A Radical New Approach to Diabetes Management


More than 2 million Virginians are pre-diabetic, and more than 600-thousand already have the disease.  Doctors usually advise those with type II diabetes to lose weight and take medication, but a psychologist at UVA has developed a radically different approach as Sandy Hausman reports.

As an expert on changing behavior to control diabetes, Daniel Cox already knew a lot about the disease when he was diagnosed ten years ago.  The usual advice is to lose weight, but that prescription wasn’t right for him.

“Some people don’t need to lose weight,” he argues.  “We’ve had marathon runners with type-2 diabetes.  Some people don’t want to lose weight.  Some people can’t lose weight, and only about 10% of people who start into a weight loss program are able to keep it up at a three-year follow-up.”

Cox’s doctor also suggested medication, but the professor was hesitant.

“Popping a pill is a good option, because pills work, but the problem with medications is you start off, typically, with Medformin, and then you have to increase that dose to the max over years, and then the maximum amount isn’t effective, so you have to add additional pills,” Cox explains.

Eventually, he says, many people end up needing injections of additional drugs and insulin.  Instead, using new technology that monitors glucose continuously, he figured out which foods caused his blood sugar to spike.

“The sensor reads out what your current blood glucose level is right now and at the bottom it gives you a curve of where your blood glucose has been for the last four hours. So, for example, I can drink an IPA beer and it won’t raise my blood glucose at all, but if I drink a stout it will jump up 100 points.”

By eliminating or scaling back on carbohydrates that caused him trouble, Cox took the first important step for someone who was no longer able to metabolize sugar normally.

“The insulin in your body that is being released in response to that food is not working very well, and that’s what they call insulin resistance.  Your body is being flooded with high levels of persistent blood glucose which is toxic to the nervous system and to the vascular system.”

Next, he added exercise.

“The skeletal muscles, when they contract, they utilize that glucose in the blood and take it out of the blood basically.”

He’s not talking about intense, aerobic exercise – just moving around after meals.

“So instead of having a nice dinner and then flopping in front of the TV for the rest of the night – which a lot of us do – the game plan is after you eat, do something.  Do your grocery shopping, walk the dog, work in the garden, clean the house, shovel the driveway, etc. Put those routine activities after meals so that it burns that glucose and brings it back down quickly.”

Cox and his colleagues have studied the effects of this simple system and found it highly effective in reducing the risk for common side effects of diabetes and in boosting good cholesterol.

“It actually reduces your risk of cardiovascular disease.  We’ve demonstrated this in several studies.  It actually leads to improvement in your high density lipoprotein.”

What’s more, he says, most patients who try this approach like it.

“They are very excited and receptive to that, because again they are empowered.  They can control their diabetes instead of being a victim of it.”

He’s now recruiting people who’ve been diagnosed with type-2 diabetes within the last year – people not yet taking medication – to try his approach which, Cox says, has left him healthier than ever.  I’m Sandy Hausman.

To learn more about Professor Daniel Cox’s latest study on diabetes management, e-mail  T2dm@virginia.edu or call 434-566-2099.



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