Paul Landherr places a small strip of what looks like pH paper into a plastic device roughly the size of a police radio. It resembles something Mr. Spock on "Star Trek" would use to check air toxicity.
But Paul isn't in biology class.
He presses a lancet against his forearm; a small needle springs out, quick as an asp, puncturing a tiny hole in his flesh. Then, he touches the drop of blood it produces onto the strip.
T-R PHOTO BY DAVID ALEXANDER
Paul Landherr, a type one diabetic, waits for his blood sugar results at his Marshalltown home Monday afternoon. November is Diabetes Awareness Month.
A moment passes. Black digital numbers on the screen materialize a number: 222 - Paul's blood sugar.
A slightly embarrassed look washes across his face. Although he is 18 now, his mother, Annette, cocks an eyebrow disapprovingly. Paul is supposed to take his blood sugar four to five times a day, and ideally, his blood sugar would be about 100.
"I must have been off estimating my lunch," Paul offers her as an excuse.
Paul like, like nearly 26 million Americans, has diabetes. November is Diabetes Awareness Month.
Dr. Anuj Bhargava, an endocrinologist with the Iowa Diabetes and Endocrinology Center in Des Moines, says people should consider being screened during Diabetes Awareness Month even if they do not exhibit symptoms.
Unless they manage their disease properly, diabetics put themselves at risk for long-term complications including heart disease, stroke, blindness, kidney failure and poor circulation that can lead to amputations, he says.
Although Bhargava does not diagnose patients with diabetes, he does regularly discuss how they can best manage it.
"You have diabetes, and you need to start doing things," he tells them. "Diabetes is a life-long disease of lifestyle. So, we are going to control it with lifestyle."
The best way to do that, he says, is to keep the heart healthy with exercise, limit junk food intake and maintain a healthy body weight. As a person gains weight, their body becomes more insulin resistant; this makes diabetes increasingly likely.
"The first sign of diabetes does not have to be a heart attack," he says.
Before doctors diagnosed Paul, Annette says she could tell something was amiss. She noticed a change in his behavior just before Christmas in 2008. Paul had been drinking far more soda and juice than normal.
"He would drink a liter bottle of pop or juice in just no time," she says. "He was so skinny. He had lost a lot of weight."
Bhargava says weight loss, excessive thirst, and blurred vision are common symptoms of diabetes.
Like many teens, Paul enjoys junk food. Prior to his diagnosis, when he was 14, he went to a movie with some friends and ordered a large soda and a box of Sweet Tarts from the concession stand. They were gone in no time.
Later that night was the first time he noticed something was wrong with him. Something was different. When he came home from the movie, he recalls seeing a flash of color dancing before his eyes.
"What is going on?" he asked his mom.
"We should probably get you to the hospital," she said.
In January 2009, doctors diagnosed Paul with type I diabetes, formerly known as juvenile diabetes.
Type I diabetes differs from type II diabetes insofar as type II is preventable, whereas type I is not. Type II is far more common.
"The immune system for some reason starts attacking our own (pancreas) cells," Bharvaga says of type I diabetes.
Treating diabetes costs the United States more than $126 million a year, according to the National Diabetes Association. Furthermore, approximately one in 10 healthcare dollars are spent treating diabetes.
Minorities, especially blacks, are genetically predisposed to diabetes, Bhargava says.
Paul says his life has changed a lot after learning he has the disease. A lot of learning about his affliction is trial and error - learning how many carbs are in a meal, how to recognize what it feels like to have low blood sugar or high blood sugar, he says.
One night, Annette says she came downstairs and Paul was standing at the counter. He was sweating. He looked light-headed. His hands were so shaky she says he wouldn't have been able to perforate the aluminum membrane of a juice box with a straw.
"Step back for a second," she told him. "Remember what this feels like."
Then she gave him some sugar.
About half of diabetics do not take their medications - often insulin but sometimes oral medication - as prescribed, which doubles their chances of needing hospitalization.
Paul says even when he is diligent about his treatment, monitoring his blood sugar isn't always as easy as just taking his medication at prescribed times. It's more of an art than a science. And being on the swim and track teams adds another layer of complexity as exercise lowers blood sugar.
Bharvaga hears of these problems often.
"I forgot my refill," his patients often tell him. "I don't know what meds I'm on."
As it turns out, diabetics often have problems keeping track of their drugs. That's why Bharvaga developed a smartphone application that helps patients manage their medications.
The app, called MedSimple, sends patients coupons and helps organize the onslaught of data that often overwhelms them, both lowering patients' out-of-pocket costs and making it more likely they will take their medications as prescribed.
When he first got sick, Paul says he was terrified. He didn't know what having diabetes meant or how it would change his life.
The grim and horrific complications of diabetes are always swimming in his subconscious.
But now, he has learned to live with it, and the fear is more of a motivator. It's what drives him to maintain his disease. A person can live with the disease as long as they are willing to make some sacrifices.
"Over the years, it gets easier," he says.
Contact David Alexander at 641-753-6611 or firstname.lastname@example.org