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Many of the symptoms do not appear until the disease has advanced, and a large number of people with mild diabetes don't experience any. Current screening recommendations call for testing at age 45, with a repeat test every three years if no disease is found.
Why Diabetes Happens
All cells use glucose (sugar) for energy, and the body needs insulin, a hormone produced by the pancreas, to get glucose to them. If you have diabetes, sugar builds up in the blood instead of moving into cells. Diabetes occurs when the body either doesn't make enough insulin or can't use it correctly. In type 1 diabetes, which generally occurs in children and young adults, the body's immune system mistakenly identifies insulin-producing cells as foreign and destroys them.
Type 2 diabetes, which occurs most frequently during middle age and accounts for nearly 95 percent of cases, can involve several different problems, according to Marian Parrott, M.D., an internist at George Washington University School of Medicine in Washington, D.C. "Either you don't make enough insulin for your needs, the insulin isn't as effective as it should be, your tissue doesn't respond the way it should, or your liver produces too much glucose," she explains. "Generally, it's a combination of these factors."
Both types of diabetes can lead to problems with the eyes, kidneys, nerves, gums, and blood vessels. Diabetes is also a major risk factor for heart disease and stroke.
Preventing the Disease
Although you have no control over some factors, you can make substantial changes in others that will lower your risk of developing diabetes. And if you already have the disease, doctors agree that keeping blood sugar levels normal through weight reduction, diet, and exercise are the cornerstones of managing it.
Weight. Being overweight is the single most important risk factor for type 2 diabetes, so maintaining a healthy weight is your first line of defense against the disease. If you have diabetes, losing weight and maintaining it at a proper level will help insulin work better and also lower blood pressure, decreasing the risk of heart disease.
Diet. A diet high in fat, calories, and cholesterol may increase the risk of developing diabetes. If you have the disease, the right food choices will help you control your blood sugar level. Individuals should have their diets tailor-made by a nutritionist, says Anne Daly, R.D., vice president for health care and education of the American Diabetes Association.
Exercise. You can reduce your risk of developing diabetes by exercising. And if you already have diabetes, exercising helps your body use insulin and lower your blood sugar level. How much exercise is enough? Ideally, at least four to six times a week for half an hour to an hour, says the American Academy of Family Physicians. But any activity is better than none.
Treating Diabetes
The goal of diabetes treatment is to control blood sugar, but sometimes weight control, diet, and exercise alone won't do the trick. If that's the case, your doctor will probably suggest oral medications. Because a single drug may not maintain optimal control of blood sugar, your doctor may recommend a combination of two medicines, each of which works in a slightly different way. When oral medications don't work, insulin, given by injection, is necessary.
Whatever your doctor recommends, take it seriously. "Don't say, 'A little bit of sugar is normal for my age,' " says Parrott. "It's not. What you do about diabetes can make a big difference to your overall health."
Nissa Simon, health editor of
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