able to pinpoint why, but research carried out by University of Southern California professor Michael Goran suggests that blacks are more likely than whites to carry a group of key genetic markers responsible for increased insulin resistance. According to the Centers for Disease Control, 11.4 percent of African-American adults twenty years and older are diabetic, compared to 8.4 percent of whites, and 8.7 percent of all adults in the United States. And the prevalence of Type 2 diabetes among Latinos is 1.5 times higher than among non-Latino whites. Statistics have not been compiled for minors -- which is perhaps why the possibility of LaJaya being diabetic didn't immediately occur to her doctor.
"'Lose weight, lose weight,'" Lavinia recalls. "That's all he ever said."
Americans today are being told to lose weight with increasing urgency. The CDC released a report in early March stating that obesity will soon surpass smoking as the nation's number one cause of preventable death. More than 60 percent of the adult population is overweight, with half of those medically defined as obese. The body mass index, a calculation of weight in relation to height, has replaced the old standard height- and weight-range charts as the best method of determining if a person is overweight. LaJaya's body mass index hovers around thirty; the CDC considers a child her age to be overweight with a value higher than nineteen. In the general adult population, anything above 25 is considered overweight, and higher than thirty is obese. Some school districts have even proposed taking such measurements to pinpoint at-risk kids.
African-American and Latino communities also face particularly high rates of obesity. The California Center for Public Health Advocacy published a report in 2002 showing that 29 percent of black and 34 percent of Latino children and teens in California are overweight, compared to 20 percent of their white counterparts. So not only do these groups bear a greater genetic risk of developing diabetes, but also a greater dietary risk.
For years, the drive behind telling young people to lose weight has been more social and aesthetic than medical. Judy Blume's perennial best-seller for young adults, Blubber, about an overweight girl's horrific hazing by classmates, paints a picture almost any child has witnessed firsthand. Parents know it as well as kids do -- overweight kids are teased, picked last in gym class, and made the class clown if they're accepted at all. But it has become dangerously clear that being overweight has far grimmer consequences than being picked on. After all, obesity is the biggest risk factor for developing diabetes. But it has become harder to fight in a world where fast food trumps the food pyramid, advertisers spend billions of dollars to get people to eat fatty snacks, and sixteen million Americans now have Type 2 diabetes.
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