World Diabetes Day

Today is World Diabetes Day. It’s time to raise awareness about this serious disease, since 1 in 3 Canadians has either pre-diabetes or diabetes.

Pre-diabetes and diabetes are conditions where your body becomes resistant to insulin, a hormone secreted from your pancreas to transfer glucose from your blood into the cells in your body. Insulin resistance first leads to high glucose levels, then pre-diabetes and finally diabetes.

Extremely high glucose levels can be dangerous and even lead to death. Even consistent mild to moderate elevations in glucose levels can lead to long term complications such as blindness, kidney failure requiring dialysis, foot/leg amputations, heart attacks and strokes.

If you have been diagnosed with high blood sugars, it is important to make exercise and weight loss priorities as both can help you prevent developing diabetes. If you have already been diagnosed with diabetes, it is also important to work on these same lifestyle changes but also to stick to any prescribed treatment and follow-up regularly with your health care provider.

Here are some important facts that you should know about these conditions:

Pre-diabetes
If you are diagnosed with pre-diabetes, your blood sugars are likely high quite a bit of the time and your pancreas is being overworked. If enough of your pancreas burns out, you develop diabetes. Fortunately, there are steps you can take to avoid this scenario.

The Diabetes Prevention Program study offers some of the best evidence we have on how to prevent diabetes if you have already been diagnosed with higher blood sugars. The study was done with 3,234 patients and published in the prestigious New England Journal of Medicine in 2002.

Patients were divided into 3 groups: One with no intervention, a second group which received metformin (a diabetes medication that lowers glucose) and a third group that received lifestyle intervention (30 minutes of exercise five times a week and 7% body weight loss).

The study's results were very interesting. After 3 years, the metformin group decreased the average risk of progressing into diabetes by 31%. More incredibly, the lifestyle group decreased the average risk of progressing into diabetes by 58%.

At the 10 year mark, the metformin group continued to have an 18% lower risk of developing diabetes and the lifestyle group continued to have a 34% lower risk.

This study shows the power of lifestyle is preventing major illnesses such as diabetes. All it takes is 30 minutes of exercise a day and working on losing at 5-10% of your body weight.

Diabetes
While the same lifestyle changes described in the Diabetes Prevention Program study above will help you to lower your blood sugars when you have diabetes, it is also important to take medications that lower your sugars and help prevent complications such as blindness, kidney failure requiring dialysis, foot/leg amputations, heart attacks and strokes.

One of these medications is insulin which was discovered right here in Canada by Sir Frederick Banting exactly 100 years ago in 1921. It has saved countless lives since then. At one time, this was the only way to treat diabetes, but now, most people will not need insulin as we have many other mediations available.

Unfortunately, some diabetes medications such as gliclizide, Actos and Avandia can lead to weight gain. Fortunately, other diabetes medications are available that don’t lead to weight gain. These include metformin and Januvia. Janumet is a combination of both metformin and Januvia and is also ‘weight neutral’.

Currently, there are also diabetes medications available that lead to weight loss in most people. These include SGLT2 inhibitors which cause you to dispose of excess glucose through your urine and have been shown to lower blood pressure slightly and decrease the risk of congestive heart failure and kidney disease. Drugs in this class include Forxiga, Invokana and Jardiance.

The other class of diabetes medications that leads to weight loss in most people is the glucagon like peptide 1 receptor agonists (GLP1s). They have also been shown to have a protective effect on the heart. These include Victoza, Ozempic, Rybelsus, Trulicity, Byetta and Adlyxine. They can also be combined with insulin in the following products: Xultrophy, Soliqua.

If you are on weight promoting diabetes medications, speak to your doctor about potentially starting on some of the ones that lead to weight loss. And don’t forget to also work on your lifestyle!