doctor's orders: a normal life with type 2 diabetes is 'doable'
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regular treatment for type 2 diabetes is a combination of a healthy lifestyle, diet or particular food choices, exercise or activity as well as medication.
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with type 2 diabetes, your body doesn’t make enough insulin or use the insulin it produces as well as it should. insulin is the essential hormone that helps control the level of glucose or blood sugar in your bloodstream, sending it to your cells so they have energy to function. over time, if left untreated, the disease can put you at serious risk of complications like stroke, vision loss and kidney damage. you can also experience mental health issues, like depression and anxiety, referred to as “diabetes distress” from the ongoing stress of managing the disease.
according to 2022 numbers from diabetes canada, there are more than 11.7 million canadians living with diabetes or pre-diabetes, a condition that can develop into type 2 diabetes.
healthing spoke with dr. christine ibrahim, an endocrinologist with the scarborough health network in scarborough, ont. about the disease and the move toward empowering patients to monitor and manage it with new treatments, technology and lifestyle habits.
what is type 2 diabetes?
dr. ibrahim: diabetes is a condition where you have an imbalance of blood sugars or blood glucose and insulin in your body. what would normally happen if your blood sugar goes up when you have something to eat, for instance, then the pancreas would release insulin and tell your other cells, like your fat cells or your muscle cells, to just take that sugar out of the bloodstream and absorb it into the cells, and that would bring down the blood sugar. so there is a balance.
in someone with type 2 diabetes, which is the most prevalent type, basically the pancreas is overproducing insulin. we call this insulin resistance. so it’s saying, ‘hey, take these sugars and absorb them so we can get them out of the bloodstream.’ but that insulin is just not as efficient and so you get these residual high blood sugars in the bloodstream, which can be due to various causes — genetics, lifestyle, medication, other medical conditions.
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what are the signs of type 2 diabetes?
dr. i.: it can actually vary person to person. what makes it a little bit tough is many individuals who have diabetes may present with no symptoms, they’re asymptomatic, but the trouble with these high blood sugars is they’re working in the background and they cause trouble to certain organs in your body that are more sensitive, such as your eyes, your heart, your kidney, your brain. sometimes these individuals don’t know until, unfortunately, a significant event happens such as a heart attack or a stroke.
for those who are symptomatic, high blood sugars can present with different symptoms, like vision changes, increased thirst and urination, fatigue, mood changes or irritability, or changes to weight. you can also get recurrent infections like yeast infections in particular, which really thrive on blood sugar.
so the key is to know if you have risk factors that increase your risk of developing diabetes. and then having routine check-ins with your health-care provider and doing general blood work to monitor and make sure that things don’t progress. the testing captures people who may not have symptoms.
how do people develop type 2 diabetes? what are the risk factors?
dr. i.: if you have one parent who has diabetes, you have a 50 per cent risk of developing it. if you have two parents with diabetes, we actually say the risk is 99 per cent. the chance of it being genetically connected is quite high. type 2 diabetes can also be medication-induced — so individuals who are on high doses of systemic steroids, for example. and then there are lifestyle factors such as a sedentary lifestyle or someone without any dietary restrictions may have an increased risk. there are also effects based on age, gender, ethnicity and other underlying medical conditions such as women who have polycystic ovarian syndrome, for instance.
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diabetes is more common than we think — there’s a diabetes epidemic. prevalence data shows that around 10 per cent of canadians have diabetes. that’s one in 10 people. when you add in pre-diabetes, that number goes up to 30 per cent.
are there lifestyle choices that can help treat type 2 diabetes?
dr. i.: there’s a lot to be said about lifestyle interventions. for individuals who are early in the course of diabetes, following safe lifestyle interventions can certainly prevent the progression of diabetes — even temporarily reverse it. i hesitate to say that you can reverse it 100 per cent because monitoring is still needed.
how is type 2 diabetes generally treated?
dr. i.: general treatment is multi-faceted. it’s a combination of a healthy lifestyle, so diet or particular food choices, exercise or activity as well as medication. for people with type 2 diabetes, this can be oral therapy, injectables or it could be a combination of both.
diabetes is one of those conditions where oftentimes there needs to be multidisciplinary expert involvement. so you’ve got your health-care provider, but you may also be connected to a diabetic clinic along with a nurse and a dietitian. but the main player in all of this is the patient themselves. while diabetes is a chronic condition that requires continued interval followups with your health-care provider and your health team, the day-to-day management is really up to the individual. they’re the one making the decisions on what they eat, what they do for activity, how they manage stress, and how they deal with illness.
dr. christine ibrahim is an endocrinologist at scarborough rouge hospital in scarborough, ont. supplied
we’re trying to move toward not just patient education, but also to a model where the patient can do their own critical appraisal and reflect on these decisions and say, ‘ok, what do i need to do differently?’ the beauty of this is that with the advent of technology and the way the field of diabetes management is growing, we’ve got devices like continuous glucose monitors which can tell you your blood sugar at any point in time. you can use those to make clinical decisions.
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low blood sugar can also be a problem for people with type 2 diabetes.
dr. i.: highs and lows exist in all types of diabetes. hypoglycemia is low blood sugar. sugar is like fuel to the body. if you think of what gas means to a car, when you don’t have enough gas in the car, it stalls and then eventually stops. so, similarly, if you run out of that glucose energy in the body, it also has a stalling effect, especially if not enough sugars are going to the brain. we don’t have statistics or a percentage on hypoglycemia, but it is common.
symptoms can be mild, they can be severe in some circumstances, and they could unfortunately be life-threatening. it might start with shakes, sweating, heart racing, hunger, dizziness, and progress to things such as trouble walking, speaking, confusion, even loss of consciousness or seizures. certainly it’s something that we want to talk about. it’s very important for patients to speak about it with their health-care providers and for health-care providers to discuss it with patients as well.
any advice for someone with type 2 diabetes?
dr. i.: one thing i would say is that you’re not alone. a lot of times when patients receive the diagnosis, they very much feel that way. there are options in terms of lifestyle changes, and a lot of advances in science and tech in terms of medication options and way to monitor blood sugars to help make living a regular life doable. this doesn’t have to be a label you wear, right? it’s just a thing that is part of your day-to-day health management.
what’s most rewarding about the work you do?
dr. i. : scientifically, you know the anatomy and physiology where things can go wrong with type 2 diabetes, how it shows up in terms of symptoms and what therapies might manage it. so you get to take all of that information, blend it, distil it, provide it, and when you see patients who are able to feel better, it’s so rewarding.
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for more information about type 2 diabetes, visit diabetes canada.
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