Diabetes is an American scourge. 25 million Americans have diabetes and the proportion is growing swiftly.

"The projection is that half of Americans will be diabetic or pre-diabetic by 2020," says Lisa Duncan, of Diabetes Wellness Solutions in Sisters.

Oregon may have lower incidence than, say, Mississippi, and Sisters Country may be more healthful than most places in Oregon, but we are by no means exempt.

"The community of Sisters may be a little better than average," says Dr. May Fan, "but it's still quite prevalent."

Diabetes is an insufficiency of insulin, creating a condition of high blood glucose. Excess glucose in the blood can damage the blood vessels, leading to complications such as heart disease, kidney damage, nerve damage, eye damage, impotence and stroke.

Type 1 diabetes is a genetic condition where the body does not produce insulin. Type 2 comes on in adulthood and is most often associated with lifestyle issues and obesity. A sugary, carb-loaded diet is a problem.

"One main problem is the easy availability of cheap, high-fructose corn syrup fast food," says Dr. Fan. "It's basically a preference for the kinds of food that taste good. It's largely diet."

Diabetes can often be prevented or reversed by changing diet and lifestyle. Duncan notes that a low-fat, high-fiber diet with lean protein and whole grains, fruits and vegetables is beneficial.

"The nutritional approach (of Duncan's practice) is unlike typical diabetes diets," she notes. "I simply teach what foods promote proper insulin function and overall health and allow them to eat freely of those foods."

Exercise is critical for people who are diabetic or pre-diabetic. It's also the hardest lifestyle change to instill.

"The people I have the toughest time with are the people who 'hate to exercise,'" says Dr. Fan. "There are just so many excuses."

Dr. Fan insists that excuses are hard to make in Sisters, where there are so many opportunities to get active safely and easily - from yoga to health clubs to an indoor walking program initiated by SPRD.

Lifestyle changes can go a long way toward managing or reversing diabetes and keeping patients off of medication.

"If they're willing to make diet and lifestyle changes, that's always first," Dr. Fan notes.

Pre-diabetics can avoid the disease - if they make that the effort to change.

"I would say the majority, within the next five years, do not go on to develop it," says Dr. Fan.

There is a lot of social science study around how successful change is made, Duncan notes.

"Part of it is having people around you that support you," she says.

Making lasting change is an acquired skill that can be learned, and structure also helps. Duncan's program is a 16-week group wellness program that seeks to provide that kind of structure and support.