Deciphering the demographics of this disease
Serenity Aberdour, ND
Diabetes affects 3 million Canadians. With its incidence continuing to rise, it's time to take prevention of diabetes seriously. Could you be at risk?
Diabetes is a disorder in which the body is unable to properly regulate blood sugar. As a result, blood sugar levels climb too high and this, over time, causes damage to various body tissues. More than 3 million Canadians are currently living with diabetes, and the numbers are rising.
The role of insulin
In all cases of diabetes, the underlying issue is the body’s level of and/or reaction to the hormone insulin. Insulin’s job is to keep our blood sugar levels down, and our pancreas should naturally release some in response to increased blood sugar—after eating, for example. In the case of diabetes, the body either does not produce enough (or any) insulin or the cells of the body do not respond properly to it.
Types of diabetes
The three main types of diabetes are known as gestational, type 1, and type 2.
Gestational diabetes is a disorder that some women experience during pregnancy. It affects up to 4 percent of pregnancies and can lead to a variety of complications for both mom and baby.
Type 1 diabetes usually starts very early in life. In this case, the body is unable to produce insulin. People with type 1 diabetes rely on injectable insulin for their survival and must maintain a proper injection schedule in order to keep their blood sugar levels under control. Type 1 diabetics did not survive very long before Canadian researchers invented insulin in the 1920s, but these days they can lead full, healthy lives.
Type 2 diabetes is the main form and accounts for about 90 percent of all diabetes cases. It generally develops in adulthood (though an alarming increase in childhood cases of type 2 diabetes is now being seen). In this diabetes, either the pancreas does not produce enough insulin or the body does not respond properly to the insulin because cells have lost their sensitivity to it.
In early stages, the classic symptoms of diabetes are increased thirst, hunger, and urination. Unusual and persistent tiredness, frequent infections, and/or infections that do not heal well are also commonly seen.
For all individuals with diabetes, a long list of complications can arise if the condition is not well managed. These are the most common complications that can occur in anyone with diabetes.
High blood pressure and increased risk of heart disease and stroke often accompany diabetes. As much as 80 percent of deaths in diabetics are due to a heart attack or stroke.
Chronically elevated blood sugar levels can lead to nerve damage that may present as numbness or tingling and often affects the feet of those with long-term and/or poorly controlled diabetes.
Diabetics are at risk of foot infections because they cannot feel (and therefore may not properly care for) small cuts or other skin problems. Minor foot injuries can lead to serious infections, which, if left too long, may result in the need to amputate part of the foot and leg. This sounds extreme, but each year in Canada, thousands of diabetics undergo limb amputations as a result of complications from diabetes.
Diabetes tends to attack the retina, the back part of the eye that is rich in blood vessels. Known as diabetic retinopathy, this type of eye disease is the leading cause of blindness for North Americans under age 65. It is extremely important that diabetics have annual eye exams to monitor their eye health.
The kidneys are another common site of damage for diabetics. About one-third of people who have had diabetes for longer than 15 years will eventually suffer from kidney disease.
This concern is about twice as common among diabetics as it is in the general population. Although it is not clear what causes this increase in risk, factors that may contribute include the stress of living with a chronic illness and the direct impact of metabolic changes on the brain.
Diabetes and men’s health
In addition to the complications listed above, men with diabetes are also at increased risk of sexual health concerns. At least 50 percent of men with diabetes will experience erectile dysfunction (ED) as a result of nerve, circulatory, or other complications of chronically high blood sugar levels.
This is a serious issue not only for the sexual and emotional well-being of men, but also for their heart health. It has been shown that ED in diabetics can be an important early warning sign for future cardiovascular disease and is associated with a significantly increased risk of heart disease and stroke.
Diabetes and women’s health
Diabetes also presents additional complications for women. Women with diabetes can experience inconsistent menstrual cycles, including delays in the onset of their cycles (in the case of type 1diabetics) and earlier onset of menopause. Diabetic women have also been shown to have about twice the risk of menstrual irregularities as nondiabetic women.
This can have a big impact on a woman’s fertility, and diabetics may experience challenges when trying to conceive. Fertility rates improve, however, when blood sugar management is achieved.
Diabetics who become pregnant are recommended to receive extra monitoring for blood pressure, eye health, and other potential complications. Some medications used to treat diabetes complications such as high blood pressure may not be suitable during pregnancy, and alternate medications may need to be prescribed.
Blood sugar levels should be very tightly controlled in order to avoid potential risks to the baby, such as fetal malformations that can occur if blood sugar levels are not maintained at a healthy level throughout pregnancy. On the other hand, hypoglycemia (blood sugar that is too low) can be a serious concern for the pregnant diabetic (particularly type 1diabetics) and must be avoided as well. For women using insulin, doses may have to be adjusted throughout the pregnancy.
Diabetes and seniors
The risk of type 2 diabetes increases with age, making seniors a vulnerable population. It is important for blood sugar levels to be checked as part of the regular annual physical for seniors, particularly because new onset diabetes may manifest differently in seniors and may only be caught by routine monitoring.
Diabetics are also at increased risk of complications over time, and so seniors with diabetes must be particularly aware of maintaining healthy blood sugar levels and have regular checkups to monitor kidney, eye, and cardiovascular health.
Seniors with diabetes have a higher risk of dangerous hypoglycemia and other adverse effects of diabetes medications.
A US study found that four drug types were responsible for 67 percent of drug reactions requiring hospitalizations in those over 65 years old. Of these four medications, two were diabetes drugs. This is partly due to the difficulty of stabilizing blood sugar levels in seniors and partly due to the increased number of medications that many seniors are prescribed, some of which can interact poorly with medications for diabetes.
The neurological complications of diabetes can also present a particular challenge for seniors. Neuropathy can lead to problems with balance and coordination, which can increase the risk of falls. Falls present a major threat to the well-being of seniors because of the potential for fractures. Hip fractures in seniors due to falls result in disability and even death for many older Canadians every year.
Risk factors for type 2 diabetes
Being over 40 years old increases your risk of developing diabetes. This may be partially due to other factors associated with aging, such as loss of muscle mass, decreased exercise, and weight gain.
Having a sibling or a parent with type 2 diabetes may also put you at risk.
Individuals from certain ethnic groups are at a higher risk, including those of African, Hispanic, First Nations, or South Asian descent. First Nations and new immigrant populations (see sidebar) are higher risk groups that have particular relevance for Canada.
Being overweight substantially increases your risk of developing diabetes. Obesity decreases the body’s sensitivity to insulin so that, even if your pancreas is working hard to pump out insulin, the body just cannot react to it appropriately.
Exercise plays a very important role in maintaining healthy blood sugar levels and is a key factor in both diabetes prevention and management.
Smokers are about twice as likely to develop blood sugar control problems as nonsmokers. However, even “passive smokers” (those exposed to second-hand smoke) are at an increased risk. Smoking, as is now well known, also increases the risk for heart attack, stroke, and circulatory problems, all of which are more likely to occur in diabetics.
Although certain risk factors for diabetes cannot be modified (age, ethnicity, genetics), the vast majority of them can. It is widely believed that type 2 diabetes is a preventable disease for most people and that lifestyle and dietary choices could save thousands from developing diabetes. The following are key preventive measures.
Weight loss and maintaining a healthy weight
As mentioned above, extra weight makes it much harder for the body to properly regulate blood sugar.
Butting out is one of the most important things that can be done to improve heath. The number of illnesses avoided and health dollars saved by quitting smoking is so high that all Canadian provinces have some type of government sponsored service to help residents quit. In BC, nicotine gum and patches are even covered by the provincial health care plan, allowing smokers to access these tools at no additional cost. Check to see what your provincial health care plan covers.
Aim for at least 30 minutes of physical activity on most days of the week. Enjoy a combination of both cardiovascular exercise (such as brisk walking, cycling, jogging, and dancing) and strength training (weights, Pilates, climbing, or a similar activity).
Diets rich in vegetables and fresh fruit and low in refined carbohydrates and processed foods are associated with a decrease in diabetes risk. For those with diabetes, a similar diet that more tightly controls carbohydrate intake can help maintain healthier blood sugar levels.
Supplements for diabetes
While supplements may not necessarily prevent the onset of diabetes, some may reduce the risk of developing this disease. Supplements can also be helpful for those who have already been diagnosed, depending on their particular situation. Here are a few examples; however, always consult your health care practitioner to determine if they are right for you.
This mainstay of complementary therapy for diabetes has been well used and well researched for many years, so you may already be familiar with it. What you might not know is that it may not be helpful for everyone. While some studies have suggested that chromium can help diabetics by improving blood sugar control, other research has shown less promising results.
The most important factor in determining whether or not chromium supplementation will help is the patient. Some research suggests that those more likely to benefit from chromium are type 2 diabetics with insulin resistance and higher HbA1c levels. (HbA1c is a blood test that tells us about long-term blood sugar control). If a diabetic has poor blood sugar control (and therefore high blood sugar a lot of the time), they will have a higher HbA1c than a well-controlled diabetic. Diabetics with good blood sugar control may benefit less from chromium supplementation.
This very busy mineral plays a key role in hundreds of reactions that keep our body going, including those involved in blood sugar regulation. Increased intake of magnesium rich foods such as nuts, leafy greens, and beans has been associated with decreased risk of type 2 diabetes.
Magnesium supplementation may also be helpful for diabetics, especially those with depleted levels of this mineral. In elderly type 2 diabetics with low magnesium, supplementation may aid in the treatment of depression. In type 2 diabetics in general, an average daily dose of 360 mg of magnesium over approximately 12 weeks has been shown to help increase HDL (“good” cholesterol) levels and decrease fasting blood sugar levels.
Alpha-lipoic acid (ALA)
Another popular supplement for diabetics, ALA has been studied mostly for its ability to prevent and treat diabetic neuropathy. Overall, studies in the treatment of this condition show that ALA at a dose of about 600 mg a day can be helpful in relieving symptoms. Side effects are also uncommon, and interactions with diabetes medications do not seem to be a concern, making ALA worth a try for those with neuropathy.
Type 2 diabetes rates have increased substantially in recent years. This chronic illness takes a huge toll on the length and quality of life of many Canadians and also on our health care system. But it really does not have to be this way. Understanding risk factors and putting in place appropriate lifestyle and dietary habits can dramatically reduce your risk of developing this disease and, for those who already have diabetes, can reduce the possibility of complications and promote a long and healthy life.
Diabetes and children
The majority of diabetes cases in children are type 1. It used to be essentially unheard of for children to have type 2 diabetes—hence one of the older names for this form of the disease: adult onset diabetes. Unfortunately, type 2 diabetes cases are not only now seen in children, but also rising at an alarming rate.
Almost all children with type 2 diabetes are overweight. And as childhood obesity rates soar (currently more than one in four Canadian children are considered overweight or obese), so too will childhood type 2 diabetes. For First Nations children, the percentage of overweight or obese children is more than 40 percent—showing, again, that this population is even harder hit by the risk of diabetes than other Canadians.
Children with type 2 diabetes are at risk of the same complications as adults but can develop them much more quickly. These children are also more likely to suffer from high blood pressure and elevated cholesterol levels, increasing their risk of cardiovascular disease at a young age.