She watches out for her brother, a former cabdriver, who is having symptoms of nerve damage in his feet. Before she insisted he get a physical exam a year and a half ago, when his diabetes finally was diagnosed, Felix hadn't seen a doctor in 28 years. Now, she makes sure he checks his blood and takes his medicine. "I taught him about diet," she says. "He was upset in the beginning. He said, 'Why can't I eat cake?' But I said it's not my fault."
Diabetes itself doesn't kill, doctors say. It's uncontrolled diabetes — the heart disease, kidney failure, nerve damage and increased susceptibility to infection — that causes illness, disability and death.
"Patients are terrified of diabetes and its consequences," Buse says. "Generally, the first step in treatment is to make patients believe that diabetes is a disease that can be effectively controlled. A well-informed patient is generally so highly motivated and the treatments generally so well tolerated that avoidance of complications is a reasonable expectation."
But rising obesity threatens to blunt progress on other fronts, Buse and other experts warn. They say it will take a major societal change of the kind that changed smoking habits to prevent a future of fatter, sicker people.
"I am optimistic, but I do think the problem is going to get worse before it gets better," says Ann Albright, director of the CDC's diabetes division. Prevention is key, but "it's going to take time to get policies in place, and for large numbers of people to be able to access new technologies and diabetes education."
Last month in Seattle, the Pacific Northwest Research Institute hosted a meeting of international scientists who formed an alliance aimed at thwarting what they called a "growing tsunami of diabetes."
The "amount of money it will cost in 10 years to manage diabetes is going to bust the economies" of many countries, says institute president Paul Robertson. "Governments need to jump in and understand, if they don't help, you can pay us now, or pay us later."