Diabetes is no picnic. Scientist believes that type 1 diabetes is triggered by genes, viruses or an auto-immune disorder, rather than by diet, inactivity or obesity. Roughly 90 to 95 percent of people with diabetes have type 2, which means that their insulin doesn’t do its job well. It’s as though the key (insulin) has trouble opening the door (insulin receptors on cell surfaces). That “insulin resistance” leaves excess sugar in the bloodstream, which damages small blood vessels in the eyes, kidneys and other organs. Getting blood sugar levels reasonably well controlled can dramatically lower the risk of eye and kidney disease, which lead to blindness and dialysis. What’s more, diabetes makes larger blood vessels more susceptible to heart attacks and strokes.

It’s not just the 24 million Americans who have diabetes that trouble doctors. Most of the 57 million who have pre-diabetes — their fasting blood sugar levels are between 100 and 125 — don’t even know they have a problem. These people have blood sugar levels that are not normal and not diabetic. It is now increasingly clear that we can see the beginnings of complications that ultimately lead to kidney failure, blindness and amputations in people; plus excess risk for cardiovascular disease.

What’s your risk?

Most people who have pre-diabetes — and many others who have diabetes — don’t know it. The only way to find out is to get your blood sugar tested (at least every three years starting at age 45). Your risk is higher if you:

• are age 45 or older

• are African American, Hispanic/Latino American, Asian American, Pacific Islander or American Indian

• have a parent, brother or sister with diabetes

• have high blood pressure (above 140 over 90)

• have low HDL (good) cholesterol (less than 40 for men; less than 50 for women)

• have high triglycerides (250 or more)

• had diabetes when pregnant or gave birth to a large baby (over 9 pounds)

• are active fewer than three times a week

Clearly, the answer for everyone — those who have or want to avoid both diabetes and pre-diabetes — is to keep blood sugar levels in or near the normal range. The question is: how?

Weight and Exercise: One cannot miss the link between weight and diabetes. More than 80 percent of people with diabetes are overweight or obese. If you want to avoid diabetes, keep your weight — especially your waist — under control, and spend more time on your feet than on your seat. Since weight is the strongest risk factor by far for diabetes:Get started now with an exercise program and eat healthier! As always, talk with your doctor before making changes in your lifestyle.