He sits on the couch drinking a six pack of his favorite beer, eating fried cheese and brats (cooked in beer, of course) and watches the game. No doubt the poor performance of the defense is raising his blood pressure. He goes outside for a cigarette during halftime, cursing out the coach under his breath. During the third quarter he nervously munches on salty chips. His team rallies in the fourth quarter. Touchdown! He jumps up off the couch, short of breath. Now he’s happy! Unfortunately for him, though, his lifestyle is also putting him at very high risk for Type II diabetes.
There are some wonderful advantages to living in a largely affluent world. Technology and abundance of resources make life easy and enjoyable for a large population This growing prosperity also affects global health, and sometimes not for the better. Increased access to food, tobacco and services worldwide mean that people are eating more foods high in saturated fat and moving less. The result is that far more people are developing chronic diseases, including diabetes. 
Diabetes mellitus is a group of diseases of the metabolic system. When either the pancreas (which is the organ responsible for secreting insulin and digestive enzymes) fails to produce enough insulin, or cells fail to respond to the insulin that is produced, a person experiences high amounts of sugar (glucose) in the blood stream. Insulin is responsible for removing excess glucose from the blood, which becomes toxic at high levels. This surplus of glucose in the bloodstream can lead to serious long-term complications if left untreated. High levels of blood sugar is a condition called hyperglycemia. There are tell-tale signs that a person is hyperglycemic: frequent urination, increased thirst and hunger.
There are three types of diabetes: Type I, Type II and gestational. Type I is the result of the body’s inability to produce insulin. Type I sufferers typically need insulin injections or must wear an insulin pump for life. Type II diabetes is the result of insulin resistance, meaning that the body has trouble managing insulin. This type of diabetes usually appears around the age of 40 in people who are overweight and have a family history of diabetes. However, increasing numbers of children are developing the disease due to an epidemic of obesity.  Gestational diabetes refers to women who are pregnant and have elevated glucose levels, and then become at risk for Type II diabetes. 
18.2 million children and adults in the United States are estimated to have Type II diabetes, and many more have it unknowingly. An estimated 800,000 have Type I diabetes, which occurs far less frequently than Type II. By the year 2050, the number of people with diabetes is projected to increase by 165%.  Diabetes is one of the leading causes of death in the United States and very costly to treat. Type I diabetes is brought about by genetics and an unclear set of circumstances making prevention extremely difficult, whereas Type II diabetes is caused by a combination of genetics and lifestyle choices. Because Type II diabetes can be prevented or be controlled with medication and diet, it is important to focus on reducing the risk factors associated with developing the disease. 
Weight is a major contributing factor to being at risk for Type II diabetes, and a person does not need to be obese but only slightly above normal weight to feel the effects. Maintaining a healthy weight is crucial to treating diabetes, as excess weight interferes with insulin management. Unfortunately it is very hard to change the lifestyle of overweight children, especially in homes where to motivation to change is lacking.  Smoking raises your risk of of developing Type II diabetes, as it also interferes with insulin regulation. Alcohol also increases the chances of being diabetic, so if you are at risk you may want to reduce alcohol consumption. (Sorry. Don’t blame the messenger.) 
Obviously, the most effective treatment for Type II diabetes is to lower your blood sugar, which can be done through diet and exercise, or a combination of diet, exercise and medication, depending on the severity of the disease. Obviously, a sedentary lifestyle contributes to weight gain so staying active and physically healthy is important in managing glucose, blood pressure and cholesterol. A healthy diet for diabetics need not be the depressing, sugar-denying diet of the past. Increasingly, the focus of a diabetic diet is on portion control and carbohydrate reduction. That doesn’t mean you can run out and eat all the sugar, though. A healthy diet for persons with diabetes may include small amounts of sugar as long as the diet is proportioned correctly and you are exercising regularly. Ideally, an individual should not consume more than 25% of their calories from fat. In addition, a person at risk for diabetes should reduce the amount of sodium consumed and - of course - increase the amounts of fruits and vegetables in their diet. Vitamin D may play a role in reducing the risk for diabetes, but this ought to be discussed with your doctor as it is not yet clear what amount is ideal. 
There are a lot of medications out there for diabetes. It can be confusing to know which one(s) to take as many of them work in combination. These drugs work in different ways: some work by stimulating the pancreas to produce more insulin or by inhibiting the liver from secreting glucose, while others do not allow enzymes in the stomach to break down carbohydrates. Your doctor should work out a treatment plan with you, as each individual will react differently to medication.  After menopause, women are at higher risk for diabetes due to changes in levels of progesterone and estrogen, as they help regulate insulin. Hormone replacement therapy is usually prescribed to ward off the disease in postmenopausal women. 
November is Diabetes Awareness Month. Now would be a good time to start making those difficult lifestyle changes necessary to prevent the disease if you are at risk. If you start making those changes now, you will reduce your risks of developing Type II diabetes, and may even turn back the disease altogether if you have already been diagnosed.
[“Diet, Nutrition and the Prevention of Chronic Diseases”, Joint WHO/FAO Expert Consultation. 2002 http://www.who.int/dietphysicalactivity/publications/trs916/en/gsfao_introduction.pdf]
 [“Type 2 Diabetes” http://health.usnews.com/health-conditions/diabetes/type-2-diabetes]
[“Diabetes mellitus” http://en.wikipedia.org/wiki/Diabetes_mellitus]
 [“Preventing Type 2 Diabetes”, Mellitus Jeff Curtis, MD, MPH and Charlton Wilson, MD http://jabfm.org/content/18/1/37.full]
[“Reduction in the Incidence of Type II Diabetes with Lifestyle Intervention or Metformin”. 2002 http://www.gghjournal.com/pdf/volume_18/18-3/reduction.pdf]
 “Lower Your Risk” http://www.diabetes.org/diabetes-basics/prevention/checkup-america/]
 [“Am I at Risk for Type 2 Diabetes? Taking Steps to Lower Your Risk of Getting Diabetes” http://diabetes.niddk.nih.gov/dm/pubs/riskfortype2/#11]
 [“Diabetes treatment: Medications for type 2 diabetes” http://www.mayoclinic.com/health/diabetes-treatment/DA00089]