Los Angeles ? During her sophomore year at Roosevelt High School, Angie Ramos, 16, had a 4.0 grade-point average and a calendar crammed with student council meetings, leadership club and school dances. “Lazy” was not part of her vocabulary.

But in the summer before her junior year, Angie just wanted to sleep.

Eva Jimenez, who keeps tabs on her granddaughter and grandson when their parents, Gabriel and Alejandra Ramos, are at work, noticed Angie’s lethargy.

There were other hints of trouble. Angie was always thirsty, and a shadowy ring on the skin around her neck wouldn’t come off no matter how much she scrubbed.

At her annual physical in September, the mystery was solved. The doctor made a matter-of-fact pronouncement. “She said I have diabetes,” Angie said.

“No es verdad!” Jimenez said. It’s not true!

Jimenez has diabetes, as did her mother. So do Angie’s paternal grandmother and her father’s older brother. But Angie? A teenager?

The doctor referred her to Childrens Hospital-Los Angeles for additional blood tests to confirm the diagnosis: Type 2 diabetes.

At home in East Los Angeles, Angie took out a journal and wrote a single sentence in letters so large they took up the entire page: I have diabetes.

“I felt so sad and angry at myself,” she recalled later. “It hurt me to know I’m not perfect.”

Not just for adults

Type 2 diabetes is the most common form of the disease, but until 1997, it was so unusual in someone under age 40 that doctors called it “adult-onset diabetes.” Diabetic children were almost certain to have the Type 1 form.

With either version, the body is unable to produce or properly use insulin, a hormone vital for converting food into energy.

Type 1 diabetes is an autoimmune disorder – the body’s disease-fighting system mistakenly attacks the body, destroying cells in the pancreas that make insulin. For unknown reasons, Type 1 is more common in white people, especially those from Northern Europe. Of the estimated 20.8 million Americans with diabetes, 5 percent to 10 percent, or fewer than 2 million, have Type 1.

The majority, as many as 19 million Americans, have Type 2, in which the pancreas makes insulin, but the body doesn’t use it properly.

Lifestyle makeover

The day after the initial diagnosis, the Ramos family drove to Childrens Hospital. They met Dreimane, who prescribed pills to help Angie’s body use insulin and three shots of insulin a day to help her overtaxed pancreas.

Nurses, counselors and nutritionists gave them a crash course on managing the lifelong disease. Angie learned to fill a hypodermic needle with insulin and plunge it into a pad that looked like human skin.

Angie thought to herself: “Just do it, and let’s get this over with.”

She practiced until she could pinch a fold of skin in her abdomen and stick in the 1 1/2-inch needle.

She followed the ritual three times a day: First thing in the morning, immediately after school and before bed. Five times a day, she pricked her finger, squeezed blood onto a test tape and popped it into a device that measured her blood-glucose level and told her how much insulin to take.

The weight-health link

Diabetes runs in Angie’s family, but her uncle, grandmothers and great-grandmother weren’t diagnosed until middle age. Angie, however, is growing up in a different world. Today, 17 percent of children under age 19 – about 12.5 million children – are seriously overweight, triple the number in 1980. Another 12.5 million are mildly overweight. This means that 1 in 3 children under age 19 is seriously overweight or on the brink of becoming so. The appearance of Type 2 diabetes in children and teenagers follows that trend.

Angie resolved to lose 20 to 30 pounds. But someone unlucky enough to have a genetic predisposition to diabetes or weight gain, or both, has to work at eating a healthy diet and exercising. It doesn’t help that Angie’s generation is considered the most inactive in history.

Angie’s parents took physical-education classes all through high school. Angie had P.E. for only her first two years, and those periods were truncated because of the school’s year-round schedule; she and her classmates spent most of the time changing in and out of gym clothes.

The Ramos’ home is on a well-kept block, but Angie’s parents don’t feel it’s safe for her to walk alone. They put a basketball hoop in the courtyard, but Angie prefers cruising on MySpace, and her brother Gabriel, 11 months younger, plays Nintendo.

Angie’s doctor prods her to exercise or walk at least 30 minutes each day. She reminds her to read food labels, watch portion sizes, avoid fats and eat fruits and vegetables.

Once every three months, Angie comes into the clinic to weigh in, show the glucose readings and get a pep talk. Dreimane asks Angie what she hates the most.

The answer: I hate giving myself shots. I hate always having to think about what I eat. I hate having this.

She hated pricking her finger to check her blood. She hated having to do it every day. She hated having to remember to carry her glucose meter. She hated that her fingers too sore to strum her guitar.

Children with Type 2 typically don’t feel sick. They don’t have a fever. It’s hard to persuade them to check their blood sugar every day.

The costs of not managing Type 2 come later, years after high blood-glucose levels begin their silent assault on kidneys, eyes, nerves and blood vessels.

But how do you explain the stakes when teenagers famously see themselves as immortal?

Hope on the horizon

Despite her anger, Angie found it hard to remain a martyr. For one thing, her family and friends wouldn’t let her. For another, she wouldn’t let herself.

After two months, Angie had walked off 5 pounds. Her grades, which had dipped, crept back up. She started to believe her life might not be over.

By Christmas, Angie was down to two insulin shots a day, three finger-prick tests and one pill.

Her journal filled again with gossip and plans for a school dance. By February, she’d lost another 5 pounds and dropped two clothing sizes. Dreimane cut her back to one insulin shot a day, plus the pill. By the next visit, she hoped Angie would be able to get off insulin.

“I can’t promise that you’ll never need it,” the doctor warned, reminding Angie that she’d always have to diet and exercise, take her pills and test her glucose levels.

“I’m going to cry,” Angie said, after receiving the good news.