Sir Frederick Banting is a real-life Canadian hero. Best known as the co-discoverer of insulin with Charles Best, Dr. Banting was a lifelong medical researcher, assisted the Canadian military with the development of G-suits, and developed antidotes to mustard gas burns—testing both the gas and the antidotes on himself. He was born in 1891 in Alliston, Ontario and moved to London, Ontario to set up a private medical practice in 1920.Read More
Did you know that eating disorders are twice as likely to occur in teenage and young adult women with type 1 diabetes as they are in the general population?
Between 30 per cent and 40 per cent of women in this age range alter their insulin doses to control their weight. This practice is referred to as diabulimia and it can have profound medical consequences for individuals who suffer from it.
Denise De Campos is one of the many Canadian women who have fought with the disorder and won.
Ms. De Campos was diagnosed with type 1 diabetes at the age of 16. She says that it didn’t really affect her life when she was initially diagnosed, and she didn't have a difficult time incorporating all the aspects of diabetes management into her life. She was very active as a dancer, and was used to leading a healthy lifestyle. Making occasional minor adjustments to her care to account for the amount of exercise that she did was her only challenge.
Ms. De Campos ran into trouble in her early 20s when she moved away from home to attend Ryerson University’s dance program, where she was studying for a Fine Arts degree. The atmosphere in her program was highly competitive, and the pressures of the dance world led her to have body image issues. On her own for the first time, she didn’t have anyone around to help her manage her medical regimen.
“I didn’t do it intentionally to start with,” Denise says. “I figured out how to manipulate insulin through neglect – I wasn’t on an insulin pump yet, and had trouble juggling multiple daily injections with a strenuous dance schedule.” After missing some injections, she found that she could lose weight and eat mostly anything she wanted without gaining it back. “So I took advantage of that opportunity.”
Gradually, this approach took its toll. “It wasn’t something I could keep up for a long period of time – I would start to take insulin or else I would get really sick.” She rebounded back and forth between taking her medication and not taking her medication. “Once you start taking insulin again, your body compensates by retaining water and food.” Her life revolved around ensuring that she was always around a bathroom and her energy levels took a major hit. She decided that it wasn’t working and she went looking for help from her medical team.
Her endocrinologist referred her to the Toronto General Hospital outpatient program for eating disorders. Because of her diabetes, she skipped the waiting list and went straight into the eight-week program. While in the program, she learned why she had an eating disorder and about the function it served for her. “My world was about perfectionism, and that carried over into my diet.”
Diabetes management – and the perfectionism it instills – was also a factor for Ms. De Campos. “Diabetes management places a lot of emphasis on control. The amount of food intake, quality of food, exercise, managing insulin doses, weight management and more become a constant focus. It can become all-consuming on its own.” Add body image, weight issues and other eating disorder risk factors to the mix and it becomes a perfect storm.
Dr. Michael Vallis is an expert on diabetes and mental health, a registered psychologist at Capital Health, and an associate professor at Dalhousie University in Halifax. In his clinical work with the hospital, he sees patients who are dealing with diabetes-related eating disorders, including diabulimia.
He says, “Diabulimia is extremely risky; the death rate is extremely high. If someone has a rapid increase in hemoglobin, this can be a sign of an eating disorder and a mental health provider should be involved in his or her care. They need more frequent doctor appointments and social support.”
Dr. Vallis cautions health-care providers on the importance of being sensitive to the needs of those with eating disorders. “It is important to be non-judgmentally supportive of these individuals. If they feel shamed in any way, they just avoid health-care providers and don’t take their insulin.”
In one instance, Dr. Vallis was approached by a health-care provider concerned about a patient who would not take her insulin. “It’s extremely distressing to health-care providers to see someone not taking their insulin, but we can’t force them. We have to hold in our distress and let her know that we are willing to listen to her,” he says.
“We help her understand why she needs to take her insulin and empower her.” With this psychological support, the young woman did eventually take her insulin.
Ms. De Campos also found that power in herself and made the decision to stop on her own. She says that while she knew logically what the consequences were of not taking insulin, “the complications didn’t mean anything until they happened. It got scary for me when I realized that I may not be able to have a child later in life.”
During the process, she looked without success for someone who had been through the same thing. While forums and social networks are now available to connect recovering diabulimics, the care of a mental health professional is still essential to the recovery process.
Once Ms. De Campos left the eating disorder outpatient program, she focused on the positive things in her life, decided to leave the world of dance, and retooled her career path to pursue social work and health promotion. She has worked for the Canadian Diabetes Association (CDA) on various advocacy initiatives, including managing the Monitoring for Health program. Currently in her late 30s, she has a satisfying career in the non-profit health sector.
When we spoke to Ms. De Campos, she was in the final weeks of her maternity leave after giving birth to a healthy baby boy. “I’m healthy for my child now,” she says.
She has had complications with her vision, with seven surgeries in the past five years that resulted in the loss of the use of one of her eyes. While this can’t be directly linked to her experience with diabulimia, Ms. De Campos says that, “it can’t be ruled out, either.”
Visit the CDA’s page on eating disorders for more information about what to do if you, a friend or loved one with diabetes is struggling with an eating disorder.
When patients with diabetes end up in hospital to be treated for other conditions, they don’t always get all the care they need.Read More
Blood sugar screening for prediabetes and type 2 diabetes isn’t something that is front-of-mind for many people, especially young adults and people in good health. But early detection of prediabetes can help you significantly reduce the risk of development of type 2 diabetes. Prediabetes is often asymptomatic, and progression to type 2 diabetes happens in 50% of those with prediabetes. So how do you know when and if you need to be screened?
Determine if you are at risk of developing type 2 diabetes
There are a number of risk factors that determine if you are more likely to develop type 2 diabetes, and are applicable at any age.
- Having a parent, brother, or sister with diabetes;
- Being a member of a high-risk group (Aboriginal, Hispanic, South Asian, Asian, or African descent);
- Having given birth to a baby that weighed more than four kilograms (nine pounds) at birth or having had gestational diabetes (diabetes during pregnancy);
- Having been diagnosed with prediabetes (impaired glucose tolerance or impaired fasting glucose);
- Having high blood pressure;
- Having high cholesterol or other fats in the blood;
- Being overweight, especially if that weight is mostly carried around the middle;
- Having been diagnosed with polycystic ovary syndrome;
- Having been diagnosed with psychiatric disorders: schizophrenia, depression, bipolar disorder;
- Having been diagnosed with obstructive sleep apnea
See more risk factors on the Canadian Diabetes Association website.
If you are at risk, get screened regularly by your doctor
If you have one risk factor, your doctor should screen your blood glucose (sugar) once every three years. Dr. Jan Hux, chief science officer for the Canadian Diabetes Association, says that if you have multiple risk factors, you may want to have your blood glucose tested once a year. For example, if you are a member of a high-risk group, members of your immediate family have type 2 diabetes, and you are overweight with weight being carried around the middle, you should be testing once per year, even if you are otherwise healthy. Those who have no risk factors do not require testing.
Early detection can prevent type 2 diabetes with just five per cent loss of body weight
If you are diagnosed with prediabetes, which is typically considered to be when your blood glucose is “high normal”, there are a number of preventative measures you can take to reduce the risk of progression to type 2 diabetes. The first and most important is lifestyle change, which doesn’t have to be a huge adjustment.
A lifestyle change can be a commitment to exercise more frequently, dietary modifications, or a combination of the two. And it doesn’t take much; a structured lifestyle change that results in a five per cent loss of initial body weight prevents progression to type 2 diabetes by nearly 60 per cent. This is true for any starting body weight.
Dietary changes can include avoiding foods that are high on the glycemic index, substituting refined grains for whole grains, limiting portion sizes and increasing your fruit and vegetable intake.
If you are making a structured lifestyle change that you make an ongoing commitment to, you probably won’t stop at losing five per cent of your body weight – but small steps make a huge difference and the process doesn’t have to be an overwhelming one. This is good news since those who have developed prediabetes may also have some measure of insulin resistance, which can make it harder to lose weight. But the more weight you lose and the better food you eat, the more likely it is that you will lose some of that insulin resistance and the weight will fall off faster.
If prediabetes is indicated, your doctor will usually ask you initially to try lifestyle changes over medication, since diet and exercise only have positive side effects. If your blood glucose doesn’t decrease significantly over time, or you have other conditions such as polycystic ovarian syndrome, your doctor may prescribe metformin or similar medications to help keep your blood glucose levels down.
Lifestyle changes can be difficult
It’s a standard assumption that lifestyle changes are easy. In reality, they can be very difficult. If you live in a neighbourhood that doesn’t have sidewalks or is unsafe at night, it isn’t that simple to just go for a walk. Similarly, if you can’t afford to buy fresh produce on a regular basis due to preventative costs on a fixed income or high produce costs in your area, changing your diet isn’t just a matter of buying more fruits and vegetables. If you face obstacles in making lifestyle changes, talk to your primary health-care provider about ways to overcome these challenges.
The payoff of type 2 diabetes prevention and screening
If you develop type 2 diabetes, there is much more work involved than testing your blood glucose on a daily basis and taking medication. While there are many medications, devices and programs to help the management of type 2 diabetes, it can be overwhelming. But those living with the disease can live active, independent and vital lives. Good management of diabetes early on is quite important as those living with the disease are at higher risk for other medical issues such as heart disease. Screening is the key!
To determine if you are at risk of developing type 2 diabetes, take our short CANRISK questionnaire online.
Diabetes is a complicated disease for anyone to live with. There are numerous self-management requirements, which can include medication and lifestyle, and can take up a significant amount of time. If missed, they can have very real consequences. If you have type 2 diabetes, you may have to live with the social stigma that you developed it from being an unhealthy person, which is not always the case.
People living with diabetes require varying degrees of support for their mental health just as much as they require their medication in order to live a balanced life and manage their disease correctly.
To get an in-depth view on this complex subject, we interviewed Dr. Michael Vallis. Dr. Vallis is a registered Psychologist at Capital Health and Dalhousie University and an expert in diabetes and mental health.
Dr. Vallis asks “Would it surprise you to know that the most typical desire of people living with diabetes is to be as normal as possible? Diabetes management requires you to be abnormal.” If you are an emotional eater, for example, you’ll be told to follow a new diet that doesn’t allow you to use this coping mechanism. In order to get healthy, you have to find new ways of coping that don’t involve emotional eating – something that is usually best done with the help of a diabetes educator or, in more extreme cases, a mental health professional.
Mental health implications of diabetes: “Diabetes Distress”
When discussing mental health and diabetes, Vallis says that it is important to distinguish between the distressing factors of living with diabetes and mental health disorders.
The term for the mental health challenges experienced by people living with the disease is “diabetes distress”. “Understanding the experience of diabetes involves a need to understand the psychological dimension of living with diabetes, not as a weakness in you or a character flaw, but as a disease that you have to manage”. Those with diabetes distress are not necessarily clinically depressed, but have to deal with societal stigma and discrimination, the stress of maintaining proper diabetes management, and much more.
One of Dr. Vallis’ patients had an experience that is common for many people living with type 2 diabetes. Every time he put the Canada Food Guide on the kitchen counter for his wife to look at, she would take it away and say “that’s your problem, not mine.” This patient now faces not just living with the disease, but having a lack of support in a very critical place – his home and his relationship. With education and support, this patient’s life could be turned around, and not necessarily with the intervention of a mental health professional.
Those with mental health disorders are typically struggling with clinically diagnosed disorders in addition to diabetes, and these individuals need regular mental health care in addition to medical care for their diabetes.
Diabetes Attitudes, Wishes and Needs Study (DAWN2)
The latest Diabetes Attitudes, Wishes and Needs study (DAWN2) drew on data from 16,000 participants around the world, including 9,000 people living with type 1 and type 2 diabetes, their families, and their health-care providers. The base rate of diabetes distress in the individuals living with diabetes was 48-53 per cent, while 12-13 per cent of them identified as being likely to suffer from depression. For comparison, six per cent of the Canadian population suffers from depression. Dr. Vallis is one of the authors of the study.
This means that about half of those living with diabetes are living with diabetes distress, and 12-13 per cent of those are at risk of being clinically depressed; which is almost twice the prevalence of depression among the general Canadian population. The study shows that it is vitally important to deal with the psychological and psychosocial issues surrounding diabetes in order to help people living with diabetes have a better quality of life.
Managing the four aspects of diabetes distress
Diabetes distress has four distinct aspects:
- Emotional burden
- Regimen distress
- Patient provider distress
- Social support distress
To determine the emotional burden of living with diabetes, patients are asked “if diabetes is an object you carry, what would you compare it to?” They are then given the option of a one pound loaf of bread, a five-pound sack of flour, a two-ton truck and other criteria. This helps medical professionals and the patient assess how much emotional bandwidth diabetes takes up in their lives.
Regimen distress describes how much sticking to a self-management regimen distresses the patient – items such as counting carbohydrates, tracking blood sugar levels, ensuring medications are taken and so on.
Patient provider distress refers to the relationship that a patient has with their health-care providers. To what extent does the patient feel judged or misunderstood? Patients are more likely to put off medical visits when they feel like their health-care provider is judging them for their disease or lifestyle.
Social support distress involves the support of friends and family. The patient with the issue with the wife who didn’t want to follow the Canada Food Guide, for example, would be perceived as suffering from social support distress.
Fighting Diabetes Distress with Diabetes Empowerment
Diabetes empowerment is about helping people living with diabetes feel like they are in control and to reduce the stress and fear of living with diabetes. People with diabetes live with fear of hypoglycemia, fear that they will be judged for their condition, and many of the other issues that live under the umbrella of the four aspects of diabetes distress.
Those living with type 2 diabetes, for instance, can see aspects of their disease, such as having to transition to taking insulin, as a failure on their part rather than as something that may have to happen eventually. The typical reaction to being told they need insulin, according to Dr. Vallis, is “I’ll be good, I’ll try harder” rather than accepting the medication. If a person living with diabetes is empowered to not think of insulin as a failure, they will be able to better manage their condition.
Empowerment happens when the person living with diabetes, their friends and their family are better informed about diabetes. For the individual with diabetes, this can come in the form of support groups and participating in diabetes education events. Family and friends can also attend some educational events so they can provide informed support. The DAWN2 study showed that Canada had the greatest use of any country of diabetes education services, which is promising for promoting diabetes empowerment.
Delivering Mental Health Support to People Living With Diabetes
Stress management is very important to managing diabetes. When you are stressed, your self-management decreases, which can have serious implications for people living with diabetes. Diabetes carries with it a number of extra tasks that the average person doesn’t have to do, and these tasks can fall off if someone is feeling stressed out.
In order to help people living with diabetes, Dr. Vallis believes in promoting a stepped collaborative health-care model that sees individuals getting the help they need from the appropriate professionals. If a patient tells their doctor that stress is keeping them from a healthy self-management routine and eating right, that doctor can then refer them to a nutritionist and a mental health-care professional who can help get them back on track. Dr. Vallis helped to create a six-session psychosocial intervention program to be used by diabetes education providers across Canada; in many cases this may be all a person living with diabetes needs rather than being referred to a mental health professional, which can take a significant period of time that a person at risk may not have.
With the stepped-care collaborative model Dr. Vallis suggests, mental health support can be delivered to people living with diabetes when they need it through the use of diabetes education services, and referrals to a mental health professional where necessary. It is up to health-care providers to help individuals navigate the system so they can find the support they need when they need it. It is up to those living with diabetes to seek out the programs they need to become informed – and empowered – to live well with their disease.
Managing diabetes in order to prevent or delay the common complications of the disease – such as heart disease and stroke, amputation, kidney failure, depression and blindness – is a challenging, 24/7 job. But the health-care realities of living in a northern community make that job significantly more difficult.Read More
A research team at The Ottawa Hospital is documenting the effects of promising mindfulness-based stress reduction on chronic pain and diabetes management.Read More
At a public event with 20,000 people in attendance, about 2,000 are likely to have diabetes. To manage their disease effectively, they may need to carry healthy snacks with them at all times and may have to inject insulin. Are public venues adapting?Read More
At least once a week Dr. Rohan Ganguli meets with a select group of clients at Toronto’s Centre for Addiction and Mental Health (CAMH) who live each day with two critical health challenges: mental illness and diabetes.
At these meetings Dr. Ganguli, a professor of psychiatry and Canada Research Chair at the University of Toronto’s Dalla Lana School of Public Health, reviews diaries that record levels of physical activity and daily diet, and discusses the small, everyday choices that people with diabetes can make to improve their health and manage their disease better.
“We started by encouraging people to self-monitor, using pedometers we gave them so they can record how much they're walking and a scale they got to keep at home so they can weigh themselves every day,” explains Dr. Ganguli, who is also a senior scientist at CAMH. “They keep a paper diary – most people I’m dealing with are poor and can’t afford a computer or mobile device – and during our meetings we go over the diaries with them, and the people in the group share their experiences and support each other.”
Dr. Ganguli’s work with this particular group of clients is part of a three-year study looking at whether an intense behavioural weight-loss intervention can help people with mental health challenges and diabetes. Funded by the Canadian Diabetes Association and the Public Health Agency of Canada, the study involves about 70 participants, with two-thirds getting intervention and one-third getting encouragement to make changes – such as losing weight – during monthly discussions with Dr. Ganguli and his research team.
So far, says Dr. Ganguli, six-month results have shown about 400 per cent more clinically significant weight loss among the participants getting weekly intervention than those who are not.
“Some people who are not getting intervention have lost a bit of weight,” says Dr. Ganguli. “But we’re seeing much more weight loss in people who are in the group getting intervention.”
Diabetes is a serious concern among Canadians with mental health challenges, says Dr. Ganguli. The rate of diabetes among people with serious mental illnesses is two to three times higher than among the general population. At the same time, life expectancy among this group is generally lower by about five to 15 years.
There are a number of factors behind the higher incidence of diabetes among Canadians facing mental health challenges, including lack of access to healthy foods, little or no opportunities for physical activity, and in some cases medications for mental illness that may cause weight gain.
“Diet and physical activity are the two key factors that determine the incidence of diabetes within a given population,” says Dr. Ganguli. “What we are trying to do is determine whether we can change lifestyle patterns within this particular population or subgroup.”
If you feel all people living with diabetes deserve the same access to care and support needed to live their healthiest lives, you believe in a Diabetes Charter for Canada (Charter). Fact is, support for diabetes treatment and medical supplies vary depending on where you live in Canada. People with diabetes can experience challenges in all aspects of their life specifically related to their disease. The Charter provides statements that clearly outline what people with diabetes can and should expect from themselves and others in the diabetes community.
We need a change. A Diabetes Charter for Canada will light the spark that leads to change. It will help all Canadians living with diabetes get the support they need. Support the Diabetes Charter – sign it today!
An estimated one million Canadians live with undiagnosed type 2 diabetes, underlining the importance of raising awareness of its risk factors. To mark Diabetes Awareness Month this November, the Canadian Diabetes Association is unveiling its “Don’t Be Risky” campaign. Canadians are encouraged to visit DontBeRisky.ca and fill out a CANRISK test to identify their risk of developing type 2 diabetes and prediabetes.
Untreated, type 2 diabetes can cause severe health problems and even be fatal. Early diagnosis and awareness can make all the difference. Find out if you are at risk by filling out the short CANRISK diabetes test, and take charge of your health. Knowing the risk factors can help Canadians take action to prevent diabetes. Early detection for those who have the disease can decrease complications and improve an individual’s quality of life.
All those who visit DontBeRisky.ca and complete the CANRISK test from October 15 to November 30 can enter a draw to win one of three Money for Life experiences – including a grand prize of a $5,000 financial portfolio of investment and/or insurance products – courtesy of Sun Life Financial. In addition, Novo Nordisk Canada Inc. will donate $1 to the CDA for each test completed.
The day Katherine Coupland turned 19 was also the same day she was “aged out” of her province’s insulin pump program, which covered the cost of purchasing the medical device for eligible residents aged 18 years or younger.
As her pump’s five-year warranty approached its expiry date, Ms. Coupland began to worry. Would she able to afford a new pump – which would likely cost between $6,000 to $7,000 – when her old one stops working or will she have to start injecting insulin again to manage her type 1 diabetes?
“Using a pump has allowed me to drastically reduce my average blood glucose (sugar) level, which in turn lowers my risk of developing other diabetes-related complications in the future,” says Ms. Coupland, who is now 21 and a fourth-year biology student at the University of Victoria in British Columbia. “It would be challenging, life-changing and devastating for me to not have my insulin pump.”
Ms. Coupland’s worries were eased when the B.C. government raised the maximum qualifying age for insulin pump coverage from 18 years old to 25 years old. But she knows that in four years, she’ll have to start thinking again about what she’ll do when it comes time to replace her pump.
She’s not the only one facing this challenge. A study by the Canadian Diabetes Association (CDA) found that the cost of medications, devices and supplies presents a significant challenge to people with diabetes. Those with type 1 diabetes who use an insulin pump generally face “far higher” out-of-pockets costs than those who don’t use a pump, according to the report.
Because of the considerable expenses associated with managing diabetes, close to 60 per cent of Canadians with the disease don’t comply with their prescribed therapy, says the report.
Jake Reid, director, government relations and advocacy - Atlantic at the CDA, says provincial coverage of medical devices, medications and supplies is a vital necessity for many Canadians with diabetes. But different coverage levels across the country makes managing their diabetes easier for some and incredibly difficult for others.
“Some provinces – for example, Ontario and Alberta – don’t have age restrictions on insulin pump coverage, whereas coverage for pump programs in Atlantic Canada ends when you become an adult,” says Mr. Reid. “ When it comes to managing your diabetes, it still matters where you live in Canada. Our vision within the Diabetes Charter for Canada is that all Canadians with diabetes no matter where they live have access to the supports they need to live life to their full potential.”
Given the body of evidence showing that insulin pump therapy provides sustained improvement in glycemic control, it’s important for Canada’s provinces and territories to give their residents low- or no-cost access to these medical devices, says Mr. Reid. The CDA has been working towards this goal with provincial and territorial governments across the country, he says.
“We’re asking that governments open up access to insulin pumps regardless of age,” says Mr. Reid. “We know that if a person can use an insulin pump to take care of themselves, then that can help prevent them from developing complications and reduce health care system costs down the road.”
Kendall Dorricott still gets angry when she recalls the disturbing incident that, a year ago, saw her humiliated in front of her peers and penalized in school.
She was a student at the time, enrolled in a practical nurse program at a Canadian college. While on clinical rotation at a city hospital, Ms. Dorricott was sitting in an enclosed room used exclusively by healthcare staff when she retrieved her insulin pump, which was tucked inside her shirt and activated it to deliver a dose of the medicine she needs to manage her type 1 diabetes.
“From across the room, my instructor called out to me and said ‘you're going to have to go somewhere else if you're going to do that,’” recalls Ms. Dorricott, who graduated this year and now works as a nurse at the University of Alberta Hospital. “When I asked her why, in front of everybody she asked me to leave the room with her and once we were outside she started going on about how it was unprofessional and offensive for me to administer my insulin in front of other people.”
Ms. Dorricott says the instructor also told her to go to a washroom next time, or to a private, unoccupied room. She says she told the instructor this wasn’t a good idea, given the risk of her passing out if her blood sugar gets too low.
“What she was telling me went against everything my doctors and nurses have ever told me,” says Ms. Dorricott, who was subsequently placed by the school into a remedial program as a result of this incident, a decision that was later reversed. She has since filed a complaint related to the incident with the Alberta Human Rights Commission. “I was so upset I started crying.”
Ms. Dorricott isn't the only person with diabetes who has complained of being singled out or denied accommodation for their disease, says Joan King, manager, outreach and individual advocacy at the Canadian Diabetes Association (CDA). While there are no statistics tracking these incidents in Canada, there's no question they happen, says Ms. King.
“We don’t hear all of the stories but we certainly receive calls and emails from people who contact us directly to talk about issues where they’ve been discriminated against or where their rights have been denied because of their diabetes,” she says.
Diabetes carries a stigma among people who have a limited understanding of the disease and may not realize that their actions or restrictive demands may be endangering and infringing on the human rights of those with diabetes.
While diabetes-based discrimination takes many forms and happens in various settings, most of the incidents reported to the CDA are work-related, says Ms. King. Common complaints include being refused a job or promotion, or failure of an employer to accommodate requests such as longer or regular scheduled breaks so they can eat or administer their insulin.
Anyone who feels they’ve been treated poorly or unfairly because of their diabetes should call 1-800-Banting or email firstname.lastname@example.org, says Ms. King.
Diabetes is a stealthy (often invisible) disease that, together with prediabetes, now affects about more than 30 per cent of Canadians.
Upon diagnosis, the burden of diabetes may seem limited to the difficult reality of managing blood glucose (sugar) with various self-management techniques, including medication, careful attention to diet and exercise, and constant vigilance, but its longer-term impact can be devastating: It is the leading cause of vision loss and kidney disease, as well as one of the leading causes of heart disease, stroke, amputations and depression.
In order to help prevent complications by ensuring that people with diabetes get the support they need, the Canadian Diabetes Association’s (CDA’s) new Diabetes Charter for Canada confirms their rights and responsibilities, along with those of governments, service providers, employers, schools, preschools and daycares.
Introduced by the CDA this year, the Charter “provides a set of standards that allow people with diabetes to optimally self-manage and live their lives to their full potential, with dignity and respect,” says Aileen Leo, executive director of government relations and public affairs, CDA.
Having diabetes is a 24-hour, seven-day-a-week job, she points out. “If people living with diabetes are very lucky and very good at self-management, it’s possible to delay complications. But we need support – we need access to education and information, as well as diabetes medications, devices and supplies.”
As most provincial health-care systems don’t cover the costs of medications except for protected groups such as seniors, “if you’re low income, even if you’re middle income, the costs of diabetes medications, devices and supplies may be beyond your reach,” Ms. Leo explains. “I’ve been to many advocate-training days where people have talked about ending up in the hospital because they simply couldn’t afford their medication.”
“When you come right down to it, if you can’t afford healthy food choices, or if you don’t have a health plan that helps to pay for medications, devices and supplies, diabetes is very difficult to manage,” says Rob Beck. The CDA chair of the National Advocacy Council, Mr. Beck was diagnosed with type 2 diabetes about 10 years ago. “I’m very fortunate – my benefit plan pays for 90 per cent of my medications. Yet the last time I refilled my insulins and test strips, my copay was $85.”
Mr. Beck says that he meets many people from Nova Scotia communities with “a very high incidence of diabetes and very low incomes. They have limited access to education, healthy foods, medications and medical advice.”
The Charter is about achieving equal access for them and all of the more than nine million Canadians living with diabetes or prediabetes, he stresses. “We’re not demanding this just for us
– we’re saying that if you want to keep your health-care system intact for everyone who needs it, you have to manage diabetes.”
Emily Johnson, a nurse and diabetes educator who was diag- nosed with type 1 diabetes in her forties, is also a member of the CDA National Advocacy Council. The Charter recognizes that people with diabetes have unique needs because of their diabetes, she says. When the daughter of one of her colleagues wasn’t allowed to keep her diabetes supplies with her in her classroom – a common occurrence as well as a risk for the student involved – the colleague brought the Charter to the school, which then changed its policy.
There is no easy fix for diabetes, Ms. Johnson adds. “But it’s doable – I describe it as a new norm in my life. I tell all my clients about the Charter, and I hope it will encourage them to speak up and advocate for themselves.”
The Charter also addresses inequality of access to care across the country. In Saskatchewan, for example, some diabetes management supplies such as test strips and lancets are publicly covered for anyone who is living with diabetes. “To me, that makes absolute sense, because the key to leading a healthy life with this insidious, chronic, progressive disease is to manage it properly from the onset,” says Phil Bobawsky.
Regrettably, Mr. Bobawsky lives in the province next door, where public coverage for supplies is more limited than in Saskatchewan. As the CDA regional chair for Southern Alberta, he says he hears “all too often” from people diagnosed with diabetes who can’t get the support they need.
The cost of an insulin pump is $7,000, he says. While some may be quick to say there simply isn’t funding available to cover these costs, health-care systems inevitably end up paying much more for hospital visits and treatment of complications, he adds. An insulin pump program was introduced in Alberta in 2013.
Mr. Bobawsky knows too well the cost of less-than-optimal management of diabetes. Diagnosed with type 2 diabetes 17 years ago, he has since lost his sight and his kidney function.
“We have to make management of the disease attainable for everyone. And we have to educate everyone on how to manage the disease. Because if we do that successfully, there won’t be as many complications,” he stresses.
Launched on April 7, the Charter has already been signed by more than more than 17,000 Canadians.
“We’re going to work together to ensure that the Charter is a tangible, robust advocacy tool to make the lives of people with diabetes in Canada better – in two years, five years, 10 years and 20 years,” says Ms. Leo.
If you are over the age of 40, the Canadian Diabetes Association (CDA) recommends you get checked every three years, and more frequently if you have any of these risk factors:
- A parent or sibling with diabetes
- Are a member of an ethnic group at high risk for type 2 diabetes (African, Hispanic, Asian, South Asian and Aboriginal)
- Are overweight
- Have high blood pressure or high cholesterol
- Have been diagnosed with prediabetes
- Have polycystic ovary syndrome
To find out your risk of type 2 diabetes, the Don’t Be Risky campaign asks you to take the Canadian Diabetes Risk (CANRISK) test at www.DontBeRisky.ca and tell your friends and loved ones about it, so they can take it, too.
When you take the Canadian Diabetes Risk (CANRISK) test as part of the CDA’s Don’t Be Risky campaign, Novo Nordisk Canada will donate $1 for every CANRISK test completed through the contest. You also have the opportunity to be entered into a contest to win one of three Money for Life experiences – including a grand prize worth $5,000 and/ or one of two grand prizes worth $2,500 – from Sun Life Financial.
For more details and to enter, visit www.DontBeRisky.ca.
Even after four months of constant thirst, frequent trips to the bathroom, and soreness in his arms and legs, Bubba Vermette simply shrugged and told himself there was nothing unusual going on.
“I thought I was as tough as nails, nothing can bother me,” recalls Mr. Vermette, a resident of Lethbridge, Alta., and owner of Bubba’s Lawn Mowing and Snow Shoveling Service. “But one night at a restaurant I pretty much drank a whole jug of iced tea in one sitting, and my father-in-law told me: you should get tested.”
Two weeks later he did, and learned he had type 2 diabetes. The news was a huge shock for Mr. Vermette, who worked out regularly and took pride in his fit physique. But after an initial bout of depression – which led to months of physical inertia and a weight gain of more than 80 pounds – Mr. Vermette decided to start living a healthier lifestyle and managing his diabetes.
“I joined a weight loss program,” says Mr. Vermette, who now does a 100-kilometre walk each year to raise funds for diabetes research and increase awareness of the disease for the Canadian Diabetes Association (CDA). “I also started walking around the block, up and down the sidewalk.”
Mr. Vermette, who has now raised more than $2,000 through his walks, is among the more than 2.9 million Canadians with type 2 diabetes – a condition that occurs when the body can’t make enough insulin or is unable to properly use the insulin it produces. Type 2 is the most common form of diabetes, affecting about 90 per cent of people diagnosed with the disease.
Many people with diabetes can also develop complications such as heart, kidney or eye disease, amputations, stroke, nerve damage and erectile dysfunction in men.
Yet in many cases, type 2 diabetes may be delayed or even prevented. Rick Blickstead, president and CEO of the CDA, says understanding your personal risk for type 2 diabetes is critical to reducing your chance of developing this disease.
“If we could prevent diabetes before it has a chance to develop, that would be a game changer,” says Mr. Blickstead. “If we don’t do this, we will have one in three Canadians living with diabetes by 2024, and will be spending almost $20-billion a year on this disease.”
To halt the advance of this disease referred to frequently as “the silent killer,” the CDA is urging all Canadians to take the Canadian diabetes risk test (CANRISK), developed by the Public Health Agency of Canada and accessible through the CDA’s website (www.diabetes.ca) or at www.DontBeRisky.ca. As part of the CDA’s Don’t Be Risky campaign – which runs from mid-October to November 30, with a focus on prevention – Canadians who complete the test have a chance to win a grand prize of a $5,000 or one of two $2,500 Money for Life experiences: a financial portfolio from Sun Life Financial. For every test completed, Novo Nordisk Canada will donate $1 to diabetes research.
Made up of 12 easy-to-answer questions – such as your age, gender, height and weight – the diabetes risk test takes only a few minutes to answer. At the end of the test, those with a high risk of developing type 2 diabetes are encouraged to see their doctor for testing.
“Once you know you are at risk, there are simple things you can do to help prevent diabetes, like eating a healthier diet, quitting smoking and leading a more active lifestyle,” says Mr. Blickstead. “Studies have shown that the risk of developing diabetes can be reduced by 58 per cent through lifestyle changes, including moderate weight loss and regular physical activity. That’s significant.”
Today, an estimated one million Canadians are living with undiagnosed type 2 diabetes. “We need to take this matter very seriously,” he says. “Take the test, don’t take the risk – because you might be one of the million who actually has diabetes and doesn’t know it.”
It started as a “little scab” on the top of his foot.
Then “it kept getting bigger and bigger,” says Jim Elliott. “I went to the hospital – I thought I was going to get antibiotics. The next thing you know, I woke up three days later in the middle of the night to go to the washroom, and I fell right to the floor. I didn’t know what was going on. I took the blanket off and said, ‘Oh my God, they took my leg.’”
Prior to the amputation, Mr. Elliott was one of the estimated one million Canadians who have diabetes but don’t know it. He learned of his condition a week after the surgery, much too late to make the changes that may have saved his leg.
An active person throughout his life, Mr. Elliott snowboards in winter, golfs in the summer and is involved in harness racing. He was shocked to receive the diagnosis. “No one in my family had diabetes. It was a wakeup call,” he says.
Three years earlier, his family doctor told him that he had “borderline diabetes,” a message that he ignored. “I’d never heard anything like that before. I never listened to my doctor, I never listened to my mother. I was in denial,” he admits today.
In 2011-12, more than 2,000 foot amputations in Canada were caused by the complications of diabetes. It is also the leading cause of vision loss and kidney disease, as well as one of the primary risks for heart disease, stroke, nerve damage and depression. In fact, complications make up 80 per cent of the costs of diabetes. Yet with effective management of the disease, complications can be delayed or even prevented.
But too many Canadians are unaware of their risk of diabetes, and of the related risk of these devastating complications. This year’s Sun Life Canadian Health Index, an annual coast-to-coast survey of over 2,700 working Canadians conducted by Ipsos Reid, found that almost 70 per cent couldn’t even identify all of the health complications that are associated with diabetes.
More than 30 per cent per cent of Canadians now have diabetes or prediabetes, which means that almost everyone knows someone affected by the disease. And according to the Canadian Diabetes Association, one in three Canadians will have diabetes by 2020 if current trends remain unchecked. Yet “what it means to live with diabetes is not well understood,” says Mary De Paoli, executive vice-president of public and corporate affairs, and chief marketing officer at Sun Life Financial.
As understanding your personal risk for type 2 diabetes is critical to reducing your risk of developing the disease, Sun Life has partnered with the Canadian Diabetes Association in the Don’t Be Risky campaign.
“We wanted to break through the inertia that Canadians have when they have to confront a message around prevention or awareness,” says De Paoli. “The message is a simple one: Take a few minutes, complete the CANRISK test and find out your risk of developing type 2 diabetes and prediabetes.
“It’s a breakthrough campaign that we hope will inspire Canadians to take just a few minutes to do something for themselves – to be more informed, prevent the onset of type 2 diabetes and live better lives.”
As a group benefits provider, Sun Life has a uniquely informed perspective on the development of diabetes, says Ms. De Paoli. “When we heard the World Health Organization call this the epidemic of the 21st century, we put all of our efforts behind trying to raise awareness and encouraging Canadians to live healthier and smarter.”
To date, Sun Life contributions to diabetes awareness, prevention, care and research exceed $11-million. “That’s been in just a few short years – we’re very committed to this cause,” she stresses.
Today, Mr. Elliott is inspiring others who are struggling with health challenges. After the amputation last December, he entered a rehabilitation program at Providence Healthcare in Toronto. “My main goal was to walk at my nephew’s wedding in August. I pulled up in a wheelchair and, at the door, got up and walked to the altar. He couldn’t believe it.
“Diabetes is not something you can play with – you have to listen to your doctors, and work hard at it. But life goes on. Don’t give up.”
AnxietyAnxiety disorders can be increased in individuals with diabetes compared with the general population and potentially impact blood sugar control.
DepressionDepression is more common in people with diabetes compared with the general population.
Eye Damage (Diabetic Retinopathy)Good eye care is important for people with diabetes to prevent or delay eye damage.
Heart Disease & StrokePeople with diabetes are at very high risk of heart disease and stroke. Ask your doctor about the ABCDEs to reduce your risk.
High Blood PressureWhen blood pressure is high, it puts stress on the body. People with diabetes should have their blood pressure checked every time they visit their health-care team.
Find more information at www.diabetes.ca/
To learn more about the different ways you can donate to the CDA, visit www.diabetes.ca/donate.
In 2013, Team Diabetes members took part in Conquer the Crater, a spectacular hike through some of Iceland’s most dramatic, unique landscapes.
A national, physical activity fundraising program developed and run by the Canadian Diabetes Association (CDA), Team Diabetes promotes a healthy, active lifestyle while raising funds for education, programs and services, advocacy and “breaking ground toward a cure.”
The hikers completed a six-, 14- or 24-kilometre trek through an ancient glacial canyon to a stunning waterfall. Those in the longer hikes continued on, with those in the 24-kilometre hike ascending two craters before returning back to base along the same route.
Hike participants stayed in Reykjavik, a city famed for its lively and distinctive culture as well as being the world’s northernmost capital. A great base from which to explore the country’s glaciers, hot springs, geysers, active volcanoes, fjords and vast lava deserts, Reykjavik’s climate is surprisingly moderate: Its highest temperature, 28.2°C was recorded in July of 2008, and the temperature has not dropped to below -20°C since January 1971.
Oliver Horton was one of the Team Diabetes members who took part in Conquer the Crater, and his daughter Tess, who lives with type 1 diabetes, came along on the trip. Tess attended the celebration dinner with her dad, and was moved by the contributions of Team Diabetes participants as well as by a D-Camps video that was presented.
As a result, says Mr. Horton, Tess decided she wanted to go to D-Camps.
D-Camps is a national CDA program designed to provide children ages eight to 15 who are living with type 1 diabetes an authentic and exciting camp experience where they become independent in managing their diabetes.
When they returned to Canada from Iceland, Tess signed up for D-Camps at Camp Huronda in Muskoka. “She also asked if she could go on an insulin pump to get away from self-injection with needles,” says Mr. Horton.
He adds that both of those decisions were “a direct consequence of being involved with a Canadian Diabetes Association event.”
In August of this year, Mr. Horton participated in a Team Diabetes hike on Kauai, the oldest of the Hawaiian Islands. The route followed the coastline, with breathtaking views of the ocean, volcanic peaks and rain forests that have served as backdrops for movies such as Avatar, Jurassic Park and Pirates of the Caribbean.
But Mr. Horton doesn’t participate primarily for the views, the experience or even the physical challenge.
“For me, Team Diabetes is about supporting research, finding a cure,” he says. “I don’t want anybody to have to look at their child and realize there isn’t a cure for their disease. That one thing alone is very difficult thing to do.
“And it’s about funding D-Camps, where kids can forget they have diabetes.”
When Sarah Minacs was 12, she was diagnosed with type 1 diabetes, an autoimmune disease that attacks the insulin-producing cells in the pancreas. A dancer and competitive cheerleader, Sarah struggled with feelings of being “different” – until she attended D-Camps at Camp Huronda in Muskoka.
D-Camps is a national Canadian Diabetes Association (CDA) program designed to give children and young people with diabetes the full, carefree camp experience while meeting new friends and also learning to better manage their diabetes.
Inspired by Sarah’s positive experience at D-Camps, her father Jack Minacs joined Team Diabetes, the national, physical activity fundraising program of the CDA, “as a way to give back.
“My wife and I have two daughters and a son, and Sarah, who is now 15, was diagnosed with type 1 diabetes in 2011. Within a year of her diagnosis, I became pretty actively involved in fundraising with the CDA,” he says.
“We hope for a cure – our long-term goal is that one day, kids like Sarah won’t have to deal with having diabetes. But in the meantime, just to live a healthy life, emotionally as well as physically, Sarah needs a lot of support in the community, and that’s what the CDA does for us.”
At first, Sarah didn’t want to go to D-Camps, Mr. Minacs says. “We had a lot of people recommend that she go, but she was not really interested. She thought she’d be lectured about eating and all that, but what the camp does is just let those kids be kids. They’re very well monitored medically, and for families, it’s like two weeks of freedom from diabetes.”
Sarah went from feeling unenthusiastic to “‘This is the best place in the world, I never want to leave – finally I realize that there’s other kids out there just like me,’” says Mr. Minacs. “It was really inspiring for her and for us as a family, and that’s really what prompted me to get involved with fundraising.”
After Sarah was diagnosed and given insulin, she started feeling better right away. But it was just the beginning of a 24-hour, seven-day-a-week care regimen that requires checking blood glucose (sugar) frequently to be sure she was getting enough insulin – but not too much insulin – while monitoring her carbohydrate intake and energy output.
“The CDA provides information and support, which is just so important to living with diabetes,” he says. “It’s a constant battle, but you keep pushing through. And when you start reading about how prevalent diabetes is, you know how much more there is to be done. There are just so many people living with diabetes. I’m proud to support the Canadian Diabetes Association, because it helps so many people across Canada.”
Aboriginal people are at high risk of developing type 2 diabetes, something that Bibianna King has experienced firsthand as she has watched many of her relatives struggle with the disease. Her husband and mother-in-law have diabetes, and her aunt had to leave the community to relocate to the city for dialysis because of kidney failure caused by diabetes.
“I don’t know if I can make a difference in their lives today, but I’m thinking into the future,” says Ms. King, who organizes an annual run with Team Diabetes each June in La Loche to raise funds for the Canadian Diabetes Association (CDA). “It’s something I’m really passionate about – the more awareness we have, the better off we will be.”
But Ms. King doesn’t stop at raising funds for research, treatment, care and prevention of diabetes. Since realizing a personal dream by completing her first marathon with Team Diabetes, the national, physical activity fundraising program of the CDA, in 2006, she has also become an inspirational champion of health in her community.
A student support worker in La Loche, a community in northwest Saskatchewan that is adjacent to the Clearwater River Dene Nation, she says “My target group is the kids that I work with, the younger kids, where I feel I’ll have the most impact. I’m always talking to them about healthy eating and the importance of physical activity.”
Once while she supervised a class, a student told her about a party planned for the following Friday. “I said, ‘You know, we always have class parties, but I never see healthy foods coming to our school. Wouldn’t it be unique if we had one where it’s just healthy foods instead of junk food?’”
She suggested some healthy options, and on Friday morning the third-grade students invited her to their party. “There were two tables full of fruit, vegetables and healthy snacks. There were no sugary drinks,” Ms. King says.
When she travelled to Rome with Team Diabetes to run in the 2011 marathon, the children of La Loche wrote letters and asked her to take them along, hoping that a representative of the CDA would sign their letters and send them back as a keepsake. “When Fred DeFina, the director of Team Diabetes, asked me if I could speak at their victory dinner, I said, ‘Only on the condition that you will send these letters back to the kids with your signature on them.’
“And he said, ‘Better yet, Bibianna, I’ll send each one a medal.’”
Those children are now in seventh grade, and many still have their medals hanging in their rooms, reminding them to make healthy choices every day, she says.
The children also inspire her, says Ms. King. “One of the boys who was in grade three at the time of his first run has since showed up with his mom at every run we’ve done. He made it to a cross-country event where he took second place last year, which was amazing. His mom tells me he has my picture on his refrigerator, and says he wants to be like me.
“It doesn’t matter if it’s 10 or 15 degrees below zero – he shows up and runs,” she says proudly.
To learn more about the different ways you can donate to the CDA, visit www.diabetes.ca/donate.
In September, Danish- based pharmaceutical company Novo Nordisk collaborated with the Royal Danish Consulate General and the Canadian Diabetes Association to host Innovation in Diabetes Care: 90 Years and Beyond.
Held at the MaRS Discovery District, the event celebrated Novo Nordisk Canada’s 30-year anniversary and the significant contribution Canada has made to diabetes care.
Guests learned more about the findings of the Novo Nordisk-sponsored DAWN2 study, an international initiative that highlights new opportunities for improving active engagement, education and support of people with diabetes and their families.
“The key to a better future for people living with diabetes is to foster these collaborations and, together, continue to drive innovation and education,” said Novo Nordisk president Vince Lamanna.
The DAWN2 study highlights new opportunities for improving active engagement, education and psychosocial support of people with diabetes and their families.
By surveying more than 15,000 people in 17 countries, including 500 in Canada, DAWN2 revealed that:
of people with diabetes feel discriminated against because of their condition
of family members feel frustrated because they do not know how best to help their relative with diabetes
of people with diabetes experience diabetes- related distress
The ‘Rule of Halves’
Of the estimated 382 million people with diabetes...
- about 50% are diagnosed...
- of whom about 50% receive care...
- of whom about 50% achieve treatment targets...
- of whom about 50% achieve desired outcomes.
Only 6% of people with diabetes live a life free from diabetes-related complications
* Hart J.T., Rule of Halves: implications of increasing diagnosis and reducing dropout for future workload and prescribing costs in primary care, Br J Gen Pract 1992, March; 42(356):116–119, and W.C.S. Smith, A.J. Lee, I.K. Coombie, H.Tunstall-Pedoe, Control of blood pressure in Scotland: The rule of halves, Br. Med. J, 300 (1990): 981–983.** Actual rates of diagnosis, treatment, targets and outcomes vary in different countries.
This global partnership initiative led by Novo Nordisk provides a new platform for dialogue and action to improve the lives of people with diabetes.