A teenage boy is still in danger after an asthma attack that stopped his heart. A girl is unconscious after life-threatening seizures. A 10-day-old baby has just had emergency abdominal surgery.

Piehl is paid to take care of these children, and that job alone keeps him plenty busy. But for Piehl, simply saving children's lives and sending them home isn't enough. He wants to make sure that some children never end up in peril -- and he is making it happen.

In the past two years, Piehl has become a self-made leader in the prevention of childhood Type 2 diabetes, a growing epidemic that arises from obesity.

Piehl, 39 and a father of three, says he got tired of watching kids suffer from a disease they could have avoided.

"I see kids over and over coming in depressed, missing school, because they can't control their diabetes," Piehl says. "It doesn't have to happen."

Nearly every week, he says, diabetic children come to the emergency room lethargic, vomiting, with blurred vision. Some are on the verge of diabetic coma, which can cause brain damage and is sometimes fatal.

Several years ago, he watched a 14-year-old boy linger for a week before finally dying from the complications of Type 2 diabetes.

Other diabetic children have skin infections, ulcers, blood clots.

Piehl wasn't the first to see that Type 2 diabetes in children was a problem growing out of control.

Type 2 is the kind of diabetes that is linked to poor eating habits and a lack of exercise. In the past, it was mostly an affliction of older adults. It is distinct from Type 1 diabetes, an unpreventable condition that causes the body to stop producing insulin and usually begins in the early teen years.

In the past decade, Type 2 has become a huge health threat to children -- garnering national press and prompting calls to curb childhood obesity.

But most doctors didn't know how to fix something that was far more complicated than anything a pill could fix. They could tell parents and children to eat healthier and exercise -- but they couldn't force them to comply.

"It's easy to get cynical and feel like there's not a lot you can do about it," says Dr. Mike Cinoman, director of pediatrics at WakeMed. "Mark has found a way to lick a problem that is extremely, extremely difficult."

Signs of progress

Two years ago, Piehl corralled a group of supporters, applied for grants and started "Energize!" The 12-week program at WakeMed targets overweight children who have elevated blood sugar but are not yet diabetic. The children attend classes three times a week to exercise, learn about healthy eating and self-esteem and talk with counselors about how to change their unhealthy habits.

So far, about 300 children have enrolled in the program, and initial results show that about half finish the program with normal blood sugar levels, WakeMed officials say.

In November, the Raleigh-based John Rex Endowment, which gives grants to improve health care, awarded Piehl its Hands of Health Award for innovation in the field. The foundation president, Kevin Cain, says the Energize! program is a regional model for fighting diabetes in children.

Piehl says that kids coming into the program are often drinking liters of soda or sugary juices and eating fast food every day. Some are watching four or five hours of television daily.

A year ago, Julia Bussey's son, Aubrey, was one of those children. At 9, Bussey says, Aubrey would proudly eat as much as his father. On weekends, he would sit in front of the television eating snacks. And when it wasn't football season, he got virtually no exercise.

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