Endocrinologists, the type of medical specialist diabetics most often seek out, are becoming harder and harder to find. The sharp rise in diabetes, along with decreased interest in the field of endocrinology, has led to a serious shortage of medical care.

In Philadelphia, which has one of the highest concentrations of hospital beds in the nation, there are just 55 endocrinologists, some of whom do only research.

"There are lots of diabetics in the city and very few of me to take care of them," said Arthur Chernoff, chairman of endocrinology at Albert Einstein Medical Center and director of the Gutman Diabetes Institute.

A 2005 study by the Hospital Association of Pennsylvania showed a 22 percent vacancy rate for endocrinologists, the highest of any specialty. Across the country there are 12 percent fewer of the specialists than needed, said Richard Hellman, president of the American Association of Clinical Endocrinologists.

Meanwhile, about a million people in the United States are found to have diabetes each year, according to the American Diabetes Association, which estimates that 20.8 million children and adults, 7 percent of the population, have diabetes.

Many patients are successfully treated by general practitioners. But diabetes treatment can be difficult because of the body's inability to regulate blood sugar; every meal is a potential complication. When the delicate balance of hormone and sugar levels winds out of control, many seek an endocrinologist.

Complications from diabetes are now among the leading causes of death in this country. Health insurers spend billions of dollars a year treating the kidney failure, heart disease, blindness and amputation that can result from the disease.

The falling number of endocrinologists is part of a trend that experts blame on retiring doctors and salaries that fall below those of other specialties.

What can be done? Should we first try to increase doctors, or decrease diabetes?