February 25, 2021

What is diabetes?

Written by Dr. Meshari F. Alwashmi and Gerald Mugford, CMH, BSc,PhD

Dr. Meshari F. Alwashmi is a clinical epidemiologist with demonstrated success across the digital health sector. He has spent more than a decade introducing new technologies to traditional medical practice while bringing a heavy patient focus to his process. Meshari is the Chief Scientific Officer at BreatheSuite. He also works as a mentor and advisor for several digital health initiatives nationally and internationally. Meshari is a guest editor at the international International Journal of Environmental Research and Public Health and has published and peer-reviewed articles in the Canadian Agency for Drugs and Technologies in Health, the journal of medical internet research, and Sage – Digital Health. Meshari participated as a guest speaker in several events and conferences to share his thoughts about digital health, including hacking health, MIT health hack, Harvard Arab conference, and the Canadian Agency for Drugs and Technologies. 

Gerald Mugford, CMH, BSc,PhD is an Associate Professor in the Faculty of Medicine, Memorial University of Newfoundland. He is a Clinical Epidemiologist, Psychotherapist and Medical and Analytical Hypnotherapist. He actively mentors a cohort of MSc, PhD and Post Doctoral students. He is a core team member and Newfoundland and Labrador  Principal Investigator of the Canadian Longitudinal Study on Aging (CLSA), a prospective national stratified sample of 51,388 men and women between 45 to 85 years old  to be studied until 2033.  His current research main focus is aging, but has published and presented on diabetes, bone density, HIV, HCV, HPV and psychological dysfunction. He haspresented his researchresults locally, nationally and internationally. He is passionate about Clinical Epidemiology, collecting art and using power tools.

Epidemiology is a branch of medicine that focuses on how diseases affect the health of populations. Clinical epidemiologists are not only interested in what causes disease, but also what can we do to cure or slow its progression. Treatment can take the form of procedures, drugs, surgeries, psychotherapy, or other interventions. Ideally, clinical epidemiologists look for prevention strategies or strategies that can reverse the disease. Type 2 diabetes is one chronic condition that can be treated in many ways and in some cases is reversible with exercise and a healthy diet. Recently, there has been a rise in the use of technologies, especially smartphones, to identify the risk factors for diabetes and suggest better treatment and management methods.  

Diabetes affects how the pancreas produces insulin, which is a substance that regulates the amount of glucose (sugar) in the blood. Insulin is also important for obtaining energy from food. People with diabetes experience elevated blood sugar levels. Without treatment, excess sugar in the blood leads to illness. Currently, 11 million Canadians live with diabetes or pre-diabetes. There is a high chance that you, or someone you know, is affected by diabetes. 

There are two major types of diabetes: type 1 and type 2. Each causes high blood sugar levels but in different ways. Type 2 is far more common. 

People with type 1 diabetes don’t produce their own insulin for regulating their blood sugar.  No one definitively knows what causes type 1 diabetes and, at this point in time, it can’t be prevented. Roughly one out of 10 people living with diabetes have type 1. Individuals can develop type 1 diabetes at any age, but It generally manifests in childhood or adolescence. People with type 1 diabetes need to inject insulin or use an insulin pump to ensure their bodies have the right amount. It is also important that they manage their diet and exercise to help keep blood sugar levels within a normal range. 

People with type 2 diabetes either can’t properly use the insulin made by their bodies, or aren’t able to produce enough of it. Roughly nine out of 10 people living with diabetes have type 2. It most commonly develops in adulthood, but children can also develop it. Type 2 diabetes can be managed with healthy eating and physical activity; but may also require insulin therapy. 

There is also a condition called pre-diabetes. People with pre-diabetes have high blood sugar but the level isn’t high enough to warrant a type 2 diagnosis. Many people with pre-diabetes go on to develop type 2 diabetes, especially if they don’t eat well and exercise enough.

The Government of Canada offers a Canadian diabetes risk questionnaire to help you to decide if you are at higher risk of being pre-diabetic or having type 2 diabetes. It can be accessed at: https://www.healthycanadians.gc.ca/en/canrisk  or https://www.healthycanadians.gc.ca/fr/. Knowing your risk can help you to make healthy choices now that will reduce your risk, or even prevent you from developing diabetes. 

It is important to follow precautionary steps. These include staying active, maintaining a moderate weight, and limiting foods that are high in sugar. Canada’s food guide offers an eating plan to help Canadians make healthy food choices. It can be accessed at: https://food-guide.canada.ca/en or https://guide-alimentaire.canada.ca/fr/

It can also be beneficial to speak with a diabetes educator or dietitian to help develop a healthy eating plan. In terms of staying active, many professionals agree that at least 150 minutes of moderate- to vigorous-intensity aerobic exercise each week, (e.g. 30 minutes, five days a week) is an effective way to prevent or manage your diabetes. Using a smartwatch allows you to keep track of your physical activity. And weighing yourself weekly is a good way to monitor your weight. So-called “smart scales” — such as fitbit, Withings, or QardioBase — offer a simple means for tracking your weight. The authors would like to caution that some professionals do not recommend frequent weighing as they believe it may contribute to poor body image and make concerns with self-perception worse. 

Some Tips for people with diabetes.

(The authors realize not all of these suggestions are easy to do.)

Following the steps below may help individuals eat healthily and manage their blood glucose levels:

  • Log your food using a diary or an app like myfitnesspal. This will help you monitor carbohydrate intake and blood sugar levels
  • Check blood sugar first thing in the morning and two hours after at least one meal a day
  • Spread food intake across three meals a day, with two or three snacks
  • Eat a variety of foods
  • Only drink one cup of milk at a time to avoid blood sugar spikes
  • Avoid pre-made fruit juices that contain added sugar
  • Eat fruit-based desserts instead of candy 
  • Keep sodium and salt intake to a minimum
  • Check the total carbohydrate content of foods
  • Minimize artificial sweeteners
  • Take care with serving sizes, for example, by using a smaller plate
  • Recently, many people started using digital Diabetes prevention programs (DPP)s. These programs use a smartphone app, a wearable tracking device (eg, fitbit or apple watch), digital scale, and a professional health coach. It has been demonstrated that digital DPPs can prevent type 2 diabetes. The following figure highlights the components of a digital DPP. 
DPP components: a smartphone app with an interactive curriculum, digital tracking and communication tools, a wireless scale, a professional health coach, a private peer community, and an activity tracker.

Diabetes rates are rising, bringing new health and economic challenges. People who learn to successfully control their diabetes can live full and healthy lives. In summary, there are many things you can do to manage or prevent diabetes. With effort, you can control or even cure your type 2 diabetes. The authors wish you great success on your prevention and cure journeys. 

By way explanation, the authors did not intend this to be a scholarly article. Our goal is to introduce user friendly diabetes information that may benefit children, adolescents, their family and their teachers. For more information, the authors strongly recommend for Diabetes Canada website (https://www.diabetes.ca/), https://kidshealth.org/en/kids/type1.htmland the article Panagiotopoulos, C., Hadjiyannakis, S., & Henderson, M. (2018). Type 2 diabetes in children and adolescents. Canadian journal of diabetes42, S247-S254.

Thank you for your time.

Meshari and Gerald