The diabetes epidemic

There’s an epidemic building in Canada — one that most people don’t even know about. It’s the third leading cause of death by disease, the largest source of adult blindness and the reason for half of all lower-leg amputations. And it targets seniors more than any other group.

This epidemic is diabetes. More than 1.5 million Canadians have it and a third of them don’t even realize it. Among older Canadians, the numbers are even higher. It’s estimated that 15 per cent of people between the ages of 40 and 75 are affected. That rises to 20 per cent after age 75. And those grim statistics are expected to get much worse. If present trends don’t change, the number of cases of diabetes in Canada will double in the next 10 to 15 years.

“It’s principally because of the boomer effect,” says Dr. Stewart Harris of the Centre for Studies in Family Medicine at the University of Western Ontario in London, Ont. “The number of older people is increasing.” At the same time, the level of obesity is on the rise — and that’s one of the strongest risk factors for developing the disease.

But while diabetes is on the rise, so is our understanding and treatment of . The last few years have seen a flurry of new discoveries that is changing the way doctors think about the disease. And it’s providing the first hard evidence that diabetes can be prevented.

Look out after age 45
Diabetes is an abnormally high level in the blood of a sugar called glucose. It occurs because of problems with insulin, a hormone that allows glucose to enter the body’s cells, where it’s burned for energy or stored for future use. Type 1 diabetes mostly affects children and happens when the pancreas, a small organ behind the stomach, can’t produce insulin. Type 2, which accounts for about 90 per cent of the cases, typically hits after about age 45. The pancreas makes insulin but the body can’t use it properly so blood sugar builds up. Doctors measure blood sugar with a standard scale, using a blood test. A level of between four and six is normal. A level of seven or higher means you have diabetes. That extra glucose leads to many serious health problems.

But the growing diabetes epidemic isn’t the only worry. In the last couple of years, researchers have come to realize that any increase in blood sugar above the normal range is dangerous, even if it’s not high enough to be defined as diabetes. As soon as glucose levels creep above six, the risk of heart disease and strokes rises dramatically. “It used to be you either had diabetes or you didn’t,” says Dr. Hertzel Gerstein, a professor of medicine at McMaster University in Hamilton. “Now we realize we should be striving not just to control diabetes but to optimize glucose levels.” Gerstein says 40 to 50 per cent of all Canadians have higher-than-normal glucose levels because insulin isn’t doing its job properly. It’s a condition known as impaired glucose tolerance (IGT).

What is Syndrome X?
Exactly why high glucose levels lead to damage is still one of the big unknowns. What is clear is that people with high blood sugar also tend to have several other problems. They tend to be overweight and get little physical activity. About 70 per cent have high blood pressure. Most have low levels of HDL, the “good” cholesterol. This cluster of problems, sometimes referred to as Syndrome X, could hold the key to control and prevention of diabetes. It’s already established that dealing with Syndrome X problems can prevent or delay the damage caused by diabetes. Now researchers are asking whether treating those problems can prevent diabetes altogether. So far the answer appears to be yes.

Next page: Your lifestyle may be the critical difference

A Finnish study published in the New England Journal of Medicine in May 2001 looked into what would happen if people with IGT adopted a healthier lifestyle. Researchers worked with 522 middle-aged, overweight people. Half received counselling to lose weight, exercise and improve their diets by cutting fat and increasing fibre. The other half continued with their lives as before. After four years, those who changed their lifestyle cut their risk of diabetes by 58 per cent.

Keep trim
There is plenty people can do to improve their chances of warding off diabetes or minimize its damaging effects. It’s remarkably similar to the advice for preventing high blood pressure. The No. 1 rule: keep trim. “Obesity is the strongest predictor of diabetes,” says London doctor Harris. Doctors gauge obesity with the Body Mass Index, which measures weight in relation to height. A BMI of 18.5 to 25 is generally considered healthy, but research shows the risk of diabetes starts to climb at 22. Equally important is where the extra pounds are distributed. Fat collected around the waist carries a much higher risk than fat collected lower down — the apple shape compared to the pear shape.

Tips and tactics

• Be active for at least 20 to 30 minutes a day. Start with simple stretching exercises to increase your flexibility. Then walk, work in the garden, dance or swim.
• Check your blood pressure regularly. 
• Eat three regular meals a day. “A lot of elderly people skip breakfast and don’t eat proper meals,” says Ingrid Belinsky, a diabetes educator at the Medicine Hat Diabetes Education Centre in Alberta. Blood sugar tends to be lower with regularly spaced meals. Do some of your own cooking. It’s more nutritious and lower in fat than prepared foods. And eat with friends to reduce the chance you’ll skip a meal. 
• Reduce fat intake and increase your fibre by choosing whole wheat bread, and fruit and vegetables with the skins left on. 
• Drink plenty of water.
• If you’re more than 45 and don’t have diabetes, have your blood sugar level checked every three years — more often if your doctor tells you you’re in a high risk group.
• For detailed information, take a course at a Diabetes Education Centre. Contact the Canadian Diabetes Association for details (416-363-3373, 1-800-226-8464, www.diabetes.ca).

If it sounds like a lot of work, there’s a bright side, says Janice Bobryk, a retired nurse in Medicine Hat, Alta., who was diagnosed with diabetes three years ago. The 71-year-old Bobryk lowered her blood pressure, cut her cholesterol and keeps active with walking, dance and swimming. Not only is her diabetes well under control, she says, but she’s enjoying life more. “I’ve got more energy and I’m enjoying being much more active. I just feel great.”

Next page: Risk factors, symptoms, complications

Risk factors
 Are you at risk of getting diabetes? Here are the top risk factors:

• Genetics. You’re at greater risk if a parent had it or if you’re part of certain ethnic groups, including First Nations, blacks, Asians and Hispanics.
• Age. The risk of type 2 increases as you age, usually starting in your 40s.
• Obesity. Diabetes is much more likely if you’re overweight, especially around the waist and tummy.
• Conditioning. Lack of exercise increases chances of several diseases, including diabetes.
• Hypertension. High blood pressure is strongly linked to diabetes.

 Symptoms
 “My kids revolted on me, I was so crabby,” laughs Art Burgess when remembering his symptoms before he was diagnosed with diabetes. The 72-year-old physical education instructor from Victoria, B.C., also found he was tired and needed to use  the washroom frequently, but he didn’t connect it to the disease. It was only after a checkup that he discovered the reason.
 
 Sometimes there are few or no symptoms of diabetes but here are the most common telltale signs:

• Extreme thirst or hunger.
• Weight loss or changes in appetite.
• Frequent infections.
• Frequent urination.
• Blurred vision.
• Slow healing of cuts or sores.
• Impotence.
• Irritability.
• Extreme tiredness.
• Painful urination and bloody or cloudy urine.
• Tingling or numbness in the feet or hands.
• Abdominal pain, nausea and vomiting.
• Digestion problems.
• Sweet-smelling breath.
• Chest pains.

Complications
The real danger of diabetes is the serious diseases that can result from it.

• Cardiovascular disease. The risk of heart attack, stroke and poor circulation starts with high blood sugar levels and gets worse as sugar levels rise. Diabetic men are twice as likely to have a heart attack; women three times as likely.
• Blindness. Diabetes is the biggest cause of blindness in Canada.
• Kidney disease. Diabetes accounts for almost a third of new cases of kidney failure.
• Amputation. Many diabetics lose sensitivity to touch in their feet and injuries can go unnoticed. Combined with poor circulation that can lead to serious infections leading to amputations.
• Nerve damage. About 60 per cent of diabetics have nerve damage, which can show itself as carpal tunnel syndrome, poor digestion, numbness in hands and feet, and impotence.
• Infections. Diabetics are more likely to suffer gum disease, flu and pneumonia.