Diabetes is classified as either Type 1, which affects younger people and seems to involve the immune system, or Type 2, which may affect older individuals. In Type 2 diabetes, the pancreas does not respond appropriately when secreting insulin, and various factors may be involved ranging from genetics to lifestyle.

At one time, Type 2 diabetes was viewed as a disease of older people, but today younger and younger people are being diagnosed with it.

Blood glucose monitoring is important in the effective management of both Types 1 and 2. If we can measure glucose in the blood, it gives us the power to adjust insulin doses or change food intake for the best health results. As well, the effects of medications can be monitored, and even high or low blood glucose can be detected.

At one time, diabetes monitoring was done with urine tests, and while still available, these are less sensitive. With blood glucose tests, an actual amount of glucose can be determined. In Canada, the units are millimoles per litre, specifically four to seven when fasting or before meals and five to 10, two hours after eating.

In the U.S., the units are milligrams per decilitre which means the numbers are in the 100s, which may be confusing to people watching American television. Everyone with diabetes will have their own individual targets and monitoring can help them achieve these targets. 

Diabetes Canada recommends people with diabetes monitor their blood glucose levels with self-monitoring devices. A drop of blood is placed on a testing strip, and when this is inserted into the monitor and read, it gives a reading of blood glucose levels.

These monitors were developed in the mid-1970s and over time the technology has improved with faster, more accurate readings requiring less blood. The frequency of self-monitoring is usually individualized with those with a greater risk of low levels or having acute illnesses usually needing testing more often.

The most recent developments in blood glucose testing are monitors that do not require “finger pricks.” These monitors are either flash glucose monitors or continuous glucose monitors. Both require a sensor to be worn, usually for several weeks, which acts to monitor glucose levels.

With “flash monitors,” when the sensor is “flashed” with a reader, the glucose level is read. With continuous glucose monitors, glucose readings are reported usually every five minutes to a phone app where they can be viewed. Continuous glucose monitoring provides trends as well as warnings about high or low levels of glucose. More accuracy and patient involvement with their diabetes are the advantages of these.

The other type of blood glucose test is A1C or glycated hemoglobin. Since glucose attaches itself to hemoglobin or red blood cells, a laboratory blood test will show blood glucose levels. Hemoglobin has a life span of about 90 days, thus an A1C test will provide a picture of blood glucose over the last three months. This test is done in a laboratory, and no self-monitoring tests are available — yet! The test results are expressed as a percentage with 4.0 to 5.6 per cent being healthy, 5.7 to 6.4 per cent being prediabetes, and anything higher diabetes diagnosis.

Regardless of what type of blood glucose monitor is used, the key is using it as often as recommended and recording the readings. Empowerment in treating diabetes, and better health, are sure to follow. 

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The class is the SGLT-2 inhibitors, that is Sodium GLucose coTransporter-2 inhibitors. They act by inhibiting this transport protein in order to prevent glucose re-absorption by the kidney.

The result is that more glucose is excreted through the kidney, lowering blood glucose levels, which is the aim of drug treatment for diabetes.

SGLT-2 inhibitor drugs include canagliflozin, dapagliflozin and empagliflozin.

These drugs improve outcomes in heart failure, also known as HF. Just as the term indicates, heart failure happens when the heart muscle doesn’t pump as it should. Narrowing coronary blood vessels or high blood pressure may account for the failure.

The left ventricle that pumps oxygenated blood to all parts of the body, and the “ejection fraction” is the measure of the amount of blood pumped with each of its contractions.

The ventricle can become enlarged and unable to pump efficiently, which is termed reduced ejection fraction or HFrEF.

Another type of heart failure occurs with preserved ejection fraction or HFpEF and is the result of the left ventricle becoming thicker and stiffer.

In several studies, researchers added a SGLT-2 inhibitor to the medication regimes of people with and without diabetes. In both groups the addition of the drug helped prevent hospitalizations and cardiovascular death about three to seven per cent of the time. It is thought that besides lowering blood glucose, these drugs contribute to lower blood pressures, to reduced blood vessel stiffness, and even to diuretic effects.

SGLT-2 inhibitors have these effects in HFrEF, which accounts for about half of all cases of heart failure.

When kidney disease is considered, these drugs can also be beneficial. They protect the nephrons which are the functional units of the kidneys.

Studies show that by adding a SGLT-2 inhibitor to a medication regime, progression of kidney disease can be slowed for people with or without diabetes.

Unfortunately, because the SGLT-2 inhibitors rely on the kidneys to excrete excess glucose, the beneficial effects are lost when kidney functioning becomes low, and these drugs are not recommended. Ideally, they are used earlier in kidney disease and can be of benefit regardless of whether there is a diagnosis of diabetes or not.

For people with diabetes, specifically type 2 diabetes, SGLT-2 inhibitors are an ideal add-on to treatment, along with dosage adjustments for other diabetes medications. It is estimated that under 50 per cent of people with diabetes adhere to their medication regime and lifestyle recommendations, thus remembering to take medications including the SGLT-2 inhibitors is key.

Currently, these medications may not be used widely except in cases of diabetes. However, this may change in the future.

In the meantime, individuals with or without diabetes need to maximize both medication regimes and lifestyle activities in order to stay as healthy as possible.

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Most people can continue to eat red and processed meat at current average intake, typically three or four times a week for adults in North America and Europe, said a study’s authors, who also made new recommendations based on the analysis.

“Based on the research, we cannot say with any certainty that eating red or processed meat causes cancer, diabetes or heart disease,” said Bradley Johnston, an associate professor at Halifax’s Dalhousie University, who co-led the review published on Monday in the Annals of Internal Medicine journal.

However, in what amounts to a scientific food fight, a group of doctors from Harvard, Yale, Stanford and elsewhere, including one of the study authors, requested in a letter to the journal that it “pre-emptively retract publication” of the papers pending further review, and said revised guidelines that could lead to increased consumption of red and processed meats would be irresponsible.

A statement scheduled for publication by the Harvard T.H. Chan School of Public Health, shared with Reuters by Dr. Frank Hu, chair of the Department of Nutrition, said, “from a public health point of view, it is irresponsible and unethical to issue dietary guidelines that are tantamount to promoting meat consumption, even if there is still some uncertainty about the strength of the evidence.”

Dr. David Katz, director of the Yale-Griffin Prevention Research Center at the Yale University School of Medicine, cited “grave concerns about the potential for damage to public understanding, and public health.”

The World Health Organization’s International Agency for Research on Cancer (IARC) and the World Cancer Research Fund (WCRF) both say red and processed meat may or can cause cancer.

The WCRF advises eating only “moderate amounts” of red meat, such as beef, pork and lamb — with an upper limit of 500 grams cooked weight per week — and “little, if any” processed meat.

A panel of experts writing in The Lancet in January outlined an “ideal diet” for human health and the planet that said global average red meat consumption should be cut by 50 per cent and consumption of nuts, fruits, vegetables and legumes should double.

For the latest analysis, researchers from Canada, Spain and Poland conducted a series of reviews of both randomized controlled trials and observational studies looking at the possible health impact of eating red and processed meat.

Among the randomized trials they selected for analysis, which included around 54,000 people, they found no statistically significant link between eating meat and the risk of heart disease, diabetes, or cancer.

Among the observational studies, which covered millions of people, they did find “a very small reduction in risk” in those who ate three fewer servings of red or processed meat a week, but said that this association “was very uncertain.”

‘Best approach’

“Our bottom line recommendation … is that for the majority of people, but not everyone, continuing their red and processed meat consumption is the best approach,” Johnston said.

Some experts not directly involved with the reviews said the work was a comprehensive, well-conducted analysis of the available evidence on eating meat and human health.

“This study will, I hope, help to eliminate the incorrect impression… that some meat products are as carcinogenic as cigarette smoke, and to discourage dramatic media headlines claiming that ‘bacon is killing us’,” said Ian Johnson, a nutrition expert at Britain’s Quadram Institute of bioscience.

Christine Laine, editor in chief of Annals of Internal Medicine, noted that nutrition studies are challenging as they are usually not randomized controlled trials and often depend on participants’ memories.

“There may be lots of reasons to decrease meat in your diet, but if you’re decreasing it to improve your health, we don’t have a lot of strong evidence to support that,” Laine said. “To be honest with our patients and the public, we shouldn’t be making recommendations that sound like they’re based on solid evidence.”

Quadram’s Johnson said people who choose to cut down their meat intake might still improve their health by doing so. “There are (also) strong environmental and ethical arguments for reducing meat consumption in the modern world.”

Eating more plant-based foods can help to reduce emissions of carbon dioxide, scientists say.

— Kate Kelland is a Reuters health and science correspondent in London; additional reporting by Linda Carroll in Mannington, N.J.

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Unfortunately, it is estimated that about half of Canadians do not get enough fibre.

Fibre has health benefits, and if you watch advertisements for fibre, it seems to be touted as a cure for everything. However, researchers have shown that good fibre intake actually does have the potential to lower cholesterol and to improve heart health, as well as to help you control diabetes, lose weight, and improve your bowel functioning.

Some studies have even shown that good fibre intake is related to reduced rates of some types of cancer, most notably colorectal cancer.

Fibre is the part of plants that your body cannot digest and therefore does not absorb. It is found mainly in fruits, vegetables, whole grains, and legumes. There are two types of fibre, insoluble and soluble, which are defined by their ability to dissolve or not dissolve in water.

Insoluble fibre, such as bran, is the type that promotes the movement of material through the bowel and increases the stool bulk.

Soluble fibre dissolves in water to form a gel-like substance. This type of fibre slows the passage of food through the digestive system and is known to lower cholesterol and glucose levels. Gums such as oatmeal and fruit pectins are examples.

Often food sources contain both insoluble and soluble fibre.

If you want to increase the amount of fibre in your diet, start slowly by adding an extra serving of high-fibre food every second or third day.

Adding too much fibre too fast will result in adverse effects like bloating, abdominal pain, gas, constipation, or even diarrhea.

Also don’t forget to drink enough fluids to ensure the fibre doesn’t get “stuck” in your bowel. Some fibre supplements actually need to be added to water before taking.

Processing food removes much of the fibre. For example, an apple has more fibre than does applesauce, which in turn has more fibre than apple juice. Cooking can also reduce the fibre content, so cooked carrots contain much less fibre than do raw carrot sticks.

Whenever possible, don’t peel fruits and vegetables like apples, pears, peaches or potatoes because their skin has extra fibre.

Even then, in order to be sure you have enough fibre in your diet, you will need to read food labels. To see how much fibre you are consuming, keep track for a couple of weeks. And, if you need more fibre, try sprinkling high-fibre ingredients like bran or oatmeal on top of cookies, cakes or muffins before baking.

They will not only have added fibre, but have a crunchy texture. Choose brown rice, kidney beans, chick peas, and lentils when making casseroles, soups, or salads. For snacking, choose high-fibre foods like popcorn or nuts.

If you need a fibre supplement follow the instructions carefully. Some products need to be mixed with water. Others can be added directly to your morning cereal or even cookie or cake batters.

The adage an apple a day keeps the doctor away is certainly true when it comes to fibre, but don’t forget other fruits, vegetables, and grains too!

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Diabetes occurs when your pancreas doesn’t manufacture enough insulin or none at all.

In your body, insulin is used to metabolize sugars or glucose. Without insulin, therefore, your blood glucose rises, which means the circulating glucose causes damage, most notably to your large and small blood vessels.

Ideally, you want to replace the insulin and/or increase the effectiveness of any insulin your pancreas is able to produce. Obviously, insulin injections do just that.

The variety of insulins today ranges from short-acting to long-acting, and they are used to mimic as closely as possible your body’s natural production of insulin.

At one time insulin was saved for when your pancreas did not produce any insulin, but now insulin is used in combination with oral tablets and much earlier, even when your pancreas is still producing some insulin.

Oral diabetes medications are most commonly given in combination, with two or more different types of drugs used to enhance the effectiveness of overall treatment.

Metformin is given with food. It enhances the effects of insulin, but it can cause stomach upset. Sulfonylureas (i.e. SUs), for example gliclazide, glyburide, act in the pancreas to stimulate insulin production. The risk of hypoglycemia or too-low blood glucose is high with the SUs, and is often the reason for stopping them.

Metformin and SUs are often the first drugs used to treat diabetes, and they have been available for the longest.

To understand some of the other drugs, you need to know about incretins. These are substances in the body that stimulate the pancreas to release insulin. You want to have more incretins and that is what both dipeptidyl peptidase-4 or DPP-4 inhibitors and glucagon like peptide-1 or GLP-1 receptors agonists do.

The DPP-4 agents like linagliptin, sitagliptin, and saxagliptin inhibit enzymes that break down incretins; the GLP-1 agents like dulaglutide, exenatide, and liraglitide activate incretin pathways. One drawback with the GLP-1 agents is that they are injectable.

The sodium glucose-linked transporter 2 or SGLT2 drugs enhance your body’s ability to excrete excess glucose in the urine, for example canagliflozin, dapagliflozin, and empagliflozin. Unfortunately, with extra glucose being excreted in your urine, you increase your risk for urinary and vaginal infections. Often, these drugs are prescribed along with treatments for yeast infection, just in case!

There are several other glucose-lowering drugs. Alpha glucosidase inhibitors like acarbose stop enzymes that break down complex carbohydrates into simpler glucose molecules which means glucose doesn’t get absorbed to raise blood glucose. Pioglitazone is a thiazolidinedione or TZD which enhances insulin sensitivity, but has potential cardiovascular effects. Repaglinide is a meglitinide whose action is similar to SUs, but less effective.

If you have diabetes, you may take a combination of these various agents, but remember that lifestyle changes are important no matter what drugs you may take. You want to eat healthy, lose weight, exercise, reduce alcohol consumption, and quit smoking.

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In 2010, it was estimated that 2.7 million Canadians were living with a diagnosis of diabetes, and that over the next 10 years this number would almost double.

Unfortunately too, about one million Canadians have diabetes but do not know it and have not been diagnosed.

The pancreas produces insulin, which is the hormone in the body responsible for carbohydrate metabolism. With diabetes, your pancreas either doesn’t produce enough or any insulin or, alternatively, your insulin doesn’t work as well as it should.

At one time, there was no cure for diabetes, but in the early 1920s Banting and Best worked with dogs and discovered that insulin recovered from healthy pancreases could be injected into animals with diabetes and the disease could be controlled.

This research lead to the use in people of insulins derived from pigs and cattle sources. Diabetes was no longer a death sentence.

Insulin must be injected. It cannot be taken orally because the digestive process destroys the molecule. However, today science has developed a wide variety of insulin pens, needles, and delivery devices including pumps that make insulin injections comfortable.

Today, insulins are also synthetically manufactured in large facilities and are very similar to the insulin that would naturally occur in your body.

Currently, insulin is commonly used along with oral drugs in the treatment of diabetes even when your body has its own supply of insulin. Used earlier and in combination with other drugs, this translates into better control of diabetes.

There are lots of insulin choices. Rapid-acting analogues include aspart, glulisine, and lispro and are intended to be used after eating when your body needs to metabolize carbohydrates. Short-acting or regular insulins are also intended to be used after eating. Intermediate-acting insulins, such as NPH, are designed to be injected less frequently throughout the day, and long-acting basal analogs, for example detemir and glargine, have the advantage of needing only one daily dosing.

There are also pre-mixed insulins which combine shorter- and longer-acting insulins. The idea is that your insulin use should mimic what your pancreas would normally be doing.

Keeping a blood glucose log will keep you up-to-date with how your body is managing and it may enable you to make insulin dosing adjustments. Too low a blood glucose (i.e. hypoglycemia) is the notable adverse effect of insulin. You don’t feel well, and you may be nervous, anxious, shaky, irritable, confused, lightheaded, clammy, sweaty, and chilly.

Boosting your blood glucose is the treatment, and 15 millilitres sugar (about three packets), 3/4 cup of fruit juice or soft drink, or even 15 millilitres of honey is recommended to reverse hypoglycemia.

One other group of diabetes drugs also needs to be injected, again because digestion will destroy it. These are the GLP-1 or glucagon-like peptide-1 receptor agonists which stimulate insulin production in the pancreas and reduce your liver’s ability to produce extra glucose.

Exenatide and liraglutide are the two products available in Canada, with the former requiring twice-daily injections and the latter once-daily ones. They can initially cause nausea which may diminish with time, but they can also reduce your appetite and result in some weight loss.

Good management of diabetes is possible with a combination of oral drugs, but can include injectable ones like insulin and the GLP-1 receptor agonists. You may need to try several regimes, but you are sure to find one that works for you.

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Should you buy them?

Vitamins are organic substances from plants or animals that your body needs in small amounts. Minerals are needed in small amounts too, but come from inorganic sources.

Luckily, an average diet usually contains sufficient vitamins and minerals.

“Natural products” are simply substances obtained from organic sources. Their variety is wide, including bee pollen, soy-based products and flaxseeds, as well as herbal remedies that usually originate from plant material.

While defining supplements can be confusing, however, it is clear that they are popular. About two-thirds of Canadians use them, with about 30 per cent taking multiple vitamin products.

Keep in mind that these numbers do not include the therapeutic use of supplements, such as the use of calcium for a diagnosis of osteoporosis, or iron for a diagnosis of anemia.

In Canada, supplements are regulated by the Canada Natural and Non Prescription Health Products Act of 2004. The aim of the legislation is to ensure that supplements are safe to use, that they are manufactured in a clean and safe manner, and that they contain the ingredients that they are supposed to contain.

If you have a problem with a supplement, there are provisions for you to be able to report adverse reactions, as well as provisions for the manufacturer to recall a defective batch of product.

Before you take a supplement, check your diet. Keep a food diary for several weeks and read your food labels. This may reveal that you are already obtaining the nutrients you need.

If you do take a supplement, find out exactly what it is supposed to do for your health and what dose is needed to produce the benefit. For example, almond milk is a good source of calcium, but unless it is fortified, it does not contain as much calcium as milk. Obviously, then, you would choose the fortified almond milk!

Keep in mind that supplements are just that; they “supplement” your other healthy-living choices and any medications you may take.

So, for example, if you have high cholesterol, you wouldn’t stop eating a low-fat, high-fibre diet or taking your cholesterol-lowering medication when you start a fish oil supplement.

It is also important that you tell your doctor, nurse, and pharmacist about any supplements that you may take. They will help you identify potential side-effects and drug interactions, and even whether the product is safe for you.

Because many supplements are plant based, allergies are a potential risk. These allergies can sometimes be severe, especially if you have a pre-existing allergy like hay fever.

A recent article in Consumer Reports listed 15 supplements that its panel of experts say should always be avoided: aconite, caffeine powder, chaparral, coltsfoot, comfrey, germander, greater celandine, green tea extract powder, kava, lobelia, methylsynephrine, pennyroyal oil, red yeast rice, usnic acid, and yohimbe.

It’s a good idea to check supplement labels for these ingredients because adverse effects and toxicities can be significant.

Some supplements are widely advertised, but if the claims seem too good to be true, they probably are.

Knowledge is key when it comes to supplement use, but the information needs to be of good quality. A discussion from the Heart and Stroke Foundation about the cardiovascular effects of fish oils is certainly of better calibre than a website that is trying to sell you a fish oil supplement.

Supplements may be part of your overall health plan, but be smart about using them.

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