Transcript: Diabetes | Nov 20, 2000

(music plays)
In animation, a title appears inside the shape of a house: “More to health.”

The opening sequence shows a wooden table with a small lit candle as several words fly by: Nutrition, medicine, prevention, treatment, health.
Fast clips show different sets of hands performing activities on the table such as pulling petals from a daisy, drawing a big red heart, tuning a violin, flipping through the pages of a book, cooking, and pouring a glass of red wine.
In animation, the title appears inside the shape of a house: “More to life.”

Then, Maureen Taylor appears in a studio with yellow walls and a small TV set in the background, which reads “More to life.”

Maureen is in her late thirties, with wavy blond hair in a bob. She's wearing a bright blue blazer over a black sweater.

She says I'M MAUREEN
TAYLOR, WELCOME TO “MORE TO LIFE.”
DURING THIS SHOW, SIX MORE
CANADIANS WILL BE DIAGNOSED
WITH DIABETES.
THEY'LL BE AT GREATER RISK
OF HEART DISEASE, BLINDNESS,
KIDNEY DISEASE, AND LIMB
AMPUTATION.
THIS AFTERNOON WE'RE GOING
TO TAKE A SERIOUS LOOK AT
DIABETES WITH Dr. IAN BLOOMER.

Ian sits in the studio. He’s in his early forties, clean-shaven, with receding gray hair. He’s wearing a gray suit over a black turtleneck.

Maureen continues HE'S AN INTERNAL MEDICINE
SPECIALIST AND DIRECTOR OF
THE DIABETES EDUCATION
CENTRE AT THE ROUGE VALLEY
HEALTH CENTRE.
IF YOU HAVE A QUESTION ABOUT
THE DIAGNOSIS AND MANAGEMENT
OF DIABETES GIVE US A CALL.

A caption reads "416-484-2727. 1-888-411-1234."
Then, it changes to "moretolife@tvo.org"

Dr. BLOOMER, WELCOME BACK.
HELLO.

Ian says OH, HELLO.

Maureen says I GUESS THERE'S
NO QUESTION DIABETES IS ON
THE INCREASE BUT DO WE KNOW
WHY?

The caption changes to "Doctor Ian Blumer. Internal Medicine Specialist."

Ian says IT'S HARD TO SAY.
IN SIGNIFICANT MEASURE IT'S
RELATED TO LIFESTYLE FACTORS,
MOST PEOPLE IT'S RELATED TO
BEING OVERWEIGHT AND CED
DENT TREE AND HAVING A
GENETIC PREDISPOSITION BUT
LIFESTYLE, IT'S A RELATIVELY
SEDENTARY SOCIETY.
SO THAT APPLIES TO A
MAJORITY OF PEOPLE AND IT'S
ALSO ON THE RISE IN KIDS AND
THAT'S A BIT HARRER TO KNOW
WHY.

Maureen says YEAH, THAT'S WORRY SOME.
IN CHILDREN THEY'RE STARTING
TO DETECT TYPE-TWO DIP BEAT
TIS.

Ian says THAT'S RIGHT, BECAUSE
THERE ARE AS YOU KNOW, THE
TWO DIFFERENT TYPES, THE
TYPE THAT WOULD
CONVENTIONALLY OCCUR IN
OVERWEIGHT ADULTS AND THE
TYPE THAT WOULD OCCUR IN
KIDS BUT A LOT OF KIDS
NOWADAYS, UP TO 25 percent OF NEWLY
DIAGNOSED DIABETIC, CHILDREN,
ACTUALLY HAVE THE TYPE TWO
FORM THAT WE USED TO
ASSOCIATE EXCLUSIVELY WITH
ADULTS.

Maureen says NOW YOU SAID
USUALLY IN OVER WEIGHT
ADULTS BUT YOU LOOK AT
SOMEONE LIKE MARY TYLER
MOORE.
I HAVE ANOTHER FRIEND WHO IS
DEFINITELY NOT OVER WEIGHT
AND SHE HAS TYPE TWO
DIABETES AND SHE WAS YOUNG
IN HER 30s WHEN DIAGNOSED.
WHAT'S GOING ON IN THOSE
PEOPLE?

Ian says WELL THAT'S A REALLY GOOD
QUESTION BECAUSE IT USED TO
BE WE WOULD DIFFERENTIATE IN
SPECIFIC TERMS.
TYPE ONE, 12 YEARS OF AGE OR
A KID, CERTAINLY YOUTHFUL,
AND YOU'D NEED TO BE ON
INSULIN STRAIGHTAWAY AND
THEN WE WOULD CONSIDER TYPE
TWO DIABETICS, PEOPLE IN 40s,
50s, 60s, OLDER, OVER WEIGHT
BUT THERE'S A LOT OF CROSS
OVER NOW.
A LOT OF PEOPLE WITH WHAT
APPEARS TO BE TYPE TWO,
FORMER LILY CALLED ADULT
DIABETES HAPPENS IN KIDS AND
PEOPLE IN THEIR 40s OR 50s
NEED TO BE ON INSULIN AND
BEHAVE MORE LIKE WHAT WE
USED TO SEE ONLY IN KIDS.
THE PREVIOUS IDEA THAT THE
CATEGORIES WERE ENGRAVED IN
STONE, THAT'S NO LONGER
APPLICABLE.

Maureen says SO THE TYPE ONE
AND TYPE TWO DESIGNATIONS
ARE REALLY A MATTER OF HOW
YOU'RE TREATING IT AND SOME
OTHER FACTORS.
YOU CAN'T DO A BLOOD TEST
AND SAY YOU'VE GOT TYPE ONE
AND YOU'VE GOT TYPE TWO.

Ian says NOT EASILY IN A SOMEWHAT
ACADEMIC WAY YOU COULD.
THERE IS A TEST CALLED
C-PEPTIDE ALLOWING AN
INDIRECT WAY OF MEASURING
PRODUCTION BUT FOR ALL
INTENTS AND PURPOSES WE
DON'T HAVE TO DO THAT
GENERALLY SPEAKING IT'S THE
OVERALL SITUATION AND
WHETHER OR NOT SOMEONE IS
PRODUCING ACIDS IN THEIR
URINE CALLED KEYTONE, THAT
OFTEN IS A STRONG CLUE AS
WELL.
THE SIM LARTS ARE QUITE
GREAT BETWEEN THE TWO TYPES
BECAUSE THE MAIN THINGS ARE
AVOIDING CLICK INDICATIONS,
WHETHER IT'S EYE DAMAGE
ORCHID KNEE DAMAGES THEY'RE
UNIFORM THROUGHOUT BOTH TYPE
ONE AND TYPE TWO DIABETES.
WE HAVE TO AVOID THEM IN
BOTH AND IF SOMEONE'S SUGAR
IS HIGH AND NOT RESPONDING
TO PILLS AND THEY'RE OVER
WEIGHT AND YOU THINK THEY'RE
TYPE TWO, YOU MIGHT
NONETHELESS HAVE TO GIVE
THEM INSULIN, WHICH AGAIN
TYPICALLY INSULIN WOULD BE
JUST WITH TYPE ONE JUVENILE
DIABETICS BUT THAT'S NOT
TRUE EITHER NOWADAYS.
MANY PEOPLE WATCHING WHO ARE
TYPE TWO DIABETICS ARE
NONETHELESS ON INSULIN
BECAUSE PILLS ARE NO LONGER
WORKING SUFFICIENTLY WELL
FOR THEM.

Maureen says SPEAKING OF ALL
THIS NEW DEFINITION AND
STUFF, LET'S TALK ABOUT THE
RESEARCH THAT'S GONE ON IN
EDMONTON INTO TRANSPLANTING
PANCREATIC CELLS IS THAT RIGHT?

Ian says SURE.
I'M GLAD YOU GAVE EDMONTON
CREDIT.
EVERYBODY THINKS THE
RESEARCH IS IN CALGARY.
NO, IT'S EDMONTON.
LET'S BE FAIR.
IT'S VERY EXCITING.
WHAT THEY DID WAS TOOK
EYELET CELLS WHICH ARE THE
ACTUAL CELLS WITHIN THE
PANCREAS WHICH PRODUCE THE
INSULIN.
SO WHAT THEY DID WAS
HARVESTED THESE EYELET CELLS
FROM CADAVERS AND IT TOOK
TWO CADAVERS TO OBTAIN
SUFFICIENT QUANTITIES THEY
COULD BE USED SO THEY
HARVESTED THESE EYELET SELLS
WHICH WAS TRADITIONALLY A
VERY LABORIOUS DIFFICULT
PROCESS BUT IT'S MUCH MORISM
PROVED NOW AND BASICALLY
SQUIRTED THESE EYELET SELLS
INTO THE SYSTEM OF A TYPE
ONE DIABETIC INDIVIDUAL.
SO THEY TOOK THESE EYELET
CELLS, VERY SIMPLE, WASN'T A
BIG SURGERY FOR THE
RECIPIENT, IT WAS ACTUALLY
FAIRLY SIMPLE.
INJECTED THESE
INSULIN-PRODUCING CELL, THE
CELLS TOOK UP RESIDENTS
WITNESS -- RESIDENCE WITHIN
THE LIVER AND SAW THEY WERE
HAPPY THERE AND STARTED TO
PRODUCE INSULIN.
AND THIS PROCEDURE WAS
PERFORMED ON JUST A FEW
PEOPLE, SIX PEOPLE, NONE OF
THEM HAVE REQUIRED INSULIN
AGAIN.
BUT IT'S VERY EARLY ON,
SMALL NUMBER, AND THE
PEOPLE -- I WOULD CONSIDER A
CURE IF SOMEONE RECEIVED
THESE EYELET CELLS, THREW
AWAY THEIR SYRINGES AND GLUE
COAST METRES AND NEVER
NEEDED ANYTHING ELSE DONE,
BUT THESE PEOPLE HAD TO BE
ON ANTIREJECTION DRUGS.
SO FATHER THEY'RE TOLERATING
VERY WELL, BUT THE LONG-TERM
IMPLICATIONS OF BEING ON
THESE DRUG, I THINK THE
COURT IS OUT ON THAT.
ARE THEY CURED?
NO, ARE THEY IN REMISSION?
YES, BUT WITH THE USE OF
OTHER DRUGS SO THEY STILL
HAVE SOMETHING ON THEIR
PLATE.

Maureen says ARE THEY
EXPANDING THOSE INTO WIDER
CLINICAL TRIALS?

Ian says THEY HAVE.
BECAUSE RESULTS WERE SO
FAVOURABLE, IT WAS TAKEN UP
A LITTLE BIT LARGER, STILL
QUITE SMALL A HUNDRED SITES.
WE'LL SEE HOW THINGS EVOLVE.
IT'S ENCOURAGING BUT I
WOULDN'T WANT ANY OF MY
PATIENTS TO SIGN UP FOR IT
YET.
I STILL THINK OF IT AS
HIGHLY EXPERIMENTAL.

Maureen says BACK INTO THE
AREA OF REALITY FOR THOSE
PATIENTS THAT ARE INSULIN
DEPEND DENT YOU'VE BROUGHT
ALONG SOME GADGETS.
DO YOU WANT TO SHOW THOSE?

Ian shows Maureen a syringe and says SURE.
THE TRADITIONAL WAY WAS TO
USE A SYRINGE WITH A NEEDLE
AT THE END, IF YOU WERE ON
TWO TYPES OF INSULIN, YOU
MAY HAVE TO TAKE ANOTHER
BOTTLE AND DROP SOME MORE,
AND IT WAS SOMEWHAT
LABORIOUS.
WOULD TAKE SEVERAL MINUTES
AT THE VERY LEAST.
YOU HAD TO BE CAREFUL ABOUT
NOT GETTING AIR BUBBLES IN
THERE BUT THEY'VE DEVELOPED
NEW TECHNOLOGIES.
THERE'S TWO COMPANY'S
PRODUCTS, BOTH OF WHICH I
THINK ARE EXCELLENT AND WORK
VERY WELL.
THESE ARE CALLED INSULIN PEN
DEVICES.
AND BASICALLY -- I DON'T
KNOW IF YOU CAN SEE IT THERE,
THERE'S A DISPOSABLE
CARTRIDGE, SORT OF LIKE THE
OLD PENS WE USED IN SCHOOL.
AND RATHER THAN FUSSING WITH
ALL THE BOTTLES, YOU CHANGE
THAT EVERY FEW DAYS, THIS
SCREWS APART AND GOES IN AND
THERE'S A LITTLE NUMBER
THERE, AND YOU JUST LOOK AT
THE NUMBER OF UNITS OF
INSULIN YOU WANT --

Maureen says OH, DIAL IT UP.

Ian says YOU DIAL IT UP, PUTS IT
IN YOU SKIRT IT, AND YOU PUT
IT AWAY, YOU'RE FINISHED.
SO THE WHOLE PROCESS WOULD
TAKE TEN SECONDS.
SO IT'S IMMENSELY EASIER
THAN THE OLD SYSTEM.
AND THE GREAT MAJORITY OF
PEOPLE WITH DIABETES NOW ON
INSULIN ARE PUT ON THIS OR
IF THEY WERE ON THE SYRINGE,
OFTEN THEY'RE CHANGED TO
THIS.
THE ONLY TIME I WOULDN'T
CHANGE IS IF SOMEONE'S BEEN
ON THE OLD STYLE FOR A LONG
TIME, THEY'RE QUITE
COMFORTABLE WITH IT, DON'T
FIND IT A MAJOR NUISANCE,
COMPARATIVELY SPEAKING.
YOU'RE NOT GOING TO TAPPER
WITH SOMETHING YOU'RE HAPPY
WITH.
BUT THE MAJORITY OF PEOPLE
FIND LIFE EASIER USING A PEN
DEVICE SIMILAR TO THIS.

Maureen says IS THAT MUCH
MORE EXPENSIVE WITH THE
CARTRIDGES HAVING TO BE
CHANGED?

Ian says THE PEN ITSELF GIVEN AWAY
FREE BY THE COMPANIES.
I THINK THEY MAKE THEIR
PROFIT FROM THE INSULIN AND
THEY CAN BE OBTAINED FROM
PHARMACIES AND SO ON AND SO
FORTH.
IT DOESN'T HAVE TO BE ON A
PRESCRIPTION.
AND THE COST OF THE INSULIN
IS ABOUT 10 percent MORE EXPENSIVE
MORE OR LESS THAN THE OTHER
INSULINS.
SO THERE IS A SLIGHT PRICE
INCREASE BUT AS DRUGS GO
IT'S NOT A PARTICULARLY
EXPENSIVE PRAUKT.

Maureen says IT IS EASIER.
THE FRIEND I WAS REFERRING
TO WE WERE OUT TO DINNER THE
OTHER NIGHT, A WHOLE TABLE
OF PEOPLE AND JUST
SURREPTITIOUSLY SHE PULLED
THIS THING OUT AND GAVE
HERSELF AN INJUNCTION, I
THINK I WAS THE ONLY ONE WHO
NOTICED THAT SHE'D DONE IT.

Ian says IT CAN BE
VERY DISCRETE.
EVEN THE ADS IN THE MEDICAL
JOURNALS SHOW A ROOMFUL OF
PEEP HE HE WILL AND THE
CAPTION ON THE ADD IS CAN
YOU FIND THE PERSON GIVING
INSULIN?
CAN BE VERY DISCRETE, SUBTLE,
FAST.
PEOPLE AT A LUNCH TABLE
OFTEN REACH UNDER THE TABLE
AND INJECT IT.

Maureen says RIGHT.
WE'RE TAKING YOUR QUESTIONS
THIS AFTERNOON ON DIABETES
FOR Dr. IAN BLUMER, HE IS
HEAD OF THE DIABETES
EDUCATION CENTRE AT ROUGE
VALLEY HEALTH CENTRE.

The phone numbers and email reappear briefly.

Maureen says AND RITA IS IN
SUDBURY.
HI RITA.

The Caller says HI HOW ARE YOU
DOING?

Maureen says GOOD, THANKS.

The Caller says I ENJOY YOUR SHOW
TREMENDOUSLY.

Maureen says THANK YOU.

The Caller says MY QUESTION IS
WITH REFERENCE TO LOW BLOOD
SUGAR, HYPOLIS SEEM I CAN'T.
MY QUESTION IS WHEN THESE
SPELLS OCCUR, CAN CONSTANT
SPELLS CAUSE DAMAGE TO
ORGANS?
CAN CONSTANT LOW BLOOD SUGAR
CAUSE DAMAGE TO ORGANS?

Ian says WELL IF
SOMEONE IS HAVING LOW BLOOD
SUGAR HYPOGLYCEMIA AS A
CONSEQUENCE OF DIABETES
THERAPY -- BECAUSE THERE'S
TWO BROADCAST GREASE OF LOW
BLOOD SUGAR.
ONE IS SEEN IN NON-DIABETICS
SEEN IN RESPONSE TO HIGH
CARBOHYDRATE MEAL, THAT'S
FAIRLY EXCEPTIONAL BUT IN
TERMS OF DIABETES MANAGEMENT
IS THE MAIN ADVERSE EFFECT
AS YOU POINT OUT IS LOW
BLOOD SUGAR.
LOW BLOOD SUGAR, FORTUNATELY,
TENDS TO BE TOLERATED VERY
WELL AND THE ONLY TIME THAT
PEOPLE GET PERMANENT BRAIN
INJURY IS IF THE LOW BLOOD
SUGAR GOES UNDETECTED,
PEOPLE LAPS INTO COMA AND
REMAIN IN A COMA FOR AN
EXTENDED PERIOD OF TIME.
HOURS AND HOURS, SIX, SEVEN,
EIGHT, 12 HOURS.
THE REASON I SAY THAT'S FOR
THE NAT THAT THAT SELDOM
CAUSES ANY BRAIN DAMAGE IS
BECAUSE WE RYE TO TREAT
PEOPLE WITH DIABETES
INTENSIVELY WITH INSULIN AND
PILLS.
AND IF WE COULDN'T DO THAT
FOR FEAR OF CAUSING LOW
BLOOD SUGAR, THEN WE'D
REALLY BE CONSTRAINED IN
TERMS OF REDUCING BLOOD SHUG
GARS AND PREVENTING
COMPLICATIONS.
BUT AS I SAY, LOW BLOOD
SUGARS TENT TO BE CALL RATED
SGL EVEN IF YOU HAD THE
MISFORTUNE OF BECOMING
UNCONSCIOUS FROM IT, IT
WOULD HAVE TO BE HOURS AND
HOURS BEFORE IT RESULTED IN
ANY PERMANENT INJURY.

Maureen says WHY WOULD THIS
BE OCCURRING IN A DIABETIC
FREQUENTLY?

Ian says TYPICALLY
IT'S SOMEONE WHO HAS WELL
CONTROLLED BLOOD SUGARS.
A NORMAL BLOOD SUGAR LET'S
SAY IS FIVE.
IF SOMEONE'S WAS 15, THEY
HAVE A LONG WAY TO GO BEFORE
THEY'RE GOING TO BECOME
HYPOGLYCEMIC, WHICH IS
TYPICALLY WHAT YOU SEE IS
PEOPLE WHO ARE TRYING REALLY
HARD -- AND THAT'S THE THING
THAT'S NOT FAIR ABOUT THIS
THIS IS AN ADVERSE EFFECT
THAT OCCURS IN PEOPLE WHO
ARE TRYING THEIR HARDEST AND
DOING THEIR BEST.
THEY HAVE VERY GOOD BLOOD
SUGAR CONTROL BUT IF YOUR
BLOOD SUGAR IS AVERAGING
FOUR OR FIVE YOU DON'T HAVE
MUCH ROOM TO MANOEUVRE
BEFORE YOU'RE DOWN IT A TWO
AND POTENTIALLY UNCONSCIOUS
AND THE MORE COMMON IT IS
THAT YOUR BLOOD SUGAR'S
REALLY AT A FINE LINE OF
BEING LOW THE LESS AWARENESS
YOU HAVE ABOUT LOW BLOOD
SUGARS.
SO IF SOMEONE COMES IN AND
REPEATEDLY HAVE LOW BLOOD
SUGAR, THEY'RE THE ONE WHOSE
SPLIGHT A BAD LOW AND NOT
SENSE IT COMING ON.

Maureen says IF I STUMBLE
ACROSS SOMEONE UNCONSCIOUS
WHO I KNOW IS DIABETIC WHAT
DO I DO?

Ian says WELL I
THINK THE FIRST THING TO
DO -- IF YOU KNOW FOR SURE
THEY'RE DIABETIC, THE FIRST
THING VALUE TO MAKE SURE
THEY'RE BREATHING AND SO
FORTH AND SEE IF THEY NEED
CPR BUT THAT ASIDE, IT'S
BEST TO JUST CALL 911.
PEOPLE EVEN UNCONSCIOUS FROM
LOW BLOOD SHUG GAS, ALMOST
ALWAYS THEIR BREATHING IS
SATISFY, THEIR HEART IS
BEATING OKAY, BLOOD PRESSURE
IS SATISFY, USUALLY YOU DO
HAVE THE TIME TO MAKE A CALL
FOR 91 1.
THERE IS HOWEVER -- I DIDN'T
BRING IT FOR DISPLAY
PURPOSES BUT IF THERE IS
SOMEONE PRONE TO LOW BLOOD
SUGARS AND TENDS TO BECOME
UNCONSCIOUS AND I HAVE SOME
PATIENTS WHO THAT'S NOT AN
INFREQUENT OCCURRENCE, IT'S
WORTH WHILE FOR FAMILY
MEMBERS TO HAVE SOMETHING
CALLED THE GLUCOCON KIT,
SORT OF LIKE AN EPI-PEN THAT
SOME KIDS KIDS OR ADULTS
WEAR IF THEY'RE ALLERGIC TO
PEANUTS, SO THIS IS AN
ANTIDOTE TO GIVE UNTIL AN
AMBULANCE ARRIVES AND FOR
SOMEONE WHO'S UNCONSCIOUS IT
WILL HELP TO RAISE THEIR
BLOOD SUGAR IN THE MEANTIME.

Maureen says THANK YOU FOR
BRINGING THAT UP.
MARIA IS IN KINCARDIN.
HI MARIA.
HI, MARIA?
HMM.
LET'S TRY JACKIE IN TORONTO.
HI JACKIE?

The Caller says OH, HI.
I WAS JUST WONDERING, MY
HUSBAND'S MOTHER HER MOTHER,
SO HIS GRANDMOTHER BOTH HAVE
TYPE TWO DIABETES AND I WAS
WONDERING WHAT ARE THE
CHANCES THAT MY CHILDREN
MIGHT GET DIABETES.

Ian says WELL, IF
THEY'RE THE ONLY ONES --
ALTHOUGH THAT DOES SOUND
LIKE A WORRY SOME FAMILY
HISTORY, AS LONG AS IT'S
JUST THAT SIDE OF THE FAMILY,
AS LONG AS THERE ISN'T
ANYBODY ON THE OTHER SIDE,
THE ODDS ARE QUITE SMALL.
PERHAPS 10 percent AND THAT'S NOT
ENGRAVED IN STONE EITHER.
IT'S LARGELY LIFESTYLE
RELATED.
IF YOUR CHILDREN ARE
ENKAURGEED TO BE PHYSICALLY
ACTIVE, PLAY SPORTS, DO NOT
SIT IN FRONT OF THE TV TOO
MUCH, IF THEY EAT PROPERLY,
THEIR LIKELIHOOD IS MUCH
SMALLER THAN IF UNIN THE
NALT THEY BECOME CED DENT
TREE, OVERWEIGHT AND THIS
SORT OF THING.
IF BOTH PARENTS IN A FOOLLY
HAVE DIABETES THE LIKELIHOOD
OF A CHILD HAVING IT MIGHT
BE AS HIGH AS 50 percent.
BUT AGAIN, THAT'S NOT
ENLAIVED STONE.
TYPE TWO DIABETES WHICH IS
REALLY WHAT WE'RE TALKING
ABOUT, THE ADULT TYPE, IS
LARGELY LIFESTYLE RELATED SO
IF THE KIDS DO THE RIGHT
THINGS THE ODDS ARE VERY
MUCH IN THEIR FAVOUR THEY'LL
BE FINE.

Maureen says IF IT WERE TYPE
ONE, IS THERE ANYMORE OF A
HEREDITARY FACTOR WITH THAT?

Ian says IT IS BUT
IT'S MUCH SMALLER, SO IF
THERE'S A FAMILY HISTORY OF
TYPE ONE, THE LIKELIHOOD IS
SMALLER THAN IF THERE'S A
FAMILY HISTORY OF TYPE TWO
DIABETES.

Maureen says COULD YOU TELL
US WHAT KEYTONES ARE?
THIS IS FROM CORRINE.

Ian says KEYTONES
ARE A TYPE OF ACID.
THEY'RE BASICALLY A
BREAKDOWN PRODUCT OF FAT
CELLS.
SO PEOPLE WHO ARE DIABETIC
ON INSULIN, WHO THEIR SUGARS
ARE WELL CONTROLLED, THEY
WOULD HAVE VIRTUALLY NO
KEYTONES TO BE PRESENT
BECAUSE THEY'RE USING SUGAR
AS THEIR FUEL.
BUT IF SOMEONE IS DIABETIC,
ON INSULIN AND THEY'RE NOT
GETTING SUFFICIENT
QUANTITIES OF INSULIN OR
THERE'S A PROBLEM WITH THE
DIET, THE BODY CAN'T UTILIZE
SUGAR PRODUCTS AS THE NORMAL
DAY TO DAY FUEL SO THE BODY
STARTS TO BURN FAT AS AN
ALTERNATIVE FUEL AND THE FAT,
AS IT'S MET TO BELIZED
PRODUCES THIS SUBSTANCE
CALLED KEYTONES FOUND IN THE
YOU'RE SCOMPRIN BLOOD IF YOU
LOOK FOR IT.
KEYTONES IN THEMSELVES
AREN'T A DANGEROUS THING,
IT'S MORE IF SOMEONE HAS A
LOT OF KEYTONES IT'S A CLUE
THEIR DIABETES ISN'T BE
SUFFICIENTLY MANAGED AND
THAT APPLIES TO TYPE ONE.
THE JUVENILE ON SET INSULIN
DENDENT, KEYTONE FACTOR
ISN'T A SIGNIFICANT FACTOR.

Maureen says IT'S MORE A
FACTOR IN TYPE ONE?

Ian says YES.

Maureen says GOT IT.
SARAH IN OSHAWA.
HI SARAH, WELCOME.

The Caller says I WAS DIAGNOSED
WITH GESTATIONAL DIABETES.
NOW I HAVE GIVEN BIRTH
ALREADY.
WHAT IS THE LIKELIHOOD OF
DEVELOPING DIABETES LATER ON
IN LIFE?

Ian says WELL,
THAT'S AN EXCELLENT QUESTION,
AND I THIT SOUND IMPRECISE
BUT THERE'S A HUGE RANGE.
THERE'S EVIDENCE THAT IF YOU
HAVE GESTATIONAL DIABETES,
NUMBER ONE THAT MEANS YOU
HAVE A GENETIC US
SEPTEMBERIBILITY TO BECOME
DIABETIC, A PREDISPOSITION.
IF YOU ARE OVERWEIGHT, AGAIN
I HATE TO SOUND LIKE A
BROKEN RECORD, OR BROKEN CD.
IF YOU'RE OVER WEIGHT AND
CED DENT TREE, DON'T EAT
PROPERLY, AS THE YEARS ROLL
BY YOU'RE LIKELY OF GETTING
OVERT, THE LIKELIHOOD CAN BE
AS HIGH AS 70 percent.
THAT'S HUGE.
BUT DON'T GET DEPRESSED
BECAUSE IF YOU'RE CAREFUL,
FOLLOW PROPER LIFESTYLE, GET
DOWNTA GOOD WEIGHT AFTER YOU
DELIVER, YOUR LIKELIHOOD CAN
BE AS SMALL AS 10 percent SO IT'S A
HUGE RANGE.
10 TO 70 percent AND OFF LOTS OF
CONTROL OVER THAT YOU CAN'T
CONTROL THE FACT THAT YOU
GOT GESTATIONAL DIABETES.
YOU CAN'T CONTROL YOUR
GENETIC DESTINY BUT YOU CAN
CONTROL THE OTHER
INFLUENCING FACTORS TO A
LARGE EXTENT.

Maureen says WHAT IS
GESTATIONAL DIABETES AND WHY
DID ROSE -- SORRY, SARAH GET IT?

Ian says GESTATIONAL DIABETES IS A
TRANSIENT FORM OF DIABETES.
IT'S BASICALLY THE ONLY TYPE
THAT IS TEMPORARY.
IT COMES ON BECAUSE OF THE
STRESS ON THE BODY OF
PREGNANCY.
PREGNANCY INDUCES WHAT'S
CALLED INSTANT RESISTANCE,
MEANING THE INSULIN IN OUR
BODIES DOESN'T WORK AS
EFFECTIVELY AS IT MIGHT IF
YOU WEREN'T PREGNANT.
SO YOUR BODY, WITH THIS
INSULIN RESISTANCE, YOU HAVE
A TENDENCY TO BECOME DIB BET
IF I CAN YOU'RE SUSCEPTIBLE.
NOW THE SIGNIFICANCE OF
GESTATIONAL DIABETES ISN'T
FOR THE INDIVIDUAL WITH IT
THE MOM WITH IT.
THAT'S NOT THE CONCERN.
THE CONCERN IS THAT THE
MOM'S SUGAR IS HIGH, THE
SUGAR GETS INTO THE BABY
CIRCULATION AND IT'S LIKE FEEDING
THE BABY WHILE STILL INSIDE
THE UTERUS SO THESE BABIES
TEND TO BE ON THE LARGE
SIDE.
BUT THAT DOESN'T HAVE TO BE
THE CASE.
AGAIN, IF THE MOM HAS
GESTATIONAL DIABETES, IF
IT'S WELL CONTROLLED, THE
BABY'S GOING TO BE EXPOSED
TO NORMAL SUGARS AND THE
LIKELIHOOD IS GREATER THE
BABY WILL BE FINE.
GESTATIONAL DIABETES IS
DIAGNOSED VERY COMMONLY AND
I TRY TO REASSURE THESE MOMS
THAT THE GREAT MAJORITY OF
BABY, REGARDLESS OF WHAT YOU
DO, ARE PERFECTLY HEALTHY,
BEAUTIFUL BABIES.

Maureen says NOW I'VE READ
RECENTLY THAT THEY THINK NOW
THEY MAY BE ABLE TO TREAT
GESTATIONAL DIABETES A
LITTLE DIFFERENTLY.
CAN YOU TALK ABOUT THE ONE
STUDY --

Ian says SURE NO
I'D BE HAPPY TO GESTATIONAL
DIABETES, GOES AWAY AS SOON
AS YOU HAVE YOUR BABY,
TRADITIONALLY TREATED IT
PRIMARILY WITH DIET THERAPY.
IF MODIFYING YOUR DIET
DOESN'T ACHIEVE OPTIMAL
BLOOD GLUCOSE CONTROL WE'VE
USED INSULIN, GENERALLY
GIVEN TWO TO FOUR TIMES PER
DAY.
PILLS THAT WE USE FOR
DIABETES, THE MOST COMMON
ONE BEING CALLED DIA BEMD T
OR GLYBURIDE, IT'S BEEN
THOUGHT TO BE TERATOGENIC,
LIKE THALIDOMIDE, DANGEROUS
TO A FEET TUESDAY.
SO WE'VE NEVER USED IT.
THE DRUG COMPANY HAS NEVER
ADVOCATED ITS NEWS THAT
SETTING AND TEXT BOOKS HAVE
ALWAYS ADVOCATED NOT USING IT.
BUT RECENTLY THERE WAS A
GROUP OF RESEARCHERS THAT
STEPPED BACK AND SAID WELL
MAYBE WE WERE WRONG.
MAYBE IT ACTUALLY IS QUITE
SAFE AND EFFECTIVE SO AGAIN
A SMALL STUDY RECENTLY
COMPLETED, UNPUBLISHED --
AND PUBLISHED IN A VERY
REPUTABLE JOURNAL LOOKED AT
A GROUP OF MOMS WITH
GESTATIONAL DIABETES, PUT
THEM ON DIABETA, NO
COMPLICATIONS DEVELOPED AND
BLOOD CONTROL'S VERY GOOD
WOULD.
THAT CHANGE MY PRACTICE?
NO.
NO WAY.
NOT AT THIS STAGE.
MAYBE LATER AS MORE STUDIES
COME OUT, MORE WELL-KNOWN
RESEARCHERS DUPLICATE THE
DATA, THEN I MIGHT
RECONSIDER.
SO BASICALLY IT DOES MEAN
THAT THERE MAY BE A CHANGE
IN THERAPY FOR GESTATIONAL
DIABETES ON THE HORIZON, BUT
I WOULDN'T ADVOCATE THAT
CHANGE AS YET.

Maureen says OKAY.
LET'S GO TO ROSE IN
SCARBOROUGH.
HELLO, ROSE.

The Caller says HI THERE.

Maureen says HI.

The Caller says GO AHEAD.

Maureen says I JUST TO WANT
ASK THE DOCTOR A QUESTION.
MY HUSBAND IS ON INSULIN,
BUT HE TAKES IT TWICE A DAY,
IN THE MORNING HE TAKES 45
OF THE M AND 18 OF THE R AND
IN THE NIGHT HE TAKES 15
UNITS OF THE M AND 10 UNITS
OF THE R.
WHAT I WANTED TO KNOW WAS
THAT PEN YOU WERE JUST
SHOWING US, WOULD THAT BE --
WOULD WE BE ABLE TO HAVE THE
UNITS IN THAT PEN?
BOTH?

Maureen says THE MIXTURE OF THEM.

Ian says SURE.
WHAT THE COMPANIES THAT MAKE
THESE PEN DEVICES HAVE DONE
IS MADE A BROAD RANGE OF
PRE-MIXED INSULINS,
BEGINNING THE TWO YOUR
HUSBAND IS ON.
THE SHORT ACTING REGULAR
INSULIN, THE TORONTO INSULIN
AND THE LONGER-ACTING CALLED
NPH SO THEY HAVE A PRE-MIXED
RATIO OF THAT THAT FITS IN
THE CARTRIDGE, AND IT MAY
NOT BE THE EXACT SAME RATIO
AS YOUR HUSBAND IS ON, BUT
THERE WOULD BE A SIMILAR
RATIO AVAILABLE.
NOW SO THE QUICK ANSWER IS
YES, YOUR HUSBAND COULD BE
ON A PEN DEVICE, AS LONG AS
HIS PHYSICIAN FIGURES OUT
EXACTLY WHICH PARTICULAR
TYPE OF INSULIN CARTRIDGE TO
USE.
HAVING SAID THAT I JUST
RECEIVED A MAILING LAST WEEK
THAT ONE OF THE TWO MAJOR
INSULIN MANUFACTURERS IS
GOING TO BE STREAMLINING OR
REDUCING THE RANGE OF PRE
MIXING SOME PRODUCTS THEY
HAVE, HOWEVER I HAVEN'T
HEARD THAT FROM THE OTHER
COMPANY.
SO THE LONGER ANSWER NONE
THE LST GETS TO THE BOTTOM
LINE THAT YES, YOUR HUSBAND
LIKELY WOULD BE A CANDIDATE
FOR A PEN DEVICE.

Maureen says OKAY.
WHY CAN'T THEY JUST MIX THEM
ALL UP IN ONE BOTTLE NOW FOR
THE PEOPLE INJECTING THEM
WITH A HYPODERMIC NEEDLE?

Ian says YOU COULD
BUT THEY TRY TO MAKE IT IN A
CONVENIENT SIZE.
THEY WOULD HAVE BIGGER
BOTTLES BUT IT WOULD MAKE
THE DEVICE A BIT UNWIELDLY.
THE THREE MILLIMETRE
CARTRIDGE ALLOWS IT TO
BASICALLY FIT IN YOUR POCKET,
RATHER THAN A BOTTLE WHICH
WOULD BE A BIT MORE
CUMBERSOME.
BUT YOU CAN GET PRE MIXED IN
A BOTTLE BUT THEN YOU GO
BACK TO USING SYRINGES.

Maureen says CAN YOU TELL US
WHAT THESE THINGS ARE?

She points at two square plastic devices which resemble battery packs.

Ian says SURE, I'D
BE HAPPY TO.
THESE ARE CALLED -- AGAIN
NOT TO SHOW FAVOURITISM,
THESE ARE CALLED INSULIN
PUMP DEVICES.
AND BASICALLY -- LIKE THIS
ONE MADE BY MEDIMED
CORPORATION, YOU TAKE
INSULIN -- IT FILLS A VIAL
INSIDE THIS AND YOU WEAR AND
IT'S AN INSULIN PUMPLT YOU
WEAR IT ON YOUR POCKET.
I HAVE MY PAGER ON, THEY'RE
NOT THAT DISSIMILAR IN SIZE.
SO BASICALLY YOU WEAR THIS
AND YOU WEAR IT ON YOUR BELT
AND IT'S GOT A LITTLE
PLASTIC TUBE --
AH, HERE WE GO.
I'M NOT
GOING TO INSERT IT.
YOU WEAR IT ON YOUR BELT AND
THIS IS TUNNELED WITH A
LITTLE PLASTIC THING UNDER
YOUR SKIN LIKE YOUR ABDOMEN.

Maureen says DOES HURT?

Ian says NO!

Maureen says ISN'T IT
SOMETHING PICKING YOU ALL
DAY LONG?

Ian says NO,
BECAUSE THE INTRODUCER, THAT
STINGS A TOONIE BIT BUT YOU
WITHDRAW THAT AND YOU'RE
LEFT WITH A LITTLE PLASTIC
SHEATH WHICH IS VERY TINY
AND FITS UNDERNEATH THE
SKIN.
SO NO, IT DOESN'T HURT AT
ALL.
AND IT WORKS WELL AND THE
ADVANTAGE TO THIS IS THAT
YOU DON'T HAVE TO FUSS ALL
DAY, AT ALL, WITH PEN DIESES
OR ANYTHING.
THIS IS A CONTINUAL -- IT'S
PROGRAMMABLE, LIKE A MINI
COMPUTER SO BASICALLY YOU
CAN PROGRAMME THIS TO GIVE A
CERTAIN AMOUNT OF INSULIN ON
A CONTINUOUS BASIS TO
STREAMLINE BLOOD SUGAR
CONTROL.
AND THEN IF YOU'RE ABOUT TO
EAT A MEAL, AND YOUR BLOOD
SUGAR IS GOING TO GO UP, YOU
JUST TRUKT THIS DEVICE TO
GIVE WHAT'S CALLED A BOLUS
OF INSULIN, EXTRA FEW UNITS
TO COVER THE RISE IN SUGAR.
AND WHAT I JUST SAW WHICH I
THOUGHT WAS REALLY NEAT,
REALLY COOL, WAS THIS.
WHICH LOOKS LIKE THOSE
LITTLE THINGS THAT YOU WOULD
WEAR ON YOUR KEY CHAIN.

Maureen says WELL THIS IS ON
YOUR KEY CHAIN TO OPEN YOUR DOOR.

Ian says RIGHT BUT
THIS ISN'T FOR OPENING UP
YOUR CAR, IT'S FOR OPENING
UP YOUR INSULIN CART TRIVELT
BASICALLY IF YOU'RE AT A
MEAL AND IT'S TIME TO GIVE A
BOLUS, YOU JUST TAKE THIS
OUT OF YOUR POCKET, PRESS IT
A COUPLE OF TIMES AND IT
GIVE US A BOLUS OF INSULIN.

Maureen says BY REMOTE
DISPLOL.

Ian says ISN'T
THAT AMAZING?

Maureen says IT IS.
I FEEL LIKE THESE ARE
CHRISTMAS GIFT IDEAS FOR THE
DIABETIC.
WHAT IS THIS --

Ian says WELL IT
MIGHT BE A CHRISTMAS GIFT IF
YOU'RE RELATED TO CONRAD
BLACK BUT THEY'RE QUITE
EXPENSIVE.
THOSE DEVICES COST ABOUT
5,000 dollars, AND SUPPLIES AND SO
FORTH WILL COST YOU ANOTHER
THOUSAND OR TWO PER YEAR SO
THEY'RE VERY EXPENSIVE.
NOW HAVING SAID THAT SOME
INSURANCE PLAN ALSO COVER
THEM.
A LOT WON'T.
MOST WOVELT BUT SOME
INSURANCE PLANS WILL, AND
THE COMPANIES -- AND I'M NOT
MARKETING THIS, I DON'T GET
MONEY FOR IT BUT THE
COMPANIES ALSO HAVE A
PROGRAM THAT IF YOU ARE
DISSATISFIED WITH THE
PRODUCT IN ANY WAY FOR A FEW
MONTHS YOU CAN RETURN IT AND
GET YOUR MONEY BACK.
I THINK IT'S A VERY GOOD
DELIVERY DEVICE.
AGAIN DOESN'T GET AWAY FROM
YOU HAVING DIABETES AND
HAVING TO MONITOR BLOOD
SUGARS, BUT MOST PEP PEOPLE
IF THEY CAN GET AWAY FROM
WORRYING ABOUT PULLING OUT
THE SYRINGE, EVEN WITH THE
PEN DEVICE, MOST PEOPLE FIND
THEIR LIFESTYLE IS BETTER
SUITED TO IT.

Maureen says DO YOU NEED IT
AT NIGHT WHEN YOU'RE
SLEEPING?

Ian says Yes.

Maureen says WHAT DO YOU
ATTACH IT TO THEN?

Ian says WELL THERE'S LONGER
TUBING AVAILABLE AND SOME
PEOPLE PUT IT ON THEIR
BEDSIDE TABLE AND IT GIVES
INSULIN THROUGH OUT THE
EVENING.
YOU CAN DETACH IT FOR
RELATIVELY SHORT PERIODS OF
TIME IF YOU'RE GOING TO BE
BATHING OR SWIMMING FOR HALF
AN THOUR AN HOUR AT A TIME
AND THEN JUST REATTACH IT.
YOU DON'T HAVE TO PUNCTURE
YOUR SKIN AGAIN.
THE PLASTIC THING HAS A STOP
DEVICE.

Maureen says VERY COOL.
ALL RIGHT, LAWYER VEN IN
ATON?
IS THAT RIGHT?

The Caller says YES IT IS.

Maureen says HI.

The Caller says YES, I GOT A
COUPLE QUESTIONS HERE.
THE FIRST ONE IS I WAS
DIAGNOSED THREE MONTHS AGO
AT 15.7 AFTER FASTING.
I'M NOW, I TAKE MY BLOOD
SUGAR ONCE, ONCE A DAY BUT I
AVERAGE IT OUT, I'M DOWN TO
AVERAGE IN A WEEK BETWEEN
7.4 TO 8.3 NOW.
WHAT SHOULD I BE AT?
I KNOW THE OPTIMUM IS FIVE,
BUT THAT'S KIND OF DIFFICULT
TO GET WHEN YOU'RE ON
METFORMET, IS IT NOT?

Ian says WELL IT'S
AN EXCELLENT QUESTION, AND
THE TARGET BLOOD SUGAR, WHAT
WE WOULD BE TRYING TO
ACHIEVE YOU'RE RIGHT IS MORE
AGGRESSIVE THAN THAT.
MIGHT BE AS LOW AS FOUR OR
FIVE OR SIX AND CAN BE VERY
DIFFICULT IN ORDER TO TARGET
THAT.
THERE'S A FEW THINGS.
FIRSTLY, I WOULD TRY REALLY
HARD NOT TO CONFINE YOUR
BLOOD SUGAR MEASUREMENTS TO
A SINGLE TIME OF DAY BECAUSE
YOU MIGHT BE MISLEADING
YOURSELF.
YOU MIGHT THINK YOUR SUGARS
ARE WELL CONTROLLED ONLY TO
FIND IF YOU'RE CHECKING AT
OTHER TIMES IN THE DAY
THEY'RE HIGHER THAN YOU
MIGHT HAVE ANTICIPATED.
METFORMIN WHICH IS A TYPE OF
PILL, ALSO CALLED GLUCOPHATE
OFTEN BY ITSELF IS DIFFICULT
TO ACHIEVE GOOD BLOOD SUGARS
BUT YOU HAVE TO STRIVE FOR
OPTIMAL.
OPTIMAL MEASURING BEFORE
MEAL, FOUR, FIVE, SIX.
THE OTHER THING YOU CAN DO,
AND THIS ACTUALLY IS A NICE
LEAD-IN FOR SOMETHING ELSE I
BROUGHT WHICH I'LL SHOW YOU,
IS YOU SHOULD ASK YOUR
FAMILY DOCTOR WHAT YOUR
HEMOGLOBIN A 1C, OR
GLYCOCICATDE MIEHM GLOBE BIN
IS.
BASICALLY, SUGAR ATTACHES TO
THE RED BLOOD CELL, AND IT
CAUSES A STRUCTURAL
DEFORMITY, SLIGHT CHANGE IN
THE WAY THIS SUBSTANCE LOOKS
AND THE SUBSTANCE IS CALLED
HEMOGLOBIN SO HEMOGLOBIN A
1C IS A TEST WHICH MEASURES
OVER ALL SUGAR CONTROL SO,
TO COMPLIK HOME BLOOD
GLUCOSE READINGS YOU OR
ANYBODY'S DOING, THEY SHOULD
FIND OUT WHAT THEIR A 1C
VALUE.
NORMAL FOR MOST LABORATORIES
IS AROUND 6 percent.
BY HIGHER READINGS IS GOOD
AS LONG AS IT'S NOT TOO BAD.
BUT A READING OF 9 percent OR 10 percent
IS REALLY NOT VERY GOOD AT
ALL.
BY WAY OF ILLUSTRATION,
LET'S PRETEND THAT THIS IS A
NORMAL HEMOGLOBIN MOLECULE,
WHICH IS A MOLECULE WITHIN
THE RED BLOOD CELLS AND IS
ALL RED BUT THE SUGAR
ATTACHES IN INCREASING
AMOUNT DEPENDING ON YOUR
BLOOD SUGAR.
I DON'T KNOW IF YOU CAN SEE
THE YELLOW DOTH ON THERE BUT
BASICALLY THE MORE SUGAR YOU
HAVE, THE MORE IT ATTACHES
THERE AND CAUSES A SLIGHT
DEFORMITY.
AND IF IT WAS PARTICULARLY
BAD, AGAIN BY WAY OF
ILLUSTRATION, YOU CAN SEE
ALL THE YELLOW DOTS ON THIS.
AND THIS REFLECTS THE
TRANSITION FOR THE RED BLOOD
CELL AS MORE AND MORE SUGAR
ATTACHES TO IT.
AND THAT ATTACHMENT IS
PERMANENT FOR THE LIFE SPAN
OF THAT RED BLOOD CELL.
SO AGAIN FOR YOU OR ANYBODY
WITH DIABETES IN ADDITION TO
MONITORING YOUR BLOOD SUGAR,
TRYING TO GET THEM DOWN TO
FOUR, FIVE, SIX, THAT SORT
OF RANGE BEFORE MEALS, ASK
YOUR FAMILY DOCTOR OR
SPECIALIST YOU'RE SEEING
WHAT YOUR A1C LEVEL IS AND
WHAT IT SHOULD BE AS AN
INDIVIDUAL.

Maureen says HOW DOES HE GET IT DOWN?

Ian says WELL IT
CAN BE VERY DIFFICULT.
IT'S A COMBINATION OF
THINGS.
AGAIN, THE LIFESTYLISH SHOE
AND THEN OFTEN PILLS ARE
USED IN TYPE TWO DIABETICS.
TRY ONE PILL.
AND WE'RE VERY AGGRESSIVE
THESE DAYS AND DOCTORS THAT
AREN'T AGGRESSIVE SHOULD BE.
WE WANT TO OPTIMIZE BLOOD
SUGAR CONTROL.
IF ONE ISN'T DOING IT, ADD A
SECOND, IF A SECOND ISN'T
DOING IT ADD A THIRD OR USE
INSULIN ARE A COMBINATION.
WE NEVER USED TO DO THAT WE
USED TO PUT PEOPLE ON ONE
PILL AND SAY THEY'RE FAIRLY
DECENT NOW, DON'T WORRY
ABOUT IT.
WE KNOW A LOT BETTER NOW
THERE.
HAVE BEEN A LOT OF STUDIES
THAT HAVE COME OUT OVER THE
PAST TEN YEARS WHICH SHOWS
WE WERE WRONG TO HAVE A
LAISER FAIRE ATTITUDE
TOWARDS TYPE TWO DIABETES.
WE HAVE TO BE AGGRESSIVE.
THAT MEANS I'M ASKING LOTS
OF PATIENTS TO DO TONS OF
THINGS.
MONITOR THEIR SUGAR,
SOMETIMES TO MONITOR THEIR
URINE, ASKING THEM TO GET
THESE A1C TESTS DONE, ASKING
THEM TO TAKE ONE PILL AND
ANOTHER PILL AND ANOTHER AT
A HIGHER DOSE.
WHAT I KNOW THOUGH IS IF WE
CAN GET A PATIENT, AN
INDIVIDUAL'S BLOOD SUGAR
DOWN TO A BETTER LEVEL, NOT
NORMAL, JUST BETTER THAN IT
WAS, THAT WILL REDUCE THEIR
RISK OF BLINDNESS, KIDNEY
FAILURE, NERVE DAMAGE, AND
THE LOWER WE CAN GET IT THE
BETTER THEY'RE GOING TO DO
IN TERMS OF PREVENTING
COMPLICATIONS.

Maureen says GOOD LUCK, LORNE.
JIM IS IN BUFFALO WATCHING
THE SHOW.
43 YEARS OLD, 6 foot 2, 190 POUNDS.
FOR MOST OF MY LIFE I'VE
BEEN SLIGHTLY UNDER WEIGHT,
165 POUND BUT IN THE LAST
TEN YEARS I'VE GAINED.
I GENERALLY EAT WELL BUT
TEND TO SUGAR BINGE BETWEEN
MEALS.
A LARGE ESPRESSO OR LATE
AFTER DINNER WITH FOUR OR SO
TEASPOONS OF SHUG DISBAR A
MINIMUM.
AM I INCREASING MY RISK OF
TYPE TWO DIABETES BY THIS
BINGEING?

Ian says TYPE TWO IS GENERALLY
PRESIDED BY SOMETHING CALLED
IMPAIRED GLUCOSE TOLERANCE
MEANING YOUR BODY DOESN'T
HANDLE SUGARS AS WELL AS IT
SHOULD BUT THE SUGARS AREN'T
HIGH ENOUGH TO LABEL YOU AS
HAVING DIABETES.
SO THERE'S A TRANSITION FROM
NORMAL TO IMPAIRED SUGARS TO
FRANK DIABETES.
THAT TERM -- THE QUESTION
REALLY IS THAT ENEXABLE IS
THERE A WAY OF INTERRUPTING
THAT PROGRESSION?
CAN YOU STOP IT AT SOME
LEVEL FROM GOING ON?
THERE'S ACTUALLY A STUDY
GOING ON IN THE STATES NOW
WITH MANY THOUSANDS OF
PATIENTS TO LOOK AT THAT
EXACT ISSUE.
BASICALLY THEY'RE SAYING IS
THE GENETIC ROLE SO STRONG
THAT REGARDLESS OF WHAT I DO
I'M BOUND TO GET IT?
AND THAT'S WHAT THEY'RE
LOOKING AT.
LOGIC DICTATES THERE'S A
GREAT WAY TO PREVENT IT.
THE GREAT MAJORITY OF TYPE
TWO DEEB BET PARTICULARS ARE
OVER WEIGHT, LARGELY RELATED
TO LIFESTYLE, OF COURSE THE
BULK OF THAT WE'RE TALKING
ABOUT DIET.
IS THE LIKELIHOOD OF
DIABETES INCREASED IF YOU
BINGE SNEET NOT SOCHT BING
EATING, IT'S INAPPROPRIATE
EATING.
SURE ENOUGH, IF YOU'RE OVER
WEIGHT, YOU COULD.
IF YOU'RE SLIM, YOU'RE FAR
LESS LIKELY TO GET DIABETES.

Maureen says OKAY.
HANG ON, KATHLEEN, YOU'RE
WATCHING “MORE TO LIFE” THIS
AFTERNOON.
I'M MAUREEN TAYLOR AND MY
GUEST IS Dr. IAN BLUMMER, AN
INTERNAL MEDICINE SPECIALIST
AND WE'RE TALKING ABOUT
DIABETES THIS AFTERNOON.

The phone numbers and email reappear briefly.

Maureen says AND KATHLEEN'S
SARNIA.
HI KATHLEEN.

The Caller says HI.

Maureen says HI.
GO AHEAD.
WHAT'S YOUR QUESTION?

The Caller says YEAH, WELL THE
CHAP THERE JUST A FEW
MINUTES AGO, I GOT A LITTLE
BIT OF A COLD.
I HOPE YOU CAN UNDERSTAND ME.

Maureen says YEAH, I CAN.

The Caller says ANSWER SOME OF MY
QUESTIONS.
BUT LIKE I TAKE FOUR
METFORMEN A DAY OF 500 GRAMS
AND US TAKE ONE 800
MILLIGRAMS OF TIAMICRON, AND
I'M WONDERING IF THAT'S TOO
MUCH PILLS TO TAKE.
THAT'S ONE OF MY QUESTIONS.

Ian says WELL I'D
BE HAPPY TO ANSWER THAT.
SO YOUR FAMILY DOCTOR OR
SPECIALIST WHO EVER'S
TREATING, YOU IT SOUNDS LIKE
THEY'RE BEING AGGRESSIVE, AS
WELL THEY SHOULD AND HAVE
YOU ON TWO DIFFERENT TYPES
OF MEDICINE, METFORMI NRGESD
THE WHITE PILL, AND THE
OTHER PILL CALLED DIMD
AMECRON, BASICALLY FROM THE
SAME FAMILY OF DRUGS AS WHAT
WE TALKED ABOUT BEFORE, AND
YOUR FAMILY DOCTOR OR WHO
EVER IS TREATING YOU CLEARLY
RECOGNIZED ONE TYPE OF DRUG
BY ITSELF WASN'T SUFFICIENT
AND ADDED A SECOND IS IT A
LOT OF PILLS TO TAKE?
ABSOLUTELY.
IS IT WORTH DOING?
ALMOST CERTAINLY, YES.
PEOPLE DON'T WANT TO TAKE A
LOT OF PILLS.
FID DEEB BEAT TIS I WOULDN'T
TO WANT TAKE A LOT OF PILLS
BUT IF I KNEW TAKING ALL
THOSE MEDICINES GETTING MY
BLOOD SUGARS DOWN REDUCED MY
RISKS OF BEING BLIND AND ON
DIAL CIRCUMSTANCE I THINK
I'D ACCEPT DISMEM SAY I'D BE
WILLING TO DO IT BECAUSE
THERE'S A NET GAIN TO BE
MADE.
OF COURSE IT'S NOT PLEASANT
TO TAKE ALL THOSE PILLS AND
I CAN'T BLAME PEOPLE FOR
SAYING TO ME YOU KNOW, DOC,
HATE THIS IDEA.
BUT IT'S VERY WORTH WHILE
FOR THE GREAT MAJORITY OF
PEOPLE.

Maureen says ARE YOU REALLY
TRY PHYSICAL DIABETES
MANAGEMENT TO KEEP SOMEONE
ON OR RAL INSULIN BEFORE
THEY HAVE TO GO INTO
INJECTED INSULIN?
IS THAT THE PHILOSOPHY?

Ian says WELL, ORAL INSULIN IN THE
CONVENTIONAL SENSE OF A PILL
ISN'T AVAILABLE AS YET
BECAUSE IT GETS CHEWED UP IN
THE STOMACH.

Maureen says SO WHAT IS SHE
TAKING THERE?

Ian says ANOTHER
PILL, IT'S CALLED A SULPHANA
UREAL TYPE OF PILL, IT'S
ABSORBED INTO THE
BLOODSTREAM AND STIMULATES
THE PANCREAS TO PRODUCE YOUR
OWN INSULIN.
IT'S BATHE OF A PUSH TO
SMART TEN UP, MAKE SOME INS
LANE.

Maureen says HEY, YOU!

Ian says YEAH, RIGHT.
GET GOING SO DRAD
TELEVISION WE STARTED IN
PEEP WITH TYPE TWO -- GET
GOING.
SO TRADITIONALLY WE STARTED
IN PEOPLE WITH TYPE TWO
INSULIN, STARTED THEM,
PROGRESSED TO ADDITIONAL
PILL, AND IF THOSE WEREN'T
ACHIEVING OUR GOAL WE'D USE
INSULIN.
BUT WE'RE INCREASINGLY
AGGRESSIVE NOW AND I OFTEN
PUT PEOPLE ON INSULIN
EARLIER THAN I WOULD HAVE
BEFORE BUT NOW I SAY TO
PATIENTS WE SHOULDN'T
PROCRASTINATE, WE SHOULD TRY
TO GET YOUR BLOOD SUGARS
DOWN FAIRLY PROMPTLY.
AND I DON'T MEAN OVERNIGHT,
BUT WEEKS OR MONTHS AND
CERTAINLY FOREOR SIX MONTHS
AND IF WE'RE NOT MAKING HEAD
WAY, I IN THE INSULIN IF THE
PILLS WEREN'T CUTTING IT.
WHEREAS BEFORE I USED TO LET
MY ARM GET TWISTED, NOW I
REVERSE IT A BIT.

Maureen says WHAT WERE THE
HEALTH RISKS ON WAITING TO
THE INSULIN.

Ian says WHEN MOST PEOPLE ARE
DIAGNOSED AS HAVING TYPE TWO
DIABETES THEY'VE GENERALLY
HAD IT FOR FIVE OR TEN YEARS
WITHOUT NOTICING.
IT'S LIKE SOMEONE WHO HAS
APPENDICITIS ONE DAY AND THE
NEXT AND TWO OR THREE WEEKS
LATER THEY'RE FINE WITH.
TYPE TWO DIABETES, THEY'VE
ALREADY HAD IT FOR A WHILE.
I OFTEN WILL SEE PEOPLE WITH
NEWLY DIAGNOSED DIABETES,
THEY THINK IT'S A NEW
PROBLEM, I LOOK IN THE BACK
OF THEIR EYES AND SEE THEIR
BLOOD VESSELS ARE ALREADY
DAMAGED.
SO IT'S BEEN THERE FOR A
WHILE.
WHEN SOMEONE COMES IN WITH
HIGH BLOOD SUGAR, IT'S NOT
THE LUCKARY OF SAYING WE
HAVE FOUR, FIVE, SIX YEARS
TO GET YOUR SHUG GARS UNDER
CONTROL.
IT'S NO RUSH.
SUBTLE CHANGES MAY ALREADY
BE OCCURRING IN THEIR BODIES
SO IT'S IMPORTANT TO GET
THINGS IN CHECK.
BUT AGAIN, I WANT TO STRESS,
PEOPLE SHOULDN'T BE
APPREHENSIVE AND FEEL THEY
HAVE TO GET SHUG GARS DOWN
OVERNIGHT.
NO, A FEW MONTHS IS PLENTY
OF TIME TO OPTIMIZE THING,
JUST NOT YEARS.

Maureen says TO LISA YOU NO
IN PETERBOROUGH.
HI LISA.

The Caller says I ACTUALLY HAVE
TWO QUESTIONS.
SOMEONE I'M A TYPE ONE
DIABETIC, THERE'S NO HISTORY
OF IT IN MY FAMILY AND I
HAVE 12 MONTH OLD SON AND I
JUST WONDERED ABOUT THE RISK
TO HIM.
AND MY SECOND QUESTION IS I
LOST MY SIGHT SIX YEARS AGO
DUE TO COMPLICATIONS AND
CURRENTLY USE A COUNTER DOSE
TO -- A COUNT-A-DOSE TO
CURRENTLY TAKE MY INSULIN,
AND I DIDN'T KNOW IF THERE
MIKT BE ANY NEW PRODUCTS
THAT WOULD MAKE IT A LITTLE
EASIER TO DO THAT.

Ian says WITH REGARD TO THE FIRST
QUESTION, THE ODDS ARE VERY
MUCH IN YOUR FAVOUR THAT
YOUR CHILD -- THE LIKELIHOOD
OF THAT CHILD GETTING
DIABETES IS VERY SMALL.
CERTAINLY IT IS HIGHER A
RISK THAN IF YOU DIDN'T HAVE
DIABETES, BUT THE RISK IS
STILL JUST A FEW PERCENTAGE
POINTS SO THE ODDS ARE VERY
MUCH IN YOUR CHILD'S FAVOUR.
WITH REGARD TO THE DIFFERENT
TECHNIQUES, THERE'S A
VARIETY OF THINGS.
THE PEOPLE ACTUALLY THAT
KEEP TABS ON THE
STATE-OF-THE-ART MINUTES
STRAIFGS INSULIN IF YOU'VE
GOT VISUAL IMPAIRMENT WOULD
BE THE CNIB, CANADIAN
NATIONAL INSTITUTE FOR THE
BLIND FULL.
CALLED THEM THEY'D BE
THRILLED TO HELP OUT AND
THEY CAN SHOW YOU ALL THE
DEVICES CURRENTLY ON THE
MARKET.

Maureen says THE
COMPLICATIONS THAT WE FEAR
THE MOST AS LISA SAID,
BLINDNESS OR LIMB AMPUTATION,
WHY DOES THAT HAPPEN?
WHY DO THESE COMPLICATIONS
HAPPEN?

Ian says WELL, I
WISH IT WAS STRAIGHT FORWARD,
AND I COULD GIVE A 15
SECONDS ANSWER, BUT IT'S A
BIT MORE COMPLICATED.
BASICALLY COMPLICATIONS IN A
BROAD SENSE CAN BE CALLED
MICRO VASCULAR SMALL BLOOD
VESSEL OR MACRO VASCULAR,
LARGE BLOOD VESSEL.
SO LARGE BLOOD VESSELS
MEANING HEART, STROKES, THIS
SORT OF THING AND THE REASON
THAT'S SO COMMON IS BECAUSE
DIABETES HAS A VERY STRONG
RISK FACTOR FOR THE
DEVELOPMENT OF HARDENING THE
ART TREES, ATHLEROSCLEROSIS
AND PEOPLE WITH DIABETES,
ESPECIALLY THE ADULT TYPE IT
TYPE TWO HAVE MULTIPLE RISK
FACTORS.
LIFESTYLE FACT TO BLOOD
PRESSURE'S OF HIGH AND
CHOLESTEROL'S HIGH AND THOSE
RISK FACTORS, IT'S NOT THAT
ONE PLUS ONE EQUALS TWO.
ONE PLUS ONE THIS THIS CASE
EQUALS EIGHT.
HE IS A AN SPECS PONENTIAL
RELATIONSHIP, WHERE THE MORE
FACTORS YOU HAVE, THE RISK
GOES UP AND UP AND UP.
SMOKING, I'M A STRONG
CAMPAIGNER AGAINST SMOKING
BECAUSE I SEE THE HARM IT
DOES.
PEOPLE WHO SMOKE -- LOTS OF
PEOPLE WHO SMOKE LIVE TO THE
AGE OF 90.
PEOPLE WITH DIABETES CAN DO
THAT BUT IF YOU ANDOK HAVE
THE DIABETES THE LIKELIHOOD
OF REEM TOUR DEATH IS
OVERWHELMING.
UP TO 40 TIMES GREATER
LIKELY HOOFD HEART ATTACKS
FOR EXAMPLE.
SO YOU HAVE TO MODIFY OTHER
RISK FACTORS.
PEEP O'HE WILL WHO HAVE
DIABETES, IT'S NOT THEIR
FAULT.
BUT YOU CAN LOOK AFTER THE
OTHER RISK FACT ARES TO AND
SO A LOT OF THAT CAN BE
PREVENTED.
FOOT AMPUTATIONS FOR
EXAMPLES, IT'S USUALLY NOT
DIABETES IN AND OF ITSELF,
IT'S USUALLY IN CONJUNCTION
WITH SMOKING, HIGH
CHOLESTEROL, BLOOD PRESSURE,
THOSE TYPES OF THINGS AND A
LOT OF THOSE ARE MODIFIABLE.
WHEN YOU GET TO THE SMALL
VESSEL PROBLEM, LIKE IN THE
RETNA, THAT IS PRIMARILY
GEARED NOT TO HIGH
CHOLESTEROL THAT'S PRIMEABLY
RELATED TO HIGH SUGAR AND
HIGH BLOOD PRESSURE.
CORRECTABLE THINGS.
YOU CAN HAVE DIABETES BUT
TRY TO OPTIMIZE YOUR SUGARS.
BY THE WAY, THAT'S
RELATIVELY NEW.
WE DIDN'T USED TO KNOW ABOUT
BLOOD PRESSURE -- WE KNEW
ABOUT HEARTS AND STROKES AND
KIDNEY PROBLEMS BUT
PARTICIPATE HE WILL DIDN'T
APPRECIATE UNTIL RECENTLY
HOW MUCH OF AN IMPACT HIGH
BLOOD PRESSURE HAD ON THE
EYES.
THAT'S SOMETHING THAT THE
PATIENT AND DOCTOR WORKING
TOGETHER ON -- IF YOU DON'T
MIND, I'LL TAKE THE
LIBERTITY OF INTERJECTING
SOMETHING I WANTED TO MAKE A
POINT ON IS THAT I THINK
PEOPLE WITH DIABETES
NOWADAYS AND JUDGING BY THE
CALLS, IT'S CLEAR THEY'RE
QUITE WELL EDUCATED BY THEIR
DISEASE.
WHERE I THINK A LOT OF
PEOPLE, THOUGH, STILL DON'T
HAVE ENOUGH KNOWLEDGE, AND
THIS ISN'T NECESSARILY THEIR
FAULT IT COULD BE THAT
THEY'RE NOT GETTING THE
CORRECT INFORMATION OR NOT
ASKING IT OR DON'T KNOW WHAT
TO ASK.
I WOULD STRESS TO ANYBODY
WHO HAS DIABETES TO KNOW
WHAT NUMBERS THEY'RE LOOKING
FOR.
FIND OUT FROM YOUR DIABETES
SPECIALIST OR NURSE EDUCATOR
OR NUTRITIONIST WHAT IS THE
TARGET BLOOD SUGAR YOU
SHOULD HAVE WHAT IS YOUR A1C,
YOUR TARGETED BLOOD PRESSURE,
YOUR TARGET CHOLESTEROL, I
ENCOURAGE PEOPLE NOT TO
ACCEPT THE STATEMENT “THINGS
ARE GOOD.
THINGS ARE FINE.”
I ENCOURAGE PEOPLE IT FIND
OUT THE SPECIFIC NUMBER THAT
THEY'RE AIMING FOR AND THEN
THEY'LL HAVE A MUCH BETTER
INSIGHT INTO WHERE THEY'RE
HEADING AND WHAT CHANGE HAS
TO BE MADE.

Maureen says TAKE SOME
CONTROL.
YEAH.
TINA IS IN TORONTO.
HI TINA.

The Caller says HI.

Maureen says HI.

The Caller says MY HUSBAND IS
TYPE ONE DIABETIC, AND
RECENTLY HE IS HAVING
PROBLEMS IN PERFORMING SEX.
MY QUESTION IS, IS THE
IMPOTENCE TEMPORARY OR IS
THIS DAMAGE PERMANENT?
AND WHAT CAN WE TO IMPROVE
THE SITUATION?

Maureen says IS THIS
CONNECTED TO DIABETES?

Ian says TYPICALLY
IT IS AND I'M GLAD YOU ASKED
THAT QUESTION.
I THINK IT'S A SIGN OF THE
TIMES.
PEOPLE ARE NOW MORE
COMFORTABLE ASKING THAT,
WHICH IS THE WAY IT SHOULD BE.
YOU'VE PROBABLY SEEN THE AD
FOR VIAGRA.
IT'S A SIGN OF THE TIMES.
PATIENTS TYPICALLY WOULDN'T
MENTION IT.
IS IT RELATED TO DIABETES?
OFTEN IT IS.
IF DIABETES IS RECENTLY
DIAGNOSED, BLOOD SUGARS ARE
HIGH AND PEOPLE ARE IN ILL
HEALTH AT THE TIME, AS THEIR
HEALTH IMPROVES, IF THEIR
SUGARS COME DOWN SEXUAL
FUNCTION CAN OFTEN BE
RESTORED BUT IF SOMEONE HAS
HAD DIABETES FOR QUITE
SOMETIME, THEY OFTEN DO GET
SMALL BLOOD VESSEL DAMAGE
AND THAT CAN INTERFERE WITH
SEXUAL FUNCTION BUT THAT'S
NOT NECESSARILY THE END.
FROM MY PERSPECTIVE THAT'S
THE POTENTIAL START FOR
OTHER THERAPIES THAT VIAGRA
PEOPLE ARE FAMILIAR WITH.
IT WORKS QUITE WELL.
IT'S NOT FOR EVERYBODY BUT
IT WORKS QUITE WELL.
THERE'S VACUUM DEVICES.
THERE'S PROSTHESIS.
THERE'S INJUNCTIONS INTO THE
PENIS TO ALLOW FOR AN
ERECTION TO OCCUR.
THERE'S MANY THERAPIES AND
THE MAJORITY OF MEN WITH
SEXUAL DYSFUNCTION CAN FIND
ONE OF THOSE THERAPIES THAT
WILL ACTUALLY GIVE THEM
SATISFY SEXUAL FUNCTION.
SO I REALLY WOULDN'T THINK
ANYBODY WITH SEXUAL
DYSFUNCTION SHOULD JUST SAY
WELL, THAT'S IT I DON'T
ENJOY THAT PART OF LIFE
ANYMORE.
THERE'S TOO MANY AFFECTED
THERAPIES AVAILABLE TO
REALLY JUST SHOVE IT ASIDE.
I THINK PEOPLE SHOULD LOOK
INTO THAT.

Maureen says BUT YOU HAVE TO
TALK TO YOUR DOCTOR ABOUT IT.
THESE ARE ALL THINGS YOU
NEED TO TALK TO YOUR DOCTOR
ABOUT.

Ian says INDEED YOU DO.

Maureen says ALL RIGHT.
THANKS TINA.
AN E-MAIL FROM CAROL.
COULD YOU TELL ME HOW MANY
GRAMS OF CARBOHYDRATES IT
TAKES TO HAVE A ONE POINT
HIGHER READING ON A GLUCOSE
METRE READING?
EXAMPLE TIGHT A NINE?

Ian says WELL I
THINK THE WRITER IS BEING
FAR TOO SCIENTIFIC.
I THINK IF WE WERE ALL A
BLACK BOX, WHERE EX GOES IN
AND Y COMES OUT THEN I COULD
ANSWER THAT VERY READILY BUT
IT'S THE SAME THING WHEN IT
COMES TO INLYNN DOSING.
I CAN START PEOPLE ON A
CERTAIN DOSE WITH AN
EXPECTATION IT WILL BRING
THEIR SUGAR DOWN BY A
CERTAIN AMOUNT BUT THAT'S A
STARTING POINT.
EACH PERSON IS DIFFERENT.
I MAY HAVE 10,000 PATIENTS
IN MY PRACTICE, NONE OF THEM
ARE THE SAME --

Maureen says DO YOU HAVE
10,000 PATIENTS?

Ian says SOMETHING
LIKE THAT.

Maureen says OH MY GOODNESS!

Ian says SO I
CAN'T ANSWER THAT BECAUSE
THE ANSWER WOULD BE VERY I
AM PRE SIS.
EACH PERSON RESPONDS
DIFFERENTLY.
IN GENERAL TERMS YOU CAN SAY
IF SOMEONE'S DIABETIC THEY
CAN EAT AN APPLE WITH THEIR
CARBOHYDRATE THEIR BLOOD
SUGAR MIGHT GO UP BY FIVE
MILIMOLES PER LITRE, BUT
THAT COULD GO UP, TOOCHL THE
OBJECTIVE IS TO PREVENT THAT
WITH APPROPRIATE PREEMPTIVE
INTERACTION.
THAT'S WHY PEOPLE ARE GIVEN
INSULIN BEFORE THEIR MEAL
BECAUSE HOPEFULLY YOU
PREVENT THE DEGREE OF RISE
IN THE BLOOD SUGAR WITH THE
MEAL.

Maureen says CAN YOU SAY
ANYTHING IN GENERAL ABOUT
DIET AND CARBOHYDRATES
VERSUS NATURAL SUGAR, LIKE
IN FRUIT, VERSUS A CANDY BAR?

Ian says WHAT I
FIND THAT PEOPLE TEND TO DO
IS WHEN PEOPLE -- BEFORE
THEY'RE DIAGNOSED AS HAVING
DIABETES, THEY FIRST START
GETTING SYMPTOMS, EVEN TYPE
TWO DIABETICS, THEY'RE OFTEN
LOSING WEIGHT, THIRST STEERX
DRINKING LOTS.
INVARIABLY WHAT PEOPLE DO IS
THEY SAY I'LL GET SOME
JUICE.
I'M NOT FEELING QUITE RIGHT,
I'LL DRINK LOTS OF JUICE
IT'LL MAKE ME FEEL BETTER
BUT IT'S THE WORST THING YOU
CAN DO BECAUSE EVEN NATURAL
SUGAR PRODUCTS ARE STILL
SUGAR IT.
DOESN'T MATTER WHAT NAME WE
GIVE TO IT, BASE CLEAT SUGAR
IS THE COMMON DENOMINATOR SO
IT'S MORE IMPORTANT TO HAVE
THE APPROPRIATE BALANCE
BETWEEN SUGAR PRODUCTS,
CARBOHYDRATES, PROTEINS AND
FATS IN THE DAY YET NOT TO
SAY THIS SUGAR IS MUCH
BETTER THAN THAT SUGAR
BECAUSE A LOT OF THE SUGARS
IS THE NET EFFECT IS THEY'RE
INTERCHANGEABLE TO A
SIGNIFICANT DEGREE.

Maureen says SOUNDS LIKE YOU
REALLY NEED TO TALK TO A
DIETICIAN ONCE YOU'RE
DIAGNOSED.

Ian says MM-HMM.
I REALLY FEEL STRONGLY
DIABETES IS A PARTNERSHIP
AND ANY THE EDUCATORS I WORK
WITH WOULD KNOW VERY WELL
HOW MUCH I RELY ON THEM IT.
HAS TO BE A PARTNERSHIP
BETWEEN PATIENT, FAMILY
DOCTOR, OFTEN THE SPECIALIST,
DIABETES NURSE EDUCATOR, THE
NUTRITIONIST.
WHERE I SEE PEOPLE WHO
AREN'T DOING WELL,
INVARIABLY ONE OF THOSE
COMPONENTS IS MISSING.
I FIND PEOPLE WHO NOT ONLY
HAVE INTRODUCTORY VISITS AND
EDUCATION FROM DIABETES
EDUCATORS BUT THEN STAY IN
TOUCH WITH THEM, THEY
INVARIABLY DO A LOT BETTER.
I OFTEN HAVE PEOPLE COME IN
WHO HAVE HAD DIABETES FOR A
NUMBER OF YEARS WHO SAY I
DON'T WANT TO GO BACK.
I'VE BEEN THAT ROUTE BEFORE.
AND I SAY BUT THAT WAS FIVE
YEARS AGO.
WHAT I KNOW HAS CHANGED WHAT
THEY KNOW HAS CHANGED SO
WHAT YOU SHOULD KNOW ABOUT
YOUR DIABETES HAS ALSO
CHANGED.
THAT'S A KEY TO SUCCESS,
ABSOLUTELY.

Maureen says OKAY, SANDRA IN KENORA.

The Caller says HI THERE.
YOU'LL HEAR MY LITTLE GIRL
IN THE BACKGROUND THERE.

Maureen says THAT'S FINE.

The Caller says I HAVE
FIVE-YEAR-OLD DAUGHTER,
TAYLOR, SHE WAS DIAGNOSED
WITH TYPE ONE DIABETES WHEN
SHE WAS THREE YEARS OLD AND
VERY ILL.
HER BLOOD SUGAR WAS AROUND
40 WHEN WE FINALLY GOT HER
INTO THE DOCTOR'S BUT SHE
WAS DRINK AN AWFUL LOT AS
YOU JUST RECENTLY SAID.
SHE WAS DRINKING APPLE JUICE,
SAME THING AS THE ORANGE
JUICE, BUT I WANTED TO MAKE
A COMMENT FIRST OFF,
ACTUALLY, THAT THE MINI-PEN
THAT SHE HAS ALSO HAS HALF
UNIT INCREMENTS WHICH IS
WONDERFUL BECAUSE SHE'S ON
SUCH A LOW DOSE OF INS
LIVELT ALSO I WANTED TO ASK
YOU, THIS IS MY QUESTION.
FOR THE PUMP, CAN YOU GET
THAT IN CANADA FOR A CHILD
OF THIS AGE?
I KNOW IN THE STATES THEY'RE
PUTTING THEM ON CHILDREN WHO
ARE AROUND THREE YEARS OLD,
BUT I'M WONDERING IN CANADA,
AND I KNOW IT'S AWKWARD
BECAUSE OF THE CATHETER, I
BELIEVE HAS TO BE CHANGED
EVERY THREE DAYS OR SO, BUT
I'M JUST WONDERING WHAT YOU
HAVE TO SAY ABOUT THAT?

Ian says I THINK
THAT AN INSULIN PUMP DEVICE
CAN BE USED ON CHILDREN.
I THINK THE AGE IS AN ISSUE.
THEY DO ATTACH TO A BELT AND
SO FORTH, BUT I MEAN, MY
KIDS ARE A FEW YEARS OLDER
NOW BUT I REMEMBER WHAT THEY
WERE LIKE AND PRETTY
RECKLESS AS TODDLERS OR
EVEN AGE FOUR, FIVE SIX.
I THINK IT CAN BE DIFFICULT
IS IT POSSIBLE?
YES, IT'S TECHNICALLY
POSSIBLE.
THERE'S NO REASON AT ANY AGE
YOU COULDN'T HAVE ONE BUT
THERE ARE SOME
PRACTICALITY IS YOU THAT
COULD GET IN THE WAY.
WHAT YOU CAN DO IS CALL ONE
OF THE DIABETES EDUCATIONAL
PROGRAMMES AT SICK KIDS OR
ELSEWHERE.
MOST PROGRAMMES NOWADAYS ARE
STARTING TO GIVE INSULIN
PUMP TEACHING.
IF YOU CALL AROUND -- YOU
MIGHT TRY SICK KIDS, IN
PARTICULAR.
THEY COULD TELL YOU WHAT
KIND OF AGE THEY WOULD
RECOMMEND.
BUT IS IT POSSIBLE?
SURE IT'S POSSIBLE
THEORETICALLY FOR ANY AGE
GROUP.

Maureen says AND DO YOU
EXPECT THAT AS MORE PEOPLE
USE THESE AND AS THE
TECHNOLOGY MAY BE -- MAYBE
GETS BETTER, THE PRICE WILL
COME DOWN TO MAKE THEM MORE
AFFORDABLE?
IT'S HARD TO BELIEVE THAT
WON'T BE THE WAY OF THE
FUTURE FOR DIB BEAT
PARTICULARS.

Ian says UM, I
THINK TO A LARGE EXTENT IT IS.
WHETHER IT'LL BE PRE-EMPTED
BY OTHER PROCEDURES LIKE
EYELET TRANSPLANT THERAPIES,
I DON'T KNOW.
BUT THERE'S OTHER
TECHNOLOGIES.
I MEAN, BASE CLEAT IDEAL
THING IS TO HAVE SOMETHING
WHICH MONITORS YOUR SUGAR
CONTINUOUSLY WITHOUT HAVING
TO POKE YOUR FINGER AND
GIVES INSULIN BASED ON IT.
WE HAVE DEVICES THAT GIVE
INSULIN LIKE THE PUMP AND
ABOUT 12 TECHNOLOGIES
COMPETING NOW TO COME TO
MARKET FIRST WITH A SEMI OR
NON-INVASIVE WAY OF CHECKING
BLOOD SUGARS OR USING OTHER
FLUIDS TO MEASURE SUGAR SO
YOU DON'T HAVE TO PRICK YOUR
FINGER.
TOUGH A DEVICE -- THERE'S
ONE CALLED A GLUCO WATCH,
NOT AVAILABLE YET, BUT IT
MEASURES YOUR LEVEL ON A
FAIRLY CONTINUOUS BASIS SO
IT'S NOT A BIG STRETCH TO
THINK YOU'LL HAVE THE
TECHNOLOGY WITHOUT YOU DOING
ANY INTERVENTION, MONITORS
YOUR SUGAR LEVEL --

Maureen says GIVES YOU WHAT
YOU NEED.

Ian says AND
THERE'S OTHER DEVICES.
I BROUGHT THIS ALONG.
THIS IS BY COMPAC BUT IT'S
SIMILAR TO OTHER DEVICES
LIKE PALM PILOTS AND WHAT WE
HAVE A NUMBER OF PATIENTS
DOING AT THE HOSPITAL I'M
AFFILIATED WITH IS USING A
SOFTWARE DEVELOPED BY A
COMPANY CALLED OPTIUM AND
WHAT THEY'VE DESIGNED IS
SOFTWARE THAT LOADS INTO
THIS, AND PEOPLE AT HOME
ENTER THEIR BLOOD SUGARS
ONTO THIS DEVICE AND THEN
THEY HAVE A MODEM LIKE
THIS -- YEAH, IT'S
INCREDIBLE.
THEY HAVE A MODEM AND THEN
THEY DOWNLOAD TO A SECURE
WEBSITE WHAT THEIR BLOOD
SUGARS ARE.
AND THEN IF I WANTED TO, I
COULD GO TO THE WEBSITE, SEE
WHAT THEIR SUGAR PROFILE IS
AND THEY E-MAIL BACK A
MESSAGE AS TO WHAT THEY
SHOULD DO, WHAT INTERVENTION
TO MAKE.
YOU ASK ABOUT NEW
TECHNOLOGIES?
I THINK THERE'S GREAT
TECHNOLOGIES.
THIS IS STILL IN A PAIL LOT
STUDY BUT THERE'S NO REASON
AS TIME GOES BY MORE AND
MORE PEOPLE CAN'T BE USING
THE INFORMATION TECHNOLOGIES
THAT ARE OUT THERE.

Maureen says NO, THAT'S
INTERESTING.
THAT'S REALLY DOCTORING
ONLINE, ISN'T?
YEAH.
OKAY, LET'S GO TO ANNE IN
OAKVILLE.
HI ANNE?

The Caller says OH HI.
I HAVE SIX-YEAR-OLD SON WHO
WAS DIAGNOSED WITH TYPE ONE
WHEN HE WAS THREE.
HE'S ON THREE INJECTIONS A
DAY, A MIX OF NPH AND HAEMOLOG
AND RECENTLY I'VE NOTICED HE
IS COMPLAINING MORE OF --
HE'LL SAY “MUMMY, MY EYES
ARE FUNNY” AND IT USUALLY
TENDS TO BE WHEN HIS BLOOD
SUGARS ARE MAYBE RUNNING A
LITTLE ON THE HIGH SIDE, THE
POST HALLOWEEN THING, AND I
GUESS MY QUESTION IS COULD
THAT INDICATE THAT HE'S
BEGINNING EYE DAMAGE OR IS
THAT JUST STRICTLY A SYMPTOM
THAT MAYBE HIS SUGARS ARE
RUNNING A LITTLE TOO HIGH?

Ian says THANKS
FOR THAT QUESTION.
I'M GLAD THAT CAME UP
BECAUSE THAT'S OFTEN, TO BE
VERY HONEST ONE OF THE
THINGS I FORGET TO TELL MY
PATIENTS.
IF I HAVE PATIENT THAT COMES
IN, NEWLY DIAGNOSED, I
REALIZE YOUR CHILD ISN'T,
WITH SUGARS THAT ARE HIGH, I
OFTEN FORGET TO MENTION AS
THE SUGARS COME DOWN THAT
CHANGES THE WATER CONTENT IN
THE EYE, THAT CHANGES THE
WAY LIGHT BENDS, JUST LIKE
PUTTING A KNIFE OR FORK IN A
GLASS OF WATER, IT HITS THE
BACK OF THE EYE DIFFERENTLY
AND YOU CAN GET TRANSIENT
VISUAL DISTURBANCE.
NOT BECAUSE OF RETINAL
DAMAGE FROM BLEEDING BUT
JUST BECAUSE OF TRANSIENT
SHORT-LIVED FLUCTUATION IN
BLOOD SUGARS WHICH BENDS THE
LIGHT DIFFERENTLY AND THEN
CORRECTS SO IN YOUR CHILD'S
CASE, IF THE CHILD HAS HAD
DIABETES FOR A SHORT PERIOD
OF TIME THE LIKELIHOOD IS
MUCH GREATER THAT THIS IS A
TRANSIENT THING RELATED TO
INADEQUATE SUGAR CONTROL,
RELATED TO HALLOWEEN OR
WHATEVER, RATHER THAN IT
BEING DUE TO ACTUAL HEM
RABLGING OR DAMAGE IN THE
BACK OF THE EYES.
VERY SIMPLE WAY TO FIND OUT.
ARRANGE A VISIT TO THE EYE
SPECIALIST, THEY CAN LOOK
AND THEN YOU'LL KNOW RIGHT
AWAY.

Maureen says SO WHAT
IF YOU'RE AN ADULT THOUGH
WHO NEEDS READING GLASSES OR
WHATEVER.
CAN YOU ACTUALLY HAVE TO
CHANGE YOUR PRESCRIPTION FOR
YOUR LENS BECAUSE OF WHAT
YOUR SUGAR LEVELS ARE DOING?

Ian says I FIND
WHAT OFTEN HAPPENS, WHEN I
TROR BRING THIS UP, WHICH I
TRY TO TO DO IS WHEN PEOPLE
COME IN, AND THEY'RE NEWLY
DIAGNOSED, I KNOW THE FINAL
VISUAL ACUITY THEY'RE GOING
TO END UP WITH, WE'RE NOT
GOING TO KNOW FOR A NUMBER
OF MONTHS OR SO WHAT I OFTEN
ENCOURAGE PEOPLE TO DO IS
GET THE OVER THE COUNTER
READING GLASSES YOU CAN GETS
FOR 20 OR 30 BUCKS AND YOU
MAY HAVE TO CHANGE PAIRS A
FEW TIMES OVER THE SPAN OF A
MONTH OR TWO BUT DON'T GO
OUT AND SPEND 200 dollars ON A NEW
PAIR OF READING GLASSES
BECAUSE YOU'VE WASTED YOUR MONEY.

Maureen says WAIT NULL GET
SOMETHING IN CONTROL.
INTERESTING.
THANKS VERY MUCH FOR THE
QUESTION.
HEATHER IS IN SMITHS FALLS.
HI HEATHER.

The Caller says UH, HELLO.
HOW ARE YOU TODAY?

Maureen says GOOD, THANK YOU.

The Caller says
THE REASON I CALLED IS THAT
FOUR YEARS AGO MY HUSBAND
PASSED AWAY WITH DIABETES.
HE WAS IN THE HOSPITAL, HIS
POTASSIUM LEVEL WENT OUT OF
WHACK AND WITHIN A WEEK HE
HAD PASSED AWAY.
IN SEPTEMBER I GOT A CALL,
MY BROTHER UP IN NORTHERN
ONTARIO, HIS KIDNEYS FAILED,
HE WAS ON DIALYSIS, AND HIS
POTASSIUM LEVEL WAS OUT OF
WHACK.
HIS SPECIALIST HAS TOLD HIM
TO NOT HAVE ANY POTASSIUM
AT ALL.
WHAT IS THE RELATIONSHIP?

Ian says IF PEOPLE
HAVE KIDNEY MA'AM FUNCTION,
NOT DIABETES PER SE, BUT
KIDNEY MALFUNCTION THAT
INTERFERES WITH THE BODY'S
ABILITY TO GET RID OF POTASSIUM.
USUALLY YOU EXCRETE IT IN
THE URINE BUT IF YOU HAVE
KIDNEY MALFUNCTION OFTEN
THAT BECOMES IMPAIRED.
ONE OF THE MAIN TYPES OF
DRUGS WE TREAT AND ALMOST
ANYBODY AND EVERYBODY WHO
HAS DIABETES AND KIDNEY
MALFUNCTION IS PUT ON A
FAMILY OF DRUGS CALLED
A.C.E., ACE INHIBITORS.
THEY GO BY A VARIETY OF
DIFFERENT NAMES.
NOW IT'S VERY EFFECTIVE AT
PREVENTING THE KIDNEYS FROM
GETTING EVEN WORSE, BUT IT
TENDS TO CAUSE POTASSIUM
RETENTION.
SO IF YOU HAVE DIABETES,
YOUR KIDNEYS AREN'T WORKING
UP TO SCRATCH AND YOU'RE ON
THAT TYPE OF DRUG, THE
KIDNEYS CAN'T GET RIFT
POTASSIUM SO IN THAT CASE
THE INDIVIDUAL MIGHT BE
INSTRUCTED TO AVOID AS MUCH
POTASSIUM IN THEIR DIET AS THUK.
USUALLY THAT'S NOT A BIG
ISSUE AND IF YOU DON'T
RESTRICT IT THEY DON'T
USUALLY RUN INTO PROBLEMS.
BUT POTENTIALLY THEY CAN,
ESPECIALLY IN THE KIDNEY
MALFUNCTION IS SEVERE.

Maureen says SO WHAT'S THAT,
BANANAS?
SOMETHING -- RETURN.

Ian says SOME NUTS, SOME TYPES OF
PRODUCTS LIKE THAT.
LEGUMES.
YOU CAN GET A LIST OFF THE
WEB.

Maureen says YEAH, OKAY,
THANKS VERY MUCH FOR THE
QUESTION.
DEAN IN TORONTO SAYS “I
OFTEN FEEL THAT MY SUGAR
LEVELS ARE GOING UP OR DOWN.
THIS MAKES ME FEEL LIKE I'M
NOT IN CONTROL OF MY LIFE.”
CAN SOMEONE FEEL THESE
THINGS IN THEIR BODY?

Ian says YES AND
NO PEOPLE OFTEN THINK THEY
CAN, BUT THE REASON PEOPLE
GENERALLY -- LET'S TALK IN
GENERAL TERMS -- THE REASON
GENERALLY DON'T FEEL WELL
WITH HIGH SUGAR IS BECAUSE
IT CAUSES THEM TO GO TO THE
BATHROOM MORE.
YOU GO TO THE BATHROOM,
URINATE MORE, START DRINKING
MORE AND GET INTO THIS CYCLE
LIKE THAT.
THAT'S GENERALLY WHY PEOPLE
DON'T FEEL PARTICULARLY
WELL.
IF SOMEONE IS NOT A NEWLY
DIAGNOSED, POORLY CONTROLLED
DIABETIC, IF YOUR SUGARS ARE
REASONABLE VARYING BETWEEN
FOUR AND NINE, FOUR AND TEN
GENERALLY SPEAKING YOU WON'T
HAVE SYMPTOMS FOR HIGH AND
LOW SUGAR.
WHERE YOU MIGHT IS IF YOU'RE
ONE OF THOSE INFREQUENT
INDIVIDUALS WHERE YOUR SUGAR
IS REALLY HAYWIRE, ON
INSULIN OR PILLS, YOUR
SUGAR'S 18, DOWN TO TWO,
FOUR, THREE, YOU'LL FEEL
DREADFUL, HAVING
CONSEQUENCES OF BOTH HIGH
AND LOW BUT THAT'S SELDOM
THE CASE.
THE GREAT MAJORITY OF TIME
WHEN PEOPLE FEEL THEIR LIKE
THEIR BLOOD SUGARS ARE UP
AND DOWN, IF THEY KEPT A LOG,
THEY'RE NOT NEARLY SO
VARIABLE AS THEY MIGHT
THINK.

Maureen says WHICH IS
WORRISOME AS FAR AS
LONG-TERM DAMAGE?
THE HIGH OR LOW?

Ian says THE HIGH
FOR SURE.
THE LOW HAS SHORT TERM
PROBLEMS, POTENTIALLY IN
TERMS OF LOSS OF
CONSCIOUSNESS, BUT IN TERMS
DAMAGE TO THE BODY IT'S
PERSISTING HIGH SUGARS.

Maureen says IT'S CAROL FROM
SIMCOE.
HI.

The Caller says HI.

Maureen says DO YOU HAVE A
LOT OF SNOW UP THERE?

The Caller says DO WE EVER.
ABOUT A FOOT.

Maureen says WHAT'S YOUR
QUESTION?

The Caller says I'VE BEEN A TYPE
ONE DIABETIC FOR 37 YEARS.
I TAKE INSULIN FOUR TIMES A
DAY AND HAVE JUST RECENTLY
BEEN PUT ON A PROGRAMME
WHERE I TAKE FIVE UNITS
EVERY MORNING BEFORE
BREAKFAST, REGARDLESS OF THE
TEST.
FOUR AT LUNCHTIME, SIX AT
DINNER AND THEN AT BEDTIME I
TAKE 12 OF NPH.
NOW I WAS PUT ON THIS FROM A
SLIDING SCALE OF MANY YEARS.
NOW WHICH PROTOCOL DO YOU
THINK IS BETTER?

Ian says OH, I
WOULDN'T CRITICIZE YOUR
DOCTOR, NOW, WOULD I?

The Caller says A DIFFERENT
DOCTOR --

Ian says NO, I'M
KIDDING.
I WAS UP IN PARRY SOUND THIS
SUMMER DOING SOME SAILING,
IT WAS LOVELY, I HAD A GREAT
TIME IN TERMS OF INSULIN
THERAPY, I HATE SLIDING
SCALE INS LIVELT I EXPLAIN
WHAT IT IS, BASICALLY YOU
MEASURE YOUR BLOOD SUGAR,
IT'S AT A CERTAIN LEVEL AND
BASED ON THAT YOU GIVE A
CERTAIN AMOUNT OF INS LIVELT
YOU'RE REACTING TO WHAT'S
HAPPENED BUT AS WE TALKED
ABOUT BEFORE, WE'RE TRYING
TO PREVENT IT FROM HAPPENING
IN THE FIRST PLACE SO IF
YOU'RE REACTING TO WHAT'S
HAPPENED YOU'RE NOT DOING
ANYTHING TO PREVENT THE NEXT
OCCURRENCE.
IT'S MUCH BETTER TO BE
PROACTIVE TO FIGURE OUT WHAT
KIND OF INSULIN YOU NEED AT
LUNCH TIME TO PREVENT YOUR
INSULIN FROM BEING HIGH OR
LOW AT SUPPER TIME.
YOU HAVE TO THINK A FEW
HOURS IN ADVANCE.
THERE'S ALWAYS, EXCEPTIONS.
I DO HAVE SOME PATIENTS WHO
I DO HAVE ON A SLIDING
SCALE.
IT'S SELDOM BUT THERE IS
SOMETIMES PARTICULAR
RATIONALE FOR IT.
BUT THE KEY THING, AS I SAY,
TO PREVENT, IS IF YOU'RE ON
A SET DOSE OF INS LIRNGS
THAT'S PROBABLY THE FIRST
TRANSITION YOUR PHYSICIAN
HAS MADE FROM SLIDING DISAIL
A SET DOSE.
THE NEXT STEP, PRESUMABLY,
AND SHOULD BE, TO BE HONEST,
SHOULD BE FOR YOUR PHYSICIAN
TO REVIEW HOW YOUR SUGARS
ARE RESPONDING TO THAT SET
DOSE, SEE WHAT CHANGES
SHOULD BE MADE AND
ULTIMATELY THE GOAL SHOULD
BE FOR YOU TO BECOME SO
ACCUSTOMED AND FAMILIAR WITH
THE CHANGES TO BE MADE AND
HOW TO IMPACT YOU CAN
BASICALLY BE EMPOWERED TO
MAKE THOSE CHANGES ON YOUR
OWN.

Maureen says GOOD LAST
QUESTION TO FINISH ON.
THANKS VERY MUCH.

Ian says MY PLEASURE.

Maureen says Dr. IAN BLUMER
IS AN INTERNAL MEDICINE
SPECIALIST AND DIRECTOR OF
THE DIABETES EDUCATION
CENTRE AT THE ROUGE VALUELY
HEALTH CENTRE.
HE'S ALSO THE AUTHOR OF
“WHAT YOUR DOCTOR REALLY THINKS.”

A picture of the book appears briefly. The cover features a picture of a doctor as seen from a lying patient’s point of view.

Maureen continues THE CANADIAN DIABETES
ASSOCIATION CAN BE REACHED
AT 1-800-226-8464,
www.diabetes.ca
and the American Version of that website is at
www.diabetes.org
Thanks for watching this edition of More to Life.
I’m Maureen Taylor.
We’re here Monday through Friday, 1 to 2 o’clock, here on TVO.

A closing slate reads “The advice given in the preceding program is of a general nature only. Viewers should consult their own medical professional for medical advice specific to their circumstances.”

Watch: Diabetes