3 DIaBetes BALANCING IS MORE THAN JUST AN ACT
Transcription
3 DIaBetes BALANCING IS MORE THAN JUST AN ACT
AN iNdepeNdeNt SUppLeMeNt FrOM MediApLANet tO tHe NAtiONAL pOSt Juvenile diabetes Affecting your family’s most vulnerable Creature comforts Manage your disease with a trained pet november 2010 DIaBetes 3 TiPS TO MAnAGinG yOuR DiABETES BALANCING IS MORE THAN JUST AN ACT nick Jonas manages his diabetic needs while living every young musician’s dream PHOtO: MaRY ELLEN MattHEWS BaCKGROUND ILLUStRatION: IStOCKPHOtO.COM/HELENa JaUNEGG 2 · NOveMber 2010 AN iNdepeNdeNt SUppLeMeNt by MediApLANet tO tHe NAtiONAL pOSt CHallenGes TiP/STEP TiP 1 COnnECT TO A STRuCTuRED SuPPORT CEnTRE WE RECOMMEND pAGe 7 Diabetes in pets even the furry members of your family can be affected by this disease. “in Canada, an average of eight in 50 cats and four in 500 dogs are diagnosed with diabetes.” Pump it up p. 4 nick Jonas’ experience p. 5 Karen Kemp explains insulin pumps. balancing diabetes management with his worldwide tour. COMinG TOGETHER Participants at World Diabetes Day PHOTO: CANADIAN DIABETES ASSOCIATION Today, more than nine million Canadians are living with diabetes and prediabetes. And the numbers are growing rapidly. research leads to progress toward a cure J uvenile, or Type 1 diabetes, is an often misunderstood disease. Unlike the more common Type 2 diabetes, Type 1 diabetes is not caused by lifestyle factors such as obesity. It is a non-preventable disease of the immune system that strikes with little warning, primarily affecting the most vulnerable members of our families—our children. Children diagnosed with this disease can look forward to a lifetime of careful, almost obsessive management of their diet and exercise regimens, numerous daily finger pricks to measure blood glucose, and multiple daily self-administered shots of that life-giving Canadian discovery, insulin. All in an attempt to keep blood sugar levels within a normal range. If they are successful— which is by no means a given, even for the most conscientious of patients— they may avoid the potentially fatal condition known as severe hypoglycemia and may ultimately escape the devastating consequences of the disease that occur later in life—loss of kidney function, blindness and limb amputations, to name a few. The Juvenile Diabetes Research Foundation (JDRF) is a non-profit organization founded in Canada in 1974 by parents of children with Type Jeff Matthews Juvenile diabetes research Foundation 1 diabetes that is dedicated to finding a cure through cutting-edge research and discovery. JDRF is a formidable balancing act, a worldwide alliance that currently supports researchers in over 22 countries, including more than 40 human clinical trials. As the world’s largest sponsor of Type 1 diabetes research, JDRF’s success stems from its unique model for funding research, one which capitalizes on the combined passions of members of the medical research community and families stricken with the disease. Canadian breakthrough Canada, in particular, holds a unique place in the world of diabetes. Since 1922, when Banting & Best first discovered insulin, Canadian scientists have remained at the forefront of research into Type 1 diabetes. This country’s historically strong focus on basic research in diabetes, coupled with investments made by non-profits like JDRF have resulted in a robust pipeline of diagnostic, preventative and therapeutic opportunities whose potential to forever change the face of diabetes is limited only by our ability to test them in human clinical trials. For recognition of this fact, one needs to look no further than the recent announcement of a partnership between JDRF and the Government of Canada to create a wide-ranging clinical trial network that will expand Canada’s capacity to push forward to a cure. new technologies and treatments The JDRF Canadian Clinical Trial Network (CCTN), initiated through a $20 million-investment from the Federal Economic Development Agency for Southern Ontario and an additional $13.9 million contributed by JDRF will help bring new diabetes technologies and treatments to the marketplace and build new infrastructure to support wide-ranging clinical trials in this country. “The JDRF Canadian Clinical Trial Network is an incredible opportunity for Canadian researchers and families living with diabetes,” says Andrew McKee, President and CEO of new approach needed to tackle diabetes With an aging and growing population, rising rates of obesity, increasingly sedentary lifestyles (particularly among young people) and 80 percent of new Canadians coming from populations at high risk, the rising prevalence of diabetes in Canada is dramatic and alarming. Today, more than nine million Canadians live with diabetes or prediabetes. Not only are the rates of diabetes growing rapidly, the disease is associated with serious complications such as heart attack and stroke, kidney disease, blindness, limb amputations and premature death. What we need is a significant shift: in government approach, private sector involvement and most of all, widespread personal and societal change. We understand that you can’t manage what you don’t measure, which is why we launched the Canadian Diabetes Cost Model in 2009. This tool calculates the prevalence and economic burden of diabetes in Canada. The current economic impact of diabetes is $12.2 billion annually in Canada—a figure on track to reach $16.9 billion by 2020. This year, we have rolled out provincial Diabetes Cost Models in New Brunswick, Ontario, Alberta and British Columbia with a further roll-out for all other regions taking place in the weeks to come.The provincial models help us to further understand the economic and human impacts of diabetes and support the development of focused and comprehensive action plans. The Canadian Diabetes Cost Models have revealed a need for targeted investments in improving access to diabetes healthcare services, education,medications,devices and supplies and financial support: all key elements in the prevention of diabetes and the serious associated medical complications. As powerful as this information is, the Models do not account for the six million Canadians living with prediabetes—50 percent of whom will develop type 2 diabetes and many of whom will experience diabetes-related complications even before a diagnosis. The Canadian Diabetes Association is committed to advancing and sharing diabetes knowledge and empowering all Canadians to protect their health. MiCHAEL CLOuTiER President and CEO Canadian Diabetes Association Jennifer McEvoy Juvenile diabetes research Foundation JDRF. “The network will give ordinary Canadians early access to cutting edge technologies and therapies by participating in clinical trials. It will also bring welcome relief to Canadian researchers, as it finally begins to release the long-standing bottle neck that exists between laboratory discovery and advances in patient care.” Developments such as this serve to remind us that World Diabetes Day is not so much a day to consider the terrible toll this disease has on our children and our society as a whole, but a day to reflect upon the enormous progress made towards a cure, and to look toward the not-too-distant future, when the efforts of thousands upon thousands of doctors, scientists and ordinary Canadians alike are finally rewarded with a cure. diAbeteS 1St editiON, NOveMber 2010 Managing Director: Gustav aspegren [email protected] Editorial Manager: Jackie McDermott [email protected] Title Developer: David Shoemaker [email protected] Responsible for this issue: Publisher: Christianne Cruz [email protected] Designer: Penelope Graham [email protected] Contributors: anna Belton, Lori Berard, Dr. Chris Cobourn, Michael Cloutier,trisha Dunning, Judi Ferne, Nick Jonas, Karen Kemp, Kim Lok, Damien Lynch, Jeff Matthews, Kristin McEvoy, Helen McGuire, Kelsey O’toole, Barbara Pasternak, Dogs4Diabetics, International Diabetes Federation Distributed within: National Post, November 2010 this section was created by Mediaplanet and did not involve the National Post or its Editorial Departments. Mediaplanet’s business is to create new customers for our advertisers by providing readers with high-quality editorial content that motivates them to act. ? DON’t MISS! Looking for more info? The Association continues to fund Canada’s best diabetes researchers in areas such as insulin innovation, complications, special populations, prevention, management and the search for new treatments for all types of diabetes. The Association also puts information into the hands of Canadians with tools such as the online Healthy Living Series and by adapting essential information for high-risk groups. For example, we recently unveiled new nutrition tools for Canadians of South Asian descent, helping them to enjoy their favourite foods while achieving target blood glucose levels and reducing the risk of developing complications. It is time to put people living with diabetes and their families at the centre of structured support systems and programs which empower them to manage their health. Preventing diabetes and keeping Canadians with diabetes healthy will cost the government, the private sector and society far less in the long-term. Visit diabetes.ca to learn more about diabetes and how you can protect your health through tools such as the Healthy Living Series. Be sure to also go online to see the stories of incredible supporters this November during Diabetes Awareness Month—people who are living healthy with diabetes, advocating for the cause and breaking ground towards a cure. not online? Call 1-800-BANTING (226-8464). World Diabetes Day To learn more about the 2010 World Diabetes Day campaign,visit worlddiabetes.ca or join the World Diabetes Day Canada Facebook page: facebook.com/WDDCanada. Disclaimer: The Canadian Diabetes Association has neither reviewed nor endorsed the remaining contents of this Diabetes supplement. AN iNdepeNdeNt SUppLeMeNt by MediApLANet tO tHe NAtiONAL pOSt NOveMber 2010 · 3 neWs Catching the early signs Early diagnosis followed by individualized self-management education is essential for children with diabetes and their families. The symptoms can be mistaken for the symptoms of other illnesses such as flu or gastroenteritis. Children and adolescents are in a time of rapid growth, varying sleep patterns and increasing independence. These normal changes may result in symptoms that are common to more than one disease making it difficult for families to recognize diabetes. Educating parents, families, community workers and school personnel about the early signs of diabetes is key to early diagnosis. The early signs of diabetes, like drinking more, urinating more often and having less energy than usual can be difficult to detect. Children are not usually in the presence of their parents all hours of the day. How would a parent know how often a child drinks or goes to the bathroom when at school? After diagnosis, parents often say the signs were there but they just didn’t associate them with diabetes. Once a child is diagnosed, there is a lot to learn. Parents, grandparents, and close family should all be involved. The child also should be involved in his or her own care to the extent possible determined by age and maturity. People who are with the child need to be educated as well, such as teachers, babysitters, extended family, coaches, and parents of friends. They should all understand the basics, particularly recognizing and treating hypoglycaemia and knowing who to call in an emergency. Education may have to be taken slowly and repeated once the first crisis has passed.Children often come to terms with diabetes before the family does. anne BeLTOn rN, bA, Mde, Cde TRiSha DUnninG rN, phd [email protected] 4 · NOveMber 2010 AN iNdepeNdeNt SUppLeMeNt by MediApLANet tO tHe NAtiONAL pOSt personal InsIGHt Diabetes: a big part of who I am W hen I was 27, my life changed forever while traveling back home to Vancouver,following an emergency flight landing in California. I was hospitalized and diagnosed with Type 1 Diabetes. (My blood glucose reading was 58 mmol - normal reading is 4-7 mmol.) I nearly died. When transferred to the Vancouver Hospital, I met two women with Type 1diabetes who inspired me. One was an 82-year-old patient and the other was my nurse, Heather. They both said that anything was possible and now I know that everything is possible! At that time I was somewhat familiar with diabetes, since my older sister had Type 1. However, I could never have imagined what lay ahead. Living with LEaRNING tO COPE Karen Kemp diabetes resource Manager diabetes entails between four to eight blood glucose tests daily, numerous insulin injections,(my most challenging) constant carbohydrate counting, daily exercise and living with an ongoing fear of the unknown. Along with having a teenage daughter, I fear for what the future holds. To better manage my diabetes, I started using an insulin pump in 1991. It is like a computerized pancreas, preprogrammed to administer dosages of insulin. I test my glucose levels before eating and the reading is automatically transmitted to the pump. My carbohydrates are entered into the pump which then calculates the insulin required.But stress,remaining sedentary for too long or engaging in prolonged or unplanned exercise can seriously affect my glucose levels and it needs to be monitored closely. Keeping a close eye By maintaining good control, I have managed to avoid many of the complications often associated with this disease. I now wear a Medtronic Continuous Glucose Monitoring system which sounds an alarm when my glucose level falls outside my target range.While not totally infallible, it does reduce my fear of going to sleep and not waking up.This fear is very real to many of us who are insulin-dependent and is of particular worry to me as I lost my sister to this when she was 29. Making a difference In addition to being an ambassador for CDA, volunteering with JDRF, coordinating Sweet Beat Walkers and co-founding Diabetes Action Network, I get immense satisfaction from working directly with individuals living with diabetes. As the Diabetes Resource Manager at White Cross Dispensary & McNeil Pharmacy in Ottawa, I emphasize that the key to controlling diabetes is to “Test, not guess!” Failure to do so allows diabetes to control your life. Equally important is to educate your family, friends, and co-workers about diabetes; show them how to help you in the event of low blood sugar. Also, when a family member has diabetes the best support one can give is for everyone to follow the same diabetes healthy lifestyle. Having Diabetes can be scary, but I feel I have made the right decisions to cope with this disease. And since meeting those two women in Vancouver who inspired me, I love life and appreciate every day as a gift. November 14th is World Diabetes Day. I challenge all readers to “Live a Day with Diabetes.” Exercise for 20-30 minutes, alter your diet by reducing high glycemic foods,count your carbohydrates, test your blood glucose, (if possible) and log your food intake. AN iNdepeNdeNt SUppLeMeNt by MediApLANet tO tHe NAtiONAL pOSt InspIratIon NOveMber 2010 · 5 2 TiP Question: How does Nick Jonas, member of the band Jonas Brothers, manage his diabetes and his busy touring schedule? Answer: With support from his family and crew and his own constant vigilance, he juggles his health and his life on the stage. It can happen to anyone ALWAyS KEEP EXTRA TESTinG SuPPLiES On HAnD t - When were you first diagnosed ,with diabetes, what was the w first thought to go through your mind? y t I was diagnosed with Type 1 diabetes w when I was 13 years old. When I first found out I had Type 1 diabetes, I was t afraid and thought ‘why me?’ Then I thought, ‘why not me?’ e I quickly decided I was not going to let diabetes slow me down. I stay d positive, eat right and check my blood glucose level several times each day so I can make better decia sions that help me stay in range. 0 Learning how to give myself insug lin was also very important in my everyday understanding of my diaf betes. My family has been very supportive and they made sure I never felt like I was alone. What symptoms did you have and when did you decide it was time to go to the doctor? it, like food, exercise and emotions. I monitor my blood sugar sometimes up to 12 times a day with my Bayer CONTOUR USB meter. I make sure my family and crew have extra testing supplies on hand while I’m on tour so I’m always prepared if I’m in a rush to get on stage. The meter I use plugs into my computer, wherever I am. The technology makes monitoring my blood sugar, logging the results and sharing information with my doctor an easier process for me, especially with my busy schedule. I can quickly see my recent blood sugar levels and trends and share them with my doctor from the road. A month or two before I was diagnosed, I noticed I was always thirsty, I was losing weight and I was irritable. I lost about fifteen pounds in two to three weeks. I took some time off from touring to see a doctor. The doctor sent me to the hospital after she heard all of my symptoms. My blood sugar was over 700,which is very, very high. Has it been difficult managing your hectic schedule on top of the demands of diabetes? Life can be complicated when you have diabetes, especially when I’m on the road for extended periods of time. It’s important to know your blood sugar level and what impacts nick Jonas Jonas Brothers PHOtO: MaRY ELLEN MattHEWS What advice can you offer readers with Type 1 and Type 2 diabetes? Stay active and stay positive. Build a support team with your doctor, family and friends and know that diabetes is nothing to be embarrassed about. Go online, read as much as you can. If you go to my website, NicksSimpleWins. com, there’s a lot of great information about diabetes and ways you manage it. Why did you decide to go public with your diabetes? Having the support of my family was definitely a big part of getting through the first couple of months with diabetes. It’s important that other people with diabetes don’t feel like they are alone and my work with Bayer helps me do that. Nearly every day I hear from someone like me who says that I make them feel it’s OK to have diabetes and that’s really cool that I can do that. Diabetes for life? we beg to differ “even some healthcare professionals are amazed when we tell them that diabetes can be reversed through weight loss.” Dr. Chris Cobourn Medical Director, Surgical Weight Loss Centre That the symbol for diabetes is a blue circle is highly ironic: it holds the same shape as a device that can put it into remission. The device,an unassuming band with an inflatable ring on one end and an access port on the other, is called a Lap-Band or laparoscopic gastric band and it has been used throughout the world for more than a decade as a well-established method of weight loss. But what is perhaps less known is that it has also been shown to improve and even eliminate type 2 diabetes. While the Lap-Band officially received Health Canada approval as a treatment option for type 2 in late 2008, the evidence had been mounting long before that.Data published in The Journal of the American Medical Association in early 2008 showed that 73 per cent of patients with type 2 diabetes experienced remission of their symptoms within 2 years – exciting news for patients who have long struggled with its debilitating complications. “Even some healthcare professionals are amazed when we tell them that diabetes can be reversed through weight loss,” says Dr.Chris Cobourn,Medical Director of the Surgical Weight Loss Centre (SWLC) in Mississauga, a clinic that specializes in the Lap-Band procedure. “It’s well accepted that the risk of diabetes increases as weight increases, but there still seems to be an element of surprise when we tell them that the opposite is also true: that diabetes can be reversed with weight reduction.” As the name suggests, the Lap-Band procedure is laparoscopic in nature and as such, is minimally invasive offering a fast recovery time. In fact, surgery can usually be completed at the clinic in less than an hour with the patient going home the same day. The procedure is relatively simple.The surgeon places the band around the upper portion of the stomach which causes the patient to feel satisfied earlier and longer with smaller portions of food.This increased satiety in turn,allows the patient to lose weight at a safe rate and,more importantly,it allows them to sustain that weight loss. In order to maximize success, longterm follow up is crucial.Surgical Weight Loss Centre, for example, ensures that patients have ongoing access to professional support throughout their weight loss program, not just on the day of surgery. The Lap-Band may not be right for everyone,however,and it is certainly not a magic bullet.Patients must be committed to returning to the clinic or a local affiliate for regular adjustments until their weight loss goals are achieved.They must also be committed to changing the way they eat, making it a habit to eat slowly and chew their food well. But these are small concessions to make when you consider the potential rewards of diabetes remission, improved quality of life, and restored self-confidence to name a few. To be sure, there are some risk factors that are beyond our control when it comes to diabetes, but excess weight doesn’t have to be one of them.A surgical solution just might be the answer you never knew you were looking for. To find out if the Lap-Band might be right for you, book a consultation with one of SWLC’s surgeons today. Call 1-888-285-7185 or visit www.lapband.ca. paid for by Surgical Weight Loss Centre 6 · November 2010 AN independent SUPPLEMENT by mediaplanet TO THE NATIONAL POST panel of experts Helen McGuire, MHSc CDE Senior Diabetes Education & Health Systems Specialist, IDF Barbara Pasternak Founder, Diabetes Hope Foundation Judi Fern Cure Diabetes Kim Lok Living with diabetes Question 1: What is your best advice for people with pre-diabetes? The development of Type 2 diabetes occurs over time and pre-diabetes is an early stage of the disease; therefore everyone with pre-diabetes is at high risk of developing diabetes. The best advice that I can give is to take the diagnosis seriously and take action. This is an opportunity to examine your lifestyle and identify the changes you need and want to make to improve your health such as increasing your activity, managing your weight,and eating a balanced diet with lots of vegetables.These changes can help to prevent or delay the diagnosis of diabetes. Take this opportunity—you may end up feeling better than you have in a long time. Pre-diabetes is a serious ailment that can be treated and often reversed simply by making an adjustment to lifestyle and avoiding certain foods. Blood sugar levels may return to normal ranges after the incorporation of exercise and diet modification. People with pre-diabetes have blood sugar levels that are higher than normal but not high enough to be diabetes. If you are prediabetic, you’re at risk of developing Type 2 diabetes and the complications that come with it. Losing weight, exercise and limiting food portion sizes help with pre-diabetes, but you need a diet plan that fits your needs and lifestyle. Know that you have tremendous influence over your health. Learn early how to eat and live in healthy ways that support steady blood sugar levels. Learn as much as you can about diabetes and its management to help prevent its onset and to ensure a smoother transition if it does. Reach out to community resources for support—your local diabetes care centre, others with diabetes and local charities can make your journey much easier.Above all, keep setting and reaching for your goals in all aspects of your life. Question 2: Why is healthy eating and physical activity key for people with diabetes? Managing diabetes has often been described as a balancing act. With the help of their health care team, people with diabetes need to manage their blood glucose,blood lipids and blood pressure in order to prevent or delay complications. Medications can help to keep these factors in the target range but food and activity play a very important role. The food we select and the amount we eat affects how high our blood glucose rises after a meal and how long it remains above target. Activity helps to lower blood glucose. Balancing the quantity that we eat with the amount we exercise is also important to achieve and maintain a healthy weight. Choosing the right amount and selection of food along with regular activity are key to the prevention of complications related to diabetes. Research demonstrates that along with healthy eating habits, regular physical activity helps the body to use insulin better,which helps to improve the symptoms—or even reduce the risk—of Type 2 diabetes and reduce complications for Type 1. In many cases, you can control and possibly reverse Type 2 diabetes through better nutrition,weight loss,increased physical activity,and regular checkups with your health care team. Physical activity has an insulin-like effect—it can help lower blood sugar levels. Eating right is one of the challenges along with checking your blood sugar regularly, taking your medication correctly, and exercising as your doctor recommends. Choosing the right amounts of appropriate foods to eat doesn’t have to be difficult; it just takes an understanding of food groups and some planning. The continual management of blood glucose levels is paramount for people with diabetes to avoid, for as long as possible, the complications that can arise as the disease advances. Managing diabetes is a constant juggling act that requires patients to balance diet, nutrition and exercise to achieve optimal blood sugar control. For many patients,an insulin pump is an important tool in balancing it all,and we at Cure Diabetes strongly support their use. Question 3: What is the future of diabetes care? By 2030 it is estimated that half a billion people will have diabetes worldwide and the greatest increase in prevalence is currently found in low income countries among the most vulnerable populations. The future of diabetes care will be determined by the decisions and actions that each one of us take now. Will we use the knowledge, skills and technology we currently have to improve outcomes for people with diabetes, prevent the onset of diabetes and eliminate discrimination against those with diabetes? Time will tell. We must act now. With recent advancements in technology, drugs, and stem cell research, the future of diabetes care is certainly looking more positive. Advances in stem cell therapy will eventually lead to a cure, but until a cure is found, the focus is on new and improved technologie. The implantable insulin pump with continuous glucose monitor for just-in-time readings will allow better control of the blood glucose levels, no more schedules to follow and will be much easier to maintain. Faster-acting insulin will help prevent long-term complications and provide for a better life for all people living with diabetes Until there is a cure…I am certainly looking forward to a future without diabetes for my children and for all children living with the challenges of diabetes. Diabetes is an epidemic and requires renewed emphasis in research in the areas of patient care, prevention AND a cure. The costs of this disease to patients and their families and to our health care system are too high. At Cure Diabetes, we believe in supporting optimal care for patients living with the disease, such as the use of insulin pumps and frequent blood sugar testing. But we also believe strongly in continuing to fund research into treatments that will provide a cure for this disease, for once and for all. One in four Canadians either have diabetes or pre-diabetes, the latter which, if left unchecked, leads to Type 2 diabetes. An under-recognized but manageable disease For many, Type 2 diabetes is linked to genetic factors, a sedentary lifestyle and being overweight. However, Cheng stresses that glucose control is just one component of management. A person with diabetes also has to monitor their blood pressure and cholesterol levels. “A complete diabetes management program must monitor all three,” she adds. According to the 2009 National Diabetes Surveillance System report from the Public Health Agency of Canada, Type 2 diabetes is one of the fastest growing diseases in Canada with more than 200,000 new cases yearly. Nine out of ten people with diabetes have Type 2 diabetes. In Canada, the cost of diabetes this year alone is about $12.2 billion,nearly double its level in 2000. Diabetes is expected to cost the Canadian economy $16.9 billion by 2020. What is diabetes? Diabetes (diabetes mellitus) is a metabolism disorder. Our bodies metabolize digested food for energy and growth. Most of what we eat is broken down into glucose. However,our cells cannot utilize glucose without the presence of insulin, a hormone produced by the pancreas. After we eat, the pancreas automatically releases an adequate quantity of insulin to move the glucose present in our blood into the cells.This lowers the blood sugar level. When a person has diabetes, the quantity of glucose in the blood is too high (hyperglycemia). The body either does not produce enough insulin, produces no insulin, or has cells that do not respond properly to the insulin. This excess blood glucose eventually passes out of the body in urine.So,even though the blood has plenty of glucose, the cells are not getting it for their When goals are not achieved Daily routine Regular management of diabetes is needed in order to reduce the risk of complications. essential energy and growth requirements. Consequently, a classic symptom of patients with diabetes is fatigue. Other common symptoms include frequent urination, unusual thirst and unexplained weight loss. The other major concern is the long term effect, explains Dr. Alice Cheng, endocrinologist and Assistant Professor at the University of Toronto. “Long standing high blood sugar levels can result in problems with the eyes, kidneys, nerves, feet, and increase one’s risk of heart attack and stroke,” she says. Canadian Diabetes Association (CDA) figures also show that four in five patients die from heart attack or stroke. The importance of early management of diabetes It is not all doom and gloom with diabetes though. The good news is that there is a lot a person can do to help themselves. Type 2 diabetes can be prevented or postponed by making lifestyle choices like following a healthy diet emphasizing whole grains, fresh vegetables and fruit and being physically active every day. “The importance of early management lies in our ability to reduce the risk of diabetes complications. We have very good data to show that the earlier we achieve control, the better people do,” Cheng says. The glycemic goals (sugar goals) as recommended by the CDA includes a haemoglobin A1c level be maintained at 7 percent or less. (The A1c blood test indicates blood glucose levels in the preceding three months). The association also recommends that patients with diabetes aim for blood glucose readings within the range of 5-10 mmol/l two hours after eating. Fasting glucose readings should span 4-7 mmol/l. There are a number of potential explanations when goals are not achieved. These factors go beyond the medical model and include the other aspects of a patient’s life. The patient’s support network of family and friends are critical in allowing them to make the lifestyle changes that are needed. Other times, the reasons are underpinned by locality—“Some patients may not have ready access to fresh fruits and vegetables, or they cannot access the healthcare system. These are factors that do play a big role in explaining non-compliance,” says Cheng. In some cases,patients may become frustrated by the fact that the medications they are taking to help them may have some bothersome side effects. Hypoglycaemia, or low blood sugar, and weight gain, are common complaints. Fortunately, there are new options for treatment which can address some of these issues. However, public access remains a factor, and a deterrent for patients without options, Cheng acknowledges. “Treatments aren’t cheap, but they are becoming more effective.” Do patients care? Yes, says Cheng. “By virtue of them coming to see me indicates to me that they are motivated to manage their diabetes. “The sobering thing is that for every patient I do see, there are several others who should be under a doctor’s care and aren’t, or who don’t know they have the condition. “Please see your healthcare team and ask about your blood sugar,” she says. Damien Lynch [email protected] Facts There is no single cause of Type 2 diabetes but some factors can put you at greater risk. ■■ Being age 40 or over; being overweight (especially with abdominal obesity); having a close family member who has diabetes; ■■ having had gestational diabetes; and/or having given birth to a baby that weighed more than 4 kg (9 lb) at birth; ■■ high blood pressure; high cholesterol or other fats in the blood; or member of a high-risk ethnic group. ■■ Aboriginal people have three to five times the risk of developing Type 2 diabetes than other Canadians. ■■ People of Hispanic, Asian, South Asian or African descent are at higher risk of developing Type 2 diabetes. M i s m e p T C c AN iNdepeNdeNt SUppLeMeNt by MediApLANet tO tHe NAtiONAL pOSt neWs y s w 3 DON’t MISS! diabetes pet companions Philip and Edie Philip Normington, who goes low every day and has lost the ability to recognize his own levels, was stuck with regular stick testing before he was teamed with Edie, a Labrador Retriever, in November 2007. “Edie has brought comfort and companionship into my life, and my family’s concern,” says Normington of his faithful canine friend. On January 30, 2008,Edie saved his life when she was unable to revive him from a diabetic coma. By locating his wife in another part of the house and alerting her, Edie ultimately saved the day. Lawton and the Schumacher family PET PREVALEnCE in Canada, an average of four in 500 dogs are diabetic. PHOTO: SHANNON WHEATLEY Diabetes in pets is on the rise Diabetes in pets, just as it is in humans, is on the rise. especially urinary tract infection Diagnosis of diabetes mellitus Signs of pet diabetes ,■■Excessive urination and/or inapt propriate urination in the house ■■Increased thirst and appetite with y weight loss ■■Weakness and lethargy ■■Lowered resistance to infection— r TiP/STEP TiP yOuR DiABETiC PET nEEDS A HEALTH TEAM AnD STRATEGy In Canada, an average of eight in 50 cats, and four in 500 dogs are diagnosed with diabetes—however this number may be higher due to nondiagnosed animals! Pet diabetes is caused by a lack of available insulin in your pet’s body due to insufficient production by the pancreas, or failure of the body cells to respond to insulin, or both. In a healthy dog or cat, glucose is absorbed from the gastrointestinal tract into the blood and needs to enter the body cells to provide energy. Insulin transfers the glucose from the bloodstream into the body cells. In a dog or cat with diabetes, the pand creas produces insufficient amount of insulin for this to occur, resulting e in high blood glucose concentrations. n m NOveMber 2010 · 7 If you suspect your pet may be suffering from diabetes, take them to your veterinarian for a general examination. Your veterinarian will check your pet’s general health to rule out the presence of other diseases and/or infections. He or she may also conduct the following tests: ■■Urine samples (To determine if there is glucose in the urine and/or a urinary tract infection.) ■■Blood samples (To confirm the diagnosis and determine the blood glucose concentration in your dog’s blood. If the blood glucose concentration is consistently higher than normal, it may indicate that your dog’s pancreas is not secreting insulin.) Treatment You can successfully manage your diabetic pet’s health with insulin therapy, proper diet and exercise. The majority of pets with diabetes mellitus, just like humans, will need insulin injections once or twice a day. Your doctor will determine the dose that’s right for your pet and teach you everything you need to know about administering the injection and monitoring your pet’s blood glucose level. Based on the improvement of the clinical signs and blood glucose levels, your veterinarian will adjust the dose until the correct dose is established. This time period can vary from weeks to months. Living with your diabetic pet Following a regular routine, as recommended by your veterinarian, is vital for successful diabetes management. Well-controlled diabetic pets enjoy a good quality of life for many years. Monitoring your pet’s blood glucose level You may be asked by your veterinarian to monitor your pet’s clinical signs as well as to regularly check the glucose concentrations in urine and/or blood samples using a handheld glucose meter. Based on your findings, your veterinarian will be able to make the right decision about the insulin dose your pet is receiving (increase, decrease or maintain). It may help to choose one insulin caregiver per household and/or to mark on a cal- endar when to give the injection and whether it has been given or not. nutrition and diet In addition to insulin therapy, your diabetic pet will also require a consistent feeding schedule. Your veterinarian will most likely recommend a specialized diet that will help control diabetes symptoms. Always ask your veterinarian before making any change to your diabetic pet’s diet. Exercise Regular exercise is important for diabetic pets as it uses energy and helps to maintain a good body condition. In addition, exercise may improve insulin absorption. The good news is that, although Pet Diabetes is a serious disease, when diagnosed early and correctly, it can be managed successfully without too much difficulty. With proper treatment and care there is a good chance of a healthy life and normal lifespan for your pet. Courtesy of infovet.ca Meri Schumacher’s three youngest sons have T1. One night their dog Lawton alerted Meri as the boys were biking. Dinner had been consumed only minutes before, so she let it go thinking Lawton wanted treats. The dog refused to give up and jumped in front of her son Ben’s moving bike, then put his head in Ben’s lap and kept pace beside the bike. Realizing the sign,Meri yelled,“Ben check your sugar!” He was at 72. “Lawton is on FIRE!” says Meri of her dog, who is consistently bang on with his alerts. Marjo Mikkola and her feline companion, Maru Marjo and Maru Marjo Mikkola’s cat, Muru, is 13 years old, and was diagnosed with diabetes last June. Muru lies on Marjo’s lap for her glucose test and injection. “Whenever it is time to give her the insulin, I whistle and she comes to me,” says Marjo, who never questioned the process. “Muru deserves many more years of healthy life.” Marjo suggests pet owners not hesitate in finding a diagnosis, and she finds administering insulin is easier than giving a pill. Muru’s activities haven’t changed either—she is still playful and loves to be cuddled. Terry and norm Terry O’Rourke has had T1 for 26 years, has lived most of his life alone,and had made peace with dealing with his disease on his own. However,Terry went to a presentation about Dogs4Diabetes and realized “what they offered was someone to share the ceaseless burden that diabetes represents.” Terry was paired with Norm,who has enhanced his life in so many ways. “Meeting his needs provides me with an outlet to focus outside of myself,” explains Terry who says Norm always reminds him to observe the joy in the here and now. an important member of your diabetic pet’s health team SHOWCaSE e ■■ Question: Your pet’s doctor has diagnosed your four-legged comhpanion with diabetes. What’s next? m■■ Answer: as a valued member of your family’s health care team, your veterinarian will give you all the information and guidance you will need in order to effectively manage your pet’s condition. Managing your pet’s diabetes will involve a customized treatment strategy. Amongst other treatment recommendations, diet and exercise will likely be included as part of your pet’s treatment plan. To ensure a healthy lifestyle, the Canadian Veterinary Medical Association generally recommends that dogs should have at least 15 to 20 minutes of exercise at least three times a day.Cats should have the same amount of activity twice a day. Treating diabetes is possible and requires commitment from a pet owner. Following up with recommended re-evaluations and ongoing therapy adjustments is essential in order to provide adequate care. If you have questions,your veterinarian and their veterinary health care team is always there to help. With good care, dogs and cats can have a good quality of life, and though the diabetes is not cured, therapy allows the pet to lead a normal life. FaCtS The Canadian Veterinary Medical Association (CVMA) is the national professional association for veterinarians in Canada. Carly took comfort in her new puppy, Cuddles. ■■ Preventative care is important. Your pet should see your veterinarian at least once each year. Carly and Cuddles Since its inception in 1948, the CVMa has been the national voice for the veterinary profession, dedicated to serving and representing Canada’s veterinarians. the association is committed to excellence within the profession and to the well-being of animals. It promotes public awareness of the contribution of animals and veterinarians to society. Here are their tips: ■■ Monitor your pet’s behaviour and call your veterinary hospital if something isn’t normal. ■■ Schedule your appointments and be on time. If you have an emergency, call ahead to let the staff know you’re coming and ensure your veterinarian is available to help. Carly was diagnosed at 10 year old. “As a child, it is so difficult for them to express themselves,” explains her mother,Denise,“but having the power of love changed so much for her.” Cuddles, Carly’s new puppy, became the highlight of her summer instead of the devastation of her diagnosis.Getting a puppy was a purely positive experience and, “if you can handle diabetes, you can handle the responsibility of a pet,” says Denise.Cuddles brings Carly purpose and unconditional love. ■■ Ensure that your cat is in a carrier and your dog is on a leash. ■■ Visit www.canadianveterinarians. net for more info. [email protected] KRiSTen mceVOy, CvMA [email protected] KeLSey O’TOOLe