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Conquering Diabetes

The world of diabetes management has changed dramatically over the past few years. New testing and treatment strategies are making life with diabetes easier, and it couldn’t come at a better time. It’s estimated that 9 million Canadians are living with diabetes or “pre-diabetes,” and many of them have no idea they even have a problem.

This number is expected to explode as the population ages, and it has been estimated that it will cost the health-care system $16.5 billion a year by 2020.

The key problem with diabetes is the body’s inability to control sugar (glucose) levels in the blood. When glucose enters the bloodstream after a meal, insulin released by the pancreas helps those sugar molecules enter the cells that need them. What we see in diabetes is that there is either not enough insulin, or the body isn’t able to use the insulin that it makes.
Type 1 diabetes is rare and usually discovered in patients at a young age. It’s caused by an immune destruction of the pancreatic cells that produce insulin. These diabetics are often very sick at the time of diagnosis and need to take supplementary insulin for life.

As for type 2 diabetes, it accounts for 90 percent of cases and is caused by a gradual inability of the body to respond to insulin. We often see the sugar slowly rise until it reaches the threshold where we can make the diagnosis.

Meanwhile, the phase between having a normal blood sugar and one high enough to be considered a diabetic is often called “pre-diabetes.” Progression to type 2 diabetes can be prevented, however, if changes are made during this important stage.
While typical features of high blood sugar include fatigue and frequent urination, often there are no early warning signs.

Screening for diabetes is therefore very important and should generally begin at age 40. Without proper treatment, diabetes can lead to devastating complications. It is the leading cause of blindness in Canada, for instance, and a major contributor to chronic kidney disease. It is also considered a risk factor for heart attack, stroke and nerve damage.

The first step in treating or preventing type 2 diabetes is physical exercise and weight loss. One study concluded that pre-diabetics could decrease their risk of progression by 16 percent for every kilogram of weight they lose. A balanced diet that favours complex carbohydrates over simple sugars is essential, along with a recommended 150 minutes of physical activity per week. Smokers who quit will also significantly reduce their risk of diabetes and its complications.

When these strategies can’t quite get the sugar under control, medication is added to the mix. Health Canada’s approval of several new drugs now means that we can create a treatment plan tailored specifically for each individual, regardless of coexisting medical conditions or allergies. These modern treatments can help release more insulin or make the body more sensitive to what is already there—all with very few apparent side effects.  

Discovering that you have diabetes can be frightening. But working with your doctor to diagnose it early and starting lifestyle or medication therapy immediately can drastically improve your chances of successful management of this serious disease.


Dr. Malcolm Hedgcock is a Toronto-trained family doctor living and working in Vancouver. He has a special interest in gay men’s health issues, including the primary care of those living with HIV and AIDS.