More common than most of us realise, and also more deadly, diabetes can be a debilitating and costly disease. It also has no cure. Characterised by high blood sugar levels, diabetes mellitus is believed to be caused by insulin deficiency; a condition which renders the body incapable of properly utilising carbohydrate, fat and protein energies. It can cause blindness, kidney failure, heart attacks, strokes, gangrene in the legs necessitating amputation, or any number of alternate complications. "In a healthy body, a substance made in the pancreas called insulin helps sugar to enter the body's cells for immediate energy use or to be stored for future needs,'' explained Deborah Jones, co-ordinator of the Diabetes Centre at King Edward VII Memorial Hospital (KEMH). "With diabetes, there is either no insulin produced or the insulin does not work effectively to allow sugar to enter into the cells. This results in extremely high levels of sugar in the blood that can cause serious immediate and long term effects. "(It) is a common health problem in Bermuda.

But even though many Bermudians are affected, there is no information on how many Bermudians have diabetes. (However) many other national surveys have shown that for every person known to have diabetes, there is another who has it and does not know it.'' Research has identified four major types of diabetes -- Insulin Dependent Diabetes (Type 1), Non-insulin Dependent Diabetes (Type II), Gestational Diabetes and diabetes due to other causes -- with the most common being Type II. In Type II Diabetes, some insulin may be produced, but it is not enough or is not used effectively by the body. It can be controlled with a special diet, routine exercise and orally-taken medication. And although the cause of all four types of diabetes is unknown, there are several factors which make some people more susceptible to developing the disease. These include those persons who are: Overweight Over the age of 40 Black Have a family history of diabetes Have delivered babies of over nine pounds at birth Under constant stress Inactive. Perhaps watching television for three or more hours a day with no regular physical activity.

"Many people have diabetes before they are finally diagnosed,'' said Mrs.

Jones. "Often this happens because they choose to ignore (or don't realise) many of the warning signs of diabetes. Failure to recognise and treat diabetes early and effectively can result in several complications including blindness, kidney failure, heart problems, problems with blood circulation or loss of feeling -- especially in the lower legs and feet -- resulting in amputations.

"In the United States, the ratio of unknown to known people with diabetes in the black population is 1:5. If the above applies in Bermuda, which presumes 5 percent of her population to have known diabetes, then the true magnitude of the diabetes problem in Bermuda is almost 14 percent. In other words, one in seven Bermudians may have diabetes!'' Type I Diabetes, the second most common form of the disease, explained Mrs.

Jones, occurs when the pancreas produces little or no insulin. It requires the person to have daily injections of insulin which they learn to administer themselves. Warning signs include: C onstant urination A bnormal thirst U nusual hunger T he rapid loss of weight I rritability O bvious weakness and fatigue N ausea and vomiting Type II Diabetes symptoms include: D rowsiness I tching A family history of diabetes B lurred vision E xcessive weight T ingling, numbness in feet E asy fatigue S kin infections or wounds that heal slowly.

"Five years ago, in Beacon House, there were 28 blind Bermudians,'' said Mrs.

Jones. "Twenty five of these 28 have diabetes mellitus. In Bermuda, 42 percent of the patients requiring dialysis have diabetes. In Bermuda, about 35 percent of people treated for heart disease at KEMH have diabetes. Finally, between 1988 and 1993, 52 patients had lower extremity amputations in Bermuda.

Twenty four of these 52 patients (or 46 percent) have diabetes.

"Diabetes, especially when poorly controlled, can be a major economic burden to the individual and society. Depending on the country, available estimates indicate that diabetes may account for 5 to 14 percent of the health care expenditures (and) the cost is growing each year. (But), if people are diagnosed early and taught to manage their diet, exercise and undertake other lifestyle changes and take medication that lowers blood sugar when necessary, many of these serious complications can be prevented.'' Diabetes Centre co-ordinator, Debbie Jones HEALTH HTH