A quiet epidemic

First of a two-part series

The neighborhood is still dark when Cecil Miles and his wife, Mervin, climb into their truck and drive through empty streets to the machine that keeps her alive. At Faulkner Hospital, Mervin slides across the familiar smoothness of the pink corner chair and pulls a knitted glove over her left hand.

The glove is habit. She no longer feels the cold settle into her hand, as the tubes that arc above her head redden with her blood, tugging it from her arm and sending it back again, clean. But still she pulls on the black glove, takes a crossword puzzle book from her bag and unfolds a faded Wile E. Coyote blanket, borrowed from her youngest grandson, across her lap.

Mervin Miles is in the grim endgame of diabetes, her kidneys ravaged and unable to rid her body of toxins. Three times a week for four years she has woken at 4 a.m. for the trip from her house near Codman Square to the hospital. Cecil Miles, too, is diabetic, and he hopes he does not see his future in her sickness.

As Mervin's blood is mechanically cleansed, day breaks and diabetes begins to make other demands in her Selden Street neighborhood. Two houses up the street, Edna Johnson is thinking about testing her blood sugar. Four houses down, Peggy Deas is measuring out white grits, trying to stick to a small portion to pacify her insulin-resistant body.

Deas's next-door neighbor also has "the sugar," as does the man whose dogs roam the yard behind the Mileses' house. So, too, does the man around the corner with the bad foot, possibly fallout from the disease, and the mother and her daughter around the corner from him. And so does their next-door neighbor, Marguarite Daniel, who has just returned from her night data-entry job to wake her grandson for school.

Diabetes rolls through the neighborhood as defiantly as the bass-thumping cars that prowl the streets on weekends. The section of Dorchester roughly from Codman Square to South Franklin Field ties with Roxbury for the third-highest rate in the city of diabetes deaths, behind only Mattapan and Fenway, according to the Boston Public Health Commission. In 2002, for the first time, diabetes crept onto the list of the top five killers of black Bostonians, according to the commission, as No. 5.

"What we're seeing is an alarming increase in diabetes among children and adults," said John M. Auerbach, executive director of the Public Health Commission.

Five of the city's community health centers have just begun using a $5 million grant to try innovative ways to help those with diabetes manage their disease, in an effort to keep them healthier longer and avoid the potentially deadly consequences of ignoring the illness: amputation, kidney failure, heart attack. The Codman Square Health Center -- one of the five, with 900 diabetic patients -- has scheduled group medical visits and cooking classes and has hired outreach workers to visit diabetics who have skipped doctors' appointments.

The programs attempt to help patients with Type 2 diabetes, by far the most common form of the disease. With Type 2, the body does not properly use insulin, the hormone that helps move glucose, or sugar, from the blood into cells. Glucose builds up in the blood, causing trouble in the body, rather than nourishing cells. Type 2 diabetes was once called adult-onset diabetes, until children began showing up with the disease.

Diabetes is linked strongly to weighing too much and exercising too little, and preventing the disease -- and managing it, once it arrives -- proves to be as difficult as getting Americans to lose weight and work out.

Marguarite Daniel, 59, is one of 10 diabetics interviewed by the Globe who live on a single city block near Codman Square, bordered by Selden, Capen, and Maxwell streets and Milton Avenue. The block is likely home to more people struggling with diabetes, since the patients were found through an unscientific, door-to-door survey.

Daniel moved to Boston from St. Lucia more than three decades ago and has long struggled with her weight. She knows she should eat less, and healthier, than she does. "It's my fault," she says, her West Indian accent still strong. "It's just that Marguarite loves her food."

She was diagnosed with diabetes five years ago, when she fixed herself a particularly sweet bowl of porridge after church and fell ill. Her doctor started her on pills, usually prescribed for Type 2 if the disease cannot be managed with exercise and watchful eating. (Type 1 diabetes requires insulin by injection or pump no matter how carefully a person eats.) Daniel's blood sugar remained high and the doctor put her on insulin. Now Daniel injects herself in the belly each day.

She doesn't test her blood sugar every day, though, because the high numbers depress her.

Daniel was one of 84 diabetics who spent a Saturday morning at Codman Square Health Center a few weeks ago at the center's first Diabetes Tune-Up Day. Doctors and nurses checked eyes and feet and teeth, monitored vital signs, and examined glucometers, machines for testing blood sugar. A trainer led them in exercise sessions. A nutritionist grilled them on carbohydrates.

After Daniel finished a session on stress management, where she learned deep breathing, she settled into a chair for a lesson on nutrition and began to sample food.

"The pumpkin pie was made with Splenda," a volunteer chirps.

"I don't want it, then," Daniel retorts.

Minority populations, especially blacks, are more likely to get diabetes for reasons that scientists do not entirely understand. In Boston, blacks are more likely to be overweight or obese than other racial and ethnic groups. In some poorer neighborhoods like Codman Square, where the population is 66 percent black, exercise can be difficult; gyms are rare and some residents say they do not feel safe walking their streets.

And high-carbohydrate, high-calorie food, the curse of the diabetic, is cheaper and easier to get than whole grains and fresh fruits and vegetables.

Reynaldo Salcedo, who has owned Salcedo's Market on Norfolk Street near Codman Square for 17 years, sees more and more people who tell him they are diabetic, searching for something they can eat. Like most convenience stores, his shelves are stacked with Doritos and Skittles and Pepsi.

"I don't have much for diabetic people," he said. "Everything I have is sweet or too much salt."

But the diabetes epidemic has made Salcedo a bit of an expert, and he steers diabetics to a single gray can: Arnold Palmer Lite Half & Half, a mixture of iced tea and lemonade, a drink with less sugar than many sodas.

Still, experts say, obesity rates alone do not explain the higher prevalence of diabetes in the black community. Even blacks with healthy weights are more than twice as likely as whites to be diagnosed with diabetes, the Boston Public Health Commission found.

"The rate of death from diabetes among the black residents of the city is more than twice the rate of death from diabetes among the white residents," said Auerbach.

"There is a genetic tendency to have insulin resistance among minority populations," said Dr. Enrique Caballero, an endocrinologist at Joslin Diabetes Center and director of the center's Latino Diabetes Initiative. Some scientists hypothesize that minority groups were more likely to be exposed, long ago, to extended periods of starvation. Their bodies adapted by absorbing less glucose into cells, the theory goes, leaving more available for tissues like the brain -- a survival tactic that in modern times may doom them to diabetes.

Between the two basketball hoops in the center of a wood-floored gym, eight women and two men grasp the backs of metal folding chairs and raise their legs to the beat of "Disco Inferno" blasting from a boom box. "We did a lot of burning today!" says Leoni Epiphaniou, who leads the group in exercise.

Soon the group will file into another room and pass around a plastic bowl filled with roasted pepper salad. The class at Dorchester House Multi-Service Center is designed to help diabetics manage their disease on their own, collectively lowering their blood sugar levels.

"It affects so many systems within your body," said Lisa Levine, chief operating officer of Dorchester House. "You're asked to measure the amount of sugar in your blood every day. You have to look at your diet in a different way. You have to start to worry about your feet," because loss of sensation there can lead to serious infection.

A pilot group at Dorchester House was started last spring, and this is the second class to go through the 12-week program. Codman Square recently began its own group. In class, the diabetics work up a sweat. They talk about their problems with busted glucometers; they learn how to cook without blowing their carb limits. Sometimes the most powerful lessons come from their peers, said Ivy Brackup, a Dorchester House doctor.

In one of the first groups, a man mentioned casually in class that he took his Dunkin' Donuts coffee with three sugars and two creams. He did not know that it was an overload of sugar for his diabetic body -- but his peers did.

"They just looked at him and said, 'You're doing what?' " Brackup recalls. "They really talk to each other."

It's too early to know whether the group, or any of the new programs at the health centers, will make diabetics healthier. But for Elaine Noble, a nursing assistant and group participant, the payoff has already been both practical and emotional. She has taken advice from the group's nutritionist to always carry healthy snacks. And she likes meeting others who must deal with the same disease.

"We have buddies," said Noble, 36, whose mother and grandmother also had diabetes. "We call each other and support each other."

Back on Selden Street, Peggy Deas recently began a class at Boston Medical Center, similar to the one at Dorchester House, and is amazed at all she didn't know after 35 years of living with diabetes. She has found out that canned vegetables contain a lot of salt, which raises blood pressure, another complication of diabetes. And that white grits, a favorite since her childhood in South Carolina, can send her blood sugar soaring. And that she can cook collard greens with smoked turkey instead of fatty bacon.

And she is learning that diabetes is not something to ignore. "I didn't know that it makes your teeth drop out," said Deas, 58.

Her doctor scared her into taking her medicine regularly, Deas said, saying she didn't want to get the call that her patient had suffered a stroke or a heart attack.

Four houses down, Mervin Miles had long struggled with her weight.

"I know I wasn't eating right," said Miles, 71, retired from his job as an assembler at Raytheon Co. "I was eating the wrong things. A lot of sweets."

Then she lost 50 pounds in the past year and a half, unintentionally, after her doctor found a cancerous lump in her neck.

Miles was treated with 32 sessions of radiation, which seemed to banish the cancer but also impaired her swallowing. She never missed a day of dialysis.

Her husband, 69, a retired MBTA bus driver, hopes his own diabetes remains under control.

"I'm just hoping and praying that I don't have to go on dialysis , seeing what she's going through," he said. "You never can tell."

Diabetes has a strong hold on their family. Her sister and brother-in-law have it; Cecil believes his mother was diabetic.

And a few years ago, their oldest son, who lives in Roxbury, was diagnosed. He is 50.

Kathleen Burge can be reached at kburge@globe.com.