Diabetes is a progressive medical condition that affects how our body converts food into energy. Clinically, diabetes is characterized by higher-than-normal blood sugar levels,  (also known as hyperglycemia,) and increased levels of glucose in the urine. 

Diabetes is a very common medical condition that affects more than 10% of the Canadian population or about 3.8 million Canadians). Unfortunately, the diagnosed cases are only considered as the tip of the iceberg, as latest data reported by the Canadian National Charity organization Diabetes Canada suggested that more than 29% Canadians are living with pre-diabetes or diabetes. 

Diabetes is a global health issue that affects individuals of all age groups and economic statuses. According to 2019 statistics, 463 million people worldwide or about 9.3% of the global population is diabetic. It is also projected that by 2030, global prevalence of diabetes will increase to 578 million (0r 10.2% of the global population).

Poorly managed diabetes is a leading cause of morbidity and mortality worldwide. In fact, diabetes is among the 10 leading causes of death in Canada.

What Causes Diabetes?

Cells in the human body depend on normal glucose levels to maintain different bodily functions such as running, thinking, breathing etc. This glucose is obtained from the breakdown of the food we consume. After every meal when blood sugar spikes, our pancreas releases insulin – a hormone that encourages our muscles, organs, and cells to take in glucose to perform regular bodily functions.  

In people suffering from diabetes, the pancreas are either incapable of producing sufficient quantities of insulin (i.e., lack of insulin) or their tissues are resistant to the action of insulin (i.e., insulin resistance). In the absence of normal insulin activity, blood sugar levels tend to stay elevated, leading to a wide variety of issues or symptoms collectively referred to as diabetes. 

What are different types of Diabetes?

There are four main clinical types of diabetes:

• Type 1
• Type 2
• Gestational diabetes
• Prediabetes

Type 1 Diabetes:  Type 1 diabetes, also known as juvenile,early onset, or Insulin – Dependent Diabetes (IDDM) is a condition that is caused by deficiency or absolute lack of insulin. It is believed to be caused by autoimmune destruction of pancreatic cells (a condition in which the body's own immune cells start attacking tissues by mistake). Type 1 diabetes accounts for almost 9% of all reported cases of diabetes in Canada. Most cases are diagnosed at a younger age, i.e., childhood or adolescence hence it is referred to as juvenile diabetes. 

Type 2 Diabetes: Also known as Adult-Onset Diabetes Mellitus or Non-Insulin Dependent Diabetes Mellitus (NIDDM) is characterized by gradually increasing insensitivity of tissues to the action of insulin. In other words, your body produces normal (or sometimes higher) levels of insulin, but the tissues gradually become resistant to the action of insulin, thus interfering with the tissue uptake of glucose, and resulting in high blood sugar levels. Type 2 diabetes is more common and affects about 90% of the diabetic population in Canada. The symptoms of type 2 diabetes develop gradually over a period of years, and most cases are diagnosed on screening tests for non-related conditions or on routine medical check-ups. Type 2 diabetes is typically diagnosed later in life as it is associated with ongoing poor diets and sedentary lifestyles. 

Gestational diabetes: Diagnosis of diabetes for the first time during pregnancy (or gestation) in a previously undiagnosed woman is referred to as gestational diabetes.  About 1 in 10 women in Canada develop diabetes during mid to late pregnancy. During pregnancy, the placenta produces several hormones to increase blood sugar levels to ensure optimal nourishment for the growing baby. In most cases, the placenta also produces insulin in sufficient quantities to handle the excess blood sugar load. But in some cases, the pancreas fails to produce ample insulin, thereby causing elevated blood sugar levels and resulting gestational diabetes. 

Statistics suggest that poorly managed diabetes during pregnancy increases the risk of complications for both mother and the baby. In most cases, gestational diabetes goes away after the baby is born, but research suggests that these women are more susceptible to developing type 2 diabetes in later pregnancies as well as later in their life. It is therefore advised that patients monitor their  blood sugar levels even after delivery to minimize the risk of developing type 2 diabetes. 

Prediabetes: Prediabetes is clinically defined as border-line high blood sugar levels – and is regarded as the stage prior to diabetes. In this condition blood sugar levels are above normal range; however, they are not high enough to meet the diagnostic criteria of type 2 diabetes. Prediabetes can be managed by making changes in the lifestyle such as incorporating regular exercise, eating a healthy diet by limiting the intake of processed foods, and maintaining a healthy body weight. You may find it alarming that 6.1% Canadians live with pre-diabetes, while 7.1% Canadians live with higher-than-normal blood glucose levels. Statistics also suggest that 1.7% Canadians are unaware of their high blood sugar levels and at high risk of developing diabetes. The prevalence of prediabetes is much higher in certain other countries such as China, India, and the United States. 

How Do I Know if I Have Diabetes?

If you are experiencing the following symptoms, you should speak to your primary care provider to get your blood sugar levels assessed.

• Increased hunger and thirst
• Weight loss
• Dizziness
• Frequent urination
• Fatigue
• Blurry vision
• Impaired wound healing 

In addition to these symptoms, some diabetic men also experience reduced sex drive, erectile dysfunction, and poor muscle strength.

In women, common symptoms that are often suggestive of diabetes are recurrent urinary tract infection, itchy skin, and vaginal yeast infections. 

The diagnosis of diabetes mellitus is confirmed by blood sugar levels. Your healthcare provider may advise a variety of tests to confirm the diagnosis. 

• A Fasting Glucose test: A fasting blood sugar level of 7 mmol/L or higher is considered diagnostic for diabetes mellitus 

Fasting Blood Sugar Levels	Diagnosis
4.0 to 6.0 millimoles per litre (mmol/L)	Normal
Between 6.1 and 6.9 mmol/L	Pre-Diabetes
Greater than 7 mmol/L	Diabetes

• An oral glucose tolerance test (OGTT): OGTT is used as a screening or diagnostic test in individuals who have impaired or normal than higher fasting blood sugar levels i.e., just under 7 mmol/L. This test is performed by taking a baseline fasting blood sugar reading after an overnight fast, after which the candidate is given a sugary beverage. The lab technician then checks your blood sugar level after every 30 to 60 minutes for up to 3 hours. Blood sugar levels higher than 11 mmol/L after 2 hours are suggestive of diabetes mellitus. 

• Hemoglobin A1C (HbA1c) Test: This test is performed by measuring the amount of glucose attached to your hemoglobin and is used as a screening, diagnostic or monitoring test for diabetes or pre-diabetes.

What Causes Diabetes?

• Cause of Type 1 Diabetes: Type 1 diabetes is an autoimmune condition. The exact cause of type 1 diabetes is not known however, genetic factors and family history of diabetes (or other autoimmune diseases) may play a key role. Research also suggests that some people may develop type 1 diabetes after a viral infection.  

• Causes of Type 2 Diabetes: The exact cause of type 2 diabetes is not known, but some of the risk factors that may aggravate your risk of developing type 2 diabetes are:
  • Genetics: Genetics plays an important role in type 2 diabetes. It runs in families. If any of your close relatives have diabetes, it will increase your chance of getting type 2 diabetes.

• Overweight: Some lifestyle choices may aggravate your risk of developing diabetes such as sedentary lifestyle, high stress levels, and obesity (especially central obesity or accumulation of fat in the abdominal region). For example, all tissue in our body possesses insulin receptors that allow the binding of insulin. But obesity causes insensitivity or resistance of these receptors especially in the cells of muscles and liver. The resultant effect is low sugar uptake by tissues that signals pancreas to release more sugar in the blood eventually worsening the hyperglycemia in the blood.  Unfortunately, obesity is prevalent in the Canadian population. According to latest estimates, 26.8% Canadians are obese (i.e., have a body mass index of 30 or more), while 36.3% Canadian adults are overweight. 

• Metabolic syndrome: People who have metabolic syndrome are also at higher risk, such as history of hypertension, excess fat around belly, high blood cholesterol levels etc. 

• Racial factors: Some ethnicities are at much higher risk of developing diabetes such as Hispanics, African American, Alaska native, Pacific Islanders, American Indian, and Asian Americans. 
• Causes of Gestational diabetes: Pregnancy is a state of hormonal and chemical imbalance. Along with several metabolic changes such as weight gain, the placenta of pregnant women also releases hormones that increase blood sugar levels. In addition, the sudden weight gain during pregnancy often causes insulin resistance that further worsens the hyperglycemia. The women who were overweight before getting pregnant or had a strong family history of diabetes are at much higher risk of developing gestational diabetes.  

Complications of Diabetes:

Glucose or sugar attracts water due to osmosis, resulting in tissue swelling, inflammation of blood vessels and tissues and resulting organ dysfunction. Long-standing or poorly controlled diabetes impacts all major tissues and increases the risk of severe complications or even death. The economic burden of diabetes is huge in Canada despite the universal healthcare system. According to estimates, an average Canadian diabetic spends 3% of their total income (or about $1,500 per year) in diabetic care and management.  

In fact, mortality rate or death rate is twice as much in diabetic Canadians than non-diabetic Canadians. Research also suggests that elderly diabetics have the highest mortality rate compared to their non-diabetic counterparts. Unfortunately, diabetes-related mortality is under-reported.  Common complications of diabetes are:

• Cardiovascular Complications: Diabetics are at much higher risk of developing stroke, heart diseases, hypertension (or high blood pressure), and other related ailments. According to a new study, 181.5 per 1,000 diabetics develop heart disease and 126.2 per 1000 diabetics develop stroke each year. The rate of complications increases with advancing age and poorly controlled diabetes. 
• Nerve damage: As suggested previously, diabetes causes tissue swelling and inflammation that mainly affects nerves and blood vessels. Long standing diabetes increases the risk of nerve damage to the limbs that may present with numbness, pain, burning sensation or loss of feeling that may begin with your toes or finger and then eventually affect all major tissues. Other symptoms of diabetic nerve damage are erectile dysfunction in men, and digestive issues such as nausea, vomiting, constipation, diarrhea. 
• Kidney disease: Also known as diabetic nephropathy is a serious complication of poorly controlled diabetes. According to estimates, 33% of all diabetics develop kidney dysfunction due to progressive damage to the blood vessels and a significant percentage of affected individuals develop end-stage kidney disease or complete kidney shutdown. 
• Eye Issues:  High blood sugar levels causes swelling of lens and inflammation due to damage to blood vessels. Diabetics are at increased risk of developing various eye related complications such as retinal damage (also known as diabetic retinopathy), cataracts, and glaucoma. Untreated diabetic retinopathy can also lead to permanent blindness. According to latest statistics, about 25% of Canadian diabetics develop diabetic retinopathy, contributing to increased risk of falls, fractures & vision loss. 
• Skin diseases: Diabetes increases the risk of various bacterial and fungal diseases. 
• Poor wound healing: Damage to blood vessels and nerves impair the blood circulation to the tissues furthest from heart (such as limbs) that may lead to peripheral artery disease (or PAD). Data suggests that PAD affects about 15-25% of the Canadian diabetic population and may present as chronic sores and blisters. If not treated in time, these blisters or sores may become septic and gangrenous – requiring surgery or even amputation. 
• Hearing problems: People with diabetes also have increased chances of developing hearing impairment. 
• Sleep apnea: Sleep apnea is a sleeping disorder that is characterized by abnormal breathing while sleeping. Sleep apnea is more common among people who have type 2 diabetes. Study suggests that more severe the sleep apnea is, more difficult it is to maintain steady blood sugar levels. 
• Dementia: Type 2 diabetes also increases the risk of developing Alzheimer’s disease and accelerated brain aging that presents as dementia. 

Complications of Gestational Diabetes:

Gestational diabetes can pose a serious threat to the life of both mother and the unborn baby. However, with properly managed blood sugar levels, the risk of complications can be minimized.  In poorly managed cases of gestational diabetes, the risk of serious complications increases. Such as: 

• Premature birth
• Still birth
• High birth weight baby 
• Increased risk of developing Type 2 diabetes in later life
• Low blood sugar levels after birth in the babies 
• Jaundice
• High risk of developing hypertension during and after pregnancy 
• Higher risk of C-section 
• Increased risk of developing gestational diabetes in subsequent pregnancies

Treatment of Diabetes

It is estimated that new cases of diabetes are estimated to result in $15.36 billion in Canadian health care costs. Regardless of medical and technological advancements, so far there is no curative treatment for diabetes, but with adequate blood sugar control, the quality of life can be restored among diabetics. 

There are various treatment options available that can help in managing blood sugar levels in diabetics, depending on the type of diabetes and how well a particular medicine suits you or controls your blood sugar levels. 

Treatment Options for Type 1 Diabetes:

Type 1 diabetes is caused by absolute lack or deficiency of insulin and hence requires insulin replacement therapy to maintain steady blood sugar levels. 

The dose and frequency of insulin varies and should be monitored very carefully. There are various types and formulations of insulin such as:

Types of Insulin:

There are four types of insulin, depending on how fast the insulin formulation begins to work and how long their impact lasts. 

1. Rapid acting insulin: It exerts its action within 15 minutes of administration and the effect can last for up to 3 to 4 hours.
2. Short acting insulin: This insulin preparation exerts its action within 30 minutes and can last for up to 6 to 8 hours.
3. Intermediate acting insulin: It starts to work within 1 to 2 hours of administration and can last for up to 12 to 18 hours.
4. Long lasting insulin: This preparation starts working within a few hours of administration and can last for about 24 hours or longer.

There are several modes of insulin administration. If you don’t like syringes or needles you may opt for alternative formulations, but it is highly recommended to speak to your doctor prior to making any changes in your dosing schedule or mode of administration. 

Preferred methods of administering insulin are needles, syringes, pens, and pumps. 

Needles and syringes: Using syringes to inject insulin requires the patient to accurately measure and withdraw the correct amount of insulin from the vial. This is more cumbersome than other methods but is more cost-effective. Typically, insulin is injected on the belly to safely regulate blood sugar levels, However, it is recommended to switch your injection spots to avoid infection or skin inflammation. Other common sites are the upper arm, buttocks, and thighs. Some people need two to three shots in a day to control their blood sugar level however, for some, one shot is enough. 

Insulin Pen: Insulin pen looks like a pen but has a needle to safely inject the drug. Insulin pens have a dial that lets you easily and accurately control the amount of insulin injected. Some insulin pens are disposable and are already filled with insulin. You can dispose them off once the insulin is finished. Other versions have a place for an insulin cartridge that can be replaced when needed. Insulin pens are a bit more expensive than syringes, but some find them more convenient and easier to use.

Pump: An insulin pump is a small instrument that gives you steady doses of insulin throughout the day.  You can wear this pump on your body through a belt, pouch, or pocket. An insulin pump is made up of a canister that contains insulin, a small plastic tube, and a needle to transfer medicine into your body. You insert a needle at a certain spot on your body and it stays there for several days. You can also get insulin doses through a machine at your mealtime. 

Inhaler: Another way to get insulin is through inhalation. Insulin inhalers consist of powdered insulin which you can breathe through your mouth. From your mouth it goes straight to your lungs and then into your bloodstream. It is suitable only for adults with type 1 and type 2 diabetes to achieve rapid blood sugar control after meals. Inhaled insulin is not yet approved for marketing in Canada, but more research is underway by different pharmaceutical companies like Afrezza to increase patient and physician acceptance of inhaled insulin.  

Treatment Options for Type 2 Diabetes 

The management of type 2 diabetes is multimodal and involves a comprehensive regimen that includes:

Diet modification: Diet modification is the key and includes consultation with a Registered Dietitian to maintain a healthy diet chart that comprises a balanced intake of complex carbohydrates and proteins. Maintain a healthy calorie intake to maintain normal body weight. Include a high fibre diet and limit simple sugars in your diet. Minimize your intake of processed foods that are high in simple sugars and spike up your blood sugar levels. 

Maintain regular physical activity: Did you know that 45.4% adults in Canada are physically inactive? Exercise is very important for weight management and regulation of metabolism as well as maintenance of normal blood glucose levels. Avoid prolonged periods of inactivity. Indulge yourself in light activity after every 30 minutes. Aerobics and resistance exercises are excellent for building your stamina and controlling your blood sugar levels.  

Regular monitoring of blood sugar levels: Your healthcare provider will guide you on how to monitor your blood sugar level daily. You may need to check your blood sugar once a day or before and after each meal. If you are on insulin therapy, you may need to obtain a blood sugar reading several times a day. There are also a variety of wearable devices that monitor your blood sugar levels at all times.

Oral medications to monitor blood sugar levels: If you are unable to maintain normal (or near-normal) blood sugar levels with lifestyle and diet modifications, your doctor may advise you of blood sugar lowering medications (also known as hypoglycemic medications) to avoid spikes in the blood sugar levels. Common hypoglycemic drugs are: 

• Metformin: Metformin is a common hypoglycemic medication which is prescribed for the management of type 2 diabetes. It exerts its action by reducing the production of glucose in the liver. It is also known to improve the sensitivity of tissues to insulin for better glycemic control. Some people who are on Metformin therapy may develop vitamin B12 deficiency and require supplementation. Possible side effects of Metformin include:
  • Nausea
  • Bloating and abdominal pain
  • Diarrhea
• Sulfonylurea: It helps in stimulating your pancreas to produce more insulin. Some of the notable Sulfonylureas are Glyburide, Glimepiride and Glipizide. Possible side effects include:
  • Weight gain
  • Low blood sugar levels
• Glinides: It also stimulates the pancreas to produce and secrete additional insulin. They work more quickly as compared to sulfonylurea, but the duration of action is shorter. Examples include Nateglinide and Repaglinide. Possible side effects include
  • Weight gain
  • Low blood sugar levels
• Thiazolidinediones: It exerts its action by increasing the sensitivity of tissues to insulin to promote utilization. Examples include Pioglitazone and Rosiglitazone. Possible side effects include
  • Increases risk of heart failure
  • Increased risk of fractures of bones
  • Weight gain
  • High cholesterol levels
• DPP- 4 inhibitors: It helps in lowering blood sugar level; however, it has a very natural effect, such as not dropping blood sugar too low. Examples include Sitagliptin, Saxagliptin and Linagliptin. Possible side effects include:
  • Joint pain
  • Increased risk of Pancreatitis 
• GLP-1 Receptor Agonists: This group of hypoglycemic drugs are administered via injections, and they exert their action by reducing or slowing the digestive process to prevent the sudden spike in blood sugar levels, especially after meals. They often help in reducing the weight as well and also helps in decreasing the risk of common complications like heart diseases and stroke. Examples include Exenatide Liraglutide, Semaglutide. Possible side effects:
  • Nausea and vomiting
  • Diarrhea
  • Risk of Pancreatitis
• SGLT2 (or Sodium-glucose Cotransporter-2) Inhibitor: This is a newer class of FDA approved drugs that exert its hypoglycemic action by facilitating the excretion of excess blood sugars via urine by limiting the renal absorption of sugars. Research suggests that SGLT2 Inhibitors also reduce the risk of cardiovascular complications associated with longstanding diabetes. Examples include Canagliflozin, Dapagliflozin and Empagliflozin. Possible side effects include:
  • Higher risk of bone fractures 
  • High risk of amputation 
  • More frequent vaginal infections
  • Hypotension
  • Higher risk of gangrene 
  • Frequent episodes of urinary tract infection 

• Insulin Therapy: Some people with type 2 diabetes may require insulin therapy to achieve better blood sugar control. In most cases, insulin is reserved for short term management of blood sugar levels in situations where oral hypoglycemic drugs are not completely effective (such as active infection, prior to surgery etc.) As discussed previously, the type of insulin prescribed by your doctor depends on the blood sugar status and duration of action. Such as, long-acting insulin is suggested to maintain steady blood sugar levels overnight or throughout the day, whereas short-acting insulin is advised before and after mealtimes to prevent sudden fluctuations in the blood sugar levels. The type of insulin suggested by your doctor, its dosage and schedule may vary depending upon your blood sugar levels.

Some of the common side effects of insulin include: 

• Hypoglycemia (or low blood sugar levels)
• High blood cholesterol 
• Diabetic ketoacidosis (a severe life threatening complication of diabetes that should be diagnosed and treated on emergency basis)

There are several modes of insulin administration. If you don’t like syringes or needles you may opt for alternative formulations, but it is highly recommended to speak to your doctor prior to making any changes in your dosing schedule or mode of administration. 

Preferred methods of administering insulin are needles, syringes, pens, and pumps. 

Needles and syringes: Using syringes to inject insulin requires the patient to accurately measure and withdraw the correct amount of insulin from the vial. This is more cumbersome than other methods but is more cost effective. Typically, insulin is injected on the belly to safely regulate blood sugar levels, However, it is recommended to switch your injection spots to avoid infection or skin inflammation. Other common sites are the upper arm, buttocks, and thighs. Some people need two to three shots in a day to control their blood sugar level however, for some, one shot is enough. 

Insulin Pen: Insulin pen looks like a pen but has a needle to safely inject the drug. Insulin pens have a dial that lets you easily and accurately control the amount of insulin injected. Some insulin pens are disposable and are already filled with insulin. You can dispose them off once the insulin is finished. Other versions have a place for an insulin cartridge that can be replaced when needed. Insulin pens are a bit more expensive than syringes but some people find them more convenient and easier to use.

Pump: An insulin pump is a small instrument that gives you steady doses of insulin throughout the day.  You can wear this pump on your body through a belt, pouch, or pocket. An insulin pump is made up of a canister that contains insulin, a small plastic tube, and a needle to transfer medicine into your body. You insert a needle at a certain spot on your body and it stays there for several days. You can also get insulin doses through a machine at your mealtime. 

Inhaler: Another way to get insulin is through inhalation. Insulin inhalers consist of powdered insulin which you can breathe through your mouth. From your mouth, it goes straight to your lungs and then into your bloodstream. It is suitable only for adults with type 1 and type 2 diabetes to achieve rapid blood sugar control after meals. Inhaled insulin is not yet approved for marketing in Canada, but more research is underway by different pharmaceutical companies like Afrezza to increase patient and physician acceptance of inhaled insulin.  

Treatment for Gestational Diabetes

If you are pregnant with gestational diabetes, it is highly recommended to very tightly regulate your blood sugar levels to minimize the risk of maternal/fetal complications. 

Consume a well-balanced, healthy, nutritious but low-calorie diet that is free from simple sugars. Exercise daily and maintain a stress-free lifestyle. Avoid excessive weight gain during pregnancy. 

Monitor your blood sugar levels regularly but if you are experiencing unstable or high blood sugar levels, you may be advised medications (such as oral drugs or insulin)  to avoid blood sugar fluctuations. 

Management of Prediabetes

Prediabetes is a stage prior to the onset of full-blown diabetes and therefore responds very well to weight reduction, lifestyle modification and dietary changes. 

If you are at a high risk of getting type 2 diabetes, or if your blood sugar levels are not responding to the lifestyle adjustments or you have other metabolic disorders (such as heart disease, polycystic ovarian disease, or fatty liver disease), you should consult with a healthcare provider. In most cases, your doctor may advise medications like Metformin to control blood sugar levels. 

Lifestyle Changes for Diabetes: 

It is highly recommended to work closely with your healthcare provider to control your blood sugar levels with medications while maintaining a healthy lifestyle. 

• Wear a medical ID tag: In some diabetics, blood sugar can fluctuate suddenly, causing hypoglycemia (low blood sugar levels) that presents with dizziness, sweating, low blood pressure and even loss of consciousness. Likewise, spikes in blood sugar levels or other complications of diabetes (such as diabetic ketoacidosis) are medical emergencies and should be treated quickly. It is therefore advised to diabetics to wear a medical tag to allow easy identification of issues and prompt treatment. 
• Reduce stress: High stress levels increases the secretion of stress hormones like Cortisol that further spikes up the blood sugar levels. It is highly recommended to adopt a stress-free lifestyle by incorporating anti-stress activities such as yoga, meditation, and exercise. 
• Quit smoking: There are 700 known carcinogens and irritants in cigarette smoke. Research suggests that smoking in diabetics can increase the risk of developing certain health issues such as heart diseases, vascular disorders, atherosclerosis, hypertension, kidney disease, stroke, and nerve damage. several folds. 
• Cut back on alcohol: Excessive alcohol consumption can make managing your blood sugar levels even more difficult. This is because alcoholic beverages such as wine, beer are high in sugars. Moreover, alcohol consumption puts more stress on the liver and kidneys, thus aggravating the risk of end-organ damage. Last but not the least, many drugs may interact with alcoholic beverages and may adversely affect your blood sugar levels. 
• Nutrition and meal timing for diabetes: Dietary modification is the key to maintaining steady blood glucose levels. Make sure you consume complex carbohydrates, ensure proper meal spacing and avoid simple sugars in high doses. In addition, avoid foods with high glycemic index (that causes a spike in blood sugar levels) such as grains, pasta, and rice. Obtain more carbohydrates from fresh vegetables, fruits, beans, whole grains non-fat or low-fat milk etc.
• Exercise:  Moderate physical activity improves glucose uptake by tissues and enhances insulin sensitivity. In addition, it also prevents protein breakdown, maintains normal body weight, and reduces the risk of complications. According to the recommendations of American Diabetic Association, individuals without any physical restrictions should work out for at least 150 minutes per week that could be a combination of aerobic and anaerobic activity such as weightlifting, walking, resistance band training etc.)

Complementary and Non Medication Strategies for Managing Diabetes  

Alternative or Complementary medicine is becoming more popular with every passing day, mainly due to the minimal risk of side effects. Diabetics may consider the following options to help support their condition:

• Yoga: Regular yoga may help manage stress and provide an opportunity for exercise 
• Massage: Massage may improve blood circulation and help manage stress 
• Acupuncture: Some research has suggested that acupuncture may be helpful in conjunction with medication to manage diabetes. 
• Aromatherapy: Some studies suggests that aromatherapy alleviates stress 
• Supplementation: Supplementation with certain supplements and  nutrients can improve glycemic control. Some common supplements that may be helpful in conjunction with medications are:  
  • Vitamin E, which prevents lipid breakdown, acts as antioxidant, and improves insulin secretion and sensitivity;
  •  Carnitine, which enhances glucose uptake and storage;
  • Chromium, which improves insulin sensitivity and also reduces risk of chromium deficiency as diabetics lose more chromium in their urine.

Coping and support:

According to the latest estimates, Diabetics in Canada are twice as likely to develop depression than the general population. This is attributed to the nature of illness, higher rate of complications, frequent hospitalizations, long list of medications, healthcare cost and dietary restrictions. Unfortunately, only 25-50% cases of depression are diagnosed in diabetics which may aggravate the rate of complications. 

Following tips can help in coping with the symptoms of diabetes:

• Educate yourself about diabetes, lifestyle modification, dietary changes, and blood sugar monitoring.
• Learn more about your other health issues that can put you at higher risk of developing complications to devise a strategic healthcare plan. 
• Adopt healthy habits and indulge yourself in productive hobbies such as meditation, gardening, physical activity to combat stress
• Join a support group or speak to a mental health counselor if you are experiencing negative thoughts about your illness. If speaking to a family member or friend doesn’t make you feel better, speak to a healthcare practitioner, and see if you need therapy or medications to feel better. 

Diabetes is a chronic metabolic disease that is a leading cause of death and disability around the world. It is predicted that by the year 2022, an additional 2.16 million cases of diabetes will be diagnosed in Canada, increasing the diabetes-related economic burden by $15.36 billion. However, with proper medications and lifestyle management, the quality of life can be improved. It is highly recommended to speak to your primary care provider to learn how you can manage your symptoms and minimize the risk of complications. 

This article offers general information only and is not intended as medical or other professional advice. A healthcare provider should be consulted regarding your specific situation. While the information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the authors as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by Mednow or its affiliates.

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