Ray Gilbert once spent his days behind the lens of a camera, using his keen eye to capture images and turn them into photographs. But a diagnosis of diabetes in 1985 would irrevocably alter life for Gilbert, a former photographer with the Afro American newspaper in Baltimore. In 1996, after more than a decade of not "doing all I was supposed to be doing," to control his diabetes, that lack of attention caught up with the West Baltimore resident. "I was driving one night along Route 301, when all of a sudden my eyes started bleeding," recalls Gilbert, 56. "I couldn't see. By the grace of God, I was able to pull over to the side of the road safely. It was frightening." Gilbert was treated at the Wilmer Eye Institute at Johns Hopkins Hospital. There, doctors told him that he had diabetic retinopathy, a diabetes-related eye disease, which damages the delicate blood vessels inside the eye, causing them to leak, bleed and become blocked. Despite performing surgery to repair his retinas, doctors could not completely save his sight. Today, Gilbert is legally blind. "I can't read or drive, although I can do many other things," he says. "I would tell anybody that you definitely must keep your diabetes under control. You've got to stay on top of it." Diabetes is a chronic condition in which the body doesn't properly produce or use insulin - the hormone needed to transport glucose (or sugar) from the blood into cells the body uses for energy. That defect in insulin production causes sugar to build up in the body. The disease has dramatically worsened for Americans, according to the Centers for Disease Control and Prevention in Atlanta. Earlier this year, the CDC released data which showed that about 24 million Americans - or about 8 percent of the population - have the disease, an increase of more than 3 million in just two years. Moreover, another 57 million people are estimated to have blood sugar abnormalities called pre-diabetes, which puts them at increased risk for developing the condition, experts say. "Diabetes is a staggering problem," says Dr. Mansur Shomali, program director of the Endocrinology, Diabetes, & Metabolism Training Program at Union Memorial Hospital. "While millions of Americans have diabetes, here in Maryland we also have significant numbers." According to 2006 statistics posted on the Maryland Department of Health & Mental Hygiene's Web site, more than 334,000, or nearly 8 percent, of adults statewide had diabetes. Another 143,000 more adults were estimated to have diabetes, but didn't yet know it. Nationwide, among adults, the CDC figures note that diabetes increased in both men and women, and in all age groups, but the disease disproportionately affects the elderly: Almost one-quarter of the population aged 60 or older had diabetes in 2007, acording to recently released figures. The rate of diagnosed diabetes is highest among Native Americans and Alaska natives (16.5 percent), followed by blacks (11.8 percent) and Latinos (10.4 percent). By comparison, the rate for Asian Americans was 7.5 percent, with whites at 6.6 percent. "Genetics and environmental factors play a role," says Shomali, citing some of the risk factors for the disease. "But so do things like physical inactivity, being overweight and diet." While experts stress that diabetes is a manageable condition, it nonetheless is the seventh-leading cause of death in the country. Baltimore ranks 11th among 54 major cities nationwide for diabetes mortality, according to the city Health Department. Sometimes benignly referred to as "sugar," diabetes can cause serious health problems, from heart disease to kidney failure, amputations and the blindness Gilbert experienced. A new study from the CDC projects that the number of adults 40 and older with diabetic retinopathy, the leading cause of blindness among working-age adults, will reach 16 million in 2050, up from 5.5 million in 2005. Diabetics are also more prone to developing cataracts and glaucoma, the study notes, and older Latinos and blacks are expected to be disproportionately affected. When the body's cells aren't getting the glucose that they need, certain signs and symptoms may result. They can include frequent urination, excessive thirst, weight loss, weakness and fatigue and tingling or numbness in the hands, legs or feet, called neuropathy. Blurred vision, dry, itchy skin and cuts or bruises that take a long time to heal are also signs that something could be wrong. "It's important to be tested, especially if your parents or siblings have diabetes," Shomali says. "That's a big red flag." Types of diabetes Diabetes is actually a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action or both. Type-1 diabetes (previously called insulin-dependent diabetes mellitus, or juvenile-onset diabetes) develops when the body's immune system destroys pancreatic beta cells, the only cells in the body that make insulin that regulates blood glucose. Type-2 diabetes (previously called noninsulin-dependent diabetes mellitus or adult-onset diabetes) accounts for 90 percent to 95 percent of all diagnosed cases in adults. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. Type-2 diabetes is associated with obesity, family history, physical inactivity, race/ethnicity and age, though the latter is changing. "Now we have children being diagnosed with type-2 diabetes due to obesity and lifestyle," says Shawn McIntosh, associate director of programs and advocacy for the Maryland affiliate of the American Diabetes Association. Gestational diabetes is a form of glucose intolerance that shows up during pregnancy. Other types of diabetes can result from specific genetic conditions, medications, infections, pancreatic disease and other illnesses. "You can't prevent type-1, and type-2 is preventable to a degree," McIntosh says. "The other types depend on varying factors." According to ADA guidelines, she says, people 45 years and older, those younger than 45 who are overweight and anyone with one additional risk factor, such as high blood pressure or a history of heart disease, are considered at risk and should be tested. Lifestyle changes Many people with type-2 diabetes can control their blood glucose by following a healthy meal plan and exercise program, losing excess weight and taking oral medication. Some people with type-2 diabetes may also need insulin to control their blood glucose. To survive, people with type-1 diabetes must have insulin delivered by injection or a pump. Healthy eating, being active and monitoring blood sugar are essential behaviors, says Mary Gianforte, a registered dietitian and certified diabetes educator at the Harbor Hospital Diabetes Center. During the party-heavy holiday season, following a diabetes-friendly diet can be especially tricky. "A lot of people will say they might cheat on their diets," Gianforte says. "I don't like to use that word because it implies guilt. People with diabetes have to make informed, healthy choices." That means for instance, portion control; monitoring carbohydrates, which affect glucose levels more than most proteins and fats; eating whole rather than processed foods; and cutting out soda or juice, she says, unless the drinks are sugar-free. "Moderation, not elimination," Gianforte says. "You don't have to be a purist to control your diabetes. You have to find your way." Gilbert, who stands about 6-foot-6 and weighs more than 400 pounds, can relate. While he did not have a family history of diabetes, for years the retired corrections officer-turned-photographer did not exercise and ate poorly, even after his initial diagnosis. "I ate a lot of fast food, drank a lot of sodas and my weakness was very sweet ice tea," he says. "Back then, even though I had a lot of fear and trepidation about the disease, I didn't change my behavior. I was in denial." Now, he takes insulin, walks more often and does water aerobics at a recreation center near the home he shares in Walbrook Junction, with his wife, Joyce. He watches what he eats, though he admits "dieting isn't easy for anyone." Thanks to the Maryland Business Enterprise Program for the Blind, which provides training and opportunities for people to operate concession, gift or food service businesses in public facilities and government buildings, Gilbert now manages the Crescent Cafe at the main Baltimore post office. "Blind," he says, "is just an acronym for 'Building Life In New Directions.' " RESOURCES American Diabetes Association Toll-free information hotline: 800-DIABETES diabetes.org Go Insulin goinsulin.com American Association of Diabetes Educators To find a local diabetes educator: 1-800-TEAMUP4 diabeteseducator.org American Association of Clinical Endocrinologists (AACE) 904-353-7878 aace.com The National Diabetes Education Program ndep.nih.gov/index.htm VEREEN'S STORY Tony Award-winning actor and Broadway star Ben Vereen was in Baltimore this fall raising awareness about diabetes. Vereen, 62, has partnered with sanofi-aventis, a pharmaceutical company, to launch Take the Stage for Diabetes Awareness, a new national campaign designed to educate people living with diabetes. Other celebrities such as Halle Berry, Patti Labelle, B.B. King and Nick Jonas of the Jonas Brothers have also spoken out about having the disease. Since being diagnosed with type-2 diabetes in 2007, Vereen has worked hard to manage his condition and is urging others to work with their health care providers to find the best overall treatment plan for them. "When I was first diagnosed, I was very scared and confused," said Vereen, sitting in a penthouse suite at the downtown Hyatt hotel. Nattily dressed in a dark suit and suspenders, his hair in neat twists and an earring dangling from one lobe, the actor looked the picture of health. But he said looks can be deceiving, especially with a disease like diabetes. "After I accepted the initial diagnosis, I committed to doing everything I could to manage my diabetes," says Vereen, who says he was often thirsty pre-diagnosis, and once collapsed during a performance. Today, he's on the right track. "My doctor talked to me about the importance of managing my blood sugar levels to help reduce the risk of diabetes-related complications. I worked closely with him to find the treatment plan that was right for me. Now I want to urge others living with diabetes to do the same. You can still have a great life."