Even those of us who keep fit and eat a balanced diet sometimes become ill. It's part of life. It is important to be aware and informed of potential health problems, so that when they arise, we can care for ourselves properly. In this series, the Senior Center will provide information about various medical conditions in a

question and answer format, based on interviews with physicians.

People with diabetes must learn to accept the fact that they have a chronic disease. Managing diabetes is a challenge and the goal is to have as normal a lifestyle as possible while taking proper care of yourself.

According to the American Diabetes Association, almost 16 million Americans have diabetes.

The following questions and answers are based on an interview with Dr. Dennis Lock, an endocrinologist.

Q. What is diabetes?

A. Diabetes is actually a set of several different diseases. Type1 Diabetes is known as "immune-mediated diabetes mellitus." Type2 Diabetes is called "insulin-resistant diabetes mellitus." A third type is "gestational diabetes mellitus", which sometimes affects pregnant women. All people with diabetes have too much glucose, or sugar, in their blood. In Type1 Diabetes the immune system destroys the cells in the pancreas that produce insulin, a hormone that helps the cells of the body use glucose as a source of energy. A person with Type2 Diabetes produces insulin but either the insulin does not work in the right way, or there is not enough insulin for the body's needs.

Q. What are the symptoms of diabetes?

A. People with all types of diabetes share certain symptoms: unusual thirst, frequent urination, extreme fatigue and weight loss. In about half of all cases, Type1 Diabetes appears in childhood or during the teenage years. Type2 Diabetes appears most frequently in adulthood and does not develop suddenly, as can be the case with Type1. There may no obvious symptoms at first, or only mild ones.

Q. Who gets diabetes?

A. For both Type1 and Type2 Diabetes, having a history of diabetes in your family puts you at a higher risk of developing the disease. However, people who develop Type1 do not necessarily have a family history. Most of the people with Type2 are diagnosed after age 30 and half of all new cases occur in people age 55 and over. In contrast to Type1, the incidence of Type 2 increases dramatically with age. Unfortunately, as people move into their 70s and 80s, there are often few of the classic symptoms of diabetes and doctors first see the complications, especially heart disease, eye problems and problems of the nervous system. It is much more common to see Type2 Diabetes in older people, although there are cases of Type1 Diabetes appearing after 70 years of age. The people most likely to develop diabetes are overweight and sedentary, in addition to possibly having a family history of the disease. People who are taking a number of different medications for other diseases, especially steroids or diuretics, are also at higher risk for diabetes.

Q. What are the treatments for diabetes?

A. People with diabetes must learn to accept the fact that they have a chronic disease. Managing diabetes is a challenge and the goal is to have as normal a lifestyle as possible while taking proper care of yourself. Each individual patient must have a personal treatment plan designed for him by his doctor. Together you will decide what the goals of your treatment are. Diabetes care plans include diet, physical exercise, insulin injections or oral medications, which are all aimed at lowering and regulating your blood glucose level. The right treatment for your type of diabetes will prevent short-term problems such as low or high blood glucose levels and long-term complications such as damage to eyes, kidneys, nerves, heart and blood vessels

Q. Are there any differences in the treatment of diabetes in people in their 60s, 70s and older?

A. For any individual, it is important to decide what the major goals of his diabetic care are. In older people who have developed complications this will affect the emphasis of their treatment. Each patient responds differently to attempts to control his blood glucose level, so the level of control is better for some than for others. Trying to lower glucose levels too aggressively may bring about episodes of hypoglycemia (low-blood glucose), which is dangerous if not treated. Elderly people are less able to tolerate aggressive control of glucose levels. However, the notion that high glucose levels are less dangerous for them is totally incorrect. It is important for people of every age to measure their glucose levels in order to achieve their individually set goals.

Q. How does having diabetes affect a person's lifestyle?

A. Managing diabetes is a full-time job. You will take time during the day to test your blood-glucose level with a special monitor. If you have Type1 Diabetes you will inject yourself with insulin and if you have Type2 you may take oral diabetes medication with or without insulin injections. Proper diet and physical activity are important parts of any treatment plan. You will learn to be sensitive to how your body reacts to food, to exercise and to stress. The point is to balance what and when you eat, how much you exercise and your medication or insulin injections. It can be tricky and frustrating at times, especially because the body's need for insulin is not always the same. It is important to know when to call your doctor and ask for help. Although it sounds complicated, you can learn to cope with the help of your doctor and other professionals, such as a dietician or diabetes-education specialist.

Q. How does having diabetes affect a person emotionally?

A. Sometimes your blood glucose level can become dangerously low (hypoglycemia) or high (hyperglycemia). You need to learn how to recognize the warning symptoms and what to do about them. In addition to the faintness and dizziness of hypoglycemia, you may find it hard to concentrate or feel unexplained sadness or anger. If you suspect that the reason for these feelings is low blood glucose, you must check your glucose level immediately. Even when your diabetes is under control, having a chronic disease can be overwhelming and stressful. If you are feeling depressed, anxious or unable to cope, it is crucial that you see a mental health professional who can help you deal with your feelings. Taking care of yourself includes getting the proper psychological care.

Q. Are there any ways to prevent diabetes?

A. Since the people most likely to develop diabetes are overweight or obese and physically inactive, maintaining close to an ideal body weight and regular physical activity may allow some people to prevent the onset of diabetes.

Q. Are there any recent developments in the treatment of diabetes?

A. In recent years, there has been a tremendous amount of research in all aspects of diabetes, from understanding the genetic and environmental factors that cause the disease to developing new ways to deal with it. There are a number of new drugs available for people who do not inject insulin. In addition, new systems of insulin injection have been developed that make it more convenient and less uncomfortable for the patient.

The American Diabetes Association publishes a full library of books with comprehensive diabetes information. The following is a partial list of these books:

1. The American Diabetes Association Complete Guide to Diabetes

2. Type 2 Diabetes: Your Healthy Living Guide, Second Edition

3. Women & Diabetes

4. Caring for the Diabetic Soul

5. 101 Tips for Staying Healthy with Diabetes

6. Reflections on Diabetes

7. The Fitness Book: For People with Diabetes

The ADA also publishes cookbooks and meal planners for diabetics. The books can be ordered by phone or by mail.

Helpful web sites:

1.Diabetes.com A satellite health channel of PlanetRx.com, a health information resource and online pharmacy.
2. New York Online Access to Health. A thorough and informative site sponsored by the City University of New York and other educational institutions and organizations.
3. The site of the American Diabetes Association.
4. Intelihealth:Diabetes. Intelihealth is one of the leading health information companies in the world.
5. Diabetes Information Center. Lists many informative diabetes related web sites.

What suggestions do you have for dealing with diabetes?