Obesity, cardiac (and eye) problems are typical companions to diabetes. Because diabetes affects all the vessels of the body, it spins out and leads to other disease, said D.C. Clark, her trainer. Sister Washington's strength training and aerobic workouts are taken at the diabetes rehabilitation lab in the Health Campus of Lancaster General Hospital. Her trainers, Clark and Brian Burk are exercise physiologists. They call her "Kathleen, our poster child," because they say her diligence proves their point:

Habits can be changed.

"We work on education and behavior change," said Clark.

Washington sees the results. She likes going to the rehab lab because the results are constantly monitored. "Today my bp went down 30 points. The sugar generally comes down from, say, 114 to 96 during one workout."

She admitted to being one of those people who need constant support and encouragement to manage an exercise program. After completing the 12-week program and a transition, she signed up for more.

Some insurance plans cover the costs. However, Clark and Burk try to keep the per-session price very low, reasonable enough that clients can pay for it on their own.

Sister Washington goes to Curves three days a week. She takes a QiGong class once a week and most of all, she walks when the weather is cool enough.

Diabetes and Exercise are good partners.

Both aerobic and resistance exercises are important, according to Dr. Lisa Aurand, an endocrinologist with Diabetes and Endocrine Specialists, Lancaster.

Aerobic and resistance exercises work better together than does aerobic exercise alone, she said. At least 150 minutes of moderate exercise are needed a week and are better split up into three sessions than done all at once.

Exercise plays an especially good role with Type 2 diabetes, said Aurand.

In that form, the body is in a state of insulin-resistance. To compensate for the resistance the body produces more insulin than it needs.

Muscle cells take up the sugar (called glucose) from the blood with exercise, she explained. The role of insulin is to allow the glucose to be taken up. Therefore, with exercise the body is more sensitive to the effects of insulin.

People who give themselves insulin injections, she explained, should NOT inject the insulin into the muscle they are about to work because it will increase the amount taken up by that muscle. For example, if you are about to run a marathon, inject insulin into the abdomen, not the leg, she said.

Marathon runners and triathletes --the ironmen and women -- as well as serious high school and recreational athletes, are the interest of Dr. Matthew Corcoran, also an endocrinologist and certified diabetes educator. Corcoran, a 1986 graduate of Lancaster Catholic High School, now works at Lehigh Valley Hospital specializing in diabetes and exercise, specifically working with athletes with Type I diabetes whose goal is performance.

"They run for the same reasons everyone does, and it is usually about time. Taking time to measure blood-glucose levels is critical during an event," he said. Preferably a meter is carried with them or is strategically placed over the running course.

It is not known how many diabetics are running tough races, he said, especially at the college and high school level. However, he believes the number is growing every day as technology improves and insulin improves.

He explained the process: "Insulin is one of the major hormones that fuels metabolism in exercise. It allows the body to mobilize carbohydrates. In people who don't have diabetes, the body manipulates the natural insulin supply. The athlete with diabetes has to manipulate the supply with a pump or injections."

Intense athletes who have diabetes derive the same health benefits, especially cardiovascular health, that comes with those people who exercise and don't have diabetes, he said. In two areas, athletes with diabetes get specific help: Depression is a bit more frequent with diabetes and exercise improves psychological health. Also exercise causes increasesd sensitivity to the insulin so that over time less may be needed, said Corcoran.

Both Aurand and Corcoran stress the need for people to get a good assessment of their overall health and their overall diabetes health before they begin to do strenuous exercise.

For example, since eye disease often accompanies diabetes, weight lifting may not be recommended for people with bleeding in the eyes, said Corcoran.

Because of the high risk of heart disease associated with diabetes, Aurand stressed that people must be assessed by a physician to see if they have underlying heart disease before they begin an exercise program.

Wednesday's Lifestyle/Food section takes a look at how understanding the glycemic index may help manage one's blood-sugar levels.

Lancaster native Charles Demuth (1883-1935) was an artist whose stylistically innovative watercolors often showed very athletic acrobats and circus performers.

He painted these acrobats in Paris in 1919.

In 1920, Demuth was diagnosed with diabetes and was often incapacitated by diabetic attacks at a time in history before pharmaceutic insulin was available.

His friend and fellow artist Georgia O'Keefe recalled that when they were out drinking, Demuth would go into shock. O'Keefe would go to the bar, get some orange juice to raise his blood-sugar levels and throw his drink into a nearby flower pot.

Coincidentally, the first attempts to produce insulin began in 1921. The first insulin was used on people in 1922, and the scientists who developed insulin research won the Nobel Prize in 1923.

Demuth's mother brought him home in 1921 and did seek insulin treatment for him. But he never regained full health and spent most of his life working at home, a diabetic invalid. Demuth died of complications from diabetes in 1935, at age 51.

Source: Gerald Lestz, local historian.

Type I people have a relative lack of insulin in the body, an auto-immune problem that makes it difficult for their pancreas to make enough insulin, according to Dr. Lisa Aurand.

Type 2 people have a lot of insulin, it is just not functioning. When they are obese, fat cells lead to insulin resistance. "We used to say it was not a problem with young people," said Aurand. "Now we are seeing it more."

In fact, the incidence of Type 2 diabetes in adolescents increased tenfold between 1982 and 1994 and the Centers for Disease Control and Prevention have predicted that 30 percent of those babies born in 2000 will develop Type 2 diabetes.