People like me who live with diabetes have a lot to celebrate today. 100 years ago, insulin was discovered and purified by a group of Canadian scientists, including James Collip of the University of Alberta. That discovery converted a death sentence for a diagnosis of diabetes into life imprisonment for living with a chronic illness. Daily fingertip grinding, carbohydrate counting, and planning ahead – a dozen daily decisions to be comfortable in the short term and avoid serious problems like vision loss, kidney failure, amputation, or heart failure in the long run – isn’t fun. But thanks to that breakthrough in 1921 and countless other advances since then, it is possible to live long and healthy lives with diabetes.
Here in Alberta, people with diabetes have a lot of help. The Alberta Diabetes Institute was founded at U of A in 2007 to focus on the prevention, treatment and ultimately cure of diabetes. It is a facility with laboratories for clinical studies, nutrition and exercise research. It’s also a brain trust of more than 50 diabetes researchers, not just in medicine, but also in law, life sciences, pharmacy, kinesiology, and public health.
They are responsible for major breakthroughs – like the famous Edmonton Protocol that set the global standard for islet cell transplants – and also for our understanding of the complex balancing act between diet, exercise, and medication that people like me need every day to treat our diabetes. I feel blessed that all three of my diabetes specialists have been ADI members over the years, which means they could wander down the hall to work together, keep up to date, and translate that into the best possible care.
I’m only one of 25 percent of Albertans who have prediabetes, type 1, type 2, or gestational diabetes. Mine is type 1, an autoimmune disease that destroys the cells that make insulin. It often occurs with younger people – for me I was 17.
Managing diabetes every day is like sitting in a three-legged chair, weighing what to eat, how and when to exercise, and how to adjust medication. If you get any of them wrong, your blood sugar can drop or skyrocket, which can lead to organ and brain damage and even death. ADI researchers help people like me maintain that balance every day.
Helping people eat well
High blood sugar makes you tired, thirsty, and grumpy and can put you in a dangerous state called ketoacidosis. When my blood sugar is too low, I get shaky and have a hard time making decisions, like whether it’s time to take some of the sugar pills I always have with me.
Knowing how to keep my blood sugar normal is based on years of experience and great teaching from my diabetes team, which includes an endocrinologist, nurse and nutritionist. I am lucky because my diabetes is not “brittle”, which means completely unpredictable and impossible to manage. I’ve never had low or high blood sugar that I couldn’t treat myself, and luckily I have never passed out or been hospitalized.
Without realizing it, I tapped the collective knowledge that is constantly being advanced by researchers like those at the Alberta Diabetes Institute, including some who literally wrote the book on Living Good With Diabetes.
People like human nutritionist Catherine Chan, professor in the Faculty of Agricultural, Biological, and Environmental Sciences who until recently was the Scientific Director of the Alberta Health Services Diabetes, Obesity and Nutrition Strategic Clinical Network, which connects research and practice for Albertans. Chan’s own mother was told she had type 2 diabetes about 20 years ago, so she changed her diet and started using a bike. Now in her 90s, Chan’s mom is still treating her diabetes without medication.
Catherine Chan co-wrote the chapter on nutrition in Diabetes Canada’s Clinical Practice Guidelines and is involved in research investigating the possibility of inducing remission in patients with newly diagnosed type 2 diabetes. (Photo: Faculty of Agricultural, Life and Environmental Sciences)
Chan has dedicated her career to helping people choose what to eat and helping them make good choices consistently. She helped write the chapter on nutrition in the Diabetes Canada Clinical Practice Guidelines, some of the best in the world for their scientific rigor. She and her colleague Rhonda Bell are also co-authors of the Pure Prairie Eating Plan, a four-week menu that translates recommended guidelines into practical recipes and shopping lists of foods readily available in Alberta.
“When you’re trying to cope with a chronic illness, sometimes it’s easier to grab a burger as part of the rest of your life,” Chan said. “Without privileges such as a good income and stable jobs, access to healthy food for people with diabetes becomes a matter of health equality.”
Growing evidence shows that a combination of weight loss achieved through diet and exercise plus early medication could even induce remission in some people with newly diagnosed type 2 diabetes. Chan is involved in a number of research projects to test this theory.
“Healing is too strong a word, but it would reduce human suffering and the burden on the health system many times over,” said Chan.
Optimizing physical activity
Here is an example of the type of day-to-day decision-making associated with diabetes. Last Saturday morning I went on a four hour bike ride. In anticipation of the workout, I cut my breakfast insulin by a third, but it took us longer to organize than I expected and by the time we were ready to roll my blood sugar levels skyrocketed. Feeling lousy, I took some extra insulin to correct it and went on my way. After an hour of cycling, I tested again and my blood sugar was back to normal. After another hour of driving, my blood sugar levels dropped … luckily we were stopping at an ice cream parlor so I had a scoop. When we finished our ride, my blood sugar was exactly in the sweet zone. Done!
Balancing exercise is the specialty of another ADI member to whom I owe the organization of my care: Normand Boulé, professor and deputy dean of the faculty for kinesiology, sport and recreation, who works with a team of exercise physiologists in the ADIs diabetes laboratory for physical activity.
Normand Boulé works with a team of exercise physiologists at the Alberta Diabetes Institute’s Diabetes Physical Activity Laboratory to find out how people with diabetes can get the most benefit from physical activity. (Photo: Faculty of Kinesiology, Sports and Leisure)
Boulé is part of the group behind the physical activity recommendations in the Diabetes Canada Clinical Practice Guidelines (which incorporate the work of the U of A), which show how a variety of activities such as weight training, swimming, and just getting up from your desk once an hour can be Reinforce the benefits of once-recommended moderate aerobic exercise.
“We’re no longer trying to figure out whether exercise is good for people with diabetes because we know there are benefits,” said Boulé. “Now we are trying to optimize the training interventions to make them more effective.”
“It’s good to have options,” he noted, pointing out that people with diabetes are prescribed exercise not only for weight control, but also because of the immediate psychological (hello, endorphins!).
In a recent study, Boulé looked at whether exercising before breakfast is better for people with type 2 diabetes who experience a morning spike in their blood sugar than later in the day.
Boulé and other ADI members are also working with researchers in Montreal and the UK to further study how diet and exercise can be combined to maintain remission in type 2 diabetics.
“We hope that with the additional movement we do not have to tighten food restrictions so much, which makes the intervention more effective and sustainable,” said Boulé.
Recognize obstacles to care
And then there are these long-term complications that I keep mentioning. My personal worst nightmare is losing my eyesight. For Padma Kaul it is heart problems. The A University epidemiologist and professor in the Faculty of Medicine and Dentistry is involved in several large studies to investigate the effects of diabetes on heart health in Canadians.
Padma Kaul is involved in major studies examining how diabetes affects heart health in Canadians, including a 10-year project to track diabetes screening, development and treatment in Albertans ages 50 to 80. (Photo: Faculty of Medicine and Dentistry)
The Canadian Institutes of Health Research funded their project to bring together data from Denmark and Alberta to study the effects of pregnancy factors, including diabetes during pregnancy known as gestational diabetes, on maternal cardiovascular health over the long term. A second study watches Albertaner ages 50 to 80 over a 10 year period to see how often they are screened for diabetes, how many develop diabetes, how many medications are prescribed, and the impact their blood sugar levels have on their future heart health Has. Kaul is also studying what prescription drugs women take during pregnancy, including diabetes drugs, and how these affect the health of mothers and their babies.
“My job is to point out problems and try to understand the barriers patients face,” said Kaul, who studies health trends at the population level. She is also a co-director of the Canadian VIGOR Center, the Heart & Stroke Chair in Cardiovascular Research, and the Canadian Institutes of Health Research Chair in Sex and Gender Differences in Diabetes.
Before all of the results are in, you can be sure that she will share her knowledge and best advice with her colleagues at the Alberta Diabetes Institute, that critical mass of basic scientists, clinical researchers, population health experts, and social scientists all out on the search – and pass it on – the best care for patients like me.
“Albertans should be sure that there is a whole community of researchers working for them here to try to fill some of the knowledge gaps and improve their health outcomes,” said Kaul.
It’s worth celebrating for me.
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