Every three minutes, day and night, a small pump drips a dose of insulin into the veins of 62-year-old Larry Bouchard through an ever-present, spring-loaded needle.

It's better than daily injections, Bouchard said, but periodic pricks are the least of the problems that accompany life with type 2 diabetes. Since his diagnosis, he has suffered at least one heart attack, multiple strokes and nerve degeneration.

"It was downheartening, and you kind of feel down on yourself for a while, but you've got to get going," he said of his diagnosis.

Bouchard, a Winslow resident who works part time in Waterville and Augusta as a mail courier, stays upbeat in the face of what likely is a lifelong illness.

People may not be as familiar with type 2 diabetes as with type 1, which is also known as childhood diabetes. But actually, type 2 diabetes is the more common variety.

In this type of diabetes, the body either does not produce enough insulin, or the cells ignore the insulin, making it impossible for the body to use sugar, a basic fuel for the cells in the body. This starves the body for energy, and high blood glucose levels may damage a person's eyes, kidneys, nerves or heart. It can begin later in life, with many people, like Bouchard, not being diagnosed until middle age.

Bouchard has had type 2 diabetes for 20 years, and has been injecting insulin for 10.

His father, grandfather and uncle, now deceased, were all diagnosed with the disease, as were two of his brothers and two of his three sons. In light of the prevalence of the disease in his family, Bouchard set out to learn all he could about living with it.

He found out that he is not alone.

His family is part of a state-and nation-wide epidemic. The American Diabetes Association estimates that the number of cases hit 20 million nationally this year.

In Maine, the number hit 76,000 this year -- more than double the cases a dozen years ago, according to Stephen D. Sears, a medical doctor who serves as a member of a MaineHealth diabetes focus group and also sits on the national board of the American Diabetes Association. The Maine Diabetes Prevention and Control Program estimates that for every two people diagnosed, one other person has it without being diagnosed. If this is true, it puts the total number of Mainers who have type 2 diabetes at well over 100,000.

The state created the Maine Diabetes Prevention and Control Program in 1977, and various other associations and focus groups sprang up as well to combat the problem, but the number of cases continues to multiply.

"One reason is, we've had a continuous increase in people who are both overweight and obese and less physically active," Sears said. "There are probably other factors, but those are pretty driving factors overall."

Sears said that 66 percent of Mainers are obese or overweight, which is slightly higher than the national figure of 64.5 percent, according to the American Obesity Association. Given the roots of type 2 diabetes, the general approach that Maine's medical community is taking is toward prevention, Sears said.

"It has to do with changing our eating patterns. We are less active; we have higher-calorie foods; we have bigger portions," he said. "This didn't happen overnight; this was over the past 15, 20, 25 years."

But health organizations and state initiatives are limited in what they can do to combat the disease. The public must fundamentally change its bad habits, Sears said.

"I really want to stress that diabetes prevention is a community activity," he said. "The medical community can help, but it's not just going to be a health system, it's a societal problem."

The preventive approach described by Sears is the reverse of that seen in many other places in the United States.

Preventing diabetes is not nearly as financially lucrative for hospitals as treating its symptoms, according to a January New York Times report. Insurance companies frequently balk at paying a couple of hundred dollars for a visit to a preventive specialist, but usually cover amputations, which can cost tens of thousands of dollars.

The Times report documented the closing of several New York diabetes clinics that specialized in educational measures aimed at helping people eat healthier and take better care of themselves. At the same time, the number of type 2 diabetes cases doubled, and more than 100 dialysis centers appeared.

In Maine, health care organizations offer a variety of resources to stop or prevent symptoms of type 2 diabetes.

Inland Hospital in Waterville provides a Diabetes Support Group that meets at 6:30 p.m. on the first Wednesday of each month in the Medical Arts Building Conference Room. Inland also has a program called Living Well With Diabetes that requires a physician's referral. This program consists of individual classes on managing diabetes and visits with a nurse and a dietitian.

Organizations such as MaineHealth provide an array of targeted information online, such as body mass index charts, diabetes basic facts, diabetes education and support, foot-care tools, lipid management, medication sheets for patients and tips on how to stop smoking, which also reduces the risk of diabetes.

The Maine Diabetes Prevention and Control Program provides education on self-management of diabetes to about 2,000 people every year, for a total of more than 27,000 since 1980.

The program is reimbursable by Blue Cross/Blue Shield of Maine, Medicaid and Medicare. State law requires all insurance policies in Maine to cover this education program. Thirty-five facilities in Maine provide this service.

These resources are readily accessible -- the key is for people to use them, Bouchard said.

"You really need education," he said. "Not knowing what would affect you if you are diabetic ... it's a problem. It leads to heart attacks, strokes, neuropathy, blindness, you name it."

Joel Elliott -- 861-9252

jelliott@centralmaine.com

TYPE 2 DIABETES IN MAINE Diabetes is the leading cause of non-traumatic lower extremity amputations. Between 2000 and 2002, three out of four such amputations in Maine were diabetes-related. Twice as many men as women had amputations. Diabetes is the leading cause of end-stage kidney disease. More than 40 percent of all newly diagnosed chronic end-stage kidney disease patients also had diabetes. Before type 2 diabetes develops, there is a period of several years when blood-sugar levels are higher than normal but not yet at levels for the diagnosis of diabetes. This condition is called pre-diabetes. Reaching this stage raises your risks of cardiovascular disease by 50 percent. It is estimated that more than 200,000 people in Maine have reached this stage. Research indicates that modest lifestyle changes can prevent or delay the onset of type 2 diabetes among high-risk adults.

Sources: American Diabetes Association, National Library of Medicine, National Institutes of Health and the Maine Center for Disease Control and Prevention