Pamala Fernandes (Pam)
I have a lot of challenges as an athlete, but I have been able to compete with people who are nondiabetic and I've been able to beat them and that's been kind of fun.

Narrator — Ted Vigodsky
On this edition of "Science and Your Life," a world class athlete against all odds.
Diabetic since age 4, the disease really started doing a number on Pam Fernandes upon entering college.

Pam Fernandes
That was back in 1965 when we actually didn't know nearly what we know about diabetes today. Back then we were testing urine for sugar rather than doing blood tests. We were taking insulin once a day or maybe twice a day, injecting on a 45-degree angle. At the age of 17, I had an eye exam and the doctor said to me, "Pam, you have a few small hemorrhages in your eyes. It's nothing to be concerned about, but you need to see a specialist." And I found out that I had proliferative diabetic retinopathy and that I was going to go blind. I had 20-20 vision and I had no pain. This was a very difficult thing for me to fathom.

I was given choices of treatments and back then laser was, I think, relatively new as a treatment. And I did get laser therapy. It did prolong my vision for a year and then I developed a blind spot in my right eye. I had surgery on my right eye, ended up having no vision. After the 3 operations, I had no retina left. I had vision in one eye though, so I was able to continue through my college studies. In fact, I didn't even take any time away from school. Over those 3 months, I kept going to school.

A year later, I had a blind spot in my left eye and at the age of 21, I was declared legally blind. So I dropped out of school for a year. I began learning how to deal with life as someone who couldn't see and how you do things like draw up insulin? How do you do things like test your blood sugar?

Those are actually fairly easy to figure out. How do you walk around? How do you read print? How do you do your academic studies? So I had a volume of things to deal with. Only a few months after that, I was told that my kidneys were failing and that I would spend the rest of my life on dialysis or get a kidney transplant. So I did spend five years on dialysis and got a transplant in 1987 and I've also got, had, GYN precancer. I've had tendonitis, I've had a number of issues, some diabetes-related, some not.

When you start taking prednisone for immunosuppression, you don't really know — you know I have a cataract in my left eye that is taking the rest of my vision, probably due to the prednisone. That's a lot to deal with for anyone. So I've seen parts of diabetes that I hope no one else ever has to see.

Narrator — Ted Vigodsky
Despite these overwhelming odds, Pam Fernandes went on to become a Paralympic gold medal cyclist.

Pam Fernandes
I was actually very physically active as a child and through my complications had to sort of take a break from physical activity. But after my transplant, I got very eager and I started going back to the gym and I found out about bike riding and I got invited to the Olympic Training Center. And I have to tell you, because, you know, we all look at things on paper and things on paper don't always give the whole story. My coach, when he got my application, saw "diabetic, kidney transplant," — you know, he saw the whole list of what I had and he said to me — "Pam, when I saw you getting off the plane, I thought you were going to be carrying an oxygen tent behind you." And he said, "You have turned out to be one of the best athletes I've ever worked with."

So I've been lucky. I got involved in cycling. I've done phenomenally well at it. Being an athlete is difficult. Being an athlete with diabetes is more difficult. But it certainly is doable. For those of you who are familiar with diabetes, getting someone to test once a day or four times a day sometimes can be a huge accomplishment.

When I'm competing, I test 15 to 20 times a day and I have to do that because blood sugars change minute to minute. With my diabetes, my blood sugar can change quite rapidly.

Narrator — Ted Vigodsky
Fernandes spends a lot of time helping the American Diabetes Association tell other women that they can do so much more to manage their own diabetes. Dr. Frank Vinicor heads the Diabetes Program at the CDC's National Center for Chronic Disease Prevention and Health Promotion.

Dr. Frank Vinicor
I think over the last 10 years particularly, what we've come to understand about the basic issues of diabetes, allows us to say [that] what we knew pales in comparison. And it's not just underlying pathophysiology, it's actually very practical things. We have better insulins that are purer. We now have insulins that will have a shorter or longer onset so that given Pam, for example, needed to control her blood sugar very well — she has a lot of choices in using insulin as to how she mixes those insulins up to get good blood sugar control.

We have now … [that is] people have to take tablets — oral agents for diabetes control. Three years ago, we had one type of oral tablet, we now have four distinct different types.
The monitoring devices — the needles are smaller, the amount of blood you need is smaller. We now don't always have to use the fingertip. You can use other parts of the body to get blood samples and of course, there are products coming on the market that are the so-called noninvasive ways to measure blood sugar.
I think the advent of the so-called certified diabetes educator, in other words, seeing the importance of non-physician health personnel being actively involved in diabetes is important.

Many large companies — General Motors, Polaroid — they are realizing that diabetes is important. Those are all practical examples of learning things. We know now that, for example, it is likely were Pam to have developed diabetes yesterday — [to Pam] — you would probably not have lost your vision because we now know with glucose and blood pressure and lipid control, you don't even need to have to develop the first red spot in the eye.

Narrator — Ted Vigodsky
Kathy Rufo is deputy director of the CDC Diabetes Program.

Kathy Rufo
We are launching a major initiative, and when I say we, that includes four of us, because I'm proud to say we have three cosponsors — the American Public Health Association, the Association of State and Territorial Health Officers, and the American Diabetes Association. Working together as partners, we believe we can make an important difference on this serious problem.

Narrator — Ted Vigodsky
An important part of the initiative is a new CDC report which focuses on the specific issues that make diabetes a serious women's health issue, through every stage of life.
Co-editor, Patricia Thompson-Reid.

Patricia Thompson-Reid
Women live longer than men, alone and poor and increasingly with diabetes. This is what a lot of people now refer to as, or recently [refer to], the feminization of old age and many of us, as you know, are getting older. The population of the United States is aging and so we must begin to think about how we are going to organize our services to serve this population.

Narrator — Ted Vigodsky
Co-editor, Dr. Gloria Beckles, is mindful that there must be a lot more focus on diabetes and women than just impressive scientific and clinical advances.

Dr. Gloria Beckles
I too would like to thank Ms. Fernandes for telling us about her life. I couldn't help being struck by the fact that she said, "I've been lucky. I have access to good health care. I have a job. I have good diabetes education. I have insurance. I have choice. I have support."

In truth, what she is saying is that she lives in a socioeconomic environment that allows or facilitates good control of her diabetes. And it is true that attitudes and effort and stubbornness of the individual is important and vital to the success.

But I would like us, please, to take on board the idea that if an individual has the best intentions in the world and the environment in which they live is hostile to their efforts, there can be no success. And public health, the public health community, that is its' business — policy, manipulating the environment in which the population-at-risk finds itself in order to facilitate greater well-being and health.

Culturally, we have this notion — "I can do it" — and that's fine, but I think it's time that we recognize that there are forces or exposures or determinants of health that the individual has no control over and that is an important issue for us as public health practitioners in the public health community.

That's the history of public health, we do not improve the health of populations by treating sick people. We change their exposure to risk and if we don't go away with anything else, as somebody who's very involved in this document, I would like us to start thinking about this notion that it is not a matter for the individual alone. If you have a chronic ongoing disease, you have to have support and that support has got to be at the family and at the community and at the national level, if you are going to reap the benefits of the knowledge that we have.

Narrator — Ted Vigodsky
For "Science in Your Life," I'm Ted Vigodsky.

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