Diabetes: Preventing Complications That Kill Part I: Understanding Blood Sugar.

Except in very unusual circumstances, people don't die of high blood sugar anymore. Credit for the control of diabetic ketoacidosis goes to insulin, which was introduced in 1922, and to the large number of oral medications that followed in the wake of the sulfonylureas, introduced in 1956. Itis been heartening progress, and more is sure to follow.

While people donit die of ketoacidosis, large numbers still die from diabetes - so many, in fact, that diabetes now ranks as the seventh leading cause of death in America, taking about 160,000 lives annually. A man diagnosed with diabetes before the age of 40 has a life expectancy that is eight years shorter than a man who is free of the disease.

Why do so many people still die from diabetes, and why do countless others suffer major disabilities from the disease? It's not the high blood sugar, but the complications. Fortunately, though, new research demonstrates that many of these complications can be prevented.

What Is Diabetes?

Diabetes mellitus is a disorder of glucose metabolism. Glucose is the sugar in the blood that fuels the body's metabolism. After a meal, carbohydrates, fats, and proteins are digested in the intestinal tract, then absorbed into the bloodstream. Blood sugar levels rise after meals, but the sugar won't do any good unless it can enter the body's cells. Insulin, a hormone produced by the pancreas, opens the door, allowing glucose to enter cells. In diabetes, the door does not open properly, so there is too much sugar in the blood and not enough in the body's cells.

Diabetes is not one disease but two. In type 1 diabetes, the pancreas does not produce enough insulin; it usually starts abruptly, typically before the age of 40 and often before 20. Patients require daily insulin injections to prevent dehydration, coma, and death. Type 2 diabetes …