At 20, Erika Rodriguez struggles to do the adult thing and manage the Type 2 diabetes that's remained stubbornly uncontrolled since she was diagnosed in junior high.
She frequently forgets to test her blood sugar and take her medications. Down from 260 pounds to 213 pounds on a 5-foot-3 frame, she's no longer morbidly obese, but a BMI of 38 puts her solidly among obese Americans.
Although she doesn't feel sick, she takes medication to protect her from the silent indications of early kidney disease and remains at risk of the heart attacks, strokes, blindness and eventual amputations that make diabetes one of the most brutal maladies.
Her struggle has become the new face of the nation's intertwined epidemics of obesity and Type 2 diabetes, as ever-widening waistlines in tender years have shifted to children and young adults the burdens of a chronic illness once called "adult onset" diabetes because it struck at 40 or later.
Unlike Type 1 diabetics, whose bodies stop making the insulin needed to break down sugar to fuel the muscles and brain, Type 2 diabetics cannot properly process the insulin they do make.
Because the disorder can go undetected for years, it's difficult to quantify the numbers of young Type 2 diabetics, although worried clinicians and federal health agencies increasingly encounter Type 2 diabetes among those who spend their days in junior high, high school and college corridors.
They're scrambling to keep them out of hospital corridors.
At a time when Rodriguez should be choosing fall courses at Bunker Hill Community College in Charlestown, Mass., 11 train stops from the house she shares in Dorchester with her non-diabetic parents and two younger brothers, she's recuperating from recent surgery for painful underarm abscesses, a diabetic complication she cannot ignore.
Like many younger patients with diabetes, she's had a tough time making lifestyle changes for a diagnosis that blindsided her.
"When they first told me about it, I was in shock," she told ABC News Friday. "I didn't know what I was going to do. I thought, 'oh, my God.' I thought I was going to die."
She was hospitalized soon afterward at Children's Hospital in Boston to lower dangerously elevated blood sugar levels.
More recently, she joined a clinical trial at Harvard's Joslin Diabetes Center in Boston, where doctors, nurses and nutritionists regularly implore her to exercise, test her blood sugar and take metformin pills and insulin injections.
Nevertheless, she admits she's largely noncompliant.
"I'm worried. I try to do one thing at a time to be able to change the way my health is now," she said. Perhaps this fall, "in between classes or after classes I could go to the gym and work out."
That youthful denial of potential death and disability down the road troubles diabetes specialists, who say that halting Type 2 diabetes' menacing march into youth requires the discipline and focus to make lasting changes.
Stubborn resistance to change, even among those participating in innovative programs for the disorder, is among topics under discussion at the American Diabetes Association's 71st Scientific Sessions in San Diego, where more than 13,500 people, including Rodriguez' doctor, Lori Laffel, a pediatric endocrinologist at Joslin, are gathered through Tuesday.