Canadian Health Awareness Society : Resources

April 2009

Diabetes was called "xiaohezheng" in ancient China. Extensive clinical trial experiences have been documented by Traditional Chinese Medical Practitioners. Despite the efforts made in research and treatment, diabetes still has no cure. Moreover, diabetes has become more prevalent, and the disease is appearing in people who are younger and younger. To prevent and manage the condition more effectively, we have to better understand this disease.

There are generally 3 types of diabetes : Type 1 diabetes, Type 2 diabetes and Gestational diabetes. Since Type 2 diabetes is most common and 90 percent of diabetics are Type 2, we will focus on Type 2 diabetes.

The pancreas in our body produces insulin. Many of the foods we eat are broken down into sugar. With the help of insulin, sugar is converted into energy. Energy is the fuel we need to maintain our body temperature and provide us with the strength for our activities. Due to factors like age and diet, the function of the pancreas deteriorates until it cannot make enough insulin, or the body becomes resistant to insulin. When this happens, the glucose in the blood (blood glucose) cannot be converted into energy. When the blood glucose gets too high, symptoms of diabetes will appear. Over time, this can lead to further complications. We call this condition "Type 2 diabetes".

• Age 40 or over
• Diabetes in the family (blood relatives)
• Overweight (especially if the weight is around the middle of the body)
• Being inactive
• Asian, Hispanic, Aboriginal, African
• High cholesterol or other fats in the blood
• Gave birth to an oversized baby (over 9 pounds or 4 kg), or had gestational diabetes
• High blood pressure
• Heart disease
• Impaired glucose tolerance or impaired fasting glucose
• Schizophrenia
• Polycystic ovary syndrome
• Acanthosis nigricans

Having risk factors doesn't automatically lead to diabetes, but those who have some of the above factors have a higher risk and should be screened for diabetes. People over 40 should be screened every three years, and screened earlier or more frequently if they have one or more risk factors.

According to Health Canada, Type 2 diabetes may be delayed or prevented through a healthy lifestyle. Studies have clearly indicated that the complications associated with diabetes can be delayed or prevented with good control of blood glucose levels and blood pressure. Healthy food choices, weight control, exercise and reduction in stress are important preventive steps. According to medical research, monitored healthy eating and physical activities to lose some weight can help reduce the chance of getting diabetes by 58%.

According to Traditional Chinese Medicine, typical signs and symptoms of diabetes include: unusual thirst, hunger, frequent urination and sudden weight loss.

Signs and symptoms of diabetes also include extreme fatigue or lack of energy, cuts and bruises that are slow to heal, frequent or recurring infections, tingling or numbness in hands or feet, blurred vision, trouble getting and maintaining an erection.

Please note: About half of people with diabetes do not experience any symptoms before diagnosis. If two or more risk factors apply to you, go to see your doctor for screening even if there are no symptoms.



Diagnosis is done through a blood test in the laboratory. In Canada, the amount of glucose in your blood is measured in mmol/L.

Fasting blood glucose:  Do not eat or drink anything except water for at least eight hours before this test. A test result of 7.0 mmol/L or greater indicates diabetes.

Casual blood glucose:  This test may be done at any time. A test result of 11.1 mmol/L or greater, plus symptoms of diabetes indicates diabetes.

Oral glucose tolerance test:  You will be given a special sweetened drink prior to this blood test. A test result of 11.1 mmol/L or greater taken 2 hours after having the sweet drink indicates diabetes.

A second test must be done in all cases (except if you have obvious signs and symptoms) in another day.

If the test result shows you have pre-diabetes, that is: your impaired fasting glucose (IFG, Fasting blood glucose between 6.1 to 6.9 mmol/L), or impaired glucose tolerance (IGT, blood glucose between 7.8 to 11.0 mmol/L after meal), which means you are at greater risk of developing diabetes, actions should be taken.

If diagnosed with pre-diabetes or diabetes, you should start managing your condition through lifestyle changes and if necessary, with medication. Information sessions and classes offered by hospitals, the community organizations and the Canadian Diabetes Association can help you know more about diabetes, as can help you work cooperatively with your healthcare team to control your diabetes. Please try your best to participate.

The Chinese culture is very well-known to the world for its cooking. Chinese people love to eat. In the past, there have not been many food choices for people with diabetes. Today, thanks to the rapid development of modern medicine, people with diabetes can still enjoy a wide variety of good foods while following the healthy eating guidelines.

General healthy eating guidelines for diabetes include: planning nutritionally balanced meals, eating three meals every day (eat at about the same time and same amount of food), eat suitable amount of carbohydrate, protein, low fat and high fiber foods. Take snacks between meals if using insulin.

There are six groups of foods we usually eat:

These are our main source of energy. Rice, noodles and breads convert to sugar after digestion, and sugar is essential for producing energy. Some people with diabetes totally avoid starchy foods, or just eat very little of them. This is not right. The intake of carbohydrate depends on the energy we need, which varies according to our age, body size and activity level. Choose starchy foods which are high in fiber and low in glycemic index such as brown rice, whole grain products. They can help to better control your blood glucose.

Vegetables are high in fiber, which are satisfying but low in carbohydrate. They are very suitable for people with diabetes, especially when people cut down their intake of starchy foods, vegetables then become the best substitute. Examples include varied green leaf vegetables and non-sweet squashes. Fruits and root vegetables (carrots, beets) contain rich fiber, vitamins but also high in carbohydrates, so use them in moderation. Whole fruit is better than juice for diabetes.

These foods are higher in sugar but also rich in nutrients. They provide calcium which is essential for strong bones. People who experience diarrhea from milk products can choose lactose free products and soybean milk.

These foods are almost sugar free so they are generally suitable for diabetes. Protein-rich foods include eggs, fish and meat. Choose low fat foods if possible. Vegetarians can choose soybean products such as tofu, press tofu, tofu stick, and other soy substitutes.

Eat or drink less of these. Use a little vegetable oil for cooking. Avoid animal fat and trans-fats. Use artificial sweeteners for dessert cravings. Approved artificial sweeteners such as Splenda®, Sweet-N-Low®, Utra-Sweet® are all safe for diabetes. Consult your doctor about the safe amount of alcohol consumption.

Consider quitting smoking which is a serious concern for diabetes.Visit a dietitian to learn about your optimal food intake if possible. Work together for an individualized meal plan.

Advantages of physical activity include: better health, relaxation and reduced stress, improvement on blood circulation, strengthening of muscles and bones, and continued independent living in later life. Exercise helps people with diabetes control the disease, lower blood glucose, help medication work better, control weight, lower cholesterol and blood fats. It is safe and effective.

Some people think vigorous exercise is more beneficial, which is a myth. The kind of exercise which is best for diabetes should be moderate and gentle, not causing the heart to beat too fast, and the person can breathe smoothly after the exercise. The person can also enjoy and sustain this chosen type of exercises.

When you are exercising, you want your heart rate to reach your "Target Pulse" for maximum benefit. These are some examples of your "Target Pulse".

Age (yrs)	Target Pulse (beats/minute)
85	95
80	98
75	102
70	105
65	109
60	112
55	116
50	119
45	123
40	126

Start slowly and build up according to your fitness and habit. Slowly increase the duration and intensity of your activity. People with Type 2 diabetes should have at least 150 minutes of moderate-intensity aerobic exercise each week. This can include brisk walking, swimming, biking or dancing, spread over at least three non-consecutive days of the week. If possible, gradually increase the time of your exercise to 4 hours or more. You should perform resistance exercises such as push-up or weightlifting three times a week.

People nowadays get so busy that they have difficulty finding time to exercise. Try to incorporate physical activity into your daily routine. Small things like walking or biking instead of driving, taking the stairs instead of the elevator, playing with children more often, these are all beneficial to your health.Older adults who have been inactive for quite a while should consult their healthcare team before starting a new activity plan.

• Ask your diabetes healthcare team how and when to test your blood glucose, how to adjust your insulin and food to prevent low blood glucose.
• Carry your meter with you. If you take diabetes pills or insulin, test your blood glucose before, during and after exercising.
• Stop and test if you feel any symptoms while exercising. Stop exercising if you feel tired or have pain, especially chest pain.
• Carry some form of sugar with you and bring extra food.
• Wear comfortable shoes and socks.
• Wear Medicalert® identification if possible.

Maintaining a positive attitude helps control blood glucose levels and better health as a whole. Physical activity, eating healthy and delicious foods, listening to music, participating in group activities all help you think positively. If you are depressed or anxious about your condition, talk with your doctor or healthcare team, or join a support group to share with others. Family support is also important. The more the family knows about diabetes, the more they understand your need and provide encouragement and support. It helps your mental health a great deal.

Diabetes is a lifelong condition. People with diabetes need to make effort to control it, as well as to consult healthcare professional regularly and make good use of community resources.

The healthcare team includes a family doctor, a diabetes nurse, and a dietitian. It may also include a pharmacist, a social worker, psychologist, psychiatrist, foot care specialist, endocrinologist or diabetologist, and eye care specialist etc.

Most hospitals and some community organizations hold diabetes education classes periodically. You may also join a peer support group in your area to get more information and support.