IAM continually grateful to be a physician in the 21st century. There is an ever-quickening pace of medical discovery that often leads to improved care and better lives for the patients I treat. There may be no better example than the evolution of diabetes care.

The term "diabetes" comes from ancient Greece, essentially meaning "to pass through," which describes the fact that elevated blood sugars cause the individual to urinate excessively.

The term "mellitus"--as in diabetes mellitus--was added in the 17th century, and in Latin means "honey." This came from an observation by people in many ancient cultures that the urine of diabetic patients contained high amounts of sugar. (Thankfully, modern medical science does not require the tasting of patients' urine.)

There are two basic types of diabetes mellitus, or excess sugar in the bloodstream. One afflicts people suddenly, and the other generally results from years of poor health habits.

HOW IT DEVELOPS

Juvenile diabetes, also known as Type I diabetes, is caused by an auto-immune destruction of the beta cells of the pancreas, which produce insulin.

We all require insulin to utilize blood sugar for energy in our muscles, brains and organs. The destruction of insulin-producing cells that occurs in Type 1 patients is thought to be triggered by a yet-to-be-identified viral illness, and it leads to a total loss of insulin throughout the body. This most commonly happens in children and leads to a lifelong requirement for insulin replacement therapy.

Type I diabetes accounts for only about 10 percent of all cases--a difficult but small proportion of cases of diabetes overall.

Type II diabetes, or adult-onset diabetes, is a much larger problem that typically results from being larger.

Whereas Type I diabetes is thought to occur very abruptly, as immune cells destroy the insulin-producing cells of the pancreas, Type II is a much slower devolution of proper blood sugar control. It has a lot to do with diet.

We have learned over the years that our fat cells--and, it seems, most importantly the fat concentrated in our spare tires, or midsections--behave as their own endocrine organ. The fat cells release hormones that lead to insulin resistance, which then begins the process of rising blood sugar.

DEVASTATING BREAKDOWN