Type 1 diabetes mellitus - diabetes, for short. This chemical disorder disrupts the body's ability to utilize certain nutrients, primarily a blood sugar called glucose.

Treatment for diabetes is made more difficult because a person can have the disease a long time before it is diagnosed. "Because the early symptoms are relatively mild," notes Asiaweek magazine, "diabetes often goes unrecognized." Hence, diabetes has been dubbed the silent killer.

Why Serious

Diabetes has been called "a disorder of the very engine of life," and for good reason. When the body cannot metabolize glucose, a number of vital mechanisms can break down, sometimes with life-threatening consequences. "People don't die directly from diabetes," says Dr. Harvey Katzeff, "they die from complications. We do a good job of preventing complications, but a poor job of treating [them] once they occur."

Diet and Exercise

Although Type 1 diabetes cannot be prevented, scientists are studying the genetic risk factors and are trying to find ways to suppress an immune attack. "With type 2, the picture is much brighter," says the book Diabetes - Caring for Your Emotions as Well as Your Health. "Many of those who might be genetically susceptible avoid showing any sign of this disease simply by eating a balanced diet and exercising regularly, thereby staying physically fit and keeping their weight within normal limits."

Underscoring the value of exercise, the Journal of the American Medical Association reported on a large study involving women. The study found that "a single bout of physical activity increases insulin-mediated glucose uptake [by the body's cells] for more than 24 hours." Hence, the report concludes that "both walking and vigorous activity are associated with substantial reductions in risk of type 2 diabetes in women." The researchers recommend at least 30 minutes of moderate physical activity on most if not all days of the week. This can include something as simple as walking, which, says the American Diabetes Association Complete Guide to Diabetes, "is probably the best, safest, and least expensive form of exercise."

However, exercise by people with diabetes should be professionally supervised. One reason is that diabetes can damage the vascular system and nerves, thus affecting blood circulation and feeling. Hence, a simple scratch on the foot may go unnoticed, get infected, and turn into an ulcer - a serious condition that may lead to amputation if not treated immediately.

Insulin Therapy

Many with diabetes must supplement their diet and exercise program with daily testing of glucose levels along with multiple insulin injections. As a result of improved health through diet and a good routine of exercise, some with Type 2 diabetes have been able, at least for a time, to discontinue insulin therapy. Karen, who has Type 1 diabetes, found that exercise increases the efficiency of the insulin she injects. As a result, she has been able to cut her daily insulin requirements by 20 percent.

If insulin is needed, however, there is no reason for the sufferer to feel discouraged. "Going on insulin does not imply failure on your part," says Mary Ann, a registered nurse who cares for a number of diabetes patients. "Whatever form of diabetes you have, if you carefully control your blood sugar, you will minimize other health problems later." In fact, a recent study revealed that people with Type 1 who kept strict control of their blood-sugar levels "had drastic reductions in the occurrence of diabetic eye, kidney, and nerve diseases." The risk of eye disease (retinopathy), for instance, was cut by 76 percent! Those with Type 2 who keep tight control of their blood-sugar levels enjoy similar benefits.

To make insulin therapy easier and less traumatic, syringes and insulin pens - the most common tools used - have microfine needles that give minimal discomfort. "The first shot is usually the worst," says Mary Ann. "After that, most patients say they hardly feel a thing." Other methods of injection include automatic injectors that shoot a needle into the skin painlessly, jet injectors that literally fire insulin through the skin by means of a fine jet blast, and infusers that employ a catheter that stays in place for two or three days. About the size of a pocket pager, the insulin pump has gained popularity in recent years. This programmable device dispenses insulin through a catheter at a steady rate according to the body's daily needs, making insulin administration more precise and convenient.

Keep Learning

All told, there is no blanket therapy for diabetes. When considering treatment, each individual must take into account a number of factors in order to make a personal decision. "Even though you may be under the care of a medical team," says Mary Ann, "you are in the driver's seat." In fact, the journal Diabetes Care states: "Medical treatment of diabetes without systematic self-management education can be regarded as substandard and unethical care."

The more those with diabetes learn about their disease, the better equipped they will be to manage their health and increase their prospects of living a longer, healthier life.

The Role of Glucose

Glucose fuels the body's trillions of cells. To enter the cells, however, it needs a "key" - insulin, a chemical released by the pancreas. With Type 1 diabetes, insulin is simply not available. With Type 2, the body makes insulin but usually not enough. Moreover, the cells are reluctant to let insulin in - a condition called insulin resistance. With both forms of diabetes, the result is the same: hungry cells and dangerous levels of sugar in the blood.

In Type 1 diabetes, a person's immune system attacks the insulin-producing beta cells in the pancreas. Hence, Type 1 diabetes is an autoimmune disease and is sometimes called immune-mediated diabetes. Factors that can trigger an immune reaction include viruses, toxic chemicals, and certain drugs. Genetic makeup may also be implicated, for Type 1 diabetes often runs in families, and it is most common among Caucasians.

With Type 2 diabetes, the genetic factor is even stronger but with a greater occurrence among non-Caucasians. Australian Aborigines and Native Americans are among the most affected, the latter having the highest rate of Type 2 diabetes in the world. Researchers are studying the relationship between genetics and obesity, as well as the way excess fat seems to promote insulin resistance in genetically susceptible people. Unlike Type 1, Type 2 diabetes occurs mainly in those who are over 40 years of age.

About 90 percent of those with diabetes have Type 2. Previously, this was referred to as "non-insulin dependent" or "adult onset" diabetes. However, these terms are imprecise, for up to 40 percent of those with Type 2 diabetes require insulin. Furthermore, an alarming number of young people - some not even in their teens - are being diagnosed with Type 2 diabetes.

The Role of the Pancreas

About the size of a banana, the pancreas lies just behind the stomach. According to the book The Unofficial Guide to Living With Diabetes, "the healthy pancreas performs a continuous and exquisite balancing act, managing to sustain smooth, stable blood-sugar levels by releasing just the right amount of insulin as glucose levels wax and wane throughout the day." Beta cells within the pancreas are the source of the hormone insulin.

When beta cells fail to produce enough insulin, glucose builds up in the blood, causing hyperglycemia. The opposite - low blood sugar - is called hypoglycemia. In concert with the pancreas, the liver helps manage blood-sugar levels by storing excess glucose in a form called glycogen. When commanded by the pancreas, the liver converts glycogen back into glucose for use by the body

The Role of Sugar

It is a common misconception that eating a lot of sugar causes diabetes. Medical evidence shows that getting fat - regardless of sugar intake - increases the risk among genetically susceptible individuals. Still, eating too much sugar is unhealthy, since it provides poor nutrition and contributes to obesity.

Another misconception is that people with diabetes have an abnormal craving for sugar. In reality, though, they have the same desire for sweets as most others. When it is not controlled, diabetes can lead to hunger - but not necessarily for sugar. People with diabetes can eat sweets, but they must factor their sugar intake into their overall diet plan.