If you counted every person with diabetes in the eight counties that make up the Lehigh Valley and surrounding region, the total would top Allentown's population of 106,632.
If you think that sounds bad, consider this:
On any given day one of every three people admitted to Allentown's Sacred Heart Hospital has diabetes.
The rate of diabetes across the country rose 41 percent to 10.3 million cases in the last decade. Another 5.4 million Americans have no idea they have the disease.
"It's a terrible, terrible problem," said Dr. Jonathan>Munves, a Bethlehem area internist with a caseload that is 50 percent diabetic.
Diabetes is a chronic, incurable disease that occurs when the body does not produce or properly use insulin, a hormone that helps deliver sugar, the body's fuel source, to cells, tissues and organs.
Without insulin, excess sugar builds up in the bloodstream, irritating and blocking the lining of blood vessels. Over time, every system in the body can shut down, leading to blindness, amputations and kidney failure.
Diabetes also is a major risk factor for heart disease, yet a recent survey found that two-thirds of diabetics were unaware of the link.
Seventy-five percent of all people with diabetes eventually will die of heart failure and stroke, according to Dr. Sidney C. Smith Jr., the American Heart Association's chief science officer.State high on sugar
Pennsylvania's demographics pushed the state into seventh place for prevalence of diabetes nationwide. More than a half-million people in Pennsylvania were diagnosed with the disease and another 200,000 were undiagnosed in 1997, the latest year available for statistics, according to the U.S. Centers for Disease Control and Prevention, Atlanta
People overolder than 45 run a greater risk of developing type 2 diabetes, a metabolic disorder that accounts for almost all diabetes cases. Pennsylvania's population is the third oldest in the country.
Likewise, the state's growing minority population -- particularly Latinos, who are twice as likely to get the disease -- helped hike the state's numbers.
Couch potatoes eating a Pennsylvania German diet heavy on fatty, starchy foods hasn't helped either, said Kathryn Dyslin, director of the Lehigh Valley and Berks district of the American Diabetes Association.
Experts blame a 50 percent hike in obesity for the sharp rise>.
Obesity is also being blamed for a frightening new phenomenon -- the diagnoses of "adult-onset" diabetes in younger adults, including teens.
"This is a whole new thing for me," said Dr. Larry Merkle, chief of endocrinology at Lehigh Valley Hospital. "The number of adolescents coming down with diabetes is a nationwide problem, but our region may be even harder hit because of its minority population, especially Hispanics."
In an obese person, the pancreas needs to make more insulin and can get overwhelmed, according to Dr. Michael Engelgau, a medical epidemiologist with the diabetes division of the CDC, Centers for Disease Control and Prevention in Atlanta.
>Munves calls it "pancreatic poop-out.
The pancreas works harder and burns out sooner."
Fat cells also might produce a hormone that makes the body "insulin-resistant," or unable to use insulin efficiently, one study showed.
Out of control roughly half of Americans with diabetes do not have their illness under control.
A survey found that the average blood sugar among residents with diabetes in Pennsylvania exceeds 200O milligrams per deciliter, when it should be less than 126 mg/dl
"That's sad. There's a big problem in Pennsylvania," said Cindy>Payonk, a diabetes nurse educato for LVH's Helwig Diabetes Center.
Payonk said the rate of poorly managed diabetes is taking its toll. In 1997, Pennsylvania's death rate from diabetes, at 13.9 per 10,000 residents, was higher than the national average.
Locally, hospitals are seeing higher rates of end-stage kidney disease and amputations.
In 1999, Northampton County's end-stage kidney disease rate was at least 28 per 10,000 residents; the stage average was 21.3.
Likewise, Carbon, Schuylkill and Northampton counties posted a rate of amputations that was 36 percent higher than the state average.
And, half of all diabetics admitted to LVH suffer from heart disease.
A big part of the problem is that people with diabetes often wait until complications set in before getting help. Compounding the problem could be a lack of specialists.
Six diabetes specialists, known as endocrinologists, serve Lehigh and Northampton counties, where an estimated 33,402 people have the disease> Two more this month joined the staff at St. Luke's Quakertown Hospital in Bucks County.
>Not every diabetes patient needs a specialist. Yet, >the Diabetes Association's Dyslin said more are needed.
"They are so overworked and dedicated to what they do that some internists are picking up some of the slack," said Dyslin.
Education the key