Our Approach to Care for Type 2 Diabetes
Most Americans diagnosed with diabetes have Type 2 diabetes. With Type 2 diabetes, the body cannot use its own insulin effectively, a condition known as insulin resistance. Untreated Type 2 diabetes can affect major organs and lead to serious health problems, including heart and blood vessel disease, nerve damage, kidney failure, vision impairment and other issues.
Type 2 diabetes is a genetic condition that isn't cured with treatment. If a Type 2 diabetes patient’s elevated blood sugar levels improve in response to dietary changes, exercise and/or medication, it means the treatment is effective. It doesn’t mean the underlying genetic condition has gone away.
Our approach to patient care begins with the understanding that diabetes has a different impact on every patient. We integrate our ongoing research into our clinic, giving our patients access to the most advanced diagnostic and treatment services. Our expertise in genetics and diabetes allows us to examine each patient’s family history and identify candidates for genetic testing, as needed, to ensure that patients receive the most appropriate and effective treatment plans for their diabetes.
We build treatment plans tailored to address each patient’s needs. Our multidisciplinary team is equipped to support patients in managing every aspect of diabetes, from the medical and physical issues to the social and emotional challenges. Because diabetes is a lifelong disease, we approach care with a “life span model” of care. Our diabetes specialists are able to provide care to patients at every life stage.
We welcome the opportunity to provide a second opinion on your diagnosis or treatment plan. Our specialists are dedicated to helping you understand your options so you can select the best care plan for your needs. Our team will use previous test results and may conduct additional diagnostic tests such as advanced laboratory analysis, genetic testing, or other methods of evaluation to provide a full evaluation and build an individualized diabetes management plan.
Type 2 Diabetes
Controllable risk factors for Type 2 diabetes include:
- Obesity — about 80% of people with Type 2 diabetes are overweight
- Physical inactivity
Uncontrollable risk factors for Type 2 diabetes include:
- Age — risk increases with age
- Family history of diabetes
- History of gestational diabetes
- Ethnic background — African Americans, Native Americans, Latinos and Asian Americans are at higher risk
Our focus goes beyond managing diabetes. We’re working to prevent diabetes in people who are most at risk. Our diabetes prevention programs target ethnic groups that have a higher-than-average prevalence of diabetes, including African Americans and Hispanic Americans.
The University of Chicago has served as a clinical study site in the ongoing, multi-center diabetes prevention program (DPP), funded by the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Disorders (NIH/NIDDK). It has focused primarily on African Americans at high risk of diabetes.
To date, the study has shown that diet and exercise can prevent or delay the onset of Type 2 diabetes in certain people at risk (those with impaired glucose tolerance). Results have also shown that the oral drug metformin helped to prevent or delay Type 2 diabetes, although not as effectively as diet and exercise.
The Diabetes Prevention Program is a 27-center, randomized clinical trial designed to evaluate the safety and efficacy of interventions that may delay or prevent development of diabetes in people at increased risk for Type 2 diabetes. The University of Chicago was selected to participate as a research site. The area near the University of Chicago is comprised primarily of African Americans, a target population identified by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) as a group at high risk for diabetes.
At the University of Chicago, research focused in part on individuals with impaired glucose tolerance (IGT), a prediabetic condition that is associated with insulin resistance and increased risk of cardiovascular disease. The University of Chicago’s results supported those of the larger DPP study group, which substantiated that appropriate interventions can help prevent Type 2 diabetes from developing in individuals with IGT.
Type 2 diabetes usually doesn’t develop as rapidly as Type 1.
While some individuals have no symptoms, symptoms may include:
- Frequent urination
- Increased thirst and/or hunger
- Weight loss
- Blurred vision
- Slow-healing wounds or sores
People with diabetes who have other chronic illnesses, such as hypertension, cystic fibrosis, celiac disease, thyroid problems or polycystic ovary syndrome, benefit from customized treatment plans that take into account how best to manage diabetes when other health problems are present.
Pregnant women and women planning to become pregnant can take advantage of our unique diabetes and pregnancy program in partnership with the University of Chicago Medicine High-Risk Obstetrics Program.
Teens with diabetes receive special care through our transitions program that helps them manage their diabetes as they grow into adulthood. Patients who require surgery can receive expert care through University of Chicago programs in transplantation (heart, lung, liver, kidney and pancreas), cardiac surgery, orthopaedic surgery, vascular surgery and bariatric (weight loss) surgery.
Diet & Exercise
Complications from Type 2 diabetes can be greatly improved by lifestyle changes beginning with eating a healthy diet, being physically active and losing extra weight. If these lifestyle changes alone cannot control blood sugar, patients may also need medication or insulin replacement therapy.
Blood Sugar Monitoring & Insulin Replacement Therapy
Regular blood sugar monitoring is essential because even if a patient does not feel symptoms, their blood sugar may be at unhealthy levels, putting the patient at risk for complications. Physicians typically provide the patient with a glucometer — a device that uses blood to determine blood glucose levels. Patients often see their doctors for regular blood tests that show average blood glucose levels for the most recent two to three months.
Medication may be used to decrease insulin resistance, slow the digestion of food or increase insulin levels in the bloodstream and essentially decrease blood glucose levels after eating. Insulin therapy can be used to increase insulin circulating in the bloodstream.
Our patients have access to the newest glucose sensor technology and monitoring devices. Patients receive one-on-one education on how to use these important devices. Our insulin pump program offers options to select specific technology that best fits each patient's needs.
Answers to Common Questions About Type 2 Diabetes
When you have Type 2 diabetes, you first need to eat a healthy diet, stay physically active and lose any extra weight. If these lifestyle changes cannot control your blood sugar, you also may need to take pills and other injected medication, including insulin.
Eating a healthy diet, being physically active, and losing any extra weight is the first line of therapy. Diet and exercise is the foundation of all diabetes management because it makes your body’s cells respond better to insulin (in other words, it decreases insulin resistance) and lowers blood sugar levels.
If you cannot normalize or control your blood sugar with diet, weight loss and exercise, the next treatment phase is taking medicine either orally or by injection.
Diabetes pills work in different ways – some lower insulin resistance, others slow the digestion of food or increase insulin levels in the bloodstream. The non-insulin injected medications for type 2 diabetes have a complicated action but basically lower blood glucose after eating. Insulin therapy simply increases insulin circulating in the bloodstream.
Don’t be surprised if you have to use multiple medications to control your blood sugar. The use of multiple medications, also known as combination therapy, is common in the treatment of diabetes! If one medication is not enough, your medical provider may give you two or three or more different types of pills. Insulin or other injected medications also may be prescribed. Or, depending on your medical condition, you may be treated only with insulin or injected medication therapy.
Many people with Type 2 diabetes have elevated blood fats (high triglycerides and cholesterol) and blood pressure, so you may be given medications for these problems as well.
Type 2 diabetes is a genetic condition or predisposition that doesn’t change with treatment. But diabetes is defined as an elevated blood sugar level.
When your blood sugar is normal with no treatment, then the diabetes is considered to have gone away. However, even when blood sugar is controlled, because Type 2 diabetes is a genetic condition, the predisposition for diabetes always exists. High blood sugar can come back.
If you have Type 2 diabetes and your blood sugar is controlled during treatment (diet, exercise and medications), it means that the treatment plan is working. Your blood sugar levels have improved because of the treatment – not because your diabetes predisposition has gone away. You will need to continue your treatment; otherwise your blood sugar will go back up.
Maybe. Historically, 30% or more of people with Type 2 diabetes required insulin therapy. However there are many new drugs available that may delay or prevent the need for insulin therapy. It is expected that fewer and fewer individuals will need insulin replacement to control their blood sugar.
No. Taking insulin does not mean that you have Type 1 diabetes. Your Type of diabetes is determined by your genetics, not by the Type of therapy.
Not necessarily. If you can lose weight, change your diet, increase your activity level, and/or change your medications, you may be able to reduce or stop insulin therapy. Under certain circumstances, you may only need insulin temporarily – such as during pregnancy, acute illness, after surgery or when treated with drugs that increase the body’s resistance to the action of insulin (such as prednisone or steroids). Often the insulin therapy can be stopped after the event or stress is over.
Exercise is very beneficial in the management of Type 2 diabetes. Always consult with your doctor about exercise guidelines, to exercise safely and reduce risks.
If you eliminate concentrated sources of carbohydrates (foods that turn into sugar in your bloodstream) like candy and cookies, you may be able to reduce or eliminate the need for diabetes medications. Everyone with Type 2 diabetes will benefit from an improved diet, but you may still need other interventions, such as increased physical activity, weight loss or medications to keep your blood sugar in the target range. Check with your doctor about any diabetes medication dose adjustments that may be required if you change your diet.
You may feel fine, but that is no guarantee that your blood sugar levels are in the target range. Remember, diabetic complications do not appear right away. And complications may develop even when the blood sugar is only slightly elevated. Regular blood sugar monitoring can help you keep your blood sugar in control and prevent serious damage to your eyes, kidneys and nerves. If your sugar levels are out of line, consult your doctor.
Yes. Type 2 diabetes is a genetic disease. The risk is highest when multiple family members have diabetes, and if the children also are overweight, sedentary and have the other risk factors for Type 2 diabetes. Your child has a 10-15% chance of developing Type 2 diabetes when you have Type 2 diabetes. And if one identical twin has Type 2 diabetes, there is a 75% likelihood of the other twin developing Type 2 diabetes also.
Although we cannot change your genetic risk for developing Type 2 diabetes, we do know that even modest exercise and weight loss can delay or prevent the development of Type 2 diabetes. A landmark research study, conducted by the Diabetes Prevention Program (DPP) in the United States in the 1990s, showed that when people modified their risk factors for Type 2 diabetes, they reduced their chance of developing the condition. Similar results have been shown in Finland.
In the DPP study, people with pre-diabetes were enrolled and assigned to 3 different treatments:
- Intensive lifestyle changes – exercise (30 minutes, 5 days a week), a healthy diet, and weight loss (loss of 7% of initial weight)
- The diabetes drug, Metformin
- An inactive placebo disguised as Metformin
The group that made lifestyle changes was 58% less likely to develop diabetes compared to the placebo group. And the group that took Metformin was 31% less likely to develop diabetes compared to the placebo group. In other words – lifestyle changes and Metformin therapy can delay or prevent the onset of Type 2 diabetes. Lifestyle changes (weight loss, healthy diet and activity) are the most effective intervention.
Help us find the answers
To donate by mail:
The University of Chicago Kovler Diabetes Center
Knapp Center for Biomedical Discovery
Attention: Peggy Hasenauer
900 East 57th Street
8th Floor, Room 8144
Chicago, IL 60637
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Diabetes Care at UChicago Medicine
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