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Prevention and treatment

All in all you're pretty satisfied. You can kick back to cruising speed after years on overdrive raising a family and building your nest egg. Your kids are on their own (well, almost) and doing fine. The road ahead looks smooth.

Yes, you're a bit overweight well, more than a bit and for a long time you've been too busy to exercise. But you've been relatively healthy so far, and you and your spouse are looking forward to some time for yourselves.

Unfortunately, if you're like many Americans, the road ahead may have an unforeseen bump. Your lifestyle adds up to too many pounds and not enough exercise the perfect road map to diabetes.

Fifteen million Americans, most of them overweight, have type 2 diabetes, the most common form of the disease and the main focus of this essay. Only about half of them know it. That's because diabetes can develop gradually, often without symptoms, over many years. It may reveal itself too late to prevent damage. In fact, you may first learn you have diabetes when you develop one of its common complications cardiovascular disease, kidney disease or vision problems.

But it doesn't have to be that way. You may be able to avoid diabetes simply by exercising, maintaining a healthful weight and eating a proper diet. And if you do develop the disease, early treatment may help minimize your risk of developing serious complications.

Today, improved methods of diabetes control, new medications and easier ways to take insulin enable most people who develop diabetes to live a long and healthy life. A diagnosis of diabetes is not a sentence of premature death, as it so often used to be.

Types of diabetes

There are several types of diabetes different disorders with different causes but the three most common are:

Type 1 diabetes One in 10 people with diabetes has type 1, commonly called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. Type 1 diabetes is now known to be an autoimmune disease. Your body's infection-fighting mechanism (your immune system) turns on itself and destroys the insulin-producing beta cells in your pancreas. You produce little or no insulin, so you must take insulin daily.
Symptoms that may indicate you have type 1 diabetes Increased urination, constant thirst and hunger, weight loss, blurred vision, extreme fatigue and slow healing.

Type 1 diabetes can smolder in silence for several years and then seem to come on relatively quickly, often after an illness. Researchers believe that several genes, plus diet or exposure to certain viruses, are involved in triggering your immune system to sabotage beta cells.

Type 1 diabetes usually develops in childhood, although it can appear later. It affects both sexes equally, but it's more common among whites and is rare among Asians and American Indians.

Type 2 diabetes Ninety percent to 95 percent of people over age 20 who have diabetes have type 2, commonly called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes.
Symptoms that may indicate you have type 2 diabetes Any of the symptoms of type 1 diabetes, plus recurring bladder, vaginal and skin infections, irritability, and tingling or loss of feeling in hands or feet. However, remember that type 2 diabetes may have no symptoms for years.

If you have type 2 diabetes, your pancreas makes some insulin but not enough. Your cells can also become resistant to insulin's effects, keeping insulin from escorting enough glucose into your body's cells.

By far the greatest risk factor for type 2 diabetes is being overweight. Researchers estimate that 80 percent to 90 percent of people who develop type 2 diabetes are overweight.

The exact role excess weight plays in type 2 diabetes is unclear, but it appears to increase insulin resistance. Your pancreas is then called on to produce more insulin to overcome the resistance. It may not be able to keep up, and blood sugar rises.

Likewise, losing excess weight appears to decrease insulin resistance. If you're overweight and have diabetes, losing weight may allow you to achieve a normal blood sugar level without medication (see "Preventing diabetes").

Other risk factors for type 2 diabetes include age, race and heredity. The disease usually develops after age 40, and the incidence increases more steeply after age 55. It's more common among American Indians, Hispanics, blacks and westernized Asians than among whites. And if you have a family history of diabetes, your risk is also increased.

Certain medications, such as thiazide diuretics used to treat high blood pressure (hydrochlorothiazide and others) and steroids (prednisone and others), can also contribute to type 2 diabetes.

Gestational diabetes Diabetes that develops during pregnancy is called gestational diabetes. It can develop because hormones secreted during pregnancy can increase your body's resistance to insulin. Gestational diabetes usually disappears after pregnancy, but more than half of women who experience it eventually develop type 2 diabetes.


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