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The Good News and the Bad News on Diabetes
We keep hearing about a "diabetes epidemic," but there are things we can do now to improve our odds of beating the statistics

We've all seen the eye-popping statistics about the incidence of diabetes and, even more alarmingly, the rate at which it is said to be growing. The Public Health Agency of Canada reports that in 2008/9, the number of Canadians living with diabetes stood at 2.4 million, or 6.8 percent of the population. It adds that the number had risen by 70 percent over the previous 10 years – and that at least another 20 percent of cases had not yet been diagnosed.

Diabetes Canada reports much higher current numbers and makes some truly mind-blowing predictions for what it claims will be the prevalence of the condition by 2025 – it suggests over 5 million people, or 12 percent of the population, will be affected by that date.

But what does it all mean?

More on this later in the blog, but what I think it means is that we, as individuals, have a real chance to catch diabetes early, or even before it develops, and to do something about it.

Most of us who are not health care professionals still have a reasonable understanding of what diabetes is – a long-term condition in which the body can’t properly regulate levels of sugar in the bloodstream. Left untreated – or, more accurately, unmanaged – full-blown diabetes can lead to a whole range of debilitating or even fatal secondary effects including high blood pressure, circulatory problems, kidney disease, amputations, blindness, strokes and heart attacks, to name just a few.

There are two distinct types of diabetes. In what is called Type 1 Diabetes, the body does not produce insulin, the hormone that controls sugar levels; in Type 2 Diabetes, the body either doesn’t produce enough insulin, or simply can’t use it properly.

Type 1, sometimes called Juvenile Diabetes, tends to show up early in life and must be treated immediately to avoid catastrophic consequences. That’s where that historic Canadian discovery – insulin and insulin therapy – comes in. Type 1 is managed by injecting carefully regulated doses of insulin, as well as by making diet and lifestyle changes. Advances in blood sugar monitoring and the technology to deliver finely calibrated dosages have greatly improved the lives of Type 1 diabetics.

But it’s Type 2 that’s responsible for most of the increase in reported numbers. From a public health point of view, not to mention the benefits management aspects, this is where the action is.

Type 2 tends to develop gradually later in life – most sufferers are of working age. For a number of reasons, including genetic predisposition and lifestyle near the top of the list, the body gradually loses its ability to use insulin properly. The condition tends to be preceded by early warning signs, such as rising blood-sugar levels, that are referred to as “prediabetes.” If ignored, these changes can lead to full-blown Type 2 Diabetes.

Prediabetes and other warning signs are now routinely diagnosed because of recent advances in medical understanding of the condition. Doctors are on the lookout for it, and standards for starting treatment have changed. At the same time – not coincidentally – several new classes of drugs have been introduced in recent years, designed to improve the body’s management of sugar levels, and to enhance the action of insulin produced in the body. We, in the benefits management business, have seen these drugs shoot up from nowhere into the top five of all prescribed medications in the last few years.

But the real news is that there are interventions that can make a difference.

The fact is that many or most people with risk factors and even prediabetes can walk back from the edge by making changes in their lifestyle and diet. This is the first, and by far the best, line of defence against Type 2. The importance of making lifestyle changes can’t be stressed too highly – and always remember that a healthy lifestyle has no drug interactions or nasty side-effects.

Here is what the experts are telling us we should be doing right now to prevent Type 2 in the long run.

Lose weight: Being significantly overweight is both a risk factor and an early warning sign of the conditions that can lead to diabetes. Losing weight and managing weight through diet and exercise are perhaps the most important step in preventing Type 2 – as well as positively impacting our overall health and wellness.

Eat better: Everything you’ve heard about a proper diet really does apply here: balanced diet, food groups, fruit and vegetables, cutting out refined sugar as much as possible, no more bingeing or yo-yo diets – it all applies.

Be more physically active: Taking up running or going to the gym a couple of times a week are great, but simpler changes can also be effective, and tend to be easier to maintain in the long term. Go for walks. Take the stairs. Avoid sitting all day. Take up a sport, ride a bike – all or any of the things those annoying Participaction ads on TV are always nagging us to do.

Think healthy: Learn to relax, manage the stress in your life, put your own health and well-being on your list of life goals, look after yourself.

Look after your blood pressure: All of the points above will go a long way in managing your blood pressure, but if your last checkup flagged your blood pressure as an issue, don’t ignore it. There are medical interventions that will help when diet and lifestyle alone aren’t enough.

Consider early medical help: As with blood pressure, if diet and lifestyle alone can’t quite do the job, your doctor now has a range of relatively new treatments that manage, slow or even prevent the development or worsening of Type 2 Diabetes.

Take charge: Don’t wait until you’re diagnosed to inform yourself, and make sure you’re covering all the bases when it comes to prevention and management. And don’t skip that medical checkup if you haven’t had one in years.

I think that the “diabetes epidemic” is really a bad-news-good-news story. The bad news is clearly that many people are struggling with blood-sugar issues. But if you had mild or severe Type 2 diabetes 40 or 50 years ago – and never mind prediabetes – you probably would never have been diagnosed. Your health would deteriorate, you might die before your time, and no one would ever have told you that changes in lifestyle could have given you a longer and healthier life. So the good news here is that the medical system is diagnosing people, often catching problems early, and is now able to offer advice and options that significantly improve patients’ quality of life.

If there is a topic that you would like me to write about, please email me at bill@penmore.com.

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