Diabetes, by definition, means high blood sugar level. It is also a disease of glucose metabolism, and people with this have no clinical symptoms. The diagnosis of diabetes is based on one of two tests: the fasting plasma glucose test or an oral glucose tolerance test, not by obesity and its complications nor it is defined by a urine test. There are three types of diabetes, Type I, Type II and Gestational Diabetes. In Type I, insulin isn't produced and there's nothing to tell the cells to take glucose and metabolize it. "Researchers believe that a combination of environmental factors and, probably, viral antigens are responsible for Type I diabetes." In Type II, insulin is present, but the signal for glucose uptake and metabolism is lost. The problem could be in the insulin itself or in any one of the proteins involved in glucose uptake and metabolism. The liver is responsible for glucose production and insulin is the main agent of production. High blood sugar causes the pancreas to let out insulin, and the insulin should signal the liver to stop making sugars. But, in diabetics, there's a boundary to that signal and the liver keeps producing glucose. Some ethnic groups, such as most Native Americans and Hispanics, have a definite genetic susceptibility to diabetes, while some groups, including Caucasians, Melanesians, and Eskimos, are at low risk. "It is very clear that there's a genetic susceptibility to developing complications; a Caucasian with a blood sugar count of 200 will have about 20% chance of developing diabetes after 20 years; a Native American with a 200 count will have an 80% chance." Most Americans are aware at the rising cost of medicine, and one solution being discussed is a managed care system.