“I’ve had diabetes for years, and I’ve learned to live with it,” says the 63-year-old widow, a retired critical care technician. “Do I have it under control? Yes. But I know I have to be very careful or it can get away from me real quick.”

Diabetes is one of the most serious chronic diseases in the United States. “It’s an epidemic,” says Robert Rizza, M.D., professor of medicine at the Mayo Medical School in Rochester, Minnesota, and president-elect of the American Diabetes Association (ADA).

More than 18 million people in the United States have the disease. It kills almost 70,000 people a year, making it the sixth leading cause of death listed on death certificates. That number is probably higher, because so many deaths are attributed to other illnesses that are nonetheless diabetes-related.

Diabetes takes a particularly heavy toll on Hispanics. About 25 percent of both Mexican Americans and Puerto Ricans and 16 percent of Cuban Americans between ages 45 and 74 have the disease. Overall, Hispanics are 1.5 times more likely to have diabetes than white non-Hispanics of similar age, according to the ADA.

Diabetes mellitus is a disorder of the body’s ability to metabolize, or digest, food. When we eat, the body breaks down certain nutrients, particularly carbohydrates from starches and sugars, into glucose. The body’s cells burn glucose for fuel. In a healthy person, the pancreas produces the hormone insulin, which carries glucose from the bloodstream into the cells. For a diabetic, the process goes awry.

There are two types of diabetes mellitus. In Type 1 diabetes, the pancreas produces little or no insulin and glucose cannot get into the cells. Often called juvenile diabetes because it is the type found most often in childhood, Type 1 can strike at any age. In Type 2, the body does not produce enough insulin or prevents insulin from transporting glucose into the cells. This is called insulin resistance. The pancreas also may not produce enough insulin. Most diabetics have Type 2, which is sometimes called adult-onset diabetes.

Either type means too little glucose gets into the cells, starving them of energy, and too much glucose remains in the blood, a condition called hyperglycemia. In the long run, hyperglycemia can lead to blindness, heart disease, kidney and nerve damage, amputation, and death.

‘The message is realistic that you can gain control over your diabetes if you eat well and exercise’

An estimated 5.2 million people have diabetes but don’t know it. Many symptoms can seem harmless. They can include frequent urination, excessive thirst or hunger, unusual weight loss, irritability, fatigue, and blurry vision. Early detection is vital for controlling diabetes, so it is important to see the doctor if you have any of these symptoms.

Researchers are working hard to find a cure by studying experimental drugs that may stop fat cells from triggering insulin resistance and others that may help control appetite, reducing the risk of obesity. Still others may trigger the pancreas to make more of the cells that secrete insulin, though it is not known if this will actually increase insulin production.

But these drugs may not be approved for years, if ever. The best medicine is still to avoid developing diabetes in the first place. While the cause of diabetes is unknown, scientists know the risk factors. Some cannot be controlled. Diabetes runs in families, so if a parent or sibling is diabetic, you may develop it, too. Age also increases the risk.

Two major risk factors that can be controlled are obesity and a sedentary lifestyle. The multi-site Diabetes Prevention Program study, based at the University of Texas Health Science Center in San Antonio, found that eating healthy meals, losing as little as 5 to 10 pounds, and exercising for 30 minutes at a time, five days a week, will help control blood sugar in diabetics and help prevent the disease in others.

“The message is realistic that you can gain control over your diabetes if you eat well and exercise,” says Evangelina Villagomez, director of clinic operations and patient education at the Texas Diabetes Institute (TDI) in San Antonio. “You may still need medications, but it’s an optimistic message.”

That’s how Menchaca got her diabetes under control. Two years ago she weighed about 228 pounds and had had enough. “I had a hornet up my nose and I was determined to lose weight and do something about this diabetes,” says the San Antonio resident.

Working with a diabetes educator from TDI, Menchaca made what she says were only minor changes in her diet. “I didn’t want to change the way I eat completely, so she taught me about portion control—learning to eat a little bit less than you normally would.”

As Menchaca has learned, living with diabetes is a full-time job. But it can be done. A certified diabetes educator can help. She has lost 33 pounds, cut her insulin needs by two-thirds, and regained control of her blood sugar. She can even occasionally splurge. “Last night I went to the Golden Corral [a steak restaurant] and had a baked potato. But my blood sugar was still below normal this morning.”

Joining a health club is next. She already gets plenty of exercise working in her garden and volunteering at a local hospital. “When I retired, I said I didn’t want to become a couch potato, and I haven’t.”