After being diagnosed with diabetes, every meal became a complicated math lesson.

Barbara Goldsmith had to become vigilant about everything she put in her body. The Edinburgh resident meticulously counted carbohydrates, too many of which can spike her blood sugar level and wreak havoc on her body.

She calculated how much she has eaten, and immediately following a meal, factored in housework, gardening or some other activity so that her sugars don’t rise to unsafe levels.

On top of the four different medications she takes, diabetes has shifted everything in Goldsmith’s life. But changing her lifestyle has been her only option.

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“Watch what you eat and how much you eat. If you have medication, take it. Watch your sugar, and try to stay active. Those are the main things,” she said. “I don’t know what would happen to me if I don’t do that.”

More and more Johnson County residents such as Goldsmith are living with diabetes or are on their way to developing it in the future. The disease has become worryingly more prevalent throughout Indiana, growing by more than 50 percent from 2000 to 2009.

Battling the growing epidemic has required a multi-faceted approach. Health officials have focused on educating patients about ways to avoid the disease, stressing diet and exercise, and teaching how the sugars we consume impact the body.

The hope is to stem the increase of new cases, while helping people already diagnosed live healthier and minimize the impact.

“Diabetes is a global epidemic. It’s out of control,” said Dr. Gaston Dana of Johnson Memorial Internal Medicine Specialists. “Once you develop it, you have it for life. By realizing that you can make changes in lifestyle that can significantly impact that, you can possibly stop that.”

Diabetes is broad term for diseases characterized by high levels of glucose, or sugar, in the blood. The disease is caused by defects in insulin production, how insulin acts in the body, or a combination of both. Insulin is a hormone necessary for the regulation of blood glucose levels.

When insulin production and action in the body works improperly, complications such as heart disease, stroke, amputation and blindness can occur. At its worst, the disease can cause death.

The disease can come in varying forms. Type 1 diabetes occurs when the immune system attacks beta cells in the pancreas, the only cells in the body that make insulin to regulate glucose.

Type 2 is the more common form, accounting for between 90 and 95 percent of all diagnosed cases of diabetes. The body’s cells start resisting insulin and not using it properly, which eventually causes the pancreas to lose the ability to make it.

Diabetes levels in Indiana, particularly Type 2, have risen sharply since 2000, climbing from 6 percent of the population to 12.9 percent. In Johnson County, 11 percent of people have the disease. Treating diabetes costs Indiana $6.6 billion in medical costs each year, according to the American Diabetes Association.

“I would say it’s over 50 percent of our patient population that is dealing with diabetes,” Dana said.

Many of those people are referred to the Diabetes Care Center at Johnson Memorial Health, where specialists help patients adapt to what is a consuming and jarring diagnosis.

“No one wants to have this diagnosis. Probably 50 percent of the people who sit in front of me are angry and in denial,” said Carla Duncan, a registered nurse at the Diabetes Care Center. “They’re not hearing a word that I say, so you have to find a way to connect to them.”

The staff works to ensure their patients understands what their disease is and what they’ll be going through. They explain the genetic factors of the disease, how things such as being overweight, skipping meals or smoking can turn the hereditary aspects of diabetes on. Medication and how it can impact the disease is also covered.

The key is to help people understand how the disease is managed now, Duncan said.

“A lot of the people who come here have preconceived ideas and old beliefs about diabetes. ‘My grandma did this, it worked for her 50 years ago, why are you telling me something different now,'” she said. “So just making people realize that what we knew 50 years ago is different than what we know now about diabetes.”

Lauren Witt was 24 when she was diagnosed with diabetes. She noticed that she was losing a lot of weight, despite still eating the same amount she always had. Her vision would get blurry, and on one occurrence, she passed out.

A blood test confirmed that her glucose levels were incredibly high. Once doctors determined that she had Type 1 diabetes, she was referred to Duncan to help manage the disease. She helped Witt learn to take insulin, count carbohydrates and learn more about nutrition.

“(Duncan) has been so helpful. I call her my ‘diabetes mom.’ She always takes care of me, and I can count on her to help with whatever questions I have,” she said.

In the five years since diagnosis, Witt has adapted every part of her life around the disease.

“It affects everything I do. When I wake up, I need to make sure sugar is decent, that I didn’t get too low during the night. When I exercise, I have to have something to eat with me because my blood sugar can drop quickly. And everything I eat I have to count,” she said. “A lot of people don’t know a lot about food, so to learn actual nutrition helped me comprehend everything better.”

Lifestyle is a huge focus for patients with diabetes, Duncan said. Many of the people they see don’t exercise, eat poorly or smoke, contributing to and exasperating the situation. Misconceptions about the disease also have to be overcome.

People have to adjust the food they consume, when and how much they eat, factor in exercise and adapt to the medications.

“Changing your lifestyle is probably the hardest thing in the world. We want everybody else in the world to change, but not us. When we’re told to change, it gets very uncomfortable,” Duncan said. “The key to being successful at this is helping the patient get to that point in their life, when they say they’re ready to change.”

Goldsmith was diagnosed with Type 2 diabetes around 2005 but refused to change much about her life. She had always eaten whatever she wanted and didn’t do much exercising.

Though she was told to watch her concentrated sugars, she didn’t pay attention. She kept gaining weight, reaching 171 pounds at the most.

“I knew I was diabetic, but I just didn’t do anything about it. I didn’t watch myself. That’s what got me out of control,” she said.

But during a checkup with her doctor, a blood test revealed that Goldsmith’s glucose levels were almost twice the normal levels.

“(My doctor) was very upset with me. She put me on medication, and sent me to Carla,” she said. “Without their help I wouldn’t be where I am today.”

Duncan schooled Goldsmith on portion control, how to count her carbohydrates so that too much wouldn’t spike her glucose levels.

Living a more active lifestyle was also very important. Goldsmith hurt her back, which prevents her from walking long distances or running. But after she eats, she makes sure to do housework, finish the dishes, take care of laundry — anything to keep moving.

“The more I move around after I eat, the better my blood sugar numbers will be. If you eat a meal and sit down, let it absorb, it will screw up your numbers,” she said.

Following Duncan’s advice, Goldsmith lost 40 pounds and dropped to 133. Her blood sugar levels have stabilized and she feels better than she has for years.

In addition to her diet and exercise, she takes one pill after breakfast, and three others after dinner to help her body regulate her blood sugar. Three times a day, she has to test her blood to monitor her sugar levels.

Medical professionals measure blood sugar to determine if a patient has diabetes. A normal blood glucose level is below 5.7 percent, while diabetes is diagnosed if that level is 6.5 percent of above.

Patients need to know how different factors affect their blood sugar, how to test it and what those numbers mean.

“Even most people who have had diabetes for many years can’t tell me what their blood sugar should be,” Duncan said.

Duncan and her staff also work with people who come to the center with prediabetes — their blood glucose levels are higher than normal, but not yet reaching the level to be considered diabetes. The condition can often be reversed with lifestyle changes, such as improving your diet and getting more exercise.

They have to know how to do that, though, Duncan said.

“Weight loss, exercise, diet. Most people with prediabetes need to lose a little bit of weight, probably aren’t as active as they need to be,” she said. “Our goal is more about lifestyle. By changing lifestyle, we can change that diagnosis back to normal to prevent the diagnosis of diabetes until later in life.”

If you go

Diabetes education series

What: A series of workshops and informational meetings presented by the Johnson Memorial Health Diabetes Care Center teaching people about diabetes, blood sugar and other aspects of nutrition and the disease.

Where: Johnson County Public Library, Franklin Branch, 401 State St.

Next session: 1 to 3 p.m. June 22, focusing on sugars and carbohydrates, reading a food label and balancing your plate.

Additional workshop: 1 to 3 p.m. Sept. 28

Cost: Free. No registration necessary.

Information: (317) 346-3846 or

Author photo
Ryan Trares is a reporter for the Daily Journal. He can be reached at or 317-736-2727.