When patients ask me to describe diabetes, I relate it to the plantation days on Kauai. During harvesting season, plantations used big trucks to haul sugar cane to the mills. The road was so narrow and the trucks were so large and slow that they would back up traffic. Cars couldn't get around the trucks, and even emergency vehicles like fire trucks and ambulances had to wait for the trucks to pass before they could get down the road.

While this might be an overly simple example, it's similar to what too much sugar does in people with diabetes. Diabetes causes sugar levels to increase, which affects the heart, blood vessels, nerves, eyes, kidneys and immune system. If too much sugar builds up in the bloodstream, it can slow down circulation inside the body. Important cells, such as infection-fighting white blood cells, are blocked by the buildup of sugar and can't function normally.

According to HMSA data, nearly 8 percent of Hawaii's population has diabetes, including more than 25 percent of residents over age 65. Each year, about 8,000 people in Hawaii are diagnosed with diabetes.

Although diabetes is one of the most common diseases in our nation, there's a lot you might not know about it. I want to set the facts straight. Separating myth from truth can help you prevent or manage diabetes and live a happy, healthy life.

MYTH: Eating too much sugar causes diabetes.

Diabetes is actually a problem with insulin, a hormone that allows sugar into cells, where the sugar can be used as fuel. Diabetes occurs when the pancreas doesn't produce insulin, doesn't produce enough insulin, or the body doesn't react to insulin that's made. Not having enough insulin causes sugar to build up in the blood, resulting in high blood sugar levels.

However, lots of insulin problems are caused by being overweight or obese, which is often due to eating foods high in sugar. That's why I urge my patients to keep themselves at a healthy weight.

MYTH: All diabetes is the same.

Actually, there are three major types of diabetes: type 1, type 2 and gestational.

Type 1 diabetes, also called auto-immune diabetes and previously called juvenile diabetes, is usually something you get early in life. It occurs when the body's pancreas doesn't produce insulin.

Type 2 diabetes, sometimes called adult-onset diabetes, usually occurs in adulthood due to factors that you can or cannot control. It occurs when the body doesn't respond to insulin or doesn't get enough insulin to control glucose. Obesity and genetics are the two main causes.

Gestational diabetes occurs in pregnant women who don't respond to insulin because of their hormones. It usually disappears after giving birth, but in many cases — especially in overweight, inactive women — it comes back within several years.

MYTH: Diabetes is only a blood sugar problem.

Diabetes is a “;systemic”; disease, meaning that it affects many areas of the body. I always teach my patients the “;ABCs of diabetes.”; “;A”; stands for A1c blood glucose testing, which shows how your blood sugar has been for the past 90 to 120 days. “;B”; stands for blood pressure, and “;C”; for cholesterol. Managing all three factors is key for diabetes care. Have your ABCs checked often. Aim for an A1c reading of less than 7 percent, a blood pressure reading of less than 130/80 and a LDL cholesterol level of less than 100.

Diabetes affects the nerves, blood vessels and organs, so I urge my patients to focus on their overall health, not only their blood sugar. In addition to the ABCs, having your eyes and kidneys tested annually is also important.

MYTH: If you're diagnosed with diabetes, you'll have to give up many foods.

Don't worry, you can still eat the foods you love if you balance your diet so that sugar and carbohydrates are kept to small, healthful amounts. The key is eating a well-rounded diet. And it's not only what you eat; how much you eat is equally important.

Carbohydrates in foods will affect your body differently, so I encourage my patients to eat a diet rich in fiber, including whole grains and lots of fruits and vegetables. Whole grains such as brown rice and whole-wheat bread have much more fiber and are healthier than foods like white rice and white bread.

MYTH: Being on insulin means you failed at managing diabetes.

A lot of my patients view the word “;insulin”; badly, like something you should fear and avoid. Many are surprised to learn that insulin is a much-needed hormone in all of us. We need insulin to control glucose, which fuels and energizes our body. People with diabetes simply need help with the level of insulin in their bodies.

But I always remind my patients that for type 2 diabetes, staying healthy through good nutrition and exercise might be the only treatment you need. I've found that by controlling blood glucose levels and losing excess fat, you may be able to prevent or reduce the use of insulin drugs.

MYTH: Once you have diabetes, you'll have a lifetime of problems.

You can live a happy, normal life with diabetes. Staying in control of your blood glucose, blood pressure, cholesterol, kidneys and eyes can make living with diabetes much easier. I've found that keeping your A1c level less than 7 percent is important, and more than 9 percent is considered poorly controlled.

A healthy diet and active lifestyle are also key. I always urge my patients to use programs like HMSA's Care Connection, which teaches people about disease management. These programs help you stay in control of chronic conditions so you can live a healthy, fulfilling life.

Lots of people with diabetes live normal lives by staying healthy and getting tested routinely. Halle Berry, Larry King, “;Smokin' Joe”; Frazier, Mike Huckabee and local pro surfer Scott Dunton are just a few people who haven't let diabetes get them down.

Remember, if you stay in control of your diabetes, it won't control you. Visit hmsa.com to learn more.

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Ron Fujimoto, D.O., is a family physician who still occasionally practices on Kauai. He is the medical director for HMSA's Health Plan Hawaii and Care Management and HMSA's Patient Safety Officer. HMSA's “;Health Scene”; appears every second Tuesday of the month in the Star-Bulletin.