diabetes among the population, according to a local expert on the disease.

Explained Herbert Hope-Gill, a specialist in Internal Medicine and a sub specialist in endocrinology, metabolism and diabetes: "There is considerable evidence that when a group of people of any race from any large population are localised in an area, there is a significantly increased incidence of diabetes. "This is probably because when people have a limited gene pool, the chance of marrying someone with similar types of genes that favour diabetes increases. Offspring are therefore more likely to get a double dose of diabetes, making this condition more likely. This situation probably explains much of the apparent high incidence of diabetes here in Bermuda.'' Most of those diagnosed locally with the disease have Type II Diabetes, usually associated with those who are overweight. As such, if weight gain can be thwarted, it is likely that the onset of diabetes can be delayed significantly or prevented altogether. "Type II is the most common, usually occurring in later life and associated with a steadily decreasing capacity to make insulin and a resistance to the peripheral effects of insulin on liver, muscle and fat tissue. The reason that it occurs later in life is that our requirements for insulin steadily increase with each year. The onset of the condition is speeded by increasing insulin demands by obesity and inadequate exercise.

"Type II Diabetes shows a strong hereditary predisposition. If one parent has diabetes, approximately 50 percent of their offspring will develop it. If both parents have diabetes, there is virtually a one hundred percent chance that their children will also have the disease. Two processes, the synthesis of insulin and the lowering of blood sugar, have numerous steps, and each contribute to the problem, Dr. Hope-Gill explained. "For example, in the case of exertion of the effects of insulin, the insulin must first bind to the cell membrane. By attachment to receptors there, various complex signals must be generated to cause glucose to enter the cell and to activate the numerous steps of its conversion to sugar stores, fat and protein. The disruption of any one of these many processes would cause an elevation of blood sugar. Mixed with the tendency for diabetes, is a genetic tendency for obesity which in itself can be transmitted genetically from many of our genes.'' Studies show that 70 percent of diabetics significantly overweight when diagnosed, Dr.

Hope-Gill said it is fairly common for one to have a sudden weight gain around the age of 40, followed by the onset of the disease. "It is well known that obesity causes a resistance to the effects of insulin,'' he said. "Over this time, the beta cells of the pancreas are continuously taxed by the inherent resistance to the effects of insulin that is present from an early age, plus the ongoing or ensuing (whichever the case may be) obesity. With the resulting continuously excessive production of insulin to overcome this resistance, the pancreas seems to eventually exhaust itself and the beta cells make less and less insulin. "At some point, with a certain combination of decreased insulin production and peripheral resistance to insulin's effects, a high blood sugar results. While the resistance to insulin increases and the ability to make insulin decrease, there is an increasing blood glucose level. This increased level is itself damaging to tissues, even the insulin-producing cells. This further damage worsens the already compromised insulin production and the diabetes worsens.'' The key to preventing this progression, Dr. Hope-Gill stressed, is to lessen the resistance to insulin, decreasing the demands on the beta cells so that they do not decrease their ability to make insulin inordinately. "While obesity bestows insulin resistance, weight loss decreases it markedly. Further good news is that it is not the speed of weight loss that determines the decrease in insulin demand, but the direction. Losing just one or two pounds a month accomplishes as much as losing ten pounds a month. The benefit of decreased demands on the insulin-producing cells and the consequent damage to the beta cells is prevented. "Exercise has an even further benefit concerning weight loss. Most Type II diabetics not only have an increased ability to make fat, but they have a reduced capacity to break it down. As soon as one tries to lose weight, the body tries to stop the process.

It does this by increasing the activity of the steps causing fat production and decreasing the activity of the steps that lead to fat breakdown. "The only practical way to avoid this deleterious response is to exercise. Since glucose and fat breakdown are needed to fuel exercising muscles, regular exercise makes the body maintain an increased ability to breakdown fat stores, thus facilitating weight loss. Because of these factors, weight loss can prevent or delay the onset of diabetes.'' PHOTO Above: Centre co-ordinator Debbie Jones takes James Johnston's pressure. Right: Lainie Andrew Koolkin and Morag Smith take blood samples from Ethne Thompson (back) and daughter, Shernette.

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