Managing diabetes

You are over 40. When is the last time you had a blood sugar test?

Olive Bryanton didn’t worry about the occasional blood test. It was a regular occurrence after removal of her thyroid gland. But in 2003, her doctor also requested a blood glucose test, and its results changed her life forever. It was higher than normal. Further testing led to a diagnosis of type 2 diabetes.

Bryanton was surprised. No one in her family had the disease. Besides, she felt just fine. “I can’t remember having even one of the symptoms,” she admits.

And there’s the rub. Without that diagnosis, she might have assumed there was no threat to her health, even while high levels of blood glucose were causing tissue damage. She was risking complications, including heart disease, stroke, blindness, kidney disease and nerve damage (in legs and feet, this can lead to amputation).

The Canadian Diabetes Association (CDA) reports there are currently more than two million Canadians with diabetes, a number conservatively projected to grow to three million by 2010. Type 1 diabetes occurs when insulin-producing cells in the pancreas are destroyednd can’t supply insulin. But type 2 diabetes affects about 90 per cent of people with diabetes. Their bodies don’t produce enough insulin, and/or their cells become insulin resistant.

There is an increased risk of developing diabetes after age 40. Bryanton, who continues to work part-time as co-ordinator for the University of Prince Edward Island Centre for the Study of Health and Aging, was 65 at diagnosis.

“Diabetes is a progressive disease. No-thing you take is going to make it go away,” she says bluntly. Bryanton learned to cope with this reality at a provincial diabetes education program. Now, she’s careful to eat a healthful diet, inspecting food labels for carbohydrates, fibre content, trans fats, saturated or monounsaturated fats. Two diabetes medications help regulate her blood glucose, and she takes drugs to keep blood pressure and cholesterol levels safely low.

The CDA notes people with type 1 diabetes may die 15 years prematurely; those with type 2 diabetes may die five to 10 years too soon. Good management of diabetes can help alter these outcomes.

Physical activity plays a vital role in controlling diabetes by reducing insulin resistance. Working out in a gym may not be for everyone (Bryanton prefers aqua fitnesss three times a week), but even brisk walking can be effective, and many shopping malls welcome walkers who want to avoid icy sidewalks or too-hot summer conditions. Check with your health-care professional before starting an exercise program.

CDA clinical practice guidelines (2003) recommend maintaining blood glucose levels between 4 to 7 mmol/L prior to eating and 5 to 10 mmol/L two hours after a meal. (This goal may be modified for certain patients.) People with diabetes need to test their blood frequently with easy-to-use blood glucose meters to keep as close to their target levels as possible.

First, a fine needle called a lancet pricks the skin of finger, forearm or thigh. A tiny amount of blood is applied to a test strip inserted in the glucometer. The glucose level (in mmol/L) appears on the screen of the device. (Some have an electronic memory; some can download information to a computer; or the results can be written in a log.) These near-instant levels can help people learn to control their diabetes as they observe how foods, physical activity, medication or illness have affected blood glucose levels.

“If you behave and eat and exercise the way you should and keep on top of the regimen your physician gives you, it will help provide you with a better quality of life and may prolong the time before you have complications,” Bryanton says.

(Usually develop gradually in type 2 diabetes)
• Frequent urination
• Thirst and a dry mouth
• Constant fatigue
• Weight loss
• Blurred vision
• Breath that smells fruity
• Yeast infections, cystitis
*Source: Living with Diabetes: A Practical Guide to Managing Your Health (Canadian Diabetes Association)

Some risk factors for type 2 diabetes
• Over 40 years of age (younger if non-Caucasian)
• Overweight or obese
• Excess weight around waist
• Close family member has diabetes
• Cardiovascular disease
• High blood pressure

This Special Educational Feature was produced by the editors of CARP magazine and Abbott Diabetes Care.