By Jane Yardley
November is Diabetes Awareness month, a time of year where we recognize the staggering number of individuals affected by diabetes in Canada and worldwide. In Canada alone, there were over 3 million people with diagnosed diabetes in 2015. Approximately 90 to 95% of these people will have type 2 diabetes, a condition that is managed initially with diet and exercise, and ultimately with medication. The remaining 5 to 10% will have type 1 diabetes, for which there is no prevention, there is no cure, and survival requires a careful balance of food intake and insulin dosage.
Canada has one of the highest rates of type 1 diabetes in the world, yet the public is not as aware of the disease as they are with cancer or cardiovascular disease. Type 1 diabetes develops when the immune system attacks and destroys the insulin-producing cells of the pancreas. Insulin acts as the key that unlocks cells in the muscles, fatty tissues and liver to allow glucose (the most common form of sugar in the body) to be taken in for storage, or burned for energy. Without insulin, glucose builds up in the blood, and the body’s tissues slowly starve. Upon diagnosis, people with type 1 diabetes are relegated to a life of counting carbohydrates (and considering carbohydrate quality) at every meal, and taking insulin (either with a needle or with an insulin pump where a small tube sits under the skin) multiple times per day when blood glucose levels creep up.
They also live with the constant fear that their glucose levels will drop too low. This phenomenon, termed hypoglycemia, can have immediate and serious consequences, with signs and symptoms ranging from dizziness, irritability, and slurred speech, to loss of consciousness, coma, and death. Fear of these lows often leads to being overcautious with insulin. Unfortunately, insufficient insulin leads to hyperglycemia (high blood glucose) where the short-term consequences include ketoacidosis (also potentially fatal), and the long-term consequences include kidney failure, heart disease, and blindness. The constant struggle of trying to maintain this balance can cause a great deal of distress, resulting in disproportionately high rates of anxiety and depression in these individuals.
An awareness of the struggles of patients dealing with this “invisible disease” has become more prevalent in recent years, but we often overlook the toll that this condition can take on the people who love and support those with type 1 diabetes. Friends and family members of people with diabetes also report having very high levels of diabetes-related distress. In some ways, they are the “invisible sufferers” of the disease.
Consider, for a moment, the anxiety experienced by parents of a child with type 1 diabetes worrying that their son or daughter’s blood glucose might drop dangerously low overnight and that they might not wake up in the morning. Watching their child playing sports will always be associated with the fear that they will go low during practices and games, due to the glucose-lowering effects of physical activity. Alternatively, imagine being the spouse of someone with type 1 diabetes, and trying to understand that the slurred speech and erratic behaviour of your partner is coming from hypoglycemia, and not anger or alcohol. As a child, wouldn’t you worry and wonder why your sibling had so many trips to the doctor or the hospital? There is often a great deal of frustration on the part of family members and friends at not being able to do more to help, and a great deal of anxiety in thinking about long-term complications.
Diabetes Canada expects that 5 million people (roughly 12% of the population) will be diagnosed with diabetes by 2025. If you haven’t somehow been affected by diabetes up until now, you probably will be (either directly or indirectly) sometime soon. November is a good time to recognize and understand the unrelenting strain that diabetes places on both those managing the disease daily and those who are closest to them. This month is also an ideal opportunity to take action, whether through making a donation to a recognized foundation or by becoming more informed about how to support those around you living with diabetes.
Jane Yardley, Physical Education, Augustana Campus, University of Alberta. This column originally appeared in the Camrose Booster on November 21, 2017.