Even though diabetes has reached epidemic proportions in the US-affecting approximately 18 million people-there's still confusion about risk factors, as well as the best prevention and treatment strategies for this devastating disease.

Example: It's well known that excessive body weight increases the risk for diabetes, but many people assume they won't develop the condition if they lose weight. Among overweight people who have a family history of diabetes, weight loss significantly reduces risk but is not a guarantee that they will avoid the disease. Other common myths...

Myth 1: Only full-fledged diabetes needs to be treated. It can take decades for elevated blood sugar (glucose) to damage nerves or blood vessels, but the risk for heart disease begins when blood glucose is only slightly elevated-before people get full-fledged diabetes.

Doctors used to treat diabetes only when a person's fasting blood glucose level was 126mg/dl or higher. The American Diabetes Association now recommends lifestyle changes to anyone who has a fasting glucose level of 100 mg/dl or higher-a condition that experts call prediabetes.

New study: The Diabetes Prevention Program followed 3,000 people who had prediabetes for three years. Patients were divided into three groups. One was given the diabetes drug metformin (Glucophage). One was given a placebo. The other was enrolled in an exercise and weight-loss program.

Results: Nearly 30% of patients in the placebo group went on to develop diabetes, For the metformin group, the number was 22%. Only 14% of patients in the exercise and diet program developed diabetes.

Important: Everyone should have a fasting blood sugar test at age 45, and every three years thereafter if the results are normal. If you are obese* or have a first-degree relative who has diabetes, testing should begin at age 35.

Myth 2: Low insulin levels cause diabetes. Insulin is a pancreatic hormone that pushes blood glucose into cells. People who have type 1 (formerly known as juvenile-onset) diabetes produce little or no insulin-but 90% to 95% of diabetics have type 2 (formerly known as adult-onset), which initially causes the body to produce excess insulin.**

For reasons that still aren't clear, the cells in people who have type 2 diabetes do not respond to insulin's effects. The pancreas churns out high amounts of insulin to overcome this "insulin resistance." Eventually, the pancreas

*Obesity is defined as a body mass index (BMI) of 30 or greater. To calculate your BMI, see www.cdc.gov/nccdphp/dnpa/bmi, or go to p.248

**The terms "juvenile-onset" and "adult-onset" diabetes are no longer used to describe type 1 and type 2 diabetes, respectively, because an increasing number of children develop type 2 diabetes each year. "burns out," failing to produce enough insulin, which precipitates a drop in insulin and a rise in blood glucose.

New approach: Until recently, most patients who had type 2 diabetes were treated with oral drugs, such as glipizide (Glucotrol) or glyburide (Diabeta), that stimulate the pancreas to produce more insulin and overcome resistance. Now, approximately half of patients are given daily injections of insulin along with oral drugs. The combination reduces stress on the pancreas and makes it easier to maintain glucose levels.

Myth 3.' Diabetes does not lead to any other serious health conditions. Not true. People who have diabetes also have an increased risk for retinopathy (disorder of the retina), kidney disease and neuropathy (nerve damage). Approximately 40% of the people who have diabetes develop high blood pressure, and heart attack is a major cause of death in this group.

On average, inadequately controlled diabetes reduces life expectancy by approximately a dozen years.

Important: Don't be discouraged by this information-you can make a difference in your health and longevity. Get your blood pressure checked at least once a year if you have diabetes.

Diabetes causes the body to produce very small particles of LDL ("bad") cholesterol that are particularly dangerous. If you do nothing else, lowering your LDL cholesterol to below 100 can reduce your risk for heart problems substantially. Do this by limiting your intake of saturated fat to less than 10% of total fat, getting regular exercise and taking medications if necessary.

Myth 4: Sugar really isn't that dangerous. Most people who have diabetes or those at risk need to lose weight. To do so, they should avoid foods that have more than 6 grams (g) of sugar per serving-a little more than one teaspoon. Check the nutrition facts label on food packages.

Even if you're at a healthful weight, having more than two daily servings of sweet foods elevates blood glucose and increases stress on the pancreas. Foods that are considered healthful but that are actually high in sugar include sweet com, potatoes, grapes and banana.

Myth 5: Diabetes always causes weight gain. Untreated diabetes causes weight loss. Often, treatment for diabetes causes weight gain. Some diabetes drugs improve appetite. If patients do not adhere to a healthful diet and change their lifestyles, weight gain can occur.

Myth 6: All people who have diabetes must receive daily shots. Patients who have type 1 diabetes do need insulin shots. However, only some patients who have type 2 diabetes need them.

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