In this episode we introduce how to stay in the range. Our guest expert answers all your questions on sugar ups and downs, hemoglobin A1C, blood pressure and cholesterol…otherwise known as your ABCs!
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[Music] hello and welcome everyone my name is
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Kayla runka and I work at diabetes Canada on the knowledge and connections team and I'll be your moderator for
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today I would like to start by acknowledging that I'm calling in today from Toronto and that I am located on the traditional
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indigenous territory of the wendat Hoda nashoni and nishnabeg and the mississaugas at the credit and that
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Toronto is now home to many diverse First Nations Inuit and metis 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 the power to create culturally safe and appropriate
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environments of care we are here today as part of our new initiative open hours diabetes open
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hours is our live call-in show especially for you to ask any and all questions regarding you or a loved one's
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lived experience with diabetes the program runs the last week of every other month with a different topic and
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guest expert so be sure to follow us on social or visit the website regularly for updates
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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
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visit with or the information you obtain from your own medical health professional
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so today's theme is know your numbers and ABCs and we're very lucky to have Dr
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harpreet Bajaj here today to answer your questions on blood sugars ups and downs hemoglobin A1c blood pressure and
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cholesterol otherwise known as your ABCs Dr Bajaj is an endocrinologist and the
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medical director of endocrine and Metabolic Research at LMC Healthcare centricity research he is a research
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associate at Mount Sinai Hospital Toronto and an adjunct lecturer at McMaster University
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he is the principal investigator of the Canadian diabetes prevention program a nationwide collaborative effort between
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LMC diabetes Canada and the public health agency of Canada and Dr Bajaj
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currently serves diabetes Canada as the chair of the clinical practice guidelines steering committee
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please feel free to use this feature if it will be helpful to you and with that are you ready Dr Bajaj hi I'm Kayla and
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thanks for the introduction yes let's go all right great so maybe while we're waiting for the first questions to come
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in we can chat about some of the basics so I have only experienced living with
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diabetes through my relationship with my mom um but I do know there are concerns with you know highs and lows and maintaining
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a steady blood sugar level so maybe we could start by just generally speaking about blood sugar it's role in the body
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and what happens for people with diabetes um when they're trying to control those levels
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sure yeah let's start with the basics absolutely and at various points I'll
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try to uh you know give a analogy to how
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we drive a car because many people many Among Us and drive a car right so so
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I'll just try to give analogies to that as we speak during this conversation if
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that's okay um so uh what does glucose do or what
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are the normal levels uh normal as in when we considered uh consider glucose
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not to be a medical problem let's discuss that first
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um so uh glucose in the body is useful to give us energy and there are various
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uh body organs that use glucose they can also use other sources of fuel other
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than glucose as well to maintain that energy and body function so other
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sources of fuel may be fat maybe what we call Ketone bodies there may be some
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other fuel sources that are that are useful as well in in other other organs
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of the body now there is one organ in the body which is the brain that only can use glucose
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as the only fuel so our brain is totally and completely dependent on glucose to
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use and and as a fuel to maintain its function the other organs like heart and
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liver and and kidneys can use other alternative fuel as well other than
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glucose but not the brain is is how it is and so for that reason because it's
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so essential for brains function for that reason our body has many different
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hormone systems to try and maintain the glucose in a good range not in a low
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range not in a very high range in a normal circumstance so one of the main hormones in our body that controls this
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uh the sugar in the normal range is insulin hormone so insulin is is a
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hormone that is released if the sugars are going up or if we eat when the sugars are supposed to be going up the
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insulin is released from the pancreas to try and bring it down into the normal range and the opposing hormone to
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insulin so a hormone that that does opposite the work of insulin to try and
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maintain that balance is glucagon glucagon is also made in the pancreas
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and it uh it kind of you know if your sugar is going too low then the glucagon
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starts going up so that the sugars are maintained in the normal level again there are other hormone systems as well
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in the body that maintain the sugars but it's mostly the insulin and glucagon that counter balance to try and control
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the sugars within that range so then uh what is the normal level of glucose in
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people where we think uh there is not a medical problem uh usually the range is
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between four to six um uh in the morning time in the passing time that we think that the sugars are
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in the normal range and after meals we expect a little Spike but that Spike uh
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up to about eight millimoles per liter is okay uh in a normal person that's
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what we think is the normal range for glucose levels if you will now the the
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analogy to the car you know if we're driving on a highway and I'm not recommending that we drive too fast or
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something of course right but let's think about uh driving on a highway that
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has a hundred kilometer per hour speed limit you know typically you would not get a ticket at least right if if you're
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driving at 110 or 90 or you know somewhere around that range right so so
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that's the analogy to the car driving on a highway is uh you know we try to
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maintain that uh that driving speed around the 100 it doesn't have to be exactly the 100 it may vary in between
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this range let's say 90 to 110 115 so that we are within that safe Zone if we
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will uh and we will not get the ticket how do we do that by pressing the accelerator or the or the break right so
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those are the ways we we control that so that's the analogy to insulin and
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glucose as well right so those are the two hormones that kind of maintain the glucose in that normal range as such as
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well so I hope that answers your first question yes for sure
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um and then I guess one of the questions that came up was um what kind of things affect our blood
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sugar so if we're looking at maintaining that sort of steady state um where do we need to pay particular
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attention yeah so um and that's a great question um so uh you know even in in people
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without diabetes but also especially in people who live with diabetes uh as well
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um there are many different things that can affect the sugar of course we know eating does and we mentioned that it can
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Spike up to it even even in people without diabetes as well but there are
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other circumstances other than eating for example exercise any kind of
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exercise even um even a moderate to a mild exercise level as well can you know help bring
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down high sugars to a normal range other factors bodily stress
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not sleeping enough or getting not not getting enough sleep can affect blood
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sugars in a in an adverse way so it can raise the sugar as well also the just a
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day and just a time of the day as well because as we are waking up many of our
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hormones uh like the adrenaline hormone the cortisol hormone are are trying to
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ramp up in the morning to try and get us awake and give us the energy boost and
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that itself in the morning can raise the sugar a little bit or or more in
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different people as well so it can vary from person to person
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um then illness can also affect the sugar um so illness as in uh having a fever
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having some infection can increase the sugars then there are some medications
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that can uh that can also Elevate the sugars uh those medications could be
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steroids for example steroid medications that are sometimes uh prescribed for
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asthma or other conditions autoimmune conditions as well or some other
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medications that can sometimes increase their sugars as well um so those are in a nutshell some of
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the conditions that can increase the sugars in a in a person who does not have
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diabetes there's still the insulin and glucagon will try to maintain the sugars
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within the normal range but in people with diabetes of course these all of
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these factors whether it's steroids whether it's you know certain kinds of
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foods or exercise or lack of exercise can play a major role as well with the
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sugar control as well now I said that you know four to six is the normal sugar
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for a person without diabetes for people living with diabetes the target range is
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up to seven for fasting and then the target range for after meal is up to 10
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uh two hours after a meal as well so two hours after a meal we want the spike to
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stay in the single digits not in double digits so kind of like again going back
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to the car analogy okay maybe up to 120 kilometers per hour most people would
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not get a ticket right I mean maybe some cop will still give you a ticket but uh up to 120 probably you will not get it
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to get as well don't quote me on that okay you get into trouble so that's uh that's
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the car analogy to that okay great um and you you've mentioned a couple times that blood sugar varies throughout
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the day so um the next question is you know
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when do you realize something might need to be addressed how how long can your
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blood sugar be High um before you need to start worrying about maybe making some changes with
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medication or other parts of um those things you've mentioned that impact blood sugar
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yeah so when people with diabetes is I guess what we're talking about about this question and so in people with
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diabetes uh you know once in a while if the sugars go up because we had a treat
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um you know we indulged a little bit that's not when we need to start
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adjusting the medication um of course everybody's uh you know allowed to have their birthday cake or
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or whatever other treat that you like um and and uh you know the uh at least
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the suggestion or request is that we maintain we try to we can try to
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maintain portions uh smaller portions of those streets and maybe even some people
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can try to compensate for having that treat by by reducing other carbs within
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that meal if you will so having less of uh let's say bread or rice or potatoes
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so at it so that it compensates for that piece of cake that you had as well so
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then if if it's just one off we don't need to start increasing or changing medications however if it's a consistent
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daily pattern or most days of the week then we need to start looking at hey
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after dinner is when when the sugar starts spiking more than 10 on most days
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of the week maybe we need to address that the other lab parameter that helps
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us in all of this is called the hemoglobin A1c or the A1C test as we
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call it it's a blood test so it's not that something that we test at home and
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this A1C number uh kind of in a in an easy way it you know to understand it
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it's basically an average of three months of last three months of sugars
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before that test was done so if I get a blood test today and I can do it anytime calendar day doesn't matter if I do it
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morning or afternoon or night it kind of averages out what my sugars have been
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for the last three months so what was my sugar in February March and now in April
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is what it will tell me and and all of the sugars not just the morning or
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evening sugars but all of the sugars over the last three months how they've been now the normal range for this A1C
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test is less than six percent uh so that's for people without diabetes we
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say normal is less than six if the A1C is between 6 to 6.4 we the diabetes
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Canada guidelines uh say it's uh it's uh it's termed termed as pre-diabetes so
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it's a precursor to diabetes condition that we call as pre-diabetes which means
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that there is a high risk that the sugars can worsen into the type 2 diabetes or range from
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that and then anything more than 6.4 so if we go to 6.5 or above is considered a
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type 2 diabetes so the target as I said for you know after uh if you're doing
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the finger prick or other means of testing your glucose at home we said
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after meal it should be less than 10 fasting it should be less than seven for people with diabetes or A1C test the
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target so that's the first of the ABC's uh Kayla as well the a of the ABCs is
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A1C and the target for most people is less than seven on that ABCs okay
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um and then while we're on that a of the ABCs how frequently should you be
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getting your A1C tested and um does That Vary based on whether you
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have type 1 or type 2 diabetes yeah that's a great question I mean it
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is it needs to be individualized and uh you know you you have to look at various
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factors when you determine how frequently you get it
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um um so maximum uh so every three months
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uh is what we uh what the diabetes Canada guidelines would say uh maximum
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every three months so maximum four times a year is when we should get it so A1C is an average of three months and so if
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you get it every three months uh that that makes sense uh as well but for some
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people um uh some people who might have uh might not need to have it every three
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months you don't need to uh necessarily go to a lab every three months right uh if you have uh if somebody if an
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individual has diabetes that is very well controlled control on the A1C and
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they're doing their their testing at home and it is very well controlled and they are on let's say one or two blood
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pressure medications uh that they've been stable on for many many months as
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well so nothing new is changing no new medication was added or or deleted as
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well then you know you can do it every six months as well so it can vary a
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little bit how frequently we should have this blood test but in most people every
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three months but it can uh you know be be relaxed to up to six months if we
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think uh somebody's uh somebody has diabetes that is within the target range
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that we want it to be okay so yes very individual best to work with your personal health care provider on that
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front um just before we move to another um participant question we haven't
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talked about low blood or low blood sugar yet um so maybe we could just spend a minute
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on you know what does that look like and what some of those values are and
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um what people can look out for when they are experiencing a low blood sugar
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yeah so it's very important to understand this so you asked about uh you know Kayla you asked about the high
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sugars and when we should address it I said if it's consistently high is when
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we address it but for low blood sugars even one low blood sugar can be can be
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challenging it can be burdensome it can it can lead to symptoms of low sugars
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and uh you know on the other hand if we think about high sugars many people
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would not have any symptoms even some people uh if they've had high sugars up
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to 15 or even 20 Sometimes some of uh you know individuals may not have any
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symptoms from high sugars on the other hand low sugars can cause a lot of symptoms so what are these symptoms uh
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the first stage of symptoms is basically warning signs of low sugars these
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warning signs could be uh trembling or shivering
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so they could be a heartbeat going very fast so what we call call palpitations
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of the heart right so racing of the heartbeat um they can be sweating they can be just
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a sense of disorientation or hunger as well so those are some of the warning
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signs of low sugar um the second stage if it goes very low
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typically um typically around two or less than two is when people can have other major
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problems with low sugar as well as there can possibly with low sugars people can
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have problems with coma they can have seizures they can have heart arrhythmias
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as well so there can be major problems from low sugars if they go very low
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um so uh so it's very important to uh to understand the low sugars now however
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it's scary right having low sugars sounds very scary with all of what I've
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just said fortunately we we know that which
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medications in diabetes can you know have the have the possibility of causing
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low sugars right so so it's not not all of the medications uh that people might
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be taking for diabetes that can cause low sugars so some of the medications that can cause low sugars are of course
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one is insulin so if somebody is taking insulin to manage their diabetes uh you
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know it's it's absolutely necessary to have a good understanding around low sugars and how to deal with them and how
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to treat the low sugars as well um and then the other medication the
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other class of medications that can have the potential for low sugars is called
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the sulfonuria class so these medications like glycolazide or
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Glyburide or glimepiride are available in Canada and these medications can also
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cause low sugars these medications are used in type 2 diabetes insulin can be
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used in type 1 diabetes can also be used in type 2 diabetes of course insulin but
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so those are the medications insulin or solving ureas that can cause low sugars
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or hypoglycemia okay so both people living with type 1 and those with type 2
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on medications are at risk for low blood sugar yeah so both uh people with type 1
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absolutely because they they are typically on insulin which is uh the hormone that that is deficient in in
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people living with type 1 diabetes and so uh uh that is a risk factor for
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people with type 2 diabetes it's the people who are using um uh either insulin or any of these
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sulfuria medications but these days we are seeing less and less use of the sulfur urea medications and other
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medications outside of sulfonuria or insulin do not cause hypoglycemia and so
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people living with type 2 diabetes if they're using other medications they're not they don't they have a very
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negligible or zero risk of of causing hypoglycemia okay good to know
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um we have a participant question wondering if you can explain
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um what time in range is and if this is a new sort of measure um and its
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importance yeah so so time and range um uh maybe I'll go back to my analogy
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on the on the car driving in this um so um you know that 90 to 110 kind of range
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right so is is where we want to uh keep driving at uh for safety of course and
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so uh time and range is kind of that safety zone if you will uh for managing
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uh blood glucose levels uh so what is that um what is the target for that so
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there's an international consensus on uh CGM so continuous glucose monitoring
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um uh continuous glucose monitoring is not the typical fingerprick but these are sensors that can be put on either
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the arm or the abdomen or other places in the body that continuously monitor
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glucoses for 24 hours so not just a static number when you check your sugars
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with a finger prick but these are sensors that stay on the body just like a tuning they're small quite small and
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they go on as a patch and these can monitor the glucose levels uh you know for 24 hours for seven days or two weeks
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depending on the on the device that you're using so on these continuous glucose monitoring devices you can get a
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time and range percentage as to how much uh the person living with diabetes or
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otherwise has their glucose is within the certain range so this International
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Concepts as recommendations suggest using the four to ten millimoles per
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liter range so anything less than four is considered below the range anything
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above 10 is considered above the range so anything between between the 4 and 10
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number is then is then the time in range if you will that's uh that's the green
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zone right so that's where uh that's where ideally uh the the glucose levels
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should be now in people especially people who may
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be using insulin to manage their diabetes we know that glucoses do fluctuate and so the consensus this
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International consensus recommends that 70 of the time and range we maintained
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uh is what the recommendation is so 70 of the time between four to ten uh is
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what the guideline States and then less than four percent below the range and
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then less than uh 25 26 percent above the range of 10 is what the guidelines
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suggests so that's a green zone time and range uh the target for that especially
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in people with diabetes who are who are you know injecting insulin for to manage
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their diabetes uh the recommended goal or Target is 70 in that range
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again to maintain that [Music] sort of stable blood sugar level to
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prevent some of the the side effects of edin and there's actually another participant question similar to that so
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they're wondering if um they're above normal number on a day-to-day basis
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whether it's fasting or post meals if if they're above that range one day does
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damage to the body and organs per se happen sort of that day or is it only
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when it's elevated over a longer period of time yeah that's a very good question and and
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uh you know the answer the response to that it is it is over a long period of
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time so um so um higher glucose levels over time over
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many years is when the damage starts showing up typically about 10 to 15
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years from the diagnosis of diabetes if a person living with with diabetes if
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their glucoses happen above that range or that Target that we we discussed then
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the complications of diabetes
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potentially can happen at that time so it's not just one of higher sugar that
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causes a bodily harm at that point but it's typically over many months and
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years if the glucose are high and just a follow-up question on the
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time and range um someone is wondering whether someone who is using a glucometer and doesn't
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have access to a CGM device um and also assess time and range with
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the glucometer yeah so um before the CGM devices became available we had this uh you know people
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who are doing many different things they would you know one of the methods was to
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check glucose levels seven times in one day we don't typically ask for as a very
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onerous very uh you know it's it's very time consuming and also a lot of
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fingerpricks for that but that's one other way of of checking uh what the
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time and range is so seven times would include you know before and after a meal
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three times a day as well as at middle of the night so midnight kind of blood
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glucose test as well so that can be another way to find uh you know what
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your what somebody's glucose fluctuations are and if the glucose
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fluctuation are within that green zone that we discussed or not typically we
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don't do that and and you know typically um maybe we'll ask to uh alternate
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glucose testing if somebody does not have access
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to CGM unfortunately access is a limitation access and costs are big
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limitations in in CGM use then you know depending on on what medications are
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being used uh their healthcare provider May and discuss whether alternate
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testing alternate as in you know test glucose fasting one day another day
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after breakfast another day after lunch you know to get kind of a sense of where
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the glucose is lie may be a less onerous and less expensive as well as less painful very
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way of glucose testing as well right I can imagine yes there's a couple more
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questions and then maybe we'll move on to the B part of ABC's since we haven't
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discussed the those components yet so one question is around type 2
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specifically and whether there's a natural progression once you're diagnosed as you age in even if it's
31:34
managed well is there always sort of that progression of the disease as you
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get older yeah so that's a good question um so um uh you know in in our
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medical school or or other graduate school um that's typically that the definition
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that we've learned uh for for type 2 diabetes the type 2 diabetes is a
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chronic condition chronic means permanent condition and a progressive
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condition Progressive as in it worsens over time and some studies like Landmark
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study from UK called the UK PDS suggests that the pancreas which makes
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insulin the ability of the pancreas to make insulin after a diagnosis of type 2
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diabetes reduces over time by about six
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percent per year so about six percent or less uh ability
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of the pancreas over uh over a year year by year uh then you can imagine you know
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if six percent times whatever it can lead to fifty percent sixty percent decline over 10 to 15 years right so so
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that's uh uh kind of uh been there and and that's uh that's uh that's how most
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of us uh learned about uh type 2 diabetes Now more recently
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um there has been some suggestions some studies suggesting that uh it's not all
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a downhill slope if you will there is a possibility uh that um uh that some of
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this um uh this downhill progression can be
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reduced at least so that uh slope of reduction slope of worsening of of the
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pancreas to uh ability to make insulin can be reduced one way that has been
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suggested is weight loss so weight loss either it is with various dietary
33:47
modifications or exercise or with bariatric surgery there is a lot
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of literature from the bariatric surgery which is a surgical operation it's also
34:00
called the gastric bypass surgery right bariatric surgery so with this there have been some
34:08
studies suggesting that the pancreas ability to to make insulin does not
34:14
deteriorate as much over time as well okay
34:19
um speaking of dietary one of the questions is can diabetes be controlled
34:25
um by diet exclusively so I'm assuming
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um that answer May differ between type 1 and type 2. yeah and thanks for pointing that out uh
34:38
of course Kayla so type 1 diabetes uh where um the pancreas has a minimum or
34:45
zero production of insulin of course insulin is the treatment that that individual will need and it should not
34:52
be withheld and it should be started as soon as possible and and maintained throughout life
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um it's life sustaining for people with type 1 diabetes and that's very important to understand the difference
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between type 1 and type 2. for people with type 2 diabetes
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initially early on within the first few years of type 2 diabetes
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and later on as well you know diet plays a big role dietary interventions play a
35:26
big role in terms of maintaining glucose within those targets that we discussed
35:32
um of course uh individual situations and social situations individual barriers
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challenges play a role in all of all of what is possible for an individual but
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um you know in in diabetes Canada guidelines um we do suggest uh you know right from
35:55
diagnosis of type 2 diabetes a comprehensive management so medications
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plus minus or I should say a diet plus lifestyle or health behavior
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modifications plus or minus medications is what is recommended as a
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comprehensive management of glucose control um if uh and and then monitoring after
36:20
that so monitoring for the glucose checks at home as well as that A1C test that we that we discussed as well so
36:28
that can guide whether an individual their glucoses can be maintained within
36:34
that Target that we that we discussed as well with uh solely with diet or or do
36:42
medications need to be added or increased over time as well so for some individuals yes and especially initially
36:49
diet can be very very helpful and not necessarily need a medication at least
36:56
in the in the initial few years of diagnosis of type 2 diabetes all right we have one more question on
37:02
the AIDS and then we're going to move on to B um the question is uh if your hemoglobin
37:08
A1c is under control and is staying quite level and and within those um
37:15
Range numbers that were provided is it recommended to get a continuous glucose monitor or are you able to just continue
37:21
on the way that you've been yeah so it's more of a cost and access
37:28
question and it'll have to depend on that there's uh these these uh monitors
37:36
unfortunately are are quite expensive um also if you look at data how much
37:43
difference does it make uh you know in terms of whether we are talking about difference you know if somebody's using
37:50
these continuous meters versus uh what we typically do with a finger prick does
37:55
it make a difference on A1C uh there are various studies that have been done on
38:01
these comparisons they suggest that for some people it may
38:07
make a difference on the A1C so for people who you who use insulin to
38:14
control their type 2 diabetes or type 1 diabetes these continuous meters may be
38:21
useful tool for some individuals with type 2 diabetes who are on at least two
38:29
or three oral drugs that are that they're using for their type 2 diabetes
38:36
it may also be useful um to control to help A1C get better at
38:42
least one one or two studies that have been done suggest that but it's not just the A1C control it's
38:49
also about reducing the risk of low sugars or hypoglycemia as well so I
38:55
think the question that you asked is about if somebody's A1C is already
39:01
within the target let's say less than seven let's say say their glucose uh their A1C 6.8 then what's the role of of
39:10
these continuous glucose monitors so in people with type 1 diabetes or people
39:16
with type 2 who may be using insulin there may still be a role to monitor as
39:23
well as alarm about low blood low blood sugars as well because many of these
39:28
sensors have built-in alarms around glucose of less than 3.9 or so and so
39:36
that can be very useful so as to prevent catastrophic low blood sugar as well so
39:44
it depends on in the on the individual situation but in some cases especially
39:50
in type 1 to reduce the risk of hypoglycemia and to Monitor and manage
39:56
hypoglycemia risk continuous glucose monitors may be useful in even if the
40:02
A1C is less than seven right okay so the B part of ABC's blood
40:09
pressure um I'm gonna kick it off with just the question around um do people living with diabetes have a
40:16
higher risk of uh experiencing issues with their blood pressure yeah so people with type 2 diabetes
40:22
there is a definite um uh kind of association with higher sugars and
40:29
higher blood pressure um so blood pressure also varies from
40:35
Individual to individual there are many different individual things that change blood pressure of course age is one of
40:41
them as we grow older our blood pressures do rise of course Salt plays
40:48
some role in blood pressure also in a in a person without having a high blood
40:53
pressure problem or or in people with high blood pressure problems as well uh salt can claro so in terms of blood
41:01
pressure you know individual variations are there but in people with type 2 diabetes there is a higher chance of
41:07
having a problem with high blood pressure okay and then sort of the two-part
41:13
question from one of the participants so um if you are at risk
41:20
um for higher blood pressure because of a living with diabetes but you also have a hereditary
41:25
genetic component um in your family of high blood pressure
41:30
can lifestyle interventions be effective um and then if so I guess what might
41:36
some of those things be or will you inevitably probably require medication
41:42
yeah so um much like glucose blood pressure as
41:49
well the first line of therapy for high blood pressure in in many individuals
41:54
unless the blood pressure is is very high above the targets then
42:01
initially health behavior changes so whether it is dietary control or or
42:09
weight reduction or salt reduction or I should mention alcohol reduction as well
42:17
so those can be helpful in terms of reducing the blood pressure however if
42:23
the blood pressure is more than 20 millimeter mercury more than the Target
42:29
and most people we think that these these health behavior modifications may
42:34
not be enough by themselves and so blood pressure medication would be recommended
42:39
right from the word go in those individuals as as such so in most people if the blood pressure
42:47
is about 10 millimeter mercury more than the target range initially health
42:53
behavior changes can be uh can be suggested and then monitoring is what we
42:58
need to do monitoring at home as well as maybe at your healthcare provider visits
43:04
as well to see if that's making a change or not and when medications may be necessary
43:09
okay and then just so we're clear that the normal range for blood pressure would be
43:15
what so when people with diabetes let's talk about ABCs of diabetes uh Kayla and
43:21
people with diabetes the target range which is recommended is 130 for the
43:28
higher number this systolic blood pressure and then 80 for the lower number or the diastolic blood pressure
43:36
so that's a Target that is recommended for people living with type 1 or type of
43:42
diabetes and so you had said that 10 10 millimoles above that would be
43:49
oftentimes lifestyle interventions but 20 or more is when potentially
43:54
medications would come into play yeah initially and if lifestyle modifications or health behavior changes are not
44:01
working then we start medications even for 10. above the target there
44:07
um so let's move on to see ABC c part is cholesterol and you know I know even with my sort of healthcare
44:15
background when I get my blood work done I find it very confusing the breakdown of the blood lipid levels that I see on
44:23
my paperwork so maybe we could start with just a general idea of what those values are and their importance and then
44:31
we can get to some of the targets with respect to diabetes sure yeah and and Kayla we should mention that these blood
44:38
pressure and cholesterol targets are important to reduce the risk of heart
44:43
problems so heart attacks or Strokes or what we call peripheral artery disease
44:49
which is basically less circulation or problem with circulation in the feet the
44:55
blood circulation in the feet as well and so that's where the blood pressure and cholesterol targets play a major
45:01
role so that's why it's like ABC it's not just a it's not just glucose control in people with diabetes but a
45:08
multi-pronged strategy to control all these three levels such so the different
45:13
cholesterols that we see on a lab report the most important one and probably the
45:19
only one that we should look at because we don't necessarily change the others and and research shows that looking at
45:27
other levels is is confusing and it doesn't change anything anyway so the
45:33
one cholesterol the one cholesterol that we should be looking at is the LDL
45:39
cholesterol or what is called the lousy cholesterol right so L for lousy right
45:44
so that's a good way to remember which cholesterol we are talking about so LDL
45:49
is the is the bad cholesterol as it's called bad as in that's what causes the
45:54
blockages to happen in the hot arteries or in the in the arteries that Supply
46:00
blood to our brain or to the feet in circulation as well right so so now LDL
46:07
cholesterol the Target for people with that with diabetes is less than two
46:14
millimoles per liter is the target for most people and and uh you know that
46:21
that's recommended to be uh maintained uh to reduce the risk of of having heart
46:28
attacks Strokes or having circulation problems in the in the feet now I should
46:33
mention that uh Beyond just looking at a Target LDL
46:39
uh in in the guidelines uh in our in the guidelines for uh diabetes Canada as
46:47
well as the guidelines that come from our uh our sister organization the Canadian cardiovascular society which
46:53
makes uh lipid guidelines or cholesterol guidelines as well right uh the recommendation is even if some people
47:01
may have their LDL cholesterol within that less than two millimoles per liter they're still recommended a medication
47:09
uh most commonly a Statin type medication to reduce the risk of having
47:16
uh or reduce the you know for prevention of a heart attack or a stroke and the
47:21
reason uh for that is you know big Studies have been done that even if the
47:27
LDL is less than two for example in people with type 2
47:32
diabetes there was a big study even if the cholesterol were less than two giving or
47:40
starting a medication like a Statin would actually reduce their risk of having a heart attack by about 50
47:45
percent and so uh for that heart heart protection is when a Statin
47:51
recommendation is there it's kind of like a going back to my analogy on cars right it's kind of like no matter what
47:59
speed you're driving at right if you're driving low or high whatever you should
48:04
always wear a seat belt right so that seat belt is your starting if you will
48:09
so people with diabetes no matter where the glucose is no matter what their blood pressure LDL is if you're above 40
48:17
years of age as one of the recommendation right so if you're wealth with 40 years of age and and if the
48:24
individual is living with diabetes then a Statin medication is recommended regardless
48:31
right um we're coming to the end of our time I just want to let everyone online know
48:37
that I've put a little summary tool about the ABCDE and s's of Diabetes Care
48:43
into the chat um and before we wrap it up I just want
48:48
to know Dr Bajaj do you have any sort of parting words for people in terms of
48:54
these tests and targets that we've been talking about yeah let's um and we know we've talked
49:00
up a lot about uh you know medical terminology and and uh maybe even I I
49:05
hope uh helped understand some of these terminologies and why they matter and and what the targets are
49:12
you know on an on a nutshell on a big picture level I think uh you know the
49:17
the bottom line is that we know a lot more about living with type 2 or type 1
49:24
diabetes um so living with diabetes we know a lot more from research as well as
49:29
experiences uh than we did ever before and so um you know uh maybe 20 30 years
49:36
ago people would think of have having a diagnosis of diabetes and then be
49:43
concerned whether their lifespan is going to be affected whether they're going to get complications uh what are
49:50
what what their future is going to hold but now over the last 23 to 20 30 years
49:55
with the innovation in technology with more research having been done we can be
50:01
actually quite confident that people with diabetes whether type 1
50:07
or type 2 we have the right tools and strategies to to help uh to uh ex to uh try and
50:17
have similar quality of life with um minimizing complications of of diabetes
50:25
as well as uh you know some of that lifespan issues uh so uh whether people
50:30
with diabetes have a smaller lifespan is also uh been clarified in many of the research studies which suggest that
50:37
people with diabetes can live as long as people were living people without diabetes as well right so
50:44
um so with these tools the technology and and Innovation and medicine I think that is uh that is the case so I want to
50:50
end on that positive note yes thank you what a wonderful way to end and I know I
50:55
learned uh a lot so I hope the participants did as well and and everyone thank you for taking the time
51:01
out of your busy schedule to join us um it's not easy uh we're busier than ever
51:07
um but the benefits are always worth it um after the session I'll follow up with
51:12
an email with an evaluation and some additional resources on the topics that we covered today and without a very very
51:19
big thank you to Our Guest expert today Dr Bajaj um I sure hope our participants enjoyed
51:26
it as much as I did and without uh the generosity of your time and expertise our open hours would not be possible so
51:33
very much appreciate the um time and effort you spent with us today it's my pleasure Kayla and uh yeah stay
51:41
here thank you stay safe yeah great thank you um to learn more and stay up to date on
51:47
Diabetes Canada's work and resources you can visit our website at diabetes.ca or
51:52
check out our social media channels we're on Facebook Twitter Instagram and Linkedin you can also feel free to call
51:58
our info team at 1-800 Banting that's b-a-n-t-i-n-g or email info diabetes.ca
52:06
with any questions make sure you stay uh close for our next episode which will be
52:12
in June and feature another guest expert speaking on Fitness for everybody
52:18
[Music] um so stay tuned for that and we hope the webinar was helpful for you and look
52:23
forward to hearing some feedback from you uh in the next little while so thank you and Dr Bajaj
52:30
thank you
52:35
[Music]
Category Tags: General Tips, Just the Basics, Management;