Are you at risk?
Risk factors for diabetes:
- Family history of diabetes
- A personal history of diabetes in pregnancy, polycystic ovary syndrome or metabolic syndrome
- Aboriginal, Hispanic, South Asian, East Asian or African descent
- High Blood Pressure, High Cholesterol
- Over 40 years of age
If you think you might be at risk, ask your doctor or take the Canadian Diabetes Risk Questionnaire (CANRISK)
When to test for diabetes (CDA guidelines)
Screen every 3 years in individuals over 40 years of age or at high risk using a risk calculator (e.g. CANRISK)
How do you screen for diabetes?
- Hemoglobin a1cover 6.5%
- Fasting glucoseover 7.0 mmol/L
- 75 gm 2 hour glucose tolerance testwith a fasting glucose over 7.0 mmol/L or
2hr glucose over 11.1 mmol/L
Know your numbers – What everyone with diabetes needs to know about their lab tests
- Hemoglobin a1c:reflects your average glucose level over the past 2 to 3 months; does not require fasting; not equivalent to glucose levels in mmol/L; Goal: less than 7.0% which generally corresponds to blood sugars under 7.0 mmol/L before breakfast, lunch & dinner AND under 10.0 mmol/L 2 hours after meals.
- LDL cholesterol: the “bad” cholesterol correlated with plaque clogging arteries;
Goal: under 2.0 mmol/L
- HDL cholesterol:the “good” cholesterol; reduces plaque in arteries; raised by eating fish and exercising; Goal: over 0.9 mmol/L for men and over 1.1 mmol/L for women
- Total cholesterol/HDL ratio:a measure cardiovascular risk; Goal: less than 4.0 mmol/L
- Microalbumin:a test for small amounts of protein in the urine; associated with potential early kidney disease; Goal: ACR under 2.0
- Blood pressure:a separate risk factor for vascular disease; Goal: under 130/80
- Estimated GFR:a blood test ordered as “creatinine”; a measure of kidney function; Normal: over 60
What physical examinations are important for people with diabetes?
- Complete Physical Examination
At least every 2 years to detect early complications
- Foot Examination by a Physician
Every year to check for damage to nerve sensation or circulation
Check your own feet every day for sores, injuries or infections.
- Eye Examination by an Optometrist or Ophthalmologist
Every 1 to 2 years to assess the retinal blood vessels
What and how to eat for diabetes
- Don’t skip breakfast or eat one big meal at night!Frequent, smaller meals keep glucose levels more even.
- Healthy portion sizes.
Half the plate:Vegetables
¼ plate:starches (rice, potatoes, pasta)
¼ plate:lean meat, beans and other protein sources
One portion of fruit:e.g. one apple, ½ cup of berries
Avoid sugar-containing drinks
- Attend to the Glycemic Index (GI) a measure of the ability of a food to raise your blood sugar. Consume foods with a low GI in preference to those with a high GI
The GLYCEMIC INDEX (GI)
Low GI Foods to choose most often:
100% stone ground whole wheat
All Bran, Bran Buds
parbroiled or converted rice
sweet potato, yam, legumes
Medium GI Foods to choose more often:
whole wheat, rye, pita bread
couscous, brown & basmati rice
popcorn, green pea soup
High GI Foods to choose less often:
white bread, kaiser roll, white bagel
bran flakes, corn flakes
pretzels, french fries
soda crackers, rice cakes
(Source: The Canadian Diabetes Association)
For more information read Rick Gallop’s book, The GI Dietor see the Canadian Diabetes Association’s website http://www.diabetes.ca/diabetes-and-you/healthy-living-resources/diet-nutrition/the-glycemic-index
The importance of PHYSICAL ACTIVITY
Some physical activity (such as walking or housework) after each meal will reduce after meal blood sugars
Guideline recommendation: 150 minutes of exercise/week or 30 minutes/day.
The Four Foundations of Self-Care
- What you eat(What you put into your body).
- What you do(physical activity and rest).
- How you feel(emotional wellbeing).
- How you connect(healthy relationships).
Keys to Achieving Your Goals
- Choose wisely.A goal that matters to you.
- Visualize yourself having achieve your goal.Reprogram your subconscious and prime the pump for success.
- Break it down from supersized to manageable morsels.You’ll gain confidence with early successes.
- Write down the details
- Anticipate and prepare for roadblocks.
- Enlist support. Choose a coach or a teammate – your partner, friend or neighbour. Consult your family doctor.
Create the SMARTEST Goals for Yourself
Be Specific.What are you going to do? Eat more fruit and vegetables? Where and by when?
Measurable.How many fresh fruit/day? One salad every day? Two glasses of skim milk each day?
Achievable.Set realistic goals that are do-able.
Relevant.The goal has to be important to you and your health.
Time-specific.What day will you start, and when will you finish?
Evaluate.How did you do? What did you learn?
Stepping Forward. What will you do next? What will you do differently?
Together.Who will work with you next? Who will you share with?
Your Positive Potential
I believe that we each have a unique potential in life, and it is our duty to realize that potential and help others achieve theirs.
With knowledge, engagement and support, we can manage chronic health conditions and lives well.
Dr. Davidicus Wong is a physician in Vancouver, British Columbia, Canada.