Health: Why So Many Of Us Are Getting Diabetes

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But most Type 2 diabetics don't have to resort to insulin shots to manage their condition. Because the fundamental problem in Type 2 diabetes is insulin resistance--not the inability to produce insulin as in Type 1--other options are available. Your physician may first give you pills that can either sensitize your body to insulin's effects or help your body produce more of the hormone. But some of your best allies in this struggle are your muscles. Building them up and using them regularly in such pursuits as walking or dancing draw more glucose out of the bloodstream and increase insulin's efficiency. It also pays to avoid easily digested foods--like chips, nondiet soda and other junk food--which require large amounts of insulin to metabolize. Finally, losing a little weight usually makes insulin's job a lot easier.

Donna Black Bradley, 52, of Los Angeles is living proof. Bradley was driving home from work one evening when she suddenly was unable to read the freeway signs. When her doctor diagnosed diabetes, she felt paralyzed. "Then I said O.K., I got something I got to do here," Bradley says. "I got to change." And change she did. The 5-ft. 7-in. mother and grandmother started eating better and working out on a treadmill several times a week. Her weight dropped from 272 lbs. to 210 lbs., and her fasting glucose fell from 300 mg/dL to 103 mg/dL. "It's amazing how your cravings diminish when you're eating the right food groups," Bradley says. Her vision problems have disappeared, and her doctor believes she will no longer need to take insulin-sensitizing drugs if she can get her weight under 200 lbs.--something she's determined to do, both for herself and for her grandson Isaiah. Says she: "I want to be around for that 2-year old."

SMALL STEPS, BIG REWARDS

The more scientists learn about diabetes and the complications it causes, the more they find themselves looking at the conditions that precede it. "The big question now is, When does the diabetes clock start ticking?" says Dr. Frank Vinicor, director of the diabetes program at the Centers for Disease Control. "For eye or small-vessel disease, we think the clock starts ticking when blood sugar starts to go up. But for heart disease, we think the clock may start ticking much, much earlier, even before the first sign of blood sugar going up."

That's why researchers are focusing on a precursor condition called prediabetes, in which glucose levels are only slightly elevated but which may put at risk an additional 20 million Americans.

In 2002 researchers published the results of the Diabetes Prevention Program (D.P.P.), one of the largest, most rigorous clinical trials ever conducted on the subject. More than 3,000 people from all over the U.S. participated. All were overweight, and blood tests indicated that their bodies were having trouble handling glucose, though none had yet developed diabetes. Half were from ethnic communities that are at higher risk.

Participants in the D.P.P. were divided into three groups. One was given the diabetes drug metformin, one was given a dummy pill, and one was enrolled in a nutrition and exercise program with the goal for participants to lose 7% of their initial weight and to exercise 30 minutes a day, five times a week.