>> hinojosa: 16 million americans have been diagnosed with type 2 diabetes, and many more are unaware they're at high risk. a large and growing percentage of them are teenagers. what do we need to know about this epidemic? meet dr. enrique caballero from the joslin diabetes center and misty anaya, diagnosed at age 12. i'm maria hinojosa, this is one on one. dr. enrique caballero, welcome to our program. >> thank you, maria. >> hinojosa: you are the director of the latino diabetes initiative at joslin diabetes center in boston. essentially, you have dedicated your entire life to the issue of diabetes. and there are probably a lot of people who say, "oh, i know that there's diabetes; i know

somebody who has diabetes; i know that in some people it can be really dangerous, in other people, they can manage it." so i'm a little confused. so what is the headline? what do we need to know about diabetes that is central to the issue? >> well, the first thing, maria, is that diabetes is a major health care problem around the world. this is not just in this country, it is everywhere. >> hinojosa: but it's not something that you see, right? isn't that one of the problems? i mean, you can be living with diabetes and be fine. >> mm-hmm. actually, it is estimated that perhaps, for type 2 diabetes, which is the most common type of the disease-- ten times more frequent than type 1 diabetes, for instance-- people only have the disease for ten or 15 years without knowing that they have the condition until they manifest the first symptoms, which would be perhaps, like, frequent urination, increased thirst, fatigue, tiredness,

infections that don't heal or don't get better very qukly. but there's a silent face. people may have the disease for years and years without really having any idea about the presence of the problem. and sometimes they know about the disease because they have already developed the complications of the disease. >> hinojosa: so if... if, for example, you start having some of these symptoms, are you saying that people just won't go to the doctor to deal with these symptoms, or they might go to the doctor but the doctor might not test them? do you have to say, "look, be sure that you test me for diabetes." is that what... or are we on the assumption that doctors will know to do this? >> well, it is part of a routine exam nowadays to check the blood sugar. it's a blood test, and it's part of the annual physical exam, for instance, for most people. >> hinojosa: so key here-- annual physical exam. >> yes. >> hinojosa: that's something that you want people to just understand, that everybody really needs to be getting an annual physical. >> absolutely, and this is not

just to check for blood sugar, diabetes, it's also for the blood pressure, for cholesterol, to check the weight, for instance, all these different conditions that we don't really pay a lot of attention to because we feel well. we don't realize that there's something going on, because we feel perfectly well. >> hinojosa: all right, well, let me... let's, though, get back to the issue between type 1 and type 2 diabetes. >> yeah, all right. so let's start from the very beginning. diabetes is a disease that is characterized by high sugar concentration in the blood that we call glucose. now, there's different ways to get to that high blood sugar. in type 1 diabetes, the problem is that the pancreas, which we have in e abdomen, doenot produce enough insulin from the very beginning, and therefore, people need to take insulin injections. this is most common in children and adolescents, although nowadays, anyone with... can have type 1 diabetes at any age. >> hinojosa: so you're born with it?

>> you're not born with it, but you have the genetic tendency to develop type 1 diabetes. >> hinojosa: okay. >> now, most of these people are thin, they do not have family history of diabetes-- that's sort of the norm-- and they, as i said before, need insulin from the very beginning. now, type 2 diabetes, given that it's alsdiabetes, different. the pancreas may still be able to produce some insulin, particularly in the early stages of the disease. another problem with type 2 diabetes is that the insulin that the body produces doesn't work very well. that's what we call "insulin resistance," meaning the body doesn't respond too well to insulin action so the blood sugars go up in the circulation and then people may be able to develop some complications. type 2 diabetes is more common as we get older... >> hinojosa: but... >> ...but one of the major problems, maria, is that now we're seeing type 2 in children and adolescents. >> hinojosa: that's what i was going to say. so now what we're hearing is type 2 diabetes, we're seeing it in kids. so what is happening with the

fact that we're now seeing type 2 diabetes, which we associated more with people kind of later in life... >> right. >> hinojosa: ...what's happening that now kids are getting it? >> so in an easy way, what i always talk about is type 2 diabetes-- let's remember the number two, you know, type 2-- has two problems. one is that the pancreas doesn't produce enough insulin, and that the insulin that the body produces doesn't work well. now, for both conditions, there's two sources of problems. one is a genetic predisposition, which means that there is a tendency to develop the disease, because that comes from our history, from our family background, but it's also, maria, related to our lifestyle. that's the other element that plays a major role in type 2 diabetes. >> hinojosa: so we're talking... >> as we become overweight, we don't exercise, we don't eat the way we should, all those factors contribute to that genetic tendency then to develop this very serious condition.

>> hinojosa: and you are the director of the latino initiative... >> yes. >> hinojosa: ...which means that within the latino community, specifically, and in broader senses, the african american community, the native american community... >> yes. >> hinojosa: ...we are seeing numbers that are spiking. >> yes, more than in other populations, and the reason for that is the two elements that i just mentioned. the genetic predisposition and also the lifestyle issues that contribute to type 2 diabetes are more common in some of these racial and ethnic minorities. >> hinojosa: so for example, paint a picture of when you are in a barrio latino and you're just looking around, what is the picture that you see that is kind of raising flags for you? >> in some of these neighborhoods where there's more racial and ethnic minorities, it's been well documented there's less access to healthy foods. it's part of a cost issue-- it's a financial situation-- but it's also a social issue. that sometimes, some of these markets are more appealing to

some of these different groups and also for businesses. yoknow, they know that they can actually succeed more by providing some of these fast foods, et cetera, in some of these neighborhoods. so it's really a big, big challenge. >> hinojosa: and the fast food issue for communities of color comes in because you have, let's say, working parents? both of them might be working, and so then the easy thing to do is, "i'll just go by and pick up those hamburgers or that fried chicken or whatever," because... not because you're a bad parent, but because you've got a lot on your plate and you're thinking, you know, time, and you're thinking money? >> oh, well, it's an easy thing. i mean, if y want to eat, you know, fast food is really available, it's affordable, it's tasty, it's filling. so it really has a lot of advantages for the working families, for people that don't have a lot of time to prepare the foods, et cetera. so we have moved away somehow from our traditions, also, maria, in the sense that... >> hinojosa: well, that's what i

was going to bring up. >> ...we used to cook at home, and you know, that was sort of the natural thing to do. but now we're so busy, we have to do a lot of different things, and fast food has come to our lives to sort of "solve" some of the chalnges that we have. of course, we are paying a huge price for that type of decision. >> hinojosa: isn't it true, also, that for newer immigrants, when you come to this country and you have a little bit of extra money, then going to a fast food place is like... it's a step up. >> you're right. >> hinojosa: is there that kind of situation where you have immigrant parents who are like, "well, this is what people eat in the united states of america, and my child is an american. i'm going to feed them fast food." >> right. there is what is called "acculturation," and acculturation is related to the adoption of the lifestyle in any country that we go to if we live there. and it's been well documented that, for people in the first five years when they come to this country, they tend to adopt some of these lifestyle issues. so as you said, people tend to

eat fast foods, they become more sedentary as well, because people may be able to buy a car now. so they don't exercise, they don't walk, they don't ride their bikes anymore, and people tend to gain some weight. if you think about it, the immigrants are usually healthy, young people that come and work in this country, but in the first five years their health status usually changes. they become more overweight, they have more risk for diabetes, high blood pressure, high cholesterol, and after five years, their risk of diseases is a lot higher than what it was when they were in their country. >> hinojosa: this is just... i mean, you're from mexico. is there a part of you that just wishes that you could just kind of stand there with a big sign that says, "if you go into the united states, beware, because what you're going to eat in the united states and the lifestyle you are now going to engage in could make you sicker." >> it is true. that's sort of the norm. now, at the same time, because let's be fair, you also have

choices, because you can always make good decisions. you may decide to exercise, you may decide to go for foods that are healthier, and this concept that always the... the better foods are more expensive, you know, is not absolutely true all the time. one of the things that we do in our program, for instance, is to teach people that within a limited budget, you can always make bettechoices, and you can always-- even if you don't have a lot of money-- go for better foods, for those that have less saturated fat, trans fats, you know, healthier meals in general. >> hinojosa: but do you feel that you are... you know, when you look at our communities, our immigrant communities, our communities of color where there is such a bombardment of, you know, again, fast food, not-such-healthy food, easily accessible, and here you are trying to say, "wait, don't make that decision; don't buy that fast food; think about taking the 45 minutes for cooking a

meal for your family," really in the end, you have a huge battle that you're confronting. >> oh, it's a big battle. it's a huge battle, maria, because there's so many messages that are delivered every second to the population about not eating the right things, not exercising, because we're concentrating on other things. >> hinojosa: i talk about it with my kids all the time. >> our values, you know, are gone, and we have to rescue those. we have to go back to very basic principles about living in family, doing things together, being more physically active. we don't need a lot of the outside messages and values that the society wants us to acquire, and if we go back to some of those simple ways of living, we could have healthier and better lives. >> hinojosa: so the conversation about diabetes, and particularly, type 2 diabetes, is one that is of concern to a lot of people. even pbs-- public television-- has started talking specifically to young people to hear their

stories and to kind of get their stories out. so we're going to take a listen to one particular story. let's take a listen. >> i would say that i am intelligent, funny, i would say that i am very determined. i am artistic. i'm a hopeless romantic. i'm an independent person, and i have type 2 diabetes. "i told her the news and she id, 'i'm sorry.' this serious look was on her face. i said, 'don't worry, i'm going to do what i have to do to benefit myself.' she said, 'i feel so bad for you. why'd it have to be your health?'" when i found out i had diabetes, i was very shocked. i thought that was something that only older people got. i was 12 years old. i thought i was like, the only person that got it at such a

young age. i didn't know anybody else who had had it. i thought that everything was going to be downhill from there. i thought i wasn't probably going to get past my 30s. "i said, 'stoppologizingthis isn'taking over my life, just one part of the many that i will overcome in this fight.'" diabetes is only a problem if you don't take care of it. i just ate healthier and became more active. i joined basketball. i like playing basketball because it just keeps you on your toes and it's a very fast-paced game. i don't like playing with girls. when i play against guys, it's more of a challenge and it gives me more like... more motivation to walk onto the court and be like, "okay, i need to beat him." i started college three months ago. i love college. i love how i have a lot of responsibility, because it makes

me feel like more of an adult. one of the dining halls is just a buffet, so when i go to eat, it's sort of like a little kid in a candy store. like, i can have anything that i want. in the beginning, it was hard, because i was like, "ooh, they have pasta and they have chicken and they have hamburgers and then they have a salad bar and they have like, an ice cream machine and they have everything. i've gotten a lot better with choosing what i eat and portion sizes, so i've learned how to control what i eat and not just get... have like a free-for-all. eating healthier and just exercising, i lost a lot of weight and it was really encouraging. diabetes does not define who i am. wh i looin the mirror, iee somebody who is very strong-willed, and i see somebody who knows what they

want in life and isn't going to let anybody stop them. "so when people say they're sorry, tell them don't worry-- you just need their support because the ball is in your court." >> hinojosa: misty anaya, thank you so much for joining us on the show! >> thank you for having me. >> hinojosa: it's great to have you. so you're 12 years old, right, you're growing up... >> yes. >> hinojosa: ...and everything is fine-- you're feeling fine. >> hinojosa: and then suddenly, what? you end up going to the doctor? was it a... >> well, one of my rel... one of my younger siblings was diagnosed with hypoglycemia, and then... so we had a sugar kit in the house, and then we went to dinner one night-- we went to a buffet-- and then we came back and my face was so red and i just wanted to go to sleep. and my mom said, "no, something's wrong with you." so we had a sugar kit in the house from my sibling, and then she checked my sugar and it was 356. >> hinojosa: oh, my god! >> yeah, so... >> hinojosa: what... how is it that your family kind of knew to check your sugar? >> because my younger sibling... >> hinojosa: they thought that maybe, perhaps, there was

something there? >> yes, and also, a whole bunch of like, all of my other relatives, pretty much, everybody has diabetes. >> hinojosa: so at that moment, when... do you then go to the doctor? >> mm-hmm. >> hinojosa: right. and the doctor says to you... you're 12 years old and the doctor says, "misty, you have diabetes." >> mm-hmm. >> hinojosa: what went on for you at that moment? >> i was really scared. i was nervous, because i knew... one of my other relatives, she didn't take care of her diabetes and she had a lot of complications, and so i was scared. i was thinking that i wasn't going to live... like, i had my whole life planned out-- i've always been like that-- and i just thought that my life was going to be shortened and that i wasn't going to... yeah. >> hinojosa: so the first thing you heard is, "you are a person with diabetes." "my live is going to be shorter than everybody else's. >> mm-hmm. >> hinojosa: okay, dr. caballero-- reality check. for a 12-year-old, that kind of response of, "oh, my god; i've got this illness, i'm 12, i'm not going to make it." >> well, it's a very natural thought.

the good news, however, is that nowadays, if you control diabetes-- even if you start very early in age as misty did-- you have a very good opportunity to really have a very normal life and prevent complications. but... >> hinojosa: but there is a sense out there that it's... >> of course, of course, because actually, diabetes has been associated with a reduction in life span for many people, because diabetes can lead to complications. but every time that we talk about it, it is not just diabetes per se, it's uncontrolled diabetes. >> yes. >> hinojosa: okay, so what did the doctors to say to you? then suddenly, at what point, misty, did you say, "okay, i've t an illne... >> mhmm. >> hinojosa: "...but if i listen to my doctors and all of the experts..." >> mm-hmm. >> hinojosa: "...they tell me that i can really control this." >> mm-hmm. >> hinojosa: and they said what to you, in terms of changing your lifestyle? >> they said one thing i had to change was my nutrition, because i was... when i was diagnosed with diabetes, i was very overweight-- well, not "very," but i was overweight for my age-- and they told me to cut

out all the soda and juice that i was drinking, stop eating a lot of fatty and greasy foods. and i changed... in the first week lost six undsust om cutting out soda and changing my nutrition, so... >> hinojosa: okay, so let me ask you something, misty. >> mm-hmm. >> hinojosa: a typical... because i've seen kids in our barrios-- in our neighborhoods... >> mm-hmm, mm-hmm. >> hinojosa: ...and it just does a number on me when i see them at 8:00 in the morning and they've got a can of whatever soda... >> mm-hmm. >> hinojosa: ...fill in the blank. sometimes it's actually, you know, the most sugariest of the sugariest... >> mm-hmm. >> hinojosa: ...and they're eating some, you know, potato chips or something or another, and this is breakfast. tell me what, let's say, breakfast or lunch. >> when i was younger, i usually ate cereal before i went to school. it wasn't that... but it was, like you said, in those... in like, especially latino communities, there's a lot of bodegas and corner stores everywhere and they sell chips,

ice cream, juice, sodas, all junk food. >> hinojosa: and kids love that stuff. >> mm-hmm. >> hinojosa: so when you were told, "misty, you need to just get rid of all that stuff," did you just think, "well, that's impossible; that's what i eat! i'll never survive if i don't eat that stuff." >> ( laughing ) i was... because i didn't know wh else to do, so like, even when like, my mom went food shopping, because there was five kids, she just bought like, chips and stuff. and so i started eating a lot more fruit cups, and i would be like, the only one on my school bus. >> hinojosa: how has it changed you? what has it done to you? because a lot of people say sometimes, when you get a certain illness or diagnosis, it changes you as a person-- not just in terms of your health, but as a person. so what has it done for you? >> it's definitely made me more responsible and i've matured a lot faster and it's also made me appreciate life more. >> hinojosa: and what would you say is the biggest thing that you've had to change? so it's about what you eat?

what other things, like your life? >> i would say it's... it's made me... everything that i do, i have to watch to make sure i'm managing my diabetes well. so even if it's before playing a sports game i have to make sure my sugar's okay, when i go to social events-- especially now like, i'm in college, there's a bunch of social events. i have to make sure that i make smart decisions. if i go somewhere, i always have to make sure i have my sugar kit on me in case it drops, an juice. like, if... everything that i have to do, i have to think about, "is my sugar going to be okay?" >> hinojosa: but do you think it's a burden, or you're just like... >> i'm used to it now. it's not so much of a... it's not a hassle. you know, diabetes isn't my life. >> hinojosa: when kids in the 'hood, let's just say... >> mm-hmm. >> hinojosa: is there a lot of teasing that's going on around the issue of diabetes? like, "oh, you're overweight-- you're going to have it; it's your fau..." what's the kind of vibe? >> the vibe espe... like, where i'm from there's not so much teasing, but i definitely think there's a lot of teens out there

that have it that don't know that they do. i notice that, because even with the obesity and the dark spots behind their necks, and... like, i... and then some of my friends are like, "oh, i don't feel good. i feel like i'm going to pass out." i'm like, "well, when did you eat?" "yesterday." well, you know? so i think there's a lot of people out there that have it that don't know they do. >> hinojosa: so... and also just kind of a misinformation or miseducation, like... >> yeah, yeah, they're not educated about it. >> hinojosa: you have to eat, like you can't... >> yes, yes. >> hinojosa: like, meal is not soda and chips and then yo don't have to eat again... >> until hours later. >> hinojosa: ...until the next day. >> yeah. >> hinojosa: dr. caballero, when you hear these stories, when you hear misty's story, again, it's a tremendous challenge. you've got a lot of food marketers who are out there, wanting to ca-ching, ca-ching, ca-ching, and you're saying if we keep on doing this, it's actually, in terms of our health care system, it's going to cost us... billions? >> oh, yes. well, diabetes, type 2 diabetes, is a major problem.

it's an epidemic issue in... around the world, basically. in the u.s., f instance, accordinto t stastic we spent $174 billion in the year 2007 in treating diabetes. now, the problem is not just the amount, which is about 14% of all the health care dollars available in the country, is that 80% of all that money was dedicated to the treatment of the complications of diabetes-- not the disease. we're treating the consequences of diabetes. >> hinojosa: which are? >> heart disease, blindness, amputations, renal kidney failure, dialysis... >> hinojosa: but that seems... >> so we are spending the money in the late stages of the disease. >> hinojosa: it seems so contradicty for an... a medically advanced society to be treating kind of the consequences of a disease. but if you had control... >> yeah. >> hinojosa: ...what would you say? what needs to change in terms of kind of the health care managing of diabetes? >> i would just reverse the way we are spending the money. i would dedicate probably 80% of that in the prevention of the

disease-- in identifying people early on and provide the best type of approach and treatment to prevent the development of complications. so for instance, there are some statistics that suggest that probably about 30% or 40% of children and adolescents in this country are overweight or obese. that's one in three or one in two in some of the racial and... that's exactly what misty says. >> hinojosa: and you saw a lot of that in your community? >> where i've grown up, yeah. >> hinojosa: kids who are just too overweight. >> mm-hmm. >> hinojosa: okay. >> and the cdc, for instance, released a couple of years the staggering statistic that for children born in the year 2000 or afterwards, the lifetime risk of developing type 2 diabetes is about 35% to 50%, so that's huge. it means that for all the young people, all the children right now that we have in our households have a huge risk of developing diabetes, unless we do something about it. and the only thing that we can do is to change our lifestyle.

because remember, there's a genetic tendency for diabetes. we can't change that. in misty's case, she comes from a family that is, you know, partially hispanic. we know that that's a high risk population. we can't change that, but we can change our lifestyle. we can improve the way we eat, we can become more physically active, we can educate ourselves as to what we can do within the limitations that we may have. it starts in the family, it's a societal issue, but that's where i would put all the money, all the efforts, all the responsibility in identifying people at risk. it makes no sense to wait until the problem is too late. >> hinojosa: misty, we've got just a few seconds left. so tell me, what is your dream? >> my dream is to make other teenagers aware of diabetes and just let them know that it's not... diabetes is only a problem if you don't manage it well. it doesn't have to be an issue in your life, and i want to aware other teens that don't have diabetes as well. >> hinojosa: okay, and dr. caballero? >> well, type 2 diabetes can be very well controlled, and we can

prevent the complications. that's very important. but the best approach is to prevent the disease. so who's at risk? people with family history of type 2 diabetes, people that belong to the ethnic and racial minorities, women with history of gestational diabetes, people with high blood pressure, people with high fats in the blood-- triglycerides, cholesterol, et cetera-- obviously, people that are overweight or obese d people that have what we call prediabetes-- elevated blood sugars not at the level for diabetes yet. that's where we have to do things-- to do things early on and aggressively to prevent the problems. so intervention as early as possible. and education-- education is key. >> hinojosa: see your doctor, eat well, lots of exercise, and for more of misty's story, you can actually go to pbs.org/mytype2 where you can see a lot more stories about young people dealing with diabetes. and for both of you, thank you so much for joining me. >> thank you for having us. >> thank you.

>> hinojosa: continue the conversation at wgbh.org/oneonone.

colonel. >> taboo no more.