leaders in health: dr. dylan mackay's life with diabetes, research and clinical trials
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dr. dylan mackay participated in diabetes canada pump couture in winnipeg, where people with lived experience model clothing along with their diabetes wearable devices and injection scars.
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dr. dylan mackay has a unique tattoo sleeve that he’s proudly displayed while modelling on the catwalk. in richly detailed illustrations, the story of the discovery of insulin unfolds. there’s a dog from the lab of co-creators frederick banting and charles best, transcribed pages from their lab books, including some of the blood sugars of the dogs from the experiments where the first two dogs survived without a pancreas, and one of the first bottles of insulin made at the university of toronto. (his cousin is a tattoo artist and came for a visit to do the work.)
like many tattoos, his sleeve is part of his own life story.
the 43-year-old winnipeg scientist and dog-lover has type 1 diabetes. the diagnosis as a young teen set him on a path to lead research in diabetes and related fields—and change lives. he participated in the diabetes canada pump couture fashion show in winnipeg this may, where people with lived experience model clothing along with their diabetes wearable devices and injection scars.
science guided by personal lived experience
“i was 13 and pretty active in junior high,” says dylan, remembering how his journey with type 1 diabetes started in his hometown of st. john’s, nfld. “i played hockey in the winter, i played soccer, i was playing a lot of basketball with my junior high basketball team. we were really doing well. but the big thing for me is that i was hungry and thirsty all the time. the hungry was like ‘growing boy’ kind of thing, but the thirst was incredible. i got home one day after school and i was thirsty, so i filled an empty two-litre pop bottle with water. i drank the entire thing.”
still thirsty, he filled it up again and sat down to read the newspaper, coincidentally noticing an ad from the canadian diabetes association, now diabetes canada, that posed the question, are you thirsty?
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it was the lightbulb moment that prompted him to yell out to his mom, as teens tend to do, that he needed a doctor’s appointment because, as he told her, “i bet you i have diabetes. i’m thirsty all the time. like, i’m getting taller, but i’m losing weight, even though i’m eating all kinds of stuff.”
right after a special urine test at the doctor’s office the next afternoon, he was sent straight to the hospital for a week at the janeway children’s hospital in st. john’s, learning how to inject insulin and survive as someone with type 1 diabetes.
he didn’t know anyone who had experience with type 1 diabetes or a family member with the condition, except he later learned he has a second cousin with type 1. but he didn’t meet a peer with type 1 diabetes until university.
the fast, intense transition to self-care and diabetes management was a turning point where his parents let dylan take the lead. “i think it was a smart choice that my parents didn’t get involved with the care because, while it did rapidly mature me in some ways, it was the right time for me to have that independence, and it worked out. it might not be for everybody, but one part of my life became very serious, very fast.”
he connected with a good endocrinologist eventually, but says there wasn’t a footprint at the time for diabetes camps or support groups in the province. he learned about the requirements of type 1 diabetes on his own, trying to balance his blood sugars with the right combination of insulin, food, activity, stress management and sleep—all important factors in type 1 diabetes daily living.
food and health connection in chronic disease
the influence on his career was like a straight line, he says. his mom was a registered dietitian, so understanding how food and health are connected was a natural fit. his parents had sparked his interest in cooking as well, reflected in his passion today for his vegetable gardens, apple trees and pumpkins that take over his lawn, reducing the need to mow, he laughs. he likes to grill in the summer, especially barbecued steak with chimichurri and vegetables from the garden.
sponsored by:
diabetes canada
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another recurring theme in his life, he says, is challenge. he’s competitive, which comes in handy when he’s playing rec hockey, coaching his daughter’s ringette team and pursuing funds for his research. his current work is supported by diabetes canada and the canadian institutes for health research (cihr), but there’s a limited pool of money available.
“i just really fell in love with the research and saw the life that my supervisors had,” dylan says of his early work in a master’s program in biochemistry with a focus on nutrition.
“i was doing a type 2 diabetes research project with them, and my background knowledge of the way i lived my life was stuff i already knew, and reading about it helped expand my knowledge about things.”
the team worked with yucatan miniature pigs as a model of type 2 diabetes because this type of pig is resistant to developing type 2 diabetes. they looked at the influence of diet on the development of type 2 diabetes and other chronic diseases.
“essentially, we were feeding them a diet that i’d best describe as almost pie crust. so it was based on the highest amounts of saturated fat, sugar, salt and refined carbohydrate that someone could be eating in canada. we had piglets that we grew from three days old until almost 14 months, where they would either eat their regular optimized chow or this pie crust,” he says.
“we wanted to see how that influenced things like their glucose metabolism. i was focused on diabetes, insulin resistance, glucose challenges and things like that. but every part of the animal was used for different experiments.”
they discovered that, unlike most people, these pigs can add a lot of body fat and store a lot of energy, all while maintaining their metabolic health. the pigs that were on pie crust were bigger; they had more subcutaneous fat; they had smoother, nicer, softer skin compared to the other pigs, but it didn’t impact their blood sugar response. they could make more insulin to manage the food consumption and keep their blood sugar in the normal range.
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animals essential in research and discovery
“you can’t really do research in people that way, right? as my tattoo shows, i have a deep appreciation for animals, but also animals and research is sometimes a necessity. i would say for my survival, it was a necessity,” he says of the discovery of life-saving insulin for type 1 diabetes.
his career has been a journey of his own lived experience with the condition and his dedication to improving patient self-care. he moved to winnipeg in 2008 to get his phd in human nutritional sciences at the university of manitoba and stayed, opting for the “long-shot” of becoming a professor in a competitive and shrinking market. that too suited his competitive nature, and he was offered a position in the university’s agriculture and food sciences program, where he teaches macronutrients and chronic disease—certainly his area of experience.
the content comprises protein, fat, sugars and carbohydrates and how we digest and metabolize them, and how they influence different chronic conditions like type 1 diabetes, type 2 diabetes, chronic kidney disease and liver disease, which are prominent chronic conditions related to nutrition.
on a personal note, he met his wife during his master’s studies in st. john’s when he was a bouncer and she was a server in a bar. she became a nurse practitioner and now she’s the director of the nurse practitioner program at the university of manitoba. they have two young teens, three dogs and love life in the sunny climate of winnipeg, an “incredibly welcoming city,” he says.
dylan’s phd studies took him away from diabetes research, but it focused him on research with humans and clinical trials, which is “uniquely challenging, but also uniquely important because, you know, for all the research you can do in mice and animals, most of it doesn’t translate to humans,” he explains.
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“i always have this running joke about how many times i keep reading about how they cured diabetes in mice, but it never makes it all the way to me.”
he worked on trials to look at postprandial glucose response, for example, where participants would try a new food in development, like a snack made from beans or chickpeas, to see how it affected their blood sugar. “for someone with type 1 diabetes, i kind of do that to myself every meal, right? every meal is a postprandial glucose response challenge.”
after his doctoral degree, he began his own research, leading the lab at the university of manitoba in clinical trials on nutrition interventions for type 1 and type 2 diabetes, and related conditions including obesity and chronic kidney disease.
he talks about his fascination with the concept of type 2 diabetes remission, where people are able to manage the condition with lifestyle and require no medication.
“i can see that as being very motivating and very successful. but it’s also very hard. it’s not for everyone.” one of the programs he’s started is looking at remission interventions, which is timely with the new medications for type 2 diabetes like semaglutide and tirzepatide that also treat obesity. he says that these medications are not without their downsides and, although effective, many people don’t want to be on them forever. but can healthy lifestyle habits support the medication, and then allow people to come off the medication and still be in remission?
the new age of glp-1 medications
“we know a lot about weight maintenance and it’s easier to do than weight loss, so can we use the medications to help with the hard part? but then do those people need to continue them? there may be many people who never want to come off those medications while there may be some people who can’t wait to.”
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the other main area of focus for his research is chronic kidney disease, where almost 50 per cent of those with chronic kidney disease have type 1 or type 2 diabetes. dylan is connected to many kidney doctors in manitoba who are interested in nutrition interventions.
one of the conditions that happens in chronic kidney disease is called metabolic acidosis, where the acid-based balance starts to go out of whack in kidney disease as the kidney functions fail. normally, this is treated with baking soda tablets that people tend to hate because they make you feel sick.
“it’s like a volcano in your stomach kind of thing. and the reason why they’re taking it is for the bicarbonate, not the sodium. the sodium is actually bad. but there are lots of fruits and vegetables that are rich in bicarbonate,” he says.
so, his research team has partnered with local grocers to deliver bicarbonate-rich fruits and vegetables, like apples, oranges and berries to people’s homes weekly for a whole year. these are rich in potassium, magnesium and calcium that act as bicarbonate equivalents.
“can we treat metabolic acidosis with it and, most importantly, can we reduce the progression of chronic kidney disease by delivering fruit and vegetables to people? so i’d probably say nobody has spent more money on fruit and vegetables in the last couple of years locally in winnipeg than us. we’ve been looking at that as an intervention compared to the sodium bicarbonate tablets and not just in winnipeg, but there was a site for this trial in halifax as well.”
the intervention appeals because telling people to eat a healthy diet can be like telling some people to fly. they don’t have the ability to do it for various reasons, but delivering it to them makes eating better a little easier.
“telling people to change a behaviour, we have years of evidence to suggest that doesn’t work as well,” he notes. dylan is also mindful that people are complex and the notion that everyone needs to do “this one thing” is not going to work out either. in other words, there’s so much work and research still to be done in his field.
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what he loves most about leading research is the human element. “the collaborating, the team, the interaction. i have graduate students and staff that i work with and collaborators that i work with. it’s very much a team sport,” he says. “science and research is the unknown and thinking of questions and trying to answer them. it’s a pretty fun way to spend your time.”
what he comes back to is like a guiding truth, shaped by his type 1 diabetes:
“living with a condition like this really reinforces the fact that you need community and you survive with others. i’m alive because other researchers and dogs and all kinds of people who had family members with type 1 diabetes worked to find a way to keep us alive. it reinforces that humans have survived, and have been able to accomplish what we have, because we work together, we’re communal. i think that was enhanced by my experience of living with type 1. you can’t do this alone.”
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