Diabetes Awareness Month: What You Need to Know About Symptoms, Prevention and New Treatments

November is Diabetes Awareness month and yet most Canadians are unaware of the risks and complications of the disease that’s all too prevalent.

One in three Canadians is living with diabetes or pre-diabetes, according to Diabetes Canada, and that figure is higher for older Canadians. 

But fewer than 50 per cent of us are aware that heart disease, stroke and kidney failure are complications of diabetes. 

And many Canadians with diabetes or prediabetes are unaware that they have the chronic condition which affects the way the body processes sugar. “You could be one of the 1.5 million Canadians who have diabetes and don’t know it,” advises Diabetes Canada.

Symptoms include excessive hunger, excessive thirst, fatigue, weight gain or weight loss, frequent urination, blurred vision or poor wound healing, suggests the Mayo Clinic.

It’s also important to be aware of the risks. One risk factor for Type 2 diabetes, which accounts for more than 90 per cent of diabetes cases in Canada, is being over the age of 40. People with Type 2 diabetes either don’t produce enough insulin or their bodies are resistant to insulin.

You can find out if you’re at risk for diabetes by completing the Canadian Diabetes Risk Questionnaire (CANRISK).

Because the risk is greater for older Canadians and for people who take statins, are overweight, have high blood pressure or have sleep apnea, it’s vitally important to be aware of how to help reduce the risk and support how your body manages insulin.

“The process that leads to diabetes is the worsening of the beta cells in the pancreas over time,” explains endocrinologist Dr. Ravi Retnakaran, clinician-scientist at Mount Sinai Hospital and professor of medicine at the University of Toronto. “Blood sugar levels first rise to prediabetes levels and the worsen to the diabetes range.

“We do know that people can try to improve how their bodies handle insulin and their insulin resistance. The more insulin-resistant you are the greater the demand on your beta cells. 

“But lifestyle modifications — targeting weight loss through a healthy diet and physical activity — can help delay or prevent the rise in blood sugar levels.”

Toronto-based consulting dietitian Fran Berkoff recommends “cutting back as much as possible on ultra-processed foods and replacing them with more fresh fruits, vegetables and foods high in fibre.”

You can still eat foods you enjoy, but cut back on quantity a little bit, she advises. 

Berkoff suggests a yogurt parfait with berries for breakfast or whole-grain bread with an egg or even cooking enough oatmeal for three days. 

And, she says, “Fresh fruit is better than fruit juice” for helping to maintain healthy blood sugar levels. As for exercise, Berkoff says, “Do something you enjoy that gets your heart beating faster — walking, yoga, cycling — and incorporate it into your daily life.”

If you have been diagnosed with early diabetes, the good news is that there have been dramatic advances in treatment and prevention of complications since insulin was discovered by Banting and Best in Toronto 100 years ago.

One of the most significant, says Retnakaran, is “the recognition that controlling blood sugars can markedly reduce the risk of complications like blindness, kidney failure, heart disease and amputation, which used to be extremely prevalent in diabetes.”

The past decade, he says, “has been a time of remarkable advances with the introduction of a series of new classes of medications.”

While he acknowledges that the word “cure” isn’t currently applicable to diabetes — which may be more of a chronic process than a disease that can be cured — there is the increasing possibility of reversing part of the underlying process.

“We’re now in the era of trying to change the natural history, in terms of progression and risk of complications, and both of those are ultimately important for the patient.”

Results of a clinical trial published by Retnakaran in August showed that a short, intensive course of insulin early in the disease can improve beta cell function “by reversing the reversible element of the defect in the beta cells,” he explains.

Based on this breakthrough, “the new model is induction therapy followed by maintenance therapy. At the outset of diagnosis, we do an intervention to improve the reversible component and then follow it with a drug (like metformin) to stabilize the function of the beta cells.”

The effect has been shown to last for two years, says Retnakaran.

He’s now studying different ways to do the initial induction and how to extend the effect beyond two years.

He’s optimistic about where things are headed.

“My sense is that diabetes is being better controlled and that there’s increasing awareness of what you can do in terms of lifestyle and management.”

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