Overview

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels.

In 2014, 8.5% of adults aged 18 years and older had diabetes. In 2019, diabetes was the direct cause of 1.5 million deaths and 48% of all deaths due to diabetes occurred before the age of 70 years.

Between 2000 and 2016, there was a 5% increase in premature mortality rates (i.e. before the age of 70) from diabetes. In high-income countries the premature mortality rate due to diabetes decreased from 2000 to 2010 but then increased in 2010-2016. In lower-middle-income countries, the premature mortality rate due to diabetes increased across both periods.

By contrast, the probability of dying from any one of the four main noncommunicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases or diabetes) between the ages of 30 and 70 decreased by 18% globally between 2000 and 2016.

Type 2 diabetes (formerly called non-insulin-dependent, or adult-onset) results from the bodys ineffective use of insulin. More than 95% of people with diabetes have type 2 diabetes. This type of diabetes is largely the result of excess body weight and physical inactivity.

Symptoms may be similar to those of type 1 diabetes but are often less marked. As a result, the disease may be diagnosed several years after onset, after complications have already arisen.

Until recently, this type of diabetes was seen only in adults but it is now also occurring increasingly frequently in children.

Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset) is characterized by deficient insulin production and requires daily administration of insulin. In 2017 there were 9 million people with type 1 diabetes; the majority of them live in high-income countries.Neither its cause nor the means to prevent it are known.

Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes, and fatigue. These symptoms may occur suddenly.

Gestational diabetes is hyperglycaemia with blood glucose values above normal but below those diagnostic of diabetes. Gestational diabetes occurs during pregnancy

Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery. These women and possibly their children are also at increased risk of type 2 diabetes in the future.

Gestational diabetes is diagnosed through prenatal screening, rather than through reported symptoms.

Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are intermediate conditions in the transition between normality and diabetes. People with IGT or IFG are at high risk of progressing to type 2 diabetes, although this is not inevitable.

Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.

Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of type 2 diabetes. To help prevent type 2 diabetes and its complications, people should:

Early diagnosis can be accomplished through relatively inexpensive testing of blood sugar.

Treatment of diabetes involves diet and physical activity along with lowering of blood glucose and the levels of other known risk factors that damage blood vessels. Tobacco use cessation is also important to avoid complications.

Interventions that are both cost-saving and feasible in low- and middle-income countries include:

Other cost saving interventions include:

WHO aims to stimulate and support the adoption of effective measures for the surveillance, prevention and control of diabetes and its complications, particularly in low- and middle-income countries. To this end, WHO:

The WHO Global report on diabetesprovides an overview of the diabetes burden, interventions available to prevent and manage diabetes, and recommendations for governments, individuals, the civil society and the private sector.

The WHO module on diagnosis and management of type 2 diabetes brings together guidance on diagnosis, classification and management of type 2 diabetes in one document. The module is for policy-makers who plan service delivery of diabetes care, national programme managers responsible for training, planning and monitoring service delivery, and facility managers and primary care staff involved in clinical care and monitoring processes and outcomes of diabetes care.

In April 2021 WHO launched the Global Diabetes Compact, a global initiative aiming for sustained improvements in diabetes prevention and care, with a particular focus on supporting low- and middle-income countries. The Compact is bringing together national governments, UN organizations, nongovernmental organizations, private sector entities, academic institutions, and philanthropic foundations, people living with diabetes, and international donors to work on a shared vision of reducing the risk of diabetes and ensuring that all people who are diagnosed with diabetes have access to equitable, comprehensive, affordable and quality treatment and care.

In May 2021, the World Health Assembly agreed a Resolution on strengthening prevention and control of diabetes. It recommends action in areas including increasing access to insulin; promoting convergence and harmonization of regulatory requirements for insulin and other medicines and health products for the treatment of diabetes; and assessing the feasibility and potential value of establishing a web-based tool to share information relevant to the transparency of markets for diabetes medicines and health products.

(1) Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Emerging Risk Factors Collaboration.

Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio et al. Lancet. 2010; 26;375:2215-2222.

(2)Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study GBD 2019 Blindness and Vision Impairment Collaborators* on behalf of the Vision Loss Expert Group of the Global Burden of Disease Study Lancet Global Health 2021;9:e141-e160.

(3) 2014 USRDS annual data report: Epidemiology of kidney disease in the United States.United States Renal Data System. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2014:188210.

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Diabetes - World Health Organization

It wasnt until a quarter century after being diagnosed with type 1 diabetes (T1D) that Lori Salsbury in Arkansas realized the condition shed been living with since she was 15 years old might not be what she thought it was.

Though her mom and sister were both initially misdiagnosed with type 2 diabetes (T2D) and later correctly dubbed T1Ds, Lori didnt have a reason at first to be suspicious of her own T1D diagnosis. Not until 2015, when she began seeing more people with diabetes sharing their stories online and realized something was off for her.

Sure, there is a mantra in our community that Your Diabetes May Vary. But for Salsbury, the particulars of her T1D just didnt match what she saw others in the D-Community sharing or what doctors and nurses described as the symptoms most newly diagnosed T1D experience.

At the time of her diagnosis, Salsbury was in her mid-20s and seemed quite healthy. She didnt get nauseous or sick, even a full day after missing an insulin dose. Her insulin dosing needs would change frequently, often sending her into super high glucose levels for weeks until adjusting her insulin or carb ratios; the same would happen on the low end of the scale.

One day, Salsbury heard about a rare, inherited form of diabetes called MODY (maturity onset diabetes of the young), that doesnt require as much insulin, at least initially. That piqued her interest.

She did some online research, and then consulted her endocrinologist and received antibody tests that came back negative. He also ran a C-peptide test that came back at T1D levels, but that was most likely due to her 20+ years of using insulin. A referral to a geneticist led to more bloodwork, and in January 2020 the findings came back showing a genetic mutation, which causes one of the several different known types of MODY.

MODY has the potential of changing how you manage your diabetes, depending on the particular form youre diagnosed with. Some changes could include stopping medications completely or changing from insulin to a different injectable or oral medication, while some MODY forms mandate changes in your diet.

In Salsburys case, the MODY diagnosis brought her some clarity, and finally an explanation of why her diabetes experience seemed so different than others in the T1D community. But she continues insulin therapy.

Since I was originally diagnosed T1D, I am still (labeled that) in my charts so that I wont lose coverage for my insulin pump and CGM that I require to live by, Salsbury said. Most often, if asked I just tell people that I was diagnosed with type 1. Its easier than going through the whole What is MODY? spiel.

The easiest way to think about MODY is that its a subset of diabetes caused by a mutation in one of at least 14 genes in a persons DNA. That mutation impacts the insulin-producing beta cells, which in turn impacts insulin production and glucose regulation.

Since just an estimated 1 to 2 percent of those with diabetes have a genetic mutation leading to MODY, there isnt much discussion about it within the patient community, and most medical professionals dont bring it up unless they are questioned. Yet some advocates and researchers believe the various types of MODY are more common than many think, and that view is becoming more accepted as genetic testing becomes more widely available.

The term MODY was first coined in the 1970s by pioneering researchers who identified what appeared to be a mild form of diabetes in children that didnt necessarily require insulin as was needed for those with the more common juvenile diabetes (before it was later renamed type 1). At that time, MODY was defined as fasting hyperglycemia diagnosed under age 25 which could be treated without insulin for more than two years, and it is inherited, as they found.

While most research existing shows its as rare as 1 to 2 percent of all diabetes cases, more current research now indicates that as many as 6.5 percent of children with antibody-negative diabetes may have a form of MODY.

MODY is passed down genetically from parent to child, making that the common thread for this form of diabetes compared to the other types that are autoimmune, partially genetic, or more lifestyle-based. The typical diagnosis comes before age 25, and its rarely diagnosed in those older than 35 or 40. While children have roughly a 50 percent chance of developing MODY if one of their parents has it, that does not mean mutations cant occur at random and appear in those without a family history of gene mutation.

The gene mutations arent the same for everyone, and they affect different organs in the body, meaning its difficult to diagnose without genetic testing, and it can be more challenging to recognize glucose fluctuations commonly found in those who are newly diagnosed.

Significantly, 80 percent of MODY cases are misdiagnosed as T1D or T2D as the signs are pretty much the same extreme thirst, increased urination, and weight loss. But some forms of MODY do not produce any symptoms. The number of misdiagnoses may be even higher at 95 percent in the United States, according to some researchers.

Dr. Miriam Udler at Massachusetts General Hospital is one of the more well-known names in MODY clinical research. She believes more cases are being diagnosed in recent years as genetic testing has become more available, particularly after COVID-19 led to a telehealth explosion and more at-home testing kits for bloodwork and diagnostic tests normally done in a lab.

Dr. Miriam Udler

It used to be rare and expensive, and that was a barrier to testing and diagnosing MODY correctly, she told DiabetesMine. But now, more providers have access to this and can order the tests to their clinics or patients at home, and insurance is increasingly covering MODY genetic testing.

While MODY is still less common and infrequently discussed in clinics, Udler says it comes down to that particular doctor or patient recognizing something might be different about their diabetes.

That matters a lot, and a correct diagnosis can change management, Udler said. In most common MODY forms, it could mean coming off medication.

For Salsbury, the particular BLK gene mutation she has causes MODY 11, an insulin secretion defect that makes her beta cells less responsive to glucose and leads to less insulin being sent out by the body when its needed. Being overweight is one common feature of this particular gene mutation, according to research.

Once MODY is recognized and diagnosed, it can also be difficult to regulate glucose levels in the same ways that T1D and T2Ds often do, because the symptoms and glucose levels can vary significantly.

As MODY 11 usually presents like T1D and is treated in much the same way, Salsbury has been using insulin since she was diagnosed at age 15 in 1991 and wears an Omnipod tubeless insulin pump and Dexcom CGM, combined into a homemade do-it-yourself (DIY) closed loop system. For her, life with MODY isnt much different from being T1D.

But she knows everyone is not as fortunate on that front and can have many challenges in getting a correct diagnosis and finding a management routine that works for their particular form of MODY.

In New York, Laurie Jones shares her story of being diagnosed at 30 with gestational diabetes late in her first pregnancy through the test often given to pregnant women. She changed her diet and followed it to the letter on exact carb and calorie allowances, and took varying doses of long and short-acting insulins. Though she describes it as intense, all signs of diabetes went away after her first pregnancy.

But within a few years during her second pregnancy, gestational diabetes returned. She began insulin injections right away as well as a strict diet, but Jones found it more difficult than before to regulate high and low blood sugars.

A number of years later, her A1C results were creeping higher and that led to a T2D diagnosis. She took Metformin on the advice of her doctor, but it didnt work to keep her blood sugars in check.

Most adult medicine endos do not push for MODY testing even when the medicine is not working, she explained. Being overweight is usually assumed the reason, therefore even star doctors dont push for MODY testing unless weight is lost.

Her sons diagnosis changed everything. When he was 6 years old, he was diagnosed with eosinophilic esophagitis, and that mandated a diet free of the top allergens. He was about 12 when she took him to an endocrinologist, as he was not growing and low on the weight scale and didnt show any signs of puberty. That endo noticed his blood sugars were elevated and assumed he was in the honeymoon period prior to becoming a fully diagnosed T1D.

Months progressed, and the doctor suggested it was MODY. Genetic testing led to a MODY 2 diagnosis.

We had no idea what that was, and before [the doctor] explained it to us, she noted that most endocrinologists and almost all doctors outside of major medical teaching and research hospitals have not heard of it, the D-Mom said.

After her sons diagnosis, Jones got her own genetic testing and learned she also had MODY 2.

Most controlled by diet, MODY 2 is one of the more common but less intensive forms of MODY that usually doesnt require insulin or other glucose-lowering meds.

That led her to stopping Metformin, and shes been eating healthier and managing her weight for better glucose levels.

MODY 2 is not just about how you produce or use insulin, but mainly when you produce the insulin, she said. We were both told that our pancreas is like a house cooling or heating system that is off-kilter. Basically, our sugar levels have to get much higher than what is considered normal before the pancreas produces insulin. There are also insulin efficiency issues.

Without her sons diagnosis, Jones doesnt think she wouldve ever had the needed genetic testing and would have remained with a T2D diagnosis taking the wrong medications.

Thats likely the story for so many people in our D-Community, she believes.

With a 50 percent chance of being passed on, chances are MODY is not as rare as it is now believed, Salsbury said. If more people knew of it and were tested, we may come to find out that it is the most common or second only to T2D in commonality.

Importantly, a correct MODY diagnosis can highlight other health issues that might potentially arise. For example, a MODY 11 mutation to the BLK gene can increase the chances of developing systemic lupus erethematosus (SLE).

While being correctly diagnosed as MODY may not change your treatment, it can give you other information, Salsbury said. Many forms of MODY also come along with other health issues that the mutation may have caused. Knowing you have MODY can alert your doctors to watch you or check you for other related health conditions.

Researchers note the same, including Dr. Toni Pollin, a genetic researcher and counselor who in 2016 co-founded the Monogenic Diabetes Research and Advocacy Project (MDRAP) at the University of Maryland School of Medicine. The MDRAP effort promotes the correct diagnosis of MODY and also helps raise money for that effort. She co-founded MDRAP with a patient advocate whod been diagnosed with a form of MODY.

While improving MODY diagnosis will certainly improve the clinical care for patients, it will also have broader implications, researchers wrote in this 2015-published Undiagnosed MODY: Time for Action manuscript. Screening and genetic testing for MODY among patients with diabetes will provide a model for identifying and diagnosing highly penetrant forms of other otherwise common complex diseases [through] the power of genetics and genomics for improving patient care and public health.

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MODY: A Rare but Increasingly Common Form of Diabetes - Healthline

Diabetes is a chronic condition that leads to serious life-threatening complications, however many people go undiagnosed and are undertreated a situation being further exposed by the COVID-19 pandemic.

For this reason, understanding risk factors, symptoms and the importance of early diagnosis and action is essential.

More than 34 million people in the U.S. are affected by diabetes, and one-in-five of them are undiagnosed, according to estimates from Centers for Disease Control and Prevention.

Health services organization Cigna reports that between January 2020 and June of 2021, nearly 800 of its patients who were diagnosed with COVID-19 were found to have undiagnosed diabetes. Only 14% of those people had previously been diagnosed with pre-diabetes.

So why are so many people living with diabetes going undiagnosed? Cigna claims data shows that those at higher risk of having social or economic obstacles to health, also had a higher risk of undiagnosed diabetes and COVID-19.

As is the case with many medical conditions, timely diagnosis and treatment of diabetes is impacted by persisting health inequities that affect certain communities and populations, says Dr. Mandeep Brar, Cigna medical director and board-certified endocrinologist. Factors such as race, ethnicity, access to healthful food, education, health care coverage and language barriers, to name a few, all contribute to undiagnosed cases of diabetes.

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Check if you have undiagnosed diabetes | Waco Today | wacotrib.com - Waco Tribune-Herald

A person who has developed a disabling condition when living with type 2 diabetes may be able to claim disability benefits. There are two types of benefits: Social Security Disability Income (SSDI), for people who have a work history, and Supplemental Security Income (SSI), which does not require a previous work history.

Type 2 diabetes results in body cells resisting the effects of insulin, which leads to impairments in a persons metabolism. Such impairments can lead to diabetes-related complications, some of which may affect a persons ability to work.

In this article, we outline some potential complications of diabetes. We also provide information on how a person with type 2 diabetes may qualify for disability benefits, the types of benefits they may be entitled to, how to apply, and how to appeal a decision. Finally, we provide tips on how to talk to an employer about a disability.

Type 2 diabetes can cause complications that may affect a persons ability to work, either in the short term or the longer term. Some examples include:

Hyperglycemia is the medical term for abnormally high blood glucose levels. This condition can result in potentially serious complications, such as diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome.

Diabetic ketoacidosis (DKA) is a serious complication of diabetes. In DKA, a lack of insulin causes the body to break down fat for energy. This process triggers the release of harmful substances called ketones, which accumulate in the blood.

The symptoms of DKA include:

A person with DKA may require hospitalization to treat or prevent complications of DKA. These complications may include:

Hyperosmolar hyperglycemic syndrome is a serious complication of diabetes, in which chronically high blood glucose levels trigger severe dehydration. This happens because excess sugar passes into the urine, causing a person to urinate more frequently.

The symptoms of HHS may include:

HHS is a potentially life threatening complication that requires urgent treatment in a hospital setting.

Chronic hyperglycemia may occur in people who have difficulty controlling their blood glucose levels. The condition may cause complications, such as:

Hypoglycemia is the medical term for abnormally low blood glucose levels. People who take insulin to control their diabetes are at increased risk of hypoglycemia.

Many people with type 2 diabetes are able to recognize the symptoms of hypoglycemia and take evasive action by consuming glucose-containing foods or beverages. Early symptoms to look out for include:

Without treatment, hypoglycemia can cause more severe symptoms, such as:

To qualify for disability benefits, a person with type 2 diabetes must provide evidence of their diagnosis and symptoms from an acceptable medical source. The evidence must be accurate and complete, and a person must submit the evidence in good time to assist claims processing.

The Social Security Administration (SSA) will consider evidence from both medical and nonmedical sources when making an assessment for disability benefits. A persons disability must have affected them for at least 12 months for them to qualify.

The medical community classifies type 2 diabetes as an unseen disability. This means that although the disability may not be visible to others, it has a significant effect on the persons day-to-day life.

The United States government takes into consideration the health problems a person with type 2 diabetes may experience that could affect their day-to-day functioning at work.

A person with this condition may need to apply for benefits if they experience one or more of the following:

The U.S. offers two different types of support for people living with conditions that result in disability: SSDI and SSI. A person will only qualify for one or both of these benefits if they are unable to work.

SSDI provides financial support for adults of any age who have worked for a qualifying period. The benefit begins after 6 full months of disability, and a person will qualify for Medicare after 24 months. This qualification will be immediate for people with amyotrophic lateral sclerosis (ALS).

SSI provides basic financial help to people of any age who have a disability and have a very limited income or resources. State programs may supplement SSI. The benefit begins 1 month after a person files the claim. In most states, a person will automatically qualify for Medicaid when they start receiving SSI.

A person may receive both benefits if they have a work history in addition to a limited income or resources.

A person may also have health insurance through their work. Some insurance policies will pay out for 12 years following disability. Longer-term health insurance policies may pay for a few years or up until the policy ends.

A person can apply for disability benefits via:

A person should have some information ready when applying for disability benefits, including:

Documents should be original or certified copies from an issuing office. A person can mail the documents or take them to a Social Security office for staff to make photocopies and return the originals.

A person will only be eligible for disability payments if they can demonstrate total or severe disability that prevents them from undertaking most work. Medical experts must expect the disability to last at least 1 year or end in death.

There is an earnings cap that changes annually. People cannot earn above this cap and continue receiving disability benefits.

A person who is turned down for disability benefits can appeal against the decision. People can appeal online or by phone within a limited period. The original response letter will provide the necessary information on how to make an appeal.

When making an appeal, a person may need to provide further information on their medical condition and any additional tests or treatments they have received since the initial decision was made.

Deciding when to disclose a disability with an employer is a personal choice. Some people may prefer to keep their disability private, particularly if it is an unseen disability. Other people may need their work to make accommodations for them, so they might wish to disclose their disability at an early stage.

People who want to talk with their employer about a disability may benefit from the following:

Type 2 diabetes can cause severe complications that may make a person eligible for disability benefits. There are two types of benefits: SSDI, which requires a qualifying length of time in work, and SSI, which can support people with disabilities at any age and time in their work career.

People can apply for disability benefits online, by phone, or by attending a prearranged appointment at their local Social Security office. People will need to provide various information, such as proof of age, their social security number, and medical records pertaining to their condition.

Some people with type 2 diabetes may feel that they would be able to continue working with appropriate adjustments within their workplace. People in this situation can talk with their employer to determine ways in which they may be able to carry out their work more effectively.

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What to know about claiming disability with type 2 diabetes - Medical News Today

A study carried out in Taiwan found that a family history of type 2 diabetes (T2D) may increase the risks of diabetes-related complications in those with type 1 diabetes (T1D).

Patients with type 1 diabetes (T1D) and a family history of type 2 diabetes (T2D) had more diabetes complications than those without a family history of T2D, according to results of a cohort study carried out in Taiwan. Findings were published in JAMA Network Open.

T1D and T2D differ in pathophysiologic characteristics and risk factors for cardiovascular disease, authors explained. The major adverse cardiovascular events (MACEs) seen in T2D are associated with insulin resistance, whereas those in T1D are associated with the presence of renal disease, they said.

Because T1D and T2D have different mechanisms, it may be possible both diseases could develop in certain individuals, researchers hypothesized. In addition, the potential coexistence of spontaneous insulin deficiency and inherited insulin resistance could serve as a risk factor for cardiovascular disease, thus leading to an increased risk of MACEs.

To better elucidate the association between a positive family history of presumed T2D and the microvascular and macrovascular complications of T1D, authors assessed data from the Taiwan National Health Insurance Research Database (NHIRD).

The NHIRD contains demographic and clinical information of those enrolled dating back to 1995, and the NHI coverage rate was greater than 99.9% of the Taiwan population in 2005. In the present study, familial transmission was defined as the function of the difference in normal variance of the threshold from the mean liability between individuals with affected relatives and the healthy population, researchers wrote.

Of the individuals included in the analysis, 11,237 had a diagnosis of T1D and had a mean (SD) age of 22.7 (14.4) years; 54% were female. Data recorded between March 1995 and December 2017 were used to create HRs. In 2017, 1302 individuals had T1D and at least 1 first-degree relative with T2D.

Overall, the crude prevalence of T1D was 0.04%, with a female to male ratio of 1.22:1, authors explained. Furthermore, the adjusted HRs in individuals who had a first-degree relative with T2D were 2.61 (95% CI, 1.32-5.16) for MACEs at an age at diagnosis of less than 20 years.

Specifically, the incidence of hypertension and hyperlipidemia was significantly higher in this population. Adjusted HRs were 1.44 (95% CI, 1.27-1.64) for diabetic neuropathy, 1.28 (95% CI, 1.12-1.47) for retinopathy, and 1.24 (95% CI, 1.06-1.47) for neuropathy at all ages of diagnosis, they said.

Results indicate that those with T1D and a family history of T2D may have more complications and thus could require closer management. Shared environmental factors in the family could play a role in the increased risk. However, the family incidence of T2D does not account for the associations between the genetic and environmental factors of insulin resistance, and further studies are warranted to clarify the association between insulin resistance and MACEs among those with T1D.

The relatively small sample size of those with T1D in the Taiwanese population marks a limitation to the study, and researchers were unable to include information on family history of T1D, cardiovascular disease, or kidney disease.

Having T1D as well as a family history of T2D was associated with increases in individual risks of hypertension, hyperlipidemia, microvascular complications, and MACEs, they concluded. An increased focus on this patient population in the prevention of these diabetes complications is warranted in further clinical investigations.

Reference

Lin C, Lo F, Huang Y, et al. Evaluation of disease complications among adults with type 1 diabetes and a family history of type 2 diabetes in Taiwan. JAMA Netw Open. Published online December 14, 2021. doi:10.1001/jamanetworkopen.2021.38775

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Family History of T2D May Increase MACE Risk in Those With T1D - AJMC.com Managed Markets Network

Marcos Aros was born in a coastal Chilean city whose name means Going to Heaven.

He says much of his heart remains back in Valparaiso. The rest of him resides at the Downtown Daily Bread mens shelter, off North Third Street in Harrisburg.

At least for now.

Aros, 56, says he wound up homeless despite being a 16-year U.S. Army veteran. He speaks a dozen languages. His service with the 101st Airborne Brigade, 75th Battalion, Charlie Company focused on what he called symbols in communication. Hes a master in the art of messages.

Now, hes trying to get through to his two young daughters.

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After traveling the world, Aros ended up in the Harrisburg area so he could build stronger relationships with his girls, who live with their mom in Perry County.

Aros says he sees them whenever he can. Unfortunately, that isnt very often.

I wish I could visit my daughters every other week, Aros said. I saw them the week of July 4th. Then I saw them about a month ago. I am restricted to visit my daughters because of all of this. I didnt have money to get a ride.

Another hurdle Aros faces is his health. Hes a Type 2 diabetic, and his bout of homelessness has worsened his condition. On the streets, Aros says hes forced to eat whatever I can get. Much of it isnt healthy.

Hes on insulin and several other drugs. But his bad diet landed him in the hospital several months ago. His future looked dire.

Tents, trucks & cold concrete: Inside Harrisburgs Tent City -- WATCH

Now, Aros is receiving medical care and meds through the UPMC Harrisburg Street Medicine program. The three-member team makes weekly house calls at the Downtown Daily Bread shelter. Aros granted permission for a PennLive reporter and photographer to observe and document his most recent appointment.

The recovering alcoholic tells the doctor hes down to the occasional beer. But Aros says he still smokes. His blood pressure comes in high. Dr. Michael Van Scoy writes him a new prescription for this. It will join the insulin and two diabetes drugs hes taking.

RN Laura Lacroix has Aros remove his shoes and socks so she can examine his feet. They look pretty good, she says. Then Lacroix conducts a monofilament test. She instructs Aros to close his eyes as she lightly presses the thin filament on different parts of his feet and toes.

The test reveals Aros has lost feeling on the balls of both his feet. He still has sensation in his toes and heels. But to keep it, his diabetes mustnt be allowed to get any worse.

Marcos Aros, 56, has his blood drawn by Laura Lacroix, R.N., who is with the UPMC Street Medicine Program, which holds office hours at Downtown Daily Bread in Harrisburg on Dec. 3, 2021. Aros is an Army veteran.Joe Hermitt | jhermitt@pennlive.com

Managing this chronic condition while living on the street has been a roller coaster for Aros.

I will always be sleepy and tired when my blood sugar is low, he said. When its high, I get dizzy. I know the symptoms very well. If I dont take care of that, Ill be dead. Id be in a diabetic coma. Not too good.

Aros blames the COVID-19 pandemic for knocking him into homelessness and setting him back in both his battle with diabetes and his ongoing efforts to remain in his daughters lives.

It was a quick succession of events. First went his job as a bi-lingual career adviser in Harrisburg. Then, he got evicted from his apartment, despite a federal ban on such actions during the COVID-19 crisis.

I was literally evicted illegally, he said. They took all my stuff and put it in a garage.

Afterward, Aros said he spent time in a shelter for veterans, but the housing was meant to be temporary. Before he wandered into Downtown Daily Bread last winter, Aros was sleeping among the dead at a Mount Holly Springs cemetery.

The biggest barrier to him securing a place is sky-high rents. Even with available aid through various veterans programs, Aros said the assistance lasts only so long. One must have his finances in order. Otherwise, the cycle of homelessness continues, he said.

Housing is a huge issue, he said. We are the richest country in the word, and we have veterans and civilians being homeless. There shouldnt be any homeless people in the U.S. Some people choose to be homeless. They like to be on the streets. Not me. Due to circumstance, I became homeless.

Indeed, if someone had told him hed be homeless, Aros said he would not believe that person. I wouldve thought they were totally crazy.

These days, Aros is working to reverse this situation. All of his efforts revolve around his gift for communication in multiple languages.

Aros is known as a great communicator at the Harrisburg mens shelter. While many homeless people keep to themselves, hes a social butterfly. Aros easily strikes up conversations with staff and those homeless individuals who are open to conversation.

I am a social guy, but I dont get involved with anybody, he said.

Its his girls Camila Ann, 16, and Abbey Irene, 11 whom Aros most wants to talk with. Until he can reunite in person, Aros spends time scrolling through scores of pictures of them on this smart phone. In the photos, dad and daughters are all smiles. Aros appears proud and happy. So do they.

Yet, his oldest daughter is angry, Aros says.

Shes not happy with the government that a veteran guy like me is homeless. Theyre worried about dad, he said.

Aros is doing something about this, too.

He said he has a second interview in early January for a $40,000-a-year job working with a national real estate rental company in need of his multi-lingual skills to communicate with non-English-speaking tenants.

It sounds promising, Aros said. It would be the first step toward getting a place and seeing his girls every other week.

Aros is well versed in picking up the pieces and starting over. Back in Chile, he says he was the black sheep of his family.

I was a badass teenager. I sell drugs, he said.

Then at a church camp, a Presbyterian pastor posed a provocative question. He asked the young Aros where his soul would go.

The youngster didnt hesitate. Straight to hell, Aros answered.

Thats when Aros began to change. His journey would lead him out of Chile, into the United States, the Army, two failed marriages and, finally, fatherhood.

I got saved when I was 17, he said. That did a 180 on me. I became a good man.

But hes had a bad time of it, lately.

My lifes been very complicated these last two years, Aros said.

Hopefully, not for much longer.

Im focused on my daughters, my career and my situation, Aros insisted. I am clean and sober for seven years, a recovering alcoholic. That was my drug of choice: Heineken and red wine. It went good with a steak dinner.

These days, he listens to the wise words of his mother, whos still alive and well in Chile. She never left heaven, Aros said.

Moms advice to the one she calls her tall, dark and handsome son: Pay attention to your career and give up the women!

Aros said he plans to do just that. All except for two very special females his daughters.

Marcos Aros, 56 looks at a photo of his daughters on his phone while at Downtown Daily Bread in Harrisburg on Dec. 3, 2021. Aros is an Army veteran.Joe Hermitt | jhermitt@pennlive.com

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Homeless dad with Type 2 diabetes says hes focused on his young daughters - PennLive