Beginners Guide to Diabetes

What is Diabetes?

Diabetes mellitus, or just Diabetes to simplify, is a metabolic disorder that is characterized by hyperglycemia (high blood sugar levels) due to impaired insulin production/secretion and/or insulin resistance. What this means is that a person with diabetes will have high blood sugar levels because their body either can’t produce insulin properly and/or their body can’t use insulin normally.

Why is hyperglycemia (high blood sugar levels) bad for you?

Having high blood sugar levels for a short period of time may not cause any long-term health effects (unless it is extremely high) but over a long period of time, it can lead to such things as heart disease, kidney disease, eye problems, weight gain, and a whole lot more. That’s why it is important to control your sugar levels (as well as other areas of your health) early to help prevent any of these long-term negative health effects.

Types of Diabetes

Diabetes can further be classified into 2 main types, Type 1 Diabetes and Type 2 Diabetes. Type 1 is usually diagnosed early on in life (before the age of 25) and Type 2 is usually diagnosed later on (after age 25). There are some other classifications such as pre-diabetes (think of it as borderline diabetes) and gestational diabetes (high sugar levels that arise during pregnancy) but we won’t focus on these in this at this time.

Type 1 – Mainly characterized as the inability to produce insulin (or very little insulin) due to a dysfunction/destruction in the cells in the pancreas (the main organ responsible for insulin production).

Type 2 – Mainly characterized as a resistance to insulin with adequate insulin production. Type 2 can progress to poor insulin production over time due to the body being overworked trying to produce higher levels of insulin to try and overcome the insulin resistance.

Symptoms and Diagnosis

It is not standard practice to test everyone for diabetes but it is a good idea to get tested if you notice any signs of hyperglycemia, have a family history of diabetes or are overweight. There are other situations that may warrant testing for diabetes (certain diseases, taking certain medications, age) but we won’t discuss this here (you should talk to your health care provider if you have any concerns).

Symptoms that may indicate hyperglycemia include increased thirst, increased urination, headaches, blurred vision, fatigue, trouble concentrating. These symptoms are not a guarantee of hyperglycemia but could be a result of hyperglycemia. Do get yourself assessed if you do experience these symptoms consistently.

Diabetes can be detected by measuring your blood glucose (sugar) levels. Two of the most common tests you’ll hear about is your fasting blood glucose (FBG) levels (your blood sugar levels in a fasted state (no food for 8 hours)) and your Hemoglobin A1c (HbA1c). An FBG level greater than 7.0 mmol/L or an HbA1c greater than 7.0% (sometimes only greater than 6.5%) would highly suggest diabetes. These numbers are obtained by a blood test.

If you have diabetes you and your health care team will monitor your glucose/sugar levels to assess how well your diabetes is being managed. For your reference, the target numbers for these tests are usually:

- Fasting Blood Glucose (FBG) between 4 - 7 mmol/L

o You may have your own blood glucose monitor and it will just display it as just the number (i.e. instead of 4.0 mmol/L it will just show you the number 4.0)

- HbA1c that is less than 7%

Other things that may be measured is your blood pressure and cholesterol levels. Talk to your health care providers to make sure these are being measured and that they tell you the targets for each for your own knowledge.

You don’t have diabetes; how can you make sure that you won't?

There is no way to guarantee that you won’t get diabetes because there are so many factors that are involved (genetics, environment, lifestyle, medications, other). BUT you can take steps to lower your risk. The following suggestions will mainly be in regards to lowering the risk of developing Type 2 diabetes.

Diet and Exercise – Weight is a major factor in the development of Type 2 diabetes and it is the one we can have the most control over. I highly recommend anyone that can afford to see a nutritionist and/or dietitian to do so. They have a wealth of knowledge and more and more these days we are recognizing and appreciating the link between what we eat and our health. In general, my recommendations are as follows:

- Reduce or eliminate processed food

o There is a great number of unhealthy fats, preservatives, salt in processed foods. There is also, very little nutritional value compared to unprocessed, whole foods. Whenever you can, eat fresh, eat whole, and eat organic.

- Vegetables over meat

o I’m not saying don’t eat meat. If you can though, there is a growing movement that says this may be the best option. But for the majority of us, that may not be something we can commit to at this time. However, we should be eating A LOT more vegetables. There are many more nutrients in vegetables (compared to meat) and in general, there are fewer calories per serving compared to meats.

Based on the latest Canada Food Guide, your meal plate should be portioned with:

½ plate of fruits and vegetables

¼ whole grains

¼ protein foods

Water as the drink of choice

Note that it is ¼ protein foods, it does NOT have to be meat but can be plant-based alternatives.

- Get moving (exercise)

If you haven’t heard it already, I’ll mention it here. 150 mins of aerobic exercise per week. Now you can divide this up however you want BUT you should have no more than 1 day of no exercise in a row per week. Math would suggest dividing your exercise into 30-minute sessions 5x per week with 2 rest days. For some of us, exercise may involve going to the gym. For some, it may be working out at home. For others it may be choosing to walk to work, taking the stairs, walking our pet, playing sports, or even some active Nintendo switch game. Whatever form you decide to get your exercise, I suggest you find something you like and find someone to do it with.

I am currently living with diabetes, am I doomed?

No, you are not. However, I won’t sugar coat things and say you can coast through the rest of your life. There are more things that you have to consider but if you take an active role in managing the condition then you can have as good of a life as anyone else.

I strongly believe that the right diet, and I don’t mean starving yourself, is THE most important thing that you can do to help manage diabetes. As mentioned above, vegetables should be a priority. There are plenty of programs available to people living with diabetes that offer nutritional and overall lifestyle advice. Adhering to the 150 minutes of aerobic exercise is also a great benefit.

Along with these lifestyle changes, medication and supplements are a key part of managing diabetes. In some cases, medication may only be needed initially to manage the glucose levels until the lifestyle modifications can adequately control the disease. Other times the disease may progress and additional medications may be needed to adequately control the disease.

Medications classes generally help with a few things:

- Increase insulin secretion/production (helps make more insulin)

- Increase insulin sensitivity (helps the body react better to insulin)

- Slow down the release of glucose into the blood

- Increase the elimination of glucose from the body

Medications can be oral tablets or injectables. Whatever medication is required a pharmacist can help you best manage when and how to take the medication, as well as explain any side effects, and make recommendations or adjustments to your medication regimen. They are a key part of your health care team and will work closely with you and the rest of the team to achieve the best results.

This has been my brief overview of diabetes.

There is much, much more information about diabetes and we can discuss this and help develop a plan to manage diabetes and help you optimize your health and feel great. All information was taken from the 2018 Canadian Journal of Diabetes.

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