Stocks Jump 2.5% on Fiscal Deal

Stock markets around the world ended the first trading day of 2013 with big gains, after investors welcomed a deal between President Obama and Congressional Republicans that ended, at least temporarily, an impasse over fiscal policy that had threatened chaos in the new year.

The benchmark Standard & Poor’s 500 index finished Wednesday up 2.5 percent. The technology-heavy Nasdaq composite index was up even more strongly, rising 3.1 percent. The Dow Jones industrial average rose 2.4 percent, or about 308 points.

The major indexes ended the day within striking distance of the highs they reached before the election.

The drama over the fiscal impasse ended when a sufficient number of Republicans in the House joined Democrats to back a deal the Senate had reached earlier. The deal modestly raises income taxes on the highest-earning Americans, ends payroll tax cuts and creates permanent tax cuts for others.

“You’ve just removed a huge worry from the market,” said Jonathan Lewis, the chief investment officer at Samson Capital Advisors.

Congress signed off on the deal late Tuesday night and it immediately sent stocks soaring first in Asia and then in Europe. Leading indexes rose 2.6 percent in France, 2.2 percent in Germany and 2.9 percent in Hong Kong. Markets in Japan and mainland China were closed for holidays.

In the United States, share prices experienced most of their increases in the first 30 minutes of the day and then plateaued for most of the rest of the day. In the bond market, investors sold off the longer-dated Treasuries that have been used as safe havens in recent years, pushing up the yield on the benchmark 10-year bond to 1.839 percent.

Many market strategists were already shifting their attention to the political sticking points that were not handled in this week’s agreement. Congress decided to defer for two months $110 billion of government budget cuts that were supposed to begin on Tuesday. Those cuts will have to be dealt with around the same time the government hits the so-called debt ceiling, beyond which it may not be able to borrow more money in the bond markets.

“There’s a recognition that this isn’t the end of the game,” said Jack Malvey, the chief market strategist at BNY Mellon.

In economic reports, the Institute for Supply Management said manufacturing in the United States expanded slightly in December. Its manufacturing activity index rose to 50.7 points in December, up from 49.5 in November.

In Europe, manufacturing activity remained in the doldrums. Surveys of purchasing managers by Markit Economics showed euro zone factories ended 2012 in poor shape, with both production and new orders declining in December. German factories posted declines in both output and new orders, according to the Markit data, while the Spanish manufacturing shrank a 20th consecutive month, with both the decline and the pace of job cuts accelerating.

This article has been revised to reflect the following correction:

Correction: January 2, 2013

An earlier version of this article misstated the surname of the chief investment officer at Samson Capital Advisors. He is Jonathan Lewis, not Jonathan Samson.

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Ruling over bumper-car injury supports amusement park

SAN FRANCISCO — The California Supreme Court, protecting providers of risky recreational activities from lawsuits, decided Monday that bumper car riders may not sue amusement parks over injuries stemming from the inherent nature of the attraction.

The 6-1 decision may be cited to curb liability for a wide variety of activities — such as jet skiing, ice skating and even participating in a fitness class, lawyers in the case said.

"This is a victory for anyone who likes fun and risk activities," said Jeffrey M. Lenkov, an attorney for Great America, which won the case.

But Mark D. Rosenberg, who represented a woman injured in a bumper car at the Bay Area amusement park, said the decision was bad for consumers.

"Patrons are less safe today than they were yesterday," Rosenberg said.

The ruling came in a lawsuit by Smriti Nalwa, who fractured her wrist in 2005 while riding in a bumper car with her 9-year-old son and being involved in a head-on collision. Rosenberg said Great America had told ride operators not to allow head-on collisions, but failed to ask patrons to avoid them.

The court said Nalwa's injury was caused by a collision with another bumper car, a normal part of the ride. To reduce all risk of injury, the ride would have to be scrapped or completely reconfigured, the court said.

"A small degree of risk inevitably accompanies the thrill of speeding through curves and loops, defying gravity or, in bumper cars, engaging in the mock violence of low-speed collisions," Justice Kathryn Mickle Werdegar wrote for the majority. "Those who voluntarily join in these activities also voluntarily take on their minor inherent risks."

Monday's decision extended a legal doctrine that has limited liability for risky sports, such as football, to now include recreational activities.

"Where the doctrine applies to a recreational activity," Werdegar wrote, "operators, instructors and participants …owe other participants only the duty not to act so as to increase the risk of injury over that inherent in the activity."

Amusement parks will continue to be required to use the utmost care on thrill rides such as roller coasters, where riders surrender control to the operator. But on attractions where riders have some control, the parks can be held liable only if their conduct unreasonably raised the dangers.

"Low-speed collisions between the padded, independently operated cars are inherent in — are the whole point of — a bumper car ride," Werdegar wrote.

Parks that fail to provide routine safety measures such as seat belts, adequate bumpers and speed controls might be held liable for an injury, but operators should not be expected to restrict where a bumper car is bumped, the court said.

The justices noted that the state inspected the Great America rides annually, and the maintenance and safety staff checked on the bumper cars the day Nalwa broke her wrist. The ride was functioning normally.

Reports showed that bumper car riders at the park suffered 55 injuries — including bruises, cuts, scrapes and strains — in 2004 and 2005, but Nalwa's injury was the only fracture. Nalwa said her wrist snapped when she tried to brace herself by putting her hand on the dashboard.

Rosenberg said the injury stemmed from the head-on collision. He said the company had configured bumper rides in other parks to avoid such collisions and made the Santa Clara ride uni-directional after the lawsuit was filed.

Justice Joyce L. Kennard dissented, complaining that the decision would saddle trial judges "with the unenviable task of determining the risks of harm that are inherent in a particular recreational activity."

"Whether the plaintiff knowingly assumed the risk of injury no longer matters," Kennard said.

maura.dolan@latimes.com

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The Future Is Now: What We Imagined for 2013 — 10 Years Ago

Predicting the future is hard, but that doesn’t stop us from trying. We’re Wired, after all.

Ten years ago, we boldly declared that we’d be living with phones on our wrists, data-driven goggles on our eyes and gadgets that would safety-test our food for us. Turns out, a lot of the things Sonia Zjawinski conceptualized in our “Living in 2013” feature way back in 2003 were remarkably close to what we’ve seen. We even got the iPhone right (sort of).

And so, as we look back on life in 2013 circa 2003, we’re going to spin it forward once again to tell you what life will be like in 2023.

Predicted for 2003 (above):

Apple redefined the desktop, laptop, and MP3 player. The next insanely great thing: an LCD arm cuff that includes a PDA, wireless Internet, a mini iPod, and, of course, a phone. The iPhone bracelet's motion sensor allows you to scroll through apps and files with the flick of a wrist, its clasp holds a digicam for use during video calls, and its wireless ear clip lets you listen and speak to callers. And everything can be done via voice recognition or touchscreen. Talk about the right call. Illustration: Kenn Brown.

Delivered in 2013:

Hey, it turns out, Apple gave us an iPhone after all! We got the name right, and even seemed to know about FaceTime. But the form factor details? Not so much. While you can wear an iPod nano as a watch, or make a call with your iPhone, if you want the watch-plus-phone combination that we teased you with 10 years ago, for now you'll need to pick up a secondary gadget that can transmit to your phone, like this Pebble. Photo: Ariel Zambelich/Wired.

Looking ahead to 2023:

Here's the thing, the screen on a watch is simply too small to display lots of data. And as an input device? Forget it. Yet keeping your phone out of sight means you often can't interact with your data on the go. The obvious answer is a variable size display. Samsung has already demonstrated a pretty convincing foldable OLED display prototype. Given 10 more years, we can easily see one screen serving multiple purposes by taking on multiple form factors, depending on whether you wanted to simply glance at it to read a message, or unfold it to write your reply. Illustration: Simon Lutrin/Wired

Mat Honan is a senior writer for Wired's Gadget Lab and the co-founder of the Knight-Batten award-winning Longshot magazine.

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Playboy Hugh Hefner marries his ‘runaway bride’

LOS ANGELES (AP) — Hugh Hefner is celebrating the new year as a married man once again.

The 86-year-old Playboy magazine founder exchanged vows with his “runaway bride,” Crystal Harris, at a private Playboy Mansion ceremony on New Year’s Eve. Harris, a 26-year-old “Playmate of the Month” in 2009, broke off a previous engagement to Hefner just before they were to be married in 2011.

Playboy said on Tuesday that the couple celebrated at a New Year’s Eve party at the mansion with guests that included comic Jon Lovitz, Gene Simmons of KISS and baseball star Evan Longoria.

The bride wore a strapless gown in soft pink, Hefner a black tux. Hefner’s been married twice before but lived the single life between 1959 and 1989.

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Study Suggests Lower Death Risk for the Overweight

A century ago, Elsie Scheel was the perfect woman. So said a 1912 article in The New York Times about how Miss Scheel, 24, was chosen by the “medical examiner of the 400 'co-eds'” at Cornell University as a woman “whose very presence bespeaks perfect health.”

Miss Scheel, however, was hardly model-thin. At 5-foot-7 and 171 pounds, she would, by today's medical standards, be clearly overweight. (Her body mass index was 27; 25 to 29.9 is overweight.)

But a new report suggests that Miss Scheel may have been onto something. The report on nearly three million people found that those whose B.M.I. ranked them as overweight had less risk of dying than people of normal weight. And while obese people had a greater mortality risk over all, those at the lowest obesity level (B.M.I. of 30 to 34.9) were not more likely to die than normal-weight people.

The report, although not the first to suggest this relationship between B.M.I. and mortality, is by far the largest and most carefully done, analyzing nearly 100 studies, experts said.

But don’t scrap those New Year’s weight-loss resolutions and start gorging on fried Belgian waffles or triple cheeseburgers.

Experts not involved in the research said it suggested that overweight people need not panic unless they have other indicators of poor health and that depending on where fat is in the body, it might be protective or even nutritional for older or sicker people. But over all, piling on pounds and becoming more than slightly obese remains dangerous.

“We wouldn’t want people to think, ‘Well, I can take a pass and gain more weight,'” said Dr. George Blackburn, associate director of Harvard Medical School’s nutrition division.

Rather, he and others said, the report, in The Journal of the American Medical Association, suggests that B.M.I., a ratio of height to weight, should not be the only indicator of healthy weight.

“Body mass index is an imperfect measure of the risk of mortality,” and factors like blood pressure, cholesterol and blood sugar must be considered, said Dr. Samuel Klein, director of the Center for Human Nutrition at Washington University School of Medicine in St. Louis.

Dr. Steven Heymsfield, executive director of the Pennington Biomedical Research Center in Louisiana, who wrote an editorial accompanying the study, said that for overweight people, if indicators like cholesterol “are in the abnormal range, then that weight is affecting you,” but that if indicators are normal, there’s no reason to “go on a crash diet.”

Experts also said the data suggested that the definition of "normal" B.M.I., 18.5 to 24.9, should be revised, excluding its lowest weights, which might be too thin.

The study did show that the two highest obesity categories (B.M.I. of 35 and up) are at high risk. “Once you have higher obesity, the fat’s in the fire,” Dr. Blackburn said.

But experts also suggested that concepts of fat be refined.

"Fat per se is not as bad as we thought," said Dr. Kamyar Kalantar-Zadeh, professor of Medicine and Public Health at the University of California, Irvine. "What is bad is a type of fat that is inside your belly. Non-belly fat, underneath your skin in your thigh and your butt area — these are not necessarily bad." He added that, to a point, extra fat is accompanied by extra muscle, which can be healthy.

Still, it is possible that overweight or somewhat obese people are less likely to die because they, or their doctors, have identified other conditions associated with weight gain, like high cholesterol or diabetes.

“You’re more likely to be in your doctor’s office and more likely to be treated,” said Dr. Robert Eckel, a past president of the American Heart Association and a professor at University of Colorado.

Some experts said fat could be protective in some cases, although that is unproven and debated. The study did find that people 65 and over had no greater mortality risk even at high obesity.

“There’s something about extra body fat when you’re older that is providing some reserve,” Dr. Eckel said.

And studies on specific illnesses, like heart and kidney disease, have found an “obesity paradox,” that heavier patients are less likely to die.

Still, death is not everything. Even if "being overweight doesn't increase your risk of dying," Dr. Klein said, it "does increase your risk of having diabetes" or other conditions.

Ultimately, said the study’s lead author, Katherine Flegal, a senior scientist at the Centers for Disease Control and Prevention, “the best weight might depend on the situation you’re in.”

Take the perfect woman, Elsie Scheel, in whose "physical makeup there is not a single defect," the Times article said. This woman who "has never been ill and doesn't know what fear is" loved sports and didn't consume candy, coffee or tea. But she also ate only three meals every two days, and loved beefsteak.

Maybe such seeming contradictions made sense against the societal inconsistencies of that time. After all, her post-college plans involved tilling her father’s farm, but “if she were a man, she would study mechanical engineering.”

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A Bigger Tax Bite for Most Households Under Senate Plan

WASHINGTON — Only the most affluent American households would pay higher income taxes this year under the terms of a deal that passed the Senate early Tuesday morning, but most households would face higher payroll taxes because the deal does not extend a two-year-old tax break.

The legislation, which still must overcome resistance exhibited on Tuesday by House Republicans, would grant most Americans an instant reversal of the income tax increases that took effect with the arrival of the new year. Only about 0.7 percent of households would be subject to an income tax increase this year, according to the Tax Policy Center, a nonpartisan research group in Washington. The increases would apply almost exclusively to households making at least half a million dollars, the center estimated in an analysis published Tuesday.

But the Senate’s decision not to reverse a scheduled increase in the payroll tax that finances Social Security, while widely expected, still means that about 77 percent of households would pay a larger share of income to the federal government this year, according to the center’s analysis.

The tax this year would increase by two percentage points, to 6.2 percent from 4.2 percent, on all earned income up to $113,700.

Indeed, for most lower- and middle-income households, the payroll tax increase most likely would equal or exceed the value of the income tax savings. A household earning $50,000 in 2013, roughly the national median, would avoid paying about $1,000 more in income taxes — but still pay about $1,000 more in payroll taxes.

The timing and outcome of a House vote was unclear on Tuesday evening.

Sabrina Garcia, a 35-year-old accounting assistant from Quincy, Mass., who together with her husband made about $102,000 last year, said the payroll tax increase equated to “about $200 a month for my family. That’s a lot of money for us. It means we will have to cut back.” She said in an e-mail exchange that she most likely would postpone buying a new computer. “And forget about being able to save money,” she added.

The deal would impose larger tax increases on those who make the most. It would raise taxes in two different ways, by restoring limits on the amounts of income affluent Americans can shelter from federal taxation, and by restoring a top marginal tax rate of 39.6 percent. The current rate is 35 percent.

For married couples filing jointly, the deduction limits apply to income above $300,000, while the top tax rate kicks in above $450,000. But both numbers are somewhat misleading, because “income” in this context is a technical term, referring only to the portion of income subject to taxation after exemptions and deductions.

Few households with actual incomes of less than half a million dollars would face a tax increase. The Tax Policy Center calculated that less than 5 percent of families earning $200,000 to $500,000 would actually pay more.

The size of those increases would be much smaller than President Obama originally proposed. The net effect, according to the center’s estimates, is that the top 1 percent of households would see an average income tax increase this year of $62,000 rather than $94,000.“The high-income people really are doing very well in this compared to what the president wanted to do,” said Roberton Williams, a senior fellow at the Tax Policy Center.

The Senate deal would impose fewer limits on deductions than the White House plan. It also would tax income from dividends at a flat rate of 20 percent, rather than the same marginal rate as earned income. And there’s another important point, often misunderstood: Affluent households would pay the new 39.6 percent rate only on income above $450,000. They and everyone else would still pay lower rates on income below that threshold.

Households making $500,000 to $1 million would pay an additional $6,700 in taxes on average. Those making more than $1 million would pay an additional $123,000 on average.

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'Fiscal cliff' deal pleases few; House unlikely to vote Monday

Senate Minority Leader Mitch McConnell says he and the White House have made agreements on a "fiscal cliff" solution.

WASHINGTON – Details of the emerging “fiscal cliff” deal ricocheted through the Capitol on Monday, appearing to please almost no one from either political party, as President Obama urged negotiators toward a conclusion. A House vote appears unlikely on Monday, even if a deal is finished.

The contours of the agreement between Vice President Joe Biden and the Republican leader of the Senate, Mitch McConnell, put into sharp focus the compromises that need to be stomached if a deal was to be struck. The outcome remained uncertain as the country prepared to go off the “fiscal cliff.”

Even if agreement could be reached to have a Senate vote before the midnight deadline, when taxes on all Americans would rise if nothing was done, Speaker John A. Boehner (R-Ohio) was unlikely to call a vote in the House until Tuesday. 

“We are very, very close,” said an upbeat McConnell on the Senate floor after Obama spoke on the White House grounds and called on the country to urge lawmakers to finish. “We can do this.”

QUIZ: How much do you know about the fiscal cliff?

The emerging deal would raise taxes on income and investments for wealthier Americans – those  households making more than $450,000 a year or individuals earning more than $400,000– although the two sides remain at odds over the automatic spending cuts that make up part of the “fiscal cliff.”

McConnell and Biden continued talking throughout the afternoon Monday, as lawmakers prepared to hunker down for a long New Year’s Eve under the dome. A final deal could be voted on first by the Senate, possibly late Monday.

One result became increasingly clear, though: With many issues still unresolved, Washington was poised to continue the partisan budget battles that have defined recent years well into 2013.

As the sun began to set over the capital on a chilly winter day, rank-and-file lawmakers, both Democrats and Republicans, bristled at what they were being asked to accept.

The office of Senate Majority Leader Harry Reid, the hardscrabble Nevada deal-maker who stepped aside for Biden to negotiate with McConnell, offered a view of the level of concern. A revolving door of lawmakers came and went throughout the day.

Liberal Democrats objected that the White House was ceding too much to Republican demands and missing the opportunity for a broader budget deal. Conservative Republicans were upset at being asked to raise tax rates without reducing the deficit with steep cuts.

PHOTOS: Notable moments of the 2012 presidential election

“Republicans should kill the compromise if there are no spending cuts,” said Erick Erikson, the conservative founder of the influential Red State blog, in a tweet.

Both parties were under enormous pressure from their political bases not to give in to what some, including Sen. Tom Harkin (D-Iowa), a liberal leader, characterized as simply a “bad deal.”

More than $660 billion in revenue would be raised – far less than the target Obama first set in talks with congressional leaders. The president sought $1.6 trillion in new revenue from a large deficit-reduction package, and at least $800 billion in earlier talks with Republicans over a deal on tax increases.

The agreement would set the top tax rates at 39.6% for income above $450,000 for households and $400,000 for individuals, which is a narrower definition of who is wealthy than Obama once sought, according to a source who was not authorized to discuss the negotiations. The president won reelection campaigning on asking those who earn above $250,000 to contribute more in taxes.

Investment income tax rates would also rise for those higher-income households, from the historic low 15% rate on capital gains and dividends to a new 20% rate. The president had sought to tax dividends at the same rate as ordinary income, and his earlier offer sought to initiate those taxes at the lower $250,000 income threshold.

The estate tax, which has been a key sticking point throughout the weekend of negotiations, appears to have been settled. The agreement splits the difference, setting the new rate at 40% on estates valued at more than $5 million – a compromise between today’s 35% rate and the 45% rate Democrats sought on estates of $3.5 million or more.

Americans would benefit from an extension of long-term unemployment benefits, which expired over the weekend, for one full year.

One area that hewed closer to Democratic priorities was Obama’s proposal to reinstate the phaseout of personal exemption tax credits and itemized deductions on upper-income households. They had been in place before the George W. Bush-era tax cuts began in 2001, but were done away with over the past decade and would fully expire, with the rest of the tax breaks, on New Year’s Eve.

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The Best of Exploration: Top 8 Stories of Space Exploration in 2012

Our recap of the year’s best exploratory exploits continues today with a look at the biggest developments in space exploration. 2012 saw the stunning debut of new spacecraft (Curiosity), the continued contributions of geriatric ones (Voyager), and the first full year since the end of the Space Shuttle program. Casey Dreier of The Planetary Society nominated 8 particularly meaningful developments from the last twelve months.

Image: Dreier’s pick for image of the year, a Cassini photograph of Saturn’s north pole through an infrared filter. (Credit: NASA / JPL / SSI / Emily Lakdawalla)

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Green Day to get back on road in March

NEW YORK (Reuters) – The members of Green Day said on Monday they will return to the road in March after the punk rock band canceled its fall club tour and postponed later dates as frontman Billie Joe Armstrong underwent treatment for substance abuse.

“We want to thank everyone for hanging in with us for the last few months,” the band members said in a statement on their website. “We are very excited to hit the road and see all of you again, though we regret having to cancel more shows.”

Armstrong, lead singer and guitarist for the Grammy-winning rock band, sought substance abuse treatment in September following an angry, guitar-smashing on-stage outburst in Las Vegas. The details of his addiction were never specified.

Armstrong, 40, added to the website posting with a note on Instagram, saying:

“Dear friends … I just want to thank you all for the love and support you’ve shown for the past few months. Believe me, it hasn’t gone unnoticed and I’m eternally grateful to have such an amazing set of friends and family.

“I’m getting better every day,” he said. “So now, without further ado, the show must go on. We can’t wait to get on the road and live out loud! Our passion has only grown stronger.”

The tour will begin in Chicago on March 28, with dates in Pittsburgh, New York, Toronto and other cities up through April 12 in Quebec City.

The band said it would announce additional West Coast dates in early 2013.

Tickets for the postponed shows will be honored at the new dates, Green Day said. Tickets for canceled shows will be refunded at the point of purchase.

In November the band moved up the release date of “iTré!,” part of an ambitious trilogy of albums that marks their first collection of new music since 2009, to December 11 from its original date of January 15, in part to make up for the canceled and postponed dates.

The California-based punk rock band, formed in the late 1980s, has sold more than 65 million records worldwide and won five Grammys, including best alternative album for its 1994 major-label debut, “Dookie,” and best rock album for “American Idiot” and “21st Century Breakdown.”

(Reporting by Chris Michaud; Editing by Jill Serjeant and Bill Trott)

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Well: Managing Diabetes, Then Told of Cancer

Nine years ago, Brenda Gray, a former schoolteacher in North Carolina, discovered she had Type 2 diabetes.

Since then, she has learned to manage the disease, diligently taking her medicine and keeping tabs on her blood sugar. But in September, she was told she had skin cancer, and her diabetes spun out of control.

Ms. Gray started an aggressive course of treatment that included radiation therapy. But the treatments weakened her and destroyed her appetite. Unable to eat, she developed dangerously low blood-sugar levels, and about two months ago, Ms. Gray’s daughter had to rush her to a hospital.

“She found me in bed shaking and sweating,” said Ms. Gray, who is 62 and lives in Durham. “When I got to the hospital, they couldn’t understand how I was still standing.”

Cancer and diabetes are two of the leading killers in America. Each can be a devastating diagnosis in its own right, but researchers are finding that the two often occur together. By some estimates, as many as one in five cancer patients also has diabetes.

In a recent joint report, the American Cancer Society and the American Diabetes Association noted that people with Type 2 diabetes have an increased risk of developing cancers of the liver, pancreas, colon and bladder. Researchers with the National Cancer Institute released a similar report last year, which found greater rates of cancer among diabetics, as well as an elevated risk of dying from cancer.

Experts say it is clear from accumulating clinical data that the two share some biological links. The problem results from simple demographics as well: with the rapid rise in Type 2 diabetes and a growing population of cancer survivors, the two diseases are coinciding more frequently in older patients.

“We are going to see a lot greater numbers of people with both diseases,” said Edward Giovannucci, a professor of nutrition and epidemiology at the Harvard School of Public Health and an author of the joint report. “By some estimates, the link between diabetes and cancer may quantitatively become even more important than the link between smoking and cancer.”

Already, oncologists say, it is not uncommon to encounter patients struggling to balance cancer treatments with insulin shots and diabetes drugs. Because cancer is generally seen as the more lethal of the two diseases, patients often make it the priority.

“Although cancer is no longer generally a death sentence, for many patients, they see it as that no matter what you say,” said Dr. June McKoy, a geriatric oncologist at the Northwestern University Feinberg School of Medicine. “Suddenly, they put their diabetes on the back burner, and they focus on the cancer.” But high blood sugar can damage kidneys and blood vessels, strain the immune system and worsen cancer prognosis.

Researchers say that the link between the two diseases is complex and driven by many factors. Typically, though, it is diabetes that sets the stage for cancer. “Most cancers don’t cause diabetes,” said Dr. Pankaj Shah, an endocrinologist at the Mayo Clinic in Rochester, Minn. “Mostly diabetes increases the risk of cancer.”

Type 2 diabetes is often preceded by chronically high insulin levels and high blood sugar, fertile conditions for cancer. Insulin is known to fuel cell growth, and cancer cells consume glucose out of proportion to other nutrients. The two diseases share many risk factors as well, including obesity, poor diet, physical inactivity, smoking and advanced age.

Another factor that complicates the relationship is the treatments given to patients. Diabetes drugs can have an impact on cancer prognosis and vice versa. Type 2 diabetics treated with the drug metformin, for example, develop cancer less frequently than diabetics given other medications. A number of clinical trials are now under way to see how well the drug performs as a cancer treatment.

Drugs used against cancer, on the other hand, tend to worsen diabetes. Chemotherapy can wreak havoc on blood sugar levels, and glucocorticoids, which are widely prescribed to alleviate nausea in cancer patients, promote insulin resistance, said Dr. Lorraine L. Lipscombe of Women’s College Hospital in Toronto.

Dr. Lipscombe was the lead author of a large study last month that found that breast cancer survivors were 20 percent more likely to receive a diabetes diagnosis than other women. The study found evidence that glucocorticoids and chemotherapy may hasten the onset of diabetes.

“They don’t cause diabetes in everyone, but they can bring out or unmask it in people who might already be vulnerable,” she said.

For diabetics who are used to tightly monitoring their blood sugar levels, the impact of cancer drugs can be alarming. Rigoberto Cortes, 71, a former metal worker in Chicago, has had Type 2 diabetes for over two decades. A year ago, he was told he had Stage 3 colon cancer.

“When I started chemotherapy, my sugar level was going way up and way down like never before,” he said. “I kept asking my oncologist what I should do.”

Mr. Cortes said his oncologist was not very concerned by the blood sugar swings. He eventually got a second opinion and switched doctors. He also lost weight and changed his eating habits, which helped minimize his blood sugar swings.

Although every case is different, the general strategy in treating such patients should be to get the cancer under control first, said Dr. Shah at the Mayo Clinic.

“Diabetes treatment essentially is given to prevent long-term complications,” he added.

At some hospitals, oncologists may take responsibility for managing blood sugar and other diabetes concerns in their cancer patients. But ideally, treatments should be coordinated by a team that includes a certified diabetes educator.

“They go over diet with the patient, review their medication, review their insulin,” said Dr. McKoy of Northwestern. “They can play a big role.”

For a diabetic trying to navigate the world of cancer, or a cancer patient navigating the world of diabetes, such interventions can be crucial. In a study published in October, Dr. McKoy and her colleagues looked at several years of health records for over 200,000 people with Type II diabetes who developed cancer.

Those who underwent a diabetes counseling session after their cancer diagnosis — consisting of two sessions a week for four to six weeks — were more likely to receives tests of hemoglobin A1c levels, a barometer of how well blood sugar has been controlled over time, and to take care of their blood sugar levels. As a result, they had fewer emergency room visits, fewer hospital admissions and lower health care costs.

Ms. Gray, the former schoolteacher in Durham, learned this firsthand. After her recent emergency, she worked with a diabetes educator at Duke University Hospital. Ms. Gray learned tips and strategies to balance the two diseases, including ways to keep her blood sugar normal when cancer treatments ruin her appetite.

“I came into the hospital and they got me back on track,” she said. “I was just so focused on the cancer. It changed everything. But I’ve learned how to face this.”

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