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HANDLE WITH CARE

There's no getting around it. Diabetes a chronic disease that has no cure -- significantly affects the lives of 16 million Americans. But while researchers look for new methods of treating and, ultimately, curing diabetes, today's patient still can benefit from improved understanding of the disease, the newest medications, educational programs and support groups.

"If you make an early diagnosis and if you treat the patient according to American Diabetes Association guidelines, you can prevent complications and the patient can lead a normal life," says Dr. Frederick Ellyin, an endocrinologist and director of the Diabetes Community Center at Swedish Covenant Hospital in Chicago.

About 1,700 people are diagnosed with diabetes every day in the United States. In 1997, more than 178,000 people are expected to die from the disease and its related complications which include kidney failure, heart disease and stroke. Diabetes also can lead to blindness and limb amputation.

The cause of diabetes is a mystery, though both genetic and environmental factors appear to play roles. There are two major types of diabetes. Type I occurs most often in children and young adults and accounts for 5 to 10 percent of all diabetes. In Type I, the pancreas does not produce insulin. Because the body needs the hormone to convert sugar, starches and other foods into the energy required for daily life, people with Type 1 diabetes must take daily insulin injections.

A new faster acting form of injectable insulin, lispro (brand name Humalog), was approved by the U.S. Food and Drug Administration in 1996. Prior to its introduction, the fastest-acting insulin took at least half an hour to work and didn't reach its peak for up to two hours. The best time to take it was about 50 minutes before eating.

"That's very inconvenient," says Dr. Irwin Brodsky, assistant professor of medicine and nutrition at the University of Illinois at Chicago. "You have to think about when to give yourself the shot and then wait to eat."

Lispro works faster because it was designed to be more rapidly absorbed than other forms of insulin. Users are told they can take lispro, then sit down to eat.

"Lispro is good for people who don't have a regular schedule," says Kathryn Torrey, program director of the Diabetes Center at Sherman Hospital in Elgin, Ill. "They can give themselves a shot when they are going to eat. It acts very fast. That's its beauty, but also its downfall. When you take it, you'd better be sure the meal is on the table."

A pump that feeds insulin directly into the body on a regular basis is another recent innovation. Worn externally, the device functions as an artificial pancreas, pumping insulin through a needle inserted under the skin. The physician sets the rate of insulin flow according to the patient's weight and body mass. Then the patient is taught to give an extra dose of insulin through the pump prior to each meal.

"Patients still have to count their carbohydrates and understand the relationship of carbohydrates to insulin," says Ms. Torrey. "But the beauty of it is that the blood sugar levels are more easily stabilized in many patients who use pumps."

Type II diabetes results from the body's inability to make enough, or properly use, insulin. It accounts for 90 to 95 percent of all diabetes and usually occurs in people over 45 and overweight.

"The incidence of Type II diabetes is increasing dramatically. People are beginning to realize that this is a very, very common disease," says Dr. Kenneth Polonsky, head of endocrinology at the University of Chicago. "It may not have as dramatic and immediate an effect as cancer, but it has an enormous impact in financial and human costs for people who have it in their families."

Finding out whether you are likely to develop Type II diabetes and working to prevent its onset are the first steps in diabetes management. You are at risk if a sibling or one or both of your parents has the disease; if you are more than 20 percent above your ideal weight; if you've had gestational diabetes or delivered a baby weighing 9 pounds or more; or if you are Hispanic, African-American or Native American.

"Diabetes is hereditary -- especially Type II," Brodsky says. "If even one parent has it, your risk is markedly increased. A sedentary lifestyle and obesity further increase that genetic risk."

What lies ahead for diabetics? Researchers continue to seek the causes of the disease. At the University of Chicago, Graeme Bell, professor of biochemistry and molecular biology, is working to find the genes that indicate a person's susceptibility to diabetes.

"If we find the genes, then determine the function of the product made by each gene, we will have a clue as to why people develop diabetes. With that information we will be able to offer advice for prevention," Bell says. "But this is an ambitious project and will take a long time."

Researchers also are studying the option of pancreas transplantation, which so far has been fraught with rejection problems.

With a cure still a long way in the future, prevention, improved drugs and better management continue to be the main hopes.

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