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But the most immediately life-threatening aspect of type 1 diabetes is the formation of poisonous acids called ketone bodies. Like glucose, they accumulate in the blood and spill into the urine. Before the advent of insulin, the consequent ketoacidosis (acid buildup) was irreversible, causing most people who got IDDM to die within months.

Symptoms of NIDDM may include any or all those of IDDM, but are often overlooked because they tend to come on gradually and be less pronounced. Instead of urgently having to urinate around the clock, for example, people with type 2 diabetes may have to use the toilet frequently only at night.

Other symptoms that may signal the presence of type 2 disease are tingling or numbness in the lower legs, feet or hands, skin or genital itching and gum, skin or bladder infections that recur and are slow to clear up. Again, many people fail to connect them with possible diabetes.

Indeed, about half those who have NIDDM — -some 6.5 million American adults — don't know it. Their ignorance is, at best, temporary bliss. While life-threatening ketone bodies are uncharacteristic of type 2 diabetes, it is, nonetheless, a serious disease. If neglected, its long-term risks of disabling and even fatal complications substantially increase.

Measuring glucose levels in samples of the patient's blood is key to the diagnosis of both types of diabetes. This is first done early in the morning on an empty stomach. For further information, the blood test is repeated, usually on another day, before the patient has drunk a liquid containing a known amount of glucose and at intervals afterwards.

"Together with the results of these tests, the patient's age and weight often pretty much tell us which type of diabetes it is," says Douglas A. Greene, M.D., of the University of Michigan Medical Center, who heads FDA's advisory panel on diabetic drugs. "If someone is young rather than old and lean rather than fat, we suspect type 1 disease (IDDM) rather than type 2, whereas we suspect type 2 disease (NIDDM) if the patient is heavy and getting along in years."

Further laboratory tests can be used when the diagnosis is uncertain. For example, type 2 patients rarely form ketone bodies while type 1 patients very often do. Thus, blood tests for evidence of ketone body activity can help to determine which type of diabetes the patient has.

Treatment for either type seeks to do what the human body normally does naturally: maintain a proper balance between glucose and insulin. The guiding principle is that food makes the blood glucose level rise while insulin and exercise make it fall. The trick is to juggle the three factors to avoid both hyperglycemia, meaning a blood glucose level that is too high and hypoglycemia, meaning one that is too low.

Either problem can make the patient feel unwell and cause mental confusion, loss of consciousness, and even death if it becomes severe. For this reason, patients should wear bracelets identifying them as diabetic and in need of immediate medical attention if unable to summon it themselves. In addition, almost any degree of hyperglycemia is thought to add to the likelihood of the long-term complications that can afflict type 1 and type 2 diabetics alike.

Accordingly, many patients regularly track their blood glucose levels themselves so that they and their doctors can take steps to keep them within fairly normal limits and promptly correct the levels when they stray too far. (See "Improving Blood Glucose Monitoring for Diabetics" in the May 1990 FDA Consumer.)

Since there is no cure for either kind of diabetes, treatment is lifelong. It always includes dietary restrictions, which most patients are better able to follow if a nutritionist or registered dietitian helps them to build flexibility and variety into their meals and snacks. A diabetes educator (usually a nurse) who can tutor patients in self blood glucose monitoring, critically important foot care, and other coping skills can also be very helpful.

All diabetes patients should, besides, refrain from smoking and abstain from or at least go easy on alcohol. And, unless there are reasons why they should not exercise, they should do so regularly, being sure to check with their doctors about what sort of exercise will be beneficial and safe for them. Type 1 diabetics, in addition, must take insulin injections or wear a small battery-powered pump that infuses insulin into the body.

Because the vast majority of type 2 diabetics are heavier than they should be, weight loss alone is often prescribed first. Slimming in itself may normalize (or nearly so) blood glucose levels, even if the patient does not get down to his or her ideal weight. But the pounds should be lost for good. Subsequent attempts at weight loss are less likely to be as successful or to lower blood glucose levels as much.

Tags: Diabetes

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