Jim moved to Southwest Florida just a couple months ago. He was a young man in his early 30s, a professional who worked the second shift in front of a computer at an area publisher. He had no family here; it was a new job that brought him and he was still getting to know folks there, just beginning to make friends, so if anything seemed amiss with Jim, nobody would have been likely to notice it as out of the ordinary.

But a few days before Thanksgiving, he called in sick to his new job. The next day, feeling worse, he took himself to the hospital. Within two days, he was dead. Diabetes. Previously undiagnosed.

Diabetes kills people. Sometimes slowly, sometimes suddenly. Sometimes it's not the primary cause of death and people end up dying with their diabetes, but not necessarily from it. It's a disease that can be managed with careful monitoring and good medical care-once it's been identified. The trouble is that more and more people are becoming diabetic at earlier ages, and the younger people are, the less likely they are to consider themselves at risk of serious disease. But there are few diseases more serious, and increasingly, there are few more common.

Maybe you've heard this before. Maybe you're tired of hearing it. Perhaps all the comfortable advertising with kids and musicians and athletes talking easily about their blood testing devices has made this killer disease seem somehow familiar and less deadly. But it is deadly. And when a productive young man suddenly dies without ever knowing what was ailing him, it simply shows that the message is still not getting out enough.

So we say it again and again. And if one needless death can be prevented, it's still worth repeating.

Plenty to go around

Diabetes rates have skyrocketed, right along with the rate of obesity. In 2002, it was the sixth leading cause of death in the United States, based on death certificates, but it's estimated that those data probably do not reflect the actual numbers.

That ranking was based on the 73,249 death certificates on which diabetes was listed as the actual cause of death. Diabetes is likely to be underreported as a cause of death since many people with diabetes die of complications of the disease, and yet only about 35 to 40 percent of people who die with diabetes have diabetes listed anywhere on the death certificate, and only about 10 to15 percent had it listed as the cause of death.

According to death certificate reports for 2002, diabetes contributed to a total of 224,092 deaths that year.

Overall, the risk for death among people with diabetes is about twice that of people without diabetes of similar age.

There are nearly a quarter of a million new cases of diabetes diagnosed each year now among people aged 20 to 39. Among those aged 40 to 59, it's more 800,000. That's a lot of sick people.

But worse, it's estimated that there are nearly 6 million people walking around with undiagnosed diabetes. Most of them are like Jim, happy people with plenty to live for, unaware that it's all silently slipping out of their grasp.

The effects:

Diabetes causes myriad health problems. If you don't have it, you may not know what's in store, and how many ways diabetes can limit and constrict your life. Consider:

Blindness - Diabetes is the leading cause of new cases of blindness in adults 20 to 74 years old, and diabetic retinopathy causes up to 24,000 new cases of blindness each year.

Kidney disease - Diabetes is the leading cause of end-stage renal disease, accounting for about 45 percent of new cases. In 2002, some 44,000 people with diabetes developed end-stage renal disease and a total of 153,730 people with diabetes underwent dialysis or kidney transplantation.

Nervous system disease - About 60 to 70 percent of people with diabetes have mild to severe forms of nervous system damage, including impaired sensation or pain in the feet and hands, inability to properly digest food, carpal tunnel syndrome, and other nerve disorders. Diabetic nerve disease is a major contributing cause of lower extremity amputations.

Amputations - Nearly two-thirds o f nontraumatic lower-limb amputations occur among people with diabetes. In 2002, about 82,000 nontraumatic lower-limb amputations were performed on diabetics.

Dental disease - Gum disease leading to tooth loss occurs with greater frequency and severity among diabetics. In fact, it's about double the rate of non-diabetics. About 30 percent of people with diabetes have this complication, and just imagine the impact of tooth loss on a diabetic's already limited dietary options. The vicious circle of dental and diabetic issues is especially prevalent among the poor, who are less likely to have adequate medical or dental care, and are more likely to end up eating whatever they manage, whether or not it's healthy for their medical condition.

Complications of pregnancy - The rate of major birth defects in babies born to women with preexisting diabetes varies about 5 percent among women who receive preconception medical care for their diabetes, to 10 percent among women who do not receive such care. Poorly controlled diabetes before conception and during the first trimester of pregnancy causes miscarriages in 15 to 20 percent of pregnancies among diabetic mothers, nearly ten times the rate among women who do not have diabetes.

High blood pressure/stroke - An estimated 60 to 65 percent of people with diabetes have high blood pressure, and the risk of stroke is two to four times higher in diabetics.

Heart disease - Heart disease is the leading cause of diabetes-related deaths. Adults with diabetes have heart disease death rates that are, again, about two to four times as high as those of adults without diabetes.

Don't even go there

Yes, diabetes is more manageable today, but the death rates are going up just because so many more people are afflicted. The best way to deal with diabetes is to avoid it altogether. Type 2 diabetes is almost entirely preventable. Obesity is a precursor condition to diabetes that puts a person at vastly greater risk for developing the killer disease.

If you are overweight-even if you feel robust and healthy, even if you are young as Jim was-you simply must get tested for diabetes. You may have other precursor conditions that are already causing you trouble that you've never even recognized. You may be experiencing symptoms-warning signals-that you think are just the normal way you feel sometimes.

As medical care goes, testing for diabetes is not expensive. It's probably less costly than a lot of special holiday presents you're considering right now, for yourself or loved ones. Maybe there's a gift idea in there.

One way or the other, if your doctor hasn't tested you, or if you haven't seen a doctor lately, go. Ask. Find out. Because what you don't know can kill you. Really.