AN iNdepeNdeNt SUppLeMeNt froM MediApLANet to tHe NAtioNAL poSt

diabetes

Don’t wait until it’s too late. Take control of diabetes, before it controls you.

Three Million Canadians & CounTing...

No.2/June 2010We make our readers succeed!

3methoDs

for achieving better glucose

control

Hypoglycaemia What it is and how to avoid it

insulin pumpsthe external pancreas

AN iNdepeNdeNt SUppLeMeNt by MediApLANet to tHe NAtioNAL poSt2 · JUNe 2010 AN iNdepeNdeNt SUppLeMeNt by MediApLANet to tHe NAtioNAL poSt

challeNges

stemming the tide of diabetes in canada

Already costing the Canadian healthcare system an estimated $12.2 billion annually, diabetes could potentially escalate to a $17 billion crisis by 2020.

t he exploding inci-dence of diabetes in Canada poses a sig-nificant threat to both individuals living with the disease and society as a whole,

as diabetes can lead to serious, costly complications such as kidney, eye and heart disease, amputations and even death.

“The rates of diabetes in Canada have nearly doubled since 2000, exceeding three million people; many are living dangerously undiagnosed,” said Dr. Vincent Woo, chair, Clinical and Scientific Section of the Canadian Diabetes Association. “Nearly one in four Canadians has either diabetes or prediabetes. Never before has there been a more urgent need to under-stand this disease, reduce its preva-lence and reduce the occurrence and severity of diabetes-related complica-tions.”

The Canadian Diabetes Association is responding with a renewed focus on leading the fight against diabetes by helping people with diabetes live

healthy lives while working to find a cure. Over the last three decades, it has invested more than $100 million in the best, most innovative diabe-tes research in Canada. Association-funded researchers work in a vast array of scientific investigations including areas such as autoimmune response, insulin secretion and resis-tance, prevention and management, treatment innovations and the health complications of the disease.

new tools are needed“To tackle this immense challenge, we need new ways of monitoring, analyzing and measuring the impact of diabetes on our society,” explained Anna Kennedy, interim president and CEO of the Canadian Diabetes Asso-ciation. “We recently released the new Canadian Diabetes Cost Model: a tool designed to calculate the prevalence and the economic burden of diabetes in Canada.”

The Association has also recently released several tools designed to empower patients with diabetes. Among the new interactive tools

available on the Canadian Diabetes Association’s website is the Healthy Living Series - online learning mod-ules designed to allow patients to learn at their own pace and in the comfort of their homes. In addition, the Clinical Practice Guidelines Tool Kit includes a series of resources for both patients and healthcare profes-sionals - designed to identify cardio-vascular risk and reduction strategies and to ensure both groups are well prepared for, and obtain maximum benefit from, each diabetes-focused

visit.However, according to Kennedy,

solving the diabetes crisis is a collec-tive responsibility. “Given the magni-tude of this epidemic, all Canadians need to get on board. Which is why, for the second year in a row, we launched Diabetes Summer Surge - a coast-to-coast individual donor fundraising movement. As a nation, Canada has a longstanding reputation for leader-ship in diabetes, dating back to the discovery of insulin. We need to con-tinue that tradition by each doing our share to champion the diabetes cause. Please visit www.diabetessum-mersurge.ca and launch your Diabe-tes Summer Surge fundraising event today.”

diSCLAiMer: the Canadian diabetes Asso-

ciation has neither reviewed nor endorsed

the remaining contents of this diabetes

supplement.

For more information on diabetes, visit diabetes.ca or call 1-800-BANTING (226-8464).

“...a motivated individual can do a lot to manage the disease, using the blood glucose monitor as a tool.”

glucose levelsWhen ignorance is not bliss.

We recommend

pAge 2

glucose index chart p. 5Complete guide for best food choices for diabetics.

exercise p. 7exercising is effective in lowering one’s glucose levels

diAbeteS2Nd editioN, JUNe 2010

country manager: gustav Aspegrengustav.aspegren@mediaplanet.comeditorial manager: Jackie Mcdermottjackie.mcdermott@mediaplanet.comProduction manager: Carrie reaghcarrie.reagh@mediaplanet.com

responsible for this issuePublisher: Michael Salmonmichael.salmon@mediaplanet.comcontributors: indrani Nadaraja

Distributed within: National post, June 2010this section was created by Mediaplanet and did not involve the National post or its editorial departments.

We make our readers succeed!

Mediaplanet’s business is to create new customers for our advertisers by providing readers with high-quality editorial content that motivates them to act.

It is understandable that when first handed a diagnosis of diabetes, many people are overwhelmed by the changes they have to make, particu-larly in the area of nutrition.

But food can be a powerful ally for a diabetic. Understanding and practis-ing good nutrition are critical to well being.

fibre, a friendHealthy eating can be simple. When using the recommended 9-inch plate method of portion control, half the plate should consist of colourful and leafy vegetables, excluding corn and potatoes; a quarter should consist of complex carbohydrates; and the remainder, lean protein.

Healthy adults should consume between 26-35 grams of fibre daily. Yet most don’t achieve this because they eat insufficient fruit and vegetables

daily and skimp on whole grains.Fibre can be a good friend. The Cana-

dian Diabetes Association says the soluble fibre in oat bran, legumes, fruit, (such as apples) and in root vegetables like carrots, are especially helpful for people with diabetes. Fibre breaks down in the digestive tract, forming a gel. This viscosity leads to a sustained feeling of fullness and helps prevent spikes in blood glucose levels.

Fibre reduces the total effect of car-bohydrate in the body. For example, if a serving cup of cereal has six grams of fibre, this can be deducted from the total amount of carbohydrates for a more accurate estimate of the prod-uct’s carbohydrate content.

follow the glycemic indexFood choices listed on the low end of the glycemic index (GI) will help sta-bilise blood glucose. The GI measures, on a scale of 0-100, how much digested carbohydrates raise blood sugar levels.

GI values of between 0-55 have a low GI ranking; 56-69 is moderate, and high is 70 +. Examples of low GI foods include: most vegetables, fruits and

legumes, brown rice and whole grain bread. With staples like bread, rice and pasta, portion control is also impor-tant, usually no larger than palm-size.

Proteins, oils and fats, have no GI value and are not listed on the index, but should be consumed in moderation.

read labels carefullySugar substitutes like saccharine and aspartame can be safely used in judi-cious amounts, but they will not main-tain healthy blood sugar levels.

“No sugar added”, “sugar-free” and “sugarless”, usually mean no sugar was added to the food during process-ing. The foods may contain natural sweeteners like honey, molasses, or fruc-tose.

Read labels carefully. Sugars that are found naturally in foods have different names, but they end in the letters “ose”. Bottom line: if a food label has a word ending in “ose”, it has sugar.

Using food as an ally ■■ Question: Does food have to be an

enemy for people with diabetes?■■ answer: Not if it is seen first as

an ally.

diabetes facts

1 Diabetes is one of the fastest growing diseases in Canada

and around the world.

2 One in 10 Canadian adults has type two diabetes.

3 About 60,000 new cases are diagnosed every year.

4 Diabetes is the seventh lead-ing cause of death in Canada.

5 It costs the Canadian health care system about $12.2 billion

a year.

6 You can reduce the total effect of carbohydrate in your body

by increasing fibre intake.

7 Opt for low GI foods (www.glycemicindex.com)

8 Always read and understand labels.

Dr. vincent WooChair, Clinical and Scientific Section of the Canadian diabetes Association

“the rates of diabetes in Canada have nearly doubled since 2000, exceeding three million people; many are living dangerously undiagnosed”

IndranI nadarajah

editorial@mediaplanet.com

eatingaPProPriately

(226-8464).

eating

1methoD

AN iNdepeNdeNt SUppLeMeNt by MediApLANet to tHe NAtioNAL poSt AN iNdepeNdeNt SUppLeMeNt by MediApLANet to tHe NAtioNAL poSt JUNe 2010 · 3

NeWs

glucose levels: when ignorance is not bliss

IndranI nadarajah

editorial@mediaplanet.com

Described as a modern epidemic, dia-betes itself has been around a long time. The ancient Egyptians and Greek referred to it, but it was left to the great 16th century Swiss physician, Paracel-sus to make the great leap forward and describe it as a general disorder.

Nearly 2 million Canadians are expected to develop type 2 diabe-tes over the next decade. Globally, experts project that diabetes will affect some 300 million people by the year 2025. The latter does not include “spin-offs” from diabetes: people who will be afflicted by car-diovascular disease, stroke, blind-ness and kidney failure because of their underlying condition.

However, a motivated individual can do a lot to manage the disease, using the blood glucose monitor as a tool.

monitors help Daily blood glucose monitoring helps people see, for instance, if their exer-cise and dietary efforts are paying off. Blood glucose monitors measure the concentration of glucose in the blood. The test is performed by piercing the skin (typically, on the finger) with a lancet to draw blood, then applying the blood to a chemically active dis-posable “test-strip”.

The Canadian Diabetes Association recommends that patients with dia-betes aim for blood glucose readings

within the range of 5-10 mmol/l. Fast-ing rates should span 4-7 mmol/l.

People with type 2 diabetes who are taking oral medication, or managing their condition through diet, should test at least once per day. Type 1 and type 2 patients who are on insulin should test their blood sugar more often (up to five times per day), both to assess the effectiveness of their prior insulin dose and to help determine their next insulin dose. The point is to test routinely, and not to wait till “you feel like it”.

Newer home blood sugar monitors can also measure ketone levels, using ketone strips. Ketones are formed when the body breaks down fat for

energy. This happens when carbo-hydrate intake is insufficient for the body’s energy needs or if the glucose is not being utilised properly.

Dangerously high levels of ketones can lead to ketoacidosis, which can cause diabetic coma or death. The body usually avoids this state by producing insulin, but people with type 1 diabe-tes are unable to produce insulin.

Another routine and very impor-tant test is the A1c test, which reflects glucose control for the previous two to three months. In the normal 120-day lifespan of the red blood cell, glucose molecules react with hemoglobin, forming glycated hemoglobin. Glycated haemoglobin quantities are much

higher in people with poorly-controlled diabetes than in healthy people.

A British study published in The Lancet, last February, drives this home. A retrospective study of 47,970 diabetes patients found that patients with an A1c readings greater than 6.5 percent had an increased mor-tality rate. A high A1c of more than 7 usually represents poor glucose con-trol. Chronic disease management requires information and the willing-ness to act. Informed, motivated indi-viduals can choose the life they want to lead, and not let diabetes define them.

One of the biggest advances in diabetes care has been the introduction of the blood glucose monitor, which first appeared in 1969.

“type 1 and type 2 patients who are on insulin should test their blood sugar more often...”

AN iNdepeNdeNt SUppLeMeNt by MediApLANet to tHe NAtioNAL poSt4 · JUNe 2010 AN iNdepeNdeNt SUppLeMeNt by MediApLANet to tHe NAtioNAL poSt

Introducing ClikSTAR®

Almost 2,000 people around the world—men and women just like you who use insulin every day—worked

with healthcare professionals to design a pen that optimizes convenience and ease of use.1

The result is ClikSTAR®, a pen that’s easy to learn and simple to use, with dosing up to 80 units, a dial-back

safety feature and one-step cartridge exchange. And, of course, an audible click to guide you through.

The NEW reusable insulin pen designe

d

by and for people just like yo

u

>

Introducing ClikSTAR

The The NEW reusable insulin pen designe

d reusable insul

in pen designed

by and for people just like yo

uby and for peo

ple just like you reusable insul

in pen designed

reusable insulin pen designe

d

by and for people just like yo

u reusable insulin pen designe

d reusable insul

in pen designed

>

>

by Carlos

by Asa

by Ann

by Peter

by Georgeby Rachel

by Fred

by Jules

by Thomasby Fabia

by Miguel

by Cesar

by Christel

by Pierre

by Rogerby Rachid

by Chase

by Patrick

by Jacques

by Brigitt

by Anning

by Cathy

by Sophia

by Laris

by Piniosby Anetaby Jean

by Allisson

by Radek

by Laris

by Maiby Laura by Louisa

by Adamby Neilby Tim by Pinios

by Flaviaby Edgar

by Irenaby Sherine

by Rosanna

by Vero

Talk to your doctor about the NEW

ClikSTAR® insulin injection pen

REFERENCE: 1. Penformis A., et al. IDF 2009 abstract accepted. CDN.GLA.09.08.01E

For some people with diabetes, experts say it’s one of the most powerful tools to help you live a full, healthy life.

avoiding insulin? Profile

Joanna yambouranis

■■ age: 50■■ Diagnosed:

11 years ago when she was pregnant with her third child.

Joanna Yambouranis loves spending time with her three children. Like many Canadi-ans, she enjoys family get-togethers, vaca-tions and an active lifestyle. A few years ago, when she was first diagnosed with type 2 diabetes, Joanna was afraid that her ability to live a full, healthy life was no longer possible. But thanks to insulin and smart lifestyle changes she still enjoys all the pleasures that life has to offer.

“It’s a way of life, but you can’t let it take over your life! I am still quite healthy—I still do what I want to do. There is no stop-ping me,” says the 50-year-old mother of three.

When Joanna was pregnant with her third child in 1998, routine tests revealed that her sugar levels were not normal and she was put on insulin. Diabetes runs in Joanna’s family, but being diagnosed in her early forties was not something she expected.

“I was devastated. It was very hard for me to accept it,” she says.

Insulin is a hormone which helps the body absorb energy. Normally produced in the pancreas, it protects the body from starvation, heart disease and nerve dam-age. For people with diabetes, the pancreas does not produce enough insulin and in some cases no insulin at all.

Patients have to take supplemental insu-lin, in the form of injections, to maintain their blood sugar levels throughout the day—and to benefit from insulin’s protec-tive powers.

Fearing being a slave to insulin injec-

tions for life, Joanna resisted treatment for a year.

But, after some research and with the help of her doctor and a dietitian, she began to refresh her views on insulin and how it could benefit her health.

She now uses LANTUS insulin each day. It helps patients like Joanna maintain A1C or blood sugar levels close to the optimum number, 7, with less hypoglycemic events.

Joanna says she can feel the difference in her health since she started taking insulin.

“I think it’s working great. It works over night so that my sugar levels are low when I wake up, which is very important for maintaining stable levels throughout the day,” she explains.

lifestyle choicesJoanna also supplements her insulin injec-tions with positive life style choices – she is careful about eating three balanced meals and exercises regularly.

“It doesn’t necessarily have to involve going to the gym. The idea is to be active. I walk about 30 to 40 minutes a day. Even a walk around the building during lunch helps your body process glucose more eas-ily,” she says.

Modern insulin innovations have even allowed her to enjoy all food groups – in moderation.

“You can live a normal life with insulin!” she says.

a “normal” life is possible Joanna says she can do everything she used to do before she was diagnosed including visiting her husband’s family in Greece.

“Back when I was first put on insulin, I thought my life was going to end right there but it did not. I felt better within a few weeks and now that I’ve found the right dose, I feel more in control of my disease. I am still able to go to family events and enjoy my life with my children,” she says.

Joanna also has sound words of advice for new insulin users.

“Re-think your views on insulin, they

are probably outdated. If your body needs it, insulin will make you feel better. It will help you stay healthy and improve your quality of life.”

If you have questions about diabetes or insulin use, talk to you doctor and dieti-tian.

change

CANAdA

iNspiratioN

your best shotJoanna yambouranis decided with her physician to use insulin to control her blood sugars and has never had better control.Photo: Joanna Yambouranis

StrategIc ObjectIveS

editorial@mediaplanet.com

take the right meDication

take the right

2methoD

AN iNdepeNdeNt SUppLeMeNt by MediApLANet to tHe NAtioNAL poSt AN iNdepeNdeNt SUppLeMeNt by MediApLANet to tHe NAtioNAL poSt JUNe 2010 · 5

3M and Nexcare are trademarks of 3M. Used under license in Canada. © 2010, 3M. All rights reserved. © 2010, Canadian Red Cross. Contest closes August 31, 2010. See full contest Rules & Regulations at www.bereadyforanything.ca. No purchase necessary. Open to all Canadian residents. Skill testing question required.

One bandage does not suit all wounds and activities. Be Ready for Anything by ensuring you have the right bandage solutions in your fi rst aid kit.

Because you need to be protected. Be ready with Nexcare™ Waterproof Bandages.

Enter the Be Ready for Summer Contest at bereadyforanything.ca and you could WIN a $2,500 summer prize package!

Because you need to be protected. Be ready Waterproof Bandages.

Contest and you could

Protects in shower, bath or pool

Seals out water, dirt and germs

Stays on in water!

3M_003910_Ad.indd 1 10-06-15 10:23 AM

Introducing ClikSTAR®

Almost 2,000 people around the world—men and women just like you who use insulin every day—worked

with healthcare professionals to design a pen that optimizes convenience and ease of use.1

The result is ClikSTAR®, a pen that’s easy to learn and simple to use, with dosing up to 80 units, a dial-back

safety feature and one-step cartridge exchange. And, of course, an audible click to guide you through.

The NEW reusable insulin pen designe

d

by and for people just like yo

u

>

>

by Carlos

by Asa

by Ann

by Peter

by Georgeby Rachel

by Fred

by Jules

by Thomasby Fabia

by Miguel

by Cesar

by Christel

by Pierre

by Rogerby Rachid

by Chase

by Patrick

by Jacques

by Brigitt

by Anning

by Cathy

by Sophia

by Laris

by Piniosby Anetaby Jean

by Allisson

by Radek

by Laris

by Maiby Laura by Louisa

by Adamby Neilby Tim by Pinios

by Flaviaby Edgar

by Irenaby Sherine

by Rosanna

by Vero

Talk to your doctor about the NEW

ClikSTAR® insulin injection pen

REFERENCE: 1. Penformis A., et al. IDF 2009 abstract accepted. CDN.GLA.09.08.01E

iNspiratioN

■■ Question: Why must people with diabetes pay special attention to cuts?

■■ answer: Higher blood sugar levels can cause wounds to fester.

Poorer blood circulation and an impaired immune system all contribute to the formation and slow healing of wounds in people with diabetes.

how wounds beginpeople with diabetes often have dry and itchy skin which cracks easily, allowing bacteria to enter the body. Blood circulation is poorest at the extremities, so it is crucial to check the hands and feet for cracks, cuts, or any other injuries.

Neuropathy, or nerve damage, means that the person with diabetes may not realise they have an injury, especially to the foot. If neglected, infection can occur.

signs of infectionsome signs of infection include: red and swollen skin around the wound; dis-charge or a foul odour and warm skin around the area as compared to nearby skin. Diabetes and wounds are a bad combination. If such symptoms are noticed, seek medical advice immediately.

blood glucose stabilitydiabetic wounds are more likely if the diabetes is not well-controlled by diet and/or medication. A good diet is important because it provides the necessary nutrients for tissue repair. At the same time, maintaining stable blood glucose levels ensures that healing is not retarded. Normal glucose levels also reduce the likelihood of wounds forming.

IndranI nadarajah

Watch for Wounds

4

Clinical Practice Guidelines

The Glycemic IndexWhat is the Glycemic Index of food?The Glycemic Index (GI) is a scale that ranks carbohydrate-rich foods by how much they raise blood glucose levels compared to a standard food. The standard food is glucose or white bread.

Why should I eat foods with a low Glycemic Index?Eating foods with a low Glycemic Index may help you to:

w Control your blood glucose level

w Control your cholesterol level

w Control your appetite

w Lower your risk of getting heart disease w Lower your risk of getting type 2 diabetes

Use these meal planning ideas to include the Glycemic Index as part of healthy eating. w Enjoy vegetables, fruits and low-fat milk products with your

meals. These are carbohydrate-rich foods that, in general, have low glycemic index.

w Plan your meals with foods in the low and medium Glycemic Index starch choices on the list that follows.

w Try foods such as barley, bulgar, couscous, or lentils, which have a low Glycemic Index.

w Consult a registered dietitian for help with choosing low GI foods, adapting recipes, and other ways to incorporate low GI foods in your meal plan.

If I eat foods with a low Glycemic Index can I eat as much as I want?No. Using the Glycemic Index to choose foods is only one part of healthy eating.

Healthy eating also means:

w Eating at regular times

w Choosing a variety of foods from all food groups

w Limiting sugars and sweets

w Reducing the amount of fat you eat

w Including foods high in fibre w Limiting salt, alcohol and caffeine

Remember that checking your blood glucose before and 2 hours after a meal is the best way to know how

your body handles the meal.

Check out the Canadian Diabetes Association website, diabetes.ca, for more information.Printed September 2008

VegetablesMilk

Fruit

Grains &Starches

Meat &Alterna-tives

LoW GI (55 oR LeSS) * †

Choose most often 333

Breads: 100% stone ground whole wheatHeavy mixed grainPumpernickel

Cereal: All Bran™Bran Buds with Psyllium™Oat Bran™

Grains:BarleyBulgarPasta/noodlesParboiled or converted rice

Other:Sweet potatoYamLegumes Lentils Chickpeas Kidney beans Split peas Soy beans Baked beans

MeDIUM GI (56-69) * †

Choose more often 33

Breads: Whole wheatRyePita

Cereal: Grapenuts™Puffed wheatOatmealQuick oats

Grains:Basmati riceBrown riceCouscous

Other:Potato, new/whiteSweet cornPopcornStoned Wheat Thins™Ryvita™ (rye crisps)Black bean soupGreen pea soup

HIGH GI (70 oR MoRe) * †

Choose less often 3

Breads: White breadKaiser rollBagel, white

Cereal: Bran flakesCorn flakesRice Krispies™

Grains:Short-grain rice

Other:Potato, baking (Russet)French friesPretzelsRice cakes Soda crackers

*expressed as a percentage of the value for glucose † Canadian values where available Adapted with permission from: Foster-Powell K, Holt SHA, Brand-Miller JC. International table of glycemic index and glycemic load values Am J Clin Nutr. 2002;76:5-76 111018 08-395 09/08 Q-2M

One change I will make now is:

A lot of starchy foods have a high Glycemic Index (GI). Choose medium and low GI foods more often.

diabetes.ca | 1-800-BANTING (226-8464)

sponsored by

What to expect To be seen four times a year for

diabetes care.

Review of recent laboratory tests.

Measurement of your blood pressure.

Examination of your feet at least

once a year.

Referral to an eye care professional

(usually once a year).

Assessment of your risk for heart

attack and stroke.

Conversation about exercise,

food choices, smoking, mood

and sexual function.

hoW to prepare Have laboratory tests done prior to

your visit.

Bring blood glucose records with you

(written down or printed from meter).

Bring a list of all medications including

non-prescription drugs and let team

know which need to be refilled.

Write down any questions about

your diabetes.

Save any non-urgent, non-diabetes

questions for another visit. This will

ensure that your diabetes gets the full

attention it deserves.

Your diabetes-focused visitIt is important that certain visits with your healthcare team focus specifically on your diabetes.

Blood pressureShould be checked at each diabetes visit.

target blood pressure:less than 130/80

cholesterolCholesterol should be measured with a fasting blood test every 1 to 3 years, and after a change in cholesterol treatment.

target ldl cholesterol: 2.0 or less

a1cThis blood test measures your blood glucose control over three months. Most people with diabetes should have an A1C every three months.

target a1c: 7.0% or less

acrThe ACR (albumin/creatinine ratio) is a urine test done once a year to look for kidney damage.

target acr:less than 2.0 (males) 2.8 (females)

date My Blood

pressure

date My ldl

date My a1c

date My acr

are you heading in a healthy direction?Keeping your blood pressure and certain other measurements

at target will help you avoid diabetes complications such as heart

attack, stroke, and damage to your eyes, nerves and kidneys.

AN iNdepeNdeNt SUppLeMeNt by MediApLANet to tHe NAtioNAL poSt6 · JUNe 2010 AN iNdepeNdeNt SUppLeMeNt by MediApLANet to tHe NAtioNAL poSt

■■ Question: did you know that diabetes can be treated with so-mething other than insulin injections?

■■ answer: if you answered no, then you are amongst the majority of Canadians who have never heard of an insulin pump. insulin pumps have been available since 1983 and have made great strides for diabetes patients in the U.S. where nearly half of patients use one for their insulin delivery. in Canada, we’re catching up—with various provinces providing finan-cial support to patients with type 1 diabetes. Currently, ontario is the only province to fund pumps for both children and adults with type 1 diabetes.

■■ Why a pump? Improved quality of life and better glucose control with less hypoglycemia.

■■ how? An insulin pump is an elec-tronic device, smaller than a pager, which infuses insulin through a tiny tube inserted under the skin. Pumps have a number of helpful features that assist in improved control and add flexibility to the lifestyle of an indi-vidual with type 1 diabetes.

Pumps come with a wizard to cal-culate a dose based on your current blood sugar level and how much car-bohydrate you’ll be consuming —that means no more guess work or compli-cated calculations!

■■ Pumps can fine-tune the amount of background insulin given at different points throughout the day and night, especially helpful for those who are struggling with low blood sugars dur-ing sleep.

■■ Pumps can be a huge help for active people, with the ability to immedi-ately decrease the amount of insulin given during sports.

In Ontario, insulin pumps are now fully funded for both adults and chil-dren with type 1 diabetes under the Assistive Devices Program (ADP). ADP covers 100 percent of the cost of the pump and provides an additional $2,400 per year to cover the cost of supplies.

To meet the criteria for ADP insulin pump funding, you need to have type 1 diabetes, be a permanent resident of Ontario, and have a valid health card. For adult funding, you must also be over the age of 19 and be treated with both long and short acting insulin for at least 1 year. You must also have the ability to self-assess and make changes to your insulin, based on your blood sugar readings and carbo-hydrate counting. It is also important to know how to manage your sick days by taking correction doses of insulin. A commitment to long-term diabetes follow up through regular assessments by diabetes educators and physicians is also essential. Our LMC Pump Program across Canada has been customized over years of

working with patients. We take a team approach with a combination of nurses, dietitians, and endocrinolo-gists working to educate and help you meet the criteria, and then, continu-ing to teach and guide you through the first days and weeks of pumping.

If an insulin pump sounds like

something that may benefit you or someone you know, please visit www.LMC.ca.

NeWs

Meet the driving force behind the only

truly integrated diabetes technology system on the planet.

To �nd out more about the #1 insulin pump* of choice, please visit

www.pumpchallenge.ca/infopack

“US Medical Devices-Update”; JMP Securities, LLC; March 17, 2009www.medtronicdiabetes.ca 1-866-444-4649

jennIfer McveIgh, baSc, rd, cde

editorial@mediaplanet.com

insulin PuMPs; The exTernal PanCreas

free of syringesthis pager sized insulin pump keeps many canadians needle free and independent. Photo: medtronic of canada

AN iNdepeNdeNt SUppLeMeNt by MediApLANet to tHe NAtioNAL poSt AN iNdepeNdeNt SUppLeMeNt by MediApLANet to tHe NAtioNAL poSt JUNe 2010 · 7

exercise: the other insulinThe statistic is sobering: nine of 10 people newly diagnosed with type 2 diabetes are overweight and sedentary.

The Canadian Diabetes Association recommends at least 150 minutes of moderate-intensity aerobic activity every week for people with diabetes, which is manageable when there are 10,080 minutes in a week. Espe-cially for type 2 patients, exercise has proved to be one of the most effec-tive ways to lose weight and promote stable blood glucose readings.

The Diabetes Prevention Program study, which involved 3,234 partici-pants (including high-risk minor-ity groups) across the United States, showed that people with prediabetes who walked or did other exercise for a half-hour at least five times a week (150 minutes), cut their risk of devel-oping full-fledged diabetes by nearly

60 percent. Better managed blood glucose levels also mean reduced risk of cardiovascular disease and stroke.

aerobic vs anaerobicregular exercise increases the body’s sensitivity to insulin, but people with diabetes should not go for the burn. Exercise can be broadly divided into two main groups: aero-bic activity, which includes walk-ing, swimming or biking, is longer in duration, low impact and low intensity. Anaerobic activity is high intensity and short in duration. Activities include weight lifting and sprinting. This distinction is impor-tant as glucose levels decrease dur-ing aerobic activity, but increase dramatically during anaerobic

workouts.During strenuous exercise, the

muscles send a signal for more energy, which the body responds to by releasing more glucose. It seems counterintuitive, but the more intense the exercise the more insulin is required to deal with the increased amount of glucose being released for energy. Without sufficient insulin, very hard exercise will increase glu-cose levels in the blood.

resistance training helpsmoderate weight training programs utilising light weights and high repetitions can be used to maintain upper body strength in nearly all people with diabetes, advises the American Diabetes Association.

Researchers at the Universities of Calgary and Ottawa found that a combined regime of aerobic and moderate resistance training was most effective in improving glu-cose control in people with type 2 diabetes. The study, which was pub-lished in the September 2007 issue of the Annals of Internal Medicine, involved 251 patients ages 39 to70.

some simple precautionsIt is important for people with type 1 and 2 diabetes to get their doctor’s nod before starting an exercise pro-gram. Secondly, track blood glucose levels. Record blood glucose levels before, during, and after exercise to note patterns and fluctuations. Thirdly, wear shoes that fit well, along with appropriate socks. Oth-erwise blisters or other sores could develop on the feet. Finally, stay hydrated and carry at least 15 grams of a fast-acting carbohydrate at all times in case of hypoglycemia.

increase sensitivitythe canadian Diabetes association recommends at least 150 minutes of moderate-intensity aero-bic activity every week for people with diabetes.

IndranI nadarajah

editorial@mediaplanet.com

■■ Question: Why is exercise impor-tant for people with diabetes?

■■ answer: Done regularly, exercise helps the body become more sensitive to insulin.

■■ Question: Why is over treating hypoglycaemia a problem?

■■ answer: It can lead to high sugar levels and weight gain. People with diabetes must not only deal with high glucose levels, they also have to guard against hypoglycae-mia, or low blood sugar.

Hypoglycaemia occurs when blood glucose levels fall below 4 millimoles per litre (mmol/L).

When blood glucose fallsAfter a meal, glucose is absorbed into the bloodstream. Insulin helps the cells use glucose for energy. If a person takes in more glucose than required, the body stores the extra glucose in the liver and muscles as glycogen. Extra glucose can also be changed to fat and stored in fat cells.

When blood glucose begins to fall, another pancreatic hormone, glucagon, signals for the liver to break down glycogen and release glucose into the bloodstream. Blood glucose will then rise toward a nor-mal level.

hypoglycaemiaWhen blood glucose levels fall too low, the body releases adrenaline. This causes the early warning symptoms of hypoglycaemia like shakiness, sweating, anxiety, dizzi-ness and hunger.

Diabetic hypoglycaemia can occur while sleeping. Signs and symptoms include: damp sheets or bed clothes due to perspiration; nightmares and tiredness, irritabil-ity or confusion upon waking.

What to do in an acute episodeHypoglycaemia is easily treated by consuming 15 grams of carbohy-drates from glucose. This can be in the form of glucose tablets, ½ cup of regular soda or one tablespoon of honey. Wait 15 minutes before testing glucose levels. If necessary, repeat treatment.

main causesMedical literature shows that hypo-glycaemia seems to occur more commonly in both type 1 and type 2 diabetic patients who are inten-sively managed. Patient awareness of this is important, to avoid “over treating”.

Indeed, a common cause of dia-betic hypoglycaemia is too much insulin or diabetes medication. However, other factors include not eating enough, postponing or skipping a meal or snack, increas-ing exercise or physical activity without eating more or adjusting medications and drinking alcohol, especially on an empty stomach.

Don’t overtreatwhile a hypoglyaemic episode is usually easily treated, patients complain that it takes a while to feel better.

The tendency is therefore to eat more or “overtreat” to avoid the slumps, but this can result in high blood sugars later and, possibly, weight gain.

Simple measures can be adopted to avoid overtreating hypoglycae-mia:

■■ Always have some glucose tab-lets handy, including on the bedside table, with a glass of water.

■■ Use the right number of glucose tablets, meaning.15 grams of carbo-hydrate from glucose. One tablet is insufficient.

■■ Treat low blood sugars even if it is just before a meal. Do not just eat the meal because it will take some time for the food to metabolise, and the hypoglycaemic symptoms will not lift.

IndranI nadarajah

hyPoglycaemiahyPoglycaemia

NeWs

exercise loWers sugar

exercise

3methoD

■■ What is diabetes?Diabetes, simply stated, is a disease that prevents your body from making or using insulin which in turn leads to increased sugar levels in your bloodstream.

■■ how does it affect the eye?Diabetes and its complications can affect many parts of the eye. Diabetes can cause changes in nearsighted-ness, farsightedness and premature presbyopia (the inability to focus on close objects). It can result in cataracts, glaucoma, paralysis of the nerves that control the eye muscles or pupil, and in decreased corneal sensitivity. Visual symptoms of diabetes include fluctu-ating or blurring of vision, occasional double vision, loss of visual field, and flashes and floaters within the eyes. Sometimes these early signs of diabe-

tes are detected in a thorough opto-metric examination. The most serious eye problem associated with diabetes is diabetic retinopathy.

■■ What is retinopathy?Diabetic retinopathy occurs when there is a weakening or swelling of the tiny blood vessels in the retina of your eye, resulting in blood leakage, the growth of new blood vessels and other changes. If diabetic retinopathy is left untreated, blindness can result.

■■ can vision loss be prevented?Yes, in a routine eye examination, your optometrist can diagnose potential vision threatening changes in your eye that may be treated to prevent blindness. However, once damage has occurred, the effects are usually permanent. It is

important to control your diabetes as much as possible to minimize your risk of developing retinopathy.

■■ how is diabetic retinopathy treated?In the early stages, diabetic retinopathy is monitored through eye health exami-nations. If necessary, it may be treated with laser therapy. A bright beam of light is focused on the retina, causing a burn which seals off leaking blood vessels. In other cases, surgery inside the eye may be necessary. Early detection of diabetic retinopathy is crucial, as treatment is much more likely to be successful at an early stage.

■■ are there risk factors for developing retinopathy?Several factors that increase the risk of

developing retinopathy include smok-ing, high blood pressure, drinking alcohol and pregnancy.

■■ how can diabetes-related eye problems be prevented?Monitor and maintain control of your diabetes. See your physician regularly and follow instructions about diet, exercise and medication. See your optometrist, an eye care specialist, for a thorough eye examination when you are first diagnosed as a diabetic, at least annually thereafter and more frequently if recommended.

diabetes and the eye

dr. rIchard Lee

chaIr, dIabeteS cOMMItteecanadIan

aSSOcIatIOn Of OptOMetrIStS

editorial@mediaplanet.com

When exercising remember...

■■ always check your blood sugar before and after a workout or heavy activity.

■■ always carry fast acting glu-cose as levels can drop quickly and drastically.

■■ to avoid hypoglycaemia, eat extra before workout or take less insulin (consult with your physician exactly how much)

■■ if not feeling well, immediately stop workout and test your blood sugar

plan for healthy eating increase your

physical activity

sample meal plan

handy portion guide

• The Canadian Diabetes Association recommends that all people with diabetes should receive advice on nutrition from a registered dietitian.

• Good management of diabetes includes healthy eating, staying active and taking required medication.

• Be sure to eat breakfast. It provides a good start to the day.

for smaller appeTiTesBreakfast:Cold cereal (½ cup, 125 mL) Whole-grain toast (1 slice)1 orange Low-fat milk (1 cup, 250 mL) Peanut butter (2 tbsp, 30 mL) Tea or coffee

Lunch:1 sandwich - 2 slices of whole grain bread or 6" pita - meat, chicken or fi sh (2 oz, 60 g) - non-hydrogenated margarine (1 tsp, 5 mL) Carrot sticks Low-fat plain yogurt (¾ cup, 175 mL) Tea or coffee

Dinner:Potato (1 medium) or rice (2⁄3 cup, 150 mL) Vegetables Non-hydrogenated margarine (1 tsp, 5 mL) Lean meat, chicken, or fi sh (2 oz, 60 g) Cantaloupe (1 cup, 250 mL) Low-fat milk (1 cup, 250 mL) Tea or coffee

Evening Snack:Low-fat cheese (1 oz, 30 g) Whole-grain crackers (4)

milK

frUiT

vegeTaBles(at least 2 kinds)

grains & sTarChes(potato, rice, corn, pasta)

meaT & alTernaTives(fi sh, lean meat, chicken, beans, lentils)

• Have a glass of milk and a piece of fruit to complete your meal.

• Alcohol can affect blood glucose levels and cause you to gain weight. Talk to your healthcare professional about whether you can include alcohol in your meal plan and how much is safe.

• Eat more vegetables. These are very high in nutrients and low in calories.

• Choose starchy foods such as whole grain breads and cereals, rice, noodles, or potatoes at every meal. Starchy foods are broken down into glucose, which your body needs for energy.

• Include fi sh, lean meats, low-fat cheeses, eggs, or vegetarian protein choices as part of your meal.

It’s natural to have questions about what food to eat. A registered dietitian can help you include your favourite foods in a personalized meal plan.

Your hands can be very useful in estimating appropriate portions. When planning a meal, use the following portion sizes as a guide:

FRUiTs*/GRains & sTaRCHes*: Choose an amount the size of your fi st for each of grains &starches, and fruit.

VeGeTaBLes*: Choose as much as you can hold in both hands.

MeaT & aLTeRnaTiVes*: Choose an amount up to the size of the palm of your hand and the thickness of your little fi nger.

FaTs*: limit fat to an amount the size of the tip of your thumb.

* Food group names taken from Beyond the Basics: Meal Planning for Healthy Eating, Diabetes Prevention and Management © Canadian Diabetes Association, 2005. Please refer to this resource for more details on meal planning.

MiLK & aLTeRnaTiVes*: drink up to 250 ml (8 oz) of low-fat milk with a meal.

• Build time for physical activity into your daily routine.

• Try to be active most days of the week.

• Walk whenever you can, instead of taking the car.

• start slowly and gradually increase the amount of effort; for instance progress from strolling to brisk walking.

• make family activities active; try swimming or skating instead of watching Tv or a movie.

• Try new activities; learn to dance, play basketball, or ride a bike.

• enjoy your improved sense of health and wellbeing.

Just the

Basics

plan for healthy eating increase your

physical activity

sample meal plan

handy portion guide

• The Canadian Diabetes Association recommends that all people with diabetes should receive advice on nutrition from a registered dietitian.

• Good management of diabetes includes healthy eating, staying active and taking required medication.

• Be sure to eat breakfast. It provides a good start to the day.

for smaller appeTiTesBreakfast:Cold cereal (½ cup, 125 mL) Whole-grain toast (1 slice)1 orange Low-fat milk (1 cup, 250 mL) Peanut butter (2 tbsp, 30 mL) Tea or coffee

Lunch:1 sandwich - 2 slices of whole grain bread or 6" pita - meat, chicken or fi sh (2 oz, 60 g) - non-hydrogenated margarine (1 tsp, 5 mL) Carrot sticks Low-fat plain yogurt (¾ cup, 175 mL) Tea or coffee

Dinner:Potato (1 medium) or rice (2⁄3 cup, 150 mL) Vegetables Non-hydrogenated margarine (1 tsp, 5 mL) Lean meat, chicken, or fi sh (2 oz, 60 g) Cantaloupe (1 cup, 250 mL) Low-fat milk (1 cup, 250 mL) Tea or coffee

Evening Snack:Low-fat cheese (1 oz, 30 g) Whole-grain crackers (4)

milK

frUiT

vegeTaBles(at least 2 kinds)

grains & sTarChes(potato, rice, corn, pasta)

meaT & alTernaTives(fi sh, lean meat, chicken, beans, lentils)

• Have a glass of milk and a piece of fruit to complete your meal.

• Alcohol can affect blood glucose levels and cause you to gain weight. Talk to your healthcare professional about whether you can include alcohol in your meal plan and how much is safe.

• Eat more vegetables. These are very high in nutrients and low in calories.

• Choose starchy foods such as whole grain breads and cereals, rice, noodles, or potatoes at every meal. Starchy foods are broken down into glucose, which your body needs for energy.

• Include fi sh, lean meats, low-fat cheeses, eggs, or vegetarian protein choices as part of your meal.

It’s natural to have questions about what food to eat. A registered dietitian can help you include your favourite foods in a personalized meal plan.

Your hands can be very useful in estimating appropriate portions. When planning a meal, use the following portion sizes as a guide:

FRUiTs*/GRains & sTaRCHes*: Choose an amount the size of your fi st for each of grains &starches, and fruit.

VeGeTaBLes*: Choose as much as you can hold in both hands.

MeaT & aLTeRnaTiVes*: Choose an amount up to the size of the palm of your hand and the thickness of your little fi nger.

FaTs*: limit fat to an amount the size of the tip of your thumb.

* Food group names taken from Beyond the Basics: Meal Planning for Healthy Eating, Diabetes Prevention and Management © Canadian Diabetes Association, 2005. Please refer to this resource for more details on meal planning.

MiLK & aLTeRnaTiVes*: drink up to 250 ml (8 oz) of low-fat milk with a meal.

• Build time for physical activity into your daily routine.

• Try to be active most days of the week.

• Walk whenever you can, instead of taking the car.

• start slowly and gradually increase the amount of effort; for instance progress from strolling to brisk walking.

• make family activities active; try swimming or skating instead of watching Tv or a movie.

• Try new activities; learn to dance, play basketball, or ride a bike.

• enjoy your improved sense of health and wellbeing.

Just the

Basics

reducing the risk of diabeteslike other serious health condi-tions, the likelihood of developing type 2 diabetes can be reduced by healthy lifestyle choices, such as controlling the diet, not smoking and losing excess weight and exer-cising.

Weight loss of five percent to 10 percent—or about 4.5 to 9 kg (10 to 20 lbs.) for a 90-kg (200-lb.) person—has been shown to signifi-cantly reduce the risk of diabetes. Other life-style factors to consider include:

body mass indexThe Body Mass Index (BMI) is a simple,

widely accepted way of assessing body weight in relation to health for most people aged 20 to 65 (exceptions include people who are very muscular, athletes, and pregnant or nursing women). The BMI is a statistical measure of the weight of a person scaled according to height. BMI is calculated by dividing the individual’s body weight by the square of their height (Kg/m2).

According to World Health Organization (WHO) guidelines, for adults over 20 years old, BMI falls into one of the following cat-egories:

Below 18.518.5-24.925.0-29.930.0-39.9Above 40.0

Body fat stored around the abdomen (rather than the hips and thighs) is also a risk factor for developing type 2 diabetes.

eating a healthy, balanced dietBy eating foods that are rich in fibre, reduc-ing the amount of fat in food selections and adding more fruits and vegetables, a person can help control their diet and maintain or lose weight. It is also possible to decrease the size and quantity of food servings while still ensuring that he or she meets healthy nutri-ent intakes.

ensure regular physical activityIncreasing physical activity is a key element in controlling weight and reducing the like-lihood of developing type 2 diabetes. Physi-cal activity also helps a person maintain bet-ter posture and balance, stronger muscles and bones, more energy, reduced stress and continued independent living in later life.

managing high blood pressure, cholesterol and glucoseDiabetes and high blood pressure are often found together. Up to three-quarters of peo-ple with undiagnosed diabetes have high blood pressure. Studies show that good con-trol of blood pressure, cholesterol and glucose can substantially reduce the risk of someone developing complications and slow their progression.

CoUrteSy of: pUbLiC HeALtH AgeNCy of CANAdA

don’t miss!

UnderweightNormalOverweightObeseVery obese

seNd yoUr feedback!

tell us what you think!Our ambition is to make our readers succeed. We strive to

provide you with the tools to execute your goals of personal happiness and professional success. Let us know how we’re doing!

email us!Send Mediaplanet an email at editorial@Mediaplanet.com