Esther Lee remembers well the day her mother was unable to drag herself out of bed.
"She was used to working in a factory 12 hours a day and then going to English classes," says Lee, 27, a Korean immigrant. "Then one morning she said she physically couldn't get up."
Korean-speaking doctors diagnosed diabetes. They told Lee's mother to get bed rest, but she continued to work because she needed the money. Several years later, after her mother's illness worsened, Lee saw Dr. Francis Rhie interviewed on Korean-language television.
Under Rhie's care, Myung Lee began to improve. But not before the disease had blinded her.
Lee's case is not uncommon in Southern California's fast-growing immigrant and minority populations. Certain types of diabetes afflict immigrants and minorities more often than European-Americans, in part because of probable genetic predisposition, cultural differences and health care problems.
According to the American Diabetes Assn. (ADA), the number of diabetics has doubled in California since 1990--from 1.4 million to 2.8 million, or 9.3% of the population.
Nationally, 6.2% of whites suffer from diabetes, compared to 10.2% of blacks, 9.3% of Cubans, 13% of Mexicans, 13.4% of Puerto Ricans and 13.9% of Japanese-Americans, ADA figures show.
As county, state and federal lawmakers argue about cutting health-care funding, more minority residents are losing limbs, kidneys and their lives to diabetes because preventive care is unavailable to them, experts say.
"This is an urban disease," says Rhie, president of the California affiliate of the ADA. As minorities and immigrants adapt an American lifestyle, they are susceptible to poor exercise and diet patterns that can induce problems.
"We're dying because of our success," Rhie says.
Diabetics are unable to metabolize sugar, leaving high levels of glucose in the blood. Like a car with a full tank of gas but no combustion, diabetes prevents the body from making the insulin necessary to get the system running.
People with the so-called non-insulin dependent diabetes are often over 30, obese and may suffer worsened symptoms during times of stress. They may require insulin for control of their symptoms.
By contrast, diabetes mellitus, or insulin-dependent diabetes, usually strikes children or young adults (commonly European-Americans) and requires daily insulin injections.
Researchers are unsure why minorities are afflicted with non-insulin dependent diabetes, but they suspect that genetics, combined with lifestyle, lead to a greater predisposition to the disease.
For instance, being 20% or more overweight is a major risk factor, Rhie says, because "the body can't keep up with the increased need for insulin."
Minorities also suffer more serious complications. Among diabetics in California, the ADA says, American Indians are eight times more likely than whites to develop kidney failure, Latinos are six times more likely, and African-Americans are three times more likely. (A lack of research money has prevented studies of the state's varied Asian population, Rhie says.)
Consequently, minorities are more often hospitalized.
Caring for diabetics costs California taxpayers nearly $1.3 billion annually, according to the American Diabetes Assn. That cost could be reduced, association officials say, if money were invested in prevention, education and the training of doctors who speak other languages.
Only recently has the medical community begun reaching out to minority and immigrant residents with:
* Increased education programs.
* Public service announcements on non-English language TV and radio, and in newspapers.
* Outreach workers at English-as-a-Second-Language classes, churches and ethnic festivals. (However, for the most part, specialists speak only two languages: Spanish and Korean.)
Diabetics can live long, productive lives if the disease is controlled, Rhie says. The problem is early detection and teaching patients to adjust their diets and lifestyles.
Diabetes, says Rhie, fails to command the same attention as AIDS and other high-profile diseases, which means less research money.
"We don't have an Easter Seal poster child. We don't use scare tactics, so we don't get the money," Rhie says. "It's staying flat."
Six years ago, Thien Tran spent half a year trying to find a Vietnamese-speaking endocrinologist.
"Vietnamese people feel more comfortable with Vietnamese doctors because of the language barrier," says Tran, 66, a middle-class government worker who fled Saigon in 1975.
During her search, Tran's weight dropped from 98 pounds to 60. Small cuts were becoming infected and taking months to heal. "I was so tired, I couldn't stand up," she says. "My family doctor really didn't know anything about diabetes." The doctor prescribed vitamin injections and relaxation. Tran was almost in a diabetic coma when she insisted that her doctor admit her to the hospital.