Diabetes

Diabetes has become a public health issue and affects a growing number of people. Today, over 830,000 Quebeckers, or more than 10% of the population, live with this chronic disease (Diabetes Québec, 2014). If you don't have diabetes, you likely know someone who does.

Although heredity plays a role, the increase in diabetes is associated with diet and lifestyle, such as too many refined sugars and saturated fats and meat, a lack of dietary fibre, excess weight, and a lack of physical activity. The more a given population has these characteristics, the greater the prevalence of diabetes.

There are three main types of diabetes: type 1, type 2, and gestational diabetes.

Type 1 diabetes

Also known as “insulin-dependent diabetes” or “juvenile diabetes,” this type appears during childhood, adolescence or early adulthood and rarely in older adults. About 10% of people with diabetes have this type. It is characterized by a total lack of insulin production. People with type 1 diabetes need daily insulin injections or an insulin pump to survive.

Type 2 diabetes

Often called “non-insulin-dependent diabetes” or “adult-onset diabetes,” type 2 diabetes is the most common form (90% of cases). It generally develops in adulthood in people aged 40 and over. Unfortunately, there has been a growing trend in recent years of people getting type 2 diabetes at a younger and younger age. In some at-risk populations, type 2 diabetes can even appear in children.

For some type 2 diabetics, the cells of the pancreas don't produce enough insulin. In For others, the insulin that the body does manage to produce can't carry out its role, a condition called “insulin resistance.” In both cases, the result is increased blood sugar levels because the body doesn't properly use glucose as a source of energy.

Gestational diabetes

Also called “pregnancy diabetes,” this type of diabetes affects about 4% of pregnant women in Canada. Blood glucose levels increase toward the end of the 2nd trimester or during the 3rd trimester of pregnancy. This affects both the baby and the mother. In 90% of cases, gestational diabetes disappears after childbirth, but the mother becomes more at risk of developing type 2 diabetes later in life.

Most pregnant women who suffer from gestational diabetes do not have symptoms. That is why a screening test is recommended between week 24 and week 28 of pregnancy.

Every day, we make choices that affect our health. Adopting a healthy lifestyle is the key to prevention. Making healthy habits part of your daily routine can prevent or delay the onset of type 2 diabetes and its complications:

• Maintain a healthy weight. According to the Canadian Diabetes Association, approximately 80% to 90% of people with type 2 diabetes are obese.
• Eat a healthy diet. Consult a nutritionist if you need to.
• Exercise regularly, which means for at least 30 minutes at least 5 times per week.
• Don’t smoke, as smoking damages the blood vessels and promotes cardiovascular disease.
• Avoid alcohol or cut down on your intake.
• Reduce your stress.

Does eating too much sugar cause diabetes?

The causes of diabetes are more complex than simply having too much sugar in your diet. Eating sweets doesn't automatically cause diabetes. However, regularly eating sweets can lead to weight gain, which is a major risk factor of type 2 diabetes.

The symptoms of type 1 and type 2 diabetes are basically the same and include:

• a more frequent need to urinate
• increased thirst and hunger
• weight change (gain or loss)
• extreme fatigue or lack of energy
• blurred vision
• increased infections of the skin, gums, bladder, vagina or foreskin
• numbness or tingling in the hands or feet
• slowed skin and wound healing

In type 2 diabetes, symptoms may go unnoticed for a long time, but the disease will continue to develop and cause damage that can be irreversible.

Wounds that won't heal

In people with diabetes, a loss of sensitivity and circulation problems increase the risk of wounds that are slow to heal.

Diabetics also have an increased risk of infection. These different factors slow down their wound healing, and infectious processes can even lead to amputation.

People with diabetes can experience decreased—if not a complete loss of—sensitivity in the feet. Since they don’t feel the pain that usually signals injury to the body, a small cut can easily turn into a chronic wound that is difficult to treat.

A few basic tips:

• Examine your feet every day. Look for any changes, no matter how small, such as redness, swelling, pain, bleeding, scratches, tingling or numbness. Use a mirror to make this easier.
• Wash your feet every day with warm water and a mild soap. Check the water temperature with your elbow.
• If your feet are dry, regularly apply a moisturizing cream. Avoid putting the moisturizer between your toes, as this can lead to a fungus called athlete's foot.
• Avoid using heating pads or hot water bottles to warm your feet or legs.
• Don’t use over-the-counter products to remove calluses or corns without the consent of your doctor or podiatrist. Don't use sharp nail care tools.
• Cut your toenails straight and file them with an emery board instead of with a metal nail file.
• Avoid walking barefoot. Before putting on your shoes, make sure they don't contain small stones or pointy objects.
• Stop smoking, as smoking can cause circulation problems.
• Have your feet checked every year by a professional (podiatrist).

The goal of treating diabetes is mainly to normalize glycemia (the amount of sugar in the blood, or blood glucose). Diabetes treatment has 4 components:

• A healthy and balanced diet.
• Regular physical activity.
• Strict adherence to your medication, if your doctor has prescribed it. Many classes of diabetes medications are available in the form of tablets or injections.
• Good stress management.

Research on drug treatment for diabetes is constantly evolving, and advances are made every year.

Checking your blood glucose will help determine how well you are controlling your diabetes. Blood glucose monitoring is also an excellent way to adjust your medication doses and schedule so that you can keep your glycemia within the target values:

Fasting glycemia and glycemia before meals

Target Values 

Between 4.0 and 7.0 mmol/L

Optimal Values

Between 4.0 and 6.0 mmol/L

Glycemia 2 hrs after meals 

Target Values 

Between 5.0 and 10.0 mmol/L 

Optimal Values

Between 5.0 and 8.0 mmol/L

Target Values 

Between 4.0 and 7.0 mmol/L

Optimal Values

Between 4.0 and 6.0 mmol/L

Target Values 

Between 5.0 and 10.0 mmol/L 

Optimal Values

Between 5.0 and 8.0 mmol/L

Blood glucose is measured with a small portable device called a “blood glucose meter” or “blood glucose monitor.” Your pharmacist can advise you on these different devices and how to use them.

Using a lancing device, you draw a drop of blood from the tip of your finger for analysis with the blood glucose meter. In a few seconds, the reader displays your blood sugar level.

How often you check your blood glucose every day will be established by your doctor and treating team depending on your condition:

At first, you’ll need to test your blood glucose more frequently (up to 8 times a day).

As your condition improves, you won't have to check it as often, but you'll have to check it at a regular frequency (1 to 4 times a day).

People with type 1 diabetes need to check their blood glucose 3 to 4 times per day on a regular basis, as the amount of insulin they inject directly depends on their blood sugar level before a meal.

Think about ease of handling, display number size, and how easy it will be to carry the device around with you.

Are the strips easy to get out of the packaging and to handle or do they require too much dexterity? Can you easily apply your blood to the strip?

Do you have trouble using it, inserting the lancets (needles), and removing them?

Some blood glucose meters require calibration. Make sure that the calibration step is easy to perform. You can also choose a meter that automatically calibrates with no additional steps, if this is easier for you.

Check how quickly the test is done and the device’s available memory. Also check whether you can upload your results to a computer, if this is something you would like to do. However, note that all devices on the market have good performance. You can simply choose one based on your specific criteria.

What type of batteries does the meter take? Are replacement batteries easy to find?

All blood glucose meters are very accurate, but you need to carefully read the instructions.

Ask about after-sales service in case you have a problem with your device.

Controlling diabetes isn’t a choice but rather essential so that you can enjoy life to the fullest. Don’t forget that a healthy diet and regular exercise are just as important as taking medication when it comes to your treatment. Don’t hesitate to talk to your health care professionals for advice and ask them any questions you may have.