The writing was on the bathroom wall.
Bob Zinn knew something was wrong, given the frequency of his trips to the restroom.
But Zinn, 59, would have never guessed the source of his bladder issue was a serious, incurable disease.
His doctor, Jeff Harwood, tested Zinn's sugar level in February 2007. The blood had all the answers.
"It was 213 (milligrams of glucose per deciliter of blood) that day," Zinn said.
A second test, the A1c, produced a reading of 10.9. A normal A1c is less than 6.
A1c tests determine a person's levels of blood sugar in the past several months, said Tracy Stadler, certified diabetes educator and registered dietitian with Fisher-Titus Medical Center.
"That 10.9 average is with a blood sugar reading, meaning over the last two to three months, prior to him being diagnosed, his blood sugar had been running at an average of 300," Stadler said. "Normal blood sugar without diabetes is 70 to 99."
Zinn had Type 2 diabetes. He did not take the news well.
"I was very in denial about it. I did not even want to accept the fact of it. I was very rude to the two nurses (who tried to help me). ... I wasn't going to answer questions -- I don't care," Zinn said.
More than 23 million Americans have diabetes, according to the Centers for Disease Control and Prevention. Type 2 diabetes is the most common form of the disease and accounts for about 90-95 percent of all adult cases. Unlike Type 1, which usually emerges in a person's youth, Type 2 is often the result of poor diet and exercise.
Huron County has one of the worst diabetes rates in Ohio. The Huron County Health Assessment 2007 found 12 percent of Huron County residents have been diagnosed with diabetes -- a rate 50 percent higher than the rest of the state.
National studies estimate almost 25 percent of people with diabetes are unaware they have it. About 57 million people are thought to have pre-diabetes -- high blood glucose levels, but not enough for a diabetes diagnosis.
Untreated, Type 2 diabetes can lead to seizures, loss of consciousness, coma and death. But even proper treatment can't always prevent serious medical complications.
"If somebody finds out that they have diabetes, and they've had it for a couple of months, you don't look at a whole lot of complications at that point. It's when those sugars are long-term high. Then you have heart disease risk, you have kidney failure risk, blindness, amputations, circulation problems," said Brandi Roeder, RN diabetes educator.
"Basically, high blood sugars affect your blood vessels, and they damage the blood vessels, and obviously our blood vessels lead to everything."
Zinn's doctor referred him to the Fisher-Titus Certified Diabetes Education program. A doctor's referral is necessary for enrollment. He agreed to go through the program, but that didn't mean he was happy about it.
"He was angry. It was one of these," Stadler said, folding her arms across her chest and mimicking an ice-cold glare.
But over time, Zinn warmed to the program. Stadler said this happened when, by following the guidelines and recommendations of his classes, his progress became apparent.
"We continued to work with him at his pace. ... The anger started lessening, and the denial started going away once he started seeing the results from the actions he had taken. We gave him the tools -- he did the hard part. He did the work," Stadler said.
Living with diabetes is no cakewalk, primarily because so many foods, such as cake, are all but forbidden. Changing diet habits can be a daunting task.
Zinn said his sugar intake far exceeded the run-of-the-mill sweet tooth. Skipping breakfast, Zinn chowed down on dinner rolls at work, downing 10-15 sodas throughout the day. During the week, he would polish off about five gallons of orange juice.
He weighed about 400 pounds.
Stadler and Roeder first encouraged Zinn to make minor changes, such as being sure to eat breakfast. Roeder said she encouraged him take walks and monitor his sugar.
The Fisher-Titus diabetes program is 10 hours long, and in one-on-one consultations with Roeder and Stadler, participants help hammer out an intervention plan tailor-fit to their needs.
There's no silver bullet, no one-size-fits-all diet and exercise plan, Roeder said. Everyone has their own unique eating pattern and lifestyle, meaning that building a successful plan is almost always individualized.
Zinn eats a fraction of the carbohydrates he did before, and he has also slashed his sugar intake.
"When a birthday came along, I'd have a big piece (of cake), and I'd end up getting a second one with ice cream. I think since then I've had several birthdays but only three little pieces of cake. I don't miss it now," he said.
Zinn has lost 103 pounds. His winter jacket is too loose to wear, and his old belt is too big. He continues to wear the belt, but had to punch new holes to make it fit around his shrinking waistline. The belt has about a foot and a half of slack, thanks to his healthy new life. He hopes to add to that slack every month.
His A1c is down to about 6.2, and his bathroom woes are gone.
While Zinn is one of the program's more memorable success stories, there are many others who learned to control their disease through Fisher-Titus. Last year, about 225 patients went through the program.
Zinn said he hopes his story will inspire others to not fear their disease and seek the help they need.
"Anyone can make these changes, but you have to be ready to. When you're ready to make some changes along the way and make them part of your lifestyle ... you'll see the same results," Stadler said.
Experts encourage people to get tested if they have a family history of diabetes, if they meet the risk factors, or are over the age of 45.