From behind a desk in a small, windowless office, smack in the middle of the third floor of Children's Hospital Los Angeles, Dr. Francine Kaufman devotes her life to fighting a killer of kids. She bobs a tea bag in a tall foam cup of hot water and takes notice of the tower of paper on her desk. With a slightly apologetic laugh, she says, “I'm a doctor deep down inside and I have a bunch of patients I need to take care of."
Kaufman is one of the world's foremost authorities on juvenile diabetes,a disease that has reached epidemic proportions. She is the head of the Center for Diabetes, Endocrinology & Metabolism, as well as the director of the Comprehensive Childhood Diabetes Center at Childrens Hospital Los Angeles. Currently, she heads a nationwide study to be completed in 2009, judginge the efficacy of two different drugs on young diabetics. Funded by the National Institutes of Health, the study is one the largest ever undertaken on young diabetics. Another component will focus on an intensive regime of diet and exercise designed to prevent children exhibiting pre-diabetic symptoms from contracting the disease, which threatens to overwhelm an already-crippled U.S. health care system.
The latest alarm was sounded earlier this year when a study of 1,700 eighth-grade students from Texas, North Carolina and California found that 40% of them were at high risk of becoming diabetic. Another study published at about the same time found that nearly half of all middle school students in America are either overweight or borderline overweight.
“The harrowing statistic is that one in three children born in the year 2000 will have diabetes in their lifetime," says Kaufman, as she sips her tea. “By 2020, 300 million people on the planet will have diabetes. It could devastate India and China." The disastrous surge in diabetes has turned Kaufman's busy office into ground zero in the battle against a disease for which there is no cure and where the bad news outweighs the good on nearly every front. For instance, since 1990, the number of diabetics in America has nearly doubled. Some 18.2 million Americans now have it.
While the overall number of diabetics is troubling, it's the explosion of diabetes among children that worries health care economists. “The diabetes problem is a time bomb," says Uwe Reinhardt, an economics professor at Princeton University who specializes in the economics of health care. “I personally believe it could be a lot worse than the aging issue. The per capita spending per diabetic is so high." Reinhardt and others point out that medical expenses for diabetics are 240 percent higher than those of non-diabetics. The U.S. now spends more than $13,000 for each diabetic. Total spending on diabetes exceeds $100 billion per year, that's equal to about one percent of America's gross domestic product.
Diabetes affects the body's ability to regulate the amount of sugar in the bloodstream. There are two varieties of diabetes, Type 1 and Type 2. With Type 1 diabetes, the pancreas stops producing insulin, a hormone that regulates the amount of sugar in the bloodstream. This disease usually hits young adults and children. Type 1 diabetics need several insulin injections per day, or an insulin pump, in order to survive.
Type 2 diabetes is more common and accounts for more than 90 percent of all diabetes cases. With Type 2 diabetes, the body produces insulin, but it either doesn't produce enough insulin or the body does not use the insulin it produces. Most Type 2 diabetics are overweight. Over the last decade, the number of diagnosed diabetes cases has jumped by 50 percent Ã¢â‚¬â€œ a result caused primarily by the upsurge in obesity. 
The warning signs couldn't be more frightening. And yet, thanks largely to poor diet and inadequate exercise, America is breeding an entire generation of children who face a life filled with the perils of diabetes: decreased life expectancy, increased risk of blindness, elevated risk for heart disease, stroke, and possible loss of limbs.
Those complications are an everyday realities for diabetics. Kaufman began learning those facts as a child, when her diabetic grandmother, a Russian immigrant, came to live with her family. Ã¢â‚¬Å“She was diagnosed when I was nine,Ã¢â‚¬Â Kaufman recalls. Ã¢â‚¬Å“I watched my father and her deal with it. She rebelled. She was older. She didn't want to face it. I watched how frustrated my parents were with her. Nobody came to where she was to help her understand. I wanted to do that. And I watched her die of diabetes.Ã¢â‚¬Â
Kaufman, 53, is a self-confessed workaholic who spends 12 or more hours a day at the hospital, which sits on Sunset Boulevard, in the heart of Hollywood. She manages a multi-million dollar budget and a staff of about 60 people who are involved in every aspect of dealing with diabetes. Some of her staffers are social workers, who go into the community to work with diabetics Ã¢â‚¬â€œ particularly ones who are at risk of getting complications. There are student doctors, faculty members, nurses, and researchers who are using stem cells to see how they might be deployed in the fight against diabetes. Kaufman is a staunch advocate of stem cell research Ã¢â‚¬â€œ an area of science that she says holds great promise in the fight against diabetes.
Kaufman manages a myriad of other diabetes-related tasks. She recently finished her first book, Diabesity: The Obesity-Diabetes Epidemic That Threatens America Ã¢â‚¬â€œ and What We Must do To Stop It . She also has helped invent a snack food called ExtendBar, which can help diabetics control their blood sugar levels. She has been a pioneer in the use of the insulin pump and has helped create a CD-ROM game that helps children understand diabetes.
Kaufman is also an advocate. In 2002, she became just the second woman to serve a term as president of the American Diabetes Association. She chaired a task force that led the Los Angeles Unified School District, the second largest district in America, to ban soft drink machines in its schools.
Kaufman also personally cares for hundreds of patients ranging from 18 months to more than 30 years of age. Ã¢â‚¬Å“I become a partner with the patient and their families,Ã¢â‚¬Â she explains. In that role, she constantly grapples with heartache. She has seen many patients die. Others have been maimed or crippled. The sorrow that comes with those cases Ã¢â‚¬â€œ combined with the great joy she gets from the victories Ã¢â‚¬â€œ fire Kaufman's desire to beat this disease. Ã¢â‚¬Å“Underlying the daily battle, it's a great foe that needs to be vanquished,Ã¢â‚¬Â she says. Ã¢â‚¬Å“I know there are no silver bullets. We haven't found the right answer. We need more technology, we need more breakthroughs.Ã¢â‚¬Â
Diabetes Ã¢â‚¬â€œ The Warning Signs
Diabetes can strike anyone. However, African Americans are 1.6 times more likely to develop diabetes than whites. Mexican Americans and Native Americans are twice as likely to get the disease when compared to whites.
The Diabetes Epidemic
-- Since 1990, the number of diabetics in America has more than doubled: more than 18 million Americans now have the deadly disease.
-- By 2020, some 300 million people on the planet will have diabetes.
-- The cost of treating diabetes is soaring. Between 1997 and 2002, the cost of treating America's diabetics Ã¢â‚¬â€œ in terms of medical expenditures and lost productivity Ã¢â‚¬â€œ went from $98 billion to $132 billion a 35 percent increase.
-- This year, 24,000 Americans go blind because of diabetes. Nearly 30,000 others will suffer from kidney failure. Another 80,000 diabetics will have to undergo amputation this year, due to the circulation problems caused by the disease.
-- More than 90 percent of all diabetics have Type 2 diabetes, a disease commonly associated with diabetes. It's this type of diabetes that is surging among our children. In the early 1970's, about five percent of children and adolescents were obese. Today, nearly 16 percent are obese.
The Childhood Diabetes Epidemic
-- A recent study found that up to 40 percent of 8 th were showing symptoms of diabetes. Another found that nearly half of all middle schoolers were overweight.
-- Turn off the TV (and the video games). Studies have found a correlation between the amount of time children spend in front of video screens and obesity: the more time they are sedentary, and watching TV, the more advertisements they see that tout junk food.
-- Exercise is critically important. Doctors recommend that children get a minimum of 30 minutes of moderate to vigorous activity every day. Swimming, cycling, running, walking, playing ball sports are all good options.
-- Limit soda pop, sweets and high-fat foods. Soda pop tastes good, but it has no nutritional value. The same is true of candy. Avoid foods that contain large amounts of sugar and animal fats. In particular, avoid most fast foods and convenience foods, which tend to have large amounts of fat and salt.
-- Replace junk foods with healthy ones. Pick foods that are unrefined and high in fiber, like fresh fruits, whole wheat bread, vegetables, legumes, and nuts.
Common symptoms for Diabetes:
Rapid weight loss
Irritability and mood changes
Nausea and vomiting
High amounts of sugar in the blood and/or urine
Tingling or numbness in the legs, feet or fingers
Frequent infections of the skin
Recurring skin, gum or urinary tract infections
Itching of skin and/or genitals
Slow healing of cuts and bruises