Most people never give it a second thought—the food they eat is transformed into energy and that's that. Their bodies do all the work for them: digesting the food and converting carbohydrates into a type of sugar called glucose that enters the bloodstream. Next, the pancreas kicks out insulin, a hormone that travels through the body, attaching to receptors on the outside of cells. Once attached, insulin acts like a key that "unlocks" the cell so that glucose can enter it and be used for energy. If the body doesn't need the sugar for energy, it stores it as fat. Usually, this process hums along like a well-oiled machine. People only take notice when the process breaks down.
The monkey wrench that interrupts the flow is diabetes. Nearly 21 million people in the United States have this disease, a number that's more than tripled in the past 30 years.
Diabetes, also known as diabetes mellitus, comes in two forms. Type 1, previously called juvenile diabetes or insulin-dependent diabetes mellitus, is believed to be an autoimmune condition in which the pancreas fails to manufacture insulin. Though onset can occur at any age, patients are usually diagnosed in childhood or as young adults and require daily insulin injections throughout their lives.
People with the other form, type 2, usually develop the disease in adulthood, although unfortunately more and more children and young adults also are developing type 2 diabetes now. In this case, the pancreas produces insulin, but the body does not use it properly, and the pancreas kicks into overdrive to make up for this "resistance." In time, the pancreas cannot make enough insulin to make up for the insensitivity, and diabetes follows. Inactivity, aging, obesity, or a high-saturated-fat diet can all contribute to insulin resistance. Type 2 diabetes, also known as adult-onset diabetes or noninsulin-dependent diabetes mellitus, accounts for 90 to 95 percent of all cases. With either form of diabetes, glucose builds up in the bloodstream. Left untreated, this can lead to serious complications including kidney failure, limb amputation, heart disease, and blindness. But the good news is that type 2 diabetes often can be controlled through simple measures. Weight loss, proper nutrition, adequate exercise, and stress reduction all can improve blood glucose levels. Some experts believe that dietary supplements may help, too. Even people with diabetes who require medication will maintain better glucose control if they adhere to a healthy lifestyle. Here's our experts' advice.
Diabetes is a serious illness that requires a doctor's care, even when it is controlled. Consult a health care professional before making any changes to your diet or exercise routines.
Three complications of diabetes require prompt medical attention: severe hyperglycemia, hypoglycemia, and ketoacidosis.
Hyperglycemia is when your blood sugar spikes high. Symptoms include frequent urination, fatigue, unexplainable weight loss, and increased thirst. "These are signs that your blood sugar is too high, and you should be in touch with a health care professional if you can't get it down," says Christopher D. Saudek, M.D.
Hypoglycemia is when blood sugar drops too low. Symptoms include shakiness, dizziness, headache, confusion, sudden mood changes, and a tingling sensation around the mouth. Many people with diabetes have periods of hypoglycemia, but you should call a doctor whenever symptoms are severe or occur frequently.
Self-treat mild hypoglycemia simply by taking three glucose tablets, eating five or six pieces of hard candy, or drinking a 1/2 cup of fruit juice. It's important to treat it immediately, since you can pass out if it gets worse.
Ketoacidosis is a serious, potentially fatal condition that occurs when ketones—acids that build up in the blood—become dangerously high and poison the body. Warning signs include increased thirst, nausea, frequent urination, fatigue, and vomiting. Ketoacidosis occurs in people with type 1 diabetes, not with type 2.
Marc A. Brenner, D.P.M., is founder and director of the Institute of Diabetic Foot Research in Glendale, New York, and past president of the American Society of Podiatric Dermatology. He has authored and edited numerous textbooks and articles over the years, and has lectured nationally and internationally.
Marion Franz, M.S., R.D., C.D.E., is a nutrition and health consultant with Nutrition Concepts by Franz, Inc. and is an author for the American Diabetes Association's 1986, 1994, 2002 and 2006 nutrition recommendations.
Robert Hanisch is the senior medical exercise physiologist and certified diabetes educator with the Diabetes Treatment Center at Columbia-St. Mary's Hospital in Milwaukee.
Angele McGrady, Ph.D., is a professor in the department of psychiatry and the director of the Complementary Medicine Center at the Medical College of Ohio in Toledo.
Carla Miller, Ph.D., R.D., is an assistant professor in the department of nutrition and co-director of the Diet Assessment Center, both at Pennsylvania State University in University Park.
Harry G. Preuss, M.D., is a diabetes researcher and professor of physiology, medicine, and pathology at Georgetown University Medical Center in Washington, D.C.
Christopher D. Saudek, M.D., is a professor of endocrinology and metabolism at Johns Hopkins Medicine in Baltimore, Maryland, and director of the Johns Hopkins Diabetes Center.
Aaron I. Vinik, M.D., Ph.D., is a professor of internal medicine, pathology, and neurobiology at the Eastern Virginia Medical School and director of the Strelitz Diabetes Research Institute, both in Norfolk.