When the first symptoms appeared, Phil Boucher had an inkling.

"I noticed my mouth was very dry. I was drinking large volumes of juices, and I was tired all the time," he says. "My mother had diabetes, and I knew I had some of the same symptoms. I went to my doctor, and a blood test showed that my blood sugar had skyrocketed."

As our nation has grown heavier and less physically active, Type 2 diabetes has become increasingly common. Individuals with this chronic illness don't produce enough insulin and their bodies don't use insulin effectively. Insulin, a hormone produced in the pancreas, helps sugar—the body's fuel—reach the cells from the blood. Without sufficient insulin, sugar builds up in the blood, leaving the cells without energy. Over time, high blood sugar levels can cause serious complications affecting eyes, feet, kidneys, and heart.

Weight loss and exercise
At MIT Medical, a team of experts—primary care physicians, nurse practitioners, and pharmacists, as well as Eye Service clinicians and specialists in endocrinology, nutrition, and podiatry—is available to treat and support patients with Type 2 diabetes. The main goal of treatment is to lower a patient's blood sugar level. This can often be accomplished through permanent changes in lifestyle and diet, including meal planning, weight loss, and exercise.

"Individuals who are overweight are at increased risk for Type 2 diabetes," explains nutritionist Anna Jasonides, R.D. "And since most patients with Type 2 diabetes are overweight, the big-picture goal is for them to lose weight."

Jasonides admits that losing weight and keeping it off is never easy. But, she says, even a moderate weight loss can produce results. "Research has shown that a weight loss of just five to 10 percent can significantly improve blood sugar levels. For many patients with Type 2 diabetes, a moderate weight loss will get blood sugar down to a level where they can avoid medication."

This was true for Boucher, who weighed 313 pounds when he was diagnosed. "I knew I didn't want to take medication," he says emphatically. "It's costly, and all medications have side effects." Boucher changed his diet immediately, and within a few weeks, his blood sugar level had decreased dramatically.

Weight-loss strategies abound, says Jasonides. But it all comes down to consuming less food. "Just changing one's morning ritual to a half a bagel instead of a whole one and having a small coffee instead of a large cappuccino can make a difference," says Jasonides. "We're not telling people to give up the food they like—just to eat in moderation."

"My whole way of eating has changed," Boucher notes. "Now I eat two or three fresh fruits a day, lots of vegetables, and less red meat. I used to eat meat and potatoes, desserts, a lot of juice. I never ate salad. But now I eat salads every day, and I get creative with them. I use different types of lettuce and spinach, and I put other interesting things in them."

And, Jasonides adds, there's always something a person can do for exercise. "Get off the subway one stop earlier, and walk the last few blocks to work," she suggests. "Exercise doesn't have to be something elaborate, like going to the gym."

If a patient isn't able to make necessary lifestyle changes, or if these measures fail to bring blood sugar levels under control, medication becomes necessary. "We usually try oral medications before insulin injections," explains MIT Medical pharmacist Georgene Bloomfield, R.Ph. "These medications stimulate more insulin production and help the body use insulin more efficiently."

Laureen Gray, R.N.,C.S., a nurse practitioner, provides education, support, and guidance to patients with Type 2 diabetes. "My goal is to motivate patients to participate fully in their own care. I try to educate patients about self-care management of the disease and to highlight the benefits of making healthy decisions." Gray also refers patients to other members of the diabetes care team when their particular expertise is needed or when patients are due for periodic screening exams.

Members of the MIT community can also turn to MIT Medical's Health Education Service. "We have extensive resources on weight management and nutrition," says health educator Marlisa Febbriello, M.P.H., "and I can consult with patients on exercise and nutrition decisions." Health Ed also offers fitness classes for men and women, along with workshops on weight management, nutrition, and diabetes.

Complications
The Heart: "We use a multi-pronged approach to preventing heart-related complications," notes MIT Medical endocrinologist Scott Grady, M.D. "Conditions like high blood pressure and high cholesterol go hand in hand with Type 2 diabetes. These conditions can be controlled with diet, exercise, and medication, all of which also bring down blood sugar levels. We know that improving patients' blood sugar levels reduces the incidence of stroke and heart disease down the road—and people feel better when their blood glucose is under control."

The Eyes: "Diabetic retinopathy is the leading cause of blindness in adults in this country," explains Patti Landry, O.D., an MIT Medical optometrist. "Diabetes damages the small blood vessels of the body, including those in the retina. In diabetic retinopathy, these blood vessels may leak or block retinal circulation.

"The longer a person has had diabetes, the more likely the development of diabetic retinopathy," Landry notes. "But," she emphasizes, "timely treatment can prevent vision loss." All patients with diabetes—even those without visual symptoms—should have an eye exam at least once a year. Landry also encourages patients to control their blood sugar, noting that clinical trials have shown that good control reduces the risk of diabetic complications, including eye problems.

The Feet: Neuropathy, a lack of sensation, often first noticed in the feet, is another complication of diabetes. People with diabetes can have blisters or cuts on their feet and not feel any pain, which puts them at risk of serious infections that may require hospitalization. Poor blood circulation in the feet, another effect of the disease, lessens the body's ability to fight infection and heal.

The goal is to prevent serious foot injuries, says MIT Medical podiatrist Harry Papazian, D.P.M. "The most important thing diabetics can do is to visually examine their feet on a daily basis—or get someone else to do it. In addition, individuals with diabetes should get a foot exam every time they visit a physician, and even those without foot complications should see a podiatrist once a year. Patients who find cuts or blisters on their feet need to see a doctor or nurse practitioner as soon as possible." Papazian also warns against ill-fitting shoes, which can cause blisters or other injuries that may go unnoticed by a patient with neuropathy.

Taking control
A team of dedicated MIT Medical clinicians is available with information, treatment options, and support for patients with Type 2 diabetes. But they all agree that self-management of the disease is crucial. "It involves a lifestyle change," Jasonides emphasizes. "I help patients set specific, reachable goals. No crash diets. Patients need to make permanent lifestyle changes—something they can live with."

This became clear to Boucher within months of his diagnosis. "Right after being diagnosed, I lost weight and my blood sugar came down. Then I binged, gained the weight back, and my sugar went back up. That was when I realized the diabetes was there to stay. And I finally understood that I had to change if I was going to beat it."

A year later, Boucher is down to 275 pounds and continues to lose weight slowly. "It took a lot of work to change," he emphasizes. "But now my blood sugar is under control, and I've lost about 35 pounds. I hope to lose more weight, but it's better to do it slowly. And I know that if I maintain my weight loss and follow the rules, I'll be okay."

You should have a blood test for Type 2 diabetes if you have a family history of diabetes, if you are overweight, if you have had gestational diabetes, or if you have any of the following symptoms:

• FREQUENT INFECTIONS

• VERY SLOW HEALING OF WOUNDS OR SORES

• FREQUENT NAUSEA

• FATIGUE, OR A FEELING OF CONSTANT TIREDNESS

• INCREASED URINATION

• INCREASED THIRST

• UNUSUAL WEIGHT LOSS

• BLURRED VISION