IT STARTED AS JUST A SMALL SORE ON HIS HEEL, nothing to worry too much about.
Twelve days later, the sore had worsened into a gangrene-infected ulcer. And soon after, diabetic Adan Monterrosa lay in a hospital bed, his left ankle and foot amputated.
"I had the thought that nothing would happen because it didn't bother me," Monterrosa, 46, of South-Central, said as he sat in his hospital bed on a recent afternoon at Rancho Los Amigos Hospital in Downey.
The loss of a limb is always horrible, but what makes Monterrosa's tale--and the stories of uncounted thousands of other diabetics like him--even more tragic is that it possibly could have been avoided.
For the Record
Los Angeles Times Sunday April 10, 1994 Home Edition City Times Page 17 Zones Desk 1 inches; 24 words Type of Material: Correction
Diabetes patient--A diabetes patient pictured in last week's City Times cover story was incorrectly identified in a photo caption. He is Richard Davis of Los Angeles.
In Central Los Angeles, minimal access to medical care and lack of awareness of the potentially serious consequences of unchecked diabetes is taking its toll on segments of the population already genetically predisposed to the disease.
With regular checkups, doctors can often catch early symptoms of diabetes that patients may overlook and can inform them of how to curb its progression. But because many do not have the means to get preventive care or wait too long before they do, diabetes among people of color is often more devastating than it needs to be.
Diabetes ranks high among illnesses affecting those in minority communities. Ranked as the third leading cause of death by disease, diabetes strikes people of color at an alarmingly high rate. Genetic makeup and environmental factors contribute to the extreme consequences of the disease among minorities, but poor diet, stress and sedentary lifestyles--all correctable, to some degree--exacerbate the problem.
"Historically, diabetes has been recognized as being in the majority population, with the insulin-dependent and kids," said Dr. Don Garcia of the Community Health Foundation of East Los Angeles' Bell office and a member of a statewide steering committee on treating diabetes at the local level. "But there has been a rude awakening that diabetes has changed. It is no longer just among Europeans and juveniles, but it is an ethnic disease that has besieged communities of color."
More than 14 million people nationwide have diabetes, half of whom are undiagnosed and most of whom are minorities, according to the American Diabetes Assn. The federal Centers for Disease Control estimates that Native Americans have diabetes at a rate five times greater than whites. The rate among Latinos and Asian Americans is three times greater than whites, and African Americans have a rate twice as high as whites.
In Los Angeles County, more than 700,000 people are afflicted with diabetes, according to the diabetes association. Latinos suffer the highest incidence rate, with one in seven having diabetes. One in 10 Asian Americans, one in 13 African Americans and one in 19 whites have the disease.
"Diabetes is a dangerous disease because initially there are no symptoms. It's just something that creeps up on you slowly," said Dr. Luz Medina of the Community Health Foundation of East Los Angeles.
Diabetes prevents the body from making insulin, a hormone that converts the sugar in food into energy. Instead, the sugar collects in the blood and urine, stalls body functions and hardens arteries.
Diabetes also contributes to increased health problems among people afflicted with other illnesses, leading to a change of lifestyle or--at the other extreme--kidney or heart failure, blindness, amputation and death.
People of color, especially Latinos, are increasingly being found to have diabetes in their late 30s and 40s, an especially young age, health officials say.
"With Latinos being diagnosed with diabetes earlier, that means they're walking around with the disease longer and that puts them more at risk of suffering the complications of diabetes)," said Marta Miyar of the American Diabetes Assn.'s Los Angeles chapter.
Monterrosa was diagnosed with diabetes 19 years ago at age 27 in his native El Salvador. As far as Monterrosa knows, he is the only one in his family with diabetes. He never knew anyone else who had the disease until he came to the United States 12 years ago.
Although he carefully watched his diet and took his insulin daily, Monterrosa made only sporadic visits to his doctor and waited until he had severe problems before he sought treatment. By then, it was too late to save his leg.
Most people wait until they have noticeable infections or feel too sick to go to work before they see doctors, Medina said. If a person then ends up with a diagnosis of diabetes, "it's so far gone they have problems with their vision or have to have an amputation," she said.
Though diabetes is a common disease, most people do not know very much about it. Some shrug off the disease as a nuisance rather than a serious condition, and others equate it with an early demise.
In reality, many diabetics live with the disease for years without severe complications.