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Norm Hente of Granite City, Ill., is among a swelling number of Americans with diabetes. He was able to keep his A1c levels fairly low with lifestyle changes, such as increased exercise and lower-calorie meals, but ultimately decided to take daily insulin injections.

Norm Hente thought he needed to see an eye doctor when the road signs along the freeway started blurring, but a few months after buying a pair of glasses, he noticed a disturbing trend: The signs were fuzzy again.

This time, Hente's glasses were, in fact, causing the problem. His vision had corrected itself when he started cutting back on fast food and desserts, eating smaller portions and taking an insulin-producing pill once a day. Turns out the medical photographer, then 49, had been diagnosed with Type 2 diabetes, and his vision loss was one of the first noticeable symptoms of the disease.

Hente, who lives in Granite City, Ill., is among a swelling number of Americans with diabetes-a disease that's nearly doubled in prevalence in the past decade, according to the CDC. Of the 17 million Americans who have the disease, about one-third are unaware that they are diabetic. Health care professionals say the dramatic rise in cases is linked to the average American's habit of overeating and sedentary living.

Nurse diabetes educators are on the frontlines in the battle to teach patients how to control the disease. These educators know just how subtle the symptoms can be at first, but gone untreated, diabetes can be deadly.

Although awareness has increased nationwide in the past several years, nurses acknowledge that patients and health providers could be waging a much fiercer war against diabetes if they were armed with better knowledge of how to identify the symptoms and then control the disease.

For nurses who work as diabetes educators, the vast majority of their patients have Type 2. These patients are "insulin resistant," meaning their bodies fail to make enough insulin or do not properly use insulin. More than 90 percent of people with the disease have Type 2, and many can control it with lifestyle changes or oral medication. Type 1 patients aren't as lucky. Their pancreases usually fail to produce any insulin, and they often need daily injections to survive.

For nurses, one of the most trying challenges is knowing that a disease ranked as the fifth deadliest in the country is still difficult to detect in many people.

Misread signs

"The most frustrating part is knowing how many cases are unrecognized," said Sandy Pieschel, RN, CDE, coordinator of the diabetes self-management education program at Torrance Memorial Medical Center in Torrance, Calif.

Pieschel said people often dismiss early warning signs-such as frequent urination or tiredness-as symptoms of aging. Sometimes patients come in for emergency procedures, and when these patients register high blood glucose readings, physicians may attribute the readings to stress.

But diabetes detection has improved as more doctors have started using the hemoglobin A1c test, which monitors the average amount of glycogen attached to a patient's hemoglobin during the past 90 days. This test can pick up diabetes in patients who might show normal readings in a typical glucose test after fasting, Pieschel said.

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