Dwayne Klucheskys symptoms developed suddenly. First, unquenchable thirst.

I couldnt get enough water, he said.

He lost weight dramatically, which was odd. He had weighed more than 250 pounds, didnt exercise and wasnt dieting.

Kluchesky had seen those symptoms before, in his mother. And he was pretty certain they spelled diabetes. But he went to see his doctor anyway.

That visit six years ago confirmed his suspicions with a diagnosis of Type 2 diabetes. His blood sugar level was in the 300s far above the 80-130 that the American Diabetes Association advises before meals, and the 180 recommended for an hour or two after.

Mine was super, super high, said Kluchesky, a Twin Falls chaplain. Since then things have changed quite a bit, but I still have a hard time keeping my blood sugar down to 150 on a regular basis.

Hes not alone. The number of American adults diagnosed with diabetes has more than tripled in the past 20 years as the population has aged and gained weight. In Idaho, an estimated 100,000 adults lived with diabetes in 2015 and an estimated 84,000 with prediabetes.

The cost is extraordinary.

People with diabetes have health care costs 2.3 times greater than those without diabetes. In Idaho, diabetes and prediabetes cost an estimated $1.3 billion each year and were the sixth leading cause of death in 2014. The American Diabetes Association estimates the total cost of diabetes and prediabetes in the U.S. at $322 billion.

But unlike Type 1 diabetes, Type 2 diabetes can be prevented or delayed by eliminating risk factors such as physical inactivity, unhealthy diets and tobacco use.

Type 1 diabetes is a chronic condition in which the pancreas produces little or no insulin. People with Type 2 diabetes make insulin, but the body doesnt use it the way it should. Prediabetes is when blood sugar is higher than normal. If left untreated, it often progresses to Type 2 diabetes.

Despite that dark specter, Idaho is seeing a steady increase in overweight and obese populations, according to 2015 data from the Idaho Department of Health and Welfare. The majority of Idahoans are too heavy 35.8 percent are overweight and 26.8 percent obese.

Yet even a diabetes diagnosis might not inspire dramatic lifestyle change.

Kluchesky watches what he eats, but not always. Its just the human condition, he said. Sometimes I want ice cream, so I eat some. In the old days, I ate a half-gallon of ice cream.

Now, hell have just one scoop. Usually.

He has lost 30 pounds and now weighs 223.

Im still considered obese, but Im not morbidly obese like I was, he said. Ideally, I should be 170 or 175.

Now, at 67, Kluchesky often thinks of his mother, who had Type 2 diabetes and died at 69.

At her death, his mothers feet were black from diabetic neuropathy, a Type of nerve damage caused by diabetes. She was blind due to diabetic retinopathy, a complication caused by damage to blood vessels in the eyes.

Kluchesky often wonders how long he has left to live. He has started to lose feeling in his toes, and he cant tell how heavy his feet are signs of diabetic neuropathy.

Ive noticed in the last two years I will suddenly become out of balance, he said, that I have to take an extra step. My feet are in a state of numbness.

Klucheskys father died at 88. He wasnt diabetic, but he loved candy.

I didnt have good examples growing up, Kluchesky said. Theyd say, Eat what you want and when you want as long as you finish it all.

Hes paying the price now.

Jody Bruffett, 55, and Helen Rector, 65, held purple weights as they walked quickly around the track at the Jerome Recreation Center.

Five days a week, to help control their diabetes, the two walk for a mile, bike for 15 minutes, then row for 10 minutes. Sometimes Bruffett takes Zumba or water aerobics classes.

But there was a time Bruffett wouldnt even walk down a store aisle, let alone a track. She used a motorized cart, because her knees hurt so badly.

I was dying, she said. I was killing myself.

Bruffett has Type 2 diabetes. She was diagnosed at 32. Attending a health fair at the rec center, she decided to have basic blood work done; the tests revealed high blood sugar.

She wasnt completely shocked. Her mother is diabetic. Her grandfather was also diabetic, but they didnt figure that out until he died. And with her last pregnancy, Bruffetts blood sugar was elevated.

It was borderline at that point, Bruffett said. I had been losing weight without trying, and sometimes thats a sign also that you are becoming diabetic. I was just run-down, not having any energy.

Rector, diagnosed at age 12, has Type 1. The two have been friends for more than 20 years.

I do things with Jody, Rector said. She looks out for me.

Bruffett used to take insulin to control her diabetes, but now she can do it with exercise and pills. Rector still requires insulin, despite exercise and weight loss.

Bruffett finally started seeing her diabetes improve after she had gastric bypass surgery. Rector saw similar results after the same surgery. Rector lost 60 pounds after surgery. Bruffett lost 150.

Bruffett was overjoyed the first time she flew in a plane and didnt have to use a seat belt extender.

I had to do a lot of soul searching and investigating before, she said. I knew thats what I wanted to do.

Dr. Bob Korn, medical director of bariatrics at St. Lukes Boise Medical Center, said gastric bypass surgery has been found to cure Type 2 diabetes for at least a decade the length of time cases have been tracked.

Korn, a member of the American Society for Metabolic and Bariatric Surgery, specializes in laparoscopic gastric bypass, laparoscopic sleeve gastrectomy and laparoscopic gastric banding. All three reduce stomach size and help the body become more sensitive to insulin, which means patients dont feel hungry all the time.

We are curing approximately 60 percent of patients that come to us with Type 2 diabetes, he said.

The bariatrics program in Boise is the largest in Idaho. Seven years ago, Korn was performing fewer than 300 of these surgeries a year. Now, he and his colleagues do 600 a year, generally for patients 80 to 100 pounds overweight.

Nationally, 200,000 gastric bypass surgeries are performed a year, Korn said. They have become the most common abdominal surgery. In terms of invasiveness, he said, its comparable to having a gallbladder removed.

Why does it work?

Obesity is the pinnacle cause of Type 2 diabetes, Korn said. Obesity is contributing to the death of 300,000 people this year. These people have a rapid improvement of their diabetes over a few days.

Surgery patients can go home in two days and back to work in two weeks.

Bruffett still has 15 pounds shed like to lose, but thats where exercise and healthy eating help.

Do I feel good? she said. I feel good, and I feel healthy.

Bruffett said her biggest pitfall is carbohydrates. People dont often look at the carbs in food, and they can raise your blood sugar higher than simple sugar.

For years, Bruffett worried that her son and daughter-in-law had Type 2 diabetes. Her son once weighed about 400 pounds, and her daughter-in-law was around 360 pounds.

His father and me are diabetic, Bruffett said. Hes 28, and there is no doubt in my mind you better do something about it. You dont know how much damage has been done.

The son and daughter-in-law were tested, but the results were negative. Since then, Bruffett said, they have lost more than 50 pounds each.

Thats a relief. But she still fears they might one day experience what shes suffering.

Diabetes had already damaged nerves in Bruffetts feet when she was diagnosed. Now her feet burn. And theres no way to repair that.

For Pauline Patheal, 80, the motivation to lose weight came from a support group she found 35 years ago.

Patheal is a member of Take Off Pounds Sensibly, or TOPS, a noncommercial weight loss, education and support organization; it costs $34 a year to enroll. A group of 15 TOPS members meets weekly at Jerome Public Library.

We always have a lesson, said Patheal, who said she has wasted her time on plenty of yo-yo diets. How to eat right and take it off sensibly. They stress exercise. We are not a diet group. We dont go on crazy fad diets.

Patheal attended the international TOPS convention in Little Rock, Ark., in late July with 1,700 other people. She currently weighs 140 pounds and can go 7 pounds below or 3 pounds above her current weight and still stay on target.

At her peak weight of 199, she had hardening of the arteries and pain in her legs. Her Type 2 diabetes was also worse. She was so sick her husband of 61 years, Leroy, thought she was going to kick the bucket, he said.

Patheal slept a lot. She had diarrhea and stomachaches.

I knew something was wrong, she said.

Patheals mother and grandmother also had diabetes. They didnt know about this stuff back then, she said.

Even after losing the weight, Patheal still needs to control her diabetes with pills, portion control and exercise.

Patheal was one of eight women exercising July 26 at Jerome Senior Center. Sitting in chairs, the women balanced their feet on red, green and orange balls. Each placed one foot on top of the ball, raising her heels, then her toes. She put the ball between her heels and lifted both legs.

Classes at the senior center last 45 minutes, with the majority spent seated. Patheal has attended for 25 years.

It helps, but you have to be careful, Patheal said. You just do what you can do. Everyone does it at their own level.

On July 28, Kluchesky met a friend for breakfast. He didnt eat the whole grain his diabetes mentor would recommend. Instead, he opted for chicken-fried steak with gravy.

Instead of using sugar in his coffee, he used a substitute sweetener called Stevia. He poured in six packets.

I like sweet stuff, he said. I dont like coffee, I just like the stuff I put in it.

He usually eats a big breakfast, a smaller lunch and next to nothing for dinner.

Kluchesky takes metformin twice a day to help regulate his Type 2 diabetes.

This is like a godsend to diabetics, he said, pulling out a blue pillbox.

Kluchesky keeps track of his blood sugar in a log book. Sometimes his blood sugar reaches 80 too low and he begins sweating profusely and has tremors or shakes. He keeps a little piece of mint candy in his pocket just in case. When his sugar is high, his heart rate is fast and he feels thirsty.

Though gastric bypass surgery is an option, Kluchesky doesnt see the point. If he doesnt eat right and exercise now, not much would change after the surgery. He doesnt even do the small things his doctor tells him to do, like walking after eating.

They just keep telling me, Well, if you limit your portions, or after you eat go and walk around the block I dont do that, he said. I got a paunch on me.

I just dont have the willpower to do the right thing.

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