November is National Diabetes Awareness month and the American Heart Association is focusing particularly on the relationship between heart disease and type two diabetes. Stroke and heart disease are the number 1 causes of death and disability among those with type two diabetes.

Diabetes occurs when the pancreas, an organ near our stomach, stops producing sufficient amounts of the hormone insulin. Insulin is necessary to help break down the sugars in the food we eat so that it can be absorbed into cell structures to provide energy for our bodies. When the body does not produce sufficient amounts of insulin, or does not efficiently use the insulin it produces, sugar levels rise in the bloodstream the can cause life-threatening problems. Without treatment, diabetes can lead to serious medical conditions such as blindness, kidney disease, nerve disease, limb amputations and cardiovascular diseases.

There are two types of diabetes — type one and type two, and both can be inherited. About 21 million Americans live with diabetes, of which 90 to 95 percent currently have type two diabetes. Type one diabetes tends to show up in children and young adults and was historically called juvenile diabetes for this reason. People with type one diabetes are dependent on daily injections of insulin. Type two generally involves inefficient use of the insulin the pancreas produces, often called "insulin resistance." This type tends to occur in middle-aged adults. When diabetes develops in the presence of other risk factors for heart disease, such as obesity, high blood pressure, abnormal cholesterol and high triglycerides, the risk of heart disease and stroke increases even more.

According to the American Medical Association’s, Heart Disease and Stroke Statistics, approximately six million adults in the United States have type two diabetes and do not know it. While many signs and symptoms are subtle or mild and may not be noticeable, it is very important to know the warning signs to help prevent the onset of full-blown diabetes.

Symptoms of diabetes include:

• Increased hunger

• Increased thirst

• Fatigue

• Increased urination, especially at night

• Weight loss

• Blurred vision

• Sores that do not heal

Studies have shown that the onset of type two diabetes often can be prevented or delayed with lifestyle changes. These include losing weight, eating a healthy and balanced diet and increasing physical activity. These activities can effect other risk factors, such as high cholesterol and hypertension, conditions that also have a huge impact on diabetes.

It is critical for people who live with diabetes to work with a healthcare provider to set personal treatment goals and successfully manage their diabetes. Unfortunately, only 7.3 percent of people with diabetes achieve treatment goals for levels of blood sugar and blood pressure. More successful management of lifestyle issues and health behaviors should improve the risk factors and improve mortality from related diseases for those with diabetes.