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During the early stages of diabetes, there may not be symptoms. As time goes by, if diabetes is well controlled, symptoms may remain minimal. But if diabetes is not well managed, the years will take their toll because poorly controlled diabetes can cause serious problems – involving the eyes, the kidneys, the nerves, the blood vessels and the heart.

Diabetes and the heart

One of the most serious complications of diabetes is cardiovascular disease. When you have diabetes, your risk of having a heart attack in 7 years is as high as the risk for someone without diabetes who has already had a heart attack. Chronically high blood sugar levels raise the risk for cardiovascular disease through many different processes – one of them is called glycation. Glycation occurs when sugar attaches to molecules – such as proteins – and changes them. When there is excess sugar, as there is in diabetes, there is excess glycation. This is very similar to the process that causes fruit to ripen: first the fruit becomes sweeter and sweeter, and then glycation causes the fruit to turn brown and deteriorate.

Women are felt to be particularly vulnerable to heart disease when they have diabetes. This is because they lose the natural protection that women have, they often have atypical symptoms, and because people – including doctors – do not think that cardiovascular disease occurs as much in women as it does in men. My mother's friend, Sylvia, who I describe in my book Diabesity (Bantam, 2005), is a good example.

The case of Sylvia

Sylvia was one of my mother's bridge partners. She was diagnosed with "mild diabetes" at age sixty-six. Because she had no symptoms of diabetes, she initially thought the doctor must be wrong.

At 30 pounds overweight with her cholesterol and blood pressure only slightly elevated, Sylvia opted to decline medications and chose to take a more "natural" route. She began to walk and watched what she ate. She also tried different herbal teas and homeopathic remedies. After losing a few pounds, she went back to her doctor who was delighted with her weight loss, lowered blood pressure and improved cholesterol levels. Her blood sugar, though, was still slightly elevated.

Over the next year, Sylvia gradually went back to her old ways. She began to put weight back on and her blood pressure and cholesterol levels rose slightly. Her doctor pushed for her to start taking medications, but still she declined.

Two years after her doctor told her she had mild diabetes, Sylvia awoke one morning with nausea and pain in her left shoulder. Thinking it was heartburn, she initially went about her business. When she did not feel better, she made an appointment with her doctor. But she never got to see him. She died of a heart attack before she could. She was found later that night on her bedroom floor, her hands still clutching her chest. I can only surmise that she was overwhelmed by pain and fear, as her heart – deprived of oxygen – stopped beating.

A 'touch' of the sugar

My mother and I often talked about Sylvia. I never stopped feeling that if she had taken the medications she needed to control her blood sugar, she might have avoided the heart attack that killed her. Sylvia's reaction to her diagnosis of diabetes was that of denial Not an uncommon response. Too many people do not heed the early warning signs of diabetes or believe they need to take medication. They believe they have only a "touch of the sugar," too small a touch to warrant pills or shots.

Once diabetes is diagnosed, it is imperative that a management plan be developed that will "normalize" blood sugar levels. And blood pressure and blood cholesterol need to be managed, too. If this is not accomplished, the years will lead to a poor quality-of-life and the potential for early death. Poorly controlled diabetes can lead to blindness, kidney failure that requires dialysis or transplantation, nerve damage that leads to amputation and an excess of stroke and heart attack. Well controlled diabetes can prevent these devastating complications from ruining someone's life.

Beyond the physical toll

Diabetes management is time consuming and expensive; lives are consumed with paraphernalia, sometimes resentment and anger and almost always, fear. Getting diabetes wreaks havoc not only on the patient but on members of the family. Spouses suffer enormously, worried that they'll wake up in the middle of the night to find their partner has stopped breathing.

Diabetes is a terrible disease. I know because I see its effects everyday in my practice. But as a physician, what is most heartbreaking to me is to know that with just a few precautions and lifestyle changes, most adults can avoid type 2 diabetes in the first place. Next week, I'll lay out the steps that will help lead to a better quality of life and minimize your risk of developing diabetes.

Diabetes Series:

Previously: How diabetes became a silent epicdmic, and why the cavemen knew better.

Next week: How to Avoid Diabetes.