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November is Diabetes Awareness Month

To wrap up our shows on Diabetes this month we will be talking to Jean Blake from The Canadian Diabetes Association. Then Pam and Toma are going to open the phones to callers as they recap the month  and discuss putting self into responsible Self Managment of Chronic Disease and Medical self advocate.

Jean Blake, M. Ed.

Jean Blake is the Executive Director, Canadian Diabetes Association, Pacific Area. Her role includes advocacy, programs and services and fund development for research and other association activities. She is also the current Chair of the BC Healthy Living Alliance, a provincial coalition of organizations working together to improve the health of British Columbians by promoting physical activity, healthy eating and living smoke-free.

She has held various roles in health care, including the North Shore Health Region and Lions Gate Hospital in North Vancouver as the Director of Education and Organization Development.

Jean also worked as a training performance consultant with AchieveGlobal. She was a Master Trainer in Organizational Effectiveness with AchieveGlobal and is a certified Change and Transition Management consultant. She has designed and delivered a variety of performance management workshops.

Some disturbing facts About diabetes.

Some disturbing facts:

• Adults with diabetes are two to four times more likely to have heart disease or suffer a stroke than people without diabetes.

• It has been estimated that at the time of diagnosis, 50% of people with type 2 diabetes already have some vascular disease, because diabetes often goes undetected for many years.

• People with Pre-Diabetes are 50% more likely to have a heart attack or stroke than are people with normal blood glucose levels.

• Yet surveys show that over 65% of people with diabetes do not consider cardiovascular disease (CVD) to be a serious complication of diabetes, and only 18% of people with diabetes believe that they are at increased risk for CVD.

Why is there a relationship between heart disease and diabetes?

• High blood glucose levels over time can damage blood vessels, resulting in blood vessel walls that are thicker and less elastic; this makes it more difficult for the blood to pass through.

• Many people with diabetes also have abnormal blood fats (also called lipids, which include cholesterol, triglycerides, LDL and HDL) caused both by poorly controlled diabetes as well as poor diet. Elevated lipids can further clog blood vessels, increasing your risk of a heart attack, stroke, or poor circulation in your legs.

Canadians seem largely unaware of the disturbing facts surrounding diabetes and unconcerned about their own risk for the disease. According to a recent national survey sponsored by the pharmaceutical company Aventis Pharma, only 39 per cent of the 1,500 people questioned said they were "very" or "somewhat" concerned about developing diabetes (compared with 60 per cent who expressed concern about cancer and 57 per cent who worried about heart disease).

Diabetes is costing British columbia $700,000,000.00 per year just for treatment. The total cost are much higher. In 1950 there was less than 1% of the population diagnosed with diabetes. That number rose to 3% in the mid 80s and is pegged at 7% in 2007. Diabetes is expexted to increase to 14% of the population. Many experts from around the world say at least 80% of the cases of diabetes can be prevented with proper diet.

One leading diabetes expert at the University of Toronto likens the rising rate of diabetes to the "perfect storm," a reference to the raging fronts that converged in the North Atlantic in 1991 to create the greatest storm in recorded history. (The tempest was depicted in the recent movie The Perfect Storm.)

"When it comes to the perfect storm of diabetes, all the conditions are right," says Dr. Bernard Zinman, a professor of medicine who heads the division of endocrinology and metabolism at Mount Sinai Hospital in Toronto. One contributing factor is that the massive baby boom generation is moving into its 50s, when the risk of diabetes normally increases. Another contributor to the storm is the current climate of what he calls "overnutrition" – the consumption of unhealthy fast foods and super-sized portions, which is driving up the rate of obesity, "a known risk factor for Type 2 diabetes," he says.

Can diabetes be prevented?

Researchers with the National Institute of Diabetes and Digestive and Kidney Diseases studied 3,234 men and women aged 25 to 85 who suffered from impaired glucose tolerance – a condition that often precedes diabetes. The trial included people who were obese and had a family history of diabetes. Some also belonged to an ethnic group known to be at higher risk for Type 2 diabetes.

The subjects were randomly divided into three groups: one group was given a diabetes medication called metformin, which decreases the amount of glucose produced by the liver; the second received an inactive placebo drug. (These two groups also received general health advice about exercise, weight loss and diet.) Those in the third group did not take any diabetes medication but attended a 24-week education program to help them follow a low-fat diet combined with moderate exercise, with the aim of reducing body weight by seven per cent.

After three years, here's what the study found: on average, 11 per cent per year of high-risk people who took the placebo had developed Type 2 diabetes, compared with 7.8 per cent per year of those who took metformin and 4.8 per cent per year of those who had changed their eating and exercise habits. Put simply, even modest changes in diet and exercise reduced the risk for Type 2 diabetes by more than half.

"[The findings] demonstrate that lifestyle changes can benefit a broad range of high-risk patients," says Dr. Lawrence Leiter, a professor of medicine and nutritional sciences who heads the division of endocrinology at St. Michael's Hospital in Toronto. "It's also the first study to show that taking a drug – in this case, metformin – also reduces diabetes risk."

The Glycemic Index, developed at U of T, offers a dietary plan for controlling diabetes
Diabetes is a complex condition that researchers are still trying to unravel. In basic terms, the disease impairs the way food is processed into the glucose that fuels our bodies. People with Type 2, or adult-onset, diabetes continue to produce their own insulin, the all-important hormone (secreted by the pancreas) that regulates glucose. But for some mysterious reason, in Type 2 diabetes this delicate hormonal balancing act falters, and blood glucose rises to unhealthy levels. (In Type 1, or juvenile, diabetes, the body stops producing insulin altogether.)

According to Dr. Thomas Wolever, a diabetes researcher and professor in the department of nutritional sciences, the goal of diabetes management is to bring blood-glucose levels into the healthiest possible range via proper nutrition, physical activity, regular glucose monitoring, the use of oral medications and/or insulin as required and stress reduction.

One aspect of proper nutrition involves making the best possible food choices, says Dr. Wolever. Twenty years ago, he and colleague David Jenkins, a professor of nutritional sciences and director of the Clinical Nutrition and Risk Factor Modification Centre at St. Michael's Hospital, developed the Glycemic Index (GI) system, which ranks a wide variety of foods according to how they affect blood-glucose levels in the body. Foods low on the index (such as barley, pasta, parboiled rice, oatmeal and whole-grain pumpernickel bread) produce a gradual rise in blood sugar, which is easier on the body; foods high on the index (such as mashed potatoes, white bread, many cold breakfast cereals and crackers) cause blood-glucose and insulin levels to spike, which may be harmful. (For more information, read The Glucose Revolution: The Authoritative Guide to the Glycemic Index, or check out www.glycemicindex.com).

Several studies have found that people newly diagnosed with diabetes who learn to follow the GI system tend to make healthier food choices and have better blood-glucose and lipid (blood fat) levels than those who follow traditional dietary advice. Some research suggests that choosing foods low on the index may reduce a person's risk of developing Type 2 diabetes in the first place.

Although the Glycemic Index system is currently recommended by the World Health Organization and other expert bodies, its use is somewhat controversial. Some doctors feel the system is too complicated for patients; others argue that the real problem for those with Type 2 diabetes isn't the glycemic nature of what they eat, but rather that they are consuming too many calories.