By Dr. CHRISTOPHER J. MORGAN
Everyone reading this article knows someone with diabetes.
Diabetes has reached epidemic proportions around the world, including here in Canada. Today, more than nine million Canadians live with diabetes or pre-diabetes and, according to Health Canada, the number of people with diabetes is increasing by seven per cent, or more than two million, each year. Globally, every 10 seconds two people develop diabetes resulting in more than 285 million people being affected and, based on current trends, it is expected that 380 million people will be affected by 2025.
The human cost of diabetes is devastating. According to the World Health Organization (WHO), more than 80 per cent of diabetes deaths occur in low and middle income countries. Over time, diabetes can damage the heart, blood vessels, eyes, kidneys and nerves. It significantly increases the risk of cardiovascular disease; in fact, 50 per cent of people with diabetes will die of heart disease or stroke.
Due to damage to the nerves and small blood vessels, diabetes is the leading cause of blindness for people over 20 and the number one cause of non-traumatic limb amputation. It is also among the leading causes of kidney failure, accounting for 10 to 20 per cent of diabetes deaths.
Here is another alarming fact: the overall risk of dying among people with diabetes is at least double the risk of their peers without the disease. Diabetes is a chronic disease without a cure.
The financial burden of diabetes is also devastating. The Canadian Diabetes Association estimates that diabetes accounts for $9 billion in direct and indirect healthcare spending. For example, it costs approximately $50,000 a year per patient on kidney dialysis. The WHO estimates that in the period 2006-2015, China will lose $558 billion in foregone national income due to heart disease, stroke and diabetes alone.
Diabetes is one of the world’s most challenging health problems of the 21st century.
In response to concern over the alarming rise and impact of diabetes globally, November is widely recognized as Diabetes Month and, in 1991, the World Health Organization and the International Diabetes Federation established November 14 as World Diabetes Day and an opportunity for governments and health and community organizations to increase awareness and education about the disease, its prevention and management.
World Diabetes Day marks the birthday of Canadian medical scientist and Nobel Laureate, Sir Frederick Banting who, in 1921, along with Dr. Charles Best, co-discovered insulin.
What is diabetes?
Diabetes is a disorder of glucose (sugar) metabolism (processing and regulating) that results in a rise in blood glucose (sugar). After a meal, food is digested in the stomach and intestines. Glucose, proteins, fats and so on are released into the bloodstream and circulated throughout your body. Your pancreas, an organ in the body, is stimulated to release a hormone called insulin. Insulin is used to carry the glucose molecules (or sugar) from the bloodstream into your body tissues like your brain and muscles where it is used as a vital source of energy or fuel.
There are three types of diabetes. Type 1 diabetes occurs when your pancreas is unable to produce insulin. This typically develops in childhood and requires lifelong injection of insulin to manage blood glucose levels. Approximately 10 per cent of people with diabetes have Type 1.
The remaining 90 per cent have Type 2 diabetes, which occurs when the pancreas does not produce enough insulin or when the body does not effectively use the insulin that is produced. Type 2 diabetes usually develops in adulthood, although increasing numbers of children in high-risk populations are being diagnosed.
A third type of diabetes, gestational diabetes, is a temporary condition that occurs during pregnancy. It affects approximately 3.7 per cent of all pregnancies in the non-Aboriginal population and 8 to 18 per cent of all pregnancies in the Aboriginal population, and involves an increased risk of developing diabetes for both mother and child.
A diagnosis of diabetes is made by simple blood tests which measures the amount of glucose in your blood. If a fasting blood glucose test is taken, a test result of over 7 mmol/L will be diagnosed as diabetes. Normal blood glucose levels are 4-6 mmol/L. A casual blood test may be done at any time, regardless of when you last ate. A test result of 11.0 mmol/L or greater, together with symptoms of diabetes, indicate diabetes. Another blood test, which is being used more regularly and is supported by the WHO expert group, is the HbA1c which has a recommended cut-off point for diagnosing diabetes at 6.5 per cent.
Know the symptoms of diabetes
The CDA lists the following signs and symptoms of diabetes:
- Unusual thirst
- Frequent urination
- Unusual weight loss
- Extreme fatigue or lack of energy
- Blurred vision
- Frequent or recurring infections
- Cuts and bruises that are slow to heal
- Tingling or numbness in hands or feet
It is very important to note that many people who have Type 2 diabetes may display no symptoms for many months or even years. As a result, many people have the disease but don’t know it.
Are you or your children at risk?
The CDA lists the following as risk factors for the development of Type 2 diabetes:
- Being age 45 or over;
- Being overweight, especially if you carry most of your weight around your waistline
- Being a member of a high-risk group, including people of Aboriginal, African, Hispanic or Asian descent
- Having a parent, brother or sister with diabetes
- Having given birth to a baby that weighted more than four kilograms (nine pounds) at birth, or having gestational diabetes during pregnancy
- Having high cholesterol; or higher than normal blood pressure; or higher than normal blood glucose levels; or heart disease.
A serious trend is emerging in diabetes. Today, young adults and even children, particularly those of Aboriginal and African descent, are developing Type 2 diabetes. Childhood obesity, sedentary lifestyle and family history of diabetes appear to be the biggest cause for this trend.
What can you do?
Here is the good news. Type 2 diabetes is, in many ways, preventable and if you have diabetes it can be well managed. Despite the risk factors, you can lower risk of developing diabetes or slow the progression of the disease by making healthy lifestyle choices for yourself and your family. Major, large-scale, research in Finland and the United States has shown a 38-58 per cent reduction in the development of Type 2 diabetes among high-risk individuals. These reductions were accomplished primarily through lifestyle modification (nutrition and exercise), in some cases aided by medication. Prevention is always less costly than cure. We must invest in our health now or pay the high interest of illness later.
Secondly, if you are experiencing the symptoms mentioned above, or are at risk of developing diabetes, do not delay in making an appointment with your family physician for a complete physical and request a blood test to check for diabetes. If a diagnosis of diabetes is made, you should be advised on the appropriate drug treatment options, either oral agents or insulin injections. In either case, you should be advised to make lifestyle changes.
Third, knowledge is power. Equip yourself with sound information about diabetes so you can make wise decisions. Remember, you are not alone.
In Canada, the federal government commits $18 million annually towards the Canadian Diabetes Strategy which focuses on prevention, early detection and management of diabetes, in addition to $275 million over five years (2010-2015) for the Aboriginal Diabetes Initiative and over $16 million towards diabetes research through the Canadian Institute for Health Research.
Provincially, Ontario has a Diabetes Strategy that focuses on attaching each person with diabetes to a health provider and ensuring that 80 per cent of people with diabetes, aged 18 or older, has had all recommended diabetes tests for diabetes management (Hb1Ac, retinal eye exam and cholesterol). It also includes the expansion of diabetes education teams throughout the province within community health centres and family health teams, expanding kidney care services such as provision of at home dialysis and community-based prevention programs for high risk groups.
I will close as I started; everyone reading this article knows someone living with diabetes. People of African descent are known to be at increased risk of developing diabetes. We have no other choice but to do a better job at securing the resources, developing the programs and carrying out the education necessary to rid the community of Type 2 diabetes.
Next week I will share some insights and a personal story of a diabetes community champion.
Dr. Christopher J. Morgan is the director of Morgan Chiropractic & Wellness, an interdisciplinary health centre in Toronto, and the President of the Black Health Alliance, a network of community organizations, health professionals and community members working in partnership to advance the health and well-being of the Black community. He can be reached at 416-447-7600 or email@example.com