Diabetes What is it and how can we prevent it? - Brigette Pereira and Natalie Wowk-Slukynsky, First Nations and Inuit Health Branch

What is Diabetes? Diabetes is a disease where your body is not able to properly control the amount of sugar in your blood. This happens for 2 reasons Your pancreas cannot produce enough insulin Your body cannot use the insulin properly

What is Insulin? Insulin is a hormone- a chemical made by your body that controls how much sugar is in your blood. It acts like a key, to unlock the door that allows sugar to enter our body’s cells. Insulin acts like a key that unlocks the doors of the cells to let the sugar move in. The cells can then use the blood sugar for energy to do their jobs. Without the key (insulin), the sugar builds up in the blood, and the cells get hungry. We need sugar in our cells so our bodies can make energy. The sugar goes into the kidneys. The kidneys make urine, which carries the sugar out of the body. This can leave a person feeling weak and tired because they have just peed out all the energy from the food they have eaten.

True or False? Diabetes is not that serious of a disease. If you have diabetes it doesn’t matter.

False! Diabetes is a very serious disease. 2 out of 3 people with diabetes will die from a heart attack or stroke. If you have diabetes it is very important to manage it so you don’t get complications If you don’t have diabetes it is still very important to prevent getting it Indigenous people continue to have the highest prevalence of diabetes in Manitoba. Diabetes rates are 3-5 times higher in First Nations communities compared to the general population. The First Nations Regional Health Survey reported that in 2008-10, 21% of adults in First Nations communities were living with diabetes. This is compared to only 6% of non-Indigenous Canadians in 2009-10. First Nations adults tend to develop diabetes much younger and First Nations adults living with diabetes tend to develop complications more rapidly compared to the general Canadian population living with diabetes (First Nations Regional Health Survey, 2008-10). Some estimates show that rates of type 2 diabetes are 12 times higher for Manitoba children compared to the Canadian average (Food Matters Manitoba).

Types of Diabetes There are 3 different kinds of diabetes Type 1 diabetes The body makes no insulin at all Type 2 diabetes The body produces some insulin, but not enough Gestational diabetes  A type of diabetes that occurs in pregnant women Now that we understand how insulin works and why it is important, we are going to talk about the three different types of diabetes.

Type 1 Diabetes Often diagnosed in children An “autoimmune” disease People with type 1 diabetes will need to take insulin for the rest of their lives Not preventable Makes up only 10% of diabetes cases This type of diabetes is not very common. Does anyone know someone with type 1 diabetes? Are they young or older? Autoimmune disease means the body attack’s it’s own insulin-producing cells leading to diabetes.

True or False? Taking Insulin cures diabetes Does everyone remember what insulin is?

False! Taking Insulin or any other medications for diabetes helps control blood sugar. They do not cure diabetes.

Type 2 Diabetes 90% of cases of diabetes are type 2 Used to be found in adults 40 years old and older Insulin resistance or deficiency Variety of treatment options Can be prevented/delayed by living a healthy lifestyle Does anyone know someone with type 2 diabetes? Are they young or older? Usually develops in adulthood but increasing numbers of children in high-risk population getting diabetes. Was once called adult onset diabetes. This type of diabetes is much more common. Pancreas does not make enough insulin or the body does not use it properly. In some cases it can be prevented or at least delayed There is NEVER a progression from type 1 to type 2 diabetes (or vise versa)

Gestational Diabetes A type of diabetes found in pregnant women Too much sugar in the blood will lead to too much sugar in the baby’s blood Affects about 13% of pregnancies among Indigenous women. Can be very serious if not monitored and treated Close follow-up is needed of both mother and infant Mothers who have gestational diabetes are at greater risk of developing type 2 diabetes after her baby is born. A baby who is born to a woman who had gestational diabetes is at higher risk of developing type 2 diabetes later in life.

Gestational Diabetes Getting hurt during delivery Risks for Mothers Difficult labor and delivery if your baby is very big Increases your risk of getting type 2 diabetes later in life Risks for Babies Low blood sugars after delivery Gaining too much weight Breathing problems Increased risk of living with obesity or having type 2 diabetes later in life Other risks for mother: -pre-eclampsia -Excessive protein in urine -Swelling in legs and feet -High blood pressure -Pregnancy loss Other risks for the baby: Getting hurt during delivery Being obese later in life

True or False? If a mother has gestational diabetes, her baby will be born with diabetes too

False! Having gestational diabetes does not mean your baby will have diabetes too, it just means your baby is at higher risk of getting type 2 diabetes later in life

Can I Help Prevent Gestational Diabetes? Yes- Eat a healthy diet and exercise! Follow Canada’s Food Guide for healthy eating Not gaining too much weight while pregnant Be physically active before pregnancy Check with your doctor before starting physical activity during pregnancy Even while you are pregnant, it is important to stay active. Check with your doctor for what types of activities are safe for you.

Gestational Diabetes Pregnant women should get tested when they are 24-28 weeks A doctor or nurse will give you a very sweet drink, then check your blood 2 hours later If you have gestational diabetes you may need to take insulin while you are pregnant It is still possible to have a healthy pregnancy and baby even if you have gestational diabetes This is called an “Oral Glucose Tolerance Test”. It means your doctor will give you a certain amount of sugar, and see how high your blood sugar goes. Taking insulin may seem scary, but it is the most natural way to control blood sugars and keep you and your baby healthy

How Much Weight Should I Gain? Your doctor or nurse will know how much weight you should gain while pregnant Remember, your baby is very small. You do not need to eat twice as much food, just a little bit more How much weight to gain depends on your age, how much you weighed before you were pregnant, and if you are having one baby or multiple. In your first trimester you do not need to eat any more than usual. In your second and third trimester you need to eat 1-2 extra snacks per day (choose foods from at least 2 food groups at each snack)

Did You Know? Babies who are breastfed are less likely than formula fed babies to develop type 2 diabetes later in life Mothers who breastfeed are also less likely to develop type 2 diabetes later in life Encourage mothers to breastfeed and help them find support for breastfeeding if needed.

Diabetes Risk Factors: Being overweight Having Aboriginal ancestry Having family members with diabetes Having prediabetes Having had a large baby, or gestational diabetes Being over 40 years old High blood pressure, high blood fats Risk Factors: Over 40 years old Mother, brother, sister, father has diabetes Aboriginal ancestry Overweight (especially around the middle) Had large baby (over 9 lbs) Gestational diabetes Stroke in the past Heart attack in the past Presence of complications association with diabetes High blood fats High blood pressure Impaired glucose tolerance Impaired fasting glucose Diagnosed with prediabetes Acanthosis nigricans Diagnosed with polycystic ovary syndrome Diagnosed with schizophrenia

True or False? You can outgrow diabetes if you get it as a child

False! Diabetes is a chronic disease. You cannot outgrow or cure diabetes.

If you have diabetes you are at higher risk of: Kidney failure Blindness Amputations Heart disease Complications for type 1 and type 2 diabetes are the same Genetics may play a role in the development of complications Treatment can be effective if complications are detected early Managing diabetes well = keeping good blood sugars

Can These Complications be Prevented? Yes, good diabetes care can help prevent and delay these complications. What does good diabetes care include? -Regular physical activity -Healthy eating -Blood sugar monitoring -Regularly checked for complications

True or False? Eating too much sugar will cause diabetes

False! Eating sugar does not cause diabetes However, over time eating unhealthy foods can lead to weight gain, which is a risk factor for diabetes

Can Diabetes be Prevented? Yes There are things you can do to reduce your risk of developing diabetes and its complications How?

1. Be Physically Active Get your body moving every day. You can walk, run, bike, swim, skate, or play sports. How will physical activity help? • Builds muscle • Strengthens bones • Increase flexibility and balance • Improve mood and self-esteem • Improve sleep Helps control your weight

2. Eat a Healthy, Balanced Diet Follow Canada’s Food Guide Avoid foods that are high in added sugar, salt, fat What are some foods that should be limited? Foods that should be limited include pre-packaged convenience foods, sugar sweetened beverages (pop, sweetened juices and iced teas), snack foods such as chips or chocolate bars. Limiting foods means you shouldn’t eat them every day. Save these foods for special occasions.

3. Stay at a Healthy Weight How? Being Physically active Eating a healthy, balanced diet Being physically active and heating healthy is important for everyone, no matter what age, size, and level of health.

What can be done in your community to help prevent diabetes? Start a walking club Plant a garden Play outdoors with your kids or grandkids Get a group together for a soccer, baseball, or hockey game Does anyone have any other ideas? Does your community do any of these things?

Remember: Preventing diabetes is just as important as managing diabetes People with diabetes can live long, healthy lives Eating healthy and exercising is the best way to prevent type 2 diabetes, gestational diabetes, and complications of diabetes It is never too early or too late to start living a healthy lifestyle!

For more information Visit The National Aboriginal Diabetes Association http://www.nada.ca Diabetes Canada http://www.diabetes.ca Canadian Society for Exercise Physiology www.csep.ca

Thank You! Any Questions?