Diabetes is a disorder of metabolism--the way our bodies use digested food for growth and energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood. Glucose is the main source of fuel for the body.

After digestion, glucose passes into the bloodstream, where it is used by cells for growth and energy. For glucose to get into cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach.

When we eat, the pancreas automatically produces the right amount of insulin to move glucose from blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. Glucose builds up in the blood, overflows into the urine, and passes out of the body. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose.

Diabetes is widely recognized as one of the leading causes of death and disability in the United States. In 2000, it was the sixth leading cause of death. About 65 percent of deaths among those with diabetes are attributed to heart disease and stroke. An estimated 18.2 million people (6.3 percent of the population) in the United States have diabetes, a serious, lifelong condition.

Diabetes is associated with long-term complications that affect almost every part of the body. The disease often leads to blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage. Uncontrolled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes.

In 2002, diabetes cost the United States $132 billion. Indirect costs, including disability payments, time lost from work, and premature death, totaled $40 billion; direct medical costs for diabetes care, including hospitalizations, medical care, and treatment supplies, totaled $92 billion.

The three main types of diabetes are:
    type 1 diabetes
    type 2 diabetes
    gestational diabetes

Common symptoms of diabetes include:
* Excessive thirst and appetite
* Increased urination (sometimes as often as every hour)
* Unusual weight loss or gain
* Fatigue
* Nausea, perhaps vomiting
* Blurred vision
* In women, frequent vaginal infections
* In men and women, yeast infections
* Dry mouth
* Slow-healing sores or cuts
* Itching skin, especially in the groin or vaginal area

Diabetes is not contagious. People cannot "catch" it from each other. However, certain factors can increase the risk of developing diabetes.
Type 1 diabetes occurs equally among males and females, but is more common in whites than in non-whites. Data from the World Health Organization's Multinational Project for Childhood Diabetes indicate that type 1 diabetes is rare in most African, American Indian, and Asian populations. However, some northern European countries, including Finland and Sweden, have high rates of type 1 diabetes. The reasons for these differences are unknown.

Type 2 diabetes is more common in older people, especially in people who are overweight, and occurs more often in African Americans, American Indians, some Asian Americans, Native Hawaiians and other Pacific Islander Americans, and Hispanic Americans. On average, non-Hispanic African Americans are 1.6 times as likely to have diabetes as non-Hispanic whites of the same age. Hispanic Americans are 1.5 times as likely to have diabetes as non-Hispanic whites of similar age. American Indians have one of the highest rates of diabetes in the world. On average, American Indians and Alaska Natives are 2.2 times as likely to have diabetes as non-Hispanic whites of similar age. Although prevalence data for diabetes among Asian Americans and Pacific Islanders are limited, some groups, such as Native Hawaiians, Japanese and Filipino residents of Hawaii aged 20 or older, are about twice as likely to have diabetes as white residents of Hawaii of similar age.

You are more likely to develop type 2 diabetes if:
    you are overweight
    you are 45 years old or older
    you have a parent, brother, or sister with diabetes
    your family background is African American, American Indian, Asian American, Hispanic American/Latino, or Pacific Islander
    you have had gestational diabetes or gave birth to at least one baby weighing more than 9 pounds
    your blood pressure is 140/90 or higher, or you have been told that you have high blood pressure
    your HDL cholesterol is 35 or lower, or your triglyceride level is 250 or higher
    you are fairly inactive, or you exercise fewer than three times a week

The prevalence of diabetes in the United States is likely to increase for several reasons. First, a large segment of the population is aging. Also, Hispanic Americans and other minority groups make up the fastest-growing segment of the U.S. population. Finally, Americans are increasingly overweight and sedentary. According to recent estimates, the prevalence of diabetes in the United States is predicted to reach 8.9 percent of the population by 2025.

Many Americans are at a high risk of developing type 2 diabetes, and being overweight increases that risk. Losing a small amount of weight, by getting 30 minutes of physical activity 5 days a week and eating healthy, will help prevent diabetes. To get started, use this guide for ideas on moving more, eating healthier, and tracking your progress.

Small Steps For Big Rewards:
    Less on your plate.
    Keep meat, poultry and fish servings to about 3 ounces.
    Make less food look like more by serving your meal on a salad or breakfast plate.
    Try not to snack while cooking or cleaning the kitchen.
    Try to eat sensible meals and snacks at regular times throughout the day.
    Make sure you eat breakfast every day.
    Use broth and cured meats (smoked turkey and turkey bacon) in small amounts. They are high in sodium. Low sodium broths are available in cans and powder.
    Share your desserts.
    When eating out, have a big vegetable salad, then split an entree with a friend or have the other half wrapped to go.
    Stir fry, broil or bake with non-stick spray or low sodium broth and try to cook with less oil and butter.
    Drink a glass of water or other "no-calorie" beverage 10 minutes before your meal to take the edge off your appetite.
    Select the healthier choice at fast food restaurants. Try grilled chicken instead of the cheeseburger. Skip the french fries or replace the fries with a salad.
    Listen to music while you eat instead of watching TV (people tend to eat more while watching TV).
    It takes 20 minutes for your stomach to send a signal to your brain that you're full. Eat slowly.
    Eat a small meal.
    Teaspoons, salad forks, or child-size utensils may help you take smaller bites and eat less.
    You don't have to cut out the foods you love to eat. Just cut down on your portion size and eat it less often.

Add more physical activity to your daily routine:
    Dance it away.
    Show your kids the dances you used to do when you were their age.
    Turn up the music and jam while doing household chores.
    Deliver a message in person to a co-worker instead of e-mailing.
    Take the stairs to your office. Or take the stairs as far as you feel comfortable, and then take the elevator.
    Make a few less phone calls. Catch up with friends during a regularly scheduled walk.
    March in place while you watch TV.
nbsp;   Park as far away as possible from your favorite store at the mall.
    Select an exercise video from the store or library.
    Get off the bus one stop earlier and walk the rest of the way home or to work at least two days a week.

Make healthy food choices:
    Snack on a veggie.
    Try getting at least one new fruit or vegetable every time you grocery shop.
    Macaroni and low-fat cheese can be a main dish. Serve it with your favorite vegetable dish and a salad.
    Try eating foods from other countries. Many international dishes feature more vegetables, whole grains and beans and less meat.
    Cook with a variety of spices instead of salt.
    Find a water bottle you really like (church or club event souvenir, favorite sports team, etc.) and drink water from it wherever and whenever you can.
    Always keep a healthy snack with you.
    Choose veggie toppings like spinach, broccoli and peppers for your pizza.
    Try different recipes for baking or broiling meat, chicken, and fish.
    Try to choose foods with little or no added sugar.
    Gradually work your way down from whole milk to 2% milk to 1% milk until you're drinking and cooking with fat free (skim) milk.
    Try keeping a written record of what you eat for a week. It can help you see when you tend to overeat or eat foods high in fat or calories.
    Eat foods made from a variety of whole grains-such as whole wheat bread, brown rice, oats, and whole grain corn-every day. Use whole grain bread for toast and sandwiches; substitute brown rice for white rice for home-cooked meals and when dining out.
    Don't grocery shop on an empty stomach and make a list before you go.
    Read food labels. Choose foods with lower fat, saturated fat, calories, and salt.
    Fruits are colorful and make a welcoming centerpiece for any table. Have a nice chat while sharing a bowl of fruit with family and friends.
    Slow down at snack time. Eating a bag of low-fat popcorn takes longer than eating a slice of cake. Peel and eat an orange instead of drinking orange juice.

Nurture your mind, body, and soul:
    You can exhale, Gail.
    Don't try to change your entire way of eating and exercising all at once. Try one new activity or food a week.
    Find mellow ways to relax--try deep breathing, take an easy paced walk, or enjoy your favorite easy listening music.
    Give yourself daily "pampering time" and honor this time like any other appointment you make... whether it's spending time reading a book, taking a long bath, or meditating.
    Try not to eat out of boredom or frustration. If you're not hungry, do something else.
    Honor your health as your most precious gift.

There are many more ways to prevent type 2 diabetes with healthy eating and physical activity. Discover your own and share it with your family, friends and neighbors.

Take the first step today. If you're overweight, you may be at high risk for developing type 2 diabetes. Talk to your health care provider today.

Type 2 diabetes is on the rise and it knows no race, age, or gender. Complications are serious.

01. Type 2 Diabetes: What Is It?

Type 2 diabetes strikes people of all ages, and early symptoms are subtle. In fact, about one out of three people with type 2 diabetes don’t know they have it. Diabetes is a chronic condition that thwarts the body’s ability to change food into energy. This allows sugar levels to build up in the blood, which can increase the risk of heart disease, loss of vision, and other serious complications.

02. Insulin: Turning Glucose Into Energy

1. After eating, the stomach breaks carbohydrates down into sugars, including glucose.
2. Glucose enters the bloodstream and stimulates the release of insulin from the pancreas.
3. Insulin and glucose travel in the blood to all the body’s cells. Insulin allows glucose to enter the cells and be used as fuel.

Excess glucose is stored in the liver.

03. Type 2 Diabetes

In diabetes, the cells cannot absorb glucose properly. That means glucose levels in the blood become elevated. With insulin resistance, the body makes excess insulin but the muscle, liver, and fat cells do not use or respond properly to insulin. With long-standing, uncontrolled type 2 diabetes the pancreas will reduce the amount of insulin it produces.

04. Diabetes Warning Sign: Thirst

One of the first symptoms of type 2 diabetes may be an increase in thirst. This is often accompanied by additional problems, including dry mouth, increased appetite, frequent urination -- sometimes as often as every hour -- and unusual weight loss or gain.

05. Diabetes Warning Sign: Headaches

As blood sugar levels become more abnormal, additional symptoms may include headaches, blurred vision, and fatigue.

06. Diabetes Warning Sign: Infections

In most cases, type 2 diabetes is not discovered until it takes a noticeable toll on health. One red flag is troubling infections, such as:
* Cuts or sores that are slow to heal.
* Frequent yeast infections or urinary tract infections.
* Itchy skin, especially in the groin area.

07. Diabetes Warning Sign: Erectile Dysfunction

Erectile dysfunction could be a complication of diabetes. Diabetes can cause damage to blood vessels and nerve endings in the penis causing impotence. It’s estimated between 35% and 70% of men with diabetes will have at least some degree of impotence in their lifetime.

08. Risk Factors You Can Control

* Being overweight, defined as a body mass index (BMI) over 25.
* Sedentary lifestyle.
* Abnormal cholesterol and blood fats, such as HDL "good" cholesterol lower than 35 mg/dL or a triglyceride level over 250 mg/dL.
* High blood pressure greater than 140 /90 in adults.
* Smoking.

09. Risk Factors You Can’t Control

* Race or ethnicity: Hispanics, African Americans, Native Americans, and Asians have a higher than average risk.
* Family history of diabetes: Having a parent or sibling with diabetes boosts your risk.
* Age: Being 45 and older increases your risk of type 2 diabetes.

The more risk factors you have, the greater your odds of developing type 2 diabetes.

10. Risk Factors for Women

Having gestational diabetes when you’re pregnant puts you at higher risk for developing type 2 diabetes later on. Women who give birth to a baby weighing over 9 pounds are also at risk. Having a history of polycystic ovary syndrome can also cause insulin resistance that can lead to diabetes

11. Diagnosing Type 2 Diabetes

A simple blood test can diagnose diabetes. The A1C test gives a snapshot of your blood glucose level over the past two to three months. An A1C level of 6.5% or more is consistent with the diagnosis of diabetes. A fasting plasma glucose test is another option. You must not eat for eight hours before the test. A result above 126 is considered diabetes. An oral glucose challenge test with a two-hour blood test may also help your doctor make a diagnosis.

12. Managing Diabetes: Diet

Fortunately, controlling blood sugar levels by changing diet can also cut your risk of complications. People with type 2 diabetes should carefully monitor carbohydrate consumption, as well as total fat and protein intake, and reduce calories. Ask your doctor for a referral to a registered dietitian to help you with healthy choices and an eating plan that will work for you.

13. Managing Diabetes: Exercise

Moderate exercise, such as strength training or walking, improves the body’s use of insulin and can lower blood sugar levels in people with type 2 diabetes. Being active also helps reduce body fat, lower blood pressure, and protect against heart disease. People with type 2 diabetes should try to get 30 minutes of moderate exercise on most days of the week.

14. Managing Diabetes: Stress Reduction

Stress can cause blood pressure to rise. Or you may turn to food to cope. Both are bad when living with diabetes. Instead of letting stress take its toll, try practicing relaxation techniques such as deep breathing, meditation, or visualization. Sometimes talking to a friend, family member, counselor, or member of the clergy can help. If you’re still battling stress, reach out to your doctor.

15. Managing Diabetes: Oral Medication

When people with type 2 diabetes are unable to control blood sugar sufficiently with diet and exercise, medication may be added. There are many types of diabetes pills available, and they are often used in combination. Some work by stimulating the pancreas to make more insulin, and others improve the effectiveness of insulin, or block the digestion of starches.

16. Managing Diabetes: Insulin

Your doctor may prescribe insulin early in on your treatment and in combination with pills. Insulin is also used in people with type 2 diabetes who develop "beta-cell failure." This means the cells in the pancreas no longer produce insulin in response to high blood sugar levels. In this case, insulin therapy -- injections or an insulin pump -- must become part of the daily routine.

17. Glucose Testing

Testing your blood glucose level will let you know how controlled your blood sugars are and if you need to take actions to change your treatment plan. How often and when you test will be based on how controlled your diabetes is, the type of therapy used to control your diabetes, and whether you are experiencing symptoms of fluctuating sugars. Talk with your doctor to find out how often you should use a glucose meter to check your blood sugar. Some common testing times may be when waking up, before and after meals and exercise, and at bedtime.

18. Long-Term Damage: Arteries

Over time, untreated type 2 diabetes can damage many of the body’s systems. About two out of three people with diabetes die of heart disease. Having diabetes also puts you at a two to four times higher risk for stroke. People with diabetes are likely to develop plaque in their arteries, reducing blood flow and increasing risk of clots. This hardening of the arteries (atherosclerosis) raises the risk of heart attack and stroke.

19. Long-Term Damage: Kidneys

The longer you have diabetes, the greater the risk of developing chronic kidney disease. Controlling risk factors such as uncontrolled diabetes, high blood pressure, and high cholesterol reduces your risk of developing this complication. Annual screening for kidney disease and medications, which slow the development and progression of kidney disease, are used to reduce your risk of kidney failure.

20. Long-Term Damage: Eyes

High blood sugar can damage the tiny blood vessels that bring oxygen and nutrients to the retina, a critical part of the eye. This is known as diabetic retinopathy, and it can cause progressive, irreversible vision loss. It is the leading cause of blindness in people between the ages of 20 and 60. Pools of blood, or hemorrhages, on the retina of an eye are visible in this image.

21. Long-Term Damage: Nerve Pain

Uncontrolled diabetes, and elevated blood sugars over time, increases the risk of nerve damage. Symptoms include tingling, numbness, pain, and a pins and needles feeling in the fingers, hands, toes and feet . Nerve damage (neuropathy) can't be reversed but treatments may help pain and numbness. Nerve damage can also affect other parts of your body such as your digestive system. Controlling your diabetes can help prevent further damage.

22. Long-Term Damage: Feet

Diabetic nerve damage can make it difficult to feel your feet and detect injury. At the same time, hardening of the arteries results in poor blood flow to the feet. Foot sores and gangrene can occur, even from small injury. In severe cases, infections can go unchecked and result in an amputation.

23. Preventing Type 2 Diabetes

One of the most astonishing things about type 2 diabetes is that such a life-altering condition is often preventable. To lower your risk, follow the same guidelines for warding off heart disease:
* Eat a healthy diet
* Exercise for 30 minutes, five days a week
* Maintain a healthy weight
* Talk to your doctor about being screened for prediabetes
* In people with prediabetes, lifestyle changes and medication can help prevent the progression to type 2 diabetes.