2 times more likely than whites to have diabetes. people die each year of diabetes-related complications. People with pre-diabetes have impaired fasting …
T HE G LO BE AN D MAI L W E D N E S D AY , N O V E M B E R 1 2 , 2 0 0 8
A special information supplement
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The numbers are swelling and the complications growing So, whats being done about it? Plenty, thank goodness
T
he current numbers are staggering more than 24 million Canadians have diabetes What the future holds is even more daunting, however, with the number of Canadians living with diabetes expected to swell to three million by 2010 In addition, nearly six million Canadians have prediabetes, a relatively new term for blood glucose levels near the level of diabetes According to the Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada, if left untreated, around 25 per cent of those with prediabetes will progress to diabetes in three to five years Canada is not alone Diabetes is a burgeoning global epidemic, with 7 million people developing the disease every year Today, more than 250 million people worldwide have diabetes, and this number is predicted to reach 380 million by 2025 With the growing numbers, we can expect more of the severe complications associated with diabetes, such as heart disease and
stroke, kidney failure and eye disease, says Dr Vincent Woo, chair of the Canadian Diabetes Association CDA Clinical and Scientific Section People with diabetes get heart disease 10 to 15 years earlier than others There are huge implications for our health care system if we arent aggressive in preventing complications in this population
DIABETES
More than 24 million Canadians already have diabetes, and if current trends continue, that number is expected to grow to 3 million by 2010 The impacts on people and Canadas health care system are significant Severe complications associated with diabetes include heart disease and stroke, kidney failure and eye disease Fortunately, efforts by concerned organizations are leading to more effective therapeutics and programs to help those living with diabetes better manage their disease PHOTO: ISTOCKPHOTOCOM Type 1 diabetes, in which the pancreas produces no insulin, accounts for about 10 per cent of cases and typically develops in childhood or adolescence For the 90 per cent of Canadians with type 2 diabetes, which usually develops later in life, their bodies are producing insulin but cant properly use it The dramatic growth is in type 2
diabetes due to a number of factors Our population is getting older, were getting heavier and we have more immigrants from populations at higher risk for the disease, Dr Woo explains And one of the biggest increases is occurring among Aboriginal Canadians, some of them quite young While diabetes is a health crisis threatening to worsen, research advances in a number of areas are offering new hope, and Canada is at the forefront of many of the most promising developments Canada is well positioned to bring about significant changes worldwide in how we understand and treat diabetes, says Dr Brian Rodrigues, chair of the National Research Council of the CDA Even though we dont have nearly the level of research dollars of countries such as the US, its been shown that Canadian researchers are producing more high-impact results For example, Canada is a leader in pancreatic beta cell research, in which patients with type 1 diabetes are injected with pancreatic cells that stimulate insulin production Canadian researchers have also developed a number of new drugs that can lower insulin resistance and increase insulin action in people with type 2 diabetes Another key area of research is in
the complications of diabetes, particularly cardiac disease Dr Rodrigues is conducting innovative research into the mechanisms by which diabetes actually causes damage to the heart Another critical area, he says, is education We really need the public and health care professionals to know about the Clinical Practice Guidelines and about our new knowledge about treatment and, of course, prevention The most serious results can often be prevented by diet, exercise and weight loss, and proper management of blood glucose levels Given the incidence of diabetes, governments in Canada have identified diabetes management as a priority area and called upon the Canadian Agency for Drugs and Technologies in Health CADTH for advice on optimal prescribing and use of medications CADTH is an arms-length agency reporting to the federal and provincial/territorial health ministries, mandated to assess the clinical- and costeffectiveness of new drugs and health technologies, as well as identifying and promoting best practices in drug prescription and use CADTH, through its Canadian Optimal Medication Prescribing and Utilization Service COMPUS, undertook an assessment of insulin analogues, a slightly
more expensive, next-generation form of insulin We look at what the evidence says about various drugs in terms of both effectiveness and cost, says Barbara Shea, COMPUS vice-president We compared the insulin analogues to conventional insulin therapy If a medication is effective and costs more, we
assess whether that cost is justified given the incremental benefit The COMPUS expert review committee has developed draft recommendations to be finalized after assessment of stakeholder feedback We found that insulin analogues have a place, although conventional therapy is more costeffective in a number of specific instances COMPUS is now undertaking a similar best practices evaluation for blood glucose test strips and plans to assess other diabetes treatments in the future Governments ultimately make the decisions about the availability of cost-effective treatments, says Ms Shea Our analysis informs those decisions and, in the end, people with diabetes benefit
Nova Scotia innovator creates BREAKTHROUGH PAIN RELIEF for diabetics
According to Dr Alexander McLellan, author of Healing Diabetes 2007 and a new book focusing on the treatment of diabetic neuropathy, The Numb Foot Book 2008,
there are new effective non-prescription treatments for nerve pain Among the treatments Dr McClellan cites is Neuragen, a topical over-thecounter pain reliever developed by Nova Scotia-based Origin Biomed Dr McLellan says Neuragen has been shown in clinical trials to be as or more effective than conventional prescription drugs in treating peripheral neuropathy, a painful, long-term complication associated with diabetes Among the most important advantages of topical pain relievers is their lack of side-effects, says Dr McLellan Another plus: Neuragen is widely available in pharmacies and can be purchased without a prescription Kudos to a Canadian innovator To learn more, visit originbiomedcom
Support
Canadian Diabetes Association summer camps allow kids to be kids
Canadian Diabetes Association-led summer camps provide kids living with diabetes not only happy summer memories, but also valuable learning experiences that teach children to better manage their diabetes PHOTO: CDA
F
or many youngsters, going away to camp is a highlight of summer Thanks to a Canadian Diabetes Association CDA initiative, summer camp is also a thrill shared by children and teenagers with type 1
diabetes, who not only get the excitement of camp, but also learn valuable lessons on how to manage their diabetes Camp is something that every kid should be able to experience, says Lisa Diamond, executive director of public programs and services at the CDA national office We give children the opportunity to attend a real summer camp without feeling limited by their disease They get to just be a kid at camp The CDA has been running camps for more than 50 years Today, the CDA operates 12 camps across the country and a number of family camps weekend getaways for children with type 1 diabetes and their entire families Every summer in Canada, more than 1,500 youngsters
between the ages of seven and 16 attend CDA camps for one or two weeks hosted, in part, by doctors, nurses, dietitians and health care students Parents feel comforted knowing their children are being fully cared for, says Ms Diamond At the same time, the parents can have some respite from the 24/7 job of being the primary caregiver of a child with diabetes There are other benefits too, says Ms Diamond The kids meet other kids just like them; they dont feel different and they dont feel outside of the group They can
talk openly about their diabetes in a supportive setting Many of the camp counsellors also have type 1 diabetes and serve as role models for the youngsters, teaching them important skills such as how to self-administer insulin Camp is often a step forward in the independence of a child caring for his or her diabetes, says Ms Diamond It is an opportunity to move them in a positive manner
towards leading a long and healthy life The CDA also provides financial assistance for those families who couldnt otherwise afford to send their kids to the camp Beyond CDA summer camps, the association runs other children and youth educational programs, teaching kids with and without diabetes about the disease and the importance of making healthy lifestyle choices Among these activities are a cartoon video aimed at five- to nine-yearolds, and the Growing Up Well program, which features educational videos tailored for children aged nine to 13 and 14 to 18 respectively These videos show youth talking to other youth about what it is like to live with diabetes, Ms Diamond says Schools, youth groups and other interested parties that would like to receive an educational presentation for children or
youth are encouraged to contact their local Canadian Diabetes Association branch
CADTH HELPS POINT THE WAY ON THE TREATMENT OF DIABETES
The Canadian Optimal Medication Prescribing and Utilization Service COMPUS program helps healthcare professionals and people with diabetes make informed decisions about treatment How? By identifying and promoting evidence-based, clinical and cost-effectiveness information on optimal drug prescribing and use Find out how we can help, and get involved by visiting us online today Evidence-based information on insulin analogues now available
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DIABETES IN CANADA
Serious complications
A special information supplement
T H E G LO B E A N D MA I L W E D N E S D AY , N O V E M B E R 1 2 , 2 0 0 8
What Canadians dont know about diabetes can hurt them
By Ellen Malcolmson
President CEO, Canadian Diabetes Association
D
iabetes is very serious, in fact, only one in five Canadians with diabetes survives heart disease
That is what the Canadian Diabetes Association wants you to know this November The harsh reality is that today only one in five people living with diabetes will survive the complications of cardiovascular disease It is essential
that
Canadians who are living with and at risk of developing diabetes work to reduce their risk factors by making healthier lifestyle choices each and every day By 2010, more than three million Canadians will be liv-
ing with diabetes, many of whom will also be suffering from serious complications This is just the tip of the iceberg as an estimated six million Canadians are also living with prediabetes, putting them at increased risk of developing
type 2 diabetes All too many people live with undiagnosed diabetes for years but dont know it Studies show that, on average, people have type 2 diabetes for up to seven years before being diagnosed During this time,
Youve got questions about diabetes Wondering where to get answers shouldnt be one of them
Whether you are living with diabetes or prediabetes, or are one of the millions of Canadians aged 40 and over who is at risk, I urge you to visit getseriousca this November and learn how you can reverse this trend Discover if your heart is older or younger than your chronological age, gain insight into your personal risk levels and start taking action today by acting on prevention and health management strategies
dangerously high
blood glucose levels can start to cause serious damage that can lead to heart disease, blindness and limb amputations The reality is that most Canadians dont recognize heart disease to be the most serious complication of diabetes However, the good news is that a diagnosis of diabetes does not have to lead to heart disease In fact, Canadians can reduce their risk of developing type 2 diabetes by more than 50 per cent by getting active, losing weight and making healthy food choices Jung-Yul Kim, who lives with diabetes and is an active Association volunteer shares his personal highs and lows with diabetes this November at getseriousca He says, Before my diagnosis, I was a professional athlete playing football in the CFL as an offensive lineman Life was good and the future was bright Because of the challenges of the disease I had to change my diet I lost close to 30 pounds in three months Mostly from not eating the way I used to, but also because I became very depressed, due to the combination of losing my source of income and dealing with diabetes My eating habits and lifestyle were profoundly changed Jung-Yul is doing much better today, thanks in a large part to his commitment to
taking his diabetes seriously Hes made important and positive lifestyle changes, but shares that the disease constantly affects me I have my good days and bad days I continue to struggle and try to maintain a positive outlook Whether you are living with diabetes or prediabetes, or are one of the millions of Canadians aged 40 and over who is at risk, I urge you to visit getseriousca this November and learn how you can reverse this trend Discover if your heart is older or younger than your chronological age, gain insight into your personal risk levels and start taking action today by acting on prevention and health management strategies Help us help more Canadians to survive diabetes and its serious complications by donating today at getseriousca
Shoppers Drug Mart is the exclusive pharmacy provider for the highlights of the Canadian Diabetes Associations 2008 Clinical Practice Guidelines
Our pharmacists are available to answer your questions and share the new Guidelines recommendations for managing diabetes We also have more than 150 Certified Diabetes Educators nationwide to give you personalized diabetes care Speak to a Shoppers Drug Mart Pharmacist today for more information and
to get your copy of the highlights
Enhanced HealthWATCH not available in BC, QC, PEI, NWT and YT /TM are trade-marks or registered trade-marks of 911979 Alberta Ltd
TH E GLO BE A N D MA I L W E D N E S D AY , N O V E M B E R 1 2 , 2 0 0 8
A special information supplement
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DIABETES IN CANADA
Priscilla Lopes-Schliep
Olympian applauds family members persistence in managing their diabetes
P
riscilla Lopes-Schlieps ability to sail over hurdles garnered the 26year-old athlete from Whitby, Ont, a bronze medal at this summers Olympics in Beijing But Ms Lopes-Schliep downplays her track-and-field accomplishments when she compares them to the challenges met by members of her family in tackling their diabetes My aunt Barb has had type 2 diabetes for 20 years and aunt Alice was diagnosed two years ago, so Ive seen firsthand the hurdles they had to overcome to manage the disease effectively They are living examples of how early diagnosis and proper treatment can enable people with diabetes to live healthy, active lives I am so proud of them for being champions for their own health and proactively working with their health care professionals to find the right
treatment options, she
says Her aunt Barb, in particular, has tackled her diabetes head on In the two decades that she has been living with type 2 diabetes, she has made maintaining a healthy lifestyle a priority When her blood glucose levels became erratic, including a couple of frightening incidents with low blood glucose hypoglycemia that made her feel faint and weak, she followed the advice of her physician and began taking
long-acting basal insulin I know a lot of people are afraid of going on insulin, acknowledges Ms Lopes-Schliep But that fear can be a barrier to good diabetes management Since my aunt started taking the longacting insulin once a day, her blood glucose levels have been very steady, even at night, and she tells me she feels so much better since then As an athlete, Ms LopesSchliep well knows the importance of taking control of ones health My coach always tells me that I am the most powerful person when it comes to my well-being Sure, I can skip training if I want to, but there will be consequences later Its the same
thing with taking charge of your diabetes Recognizing that her familys history of type 2 diabetes puts her at increased risk of developing the disease herself, Ms
Lopes- Schliep plans to do whatever she can to lead a healthy lifestyle including maintaining a balanced diet and, of course, lots of physical activity even after she decides to hang up her hurdling spikes Ive already talked to my doctor about my risk factors for diabetes and know the warning signs I feel this is important because the earlier you are diagnosed, the sooner you can find a treatment plan that will help reduce your risk of complications down the road, she says Next month, Ms LopesSchliep will resume her trackand-field training full time as she prepares for the World Championships in Germany
next year In the meantime, she is taking advantage of World Diabetes Day to share her familys history with diabetes and draw attention to the importance of early diagnosis and proper management
I want to inspire all Canadians living with diabetes to achieve the same success that my aunts have in managing their diabetes, she says Diabetes management may be a life-long commitment, but it doesnt have to be a hurdle
Four things you should do about diabetes
Diabetes is a family affair, says Dr Stewart Harris, a family physician and researcher who holds the Canadian Diabetes
Association Chair in Diabetes Management at the University of Western Ontario in London, Ontario If you have diabetes in your family, Dr Harris suggests taking these important steps: Get tested A simple blood test for type 2 diabetes is recommended for all Canadians over the age of 40; earlier if you are at high risk or experience any symptoms Early diagnosis is crucial to start a treatment plan to avoid complications down the road Get active Do everything you can to reduce the risk of developing type 2 diabetes and its complications The healthy lifestyle component of diabetes prevention and management is almost impossible to realize in isolation Shop for and cook healthy foods as a family and enjoy physical activity together Get aggressive Preventing complications is the name of the game Talk to your health care professional about the importance of early and aggressive treatment options
Olympian Priscilla LopesSchlieps family, including her aunt Barb left, cousin Angela centre and aunt Alice right, know all about diabetes My aunts are living examples of how early diagnosis and proper treatment can enable people with diabetes to live healthy, active lives, says Ms Lopes-Schliep
PHOTOS: SUPPLIED
Get informed We are moving out of the era where fear and lack of knowledge kept people from getting diagnosed or getting the treatment they need when they need it Understanding diabetes and its treatment options, which may include going on insulin, is the b 
est strategy to avoid serious complications
This repor t was produced by RandallAnthony Communications Inc wwwrandallanthonycom in conjunction with the adver tising depar tment of The Globe and Mail Richard Deacon, National Business Development Manager, rdeacon@globeandmailcom
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Copyright 2008 sanofi-aventis All rights reserved sanofi-aventis Canada Inc, Laval, Quebec H7L 4A8
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DIABETES IN CANADA
Diabetes management
A special information supplement
THE GLOBE AND MAIL W E D N E S D AY , N O V E M B E R 1 2 , 2 0 0 8
Diet, exercise, oral medications and insulin factor into blood glucose control
I
n the world of
diabetes, feeling high or low isnt about emotion, a meter isnt a measurement of distance, and a poke has nothing to do with Facebook Rather, these terms relate to the central factor in diabetes: blood glucose Diabetes is a disease in which the body cannot control the amount of glucose commonly but inaccurately referred to as sugar in the blood Insulin is the key that allows the body to use glucose from food and turn it into energy, but in diabetes the body either doesnt produce any insulin type 1 or doesnt produce enough and/or cant effectively use what it does produce type 2 In both types of diabetes, the result is a dangerous condition called hyperglycemia, or high blood glucose In the short term, high blood glucose can cause excessive thirst, frequent urination, weight loss and fatigue, says Dr Amir Hanna, director of the diabetes clinic at St Michaels Hospital in
Toronto Long-term, high blood glucose can damage both large and small blood vessels, leading to potentially devastating complications such as heart disease, stroke, blindness, lower limb amputation and kidney disease According to Dr Andrew Farquhar, a family physician in Kelowna, BC, many people dont realize they have
diabetes until they land in the emergency department with a heart attack One of my main goals in treating diabetes is to prevent patients from having to see a cardiologist The key is to get blood glucose under control early in the game, he continues, explaining that a legacy effect may lower the risks of future complications even if blood glucose is less well controlled later on Although a healthy diet and regular physical activity are important and can help manage blood glucose levels, type 2 diabetes is progressive, and many people will require more intensive medical interventions The most successful
Technology has led to modern devices that make diabetes management easier and less painful PHOTO: SUPPLIED approach is multi-faceted and may include one or more oral diabetes medications, drugs to control high blood pressure and abnormal cholesterol both of which are commonly associated with diabetes and increase the risk of serious complications and/or insulin Insulin is the single most
effective agent we have to lower blood glucose, but unfortunately many people unduly postpone beginning insulin because they are afraid of the injections, says Dr Farquhar The good news is that
injection devices, such as preloaded insulin pens, and the insulins themselves have improved significantly in recent years When my patients start insulin, they are surprised by how easy it is Many people feel so much better when their blood glucose control improves that they say they should have started insulin earlier, says Dr Hanna Another common concern that people have about starting insulin is that it may cause low blood glucose hypoglycemia Low blood glucose is a potentially dangerous condition marked by trembling, sweating, anxiety and/or heart palpitations Normally the treatment for low blood glucose is to eat or drink about 15 grams of carbohydrate for example, six Life Savers or a
tablespoon of honey But some people experience low blood glucose in their sleep or have no symptoms, and this can be cause for concern Untreated, blood glucose can drop severely and lead to loss of consciousness Thanks to the development of long-acting basal insulin, the risk of low blood glucose is significantly reduced Long-acting insulin mimics the bodys normal insulin production to keep a small amount of insulin continuously in the blood stream People need to get past the misconception that
starting insulin means their diabetes is at a very advanced stage or that theyve failed in taking care of their diabetes Really, its about taking charge of their health, says Dr Farquhar The take-home message, concludes Dr Hanna, is that a combined approach with diet, exercise, oral medications and insulin can effectively control diabetes Patients need to take advantage of all the tools at our disposal
Insulins evolution marks milestones in health innovation
1922: Discovery of insulin by Drs Frederick Banting and Charles Best at a University of Toronto laboratory 1923: Start of insulin production in Canada by Connaught Laboratories now sanofi pasteur 1936: Better purification of insulin is introduced, substantially improving product tolerability 1950s: Introduction of new generation insulins NPH, lente, semi-lente and ultra-lente 1974: Insulin pump is introduced 1985: Insulin pen is introduced 2005: Insulin glargine, the first and only long-acting insulin to provide 24-hour glucoselowering activity with just one injection, becomes available in Canada
Since insulins discovery in 1922, ongoing research and development has led to advancements in its efficacy PHOTOS:
SUPPLIED
Profile
Winnipeg family taking insulin daily say no big deal
I
f you were to join the Compayre clan for dinner, you would notice something special about this family Before unfolding napkins and passing platters of food, several members of this Winnipeg family poke their fingers to draw a drop of blood for their personal pocked-sized meters, check the
readings, then administer insulin with pen-shaped injectors The entire process takes less than five minutes Across Canada, hundreds of thousands of people with diabetes follow the same routine several times a day What makes the Compayres so unusual is that four members of the same family have type 1
diabetes: 78-year old matriarch Helen Compayre; daughters Tina Trotter, 46, and Carmen Trudel, 40; and Carmens 10year-old son, Jonathan While family history is considered a strong risk factor for type 2 diabetes, it is not as common to see more than one case of type 1 diabetes in a family, says Lori Berard,
Carmen Trudel left, her son Jonathan and her sister, Tina Trotter, get a live demonstration of the Lantus SoloSTAR insulin pen from nurse educator Lori Berard PHOTO: SUPPLIED
nurse manager with the Health Sciences Centre
Diabetes Research Group in Winnipeg Regardless of the type of diabetes, when someone in the family is affected, the whole family becomes affected Thats why its important for all family members to understand diabetes and learn how to support the person living with the condition, she says The good thing about our family is that you never feel alone with your diabetes, says Tina I can talk about it with my sister and she understands where Im coming from and can offer advice One piece of advice that has made a significant difference for everyone in the family was the suggestion to begin using long-acting basal insulin Tina was the first to try insulin glargine a couple of years ago when she couldnt get consistent blood glucose levels with the insulin she was using The insulin Im on now acts like the insulin from my own pancreas, so my blood glucose doesnt go too high or too low, she says Carmen and her mother then began using the same long-acting insulin as Tina, and they couldnt be happier We both used to wake up three or four times a week sweating and shaking because our blood glucose was dropping, she remembers The insulin were taking now is released into our bloodstream over 24
hours at an even rate and, because of that, were having practically no incidents of hypoglycemia Jonathan, too, is on the
same insulin and he especially likes the prefilled insulin pen he has started using recently Its easier than grade 5 homework I just push a button to inject it in my leg, he says Carmen marvels at the ease with which her son manages his diabetes, especially
compared to her own experiences as a child There has been a huge evolution in insulin and devices since I was young, she says Today, everything is so simple and convenient It makes it much easier for Jonathan to manage his diabetes
Technology
Insulin pen a boon to diabetes care
C
armen Trudel lost her eyesight 15 years ago as a result of complications from type 1 diabetes Without her vision, the 40year-old Winnipeg mother was dependent on others to prepare daily insulin injections for her and her son, who also has type 1 diabetes Finding the right once-daily longacting insulin and the right insulin pen gave her back her independence Insulin pens in general combine a needle and insulin cartridge in a single device, so there is no fiddling with syringe, needle and separate vials of insulin The prefilled
pen Carmen and Jonathan are using takes convenience one step further as there is no need to reload cartridges An important feature for people with visual impairment is to be able to hear a click with each turn of the dial Hearing and feeling a click
reassures me that Ive dialled the right dose, says Carmen Its great to have a pen where we dont have to depend on other people to prepare injections for me or Jonathan In her 21 years as a diabetes nurse, Lori Berard has seen the positive impact that easy-to-use devices have had on diabetes management Whenever an insulin pen or a blood glucose meter has fewer steps, there is less room for human error Not only does this lead to greater convenience, but it also improves safety, especially for people who have limited vision or manual dexterity, or who are elderly, she says, adding that todays needle tips are finer and shorter than ever, making injections virtually pain-free Weve come a long way since the days when people had to boil syringes and sharpen needles to reuse them
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DIABETES IN CANADA
CDA partnership helps broaden support
A special information supplement
T H E G LO B E A N D MA I L W E D N E S D AY , N O V E M B E R 1 2 ,
2 0 0 8
People with diabetes find welcome support from pharmacists
M
onitoring blood glucose levels, injecting insulin, taking medication, eating the right foods, undergoing frequent tests all this and more may be part of the often overwhelming responsibilities of a person trying to manage their diabetes Increasingly, Canadians with this disease are looking for support from the health care provider they tend to see the most, their community pharmacist Patients quest for diabetes advice and help from pharmacists has grown over the years, and Shoppers Drug Mart has responded to this rising demand with an array of programs, services and tools, including some developed in partnership with the Canadian Diabetes Association CDA Its an area where a pharmacist can really make an impact, says Shelley Diamond, a pharmacist who is responsible for the Shoppers Drug Mart diabetes educational program Some diabetes education centres in communities have three- to six-month waiting lists Pharmacists are
People living with diabetes find welcome support at Shoppers Drug Mart thanks to an array of programs it has developed, some in partnership with the Canadian Diabetes Association PHOTO:
SHOPPERS DRUG MART accessible health care professionals who can be a key resource for people with diabetes, many of them struggling with information overload Shoppers has been expanding its diabetes services since it began 14 years ago to train pharmacists in blood glucose monitoring and to hold periodic diabetes clinic days About four years ago, we moved away from clinic days, so we could have a larger reach, Ms Diamond says Now, our pharmacists provide patients with a valuable intervention on diabetes at the time they get their prescription, giving them tips on a specific aspect of the disease, such as how to reduce their risk of heart disease The pharmacist role is all the more important today, she adds, with a growing number of people on oral diabetes medications and insulin treatment starting much sooner than it used to for people living with type 2 diabetes Shoppers has approximately 150 pharmacists nationally who are Certified Diabetes Educators with advanced knowledge and training in diabetes The retailer helps pharmacists obtain the certification by providing a study program that includes mentoring from Certified Diabetes Educator nurses and dietitians in the Diabetes
Education Centre at Torontos Mount Sinai Hospital Shoppers pharmacies also offer patients a number of tools, including a three-month blood glucose log book and a wallet-sized diabetes monitoring record for keeping track of tests The CDA and Shoppers are partners in education The pharmacy chain has developed an information resource
that responds to 52 questions about diabetes, ranging from What can I eat to control my diabetes to What is an insulin pump? Not only is this information approved by the CDA, Shoppers is the pharmacy chain responsible for distributing an easy-to-read summary of the Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada, with the latest information on managing the disease Working with the leading retail pharmacy chain in Canada is a powerful partnership that helps us extend the reach of our messages to Canadians with diabetes, says Christina Beyer, CDA senior manager, Corporate Partnerships As our exclusive pharmacy retail partner in the dissemination of the 2008 guidelines to consumers, Shoppers is providing us with valuable support using its extensive national network to provide
up-to-date information and the best possible care to Canadians affected by diabetes
CDA Clinical Practice Guidelines
Understanding blood glucose levels critical in diabetes management
M
ost people with diabetes understand that to stay healthy, they need to manage their blood glucose levels What they may not understand as clearly is exactly why this is important and how these levels affect their health The Canadian Diabetes
Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada recommends target blood glucose levels for most adults with diabetes: A1C of 7 per cent or lower Fasting blood sugars of 4-7 mmol/L
Post-meal two hours after the start of the meal blood sugars of 5-10 mmol/L o Post-meal blood sugars of 5-8 mmol/L if necessary to reach an A1C of 7 per cent or lower A person with diabetes can use a blood glucose monitor to check his or her own levels
Diabetic Nerve Pain?
Post-Shingles Pain? Chronic Nerve Pain?
The numeric reading helps the patient to understand how close they are to their target range at any given moment Another very important test, which is conducted at the lab, is the A1C and every patient with
diabetes should be asking for those results According to Dr Ian Blumer, a diabetes specialist practicing in Ajax, Ontario, and author of Diabetes for Canadians for Dummies, the A1C test helps to provide an understanding of the bigger picture Your A1C reflects your average blood glucose readings over three to four months, says Dr Blumer This overall estimate is important because it tells us the likelihood of someone developing complications of diabetes, such as kidney disease, nerve damage and blindness It is not a replacement for finger prick testing, which provides crucial, specific and immediate information Finger prick testing and A1C results work in tandem If a patient is having difficulty
reaching the target A1C level of 7 per cent or lower, even though their fasting blood glucose levels are within the target range, their doctor may recommend a tighter postmeal target of 5-8 mmol/L The only way to know if youre reaching this goal is to test Testing can seem like an inconvenience, it can be uncomfortable, and it can be costly Because of these potential deterrents, Dr Blumer explains that it needs to be worthwhile Patients need to understand what the numbers mean and what to do
with the information They need to understand how to reach their pre- and post-meal targets and what to do if these targets arent being met If a person doesnt know how to interpret their readings and what to do with the results, testing is of little value This point is also strongly emphasized by Lori Berard, diabetes nurse educator and nurse manager, Diabetes Research Group in Winnipeg,
Manitoba With diabetes, many factors are at play When we are provided with post-meal test results, along with notes about food choices, medications taken including insulin doses and activity, we can start to identify patterns These patterns allow us to work with our patients to determine which choices are good for blood glucose levels, and which are not This helps our patients to learn and plan for the future To fully understand when to test, why and what to do with your results, Ms Berard strongly recommends finding a source of education Ask your doctor to refer you to you a local diabetes educator You can also visit the Canadian Diabetes Association website at wwwdiabetesca or contact your local branch, she says, adding, Talk to your pharmacist he or she can be a valuable source of information
Test with understanding This is short-term work with longterm gain: securing good health down the road
CDA blood glucose targets for people with diabetes
A1C Fasting blood glucose 4 to 7 mmol/L Blood glucose two hours after the start of a meal 5 to 10 mmol/L 5 to 8 mmol/L if A1C targets are not being met
Target for most patients with diabetes
7
These targets are for most adults with diabetes and serve as a guide Thezy do not apply to children 12 years of age or under, or pregnant women Talk to your doctor about YOUR blood glucose target ranges
What is an A1C?
A1C is a blood test that indicates an average of your overall blood glucose levels over the past three to four months Also known as a hemoglobin A1C, glycosylated hemoglobin, HgbA1C and HbA1C, the A1C test levels are measured in different units and on a different scale than is blood glucose According to the Canadian Diabetes Association, those living with the disease are well advised to ask their physician about the A1C as staying in-target can reduce the potential for long-term complications from diabetes Source: wwwourdiabetescom
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