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Since you are coming to this book, you or a loved one may have been diagnosed recently with diabetes. Perhaps you have long-standing diabetes and are not satisfied with treatment that has left you plagued with complications such as encroaching blindness, foot pain, frozen shoulder, inability to achieve or maintain an erection, or heart or kidney disease.

Although diabetes is still an incurable, chronic disease, it is very treatable, and the long-term "complications" are fully preventable. I've had Type I diabetes, also called juvenile-onset or insulin-dependent diabetes mellitus (IDDM), for more than fifty years. This form of diabetes is generally far more serious than Type II, or non-insulin-dependent diabetes mellitus (NIDDM), although both have the potential to be fatal.* Most Type I diabetics who were diagnosed back about the same time I was are now dead from one or more of the serious complications of the disease. Yet, after living with diabetes for more than fifty years, instead of being bedridden or out sick from work, I am more fit than many nondiabetics who are considerably younger than I. I regularly work 12-hour days, travel, sail, and pursue a vigorous exercise routine. If I can take control of my disease, you can take control of yours.

In the next several pages I'll give you a general overview of diabetes, how the body's system for controlling blood sugar (glucose) levels works in the nondiabetic, and how it works—and doesn't work—for diabetics. In subsequent chapters we'll discuss diet, exercise, and medication, and how you can use them to control your diabetes. If talk about diet and exercise sounds like "the same old thing" you've heard again and again, read on, because you'll find that what I've observed is almost exactly the opposite of what you've probably been taught. The tricks you'll learn can help you arrest the diabetic complications you may now be suffering, may reverse many of them, and should prevent the onset of new ones. We'll also talk about new medical treatments and drugs that are now available to help manage blood sugar levels and curtail obesity.

The Body In and Out of Balance

Insulin is a hormone produced by the beta cells of the pancreas. Its major function is to regulate the level of glucose in the bloodstream, which it does primarily by facilitating the transport of blood glucose into most of the billions of cells that make up the body. Insulin also stimulates centers in the brain responsible for feeding behavior, and it instructs fat cells to convert glucose and fatty acids in the blood into fat, which the fat cells then store until needed. Insulin is essential for the growth of many tissues and organs. In excess, it can cause excessive growth—as, for example, of body fat and of cells that line blood vessels. Finally, insulin helps to regulate, or counterregulate, the balance of certain other hormones in the body. More about those later.

One of the ways insulin maintains the narrow range of normal levels of sugar in the blood is by regulation of the liver and muscles, directing them to manufacture and store glycogen, a starchy substance the body uses when blood sugar falls too low. If blood sugar does fall too low—as may occur after strenuous exercise or fasting—the alpha cells of the pancreas release glucagon, another hormone involved in the regulation of blood sugar levels. Glucagon signals the muscles and liver to convert their stored glycogen back into glucose (a process called glycogenolysis), which raises blood sugar. When the body's stores of glucose and glycogen have been exhausted, the liver can transform the body's protein stores—muscle mass and vital organs—into sugar.
 
Insulin and Type I Diabetes
As recently as seventy-five years ago, before the clinical availability of insulin, the diagnosis of Type I diabetes—which involves a severely diminished capacity to produce insulin—was a death sentence. Most people died within a few months of diagnosis. Without insulin, glucose accumulates in the blood to extremely high toxic levels; yet, since it cannot be utilized by the cells, many cell types will starve. The absence of insulin also leads the liver to perform gluconeogenesis, turning the body's protein store—the muscles and vital organs—into even more glucose that the body cannot utilize. Meanwhile, the kidneys, the filters of the blood, try to rid the body of inappropriately high levels of sugar. Frequent urination causes insatiable thirst and dehydration. Eventually, the starving body turns more and more protein to sugar, leaving no organ unaffected. The ancient Greeks described diabetes as a disease that causes the body to melt into sugar water. When tissues cannot utilize glucose, they will metabolize fat for energy, generating by-products called ketones, which are toxic at high levels and cause further water loss as the kidneys try to eliminate them (see ketoacidosis, in Chapter 20, "How to Cope With Dehydrating Illness").

Today Type I diabetes is still a very serious disease, and still eventually fatal if not properly treated with insulin. It can kill you rapidly when your blood glucose level is too low—through impaired judgment or loss of consciousness while driving, for example—or it can kill you slowly, by heart or kidney disease, which are commonly associated with long-term blood sugar elevation. Until I brought my blood sugars under control, I had numerous automobile accidents due to hypoglycemia, and it's only through sheer luck that I'm here to talk about it.

The causes of Type I diabetes have not yet been fully unraveled. Research indicates that it's an autoimmune disorder in which the body's immune system attacks the pancreatic beta cells that produce insulin. Whatever causes Type I diabetes, its deleterious effects can absolutely be prevented. The earlier it's diagnosed, and the earlier blood sugars are normalized, the better off you will be.

At the time they are diagnosed, many Type I diabetics still produce a small amount of insulin, and if they are treated early enough and treated properly, what's left of their insulin-producing capability frequently can be preserved. Type I diabetes typically occurs before the age of forty-five and usually makes itself apparent quite suddenly, with such symptoms as dramatic weight loss and frequent thirst and urination. We now know, however, that as sudden as its appearance may be, its onset is actually quite slow. Routine commercial laboratory studies are available that can detect it earlier, and it may be possible to arrest it in these early stages by aggressive treatment. My own body no longer produces any insulin at all. The high blood sugars I experienced during my first year with diabetes burned out, or exhausted, the ability of my pancreas to produce insulin. I must have insulin shots or I will rapidly die. I firmly believe that if the kind of diet and medical regimen I prescribe for my patients had been available when I was diagnosed, the insulin-producing capability left to me at diagnosis would have been preserved. My requirements for injected insulin would have been lessened, and it would have been much easier for me to keep my blood sugars normal.

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