BISMARCK, N.D. – It is a disease that can have negative lifelong impacts, but the good news is that there are some simple lifestyle changes that one can make to delay or even prevent the onset of diabetes.

Rhonda Pfenning, a registered nurse who is the chronic care coordinator at the Coal Country Community Health Center in Beulah, says even small improvements in healthy eating and physical activity can cut the risk, but the prevalence continues to rise and those diagnosed with Type-2 aren't just middle-aged adults.

"What I'm seeing is these children are coming in and they are heavier and looking at some hypertension issues already,” she explains. “So they've got a lot of the adult illnesses early on in life, and I do believe a lot of it is the result of a lack of exercise and a poor diet."

Pfenning says Coal Country does offer free diabetes education and nutrition classes on a regular basis, as do some other clinics within the Community HealthCare Association of the Dakotas - with locations and other details online at www.communityhealthcare.net.

This is National Diabetes Awareness Month.

Pfenning says symptoms of diabetes or pre-diabetes are not always easily detectable, but among the changes to watch for is sudden weight loss.

"You might be going to the bathroom frequently, extremely thirsty,” she advises. “Those are kind of the beginning symptoms.

“Later on you will notice kind of a fruity odor to the breath of that person, but a lot of it too is feeling tired, just no energy."

In addition to lifestyle changes, Pfenning encourages regular well visits, including checks on blood sugar and cholesterol, and, she says, be your own best advocate.

"That would be taking charge of your own health and being aggressive as far as education,” she explains. “Asking the questions. We are here to help you in any way we can. And a lot of it is, people who end up with diabetes don't understand what is going on in the body and why it's important to take care of yourself."

When not properly managed, diabetes can lead to vision loss, kidney issues, nerve damage and the amputation of feet or legs.

In North Dakota, there are about 40,000 people who are living with diabetes, and upwards of another 15,000 who have the disease, but have not yet been diagnosed.




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After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.

Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.

Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.

"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."

Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.

Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.

"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."

Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.