Diabetes mellitus is the third leading cause of death among African-Americans. Black men accounted for over 3,500 deaths from diabetes in 1994, while black women accounted for over 6,000 deaths. These numbers are increasing with every passing year. Diabetes can also greatly contribute to other causes of death such as heart disease and stroke. The age-adjusted death rate for Black men was 27.1 per 100,000 population, more than 45 percent higher than the 12.7 percent age-adjusted death rate for white men. Overall, diabetes-related deaths increased by 10 percent for African-Americans between 1988 and 1999, compared to 6 percent for all other groups. Overall, African-Americans are nearly twice as likely to suffer from diabetes as are European Americans.

Diabetes occurs when the body has difficulty making or using insulin, a hormone that allows cells to absorb sugar from food. Normally, the pancreas produces the needed amount of insulin, helping sugar pass into the bloodstream to the cells. As the sugar is transmitted, the amount of insulin in the blood decreases. However, if the pancreas fails to produce enough insulin, or if the insulin does not process sugar correctly, the body's cells will become malnourished, and sugar will build up in the bloodstream.

There are many kinds of diabetes. Type 1 is called juvenile onset or insulin-dependent diabetes mellitus (IDDM). Ten percent of Americans are afflicted with Type 1 diabetes; the rate is slightly lower among African-Americans. This form of diabetes occurs suddenly in childhood or adolescence and sometimes appears in adults under age 40. With Type 1 diabetes, the body stops producing insulin and uses fat and protein for energy. This process can result in rapid weight loss and damage to the heart, nerves, eyes, and blood vessels. Type 1 diabetes can lead to coma or death if it is not properly treated. Patients with Type 1 must inject themselves with insulin daily to balance their sugar levels, and they must follow a regimen of regular exercise and a diet of regular meals that balance carbohydrates, fats and proteins.

Type 2 diabetes is called adult-onset or non-insulin-dependent diabetes (NIDDM) and accounts for more than 90 percent of all diabetes cases among African-Americans.

Type 2 diabetics produce normal levels of insulin, but their bodies cannot use it. This form of diabetes develops more slowly and unfortunately, is often diagnosed only after it has caused severe damage to the heart, eyes, kidney, or nerves. This type of diabetes is commonly treated through exercise, weight loss, and oral medication.

Before people develop type 2 diabetes, they almost always have what the American Diabetes Association refers to as, "pre-diabetes", a condition where blood glucose levels are higher than normal but not yet high enough to be diagnosed as diabetes. Over 40 million people in the United States, ages 40 to 74, have pre-diabetes. Research has shown that pre-diabetes may begin causing long-term damage to the body, especially the heart and circulatory system, long before a person is diagnosed with full diabetes. Those who have pre-diabetes may be able to delay or prevent diabetes if they start managing blood glucose levels.

A third form of diabetes, called gestational diabetes, occurs in 3 percent of pregnant women and disappears after delivery. At increased risk for gestational diabetes are women who are more than 20 pounds overweight prior to conception, are over age 30, have a family history of diabetes, or have had a baby who was especially large (over 9.5 pounds) or stillborn. Most pregnant women with gestational diabetes have no symptoms, though some may experience extreme thirst, hunger, or fatigue. Black diabetic women are three times more likely to lose their babies due to gestational diabetes than are white diabetic women because they are less likely to receive proper prenatal care.

Risk Factors

Medical researchers have found that Type 2 diabetes often occurs in succeeding generations of families. In addition to family history, these additional factors define those at higher-than-average risk for the disease among Black men:

• Age 40 and older
• Weight 20 pounds or more over what is considered, medically ideal
• Insufficient exercise
• Stress
• Not eating enough low-fat meals high in fruits, vegetables and whole grain foods

Prevention

Diabetes can be controlled through such factors as food intake, exercise, body weight, blood-sugar monitoring, and medication. All of these methods affect the blood-sugar level. Preventive care necessitates a healthy low-fat, low-cholesterol, and high-fiber diet; regular exercise such as jogging, walking, or yoga; and frequent medical checkups. Additional information can be obtained from the American Diabetes Association. www.diabetes.org

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