T he current numbers arestaggering – more than2.4 million Canadians

have diabetes. What the futureholds is even more daunting,however, with the number ofCanadians living with diabetesexpected to swell to three mil-lion by 2010.

In addition, nearly six mil-lion Canadians have predia-betes, a relatively new term forblood glucose levels near thelevel of diabetes. According tothe Canadian Diabetes Associ-ation 2008 Clinical PracticeGuidelines for the Preventionand Management of Diabetesin Canada, if left untreated,around 25 per cent of thosewith prediabetes will progressto diabetes in three to fiveyears.

Canada is not alone. Dia-betes is a burgeoning globalepidemic, with 7 million peo-ple developing the diseaseevery year. Today, more than250 million people worldwidehave diabetes, and this num-ber is predicted to reach 380million by 2025.

“With the growing num-bers, we can expect more ofthe severe complications associ-ated with diabetes, such asheart disease and stroke, kid-ney failure and eye disease,”says Dr. Vincent Woo, chair ofthe Canadian Diabetes Associa-tion (CDA) Clinical and Scien-tific Section. “People with dia-betes get heart disease 10 to 15years earlier than others. Thereare huge implications for ourhealth care system if we aren’taggressive in preventing com-plications in this population.”

Type 1 diabetes, in whichthe pancreas produces noinsulin, accounts for about 10per cent of cases and typicallydevelops in childhood or ado-lescence. For the 90 per centof Canadians with type 2 dia-betes, which usually developslater in life, their bodies areproducing insulin but can’tproperly use it.

The dramatic growth is intype 2 diabetes due to a num-

ber of factors. “Our populationis getting older, we’re gettingheavier and we have moreimmigrants from populationsat higher risk for the disease,”Dr. Woo explains. “And one ofthe biggest increases is occur-ring among Aboriginal Cana-dians, some of them quiteyoung.”

While diabetes is a healthcrisis threatening to worsen,research advances in a number

of areas are offering new hope,and Canada is at the forefrontof many of the most promisingdevelopments.

“Canada is well positionedto bring about significantchanges worldwide in how weunderstand and treat dia-betes,” says Dr. BrianRodrigues, chair of theNational Research Council ofthe CDA. “Even though wedon’t have nearly the level ofresearch dollars of countriessuch as the U.S., it’s beenshown that Canadianresearchers are producingmore high-impact results.”

For example, Canada is aleader in pancreatic beta cellresearch, in which patientswith type 1 diabetes are inject-ed with pancreatic cells thatstimulate insulin production.Canadian researchers havealso developed a number ofnew drugs that can lowerinsulin resistance and increaseinsulin action in people withtype 2 diabetes.

Another key area ofresearch is in the complica-tions of diabetes, particularlycardiac disease. Dr. Rodriguesis conducting innovativeresearch into the mechanismsby which diabetes actuallycauses damage to the heart.

Another critical area, hesays, is education. “We reallyneed the public and healthcare professionals to knowabout the Clinical PracticeGuidelines and about our new

knowledge about treatmentand, of course, prevention.The most serious results canoften be prevented by diet,exercise and weight loss, andproper management of bloodglucose levels.”

Given the incidence of dia-betes, governments in Canadahave identified diabetes man-agement as a priority area andcalled upon the CanadianAgency for Drugs and Tech-nologies in Health (CADTH)for advice on “optimal pre-scribing” and use of medica-tions.

CADTH is an arm’s-lengthagency reporting to the federaland provincial/territorialhealth ministries, mandated toassess the clinical- and cost-effectiveness of new drugs andhealth technologies, as well asidentifying and promoting bestpractices in drug prescriptionand use.

CADTH, through its Cana-dian Optimal Medication Pre-scribing and Utilization Ser-vice (COMPUS), undertookan assessment of insulin ana-logues, a slightly more expen-sive, next-generation form ofinsulin.

“We look at what the evi-dence says about various drugsin terms of both effectivenessand cost,” says Barbara Shea,COMPUS vice-president. “Wecompared the insulin ana-logues to conventional insulintherapy. If a medication iseffective and costs more, we

assess whether that cost is justi-fied given the incrementalbenefit.”

The COMPUS expertreview committee has devel-oped draft recommendationsto be finalized after assessmentof stakeholder feedback. “Wefound that insulin analogueshave a place, although conven-tional therapy is more cost-effective in a number of specif-ic instances.”

COMPUS is now under-taking a similar best practicesevaluation for blood glucosetest strips and plans to assessother diabetes treatments inthe future.

“Governments ultimatelymake the decisions about theavailability of cost-effectivetreatments,” says Ms. Shea.“Our analysis informs thosedecisions and, in the end, peo-ple with diabetes benefit.”

A special information supplementT H E G L O B E A N D M A I LW E D N E S D AY , N O V E M B E R 1 2 , 2 0 0 8 CDA1

F or many youngsters,going away to camp is ahighlight of summer.

Thanks to a Canadian Dia-betes Association (CDA) initia-tive, summer camp is also athrill shared by children andteenagers with type 1 diabetes,who not only get the excite-ment of camp, but also learnvaluable lessons on how tomanage their diabetes.

“Camp is something thatevery kid should be able toexperience,” says Lisa Dia-mond, executive director ofpublic programs and servicesat the CDA national office.“We give children the opportu-nity to attend a real summercamp without feeling limitedby their disease. They get tojust be a kid at camp.”

The CDA has been run-ning camps for more than 50years. Today, the CDA oper-ates 12 camps across the coun-try and a number of “familycamps” – weekend getawaysfor children with type 1 dia-betes and their entire families.

Every summer in Canada,more than 1,500 youngsters

between the ages of seven and16 attend CDA camps for oneor two weeks hosted, in part,by doctors, nurses, dietitiansand health care students. “Par-ents feel comforted knowingtheir children are being fullycared for,” says Ms. Diamond.“At the same time, the parentscan have some respite fromthe 24/7 job of being the pri-mary caregiver of a child withdiabetes.”

There are other benefitstoo, says Ms. Diamond. “Thekids meet other kids just likethem; they don’t feel differentand they don’t feel outside ofthe group. They can talk open-ly about their diabetes in asupportive setting.”

Many of the camp counsel-lors also have type 1 diabetesand serve as role models forthe youngsters, teaching themimportant skills such as how toself-administer insulin.

“Camp is often a step for-ward in the independence of achild caring for his or her dia-betes,” says Ms. Diamond. “Itis an opportunity to movethem in a positive manner

towards leading a long andhealthy life.”

The CDA also providesfinancial assistance for thosefamilies who couldn’t other-wise afford to send their kidsto the camp.

Beyond CDA summercamps, the association runsother children and youth edu-cational programs, teachingkids with and without diabetesabout the disease and theimportance of making healthylifestyle choices. Among theseactivities are a cartoon videoaimed at five- to nine-year-olds, and the Growing UpWell program, which featureseducational videos tailored forchildren aged nine to 13 and14 to 18 respectively.

“These videos show youthtalking to other youth aboutwhat it is like to live with dia-betes,” Ms. Diamond says.

Schools, youth groups andother interested parties thatwould like to receive an edu-cational presentation for chil-dren or youth are encouragedto contact their local CanadianDiabetes Association branch.

Canadian Diabetes Association summercamps allow “kids to be kids”

Support

DIABETES

Canadian Diabetes Association-led summer camps provide kids livingwith diabetes not only happysummer memories, but also valuable learning experiences that teach children to better managetheir diabetes. PHOTO: CDA

More than 2.4 million Canadians already have diabetes, and if current trends continue, that number is expected to grow to 3 millionby 2010. The impacts on people and Canada’s health care system are significant. Severe complications associated with diabetesinclude heart disease and stroke, kidney failure and eye disease. Fortunately, efforts by concerned organizations are leading to moreeffective therapeutics and programs to help those living with diabetes better manage their disease. PHOTO: ISTOCKPHOTO.COM

The numbers are swelling and the complications growing. So, what’s being done about it?Plenty, thank goodness.

Nova Scotiainnovator createsBREAKTHROUGH

PAIN RELIEFfor diabetics

According to Dr. AlexanderMcLellan, author of HealingDiabetes (2007) and a newbook focusing on the treat-ment of diabetic neuropa-thy, The Numb Foot Book(2008), there are new effec-tive non-prescription treat-ments for nerve pain.Among the treatments Dr.McClellan cites is Neura-gen, a topical over-the-counter pain reliever devel-oped by Nova Scotia-basedOrigin Biomed.

Dr. McLellan says Neuragenhas been shown in clinicaltrials to be as or moreeffective than conventionalprescription drugs in treat-ing peripheral neuropathy,a painful, long-term com-plication associated withdiabetes.

Among the most importantadvantages of topical painrelievers is their lack ofside-effects, says Dr. McLel-lan. Another plus: Neura-gen is widely available inpharmacies and can bepurchased without a pre-scription. Kudos to a Cana-dian innovator.

To learn more, visitoriginbiomed.com.

TheCanadianOptimalMedicationPrescribing andUtilizationService (COMPUS)program helps healthcare professionals and people with diabetes make informeddecisions about treatment. How? By identifying and promoting evidence-based,clinical and cost-effectiveness information on optimal drug prescribing and use.Find out how we can help, and get involved by visiting us online today.

Evidence-based information on insulin analogues now available.

CADTH HELPS POINT

THE WAY ON THE

TREATMENT OF

DIABETES

�������������������

By Ellen MalcolmsonPresident & CEO, CanadianDiabetes Association

D iabetes is very serious,in fact, only one in fiveCanadians with dia-

betes survives heart disease.

That is what the CanadianDiabetes Association wantsyou to know this November.The harsh reality is that todayonly one in five people livingwith diabetes will survive thecomplications of cardiovascu-lar disease. It is essential that

Canadians who are living withand at risk of developing dia-betes work to reduce their riskfactors by making healthierlifestyle choices each andevery day.

By 2010, more than threemillion Canadians will be liv-

ing with diabetes, many ofwhom will also be sufferingfrom serious complications.This is just the tip of the ice-berg as an estimated six mil-lion Canadians are also livingwith prediabetes, putting themat increased risk of developing

type 2 diabetes.All too many people live

with undiagnosed diabetes foryears but don’t know it. Stud-ies show that, on average, peo-ple have type 2 diabetes for upto seven years before beingdiagnosed. During this time,

dangerously high blood glu-cose levels can start to causeserious damage that can leadto heart disease, blindness andlimb amputations.

The reality is that mostCanadians don’t recognizeheart disease to be the mostserious complication of dia-betes. However, the goodnews is that a diagnosis of dia-betes does not have to lead toheart disease. In fact, Canadi-ans can reduce their risk ofdeveloping type 2 diabetes bymore than 50 per cent by get-ting active, losing weight andmaking healthy food choices.

Jung-Yul Kim, who liveswith diabetes and is an activeAssociation volunteer shareshis personal highs and lowswith diabetes this November atgetserious.ca. He says, “Beforemy diagnosis, I was a profes-sional athlete playing footballin the C.F.L. as an offensivelineman. Life was good andthe future was bright. Becauseof the challenges of the diseaseI had to change my diet. I lostclose to 30 pounds in threemonths. Mostly from not eat-ing the way I used to, but alsobecause I became verydepressed, due to the combi-nation of losing my source ofincome and dealing with dia-betes. My eating habits andlifestyle were profoundlychanged.”

Jung-Yul is doing muchbetter today, thanks in a largepart to his commitment to tak-ing his diabetes seriously. He’smade important and positivelifestyle changes, but sharesthat “the disease constantlyaffects me. I have my gooddays and bad days. I continueto struggle and try to maintaina positive outlook.”

Whether you are livingwith diabetes or prediabetes,or are one of the millions ofCanadians aged 40 and overwho is at risk, I urge you tovisit getserious.ca this Novem-ber and learn how you canreverse this trend. Discover ifyour heart is older or youngerthan your chronological age,gain insight into your personalrisk levels and start takingaction today by acting on pre-vention and health manage-ment strategies. Help us helpmore Canadians to survivediabetes and its serious com-plications by donating today atgetserious.ca.

What Canadians don’t know aboutdiabetes can hurt them

Serious complications

A special information supplementT H E G L O B E A N D M A I L

W E D N E S D AY , N O V E M B E R 1 2 , 2 0 0 8CDA2

DIABETES IN CANADA

Whether you areliving with diabetesor prediabetes, or areone of the millionsof Canadians aged40 and over who is atrisk, I urge you to visitgetserious.ca thisNovember and learnhow you can reversethis trend. Discoverif your heart is olderor younger than yourchronological age,gain insight into yourpersonal risk levelsand start takingaction today by actingon prevention andhealth managementstrategies.

Enhanced HealthWATCH not available in B.C., Q.C., P.E.I., N.W.T. and Y.T. ®/™ are trade-marks or registered trade-marks of 911979 Alberta Ltd.

Shoppers Drug Mart® is the exclusive pharmacy provider for the highlightsof the Canadian Diabetes Association’s 2008 Clinical Practice Guidelines.

Our pharmacists are available to answer your questions and share the newGuidelines’ recommendations for managing diabetes. We also have more than150 Certified Diabetes Educators nationwide to give you personalized diabetes care.Speak to a Shoppers Drug Mart Pharmacist today for more information and to getyour copy of the highlights.

You’ve got questionsabout diabetes.

Wondering where to get answersshouldn’t be one of them.

DIABETES IN CANADA

A special information supplementT H E G L O B E A N D M A I LW E D N E S D AY , N O V E M B E R 1 2 , 2 0 0 8 CDA3

P riscilla Lopes-Schliep’sability to sail over hur-dles garnered the 26-

year-old athlete from Whitby,Ont., a bronze medal at thissummer’s Olympics in Beijing.But Ms. Lopes-Schliep down-plays her track-and-fieldaccomplishments when shecompares them to the chal-lenges met by members of herfamily in tackling their dia-betes.

“My aunt Barb has hadtype 2 diabetes for 20 yearsand aunt Alice was diagnosedtwo years ago, so I’ve seenfirsthand the hurdles they hadto overcome to manage thedisease effectively. They areliving examples of how earlydiagnosis and proper treat-ment can enable people withdiabetes to live healthy, activelives. I am so proud of themfor being champions for theirown health and proactivelyworking with their health careprofessionals to find the right

treatment options,” she says.Her aunt Barb, in particu-

lar, has tackled her diabeteshead on. In the two decadesthat she has been living withtype 2 diabetes, she has mademaintaining a healthy lifestylea priority. When her bloodglucose levels became erratic,including a couple of frighten-ing incidents with low bloodglucose (hypoglycemia) thatmade her feel faint and weak,she followed the advice of herphysician and began taking

long-acting basal insulin.“I know a lot of people

are afraid of going oninsulin,” acknowledges Ms.Lopes-Schliep. “But that fearcan be a barrier to good dia-betes management. Since myaunt started taking the long-acting insulin once a day, herblood glucose levels havebeen very steady, even atnight, and she tells me shefeels so much better sincethen.”

As an athlete, Ms. Lopes-Schliep well knows the impor-tance of taking control ofone’s health. “My coachalways tells me that I am themost powerful person when itcomes to my well-being. Sure,I can skip training if I want to,but there will be conse-quences later. It’s the same

thing with taking charge ofyour diabetes.”

Recognizing that her fami-ly’s history of type 2 diabetesputs her at increased risk ofdeveloping the disease herself,Ms. Lopes- Schliep plans todo whatever she can to lead ahealthy lifestyle – includingmaintaining a balanced dietand, of course, lots of physicalactivity – even after shedecides to hang up her hur-dling spikes.

“I’ve already talked to mydoctor about my risk factorsfor diabetes and know thewarning signs. I feel this isimportant because the earlieryou are diagnosed, the sooneryou can find a treatment planthat will help reduce your riskof complications down theroad,” she says.

Next month, Ms. Lopes-Schliep will resume her track-and-field training full time asshe prepares for the WorldChampionships in Germany

next year. In the meantime,she is taking advantage ofWorld Diabetes Day to shareher family’s history with dia-betes and draw attention tothe importance of early diag-nosis and proper manage-ment.

“I want to inspire all Cana-dians living with diabetes toachieve the same success thatmy aunts have in managingtheir diabetes,” she says. “Dia-betes management may be alife-long commitment, but itdoesn’t have to be a hurdle.”

Olympian applauds family members’persistence in managing their diabetes

Priscilla Lopes-Schliep

Four things you shoulddo about diabetes“Diabetes is a family affair,” says Dr. Stewart Harris, a familyphysician and researcher who holds the Canadian DiabetesAssociation Chair in Diabetes Management at the Universi-ty of Western Ontario in London, Ontario.

If you have diabetes in your family, Dr. Harris suggeststaking these important steps:

Get tested. A simple blood test for type 2 diabetes is re-commended for all Canadians over the age of 40; earlier ifyou are at high risk or experience any symptoms. Earlydiagnosis is crucial to start a treatment plan to avoid com-plications down the road.

Get active. Do everything you can to reduce the risk ofdeveloping type 2 diabetes and its complications. Thehealthy lifestyle component of diabetes prevention andmanagement is almost impossible to realize in isolation.Shop for and cook healthy foods as a family and enjoyphysical activity together.

Get aggressive. Preventing complications is the name ofthe game. Talk to your health care professional about theimportance of early and aggressive treatment options.

Get informed. We are moving out of the era where fearand lack of knowledge kept people from getting diagnosedor getting the treatment they need when they need it.Understanding diabetes and its treatment options, whichmay include going on insulin, is the best strategy to avoidserious complications.

This repor t was produced by Randal lAnthony Communicat ions Inc. (www.randal lanthony.com) in conjunc t ion with the adver t is ing depar tment of The Globe and Mai l. R ichard Deacon, Nat ional Business Development Manager, rdeacon@globeandmai l.com.

Olympian Priscilla Lopes-Schliep's family, includingher aunt Barb (left),cousin Angela (centre)and aunt Alice (right),know all about diabetes.“My aunts are living examples of how early diagnosis and proper

treatment can enable people with diabetes to live healthy, active lives,” says Ms. Lopes-Schliep. PHOTOS: SUPPLIED

HER PASSION:TAKING THE HELMHER POWER:ONCE-DAILY LANTUS INSULIN

With LANTUS® basal insulin, in the ready-to-use LANTUS® SoloSTAR®

injection pen, one dose can last for 24 hours.

Wherever you make waves

LANTUS® SoloSTAR® now available in Canada.Ask your doctor if LANTUS® is right for you.

Copyright © 2008 sanofi-aventis. All rights reserved.sanofi-aventis Canada Inc., Laval, Quebec H7L 4A8 CDN.GLA.08.01.15E

I f you were to join theCompayre clan for dinner,you would notice some-

thing special about this family.Before unfolding napkins andpassing platters of food,several members of thisWinnipeg family poke theirfingers to draw a drop ofblood for their personalpocked-sized meters, check the

readings, then administerinsulin with pen-shaped injec-tors. The entire process takesless than five minutes.

Across Canada, hundredsof thousands of people withdiabetes follow the same rou-tine several times a day. Whatmakes the Compayres sounusual is that four membersof the same family have type 1

diabetes: 78-year old matriarchHelen Compayre; daughtersTina Trotter, 46, and CarmenTrudel, 40; and Carmen’s 10-year-old son, Jonathan.

“While family history isconsidered a strong risk factorfor type 2 diabetes, it is not ascommon to see more than onecase of type 1 diabetes in afamily,” says Lori Berard,

nurse manager with the HealthSciences Centre DiabetesResearch Group in Winnipeg.“Regardless of the type of dia-betes, when someone in thefamily is affected, the wholefamily becomes affected.That’s why it’s important forall family members to under-stand diabetes and learn howto support the person livingwith the condition,” she says.

“The good thing about ourfamily is that you never feelalone with your diabetes,” saysTina. “I can talk about it withmy sister and she understandswhere I’m coming from andcan offer advice.”

One piece of advice thathas made a significant differ-ence for everyone in the familywas the suggestion to beginusing long-acting basal insulin.Tina was the first to try insulinglargine a couple of years agowhen she couldn’t get consis-tent blood glucose levels withthe insulin she was using. “Theinsulin I’m on now acts like theinsulin from my own pancreas,so my blood glucose doesn’t gotoo high or too low,” she says.

Carmen and her motherthen began using the samelong-acting insulin as Tina,and they couldn’t be happier.“We both used to wake upthree or four times a weeksweating and shaking becauseour blood glucose was drop-ping,” she remembers. Theinsulin we’re taking now isreleased into our bloodstreamover 24 hours at an even rateand, because of that, we’rehaving practically no incidentsof hypoglycemia.

Jonathan, too, is on the

same insulin and he especiallylikes the prefilled insulin penhe has started using recently.“It’s easier than grade 5 home-work. I just push a button toinject it in my leg,” he says.

Carmen marvels at theease with which her son man-ages his diabetes, especially

compared to her own experi-ences as a child. “There hasbeen a huge evolution ininsulin and devices since I wasyoung,” she says. “Today,everything is so simple andconvenient. It makes it mucheasier for Jonathan to managehis diabetes.”

A special information supplementTH E G LOB E AND MA I L

WEDNE SDAY , NOV EMB E R 1 2 , 2 0 0 8CDA4

DIABETES IN CANADA

I n the world of diabetes,feeling high or low isn’tabout emotion, a meter

isn’t a measurement of dis-tance, and a poke has nothingto do with Facebook. Rather,these terms relate to the cen-tral factor in diabetes: bloodglucose.

Diabetes is a disease inwhich the body cannot controlthe amount of glucose (com-monly but inaccuratelyreferred to as sugar) in theblood. Insulin is the key thatallows the body to use glucosefrom food and turn it intoenergy, but in diabetes thebody either doesn’t produceany insulin (type 1) or doesn’tproduce enough and/or can’teffectively use what it doesproduce (type 2). In bothtypes of diabetes, the result isa dangerous condition calledhyperglycemia, or high bloodglucose.

“In the short term, highblood glucose can causeexcessive thirst, frequent uri-nation, weight loss andfatigue,” says Dr. Amir Hanna,director of the diabetes clinicat St. Michael’s Hospital in

Toronto. “Long-term, highblood glucose can damageboth large and small bloodvessels, leading to potentiallydevastating complicationssuch as heart disease, stroke,blindness, lower limb amputa-tion and kidney disease.”

According to Dr. AndrewFarquhar, a family physicianin Kelowna, B.C., many peo-ple don’t realize they havediabetes until they land in theemergency department with aheart attack. “One of my maingoals in treating diabetes is toprevent patients from havingto see a cardiologist.”

The key is to get bloodglucose under control early inthe game, he continues,explaining that “a legacyeffect” may lower the risks offuture complications even ifblood glucose is less well con-trolled later on.

Although a healthy dietand regular physical activityare important and can helpmanage blood glucose levels,type 2 diabetes is progressive,and many people will requiremore intensive medical inter-ventions. The most successful

approach is multi-faceted andmay include one or more oraldiabetes medications, drugs tocontrol high blood pressureand abnormal cholesterol

(both of which are commonlyassociated with diabetes andincrease the risk of seriouscomplications) and/or insulin.

“Insulin is the single most

effective agent we have tolower blood glucose, butunfortunately many peopleunduly postpone beginninginsulin because they areafraid of the injections,” saysDr. Farquhar.

The good news is thatinjection devices, such as pre-loaded insulin pens, and theinsulins themselves haveimproved significantly inrecent years. “When mypatients start insulin, they aresurprised by how easy it is.Many people feel so muchbetter when their blood glu-cose control improves thatthey say they should havestarted insulin earlier,” saysDr. Hanna.

Another common concernthat people have about start-ing insulin is that it may causelow blood glucose (hypo-glycemia). Low blood glucoseis a potentially dangerous con-dition marked by trembling,sweating, anxiety and/or heartpalpitations. Normally thetreatment for low blood glu-cose is to eat or drink about15 grams of carbohydrate (forexample, six Life Savers or a

tablespoon of honey). Butsome people experience lowblood glucose in their sleep orhave no symptoms, and thiscan be cause for concern.Untreated, blood glucose candrop severely and lead to lossof consciousness.

Thanks to the develop-ment of long-acting basalinsulin, the risk of low bloodglucose is significantlyreduced. Long-acting insulinmimics the body’s normalinsulin production to keep asmall amount of insulin con-tinuously in the blood stream.

“People need to get pastthe misconception that start-ing insulin means their dia-betes is at a very advancedstage or that they’ve failed intaking care of their diabetes.Really, it’s about takingcharge of their health,” saysDr. Farquhar.

“The take-home message,”concludes Dr. Hanna, “is thata combined approach withdiet, exercise, oral medica-tions and insulin can effective-ly control diabetes. Patientsneed to take advantage of allthe tools at our disposal.”

Diet, exercise, oral medications and insulinfactor into blood glucose control

Diabetes management

Insulin’s evolution marks milestones in health innovation1922: Discovery of insulin by Drs. FrederickBanting and Charles Best at a University of Torontolaboratory

1923: Start of insulin production in Canada byConnaught Laboratories (now sanofi pasteur)

1936: Better purification of insulin is introduced,substantially improving product tolerability

1950s: Introduction of new generation insulins(NPH, lente, semi-lente and ultra-lente)

1974: Insulin pump is intro-duced

1985: Insulin pen is introduced

2005: Insulin glargine, the firstand only long-acting insulin toprovide 24-hour glucose-lowering activity with just oneinjection, becomes available inCanada

Since insulin's discovery in 1922, ongoing research and development has led toadvancements in its efficacy. PHOTOS: SUPPLIED

Winnipeg family taking insulin daily say ‘no big deal’Profile

Insulin pen a boonto diabetes care

Technology

C armen Trudel lost hereyesight 15 years agoas a result of compli-

cations from type 1 diabetes.Without her vision, the 40-year-old Winnipeg motherwas dependent on others toprepare daily insulin injec-tions for her and her son, whoalso has type 1 diabetes. Find-ing the right once-daily long-acting insulin and the rightinsulin pen gave her back herindependence.

Insulin pens in generalcombine a needle and insulincartridge in a single device, sothere is no fiddling withsyringe, needle and separatevials of insulin. The prefilledpen Carmen and Jonathan areusing takes convenience onestep further as there is noneed to reload cartridges.

An important feature forpeople with visual impairmentis to be able to hear a clickwith each turn of the dial.“Hearing and feeling a click

reassures me that I’ve dialledthe right dose,” says Carmen.“It’s great to have a pen wherewe don’t have to depend onother people to prepare injec-tions for me or Jonathan.”

In her 21 years as a dia-betes nurse, Lori Berard hasseen the positive impact thateasy-to-use devices have hadon diabetes management.

“Whenever an insulin penor a blood glucose meter hasfewer steps, there is less roomfor human error. Not onlydoes this lead to greater con-venience, but it also improvessafety, especially for peoplewho have limited vision ormanual dexterity, or who areelderly,” she says, adding thattoday’s needle tips are finerand shorter than ever, makinginjections virtually pain-free.

“We’ve come a long waysince the days when peoplehad to boil syringes andsharpen needles to reusethem.”

Carmen Trudel (left), her son Jonathan and her sister, Tina Trotter, get a live demonstration of theLantus SoloSTAR insulin pen from nurse educator Lori Berard. PHOTO: SUPPLIED

Technology has led to modern devices that make diabetesmanagement easier and less painful. PHOTO: SUPPLIED

M ost people with dia-betes understand thatto stay healthy, they

need to manage their bloodglucose levels. What they maynot understand as clearly isexactly why this is importantand how these levels affecttheir health.

The Canadian Diabetes

Association 2008 ClinicalPractice Guidelines for the Pre-vention and Management ofDiabetes in Canada recom-mends target blood glucoselevels for most adults with dia-betes:• A1C of 7 per cent or lower• Fasting blood sugars of 4-7mmol/L

• Post-meal (two hours after thestart of the meal) blood sugars of5-10 mmol/Lo Post-meal blood sugars of 5-8mmol/L if necessary to reachan A1C of 7 per cent or lower

A person with diabetes canuse a blood glucose monitor tocheck his or her own levels.

The numeric reading helps thepatient to understand howclose they are to their targetrange at any given moment.Another very important test,which is conducted at the lab,is the A1C – and every patientwith diabetes should be askingfor those results.

According to Dr. IanBlumer, a diabetes specialistpracticing in Ajax, Ontario,and author of Diabetes forCanadians for Dummies, theA1C test helps to provide anunderstanding of the biggerpicture. “Your A1C reflectsyour average blood glucosereadings over three to fourmonths,” says Dr. Blumer.“This overall estimate isimportant because it tells usthe likelihood of someonedeveloping complications ofdiabetes, such as kidney dis-ease, nerve damage and blind-ness. It is not a replacementfor finger prick testing, whichprovides crucial, specific andimmediate information.”

Finger prick testing andA1C results work in tandem. Ifa patient is having difficulty

reaching the target A1C levelof 7 per cent or lower, eventhough their fasting blood glu-cose levels are within the tar-get range, their doctor mayrecommend a tighter post-meal target of 5-8 mmol/L.The only way to know ifyou’re reaching this goal is totest.

Testing can seem like aninconvenience, it can beuncomfortable, and it can becostly. Because of these poten-tial deterrents, Dr. Blumerexplains that it needs to beworthwhile. “Patients need tounderstand what the numbersmean and what to do with theinformation. They need tounderstand how to reach theirpre- and post-meal targets andwhat to do if these targetsaren’t being met. If a persondoesn’t know how to interprettheir readings and what to dowith the results, testing is of lit-tle value.”

This point is also stronglyemphasized by Lori Berard,diabetes nurse educator andnurse manager, DiabetesResearch Group in Winnipeg,

Manitoba. “With diabetes,many factors are at play.When we are provided withpost-meal test results, alongwith notes about food choices,medications taken – includinginsulin doses – and activity, wecan start to identify patterns.These patterns allow us towork with our patients todetermine which choices aregood for blood glucose levels,and which are not. This helpsour patients to learn and planfor the future.”

To fully understand whento test, why and what to dowith your results, Ms. Berardstrongly recommends finding asource of education. “Ask yourdoctor to refer you to you alocal diabetes educator. Youcan also visit the CanadianDiabetes Association websiteat www.diabetes.ca or contactyour local branch,” she says,adding, “Talk to your pharma-cist – he or she can be a valu-able source of information.Test with understanding. Thisis short-term work with long-term gain: securing goodhealth down the road. ”

A special information supplementT H E G L O B E A N D M A I L

W E D N E S D AY , N O V E M B E R 1 2 , 2 0 0 8CDA6

DIABETES IN CANADA

M onitoring blood glu-cose levels, injectinginsulin, taking med-

ication, eating the right foods,undergoing frequent tests – allthis and more may be part ofthe often overwhelmingresponsibilities of a person try-ing to manage their diabetes.Increasingly, Canadians withthis disease are looking forsupport from the health careprovider they tend to see themost, their community phar-macist.

Patients’ quest for diabetesadvice and help from pharma-cists has grown over the years,and Shoppers Drug Mart hasresponded to this risingdemand with an array of pro-grams, services and tools,including some developed inpartnership with the CanadianDiabetes Association (CDA).

“It’s an area where a phar-macist can really make animpact,” says Shelley Dia-mond, a pharmacist who isresponsible for the ShoppersDrug Mart diabetes education-al program. “Some diabeteseducation centres in commu-nities have three- to six-monthwaiting lists. Pharmacists are

accessible health care profes-sionals who can be a keyresource for people with dia-betes, many of them strugglingwith information overload.”

Shoppers has beenexpanding its diabetes servicessince it began 14 years ago totrain pharmacists in blood glu-cose monitoring and to holdperiodic diabetes clinic days.“About four years ago, wemoved away from clinic days,so we could have a larger

reach,” Ms. Diamond says.“Now, our pharmacists pro-vide patients with a valuableintervention on diabetes at thetime they get their prescrip-tion, giving them tips on aspecific aspect of the disease,such as how to reduce theirrisk of heart disease.”

The pharmacist role is allthe more important today, sheadds, with a growing numberof people on oral diabetesmedications and insulin treat-

ment starting much soonerthan it used to for people liv-ing with type 2 diabetes.

Shoppers has approxi-mately 150 pharmacistsnationally who are CertifiedDiabetes Educators withadvanced knowledge andtraining in diabetes. The retail-er helps pharmacists obtainthe certification by providinga study program that includesmentoring from Certified Dia-betes Educator nurses and

dietitians in the Diabetes Edu-cation Centre at Toronto’sMount Sinai Hospital.

Shoppers pharmacies alsooffer patients a number oftools, including a three-monthblood glucose log book and awallet-sized diabetes monitor-ing record for keeping track oftests.

The CDA and Shoppersare partners in education. Thepharmacy chain has devel-oped an information resource

that responds to 52 questionsabout diabetes, ranging from“What can I eat to control mydiabetes” to “What is aninsulin pump?” Not only isthis information approved bythe CDA, Shoppers is thepharmacy chain responsiblefor distributing an easy-to-readsummary of the CanadianDiabetes Association 2008Clinical Practice Guidelinesfor the Prevention and Man-agement of Diabetes in Cana-da, with the latest informationon managing the disease.

“Working with the leadingretail pharmacy chain inCanada is a powerful partner-ship that helps us extend thereach of our messages toCanadians with diabetes,”says Christina Beyer, CDAsenior manager, CorporatePartnerships. “As our exclu-sive pharmacy retail partnerin the dissemination of the2008 guidelines to consumers,Shoppers is providing us withvaluable support – using itsextensive national network toprovide up-to-date informa-tion and the best possible careto Canadians affected by dia-betes.”

People with diabetes find welcome supportfrom pharmacists

CDA partnership helps broaden support

CDA Clinical Practice Guidelines

People living with diabetes find welcome support at Shoppers Drug Mart thanks to an array of programs it has developed, some inpartnership with the Canadian Diabetes Association. PHOTO: SHOPPERS DRUG MART

Understanding blood glucose levels critical in diabetes management

CDA blood glucose targets for people with diabetes*A1C Fasting blood Blood glucose two

glucose hours after the startof a meal

Target for most ≤7% 4 to 7 mmol/L 5 to 10 mmol/Lpatients with diabetes (5 to 8 mmol/L if A1C

targets are not being met)

*These targets are for most adults with diabetes and serve as a guide. Thezy do not apply to children 12years of age or under, or pregnant women. Talk to your doctor about YOUR blood glucose target ranges.

What is an A1C?A1C is a blood test that indicates an average of your overall blood glucose levels over thepast three to four months.

Also known as a hemoglobin A1C, glycosylated hemoglobin, HgbA1C and HbA1C, theA1C test levels are measured in different units and on a different scale than is blood glucose.According to the Canadian Diabetes Association, those living with the disease are welladvised to ask their physician about the A1C as staying in-target can reduce the potential forlong-term complications from diabetes. Source: www.ourdiabetes.com

Take Control of Your Diabetes!

Available wherever books are sold.

Filled with expert advice, these essential resources explore the complexworld of diabetes, bringing up-to-date information to your fingertips!

Diabetic Nerve Pain?Post-Shingles Pain? Chronic Nerve Pain?

Fast Relief fromNerve Related Pain.

• Works in minutesApply topically, as needed

• Non-prescription andno burning sensationNo disruptive side effects

• Clinically tested70% of users report reliefUp to 8 hours of relief

Neuragen is available at:

UPC Code: 851877000026 | For a store listing visitwww.neuragen.ca, for more information call 888-234-7256