By Dr. CHRISTOPHER J. MORGAN
Everyone reading this article knows someone with diabetes.
Diabetes has reached epidemic proportions around the world and here in Canada. Today, more than 9 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 2 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 will be affected by 2025.
On April 7, World Health Day, the Canadian Diabetes Association (CDA) unveiled the Diabetes Charter for Canada. According to CDA the guiding principles of the Charter are to: ensure that people who live with diabetes are treated with dignity and respect; advocate for equitable access to high-quality diabetes care and supports; and enhance the health and quality of life for people who live with diabetes and their caregivers.
Kathy Nelson, a Registered Nurse, a Certified Diabetes Educator and the Founder and President of the Caribbean Chapter of the Canadian Diabetes Association, was involved in the consultation process in the development of the Charter. One of the key issues she wanted included in the Charter was that strong efforts be made to eliminate barriers to timely and culturally appropriate diabetes education and care to lessen the burden of the disease on high risk populations such as the Black community.
In keeping with providing expert diabetes education to the Black community, everyone is encouraged to attend the 5th Annual Black Diabetes Expo, presented by the Canadian Diabetes Association and its Caribbean Chapter. The free, full day (9 a.m. – 4 p.m.) event will take place on Saturday, April 26 at the Jamaican Canadian Association located at 995 Arrow Road in North York. A free shuttle bus from TAIBU Community Health Centre in Malvern will help ensure no one has to stay home and miss out.
The theme of this year’s expo is Kidney Disease and Diabetes …Connecting the Dots. There are a number of complications that arise from the effects of chronic, elevated blood sugar levels. One of them is kidney disease. In fact, diabetes is among the leading causes of kidney failure, accounting for 10 – 20 per cent of diabetes deaths. To help us “connect the dots” between diabetes and kidney disease I spoke with Kathy Nelson and one of this year’s keynote speaker, Registered Nurse, Jill Campbell, a regional director of the Ontario Renal Network, program director at St. Michael’s Hospital, and an executive member of the African Caribbean Kidney Association.
What is the function of the kidney?
The kidneys function to filter the blood, remove wastes, control the body’s fluid balance, and regulate the balance of some hormones and chemicals in the blood system including blood pressure, red blood cell production and acids.
What are the early signs of kidney problems in people with type 2 diabetes?
Diabetes is the primary cause of Kidney Failure. Early signs and symptoms of kidney problems include swelling primarily of the feet and hands, but also the face. Some patients present with itchiness, difficulty sleeping, loss of appetite and nausea.
Kathy added that sometimes there may not be any physical signs or symptoms and recommends that we ask ourselves, “When was the last time I had a urine or blood test for my kidneys?” A simple urine or blood test that will look for elevated creatinine (a type of protein) levels will indicate a potential problem with your kidneys.
Is it possible to reduce the risk of kidney complications for people living with diabetes?
Changing the course of diabetes is possible and can thus reduce the risk of kidney complications. These changes include modifications to lifestyle such as keeping blood sugars within normal range, keeping blood pressure under control, taking blood pressure medications as prescribed and not stopping them without a doctor’s order, limiting salt intake, exercising under medical supervision, and stop smoking.
Kathy urges us to know our numbers. For people with diabetes the target blood pressure should be 130/80. Kathy encourages monitoring our blood pressure and blood sugar regularly at home and at the pharmacy to keep track of any changes. Also follow the Dietary Approaches to Stop Hypertension (DASH) diet which promotes low fat, low salt, low dairy and lots of fruits and vegetables. Furthermore, we have to be more physically active; walk, swim, do resistance exercises with bands, stationary bikes and so forth.
Once kidney disease has developed, how is it treated and what are the success rates?
If the kidney function tests (mentioned earlier) suggest abnormal kidney function you should be referred to a nephrologist who will conduct further kidney function tests and provide counselling on achieving target blood pressure and blood sugar and cholesterol levels. He or she will then prescribe specific medications to help slow down the progression of kidney failure.
Jill added in the later stages of kidney disease, when the kidneys lose the majority of its functions, the options are hemodialysis done 3 times per week either at home or in hospital, peritoneal dialysis done at home on a daily basis, or kidney transplantation.
The success rates for all of these treatment options are good in individuals that have kidney failure without other illnesses such as heart disease. Transplantation is the best of the three options and particularly if the kidney comes from a living donor such as a family member.
I commented that this spotlights another issue because our community is not particularly active when it comes to donating blood or organs – until it’s your son or sister who needs it.
Are people of African descent more likely to develop kidney complications from diabetes compared to other populations and, if so, why?
It is unclear why, but people of African descent have a higher prevalence of both diabetes and hypertension. Diabetes and hypertension and the number 1 and number 2 cause of kidney failure. The prevalence in people of African descent may be related to attention we pay to medical care and how committed we are to accessing the medical system when signs and symptoms of illness develop; cost of drugs might be another factor, lifestyle choices including diet may also contribute.
Kathy referred to reports from the United States National Institute of Health which states the rate of kidney failure among patients of African descent in the U.S. and the United Kingdom is three to four times higher than in White populations and when compared to other racial groups, Black populations are more likely to develop kidney failure from diabetes and high blood pressure than other populations. Another alarming statistic is kidney failure occurs at a younger age among Black populations. In the U.S., the average age is 57 among African-Americans compared to 63 years of age among White Americans.
This reminded me of a research project done by Dr. Leighton James, nephrologist, over a decade ago here in Toronto in which he looked at the ethnicity of dialysis patients and the cause of their kidney disease at a couple of Toronto hospitals. He found that people of African descent were disproportionately over-represented among dialysis patients, their average age was younger, the primary cause of their kidney dysfunction was diabetes and hypertension and many of the patients were males.
From a community and public health perspective, what should we be doing to further reduce the burden of kidney disease in people living with diabetes?
Education of all ages about the risk of diabetes and hypertension is critical. An informed and knowledgeable population can help to improve not only their health, but the health of future generations. Having regular check-ups, including asking the doctor to screen for diabetes, hypertension and kidney disease, and also living a healthier lifestyle will further reduce the burden of kidney disease in individuals living with diabetes.
Kathy reiterated the importance of education and suggested the Ministry of Health and Long-Term Care provide improved funding for education in lifestyle changes. Further, greater attention should be paid to high blood pressure, the “silent killer”, with screening programs especially for high risk populations.
Kidney Disease and Diabetes…Connecting the Dots is the theme of the 5th Annual Black Diabetes Expo. Participants at the expo will hear from various health care professionals on topics such as medications used in treatment of kidney disease; the relationship between gestational and type 2 diabetes; there will be free kidney disease and diabetes (CANRISK) screening, and numerous health related exhibitors.
Lastly, the day before I prepared this article a long time patient of mine proudly told me her doctor recently told her she can stop taking Metformin, a common type 2 diabetes medication, because she has done such a good job in controlling her blood sugar levels. After being diagnosed with diabetes years ago, she made all the right decisions. She started taking her medication as prescribed by her doctor, regularly monitoring her blood sugar at home, and made several lifestyle changes including changing her diet and participating in physical activity programs four to five times per week such as line dancing at TAIBU Community Health Centre, and here she is today. We would like to multiply her story a thousand fold in our community.
See you at the Black Diabetes Expo.
For more information about the Black Diabetes Expo or to register for the shuttle bus from TAIBU CHC, call 1-800-226-8464, option 4. For information about the Caribbean Chapter of CDA call Kathy Nelson at 416-987-0339. The next Caribbean Chapter Meeting will be held on Tuesday May 20 at the Anglican Church of the Nativity in Malvern. The topic will be medications for high blood pressure. Know the facts, presented by Ann Petgrave, Pharmacist and Certified Diabetes Educator.
Dr. Christopher J. Morgan is the director of Morgan Chiropractic & Wellness, an interdisciplinary health centre in Toronto, and the Past 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 firstname.lastname@example.org