Your body with uncontrolled diabetes

Dr. Tobe says he often describes high blood sugar in the blood vessels as icing sugar that is being sprayed in a room, coating everything in sight and sticking to it.

“The net result is that everything becomes brittle and more worn out and the net effect over years of having high blood sugar in the blood vessels is that everything the blood vessels touch — which is everything in our body — is more likely to become damaged.”

Potential complications from uncontrolled high blood sugar are wide-ranging. Dr. Jain, who is the primary-care representative on the project advisory committee for the Canadian Diabetes Prevention Program (C-DPP), says patients could experience eye disease, foot and leg problems, heart attack, stroke, kidney disease or nerve damage.

“It’s important to properly manage blood sugars early on to reduce the risk of developing these complications, which can be very serious or even life-threatening,” he says.

The importance of screening

“A lot of people don’t have symptoms with diabetes,” says Dr. Jain. “The goal of screening is to catch people early before damage begins.”

For the general population, Dr. Jain says screening should begin at age 40 with a blood test. He says the recommended interval for screening is every three years, although he and Dr. Tobe say patients should speak with their family doctor to determine if and when screening is appropriate.

For those with a family history of diabetes, pregnant people who had gestational diabetes, people with prediabetes or certain cardiovascular risk factors can speak with their doctor about whether earlier and more frequent screening is right for them.

And certainly reach out to your doctor if you’re experiencing increased thirst, frequent urination, blurry vision or increased fatigue because these can be symptoms of diabetes.

Managing diabetes 

A diabetes diagnosis can be overwhelming, but Dr. Tobe says patients can start with changing exercise and eating habits.

“We try to help people build up their muscle and try to keep their calories under control,” he says.

Dr. Jain says to combat that feeling of being overwhelmed, patients can take a step-by-step approach, working with their family doctor and other health-care professionals.

“It’s a journey, it’s a process, and you don’t have to fix everything overnight,” he says. “And education is key.”

Sunnybrook has a diabetes education program, SUNDEC, providing participants with individual and group education sessions and resources to help understand and manage their diabetes.

It’s not your fault

Dr. Tobe says management with nutrition and exercise may not always be enough for patients because diabetes is a progressive disease.

This means doctors may eventually recommend medication to help manage blood sugar levels, or a patient may find themselves crossing the threshold from prediabetes to diabetes. And while it might feel like a failure, Dr. Tobe cautions against that mindset.

“We don’t want [patients] to feel like a failure,” he says. “Some people are just more genetically predisposed. If, unfortunately, despite all your best efforts you’ve crossed that threshold, it’s not your fault. But you must help yourself from progressing further and prevent the downstream complications.”

*Statistic from Diabetes Canada

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Along with these dietary changes, many also wonder if they should choose lower fat milk, avoid fried foods or opt for margarine over butter. While choosing foods containing lower levels of fats won’t directly improve blood sugar levels, this can help protect and improve heart health. That’s important because people living with diabetes may be at risk of developing heart disease up to 15 years earlier compared to people who don’t have this condition. Here are some of the reasons why:

Gender
In Canada, women with diabetes are 4 times more likely to develop heart disease due to its connection with hormonal levels during menopause, as diabetes cancels out the protective effect that estrogen provided.

Insulin resistance
Insulin resistance plays a role in the development of diabetes and prediabetes. Insulin is the hormone in our bodies that regulates energy or glucose, and resistance happens when the cells in your muscles, fat and liver don’t respond properly. Over time, your blood sugar levels go up because your body isn’t able to use glucose from your body for energy. Insulin resistance plays a role in the development of plaque in the arteries. If plaque builds up too much, it can lead to blocking the blood vessel, significantly increasing the risk of heart attack or stroke.

Unhealthy cholesterol levels
Diabetes can increase the risk of “bad” cholesterol in the body, and lower the “good” cholesterol, which in turn can increase the risk of stroke and heart disease.

High blood pressure
Many people with type 2 diabetes also have high blood pressure, also known as hypertension. There are likely many factors contributing to both conditions including obesity, a diet rich in fat and salt as well as inactivity.

Inactivity
Physical activity is important for overall general health, and may be especially important if you have diabetes. It can help maintain a healthy weight, keep the heart strong and reduce insulin resistance.

Increased body weight
Insulin therapy can lead to weight gain, as insulin promotes fat storage in the body. In turn, being overweight or obese means your heart has to work harder to do its job, increasing the risk of heart disease and other cardiac complications.

Ways to protect your heart

When it comes to diabetes there are many ways to protect your heart, such as having regular check ups with your doctor or endocrinologist to monitor your blood pressure, cholesterol and blood sugar A1C to get these levels into health ranges. The target ranges for blood pressure and cholesterol are much lower for people with diabetes, and similar to targets for someone who has already has had a heart attack or stroke. It’s also important to not smoke, and to take any medications as directed.

Coming back to diet, it plays a critical role. Worldwide, diets low in fruits and vegetable are major contributors to the risk of developing diabetes and heart disease, and nutrition therapy is an integral part of managing both conditions together. Generally, avoid processed foods as they are normally high in salt, sugar and saturated fat. Opt for fresh fruits, vegetables, legumes, beans, lentils, nuts, whole grains and lean proteins, while limiting alcohol intake. Be sure to reach out to your diabetes care team for more information and direction.

View the full Speaker Series event here:

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A new study has found 24-hour glucose monitoring during pregnancy improves birth outcomes for women with type 1 diabetes and their babies.

The study

Who: the study involved 214 pregnant women with type 1 diabetes, aged 18-40, who manage their condition with daily insulin therapy.

What: an implanted continuous glucose monitoring device that provided 288 glucose recordings per day.

How: half of the women received a continuous glucose monitoring device and half used a traditional monitoring method.

Where: the study took place in 31 hospitals in Canada, England, Scotland, Spain, Ireland, Italy and the United States.

The results

(when compared with traditional monitoring)

Moms

• Women using continuous glucose monitoring  spent more time in normal range for blood sugar levels (68% vs 61% – equivalent to 100 minutes more a day)
• Women using continuous glucose monitoring spent less time with high blood sugar levels (27% vs 32% – equivalent to one hour less per day).

Babies

• In moms using continuous glucose monitoring, the number of babies born larger than average was reduced (53% vs 69%)
• Fewer babies were admitted to intensive care for more than 24 hours (27% vs 43%)
• Lower number of babies were born with low blood sugar levels (15% vs 28%)

The Clinical Trial Services/Centre for Mother, Infant, and Child Research at Sunnybrook Research Institute coordinated this study*.

*The study is also referred to as CONCEPTT

What it means for you

• Talk to you doctor: Ask your doctor about the best glucose monitoring option for you.
• Reduce risk: It is crucial to keep blood sugar levels within the normal range.
• Plan ahead: If you’re thinking of becoming pregnant, speak to your health care team about managing blood glucose levels.

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What is Peripheral Artery Disease?

Peripheral artery disease (PAD) is the result of plaque building and causing narrowing in arteries inside the body.

Most commonly, it is the narrowing or obstruction of an artery that affects the blood flow to your legs.

The heart pumps blood.

The arteries deliver oxygen-rich blood throughout your body. Imagine this like a network of roads.

Plaque in your arteries narrows the size of the artery and blocks the flow of blood to your legs. Imagine this like a traffic jam when a road is damaged or a lane is blocked..

Symptoms

During early stages, there are often no symptoms of PAD, however medical management is important to prevent or limit progression

Cramping pain and weakness during walking (called claudication), numbness and tingling, or constant pain in the legs.

If the blood flow is severely restricted, painful ulcers or wounds can develop on the leg or foot that will not heal.

PAD puts you at risk for losing your leg. In Ontario, the amputation rate for patients with a painful ulcer and untreated PAD is 40%.

You are at risk if you are:

Smoke

Over age 50

Have diabetes

Have high cholesterol and/or blood pressure

Have had coronary artery disease or strokes in the past

You can reduce your risk:

Quit smoking

Exercise

Eat right

Work with your doctor to keep tight control of your blood pressure, cholesterol and blood sugar if diabetic.

For help quitting smoking, visit sunnybrook.ca/quitsmoking

For more information, talk to your doctor.

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While this sounds like something straight out of a movie like Supersize Me, it’s actually just a small sample of the foods being served up at Toronto’s CNE this year.

I’ll admit I was intrigued – until I got to the chocolate-covered hot dog. And as much as I love bacon, eating all of these artery-clogging foods in the span of a few hours sounds like a recipe for some major indigestion.

So, just how bad is it to eat all of these deep-fried delicacies in one go? Marsha Feldt, a dietitian with Sunnybrook’s Family Practice, says that while our bodies are designed to handle a lot, eating a burger containing several thousand calories is not the best idea. “These foods are already high in fat, and even more fat is added when you cook them in a deep fryer,” she says.

Many of the foods listed are high in sodium as well as carbohydrates, which your body converts to sugar during digestion. “People with certain medical conditions like high blood pressure and diabetes should definitely stay away from eating these kinds of foods, as it’s a heavy load for your body to handle,” says Feldt.

If you absolutely must taste test the outrageous food at the Ex, don’t eat it every day. “From a common sense perspective, you probably aren’t going to feel very good after eating that much,” says Feldt.

If you do decide to indulge, keep in mind that it will take a lot of physical activity to work off what you’ve eaten. Assuming a 160-pound person consumes 3,000 calories at the CNE’s Food Pavilion, to burn it all off would take:

[list type=”arrow”]
[li]7 hours of swimming laps[/li]

[li]3.5 hours of jumping rope[/li]

[li]5 hours of running at 5 mph[/li]

[li]13.5 hours of ballroom dancing[/li]

[li]9.5 hours of walking at 3.5 mph[/li]

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Suddenly, a simple sandwich or salad is looking pretty appealing!

(activity source: Ainsworth BE, et al. 2011 compendium of physical activities: A second update of codes and MET values. Medicine & Science in Sports & Exercise. 2011;43:1575)

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The Answer: Intuitively, you would think that drinking would cause a spike in insulin, given the sugars involved in wine, spirits and other alcoholic beverages. But in fact, alcohol can cause the opposite problem – hypoglycemia or low blood sugar – oftentimes, many hours after a drink has been ingested, making it particularly very risky for those diagnosed with diabetes.

Those with diabetes who imbibe require vigilance in the form of testing blood sugars. In some cases, it can be as simple as remembering to eat before drinking and reducing insulin. In others, it may be that drinking to excess and falling asleep late could trigger a hypoglycemic attack in the form of seizures.

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