Diabetes Open Hours

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[Music] welcome everyone my name is Anne besner

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I work with the people affected by diabetes knowledge and connection team at diabetes Canada and I will be your

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moderator for today's webinar I'd like to begin by acknowledging that I'm joining today's event from Ottawa

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which is the traditional unseated territory of the Algonquin anishinaabeg people

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as a health focused organization diabetes Canada recognizes that there is systemic racism within and throughout

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our institutions and that we have the responsibility and power to create culturally safe and

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appropriate environments of care from wherever you are tuning in I invite

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you to take a moment to reflect on the land on which we live recognize the harms and mistakes of the

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past and consider how we can all contribute in a meaningful way to reconciliation and collaboration

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we are here to kick off a new live webinar series at diabetes Canada called diabetes open hours thank you so much

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for being part of this event diabetes open hours is all about you the

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person who is affected by diabetes if you have been diagnosed or are caring for someone with diabetes you're not

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alone millions of Canadians are living this reality but diabetes is complex and different

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people experience it differently whether diabetes is new to you or you've been living with it for a long time

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you've inevitably got questions questions about risk factors complications management options

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questions like why me diabetes open hours is a live virtual

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agenda free hour that allows participants to interact with a feature guest in a community of individuals with

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lived and professional diabetes experience this is your time to ask Customs tell

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your story and share with others in a safe non-judgmental space diabetes open hours will take place

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toward the end of the month every second month each one will have a different guest that will be welcoming and a different

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broad theme diabetes open hours is being recorded and will be archived on the diabetes

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Canada website as well as on our YouTube channel for on-demand viewing

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today's theme is nutrition and we are so pleased to have with us Jenna Walsh registered dietitian and certified

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diabetes educator Jenna Walsh completed her degree in human nutrition at the University of

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Guelph followed by a dietetic internship through the Ottawa Hospital she has been working as a clinical

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dietitian in Renfrew County since 2010 dividing her time between long-term care

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inpatient and outpatient support Private Practice as well as Community nutrition

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which includes developing and coordinating an initiative called kids in the kitchen and more recently a

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virtual Eating Disorders Support Program she added certified diabetes educator to

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her resume in 2017 and continues to support those living with diabetes in

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her community by normalizing food and movement as part of their diabetes management

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she loves spending time outdoors with her spouse and three daughters and in the kitchen whipping up new recipes

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welcome Jenna thank you so much for being here thank you so much Anne I'm very much

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looking forward to chatting with everyone today so thank you okay here's how things are going to go

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over the next hour participants who are joining us for today's event can use the chat feature

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to submit their diabetes related questions to Jenna we know that nutrition is a really interesting

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subject it's a huge topic and one that can be a source of confusion for many because it's very Dynamic and evolving

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sometimes it's hard to separate nutrition fact from fiction and challenging to identify reliable sources

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of info about nutrition but not to worry Jenna is here to help us Wade through it all

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as a certified diabetes educator she has a wealth of knowledge when it comes to All Things diabetes and as a registered

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dietitian of course her area specialty is nutrition so we're in really good hands today with Jenna

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using that chart feature please starting now and throughout the next hour type in your diabetes nutrition questions for

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Jenna so you can simply click on the chat icon that's near the bottom of your screen to open the chat

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you can post your question by typing it into the text box with the recipient being everyone and that way everybody

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will be able to see your question we also encourage people to share their diabetes stories in the chat

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we welcome supportive positive comments and emojis from the audience so feel free to be actively part of the

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conversation through the chat as a moderator I'll relay the questions comments and stories to the group and

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we'll do our best to get through as many as we can in the time that we have together a few quick ground rules regarding the

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chat we just ask that any comments or reactions that you share be affirming

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and positive and that you use this time and the chat feature as an opportunity to further

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your learning engagement and curiosity and support the same for others

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following this webinar we'll be sending out an evaluation to hear what you thought about open hours and how we can

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better tailor it to suit your needs so with all of that Jenna are you ready

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to begin good to go great let's get started

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so while we are waiting for some questions to come in maybe we can just start by sort of setting the stage

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Jenna can you talk to us really briefly about what the connection is between nutrition and diabetes and what rules

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does healthy eating play in diabetes management um so I think I would start I mean I I

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think I'm a little bit biased in terms of the the role I I feel that nutrition

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plays um at the same time I really try to approach diabetes management with with

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patients and clients as part of management um we all come from very different uh

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socioeconomic backgrounds we all grew up with a different relationship with food some of our parents may have loved being

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in the kitchen they may have included Us in the kitchen other people may have grown up not having a clue how to cook

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we all have different food budgets um cultural preferences and so

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nutrition is a very um individualized part of management

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I think it needs to be and it should be but it can absolutely make a drastic

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role and in impact on our diabetes management so even into the guidelines we see at least a one to two percent A1C

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reduction potential with with nutrition I would say absolutely I've seen much higher than that with patients depending

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where A1C is starting and what level of change they end up making so nutrition is a pretty big one

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absolutely yeah that's very true Jenna

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um now we have people joining us who are impacted by diabetes in lots of different ways

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um may have nearly been diagnosed or have been living with diabetes for quite some time

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um maybe we can just kind of go back to basics um and this is useful for for anybody

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um who's living with diabetes can you take a second to just talk to us a little bit about carbohydrates so

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um what are carbohydrates and uh what impact do they have generally on blood

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sugar yeah absolutely and and I'm glad you bring that up because more often than not when I'm speaking to people I'd say

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at least half will pause me and say you know what which foods are carbohydrates um so there's a few different categories

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that we start to talk about when we talk about carbohydrates but essentially it's think of them as a like a chain I like

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people to think of food kind of like Lego blocks that make sense for people and then once we eat carbohydrates they

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essentially are broken down to simple sugars in our in our body so even if something is sugar-free they can still

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have carbohydrates meaning they will still impact your blood sugar once we ingest them so the big one that most

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people know about are starch-based foods so any grain based um think your wheat your oats your

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barley um all of those grains are carbohydrates

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and any of the foods that they end up making we also then have our starchy veggies that's where potatoes fall into

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as well and then our fruit they all naturally that's where we get their delicious sweetness from is from sugars

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right it's natural and dairy as well so oftentimes people forget that Dairy

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especially milk has lactose and lactose is simply a sugar or a carbohydrate so I

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like people to think not so much as like does it have sugar but thinking in terms of carbohydrates and that makes label

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reading a lot easier as well now with respect to diabetes though in blood sugar management just because

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carbohydrates affect our blood sugar it doesn't mean we can't eat them

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the most important piece I ask people to pay attention to is how much can each

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person's own body handle or tolerate at a meal or an eating period and blood

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sugar stay within target range so that's again where our nutrition becomes very individualized because a

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what carbohydrates do you like eating right which one still give you enjoyment

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with your meals and allow you to continue to eat that way how much of it do you need to feel satisfied from that

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meal and then on top of that you know does it keep your blood sugars within a within a safe range

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that's really helpful Jenna just a reminder to everybody that if you have questions please go to that chat feature

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and put them right in we're happy to answer any questions you have related to diabetes nutrition

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if you're more comfortable coming off mute you can certainly pose your question as well out loud

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um I see here from a comment in the chat that Kathy is having a bit of difficulty understanding with with an echo so we'll

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work on that Kathy apologies for that um but you can come off mute anybody if

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you'd like to ask a question or feel free to put that in the chat and while we're waiting for some more of those questions to come in Jenna

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um wondering if you could talk a little bit more about um some some different foods and their effects on blood sugar so what about

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vegetables you mentioned that potatoes are a starchy vegetable but what about other veggies what what impact do those

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have on um blood sugar yeah um so we we try to divide Foods up into

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sort of those starchy and then non-starchy right so non-starchy typically being

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um things like your dark leafy greens things like zucchini and cucumbers and celery whereas some other ones where

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that might have more sugar in them may have a bigger impact unless people are on multiple daily

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injections of insulin I try not to get them too focused on the exact number of carbohydrates in

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Foods versus focusing on eating more vegetables in general checking blood

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sugars two hours after and just seeing how that meal has affected them because the one really neat thing that

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some Studies have shown us is within each person right so the individual

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person not larger populations we will see repetitive similar responses to food

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so one person might say their blood sugars go through the roof after having you know some bran flakes and a banana

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and it might be you know whatever maybe they've had 45 grams worth of carbohydrates at that meal the person

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next to them might not it might be pretty modest we can expect for that person where that blood sugar has spiked

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with that specific food we can expect that to repeat so it's it's simple

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enough simple it's still a lot of tedious work and learning but we can start to learn our own patterns and

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which foods our body does well with versus what foods our body struggles a little bit more with and so absolutely

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some of those squashes the sweet potatoes potatoes the ones that really when we think about it have a little bit

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more of that sweeter taste tend to have more complex carbohydrates and and some sugars in them and they may

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they may affect your blood sugars more there's a more complex part to that in terms of what we know to be the glycemic

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index in terms of how much a particular food will spike a blood sugar so that part's important as well

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all really important points and and we can see some questions now coming in through the chat which is terrific keep

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those coming everybody um so Kathy asked a really excellent question here

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um thanks Kathy how do carbs impact type 1 diabetes versus type 2 diabetes versus

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pre-diabetes so maybe you can kind of unpack that a little bit for us great question

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um so I want you to think about type 1 diabetes uh so let's back up a little bit with diabetes when we eat those

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carbohydrates our body breaks them down into those very simple carbohydrates and then asks

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the pancreas for insulin so the pancreas is that organ that we have and in those

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beta cells that we have in the pancreas it secretes insulin insulin is just a hormone its job is to hook onto that

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Sugar bring it to our muscle and brain cells and convince them to open up and

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let that sugar in now sometimes with diabetes the insulin comes takes it cells don't

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open up that's foreign resistance with other people we may it may be more

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genetic in terms of type 1 diabetes sometimes it's a viral infection or something that damages those beta cells

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and they no longer are making insulin people with type 1 diabetes are not

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making any insulin okay so we pay a little bit more attention to you know specifically how

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many grams of carbohydrates we're getting in a meal because we have to then give ourselves the exact amount of

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insulin to keep blood sugars in range with type 2 diabetes we have a little

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bit more flexibility sometimes because we still have some insulin being made so the body is still taking care of some of

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that naturally right so we we have a little bit of wiggle room to say it also depends too if we're on any

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other medications so with type 2 diabetes we would also potentially be on some oral medications or pills that

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address different parts of blood sugar management so they may work at the cell level to reduce that insulin resistance

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we talked about convince those cells to open up and let the sugar in some medications work at the liver so while

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we're not eating the liver also slowly release the sugar back into our bloodstream so that the levels are

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consistent some medications work at the kidneys so the kidneys also filter out sugar

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um and and also keeps them in our blood so some medications try to convince the kidneys to pee more sugar out so those

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carbohydrates are important in all three stages so pre-diabetes type 2 and type 1

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were a little bit more specific with the amounts

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uh with type 1 because we're giving insulin for every gram of carbohydrate

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essentially type 2 if we're on insulin so sometimes we're still in insulin we are again

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being a little bit more specific we're paying attention to you know if I have 45 grams of carbohydrates how much extra

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insulin do I need right so we're still paying attention we may not be as specific with those

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starchy versus non-starchy veggies because you start to learn yourself how your body does

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with pre-diabetes think of pre-diabetes kind of as that yellow warning flag that

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things are starting to go awry we need to be more specific and more pay a

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little bit more attention to how our body's doing with meals now guidelines still don't really

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suggest that we have to be testing our blood sugars in the pre-diabetes stage I am a very vocal advocate for testing our

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blood sugars at this stage because of what we just talked about you can eat

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your normal meals and check your blood sugars two hours after to see how your body is coping with what you're eating

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um and I find even with people if we can get a you know continuous or floss glucose monitor on in the pre-diabetes

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stage for that two weeks we see such better outcomes because they

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can make small tweaks without being overly restrictive and they can maintain those changes for

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a long time and so little things Kathy like for

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example I often hear people when they're diagnosed with pre-diabetes being terrified if things even like carrots

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where as I would rather you eat carrots because they're nutritious and they're so valuable with lots of nutrition and

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let's just check and see how your body does and what are you eating with the carrots in terms of protein and other

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nutrients to see how that impacts it I hope that answered your question

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that's a really good point Jenna um certainly when we're eating we're not just consuming carbohydrates right so

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what else would make up our plate in terms of foods or nutrients and what

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kind of an impact would those things have on blood sugar and then how can we kind of incorporate

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all things to eat in a in a really well balanced way would you say

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yeah um I mean ideally we I try to focus um more on a plate method right where

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we're really trying to get Back to Basics around eating enough food first I

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I really don't find that anyone does well when we try to impose restriction and taking things away as opposed to

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First focusing on you know are you eating enough vegetables at every meal because they're high in fiber and

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they're typically low on carbohydrates are you eating enough protein a to maintain muscle mass

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um fantastic in terms of Just Energy and also satiety keeping us full longer and

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then those carbohydrates which also give us all the you know vitamins and minerals and fiber having all of those

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together again if I go back to that Lego analogy for people it's like having a really intricate Lego block that your

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body has to work really hard to pull all of those pieces apart it takes longer for the body to access those

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carbohydrates and so we don't see this massive Spike of blood sugars but you know hopefully more Rolling Hills

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and so for a lot of patients where we start is okay what are you currently doing when are you eating what are you

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eating how much are you eating and is there room to add so far you know typically having say you

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know toast and jam and a coffee for breakfast great but we're just having carbohydrates and

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carbohydrates can we add some veggies can we add some protein it might be adding some peanut butter and um sliced tomatoes on the side or

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something right a veggie omelet and one piece of toast try a whole bunch of different varieties a to see how their

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individual body tolerates I think that's really helpful

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um we've got another question coming in here from Jennifer uh Jennifer works at diabetes Canada and has lived with type

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1 diabetes for a long time and also happens to be a dietitian so I'm very knowledgeable when it comes to food and

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nutrition but she says in spite of all of this eating out for her can be an ongoing challenge so what's your advice on

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eating out for people who are living with diabetes um perhaps for for people with type 1 but also for people with type 2.

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um and how how would you go about sort of estimating um carb amounts of things like sauces

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which which may be a little bit trickier to figure out um and then working to kind of maintain

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those blood sugar targets yeah absolutely and I mean um eating out in in general is can be a

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challenge um for anyone living with diabetes in terms of knowing how much and also how it then

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impacts their blood sugars right so uh especially for type 1 whether they're MDI or whether they're pumping there's a

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few things I'm a big fan of first of all is be part of a group so any sort of

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diabetes online support groups Facebook has a ton of them but there's more outside of Facebook I really truly find

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that people living the experience have more inside scoop and knowledge of the

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best places to eat where they're serving consistent amounts right so most of the

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food chains that that we frequent have their nutrition information available

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but the sauces and all the little pieces really come down to are they following the amounts that that standard recipe

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suggests that they're putting on when it comes to sauces right versus are they just doing a big old squirt

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um easy enough we can ask for those things on the side that's always the safest

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it's sometimes annoying for sure but safest in terms of if we're if we're dosing specific amounts or bolusing

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the second piece too is what you may do especially if you're eating out often is

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you may have some of your own staple foods for a meal and just be getting a portion that's takeout so I've had some

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patients have success with that especially if they're on the road a lot say you're a busy um you know parent with sports and

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you're on the road a lot or um with work if you're traveling with work having some of those Staples where

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you're boosting fiber you're boosting protein um that can be easy as well to know the

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specific amounts that you're getting or vice versa you're bringing your carbohydrate amounts and what you're

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ordering might be like you know a salad with chicken to get extra

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it's a super question from Jennifer thanks so much and just as a reminder to everybody keep

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those questions coming recall that open hours is all about you so ask anything that's on your mind about diabetes and

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nutrition feel free to use the chat feature or you can come off mute and ask your question in person

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uh Jenna we've heard a lot about low carb diets so maybe we could talk a

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little bit about about that um what is your perspective on low carb

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diets um are they a fud are they helpful for people with diabetes

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um give us the lowdown yes so this is still a really big topic

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and still a very controversial one and controversial even I find in in terms of my own head

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um because it's only effective if it's effective

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and realistic for the patient long term and so when we look at eating patterns

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for people whether it's ketogenic meaning less than five percent of the diet is carbohydrates versus low carb

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which is typically under 20 percent of total calories coming from carbohydrates

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um it's effective we can eat well nutritionally balanced if it fits their

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budget they enjoy the foods they're eating they're eating enough nutrition and they're still managing their

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diabetes Well right so we can still be eating that 20 percent have very low carb very low carb

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and a higher carb meal without any medications and blood sugar still you know increase after that one meal so

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there's still some education there's still some learning there's still self-monitoring of blood glucose even in

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those contexts um is it necessary I would say no

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we can still manage our diabetes very well with a you know standard Mediterranean style of eating or a more

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flexible carbohydrates which I find for most people again I

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work a lot with eating disorders so I'm very sensitive to restriction and what

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long-term impacts that can have um if we can make sure that carbohydrates don't feel like a bad food

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for patients I'm all for that so yes it can be

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effective for patients if they're interested in addressing or trying a lower

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carbohydrate diet I definitely suggest that they chat with an RD or with someone who has experience just to make

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sure they're getting enough food they're never feeling restricted and they're still managing well

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in your experience what are some of the risks of somebody following a low carbohydrate diet particularly if if

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somebody maybe isn't um doing it alongside a registered dietitian or or hasn't

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um consulted with a healthcare provider about that so if someone's living with diabetes are are their risks

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yeah um absolutely um I think I think the biggest thing

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that we really want to look at right is um the reason that they're choosing

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right so it might naturally already be the way that they prefer to eat one of

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the key things that we really want to look at is you know what medications are they on some of them are not safe to

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continue taking and so we really want to look at you know where is insulin at and the sglt2s some of the sulfonurias

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certain medications we really should look at stopping so that's one thing

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that we definitely want to start with if there's any history of Eating Disorders or disordered eating

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that big red flag for me and it's something I I really dig deeply in with with people

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um risk factors too is really a cost right if they have a fairly low uh budget for

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food High veggies and high protein is really expensive

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so my my concern is actually more in terms of how are they managing to eat

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enough nutrition following a low carb diet uh that's a

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that's a big one that I think is overlooked way too often um I mean outside of that those are the

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biggest factors so the medications you know the disordered eating and then is it reasonable for that for that

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patient it's helpful to think about the benefits and the risks and making decisions about

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eating patterns um so and speaking of eating patterns you mentioned the Mediterranean diet

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so just wondering if you can describe what that eating pattern is like for people who aren't familiar with the

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Mediterranean diet yeah so I think it's great to think of it more as a as a lifestyle that's

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really the way that we know there's more benefit we're we're focusing on lots of plant Foods

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um lots of plant-based fats and proteins nuts and seeds you know olive oils avocados

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um less red meat so it's not gone but it's definitely less frequent like a few

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times a month as opposed to a few times a week more fatty fish like trout and and tuna sardines

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Etc um the lifestyle Factor too comes in in terms of focusing on taking time to eat

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right we're not scarfing food down in five minutes and going on a better day is making time to

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cook trying to cook more meals at home trying to sit socially together to eat

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we actually see much better outcomes and much more satisfaction from food when

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we're able to do that digestively too we tend to actually have better Digestive Health when we actually

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sit you know kind of that 30 45 minutes that we would all ideally have for three meals a day

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is important as well so it's not so much a diet in today's sense of the word but a way of eating

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now you mentioned with the Mediterranean way of eating that that it heavily features vegetables

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um I think uh one thing that a lot of people are wondering about uh when they're diagnosed with diabetes or

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they've been living with it for a while is is there any benefit to adopting a vegetarian diet so cutting out animal

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products all together and and you know whether it's a vegetarian diet or a vegan diet or any sort of variation can

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you talk to us a little bit about that is it necessary to be vegetarian when you have diabetes

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yeah so definitely not necessary um the interesting thing with the evidence that we have with uh vegetarian

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Lifestyles is that we also see a fairly significant reduction in heart disease for those who do follow more of a

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plant-based diet so less elevated cholesterol less elevated blood pressure

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which we know risk factors for both right when we have diabetes and heart disease is is high so we see

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improvements there um we also because I I got a lot of questions when people are asking to eat

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more plant-based and we're encouraging them to eat more pulses which is you know they're high fiber

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um beans and legumes and higher in carbohydrates and there's that moment of

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confusion of what I thought I had to watch my carbohydrates we don't see as much of an impact with a

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lot of those pulses when they're Incorporated with other plant proteins as well in high fiber grains because

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there is more protein in fiber so we see some benefits there as well

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from a higher intake of fiber when we're following more plant-based proteins

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because things like um you know almonds and walnuts and black beans and lentils they do they

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have protein but they also have a ton of fiber that helps to reduce cholesterol and

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also Keeps Us full longer and is lower on that glycemic index we talked about

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so we definitely see good at in outcomes sorry with respect to diabetes

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I would argue it's potentially cheaper meat is still through the roof right now since covid so budget wise we can really

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stretch that dollar with more plant-based I find for people it's more of a lifestyle switch we're very much

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still a meat potatoes veggie way of eating and so it can be more of a switch that way

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I find that's helpful for people to pick say one meal a day to start in terms of

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trying to transition to more plant proteins so they may have a salad or a soup and

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instead of putting meat on it putting again even canned black beans or canned lentils in that pot of soup or you know

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a quarter of a cup even to start on their salad or if they're having a wrap you know mashing some chickpeas and and

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using that as the protein instead of leftover chicken or ham or something along those lines necessary no but

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there's definitely benefits that's great I was actually going to ask you if you could provide some

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suggestions for how people can incorporate more plant-based proteins in their diet so

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um good to get those ideas for people who maybe are not accustomed to eating a lot of plant-based proteins but want to

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want to start um so we're about halfway through open hours now everybody the time is just

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flying by thanks again so much for joining us uh we're here with Jenna Walsh registered dietitian and certified

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diabetes educator she's here to answer all of your nutrition related questions so use that chat feature to ask anything

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about diabetes and nutrition you can certainly also share your story about how you're affected by diabetes talk a

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little bit about how diabetes is impacting your life um and and we'll just keep going

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um Jenna you were talking before a little bit about um

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different types of carbohydrates and wondered if you could just provide a little information about simple versus

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complex carbs so people may have heard those terms before and there may be a little bit of confusion about what those

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are so tell us about simple and complex cards

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yeah so think of your simple carbohydrates basically as your sugars

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there are one unit doesn't take your body much ever to break down it's going to be things like

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your honey your maple syrup um you know juice really is is

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everything's been broken down and removed as well they're they're very easy for the body to use right away now

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most people when I say that say okay so they're about they're not bad but if we're having them

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we want to have them with again going back to that protein and the fiber to help again reduce that Spike where

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they're beneficial is when people are having a low so when blood sugars fall under that

33:14

four or three point eight we actually want to be reaching for those simple sugars

33:19

tablespoon of honey you know a half a cup of juice a half a cup of regular pop because that's what's actually going to

33:26

take little time for your body to bring those sugars back up to a safe level now on the flip side of that your complex

33:32

carbohydrates I want you to think of a whole bunch of sugars tied together like a chain

33:39

um they're complex they've got some hydrogen and oxygen as well and you know potentially different fiber molecules

33:45

some protein all of those good things again that really complex Lego block right

33:51

takes more effort for the body to break it down uh and to absorb it into the

33:56

bloodstream so from a meal in day to day into we want

34:02

to focus on more complex carbohydrate and yeah try to build most of our meals around

34:09

those on the flip side of that if we're having a low these are not the ones we want to

34:14

grab we don't want um you know a half a cup of lentils with whatever mixed in

34:20

veggies mixed in it's going to take too long for the body to bring those sugars up so complex exactly as they sound they're

34:27

complicated for the body to break down simple super easy very quick for the blood sugar to spike

34:36

okay that makes sense um now related to that concept and also something you mentioned before I'm just

34:43

wondering if you can expand a little bit on this whole concept of carb Counting what is it

34:49

who needs to do it how do you do it why is it important yeah

34:55

I um with type 2 diabetes I I avoid getting too in depth with carb counting

35:03

because I try not to have food become numbers for people with insulin use we do get into carb

35:11

counting not necessarily right away we start with kind of that plate method again but we're very much looking at a food

35:18

label or measuring food we have different lists for foods that let us know how many grams of carbohydrate per

35:26

weight of food so then we would be essentially weighing that food using that calculation to

35:32

figure out in what we're about to eat how many grams of carbohydrates

35:38

that with insulin we figure out a ratio of how many units of insulin we need at

35:44

a meal per grams of carbohydrate so that's pretty complex and detailed

35:51

for for today there may be some people out there any of our type ones especially or any of our type twos on

35:57

MDI who maybe have already you know been dabbling in that or experts in it that

36:03

is the simplest way to look at it if we are for example looking at a food product

36:09

and it says you know there's 48 grams of carbohydrates we also use an exchange

36:15

system to simplify that where roughly 15 grams of carbohydrate would be one

36:21

carbohydrate so for example we have some great resources that sort of already list the

36:27

carbohydrates in foods and what portion would equal one and the simplest way is

36:33

typically one piece of bread one cup of milk and one medium sized fruit are all roughly equal to 15 grams or one serving

36:41

so there's a difference depending where a patient is at with their their diabetes or what type and what

36:48

medications or insulins they're using that determines whether we get into that in depth

36:54

discussion around carbohydrates because it it even goes beyond that rate it also depends on the amount of fiber subtract

37:00

fiber from the total carbohydrate um the complexity of that meal again we

37:05

talked about you know how much protein is in there and fat so

37:12

but you can see why nutrition is such an interesting topic to people because it's it's complex and

37:20

um one question kind of leads into the next um so so happy to have you here to help

37:26

us um figure this all out um let's talk about carbs a little longer

37:33

and then maybe we'll shift away and again just encouraging people to bring up anything that they're wondering about

37:38

related to diabetes nutrition in the chat or you can come off mute to ask your question to Jenna

37:44

we welcome story sharing as well and reactions in the in the chat feature

37:51

um you mentioned uh recently um in one of your responses the glycemic

37:57

index um so walk us through that for people who don't know what the glycemic index

38:03

is tell us about how you use it and kind of what it's all

38:09

about yeah so um the easiest way to do it is there's

38:15

been different studies and evaluations on different foods on how quickly they

38:20

raise our blood sugar so from there then um

38:26

Foods were categorized using basically a light system so like green yellow red

38:32

into being low glycemic index meaning they had minimal impact or less impact

38:37

things like you know really um higher fiber higher protein really is

38:43

the easiest way to simplify it greens and cereals versus as they get more into

38:49

the red they're typically more refined with less protein and fiber right so

38:54

like really dense 12 grain bread being low versus like a low fiber low protein

39:02

white bread now since then though I mean if you look in

39:07

the bread aisle right there's 200 varieties of bread we also now have white bread that has added fiber and

39:12

protein and so it's different so we can't just simplify it that way um but we use it as a really good

39:17

starting point in education piece for patients um I don't know if I can share my screen

39:22

in but I did have it open in case anybody asked me amazing thank you you shared it perfect

39:29

I I figured that would come up it comes up a lot so it is one of those things I always say to people you know what use

39:35

it as a guide as a starting point and then little things right like I I brought up before

39:40

in terms of bananas for some people because that's a big one but even something like barley is low on

39:46

the glycemic index for some people they might have barley and it might still impact their blood

39:52

sugars fairly significantly we can also take a high glycemic index food

40:00

like instant white rice and add protein

40:06

canned tuna chicken lentils and veggies Frozen fresh canned

40:13

whatever you know fits your budget or makes you happy and make that high glycemic index

40:19

food a low glycemic index meal so again I never like people to feel stuck

40:27

with Foods or deterred based on their budget or their ability to cook certain foods we

40:34

can still eat really well on any of those budgets and also with any of the foods that we're used to

40:39

eating so again use it as a guide but keep in mind when we talk glycemic index and blood sugar spiking

40:47

we still have that ability to to reduce the glycemic load of a meal by adding protein and fiber and fat

40:56

I see a question in the chat here from Maria thanks Maria um so Maria is wondering about

41:01

incorporating glycemic variability into patient education and Maria's wondering

41:07

how you personally use this concept in your practice it's a it's a super

41:13

question Maria thank you yeah absolutely and um I think for some people so I think what

41:20

you're meaning is you know some people will stay fairly low carbohydrate and then you know occasionally have higher

41:26

carbohydrate meals um and or choosing right from some of those lower glycemic index foods and and

41:32

higher and trying to pair them and so both are always fine

41:38

right like having variety and variability in Foods is normal it's

41:43

natural that's an intuitive way of eating for a lot of people the most

41:48

important piece I always say or encourage people is just check your blood sugars

41:54

right so if most of the time you're eating fairly low glycemic index or low carbohydrate or whatever and blood

42:01

sugars are typically within Target and you do have something that's higher glycemic index or you do go out for

42:07

higher carbohydrate meal or you have one at home it's fine just check and see where your blood

42:13

sugars are at later because if we stay suddenly out of nowhere have um you know a lasagna or a spaghetti or

42:19

pizza and that's all we eat we have some room that even if blood sugars are high later again we can reduce that glycemic

42:26

load by adding some veggies with the next time around having more protein

42:31

right so maybe having less pasta have more sauce have a salad on the side so you can always have that variability

42:38

and that variety we always encourage that I'm hoping most people who are doing education are encouraging that as

42:45

well because it's not realistic for us to assume living with diabetes these are

42:50

the only Foods we're allowed to eat for the rest of our our time here we need to have variety

42:58

yeah that's that's a really terrific question from Maria um and just want to direct everybody's

43:04

attention to the chat where I put in the link to diabetes Canada's resource about the glycemic index food guide so

43:11

you can access that it's a PDF on the diabetes Canada website

43:17

um so wondering a little bit about sweeteners Jenna if you can talk to us a

43:22

bit about sugars and sweeteners so artificial sweeteners and then sort of natural sources of sugar

43:29

um and and starting with the whole idea of like are all sugar is created equal so brown sugar white sugar honey

43:37

molasses maple syrup are those all the same or are some better than others hmm

43:46

yeah it's such a big topic um sugar is sugar so when we're talking in a diabetes World

43:53

um all of the the sugars right whether it's agave syrup which again is like

43:58

this trendy sugar um lactose honey glucose all of it maple

44:05

syrup molasses it's all gonna give us you know those four grams of carbohydrates

44:11

um so in a diabetes world they're all the same some people will argue you know natural maple syrup has more

44:17

micronutrients the amount of sugar that we would have to eat to get any valuable

44:23

nutrition from them blood sugars would be through the roof so it's not a source of micronutrients

44:29

when we when we look at it and so the biggest thing is always if you're having sugar

44:35

or maple syrup or honey eat the one that you enjoy that's the most important piece when we

44:41

start to get into sweeteners right so everyone also has their own personal belief in view on sweeteners

44:48

that they're either okay or they're not good for us

44:54

from an Evidence point of view which is where we practice from is we look at you know what is the the

45:01

safety level that's been tested it doesn't necessarily mean Beyond there it's not safe it means that's the level

45:07

at which they've tested and there's been no adverse effects right so with each

45:13

sweetener that's out there um so there's sugar alcohols for example sugar alcohols are also naturally found

45:21

in in foods right so like sorbitol Mannitol all of these are are natural

45:27

sugars and same with Xylitol in Foods um there's no issue with them they they

45:34

don't boost our blood sugar like regular sugar does

45:39

the difference being with sugar alcohols is if you're having too much typically Beyond 10 grams a day you might have

45:45

digestive side effects because they pull fluid into the gut okay so any of those ones typically that end in ol

45:51

are those sugar alcohols outside of that there's there's a bunch

45:57

of of sugar-free substitutes available out there the one I typically like to

46:02

highlight to people where they potentially could be eating beyond that suggested safe limit is the cyclamate

46:09

which is like the sugar twin or the Sweet and Low the ADI which is that acceptable daily amount is really around

46:17

um just under that 600 milligrams and one of those pockets would be close to 270 milligrams so for people if they're

46:23

constantly eating Sweet and Low um that's the only one that you know to kind of just be cautious with outside of

46:30

that things like sucralose which is you know your Splenda again great you'd have to eat a lot of Splenda I think it's

46:37

close to two cups in a day to even come close to that um ADI uh Stevia again same thing you

46:45

can buy the actual Stevia plants and plant them if you really like it um

46:50

the levels are there it would take a lot for people to get close to that ADI and

46:55

again that tested level doesn't necessarily mean there's adverse effects Beyond it

47:01

um it's just more that that's the level they've been tested at again the bigger thing to look at that I

47:08

say to people you know if they're baking and all of a sudden they're feeling like okay well I'm gonna have to buy a Splenda or Stevia and start baking if

47:15

you're making cookies that have oats and flour and spending more money to add Stevia or

47:22

splenda that you don't like there's still carbohydrates in those cookies from the flower and the oats so

47:29

removing the sugar doesn't remove the carbohydrates it absolutely can decrease it but there's a balance between

47:36

the satisfaction from food and how much you need to be satisfied and enjoy versus

47:42

um just feeling restricted by a lot of Foods right so that's a balance if

47:50

you're having coffee and you're just as happy with stevia or splenda or whatever in your coffee amazing that makes a big

47:55

difference because some people will end up with a tablespoon or more um but in terms of baking and cooking again just be mindful in terms of

48:02

there's still going to be carbohydrates likely in a lot of those Foods

48:07

there's also a great resource and sorry and I can remove some of that as well yes I just popped into the chat a link

48:14

to the diabetes Canada resource on sugars and sweeteners again it's a PDF that people can access that has good

48:21

general information about sugars that affect blood glucose and

48:26

um sugars and sweeteners that don't so much so that's there for people to take a look at

48:32

um so we've got about 10 minutes left in our time here

48:38

um I can't believe how quickly this hour is going now is your chance everybody to put those questions into the chat come

48:44

off mute if you'd like to share your story or to talk to us a little bit about how diabetes impacts your life and

48:51

what you're wondering about nutrition uh maybe we can shift away a little bit

48:56

from um carbs and talk a bit about some other

49:01

things that we find in our food so alcohol and caffeine so what is the deal

49:07

with these for somebody living with diabetes do they have to avoid them are there special things that they should

49:12

know about intake of alcohol and caffeine what what do you tell people

49:18

yeah so um caffeine in general right so caffeine is

49:23

is going to constrict blood vessels and just the way that it affects the body is going to increase blood sugars and so we

49:30

know that even if it's black uh it doesn't mean don't drink it again biggest thing of awareness right if you get up in the morning and you have a

49:36

coffee and test your blood sugars two hours after and you know it's eight or ten or whatever and you haven't eaten

49:41

anything it's just be mindful that it's probably the coffee which is okay if you're you know hitting

49:48

Tim's for a triple triple there's a lot of added sugar in your coffee so I find it's not so much just

49:53

the caffeine sometimes it's what we're adding to it to be mindful that it can be impacting your blood sugar

50:00

um with alcohol the same is true in a few ways it's a bit more complex

50:05

right so alcohol in itself if we're just having liquor with no added carbohydrates is

50:12

going to divert the liver from releasing sugar while it breaks down the alcohol so we sometimes actually see blood

50:18

sugars dip a little bit now it gets a bit more complicated depending how much we have and also what

50:24

medications we're on because if we're on medications that can cause our blood sugars to go low

50:30

we run the risk of going low right I also find that if people are

50:35

having things like beer or alcohol as well like any of the coolers that do

50:41

have carbohydrates or even wine we get kind of just more erratic blood

50:46

sugars where you might see a dip but then you might see them Spike one way or the other because it also then depends

50:52

on how we're eating and behaving while we're having those drinks so

50:58

typically I mean people with pre-diabetes and type 2 if they're not on insulin it's not as much of a concern

51:05

from a safety perspective the other thing that alcohol does is it increases our triglycerides or it can which is a

51:13

blood fat which again it's just more that we kind of see that increased double risk of heart disease with diabetes

51:20

um there were just recently updated guidelines around the alcohol suggested

51:25

alcohol limits they're quite strict I don't know if people have already seen them and sort of what their thoughts on

51:31

on them are but it's really suggesting less than two drinks a week um and that's more from a heart health

51:38

perspective chronic disease perspective and and also cancer so

51:44

um you don't have to cut it out again it comes back to management right I mean if you're going to have a few

51:49

glasses of wine help them enjoy them but check your blood sugars that's all

51:55

yeah I think those those alcohol guidelines that you were talking about Jenna that were recently released are from the um Canadian Center on substance

52:03

use and addiction so people can check those out online

52:08

um and and you know good to consider the impact of both alcohol and caffeine on

52:14

blood sugars um so that people with diabetes are really aware when they're consuming

52:19

different things what effect it might have no speaking of beverages

52:25

um we know we hear from a lot of places a lot of sources that water is really important for our health

52:32

um but some people just are not crazy about water it can be maybe boring or

52:37

Bland so even though we know we should probably drink a fair bit of water in the day

52:43

um maybe we're less inclined so so what tips or tricks do you have for people to increase their intake of water

52:51

yeah uh first starting point I always suggest is whatever else you're having

52:57

at ice cubes it's an easy starting point tons and tons of ice every time you're having something else add ice

53:04

um outside of that is there's a little bit of mind over matter

53:09

too sometimes right like sometimes I find it's habit if we're always grabbing for something sweet it's because we've also trained our brain that this is what

53:16

I enjoy water tastes gross I hear sometimes because we're actually expecting the sweetness there's there's

53:23

some gradual transition that we see when people actually just actually start increasing their water so we we can

53:29

actually just start there versus also adding frozen fruit you can buy Frozen sliced

53:36

lemons and limes which are Super convenient to add into even a full jug of water and leave it in the fridge some

53:41

people really just like cold water so actually getting a really nice decanter or something that fits in your fridge

53:48

um to leave it in there so it's nice and cold the other thing that I ask is depending on your water

53:55

um you might not like the taste of it so some water is really high in iron or or

54:01

other minerals it might be worth investing in like a Culligan system right just even the ones where you can

54:07

get the filled up jugs so those are options you can also get now like the

54:12

carbonated um like the PC waters for the bubblies they're sugar-free they're really just

54:19

flavored carbonated waters um those are nice sometimes they're also a really nice alternative if you're

54:25

looking for that drink in the afternoon or in the evening there's something that's just a little bit different right

54:32

um yeah I'm a big fan of adding the frozen fruit sometimes even veggies like adding

54:37

mint and cucumber is lovely um and you can sometimes even just save

54:42

the tips of your cucumber and throw them in as in a tupperware or baggie in the freezer

54:48

and then throw them in your jug of water so that's super easy to do as well

54:55

outside of that I sometimes too if people are drinking coffee all day is even just start with before you fill up

55:01

another cup fill your mug with water and just down it

55:07

an easy way to start yeah that's a really good tips

55:12

um just on a couple minutes left here and welcoming any last questions comments stories anything in the chat or

55:20

you can come off mute to share um Jenna

55:26

um you've talked a couple times about cost and we we know right now that we're dealing with Rising food costs

55:32

um and that healthy eating can be quite expensive and sometimes people feel like

55:39

prohibitively so so what are what are some tips that you have

55:46

um really I mean for anybody but but specifically for people who are living with diabetes about

55:51

um eating well on a budget yeah um first thing and I think most people

55:56

who are on a budget know this is don't buy into the name brand um the No Name you know the the store

56:04

brand are typically as new nutritious for a fraction of the cost I'm a huge

56:11

fan of frozen veggies and fruit they're as nutritious you know they're picked up

56:17

Prime flash frozen for the most part and they last longer they're not going to spoil on us and now the lovely thing is

56:23

you know you can buy frozen spinach and frozen kale and Frozen edamame beans and you know pretty much every veggie Frozen

56:31

butternut squash all of those things that give you a ton of variety they give

56:37

you a lot of options for your meals and they're they're less expensive

56:42

I definitely don't recommend you know buying things out of season like strawberries and berries this time of

56:48

year are astronomical um there is some value sometimes also in

56:54

the points programs so different grocery stores like independent for example will do the PC

57:01

points you can surprisingly actually build up quite a bit of money to then get free groceries right so

57:09

people if you think of kind of some of those like coupon clipping behaviors if

57:14

you're mindful of what foods points are available for and you're

57:19

buying more of those things in bulk those weeks especially if they're frozen or canned items you can build up a lot

57:25

of return income for that outside of that canned and bagged beans so again

57:31

going back to the vegetarian it's like a dollar 25 to buy a bag of dried beans

57:37

um there's tons of YouTube videos on how to cook them what to add them to you can add them to anything

57:42

they're fantastic for protein and fiber balanced nutritionally right when we

57:49

really get down to it in terms of those two nutrients alone and so then adding even just

57:55

um whether it's rice or whether it's some frozen veggies and you have a nutritionally balanced meal for really

58:00

under a dollar fifty or two bucks compared to if we're trying to buy fresh veggies and meat and whatever else so it

58:07

makes a big difference that's a great practical note to leave things on

58:14

um Jenna I just want to thank you so much for being with us today on Diabetes open hours it was a pleasure and I

58:20

learned a lot from you I I hope that our our viewers did as well

58:25

um and and just as a final message to everybody we want to thank you the participants for joining us today and for being part of this very first

58:32

diabetes open hours um there will be an evaluation coming to you so please let us know what you

58:38

thought about this format and uh we are looking for ways to um to really tailor

58:43

this to suit you the the participants so please share your feedback with us to learn more and to stay up to date on

58:50

Diabetes Canada work and resources you can also visit our website diabetes.ca or check out our social

58:56

media channels we're on Facebook Twitter Instagram LinkedIn you can also call our

59:01

information team at 1 800 Banting so b-a-n-t-i-n-g or email us at info

59:08

diabetes.ca with Customs join us in April for our next diabetes open hours

59:13

and please stay tuned to our social channels and to the diabetes Canada webinar page if you Google diabetes

59:19

Canada upcoming webinars you'll find that page and there will be information there posted shortly about our next open

59:25

hours what the date will be and the topic as well as the registration information we hope you found this

59:31

webinar helpful for you and we look forward to hearing your feedback and to seeing you back again soon thanks so much

59:38

foreign [Music]

English (auto-generated)

01:04:38:05 - 01:05:04:16
Cayla Runka
Hello and welcome, everyone. My name is Cayla Runka and I work at Diabetes Canada on the Knowledge and Connections team and I'll be your moderator for today. I would like to start by acknowledging that I'm calling in today from Toronto and that I'm located on the traditional Indigenous territory of the Wendat, Haudenosaunee and Anishnabeg and the Mississaugas at the credit and that Toronto is now home to many diverse first nations, Inuit and native people.

01:05:05:18 - 01:05:34:06
Cayla Runka
As a health focused organization, Diabetes Canada recognizes that there is systemic racism within and throughout our institutions and that we have the responsibility and the power to create culturally safe and appropriate environments of care. We are here today as part of our new initiative, Open Hours. Diabetes Open Hours is our live call in show, especially for you to ask any and all questions regarding you or a loved one's lived experience with diabetes.

01:05:35:06 - 01:05:55:08
Cayla Runka
The program runs the last week and every other month with a different topic and guest expert, so be sure to follow us on social or visit the website regularly for updates. And while we do have a medical expert on the call with us today, this session is in no way meant to replace a regular visit with or the information you obtain from your own medical health professional.

01:05:56:12 - 01:06:21:02
Cayla Runka
So today's theme is Know your numbers and the ABCs. And we're very lucky to have Dr. Harpreet Bajaj here today to answer your questions on blood sugars, ups and downs, hemoglobin A1C blood pressure and cholesterol, otherwise known as your ABC. Dr. Bajaj is an endocrinologist and the medical director of Endocrine and Metabolic Research at LMC Health Care Centricity Research.

01:06:21:18 - 01:06:50:22
Cayla Runka
He is a research associate at Mount Sinai Hospital, Toronto, and an adjunct lecturer at McMaster University. He is the principal investigator of the Canadian Diabetes Prevention Program, a nationwide collaborative effort between LMC, Diabetes Canada and the Public Health Agency of Canada. And Dr. Bajaj currently serves Diabetes Canada as the chair of the Clinical Practice Guidelines Steering Committee. Before we get started, just a few housekeeping things.

01:06:50:23 - 01:07:20:18
Cayla Runka
Please note this session will be recorded and may be included as part of our public facing channels, including our website and YouTube channel. Please know that we will take all measures to protect your privacy and will not be sharing any names or record of the chat or Q&A features. We ask that any comments or reactions you share be affirming and positive and that you use this time and this feature as an opportunity to further your learning, engagement and curiosity and support the same in a respectful way for others.

01:07:21:16 - 01:07:44:16
Cayla Runka
On the Zoom taskbar below, you will notice two buttons the chat and the Q&A buttons. Simply click the icon and type your question or comment into the space provided since guests will be muted, the chat button is an opportunity to communicate with each other and share your thoughts and personal anecdotes and stories. The chat is visible to others on this call, but again, there will be no use of the chat on the video recording of this session.

01:07:45:11 - 01:08:06:03
Cayla Runka
Now the other button I mentioned is for the Q&A. This will allow you to post your questions throughout the session confidentially directly to our guest expert. If you would like your question to remain anonymous. Also, if you choose to unmute at any time to ask a question, that's fine. But please know your voice may appear in the recording of the video but your name and account image will not.

01:08:07:04 - 01:08:16:09
Cayla Runka
Lastly, the closed captioned feature has been activated for this session, so please feel free to use this feature if it will be helpful to you. And with that, are you ready, Dr. Bajaj?

01:08:16:17 - 01:08:20:00
Dr. Harpreet Bajaj
I am, Cayla, and thanks for that introduction. Yes, Let's go.

01:08:20:06 - 01:08:47:06
Cayla Runka
All right, great. So maybe while we're waiting for the first questions to come in, we can chat about some of the basics. So I have only experienced living with diabetes through my relationship with my mum. But I do know there are concerns with highs and lows and maintaining a steady blood sugar level. So maybe we could start by just generally speaking, about blood sugar, its role in the body and what happens for people with diabetes when they're trying to control those levels.

01:08:47:24 - 01:09:30:17
Dr. Harpreet Bajaj
Sure, yeah. Let's start with the basics. Absolutely. And at various points, I’ll try to, you know, give an analogy to how we drive a car, because many people, many among us drive a car. Right. So so I'll I'll just try to give analogies to that as we speak during this conversation if that's okay. So what does glucose do or what are the normal levels normal as And when we consider and consider glucose not to be a medical problem, let's discuss that first.

01:09:31:12 - 01:10:06:15
Dr. Harpreet Bajaj
So glucose in the body is useful to give us energy and there are various body organs that use glucose. We can also use other sources of fuel other than glucose as well to maintain that energy and body function. So other sources of fuel may be fat, maybe what we call ketone bodies. There may be some other fuel sources that are very useful as well in other other organs of the body.

01:10:07:12 - 01:10:37:03
Dr. Harpreet Bajaj
Now there is one organ in the body, which is the brain that only can use glucose as the only fuel. So our brain is totally and completely dependent on glucose to use and as as a fuel to maintain its function. The other organs like heart and liver and kidneys can use other alternative fuel as well other than glucose, but not the brain is how it is.

01:10:37:15 - 01:11:06:01
Dr. Harpreet Bajaj
And so for that reason, because it's so essential for brain function, for that reason, our body has many different hormone systems to try and maintain the glucose in a good range, not in a low range, not in a very high range in a normal circumstance. So one of the main hormones in our body that controls this sugar in the normal range is insulin hormone.

01:11:06:11 - 01:11:30:07
Dr. Harpreet Bajaj
So insulin is is a hormone that is released into sugars are going up. Or if we eat when those sugars are supposed to be going up, the insulin is released from the pancreas to try and bring it down into the normal range and the opposing hormone to insulin. So a hormone that that does opposite the work of insulin to try and maintain that balance is glucagon.

01:11:30:10 - 01:11:55:06
Dr. Harpreet Bajaj
Glucagon is also made in the pancreas. And it it's kind of, you know, if the sugar is going too low, then the glucagon starts going up so that the sugars are maintaining the normal level. Again, there are other hormone systems as well in the body that maintain the sugars, but it's mostly the insulin and glucagon that counterbalance to try and control the sugars within that range.

01:11:55:22 - 01:12:26:05
Dr. Harpreet Bajaj
So then what is the normal level of glucose in people where we think there there is not a medical problem. Usually the range is between 4 to 6 in the morning time and the fasting time that we think that the sugars are in the normal range and after meals we expect a little spike. But that spike up to about eight millimoles per liter is okay in a normal person.

01:12:26:11 - 01:12:58:09
Dr. Harpreet Bajaj
That's what we think is a normal range for glucose levels, if you will. The analogy to the car, you know, if we are driving on a highway and I'm not recommending that we drive too fast or something, of course. Right. But let's think about driving on a highway that has 100 kilometers per hour speed limit. And so typically you would not get a ticket at least, right, if you're driving at 110 or 90 or, you know, somewhere around that range.

01:12:58:09 - 01:13:22:00
Dr. Harpreet Bajaj
Right. So so that's the analogy to the car driving on a highway is, you know, we try to maintain that that driving speed around the road. It doesn't have to be exactly the 100 and may vary in between this range, let's say 90 to 110, 115 so that we are within that safe zone, if we will and we will not get the ticket.

01:13:22:04 - 01:13:43:09
Dr. Harpreet Bajaj
How do we do that? By pressing the accelerator or the or the brake. Right. So those are the ways we we control that. So that's the analogy to insulin and glucose as well. Right? So those are the two hormones that kind of maintain the glucose in that normal range. Such as Well. So I hope that answers your first question.

01:13:43:16 - 01:14:00:22
Cayla Runka
Yes, for sure. And then I guess one of the questions that came up was what kind of things acts our blood sugar? So if we're looking at maintaining that sort of steady state, where do we need to pay particular attention?

01:14:01:24 - 01:14:46:20
Dr. Harpreet Bajaj
Yeah, so and that's a great question. So and even in people without diabetes, but also especially in people who live with diabetes as well, there are many different things that can affect the sugar. Of course, we know eating does and we mentioned that it can spike up to it, even even in people without diabetes as well. But there are other circumstances other than eating, for example, exercise, any kind of exercise, even even a moderate to a mild exercise level as well can, you know, help bring down high sugars to a normal range.

01:14:47:16 - 01:15:18:23
Dr. Harpreet Bajaj
Other factors, bodily stress, not sleeping enough or getting not not getting enough sleep can affect blood sugars and and adversely so it can raise the sugar as well also just the day and just the time of the day as well. Because as we are waking up, many of our hormones like the adrenaline hormone, cortisol hormone, are trying to ramp up in the morning to try and get us awake and give us the energy boost.

01:15:19:07 - 01:15:46:24
Dr. Harpreet Bajaj
And that itself in the morning can raise the sugar a little bit or more and different people as well. So it can vary from person to person. Then illness can also affect the sugar. So illness as in having a fever, having some infection can increase the sugars. Then there are some medications that can also elevate the sugars.

01:15:47:10 - 01:16:22:00
Dr. Harpreet Bajaj
And those medications could be steroid, for example, steroid medications that are sometimes prescribed for asthma or other conditions, autoimmune conditions as well, or some other medications that can sometimes increase the sugars as well. So those are, in a nutshell, some of the conditions that can increase the sugars normal. And in a person who does not have diabetes, there's still the insulin and glucagon will try to maintain the sugars within the normal range.

01:16:22:19 - 01:16:47:06
Dr. Harpreet Bajaj
But in people with diabetes, of course, these all of these factors, whether it's steroids, whether it's, you know, certain kinds of foods or exercise or lack of exercise can play a major role as well with the sugar control as well. Now, I said that, you know, 4 to 6 is the normal sugar for a person without diabetes, for people living with diabetes.

01:16:47:14 - 01:17:16:00
Dr. Harpreet Bajaj
The target range is up to seven for fasting. And then the target range for after meal is up to ten, 2 hours after a meal as well. So 2 hours after a meal, we want the spike to stay in the single digits, not in double digits. So kind of like, again, going back to the car analogy, okay, maybe up to 120 kilometers per hour.

01:17:16:10 - 01:17:32:10
Dr. Harpreet Bajaj
Most people would not get a ticket, right, well maybe some cop will still give you a ticket. But up to 120, probably you will not get a ticket as well. So don't quote me on that. Okay. You get into trouble. So that's that's the car analogy to that.

01:17:33:10 - 01:18:01:11
Cayla Runka
Great. And you've mentioned it a couple of times that blood sugar varies throughout the day. So the next question is, you know, when do you realize something might need to be addressed? How how long can your blood sugar be high before you need to start worrying about maybe making some changes with medication or other parts of those things you've mentioned that impact blood sugar?

01:18:02:17 - 01:18:31:14
Dr. Harpreet Bajaj
Yeah. So in people with diabetes is I guess what we are talking about, about this question. And so in people with diabetes, you know, once in a while if the sugars go up because we had a treat, you know, we indulge a little bit, that's not when we need to start adjusting the medication. Of course, everybody's, you know, allowed to have their birthday cake or whatever other treat that you like.

01:18:32:16 - 01:19:06:08
Dr. Harpreet Bajaj
And, you know, the at least the suggestion or request is that we maintain we try to we can try to maintain portions, smaller portions of those treats and maybe even some people can try to compensate for having that treat by by reducing other carbs within that meal, if you will. So having less of, let's say, bread or rice or potatoes selected so that it compensates for that piece of cake that you had as well.

01:19:07:06 - 01:19:29:03
Dr. Harpreet Bajaj
So then if it's just one off, we don't need to start increasing or changing medications. However, if it's a consistent daily pattern or most days of the week, then we need to start looking at, hey, after dinner is when when the sugar starts spiking more than ten on most days of the week. Maybe we need to address that.

01:19:29:14 - 01:19:59:02
Dr. Harpreet Bajaj
The other lab parameter that helps us and all of this is called the hemoglobin, the A1 C or the A1 C test, as we call it. It's a blood test. So it's not something that we test at home. And this A1C number kind of in a, you know, easy way it, you know, to understand it, it's basically an average of three months of last three months, of sugars before that test was done.

01:19:59:14 - 01:20:17:15
Dr. Harpreet Bajaj
So if I get a blood test today and I can do it any time of the day, doesn't matter if I do it morning or afternoon or night, it kind of averages out what my sugars have been for the last three months. So what was my sugar in February, March and now in April is what it will tell me.

01:20:17:24 - 01:21:02:19
Dr. Harpreet Bajaj
And all of the sugars, not just the morning or evening sugars, but all of the sugars over the last three months. How they've been now the normal range for this A1 C test is less than 6%25. So that's for people without diabetes. We say normal is less than six. If the A1C is between 6 to 6.4, we the Diabetes Canada guidelines say it's it's termed as pre-diabetes so it's a precursor to diabetes condition that people as pre-diabetes which means that there is a high risk that the sugars can worsen into the type two diabetes or range from that.

01:21:03:02 - 01:21:30:01
Dr. Harpreet Bajaj
And then anything more than 6.4. So if we go to 6.5 or above is considered type two diabetes. So the target, as I said, for, you know, after if you're doing the finger prick or other means of, of testing your glucose at home, we said after meal it should be less than ten fasting, it should be less than seven for people with diabetes or A1C

01:21:30:01 - 01:21:45:04
Dr. Harpreet Bajaj
test the target. So that's the first of the ABCs Cayla as well. The A of the ABCs is A1 C and the target for most people is less than seven on that ABCs.

01:21:45:24 - 01:21:59:24
Cayla Runka
Okay. And then while we're on that A of the ABCs, how frequently should you be getting your A1C tested and does that vary based on whether you have type one or type two diabetes?

01:22:00:23 - 01:22:29:01
Dr. Harpreet Bajaj
Yeah, that's a great question. I mean, it is it needs to be individualized. And, you know, you have to look at various factors when you determine how frequently you get it. So maximum so every three months is what we what the Diabetes Canada guidelines would say maximum every three months or maximum four times a year is when we should get it.

01:22:29:12 - 01:23:10:08
Dr. Harpreet Bajaj
So everyone sees an average of three months. And so if you get it every three months, that that makes sense as well. But for some people, some people who might have might not need to have it every three months. You don't need to necessarily go to a lab every three months. Right. If you have if somebody and if an individual has diabetes, that is very well control on A1C and they're doing their their testing at home and it is variable control and they are on, let's say, one or two blood pressure medications that they've been stable on for many, many months as well.

01:23:10:08 - 01:23:34:11
Dr. Harpreet Bajaj
So nothing new is changing. No new medication was added or deleted as well. Then, you know, you can do it every six months as well. So it can vary a little. But how frequently we should have this blood test, but in most people every three months. But it can, you know, be the last to up to six months.

01:23:34:24 - 01:23:42:13
Dr. Harpreet Bajaj
If we think somebody is somebody has diabetes that is within the target range that they want it to be.

01:23:42:23 - 01:24:09:16
Cayla Runka
Okay. So, yes, very individual. Best to work with your personal health care provider on that front. Just before we move to another participant question, we haven't talked about the blood or low blood sugar yet, so maybe we could just spend a minute on, you know, what does that look like and what some of those values are and what people can look out for when they are experiencing a low blood sugar.

01:24:10:15 - 01:24:31:17
Dr. Harpreet Bajaj
Yeah. So it's very important to understand this. So you asked about, you know, Cayla, you asked about the high sugars and when we should address that. I said if it's consistently high is when we address that. But for low blood sugar, even one low blood sugar can be can be challenging and can be burdensome. It can it can lead to symptoms.

01:24:31:17 - 01:24:56:15
Dr. Harpreet Bajaj
So it's low sugars. And, you know, on the other hand, if you think about high sugars, many people would not have any symptoms. Even some people, if they've had high sugars up to 15 or even 20, sometimes some of, you know, individuals may not have any symptoms from high sugars. On the other hand, low sugars can cause a lot of symptoms.

01:24:56:15 - 01:25:26:22
Dr. Harpreet Bajaj
So what are the symptoms? The first stage of symptoms is basically warning signs of low sugars. These warning signs, signs could be trembling or shivering. So they could be a heartbeat going very fast. So what we call it called palpitations of the heart rate. So a racing of the heartbeat, they can be sweating. They can be just a sense of disorientation or hunger as well.

01:25:27:04 - 01:25:58:13
Dr. Harpreet Bajaj
So those are some of the warning signs of low sugar. The second stage, if it goes very low, typically typically around two or less than two, is when people can have other major problems with low sugar as well as their can, possibly with low sugars. People can have problems with coma, they can have seizures, they can have heart arrhythmias as well.

01:25:59:11 - 01:26:30:04
Dr. Harpreet Bajaj
So there can be major problems from low sugars if they go very low. So so it's very important to to understand the low sugars. Now, however, it's scary, right? Having low sugars sounds very scary with all of what I've just said. Fortunately, we know that which medications in diabetes can have the possibility of causing low sugars.

01:26:30:04 - 01:26:58:08
Dr. Harpreet Bajaj
Right. So so it's not all of the medications that people might be taking for diabetes that can cause low sugars. So some of the medications that can cause low sugars are, of course, one is insulin. So if somebody is taking insulin to manage their diabetes, you know, it's absolutely necessary to have a good understanding around low sugars and how to deal with them and how to treat the low sugars as well.

01:26:59:20 - 01:27:29:13
Dr. Harpreet Bajaj
And then the other medication, the other class of medications that can have the potential for low sugars is called a sulfonylurea class. So these medications, like gliclazide or glyburide or glimepiride are available in Canada. And these medications can also cause low sugars. These medications are used in type two diabetes. Insulin can be used in type one, diabetes can also be used in type two diabetes.

01:27:29:13 - 01:27:38:14
Dr. Harpreet Bajaj
Of course, insulin. But so those are the medications, insulin or sulfonylureas that can cause low sugars or hypoglycemia.

01:27:38:23 - 01:27:46:24
Cayla Runka
Okay. So both people living with type one and those with type two on medications are at risk for low blood sugar.

01:27:48:02 - 01:28:23:03
Dr. Harpreet Bajaj
Yeah. So both people with type one. Absolutely, because they are typically on insulin, which is the hormone that that is deficient in people living with type one diabetes. And so that is a risk factor for people with type two diabetes. It's the people who are using either insulin or any of these sulfonylurea medications. But these days we are seeing less and less use of the sulfonylurea medications and other medications outside of sulfonylurea or insulin do not cause hypoglycemia.

01:28:23:11 - 01:28:34:03
Dr. Harpreet Bajaj
And so people living with type two diabetes, if they're using other medications, they don’t they don't they have a very negligible or zero risk of of causing hypoglycemia.

01:28:34:06 - 01:28:50:02
Cayla Runka
Okay, good to know. We have a participant question wondering if you can explain what time in range is and if this is a new sort of measure and its importance.

01:28:51:01 - 01:29:16:19
Dr. Harpreet Bajaj
Yeah, so, so time in range. Maybe I’ll go back to my analogy on the on the car driving in this so you know that 90 to 110 kind of range right. So is where we want to keep driving at for safety Of course. And so time and range is kind of that safety zone, if you will, for managing blood glucose levels.

01:29:17:13 - 01:29:46:11
Dr. Harpreet Bajaj
So what is that? What is the target for that? So there's an international consensus on CGM. So continuous glucose monitoring, continuous glucose monitoring is not the typical finger prick, but these are sensors that can be put on either the arm or the abdomen or other places in the body that continuously monitor glucoses for 24 hours and not just a static number.

01:29:46:11 - 01:30:22:03
Dr. Harpreet Bajaj
When you check your sugars with a finger prick. But these are sensors that stay on the body just like a tuning. They're small, quite small, and they go on as a patch and these can monitor the glucose levels, you know, for 24 hours, for seven days or two weeks, depending on the on the device that you're using. So on these continuous glucose monitoring devices, you can get a time and range percentage as to how much the person living with diabetes or otherwise has their glucose is within the certain range.

01:30:22:15 - 01:30:56:17
Dr. Harpreet Bajaj
So this international consensus recommendation is suggest using the 4 to 10 millimoles per liter range. So anything less than four is considered below the range. Anything above ten is considered above the range. So anything between between the four and ten number is then is then the time in range if you will. That's, that's the Green Zone. Right. So that's where, that's where ideally the people's level should be now.

01:30:56:17 - 01:31:34:06
Dr. Harpreet Bajaj
And people, especially people who may be using insulin to manage their diabetes, we know that glucoses do fluctuate. And so the consensus, this international consensus recommends that 70%25 of the time in range be maintained is what the recommendation is. So 70%25 of the time between 4 to 10 is what the guideline states and then less than 4%25 below the range and then less than 25, 26%25 above the range of ten is what the guideline suggests.

01:31:34:15 - 01:31:52:00
Dr. Harpreet Bajaj
So that's a green zone time in range. The target for that, especially in people with diabetes who are who are, you know, injecting insulin for to manage their diabetes. The recommended goal or target is 70%25 in that range.

01:31:52:13 - 01:32:29:03
Cayla Runka
Okay. And I'm assuming the importance of that is again, to maintain that sort of stable blood sugar level to prevent some of the side effects. And that and there's actually another participant question similar to that. So they're wondering if they're above normal number on a day to day basis, whether it's fasting or post meals. If if they're above that range one day does damage to the body and organs per se happen sort of that day, or is it only when it's elevated over a longer period of time?

01:32:29:19 - 01:33:16:16
Dr. Harpreet Bajaj
Yeah, that's a very good question. And, you know, that answer, the response to that. It is it is over a long period of time. So so higher glucose levels over time, over many years is when the damage starts showing up, typically about 10 to 15 years from the diagnosis of diabetes. If a person living with with diabetes, if their glucose levels have been above that range or that target that we discussed, then the complications of diabetes potentially can happen at that time.

01:33:16:24 - 01:33:29:18
Dr. Harpreet Bajaj
So it's not just one of higher sugar that causes bodily harm at that point, but it's typically over many months and years if the glucoses are high.

01:33:31:04 - 01:33:46:10
Cayla Runka
And just a follow up question on the time in range, someone is wondering whether someone who is using a glucometer and doesn't have access to a CGM device and also assess time in range with the glucometer.

01:33:47:06 - 01:34:16:06
Dr. Harpreet Bajaj
Yeah. So before the CGM devices became available, we had this, you know, people were doing many different things. They would you know, one of the methods was to check glucose levels 7 times in one day. We don't typically ask, but that's a very onerous, very you know, it's it's very time consuming and also a lot of finger pricks for that.

01:34:16:15 - 01:34:44:19
Dr. Harpreet Bajaj
But that's one other way of checking on what the time in range is. So seven times would include, you know, before and after a meal three times a day as well as at middle of the night. So midnight kind of a blood glucose test. So so that can be another way to find out what your what somebodys glucose fluctuations are.

01:34:45:01 - 01:35:39:04
Dr. Harpreet Bajaj
And if the glucose fluctuations are within that green zone that we discussed or not, typically we don't do that. And you know, typically maybe we'll ask to alternate glucose testing if if somebody does not have access to CGM. Unfortunately, access is a limitation. Access and costs are big limitations. And the CGM use, then, you know, depending on on what medications are being used, their healthcare provider may and discuss whether alternate testing alternate as in you know, test glucose fasting one day, another day after breakfast, another day after lunch, you know, to get kind of a sense of where the glucoses lie.

01:35:39:04 - 01:35:49:09
Dr. Harpreet Bajaj
May be a less onerous and less expensive as well as less painful way of glucose testing as well.

01:35:49:17 - 01:36:16:12
Cayla Runka
Right? I can imagine. Yes. There's a couple more questions and then maybe we'll move on to the B part of ABC. And since we haven't discussed that, that was components yet. So one question is around type two specifically and whether there's a natural progression once you're diagnosed as you age in, even if it's managed well, is there always sort of that progression of the disease as you get older?

01:36:17:17 - 01:37:10:18
Dr. Harpreet Bajaj
Yeah, So that's a good question. So, you know, in our medical school or or other graduate school, that's typically that the definition that we've learned for for type two diabetes, that type two diabetes is a chronic condition, chronic means permanent condition and a progressive condition progressive as it worsens over time. And some studies like landmark study from UK called the UK PVS, suggest that the pancreas, which makes insulin the ability of the pancreas to make insulin after a diagnosis of type two diabetes reduces over time by about 6%25 per year.

01:37:11:09 - 01:37:38:16
Dr. Harpreet Bajaj
So about 6%25 or less ability of the pancreas over over a year, year by year. Then you can imagine, you know, if 6%25 times whatever, it can lead to 50%25 and 60%25 decline over 10 to 15 years. Right. So so that's kind of been there. And that's that's that's how most of us learned about type two diabetes.

01:37:39:05 - 01:38:16:12
Dr. Harpreet Bajaj
Now, more recently, there has been some suggestions, some studies suggesting that it's not all a downhill slope, if you will. There is a possibility that that some of this and this downhill progression can be reduced, at least. So that slope of reduction, slope of worsening of about pancreas to ability to make insulin can be reduced. One way that has been suggested is weight loss.

01:38:16:22 - 01:38:52:02
Dr. Harpreet Bajaj
So weight loss with either it is with various dietary modifications or exercise or with bariatric surgery. There is a lot of literature from the bariatric surgery, which is a surgical operation. It's also called the gastric bypass surgery, bariatric surgery. So with this, there have been some studies suggesting that the pancreas ability to to make insulin does not deteriorate as much over time as well.

01:38:52:24 - 01:39:09:09
Cayla Runka
Okay. Speaking of dietary, one of the questions is can diabetes be controlled by diet exclusively? So I'm assuming that answer may differ between type one and type two.

01:39:10:18 - 01:39:40:21
Dr. Harpreet Bajaj
Yeah, thanks for pointing that out. Of course. So type one diabetes, where the pancreas has a minimum or zero production of insulin, of course, insulin is the treatment that that individual will need and it should not be withheld and it should be started as soon as possible and maintained throughout life. It's life sustaining for people with type one diabetes, and that's very important to understand the difference between type one and type two.

01:39:42:06 - 01:40:20:13
Dr. Harpreet Bajaj
For people with type two diabetes, initially, early on, within the first few years of type two diabetes and later on, well, you know, diet plays a big role. Dietary interventions play a big role in terms of maintaining glucose within those targets that we discussed. Of course, individual situations and social situations, individual barriers, challenges play a role. And all of all of what is possible for an individual.

01:40:20:13 - 01:41:02:05
Dr. Harpreet Bajaj
But, you know, in Diabetes Canada guidelines, we do suggest, you know, right from diagnosis of type two diabetes, a comprehensive management. So medications plus minus or I should say a diet plus lifestyle or health behavior modifications plus or minus medications is what is recommended as a comprehensive management of glucose control if and then monitoring after that. So monitoring for the glucose checks at home as well as that A1 c test that we that we discussed as well.

01:41:02:22 - 01:41:35:00
Dr. Harpreet Bajaj
So that can guide whether an individual their glucoses can be maintained within that target that we that we discussed as well with solely with diet or do medications need to be added or increased over time as well. So for some individuals, yes, and especially initially, diet can be very, very helpful and not necessarily need a medication, at least in the in the initial few years of diagnosis of type two diabetes.

01:41:35:22 - 01:41:58:10
Cayla Runka
All right. We have one more question on the As and then we're going to move on to B the question is, if your hemoglobin A1C is under control and is staying quite level and within those range numbers that were provided, is it recommended to get a continuous glucose monitor or are you able to just continue on the way that you've been doing things

01:41:59:07 - 01:42:31:24
Dr. Harpreet Bajaj
Yeah. So it's more of a cost and access question and it'll have to depend on that. There is these, these monitors unfortunately are quite expensive. Also, if you look at that data, how much difference does it make, you know, in terms of whether we are talking about difference, You know, if somebody is using these continuous meters versus what we typically do with a finger prick, does it make a difference on A1C?

01:42:31:24 - 01:43:10:10
Dr. Harpreet Bajaj
There are various studies that have been done on these comparisons. They suggest that for some people it may make a difference on the A1C. So for people who use who use insulin to control their type two diabetes or type one diabetes, these continuous meters may be a useful tool for some individuals with type two diabetes who are on at least two or three oral drugs that are that they're using for their diet type of diabetes.

01:43:11:05 - 01:43:46:04
Dr. Harpreet Bajaj
It may also be useful to control to help everyone see get better. At least one one or two studies that have been done suggest that. But it's not just the A1C control. It's also about reducing the risk of low sugars or hypoglycemia as well. So I think the question that you asked is about if somebody is A1C’s already within the target, let's say less than seven, let's say their glucose, the A1C is 6.8, then what's the role of of these continuous glucose monitors?

01:43:46:22 - 01:44:17:13
Dr. Harpreet Bajaj
So in people with type one diabetes or people with type two who may be using insulin, there may still be a role to monitor as well as alarm about low blood sugar, low blood sugars as well, because many of these sensors have built in alarms around because of less than 3.9 or so. And so that can be very useful so as to prevent catastrophic low blood sugar as well.

01:44:18:06 - 01:44:38:12
Dr. Harpreet Bajaj
So it depends on and on the individual situation. But in some cases, especially in type one, to reduce the risk of hypoglycemia and to monitor and manage hypoglycemia risk, continuous glucose monitors may be useful and even if the A1C less than seven.

01:44:39:10 - 01:44:54:15
Cayla Runka
Right. Okay. So the B part of ABC blood pressure, I'm going to kick it off with just the question around. Do people living with diabetes have a higher risk of experiencing issues with their blood pressure?

01:44:55:15 - 01:45:31:24
Dr. Harpreet Bajaj
Yeah. So people with type two diabetes, there is a definite kind of association with higher sugars and higher blood pressure. So blood pressure also varies from individual to individual. There are many different individual things that change blood pressure. Of course, age is one of them. As we grow older, our blood pressures do rise. Of course, salt plays some role in blood pressure also in a person without having a high blood pressure problem or in people with high blood pressure problems as well.

01:45:32:07 - 01:45:44:21
Dr. Harpreet Bajaj
All can play a role. So in terms of blood pressure, you know, individual variations are there, but in people with type two diabetes, there is a higher chance of having a problem with high blood pressure.

01:45:46:02 - 01:46:12:10
Cayla Runka
Okay. Then sort of the two part question from one of the participants. So if you are at risk for higher blood pressure because of living with diabetes, but you also have a hereditary genetic component in your family of high blood pressure, can lifestyle interventions be effective? And then if so, I guess what might some of those things be?

01:46:12:10 - 01:46:15:24
Cayla Runka
Or will you inevitably probably require medication?

01:46:17:07 - 01:46:57:07
Dr. Harpreet Bajaj
Yeah, so much like glucose, blood pressure as well. The first line of therapy for high blood pressure in many individuals, unless the blood pressure is is very high above the targets, then initially health behavior changes. So whether it is dietary control or weight reduction or salt reduction or I should mention alcohol reduction as well. So those can be helpful in terms of reducing the blood pressure.

01:46:57:15 - 01:47:31:19
Dr. Harpreet Bajaj
However, if the blood pressure is more than 20 millimeter mercury more than the target, and most people, we think that these these health behavior modifications may not be enough by themselves. And so blood pressure medication would be recommended right from the word go. And those individuals as as such. So in most people, if blood pressure is about ten millimeter mercury, more than the target range, initially health behavior changes can be can be suggested.

01:47:31:19 - 01:47:43:16
Dr. Harpreet Bajaj
And then monitoring is what we need to do, monitoring at home as well as maybe at your health care provider visits as well to see if that's making a change or not and when medications may be necessary.

01:47:44:14 - 01:47:50:17
Cayla Runka
Okay. And then just so we're clear that the normal range for blood pressure would be quite.

01:47:51:04 - 01:48:17:00
Dr. Harpreet Bajaj
Low in people with diabetes. Let's talk about the ABCs of diabetes, Cayla and people with diabetes. The target range, which is recommended is 1 to 3 for the higher number, the systolic blood pressure and then 80 for the lower number or the diastolic blood pressure. So that's a target that is recommended for people living with type one or type two diabetes.

01:48:17:14 - 01:48:32:11
Cayla Runka
Okay. And so you had said that ten, ten, millimoles above that would be oftentimes lifestyle interventions. But 20 or more is when potentially medications would come into play initially.

01:48:32:11 - 01:48:40:19
Dr. Harpreet Bajaj
And if lifestyle modifications or health behavior changes are not working, then we stopped medications, even for ten above the target. Ten. Okay.

01:48:41:20 - 01:49:08:08
Cayla Runka
So let's move on to C the ABCs part is cholesterol. And, you know, I know even with my sort of health care background, when I get my blood work done, I find it very confusing. The breakdown of the blood lipid levels that I see on my paperwork. So maybe we could start with just a general idea of what those values are and their importance, and then we can get to some of the targets with respect to diabetes.

01:49:08:18 - 01:49:36:08
Dr. Harpreet Bajaj
Sure. Yeah. And Cayla we should mention that these blood pressure and cholesterol targets are important to reduce the risk of heart problems. So heart attacks or strokes or what we call peripheral artery disease, which is basically less circulation or problem with circulation in the feet, the blood circulation in the feet as well. And so that's where the blood pressure and cholesterol targets play a major role.

01:49:36:13 - 01:49:59:05
Dr. Harpreet Bajaj
So that's why it's like ABC. It's not just it's not just glucose control in people with diabetes, but a multi-pronged strategy to control all these three levels such so the different cholesterols that we see on a lab report, the most important one, and probably the only one that we should look at because we don't necessarily change those.

01:49:59:10 - 01:50:27:01
Dr. Harpreet Bajaj
And research shows that looking at other levels is is confusing and it doesn't change anything anyway. So the one cholesterol, the one cholesterol that we should be looking at is the LDL cholesterol or what is called the lousy cholesterol. Right. So, L for lousy, Right. So that's a good way to remember which cholesterol we’re talking about. So LDL is the is the bad cholesterol, as it's called.

01:50:27:03 - 01:50:53:01
Dr. Harpreet Bajaj
Bad as in that's what causes the blockages to happen in the heart arteries or in the in the arteries that supply blood to our brain or to the feet and circulation as well. Right. So so that LDL cholesterol, the target for people with with diabetes is less than 2 millimoles per liter as the target for most people.

01:50:53:21 - 01:51:31:21
Dr. Harpreet Bajaj
And you know that that's recommended to be maintained to reduce the risk of of having heart attacks, strokes or having circulation problems in the feet. Now, I should mention that beyond just looking at a target LDL in the guidelines, you know, in the guidelines for Diabetes Canada, as well as the guidelines that come from our our sister organization, the Canadian Cardiovascular Society, which makes lipid guidelines or cholesterol guidelines as well.

01:51:31:22 - 01:52:20:23
Dr. Harpreet Bajaj
Right. The recommendation, even if some people may have their LDL cholesterol within that less than 2 millimoles per liter, they're still recommended a medication, most commonly a statin type medication, to reduce their risk of having or reduced the, you know, a for prevention of a heart attack or stroke. And the reason for that is, you know, some big studies have been done that even if there really is less than two, for example, in people with type two diabetes, there was a big study, even if the cholesterol were less than to giving or starting a medication like a statin, would actually reduce their risk of having a heart attack by about 50%25.

01:52:21:10 - 01:52:54:19
Dr. Harpreet Bajaj
And so for that heart protection is when statin recommendation is there. It's kind of like going back to my analogy on cars, right? It's kind of like no matter what speed you're driving and if you're driving low or high or whatever, you should always wear a seatbelt. So that seatbelt is your statin, if you will. So people with diabetes, no matter where the glucose is, no matter what their blood pressure LDL is, if you're above 40 years of age as one of the recommendation.

01:52:54:19 - 01:53:04:12
Dr. Harpreet Bajaj
Right. So if you're about 54 years of age and and if the individual is living with diabetes, then a statin medication is recommended regardless.

01:53:06:12 - 01:53:31:18
Cayla Runka
Great. And we're coming to the end of our time. I just want to let everyone online know that I've put a little summary all about the ABCDE and S's of diabetes care into the chat. And before we wrap it up, I just want to know, Dr. Bajaj, do you have any sort of parting words for people in terms of these tests and targets that we've been talking about?

01:53:32:20 - 01:53:59:13
Dr. Harpreet Bajaj
And let's we know we've talked a lot about, you know, medical terminology and maybe even, I hope, help to understand some of these terminologies and why they matter and what the targets are. You know, in a nutshell, on a big picture level, I think, you know, the the bottom line is that we know a lot more about living with type two or Type one diabetes.

01:54:00:05 - 01:54:26:16
Dr. Harpreet Bajaj
So living with diabetes, we know a lot more from research as well as experiences than we did ever before. And so, you know, maybe 20, 30 years ago, people would think of have having a diagnosis of diabetes and then be concerned whether their lifespan is going to be affected, whether they're going to get complications, what what, what their future is going to hold.

01:54:27:02 - 01:55:03:08
Dr. Harpreet Bajaj
But now, over the last 23 or 20, 30 years, with innovation in technology, with more research, having been done, we can be actually quite confident that people with diabetes, whether type one or type two, we have the right tools and strategies to to help to try and have similar quality of life with minimizing complications of of diabetes as well as, you know, solve that lifespan issues.

01:55:03:16 - 01:55:26:22
Dr. Harpreet Bajaj
So whether people with diabetes have a smaller lifespan is also been clarified in many of the research studies which suggest that people with diabetes can live as long as people living people without diabetes as well. So so with these tools that technology and innovation in medicine, I think that is that is the case. So I want to end on that positive note.

01:55:26:23 - 01:55:52:12
Cayla Runka
Yes, thank you. What a wonderful way to end. And I know I learnt a lot, so I hope the participants did as well. And everyone, thank you for taking the time out of your busy schedule to join us. It's not easy. We're busier than ever, but the benefits are always worth it. After the session, I'll follow up with an email, with an evaluation and some additional resources on the topics that we covered today.

01:55:53:00 - 01:56:12:12
Cayla Runka
And with that, a very, very big thank you to our guest expert today, Dr. Bajaj. I sure hope our participants enjoyed it as much as I did, and the generosity of your time and expertise, our Open Hours would not be possible. So very much appreciate the time and effort you spent with us today.

01:56:13:03 - 01:56:17:10
Dr. Harpreet Bajaj
So pleasure Cayla and stay healthy and stay safe.

01:56:17:24 - 01:56:53:11
Cayla Runka
Great. Thank you. To learn more and stay up to date on Diabetes Canada's work and resources, you can visit our website at diabetes.ca or check out our social media channels. We're on Facebook, Twitter, Instagram and LinkedIn. You can also feel free to call our info team at 1-800-BANTING. That's B-A-N-T-I-N-G or email info@diabetes.ca with any questions. Be sure you stay close for our next episode, which will be in June and feature another guest expert speaking on fitness for everybody.

01:56:54:07 - 01:57:11:16
Cayla Runka
So stay tuned for that and we hope the webinar was good for you and look forward to hearing some feedback from you in the next little while. So thank you again Dr. Bajaj.