Diabetes is on the rise. A study published in Archives of Internal Medicine showed that between 1995 and 2004, the incidence of diabetes in people 65 and older increased by 23 percent, and now 62 percent of people over 65 have the disease.

Diabetics are at high risk for heart attacks, strokes and heart failure. It is a major cause of kidney disease and blindness. Within six years of diagnosis, virtually every diabetic develops a major complication, and more than 50 percent have heart failure.

Other serious complications include: damage to the nervous system that causes peripheral neuropathy (manifesting with pain, numbness and tingling in the arms and the legs), erectile dysfunction and impairment of the autonomic nervous system (that controls bowel and bladder function, heart rate, blood pressure and temperature regulation).

Many diabetics develop urinary retention, diarrhea, constipation and an inability to maintain a normal blood pressure, with changes in posture and difficulties with gait and balance. Damage to small arteries leads to a high risk of foot ulcers, which on occasion cause gangrene and can require foot amputation.

The diabetic epidemic demands our immediate attention. The best approach to diabetes is prevention, which can be accomplished through diet and exercise. Modest weight loss combined with exercise and an appropriate diet can prevent the scourges of diabetes. Everyone over the age of 50, particularly those who are sedentary and overweight, should be screened for diabetes by measuring a fasting blood sugar. If it's elevated, a patient should seek counseling and, most importantly, a nutritionist who can instruct on how dietary modifications can normalize the blood sugar.

If your blood sugar is very high and tests indicate that your average blood sugar is continuously elevated, medication (in addition to diet and exercise) could be needed. A special test called the hemoglobin A1C is used to evaluate the average blood sugar over the previous two to three weeks. The higher your average blood sugar, the higher the hemoglobin A1C. A normal value is six, with many diabetics having values greater than nine.

Provided kidney function is normal, the initial medication to treat diabetes is metformin, a generic drug that does not cause weight gain and effectively lowers blood sugar levels.

Patients are taught to measure their blood sugars frequently, and this with the hemoglobin A1C is used to monitor progress. The aim is to have the blood sugar in the normal range for most of the day, and the hemoglobin A1C at about seven.

Until recently, conventional wisdom suggested that the more compulsively the diabetes is controlled, and the closer the blood sugar and hemoglobin A1C are to normal, the better. To examine this possibility, a study conducted by the National Institutes of Health aggressively treated diabetics to assure a continuously normal blood sugar and a hemoglobin A1C of six. It was hoped that by maintaining the blood sugar in the normal range, all of the adverse effects of diabetes would be prevented.

Remarkably, the aggressively treated patients had a higher risk of heart disease, and so many more patients died that the study was halted. Why this occurred is not clear, but most now believe that managing diabetes involves much more than just lowering the blood sugar to the normal range.

This possibility was confirmed by the results of a seminal study published recently in the New England Journal of Medicine. This research showed that the lives of diabetic patients could be significantly prolonged if their diabetes was adequately but not compulsively treated, maintaining a hemoglobin A1C level at about seven (a value that is still moderately elevated), provided they simultaneously treated high blood pressure, lowered cholesterol and prevented clotting with aspirin treatment.

The message is clear: An ounce of prevention is worth a pound of cure. Exercise, eat right, avoid obesity, and diabetes can be prevented. Sadly, many of us will have to deal with this illness in the future. Paying attention to all aspects of health — including diet, exercise, treating high blood pressure, preventing heart disease and lowering cholesterol, in combination with approaches to adjusting blood sugar toward the normal range — is required to assure that diabetics have a longer, better and more productive life.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.

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