MODESTO BEE
ORIGINAL ARTICLE

By KEN CARLSON
BEE STAFF WRITER

Last Updated: October 18, 2006, 06:30:51 AM PDT

Gina Leguria of Modesto noticed that her then-4-year-old daughter, Rosa, looked dehydrated and was constantly thirsty. The girl wet her bed even though she had been potty-trained at an early age.
When the child complained of stomach pains, her mom brought her to the doctor.

"Our pediatrician took one look at her and ordered a glucose test," Leguria said, noting the test showed her blood sugar was skyhigh and she was in danger of severe complications. "She was in the hospital in San Francisco that eve-ning."

Thus began the family's bout with Type 1 diabetes. Rosa, now 6, requires insulin injections from a pump several times a day. Her parents monitor her intake of carbohydrates, and they frequently check her blood sugar.

Her father, Jack Leguria, pricks her finger at midnight to run the test; Gina Leguria handles the 4a.m. check.

The Legurias soon made one other discovery: They couldn't find an endocrinologist in Stanislaus County to give specialized care for their daughter.

Four to six times a year, they travel to San Francisco so their daughter can see a pediatric endocrinologist. Many other parents with diabetic children see specialists in Sacramento, Fresno or Madera.

The Legurias consult their pediatrician for daily management of their daughter's disease. Their endocrinologist reviews Rosa's blood sugar readings, examines her hands and feet for circulation, sets nutrition guidelines, and discusses flexible insulin therapy with the parents. Rosa's insulin may be adjusted based on what her activities are on a given day.

"We are a county of more than 500,000 (residents), and by and large, people are leaving the county to get the care needed for their children," Gina Leguria said.

An estimated 20.8 million people in the United States have diabetes, about 7 percent of the population. Type 1 diabetes, which most often strikes children and young adults, accounts for 5 percent to 10 percent of cases.

Type 2, accounting for 90 percent to 95 percent of diabetes cases, most often strikes adults who are overweight and inactive, but also is showing up in children.

Stanislaus County health officials have been concerned about data suggesting that the disease hits especially hard locally.

According to the Center for Public Health Advocacy, the occurrence of diabetes-related deaths was almost 87 per 100,000 people in the sprawling 25th Assembly District, which includes part of Stanislaus County, plus Calaveras, Tuolumne, Mariposa and Madera counties. The statewide death rate was 82 per 100,000.

The most recent data cited in the study was from 1996 to 2000, but public health officials believe the numbers are significant.

"I think we see a trend in this county," said Phoebe Leung, associate director of the Stanislaus County Health Services Agency. "I don't think it is getting better."

The larger physician groups in the county include endocrinologists who treat adults, but they are taking few, if any, pediatric diabetics.

Craig Baize, spokesman for Sutter Gould Medical Foundation, said pediatric patients are referred to endocrinologists in Sacramento and the Bay Area. Some out-of-town specialists come to this area a couple of times a month to see patients, he said.

A Sutter-affiliated endocrinologist from Sacramento sees pediatric patients in Tracy the first and third Thursday of the month.

Dr. Saleh Adi of Sutter's California Pacific Medical Center in San Francisco will offer an outreach clinic in Modesto starting in November.

"It will probably be on a regular basis, but I'm not sure if it will be every month or every quarter," Baize said.

"I think there is just not enough volume to support a pediatric endocrinologist full time. It is a subspecialty that is generally located in a metropolitan area, and they get referrals from a large geographic area."

Kaiser Permanente said one of its pediatric endocrinologists from Sacramento comes to Stockton on a weekly basis and to Modesto once a month.

Elizabeth Martinez, a diabetes educator in Stanislaus County, said there is need for local specialists willing to treat children with diabetes. "These patients are time-consuming," she said. "They need constant evaluation. Their management is more intense."

Gina Leguria said about 20 to 30 families come to a childhood diabetes support group tied to Doctors Medical Center, and the group has a mailing list of 150.

The Legurias are doing everything to take make sure their daughter has an active life. Rosa has played baseball, attends diabetic camp and is learning to play tennis.

"With the support of a good care team, we are raising her to be an active kid — in moderation," Leguria said.

Bee staff writer Ken Carlson can be reached at 578-2321 or kcarlson@modbee.com.

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MORE INFORMATION

California Pacific Medical Center's outreach clinic for insulin-dependent children will begin in November at 1635 Tully Road, Modesto. Appointments are required. Call 866-663-5437 or 415-600-3410. The program accepts major insurance, except Kaiser Permanente.

Free diabetes education and information will be offered at the Diabetes Info Fair from 2 to 6 p.m. Nov. 8 at Modesto Centre Plaza, 1000 K St. The annual fair is organized by the Stanislaus County Health Services Agency. Flu shots will be offered from 2 to 4 p.m. Cost for a flu shot is $20.