♪ <Patricia Brown> My grandmother was diabetic and I had an uncle who had severe diabetes, so I didn't want to be like them.

<Kevin Darley> Hit!

I'm very active, so I never thought that they would be me.

I can remember being pre-diabetic and, say, oh, okay, it'll go away.

<Robin Jordan> Being a compliant patient was not my thing for many, many years.

<Ronald Taylor> When you fall, you break your leg and then it causes you to have to have an amputation, you'll learn very quickly that you should have done something different.

<Vida Berry Bloome> When we were growing up, Grandma had a touch of sugar.

They don't tell you that not only will diabetes kill your kidneys, it can take you from the best top health to the worst.

[slamming sound] [Narrator] There is a diabetes crisis in South Carolina.

Diabetes is the 7th leading cause of death and costs the state $6.4 billion a year.

1 out of 6 adult South Carolinians has the disease.

1 in 3 has pre-diabetes, which means that nearly half of the state's adult population has a problem with their blood sugar.

♪ soft music ♪ ♪ <Elizabeth Knight> As we eat, food breaks down to sugar.

The body's pancreas produces insulin, which is a hormone that takes the sugar from the bloodstream and pulls it into the body's cells to give us energy.

But when you have diabetes, you have a problem either with type one diabetes not making the insulin or with type two diabetes not making enough insulin.

You have more sugar floating around in the blood, and that's what causes the problems that we see from diabetes.

♪ <Dr.

Timothy Lyons> Eye disease, kidney disease, damage to the nerves in the legs, damage to the blood vessels throughout the body causing strokes and heart attacks and amputations.

♪ All of those things are to a large extent driven by chronically elevated sugar levels.

[water rinsing sound] <Patricia Brown> In the late 90s, my internist and I were arguing with each other because she was saying, Ms. Brown, you're pre-diabetic.

And I'm saying, No, I'm not.

This went on for about a year and a half until finally, early in 2000, she says, Ms. Brown, your numbers are inching up and we're going to have to give you medication.

[sigh] I did not want the medication because I knew the diagnosis of diabetes was a life sentence, but my doctor explained to me some of the things I needed to do, what the medication would do, how I needed to take it, and I tried to cope with it.

<Jestine Coaxum > I like to have a little mayo on mine.

How about you?

<Brown> You know I love mayonnaise.

<Dr.

Lyons> Black people, African-Americans and Native Americans in this country are more susceptible to developing high blood sugar if other circumstances are not favorable.

<Kevin Darley> Attack!

That's the word I want.

Attack!

I was at the age of 40.

About ten years ago.

I found out I was, borderline diabetic.

And, I ended up getting tested and my sugars were high.

I didn't really have insurance, so I didn't go to the doctor as needed.

I was very lackadaisical in the beginning.

My mother and father were diabetic, and I wasn't really following it or looking into it, but once I found out it was, it was very disturbing.

I then started walking and drinking water, but, it didn't help as much as I thought it would because I didn't change my eating habits.

♪ I did my aunt's eulogy, my uncle's eulogy; I actually spoke over their body, and to see them die with, diabetes and C.O.P.D.

It was scary for me.

And I had to make a conscious decision to do better, or I wouldn't be here.

<Courtney Hunt> One of the main pieces of diabetes education is to help the patient change their behavior, really to change their lifestyle.

These are not changes we want only just a week or two or a few months, even a year.

This is a lifestyle change for the rest of their life, because they're going to have diabetes for the rest of their life.

So even if they get their diabetes controlled, they still need to keep in mind all of the lifestyle changes that we speak about.

<Robin Jordan> I learned that I was diabetic when I was about 35 years old.

♪ It's kind of strange how I found out.

My mother had been kind of locked in her room for three days, so we took her to the doctor to find out what was wrong.

♪ You know, of course, he's asking her questions.

Things like, you know, are you thirsty a lot?

And she'd say, yes.

And I think, yeah, me too.

He'd say, do you go to the bathroom a lot?

And I'd say, yeah, me too.

So pretty much everything he was asking her, I realized that I had the same symptoms.

He went ahead and checked me for diabetes.

Checked my blood sugar.

At that time, my mother's was 200 and mine was 300.

So she was nearly passed out at 200.

And I was walking around at 300.

But yes, we both had diabetes.

<Dr.

Albert Humphrey> Until you're really bad off, you know, your sugar is so high that your vision gets blurred, or you have a fruity fragrance to your breath, you may not know you're diabetic.

You develop hardening of the arteries.

The further you go away from the heart, the smaller the vessels get.

And the furthest apart from the heart... feet.

A lot of things that predispose you to get an infection and first thing you know, The only realistic thing to do would be to amputate.

<Ronald Taylor> I had been watching my... blood sugar and monitoring it.

It was always a little high, you know, 170 sometimes, maybe get to 200 every now and again.

All right.

Well.

I'd travel overseas and put in computer systems and we were leaving the site and I fell.

I thought, wow, I missed a sprained my ankle.

I went to see the doctor.

He said, well, don't see anything on the X-ray.

Let's just have you wear a boot and have you stay off of it for a while.

60 days came and I said, look, Doc, it still hurts a lot.

He said, okay, let's get an M.R.I.

And he called me back and he said, we found out it's broken.

He says the bone has died.

We can't save it.

He said, but we're going to try some new things and we'll see what we can do.

♪ dramatic piano music ♪ ♪ I went online and I did my research, and we have all the data that shows that there's only a 25 percent chance of recovery.

♪ I knew what had to be done.

[chokes up] I cried for two days.

To add insult to injury here, my mother was living with me and she was in the hospital and... she died three days before I had my amputation.

♪ I went into severe depression.

Severe.

♪ dramatic music ♪ <Safiya Tate> Mental health is a real thing.

People who have amputations are affected by their mobility, the way that they see themselves, their level of independence, being able to drive, being able to participate in sports activities with their children.

It's a really big change.

It's like losing, of course, a part of yourself.

[air pressure sound] <Russell Riley> Probably 70% of my patients are diabetic.

We're finding some younger people are having amputations from diabetic complications in their late 30s, 40s.

I've basically seen a rise of it with the diabetes.

I love actually helping my patients get up and gain their independence again.

Actually being able to help themselves at that stage.

♪ <Dr.

Lyons> There's gestational diabetes, which is diabetes that develops during a pregnancy but goes away after the pregnancy.

The problem is that often women get pregnant and they don't know that they have diabetes when they get pregnant, so then it becomes hard to distinguish gestational diabetes from diabetes that was present before the pregnancy.

<Berry Bloome> In...1980, I became pregnant.

They said I had gestational diabetes, and the doctor said, watch what you eat.

You're fine.

It's normal, sometimes with pregnant women.

I lost the baby.

♪ dramatic music ♪ I got pregnant again.

At that point, I was, like, told, hey, you know, you're pre-diabetic.

Watch what you eat.

And I'm like, you know what?

I'm not going to.

I wouldn't listen to him.

♪ dramatic music ♪ ♪ And in 2013, I went to work.

All of a sudden, I got hit with body aches, fever, chills.

I'm sitting up there going, what's going on here.

Didn't know, I was septic.

Went to, doctors.

And he was like, hey, he says that foot's got gangrene in it.

He says...you got a choice.

He says, you either let me have your foot... he says, and I'll have you up and walking in six months.

Or, he says, I can let you go home and you tell all your family goodbye.

I looked at him, I said, 'No, sir.'

I said, 'This is just my earthly body'.

'This is not my heavenly body.'

I said, 'you can have the foot.'

[machine sound] I deal with having to do dialysis now, not knowing that the diabetes would, impact the kidneys.

<Knight> Dialysis treatment is a process of cleaning the blood of the toxins because your kidneys aren't working properly, and so there's no way to clear all of that from your system.

(machine whirring and pumping) <Safiya Tate> If you do have diabetes and you end up on dialysis, then that's a permanent condition.

So they have to commit their lives to, either coming into the center three times a week or doing their treatment at home every night.

<Narrator> There is a place in South Carolina where risk factors have come together to create a perfect storm of diabetes.

29203 is a large ZIP code in Columbia, South Carolina's capital city.

It consists of a myriad of diverse communities.

Some large, some small.

29203 has a majority African-American population.

30 percent of the residents of the area live in poverty, and it is deemed the food desert for its shortage of grocery stores.

Many of the people here have diabetes, leading to a plethora of dialysis centers and one of the highest rates of diabetic amputation in the country.

<Dr.

Lyons> The fact that 29203 achieved regional, if not national prominence is that we are in our state, near the bottom of the nation, in the state rankings, and therefore the worst ZIP codes in South Carolina are likely to be some of the worst in the nation.

♪ The social determinants of health are social factors that determine risk for health and health outcomes.

So there's racial disparities.

There's...racial discrimination.

There's discrimination according to income, according to where you live.

<Brown> We in 29203, we really have a pronounced food desert.

You know, it's just not easy sometimes to get to the grocery store.

And the vegetables are always more expensive than the processed food.

Also, mamas are working and daddies are working longer hours.

People aren't having time to cook nutritious meal.

So you picking up food and bringing it home.

And all of that's processed.

That processed food is killing us.

♪ ♪ dramatic music ♪ ♪ <Tina Herbert> I've lived in 29203 my whole life.

The idea of the mobile food market came up no later than 2017, which allowed us to address food insecurity.

But for the federal dollars that we got for Covid, I don't know if we would have been able to implement that program.

We tried different locations because we want it to be successful and sustainable.

In every neighborhood, particularly neighborhoods that haven't had a lot of investment, additional resources is what we need.

Typically, a lot of programs, you know, we may give them two or three years, but they don't have the sustainability because they don't have the funding.

If we had more resources, I think we could definitely change the outcomes that we're having in our communities.

<Brian Thomas> Your Dollar Sto' is a community based grocery store that's providing a means of fresh produce and grocery items, that's in an area considered a food desert I should say.

The neighbors here in this community, they love this store being here.

To be able to come to a store that's in walking distance and get some fresh produce was a win-win for them because now they don't have to catch a bus, which is money spent, or you got to catch a cab or Uber, which is money spent.

If they spend at least five dollars off their E.B.T.

or SNAP card, they'll then get 15 dollars in fresh produce.

I want to say thank you to Doctor Humphrey at Prisma because he said, we got a plan here, and we want to use your store as a hub to provide a voucher program to send our diabetics here.

So instead of going to a fast food restaurant, instead of going to, you know, get a bag of chips per se, they can come get an apple, or an orange or a pineapple, strawberries, squash, cabbage, and so forth on.

<Dr.

Humphrey> In 1980, my goal was to see the Black man live to age 65 because they were dying before 65.

<Dr.

Lyons> Here in Columbia, there's a ten or more year difference in life expectancy according to what ZIP code you live in.

<Dr.

Humphrey> The health care system isn't currently set up for providing care for people without money.

♪ dramatic music ♪ It's always good to have insurance and some money.

The reality.

(machine whirring) <Tate> It's a big issue for us right now, and dialysis is, affordability, and it really just is health insurance.

So you have your different groups of persons with insurance.

You have your people who are working, who are employed.

You have your retired population.

They generally have their Medicare.

They typically will always have a secondary.

And then you have your group of persons who come in and they only have Medicaid.

Medicaid is limited in what they pay for and you can't use the outside of South Carolina.

But I will say that when people come from other states to South Carolina and they compare the Medicaid in New York or California or even North Carolina, they typically go back.

♪ dramatic music ♪ ♪ <Dr.

Lyons> Accepting Medicaid expansion is, to me, a no brainer.

It would support care for about 350,000 people in South Carolina who have very inadequate care right now.

<Knight> Because South Carolina did not expand Medicaid, we still have, a large portion of individuals in our state who are uninsured and that is where we as cooperative health can help support individuals who don't have insurance.

<Dr.

Eric Schlueter> Cooperative Health, we try and provide compassionate health care, respectable health care in the spirit of the Good Samaritan, and especially with pediatrics, we have our Eau Claire High School, which is essentially across the street from our Eau Claire Neighborhood Health Center.

And so being able to provide accessible, excellent health care to the children in the community, to try and help them establish themselves for a great future is an important part that we provide.

♪ We've been in the 29203 ZIP code since 1981.

There still is a desert in some respect as it relates to health care services.

And as a community health center, not only can we take the traditional insurance, Medicare and Medicaid, but we also have a sliding fee for our patients that are uninsured.

So, it has been our hope that we can be able to help our patients, wherever they are, to maximize their health status.

Diabetes is really challenging.

We have maybe about 25,000 adult patients that we take care of and about 5000, have a diagnosis of diabetes.

Starting in January 2023, we on-boarded our virtual diabetes program and it has been a smashing success.

<Knight> Hello, pharmacy.

<Dr.

Eric Schlueter> Our goal was to be able to bring everything together that our clinician is in sync with our pharmacy, our clinicians in sync with our behavioral medicine support, is in sync with our diabetes education and they're a team that's able to work together as a unit.

<Hunt> Today we're just going to talk a little bit about... sugar in our drinks and how much sugar is in some of the drinks that you might be consuming because...

I love my job as a diabetes educator.

It's very patient centered and trying to help them figure out how does this apply to their life, and really just seeing the patients do the work.

<Knight> You might have somebody who's drinking six sodas a day, and they're not willing to give up that habit.

<Patient> It's going to be a little adjustment...

I mean... <Knight> Also helping them to make these changes in small steps so that it's more easily done and then they can kind of see the impact of it, realize how much better they're going to feel if they start cutting these sodas out, their blood sugar starts to improve.

And I think then a lot of times it kind of falls in place from there.

<Jordan> Hey!

<Knight> Hey, Ms. Jordan.

Welcome!

Good to see you!

<Jordan> Ms. Knight, she always left me in charge of my body.

And so, I always felt like we were kind of, hooked together in my pursuit of wellness.

(indistinct conversation) These people were like, they were like my team.

They were like my friends.

They really showed that they cared about how I was doing.

So I had a kind of support that I had never had before.

And that made a big difference in me being able to finally, after 35 years, get my blood sugar under control.

(indistinct conversation) <Darley> I talk to the youngsters all the time about their lifestyle because they want to eat the Twinkies.

They want to drink the sodas and, with playing football, you can't do all of that because you get cramps, you get tired quicker.

So, I speak about it every day, to them.

Some of them know I have diabetes and some of them don't.

I do wear my patch, my insulin pen.

So, sometimes they ask and sometimes I'll volunteer and let them know, you know, you don't want to get one of these.

So, you know what's going to be important, your first step, right!?

<Hunt> People under the age of 20 within the next 40 years, their rates of diabetes are expected to go up by 700 percent.

So, and that's not just in 29203, that's just a national statistic.

♪ Diabetes is preventable, but you have to catch it, either in the pre-diabetes stage or before the person, you know, gets diagnosed.

<Dr.

Lyons> New agents, they're called GLP-1 agonists have the capacity to address some of the fundamental drivers of type-two diabetes and obesity.

♪ There's all kinds of problems with expense issues, coverage issues, but those will change with time and I think these are a revolution.

♪ Diabetes Free SC began four years ago.

Blue Cross executive walks into my office says, we want to deploy our foundation moneys, not all of them, but a significant amount.

And, I became involved with it and became the medical director because I thought it was such an extraordinary, surprising, visionary thing.

So in our work, we're really trying to knit people together.

We're trying to break down silos.

Patients need coordinated, inter-communicative, team based care.

We have the potential to be a leader in the nation to show how things can be done to win the fight against diabetes in South Carolina.

[doors sliding sound] <Taylor> I wanted to do something where I could get around and do things.

I thought about a golf cart, but I thought, you know, I was a farmer when I was young.

I think I want to do some more farming again.

So, I bought a tractor and...that has been one of the best things I've ever done.

It's just, that almost defines who I am now, just a little guy on the tractor, and my wife.

My wife says, "Oh God, here he comes to that tractor again.

"He's probably going to dig another hole "and fill it back in."

Well, at least something I can do.

You know, so...I'm happy.

[riding mower engine sound] <Knight> Your blood sugar is beautiful!

<Jordan> When your blood sugar is up, it can change your mental state.

And one of the things that I have wrestled with for many years is depression and I have found since my blood sugar is on key now, on level, that I'm not as depressed as I had been before, which is a miracle for me because I've spent so much of my life in that state.

<Brown> Would you like a little ice in it?

<Coaxum > Very little.

<Brown> Jestine is my sister-in-law.

We plan meals together.

We do family dinners.

We consider ourselves the matriarchs of the family now, and we are trying to set the example for the younger ones to follow.

The family members have a propensity for gaining weight.

The family members have a propensity for being diabetic.

♪ <Coaxum > We do eat a lot of meals together, so we try to make them as healthy and as satisfying as possible, realizing that our health is important.

<Brown> Cheers to you!

<Coaxum> And cheers to you!

♪ <Darley> And...hit!

That's good!

It's a big subject because no one really cares.

I don't think they care or really see what it can do.

I'm grateful.

I'm thankful that I took control of my health.

And I'm still working on.

It's a challenging situation to be able to check your sugars every day and to, take your insulin every day.

And, I'm just happy to have the chance to get it right.

♪ motivating music ♪ ♪ <Berry Bloome> Here we go.

I had to learn how to communicate.

I had to learn to communicate with others so that they could communicate with me.

I've been looking for something to do and some place to go.

I don't forget that I'm diabetic.

I don't forget that I wear a prostheses.

I don't forget that I am on dialysis.

No, woe is me.

Yay!

It's me.

I've learned how to live again.

And it may be minus a few things, but I'm living.

Bingo!

♪ [slamming sound] ♪ Amazing grace!

♪ ♪ How sweet the sound ♪ ♪ That saved a ♪ ♪ soul like me!

♪ ♪ ♪ I once was lost, ♪ ♪ But now, I'm found, ♪ ♪ I was blind, ♪ ♪ But now I see.

♪ ♪