Diabetes is on the upswing in the United States. Between 1980 and 1994, the incidence of new cases increased by 39 percent. In 1998, about 798,000 people were diagnosed with the disease, bringing the total number of Americans who have the disease to 16 million. Yet at least one-third of those with diabetes don’t know they have it. Diabetes increases the risk of blindness and limb amputation, as well as kidney and heart disease and stroke.

To avoid the risk of dying early as a result of diabetes, maintain a healthy weight, exercise, and take these additional steps to prevent diabetes or control the risk of complications.

· Get a blood glucose test.

The American Diabetes Association (ADA) calls for routine screening of all Americans starting at age 45 to detect type 2 diabetes. See chart on page 13 for complete screening recommendations.

· Consider estrogen replacement therapy.

New studies have shown that postmenopausal women who take estrogen are less likely to develop diabetes, and if they do, their risk of complications is decreased. A survey of 14,000 postmenopausal women with diabetes showed that those who took the hormone had better blood sugar control, the Kaiser Permanente HMO reported. And a Milwaukee study showed that postmenopausal woman who don’t take estrogen are five times more likely to get diabetes than those who do.

If you already have diabetes, you can take the following steps to reduce your risk of life-threatening complications.

· Lower glucose levels.

The United Kingdom Prospective Diabetes Study, the longest and largest study of people with type 2 diabetes, showed that intensive control of blood glucose in type 2 diabetes reduces by 25 percent the chances of developing eye damage potentially leading to blindness and kidney damage leading to kidney failure.

· Control blood pressure.

The U.K. Prospective Diabetes Study also found that aggressive control of high blood pressure in people with type 2 diabetes significantly reduces the risk of heart failure (by 56 percent), stroke (by 44 percent), and death from diabetes (by 32 percent).

· Find coronary artery disease early.

Atherosclerotic damage to the coronary arteries is two to four times more common in people with type 1 diabetes than in the general population. People with diabetes should have their cholesterol levels checked every three to six months. The ADA recommends that people with diabetes keep their cholesterol levels under 200 mg/dL.

· Get immunized.

People with diabetes are more likely to die of complications of influenza such as pneumonia. Deaths among people with diabetes increase 5 to 15 percent during flu epidemics.