Written by Shaista Zainul, RN CDE, Diabetes Outreach Coordinator, William Osler Health System
Eleven million Canadians are living with diabetes or pre-diabetes and the number of people affected by this illness continues to grow each day. In fact, according to the Canadian Diabetes Association, diabetes is estimated to rise by 44 per cent from 2015 to 2025 in Canada. This is a very challenging disease for patients, caregivers and loved ones, and can touch anyone. Without proper management, the illness can seriously affect major organ systems in the body, and the quality of life of anyone living with the disease.
As we collectively work towards helping lessen the prevalence of diabetes and living healthier lives, it is vital for people to have the knowledge at hand to understand and help prevent or effectively manage it.
So, what is diabetes? In order for glucose (sugar) to be used as energy by the body, it needs a hormone called insulin, which is produced by the pancreas. Individuals are diagnosed with diabetes when the pancreas is not able to produce enough insulin and glucose remains in the blood stream, causing high blood sugar.
The different types of diabetes are:
- Type 1 - occurs when the pancreas does not produce any, or very little insulin. Type 1 diabetes usually develops in childhood and requires insulin to regulate blood sugar levels.
- Type 2 - occurs when the pancreas does not produce enough insulin; or the insulin being produced doesn't work effectively. Approximately 90% of people living with diabetes have Type 2 diabetes.
- Gestational diabetes - this can occur during pregnancy when hormones cause the body's insulin not to work well, resulting in high blood sugar. A woman who has had gestational diabetes is at an increased risk of developing Type 2 diabetes later in life.
Some signs and symptoms of high blood sugar include excessive fatigue, unusual thirst,
excessive urination, increased hunger, cuts that take longer to heal, blurred vision, numbness or tingling in the hands or feet, weight change and frequent or recurring infections. However, it is important to note that one can have high blood sugar without experiencing any of these symptoms. This is why it is important to have regular checkups with your family physician.
Typically, individuals who are at greater risk of Type 2 diabetes include those who have a biological family member with diabetes, are overweight, have high blood pressure or high cholesterol, and/or are of Aboriginal, Hispanic, South Asian or African descent.
Pre-diabetes is also a diagnosis that should not be taken lightly. It refers to blood glucose levels that are higher than normal, but not high enough to be diagnosed with diabetes. If this condition is ignored, the individual may be at risk of developing Type 2 diabetes. This is a critical period, as although a diagnosis of diabetes may not be preventable for some, for others, being aware of risk factors and implementing healthy lifestyle practices can help decrease the risk or delay onset of the disease. Should you have pre-diabetes, we encourage you to consult with your local diabetes education centre to learn about self-management skills which you can apply to your daily routine.
Some of the healthy lifestyle practices recommended by the Canadian Diabetes Association include increasing physical activity, maintaining a healthy weight and establishing a daily healthy eating routine. Adopting these practices can help effectively manage blood sugar levels, preserve organ function and prevent serious complications such as a heart attack, stroke, blindness, amputation or kidney failure.
For the past 26 years, William Osler Health System's (Osler) Diabetes Education Centre has been dedicated to supporting patients with diabetes and pre-diabetes in the community. It provides education on things like monitoring blood sugar levels, medication administration, physical activity and detailed nutritional counselling. The centre, which has been accredited by the Canadian Diabetes Association five times, provides personalized care to patients and equips them with the knowledge and skills needed to cope with this illness. Honoured to be part of their circle of care, Osler's diabetes educators work with patients to set goals tailored to their lifestyle and monitor progress through follow up appointments to successfully manage their diabetes.
If you think you might be at risk for developing diabetes, we recommend that you complete the Canadian Diabetes Risk Questionnaire (CANRISK), and speak to your doctor regarding screening.
Shaista Zainul is a Registered Nurse and Certified Diabetes Educator. As the Coordinator of the Diabetes Outreach Program at William Osler Health System, she and her team of educators conduct monthly clinics and presentations at various community locations. She is passionate about helping our communities implement healthy lifestyle measures to lower diabetes in the region.
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Commonly referred to as Juvenile Diabetes, because it’s often diagnosed in childhood. However, it can also be diagnosed in adults. Type 1 diabetics have a pancreas that produces little or no insulin, which requires insulin management through medication that is usually injected.
Type 2 diabetes is a chronic condition that almost always develops in adulthood — which is why it’s sometimes referred to as adult-onset diabetes. "About 90 per cent of diabetics are Type 2, meaning that their ability to produce adequate levels of insulin is highly compromised and they have significant levels of insulin resistance,” says Dr. Barry Sears, president of the Inflammation Research Foundation. "The combination leads to significant increases in a variety of additional disorders — in particular heart disease and Alzheimer’s — in addition to the standard problems of loss of vision, increased amputation, and kidney failure."
Insulin is a hormone. It’s produced by the islet cells of the pancreas, and its role is to regulate glucose levels in the blood. The pancreas secretes insulin into the bloodstream, where it works to allow sugar to enter the cells and lowers the level of sugar in your bloodstream. As blood sugar drops, the secretion of insulin from the pancreas does too. While both types of diabetes involve insulin and the functioning of the pancreas, there are key differences in their causes and treatments.
Symptoms of type 1 diabetes include the emergence of bedwetting in children, frequent thirst, frequent urination, unintended weight loss, extreme hunger, blurred vision, and fatigue.
With type 2 diabetes, the condition can exist for years before diagnosis. But many of the symptoms are the same as with type 1: blurred vision, unexplained weight loss, excess thirst and urination, fatigue. Also watch for sores or infections that are slow to heal, as type 2 diabetes can affect your ability to heal and fight infection. As well, areas of darkened skin (acanthosis nigrican) in creased areas like the armpits and neck are a sign of insulin resistance.
A variety of factors may contribute to the development of type 1 diabetes, according to the Mayo Clinic, including possible genetics and exposure to certain viruses. Risk factors for the disease include family history and young age, with peaks in outset occurring between ages 4 and 7 and ages 10 and 14.
With type 2 diabetes, the risk factors include having excess fatty tissue, carrying fat around the abdomen, having a family history of diabetes, being inactive, having polycystic ovary syndrome, and getting older. As well, people of black, Asian, Hispanic, and Aboriginal backgrounds are at higher risk of developing type 2 diabetes, though it’s not known why.
Interestingly, the incidence of type 1 diabetes increases as you travel away from the equator, according to the Mayo Clinic, leading some researchers to think it could develop more readily in winter than summer. The highest incidences of type 1 diabetes are found in Finland and Sardinia, for example, where rates are about double or triple those in the U.S. and 400 times those in Venezuela.
It’s unknown exactly what causes type 1 diabetes, but in those with the condition, the immune system attacks the insulin-producing cells of the pancreas. In type 2 diabetes, the islet cells are still functioning as they should, to release insulin — the problem instead is that the pancreas doesn’t produce enough insulin, the body becomes resistant to the insulin, or both. But while we know about some contributing factors, it’s also not known exactly what causes type 2 diabetes.
Type 1 and type 2 diabetes can both have serious effects on your health if not managed. Diabetes can affect your eyes, heart, blood vessels, nerves, and kidneys, though keeping your blood sugar levels well managed does a lot to mitigate these effects. Nerve damage can manifest in loss of feeling or pain, usually beginning in the feet or hands. It could cause gastrointestinal problems or erectile dysfunction. Damage to the blood vessels in the kidneys can lead to kidney failure or kidney disease. Eye problems are also seen in some diabetics, and problems in pregnancy are also a risk.
Prevention of type 2 diabetes can be done in part through dietary choices, and making sure you get enough magnesium may be one of them. "Magnesium plays a pivotal role in the secretion and function of insulin,” Dean says. “Without it, Type 2 diabetes is inevitable.” Measurable magnesium deficiencies is common with the condition, she says, and related to many of the related complications.
Managing stress and anxiety can also help to keep your overall health steady, including possibly staving off type 2 diabetes. "The connection between stress, obesity and diabetes cannot be overlooked,” Dean says. "The stress chemical cortisol signals a metabolic shutdown that makes losing weight almost impossible. Magnesium can neutralize the effects of stress and is known as the anti-stress mineral.” And of course, if you do have diabetes, it’s easier to manage your condition if you aren’t overwhelmed.
There is no cure for type 1 diabetes, though the disease is manageable and treatment has advanced considerably in recent decades. Those with type 1 diabetes must take insulin for the duration of their lives; the physician works with the patient to find the best insulin and dose for blood sugar maintenance. Other medications may be required for related conditions. Not all type 2 diabetics require insulin therapy, but some do. For both types, regular exercise and a healthy diet, along with weight control, can also help keep glucose levels consistent.
For some type 2 diabetics, bariatric surgery may be an option to lose weight and control the disease. However, the surgery does involve serious risks that should be discussed with your physician.
If you suspect you or a family member has type 1 or type 2 diabetes, it’s important to seek medical help as soon as possible. It may be helpful to keep track of your symptoms leading up to the appointment, and go in with a list of your medications and general information about your diet and exercise routines.
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