What used to be a death sentence in the time before insulin, diabetes has become a much more manageable disease, provided the patient is willing to put in the effort and live a healthier life.
For the newly diagnosed, however, testing positive for high blood sugar can be a terrifying event, particularly if they have seen a loved one struggle with the disease.
According to Dr. Kavi Gosal and nurse and diabetes educator Monique Laliberté – both Cree Board of Health and Social Services of James Bay (CBHSSJD) employees who have worked in the communities for a few decades between them – treatment for diabetics has evolved over the years and is now a lot more personalized.
“The big difference between now and 10 years ago is that people wouldn’t come to the clinic back then and ask for the test because they were scared and didn’t want to know. Today they want to find out and this is a big change.
“They know now that the earlier you find out, the better it is because you can do something about it and prevent the complications,” said Laliberté.
When a patient is newly diagnosed, not only does the expert team in each of the communities do their best to find treatment options that work for that patient, the team addresses the patient’s fears so to empower him/her and get him/her on the right track.
This involves not only taking their medication but learning to eat well and exercise. As Laliberté explained, there is no specific diet for diabetics as everyone needs to eat well whether or not they have this disease.
According to Gosal, one of the major changes he is seeing in the North is the profile of who is being diagnosed. Ten to 15 years ago, the profile was of someone in their 40s or 50s or older who was overweight. But in recent years, there are more younger Crees who are afflicted. He and Laliberté are now seeing teens and adults in their early 20s as well as young pregnant women being diagnosed as well as the older generation.
While the rate of diabetes among Crees is significantly higher than that of the rest of Quebec, according to Gosal, the North isn’t the only place where this is a problem.
“It is not just here that we are seeing younger diabetics being diagnosed, but it does happen to be more pronounced here. The same thing, however, is being seen all over the world in places like India, Saudi Arabia and China,” said Gosal.
People around the world are now eating more than ever and eating more junk food than ever. Plus, they are more sedentary than before and this is what has contributed to the weight gain and, as a result, diabetes.
At the same time Gosal recognizes that managing the disease isn’t as simple as telling his patients to lead a balanced lifestyle as it is much easier said than done.
The typical young family in the North will have working parents with young children who have activities after school and then have homework and other chores. The tendency is to cut corners wherever possible and eating convenient foods is a popular choice. Parents often will end up cutting out their own activities and this will often result in a weight gain that leads to diabetes.
“When they leave my office the rest of their lives have not changed. They still have their jobs to go to, they still have to pick up their kids and take them wherever they need to go, so me telling them that they have to do this, that and the other thing doesn’t result in much change,” said Gosal.
Instead, he and Laliberté work on putting the patient at the centre of the diabetes team. So having them meet with a nutritionist, a CHR, a nurse and a doctor, they are the ones who really call the shots. If the patient is not on board, nothing is going to happen.
When it comes to medication to treat diabetes, the approach the CBHSSJD is now using is much different from the model they used 10 years ago when everyone would have automatically been prescribed the same thing.
“Diabetes is a progressive disease. Over time the patient will be able to make less of their own insulin and so that is why you will eventually have to replace it altogether.
“We tell people that making insulin is not bad so if you don’t make enough you should take some. That way your sugar will return to a normal level. It is the high sugar that causes complications and so if you can maintain your sugar at a normal level you are actually at less risk for complications,” said Laliberté.
Besides the typical insulin injections that most people are familiar with, Laliberté explained, there are medications in pill form that are often prescribed.
One of the most popular is Glucosage, a medication that works on the insulin resistance and makes the patient’s own existing insulin work better. This will also not leave the patient in a situation where they have low blood sugar.
There are other types of pills that force the pancreas to make more insulin and then there is insulin. The pills will only work for as long as you have enough insulin in your pancreas.
While some individuals may be afraid of taking insulin for whatever reason, both medical practitioners stressed that it is important to take the medication properly as if you need insulin, even starving yourself for a day won’t bring your sugar down.
“It also makes sense. Once you start the insulin, the patient will regain their energy and often we hear from patients that if they had known how they were going to feel they would have started it earlier,” said Laliberté.
Outside of taking their medication properly, when someone is newly diagnosed, both practitioners recommend that the patient start moving around a bit more as a means of treating their diabetes.
This has become a new focus. Instead of immediately focusing on a patient’s diet, incorporating a bit more exercise is more sustainable as a lifestyle change.
“We try not to focus too much on food because people tend to overdo it, starve themselves and then give up two weeks later.
“We tell them to start moving around a bit more. Maybe once or twice a week they can make the decision to walk instead of drive to work. When you start to exercise more, you tend to want to eat better,” said Laliberté.
The good chemicals the body releases tend to make people feel better and that is like a natural medicine, explained Gosal. This can also help diabetic patients on a whole other level as diabetics are 50% more likely to suffer from depression.
Gosal suggests picking something that you like instead of just going to the gym otherwise you aren’t going to stick with it.
“What we find is that people will start doing this kind of thing and then it will drop off at around week 8-10.
“Twelve weeks seems to be the cut-off. If you are able to continue doing an activity for 12 weeks you tend to be able to keep going as it has now become part of your daily routine. I tell them to pick something that they like and usually the most obvious choice is walking,” explained Gosal.
And, with making these kinds of lifestyle changes, a healthier and happier life is possible.
If you suspect that you may have diabetes or just want to learn more about the disease, contact your local clinic.
