Diabetes begins as a silent disease and may take several years before it is discovered.
      Diabetes starves the body by holding the sugar in the blood and thus keeping it away from the tissues that need it.  It is similar to what happens when the UN cannot get food to a starving population because the roads are blocked by war.  In both situations, the food is plentiful but cannot be transported to where it is needed.
      Type I diabetes begins in childhood as a viral illness which causes the rapid and total failure of the pancreas to produce insulin.  Children with diabetes do not respond to oral medications and will need insulin treatment form the outset.
      Type II diabetes begins in adulthood, progresses slowly over time, and is an inherited autoimmune disease whereby the immune system of the person attacks the person’s pancreas.  There are two defects in adult or Type II diabetes that collaborate to produce the high blood sugar:
            a) The pancreas produces insulin slower than normal and in insufficient amounts (Insulin Insufficiency).
            b) The body becomes resistant to the actions of insulin (Insulin Resistance).
      Adult or Type II diabetes begins when the fasting blood sugar rises above 100 mg/100cc.  At that stage it is called pre-diabetes.  If no action is taken to delay its progression, it will be called diabetes when the fasting blood sugar reaches 126.
      At the pre-diabetes stage, the progression to diabetes can be reversed by increasing exercise and decreasing weight.  That is why it is important to make an early diagnosis because it allows the patient to be promptly and aggressively treated before the diabetes causes irreversible tissue damage.  Most diabetics are overweight or obese and the global epidemic of obesity is increasing the incidence of diabetes to alarming levels.
      The treatment of adult Type II diabetes should always include exercise, weight control, and a low carbohydrate diet.  The main carbohydrates that should be minimized are: bread, rice, potato, corn, sugar and sweets.  When these measures fail to bring the person back to normal, then medicines become necessary.
      The first and most important oral medicine is Metformin.  It reduces insulin resistance, decreases liver production of sugar, does not cause low blood sugar, and does not cause weight gain, which is a major problem in adult diabetes.  It is used alone as the primary treatment as long as it can control the blood sugar.  When the disease progresses in spite of Metformin, then medicines that increase the secretion of insulin by the pancreas are usually added.  These types of medicines may cause the blood sugar to drop to dangerously low levels if meals are skipped or delayed.  When these insulin-secreting medicines are no longer able to control the blood sugar, then insulin is added.  However, both insulin and the medicines that increase insulin secretion cause weight gain, which increases insulin resistance and defeats the person’s weight-reduction efforts.
      Moving from Metformin to insulin—without using the medicines that increase insulin secretion—is becoming the preferred approach by diabetes experts because of better results.  There are some new, very safe, long-range insulins that can control diabetes with only one injection per day.
      Perfect control of diabetes aims at having a fasting blood sugar between 90 and 110 mg/100cc and the blood sugar two after a meal at no more than 140 mg/100cc.  The patient can help achieve these goals by increasing exercise and decreasing weight.
      A measure of diabetes control that reflects the blood-sugar state over the past three months is a test called the Glycosylated Hemoglobin or Hemaglobin A1C.  Normal people have an A1C below 6.  A well-controlled diabetic will have an A1C between 6 and 7 and that should be the goal of treatment because the higher the A1C, the higher the complication rates.
      The complications of diabetes are numerous.  Basically diabetes damages the arteries, nerves, kidneys, and eyes and causes heart attacks, strokes, kidney failure, blindness, and loss of sensation in the feet leading to foot ulcers.  Diabetic complications not only shorten life, they also ruin life’s quality and are a major cause of disability and amputations.
      Any person who is overweight and does not exercise is at an increased risk of developing diabetes.  Teaching children to eat properly and to make exercise a daily habit is one way to combat the rising global epidemic of adult diabetes.
      Treating high blood pressure, high cholesterol, and tobacco addiction will help reduce the complications of diabetes.  These three risk factors, when they coexist with diabetes, portend a very bad prognosis and should be aggressively treated.