Despite the flurry of public service campaigns and education efforts, the diabetes epidemic in the US continues to escalate out of control.

Almost 21 million Americans - or 7 percent of the population - are now believed to have some form of diabetes. Of those, 6.2 million people have the disease but are not aware of it.

And that does not include the 41 million people with prediabetes, a condition in which blood-glucose levels are higher than normal but not high enough to be diagnosed as type 2 diabetes.

New Form of Diabetes Seen
The epidemic has become so pervasive that doctors are now finding patients who suffer from both type 1 and type 2 diabetes - a phenomenon known as "double diabetes" or "hybrid diabetes."

"We are seeing more cases of hybrid diabetes in our EatRight Risk Reduction Clinic," says Dr. Jamy D. Ard, Assistant Professor at UAB. " Typically, those who have type 1 diabetes have lower body fat percentages, despite being on insulin treatment. However, those that develop both types of diabetes tend to have more fat around their waist. Fat stored around the waist puts you at a higher risk of heart disease. This further increases the already high risk associated with type 1 diabetes."

"It's mostly people who have type 1 diabetes who become overweight and show the profile of a type 2, with obesity and hypertension," says Dr. Stewart Weiss, an assistant clinical professor of medicine at New York University School of Medicine in New York City.

With November designated as American Diabetes Month, doctors and health-care experts are urging people to take the steps necessary - basically proper nutrition and plenty of exercise - to avoid joining the ranks of those already diagnosed with the disease.

Type 1 diabetes is caused by the body's inability to produce insulin, the hormone that moves blood sugar - called glucose - into cells for energy. An estimated 5 percent to 10 percent of Americans with diabetes have type 1 disease.

Type 2 diabetes results from insulin resistance - the body's inability to properly use insulin. Most Americans diagnosed with diabetes have type 2 diabetes, and excess weight and lack of exercise are big contributors to this form of the disease.

But, doctors are now seeing strong indications that double diabetes is a growing phenomenon. For instance, recent studies suggest that as many as 30 percent of newly diagnosed diabetes cases among children involve youngsters with both type 1 and type 2 diabetes.

Generally, double-diabetes sufferers will often look as though they have the more common type 2 version because they are overweight. But subsequent blood tests reveal they also have type 1 disease.

Different Treatment Needed
Double diabetes takes the suffering caused by diabetes a step further and complicates efforts to treat it.

Type 1 diabetics normally have to take daily injections of insulin to remain healthy, while type 2 diabetics require different medication and regular monitoring of their blood sugar. Doctors now are researching how to juggle treating both types of diabetes in the same patient, Dr. Weiss says.

"We have all sorts of medications that address different problems for different types of diabetes," says Dr. Weiss. "The question with double diabetes becomes, when can we use the different types of medications and what would be appropriate for different patients?"

Dr. Weiss suspects that double diabetes might be caused, in part, by type 1 diabetics who are taking insulin but have not made the other lifestyle changes necessary to deal with the disease.

"One of the consequences of proper insulin use is weight gain," he says. "Often, patients who have not had a good understanding of how to eat are taking the insulin to cover what they normally eat."

Dr. Ard says, "Personalized dietary plans that focus on eating more food while losing weight has been their approach to treatment." He says, "We accomplish this by using foods that are low in calories but provide more bulk. The high fiber content helps to stabilize blood sugars and lower insulin requirements. The higher food volume prevents hunger and makes the weight loss easier to achieve. A structured physical activity program helps to improve the body's response to insulin, further decreasing the need for high levels of insulin."

The national trend toward unhealthy weight gain has spurred both the diabetes epidemic and this newer, more complex form of the disease, agrees Dr. Francine Kaufman, past president of the American Diabetes Association and head of the Division of Endocrinology and Metabolism at Children’s Hospital Los Angeles.

"It's mirroring the obesity epidemic," Dr. Kaufman says.

Delaying or Preventing Diabetes Complications
Diabetes can cause a number of complications that range from life-damaging to life-threatening. They include heart disease and stroke, high blood pressure, blindness, diseases of the nervous system, lower-limb amputations, dental disease, and complications during pregnancy.

The best way to avoid these complications is to avoid contracting diabetes. A recent study conclusively showed that people on the verge of contracting type 2 diabetes prevented its onset through changes to their diet and increased exercise, according to the American Diabetes Association.

The federal Diabetes Prevention Program study found that diet and exercise actually worked better than some medications in delaying the development of diabetes, according to the association. Just 30 minutes a day of moderate physical activity, coupled with a five percent to 10 percent reduction in body weight, produced a 58 percent reduction in diabetes.

"People need to maintain a healthy weight and a healthy lifestyle," Dr. Kaufman says.

Dr. Weiss recommends improving diet by eating more vegetables, fewer starches and more lean meat and fish. "I like to say there's no medication that can overcome a bad diet," he says.

He also says people should not only eat healthier, but they should try to eat less, too.

"The problem really is overeating in general," he says. "The portion size put before us is very large, so portion control is the single most important thing. You've got to know when to say when."