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xiii Introduction Diabetes has reached near epidemic proportions. In 2017, 30.3 million Americans, or 9.4 percent of the population, were diabetic. The disorder is big business. One can hardly turn on the television without seeing ­ advertisements for the latest glucose monitoring device or newest drugs to manage the disorder. In 2017, the United States spent 12 percent of all health care dollars—a whopping $727 billion—on diabetes care. These numbers are only expected to increase because 84.1 million American adults, or one-third of the population, have a condition called prediabetes. For many people, prediabetes will progress to full-blown type 2 diabetes. The most common kind of diabetes, type 2 diabetes, is a stealthy ­ disorder. Initially, it causes vague symptoms such as fatigue, increased thirst, and more frequent infections, all of which develop slowly and are often ignored. Even later symptoms such as blurred vision, cuts and bruises that are slow to heal, and numbness in the hands and feet tend to be blamed on aging. No wonder that, of the 30.3 million Americans with the disorder, almost one-quarter do not know they are affected, and many others find out they have the disorder only incidentally when they go to the doctor for a different complaint. Worldwide, the situation is no better. The International Diabetes ­ Foundation estimates that 425 million adults are diabetic. The greatest number of them are between 40 and 59 years old. Even more disturbing is that half the people with diabetes don’t know they have the disorder and receive no treatment. The number of diabetics worldwide is projected to increase to 629 million by 2045, with the fastest rate of increase in low- and middle-income countries. Diabetes can be confusing because it is not a single metabolic disorder. Only about 5 percent of diabetics have type 1 diabetes. Type 1 is an auto- immune disorder in which the body’s immune system is triggered to attack and kill the cells that produce insulin. Insulin allows glucose, a simple