This is the first of two stories on Type 2 diabetes. Part 2 explores what's happening on the front lines of the fight against the disease.
Carolina Torres cradles her marmalade cat in her arms and prances around the cozy apartment she shares with her mother and brother in South Los Angeles' Crenshaw district. The cat purrs while she bounces.
"This is my baby," Carolina says. "Orange Chicken."
Her mother, Margarita Montes, giggles. Orange Chicken is Carolina’s favorite Chinese food.
But Carolina, 17, tries to avoid it these days. Diagnosed with Type 2 diabetes when she was 11 years-old, she takes three types of insulin and four other medications every day.
Margarita, a single mother who works as a babysitter, has Type 2 as well. So does Carolina's paternal grandmother, who has lived with the disease for decades and is on dialysis.
Diabetes experts say the Torres-Montes family's situation is fairly common; Type 2 hits low-income families, especially Latinos and African-Americans, more than other groups, and it poses a variety of challenges as it strikes children, parents and grandparents.
"It was a trauma"
Latinos with some indigenous heritage, like Carolina's family, have a genetic predisposition for diabetes. But she knows it’s not the only factor.
"It starts if you eat a lot of junk food like I used to and I still do," she adds.
"There are a whole host of factors that contribute," says Dr. Steve Mittelman, director of the Diabetes and Obesity Program at Children’s Hospital Los Angeles. "The sedentary lifestyle, the junk food, the sodas, the video games, high fructose corn syrup, higher-calorie less-nutrient rich food. All undoubtedly contribute to obesity and diabetes."
Margarita remembers when doctors revealed Carolina had Type 2 diabetes.
"It was a trauma because she was so little," she says. "It seemed so difficult ... The food, she wanted to eat everything, and I was used to buying them whatever they wanted."
Margarita says she tries to make sure Carolina takes her medications and sees her doctor, but she admits that she’s not taking good care of herself.
"I have not taken it very seriously because I am busy,” Margarita says. "I’m often thinking about how I have to go to work as a babysitter whenever they call me, the kids are coming home and I have to prepare food, and other worries."
Margarita says she hasn’t seen a doctor in over a year and isn’t taking any of her diabetes medications. She has no car, and says it would take hours to get to L.A. County-USC Medical Center by bus or train and see a doctor without a guarantee that she’d get help.
And if she doesn’t work, she does not get paid, she adds.
A cold bath to numb the pain
Carolina worries that her mom is going to get very sick. When she notices Margarita is not feeling well or is having symptoms of low blood sugar, she will give her mom juice until she feels better.
That’s not the only thing Carolina has observed.
"Recently she’s been getting leg pain and her nerves are getting much worse," Carolina says. "So it’s not good for her but she doesn’t have the time to take care of herself."
Margarita says she often plunges her feet into a cold bath at night because it numbs the pain a little bit and helps her sleep.
With Type 2 diabetes, the body’s insulin can’t do its job of directing blood sugar where it’s supposed to go. If it is not managed well with medication, healthy foods and exercise it can eventually cause, among other things, blindness, nerve damage and heart disease.
Type 2 diabetes has increased along with obesity. In Los Angeles County, about 10 percent of people over 18 have the disease and another 44 percent are at risk, according to a recent study by the UCLA Center for Health Policy Research. One in five new diabetes cases in kids is Type 2, which used to be called adult onset, says Mittelman.
For Latinos, the combination of a genetic predisposition, lack of access to healthy foods and no space for exercise can create the perfect environment for the disease, experts say.
|Race/ Ethnicity||% of Population with diabetes|
|Native Hawaiian/ Pacific Islander||29.9%|
|American Indian/Alaskan Native||15.2%|
* Data from the L.A. County Department of Public Health's 2015 Los Angeles County Health Survey
Those with diabetes who lose weight by eating better and getting regular exercise can minimize the effects of the disease. Some may even get to the point where they need little or no medication.
But that's hard to do, experts acknowledge, especially for those who lack the funds to buy healthy foods, who work two jobs or unusual hours and who may not have access to a safe or affordable space to exercise, says Dr. Tony Kuo, who oversees chronic diseases for the L.A. County Department of Public Health.
Living in a hot spot
The Torres-Montes family lives in a so-called diabetes hot spot, according to L.A. County data that maps diabetes diagnosis and prediabetes estimates. South L.A., Boyle Heights and parts of the San Fernando Valley and Pasadena are all hot spots, says Kuo.
* An interactive map from UCLA's Center for Health Policy displays the percentage of residents aged 18+ who have ever been diagnosed with diabetes in eastern Los Angeles. Mouse over the zip code designations to see information on your area.
Part of the problem is lack of access to healthy food.
There is a Ralph’s market near Margarita’s apartment and she shops there, but she says it’s a bit more expensive so she has to be strategic about what she buys and when. She tries to cook healthy meals at home, but adds that it's hard not to eat the things they’ve been told to cut back on, like meat, cheese and rice.
"I’m from Honduras," says Margarita. "I often make rice because it is our custom. We prefer not to eat tortillas but the rice must be on the plate."
Carolina says she can eat almost anything she wants, but her nutritionist says to stick with small portions.
The temptation of fried chicken
Still, it’s tough, says the upbeat teenager with the infectious laugh who "loves food."
"It’s a struggle sometimes because my brother doesn’t have diabetes so he loves eating fried chicken or stuff that is very greasy or very high in sugars," Carolina says. "Me and my mom, we try our best but the temptation is always there and so sometimes it’s harder."
The other challenge for families is getting enough exercise. That’s true across the income spectrum, doctors say, but those who live in low-income areas find it especially challenging.
When Carolina was younger she hardly got any exercise because there wasn’t a space to play outside, she says.
These days she’s doing better.
"I swim, that’s my sport, I love swimming. Second semester swim team," says Carolina. "I’m doing SRLA – Students Run LA - you do marathons and stuff. Sometimes I do Pilates here."
Her recent adventure at diabetes camp in Big Bear helped get her moving a lot. The camp is organized by UCLA in partnership with Children’s Hospital L.A., where Carolina is treated for the disease. The hospital invited her to attend the free camp.
While in the mountains, Carolina was able to decrease the amount of insulin she needed to inject during the week of zip lining, swimming and playing games with other teens.
But she says when she got back home she fell back into old habits, like not checking her blood sugar before taking her medications.
"I forget most of the time, I’m very forgetful in checking my stuff," Carolina says. "But I do take my meds. I guess that’s the only good thing that I do in controlling my diabetes."
Since going to the camp, Carolina says she’s been researching how to lose weight and eat more fruits and vegetables.
Children's Hospital's Mittelman says that is the hope for kids who attend camp or any of the hospital’s programs, that they begin to think about how to better manage their disease either now or in the future.
This story was produced as part of a project for the California Health Journalism Fellowship, a program of the Center for Health Journalism at the USC Annenberg School for Communication and Journalism.