The new face of diabetes

When Jodi Dianchrist, 35, and her husband decided to buy more life insurance four years ago, she figured that her husband was the one who should worry about passing the physical exam required by State Farm.

Both were in good health, but Jodi exercised and tried to watch her diet, although she needed to lose some weight. Nor was the Inver Grove Heights woman's family tree clouded by cancer, heart disease or other serious health conditions. Her relatively young age also was a plus.

So when her physician told her that she had Type II diabetes, the adult-onset form of the disease, Dianchrist was shocked:

"I kept thinking: Me? I have diabetes? And then I thought: You can't tell me this, because I hate needles! I can't have diabetes!"

Not long ago, a diagnosis of Type II diabetes in a young adult was a rarity. The juvenile form of this disease -- a malfunction of the immune system -- usually begins in childhood, while Type II has historically been a condition of the elderly. In fact, many of today's physicians were taught that age was a critical component of diagnosis: Type II happened mostly to those 60 and older, while anything in those age 40 and under was Type I.

That's changing rapidly, however, and experts are sounding the alarm about a new and serious public health threat.

In August, the federal Centers for Disease Control and Prevention reported that the incidence of diabetes grew by 33 percent in the United States from 1990 to 1998, with an especially sharp increase among young adults. The number of diagnoses among people in their 30s rose 76 percent, while diabetes among those in their 40s rose 40 percent.

Most of the new cases involved Type II diabetes.

Physicians also report a growing number of teens and people in their 20s with this disease, and sharp increases among certain ethnic groups, such as American Indians, blacks and Hispanics.

"What we have is an epidemic of Type II diabetes," said Dr. Lee Sanders, a spokesman for the American Diabetes Association (ADA).

Added Dr. Charles Billington, an endocrinologist and obesity expert at the Minneapolis Veterans Medical Center: "Type II diabetes should not be a disease of young people. That we are seeing it, and seeing it track with an explosion of obesity, tells us that there is something wrong."

When sugar isn't sweet

Part of the problem, experts say, is that most people are only vaguely aware of diabetes and the health problems it brings, which is why a diagnosis of the disease is typically followed by classes that focus on nutrition, medication management and self-care.

At the core of the classes, however, are such diabetes basics as what insulin is and the critical role it plays in the body.

According to Dr. David Kendall, medical director of Park Nicollet's International Diabetes Center in St. Louis Park, diabetes is a disorder of the body's metabolism -- the process by which we break down food and use it for energy. In people who have diabetes, the body either doesn't produce enough insulin, is resistant to it, or both.

Insulin, a hormone produced by the pancreas, essentially serves as a chemical escort for glucose, the sugar that results from the metabolizing of food. Glucose is the fuel of choice for the body's cells, but it needs to be accompanied by insulin to get into the cells.

In people with diabetes, something goes wrong with this process, Kendall said. Either there's not enough insulin to get glucose into the cells or the body resists the insulin's action. The result is that glucose builds up in the blood, eventually passing out of the body in urine.

An upset in the glucose balance can lead to serious effects, including nerve damage, infections and poor wound healing, kidney damage, blindness, amputations and an acceleration of cardiovascular disease. U.S. health care costs from diabetes are estimated at $98 billion a year by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

There are three main types of diabetes, according to the NIDDK. Perhaps creating some confusion about diabetes is that there have been different names for them, and they changed in recent years. Diabetes experts have settled on these: