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A SPONSORED FEATURE BY MEDIAPLANET
Diabetes
D
iabetes is a complex global disease with
many causes and no known cure. It is es-
timatedthatmorethan10millionCanadi-
ansarelivingwithdiabetesorprediabetes
today. If you don’t have it, there is a good chance someo-
ne in your family or circle of friends is affected. Not only
is the number of cases growing, so are the serious com-
plicationsitcauses.Diabetesisacauseof30percentofall
strokes, 40 percent of all heart attacks, 50 percent of kid-
ney failure requiring dialysis and 70 percent of all lower
limbnon-traumaticamputations.
MMA Fighter and type 1
diabetic, Dessi Zaharieva,
challenges diabetes inside
and out of the ring. p04
Publisher: Ryan Shepherd Business Developer: Ian Solnick Managing Director: Martin Kocandrle Production Manager: Carlo Ammendolia Lead Designer: Matthew Senra
Contributors: Rick Blickstead, Ken Donohue, Randi Druzin, Duff McCourt, Katherine O’Brien, Michele Sponagle Cover Photo: Submitted Photo credits: All images are from Getty Images
unless otherwise accredited. Send all inquiries to ca.editorial@mediaplanet.com This section was created by Mediaplanet and did not involve Maclean’s Magazine or its Editorial Departments.
Please recycle after readingStay in Touch facebook.com/MediaplanetCA @MediaplanetCA @MediaplanetCA pinterest.com/MediaplanetCA
YORKU.CA/OPENMIND
THIS IS KINESIOLOGY &
HEALTH SCIENCE
[ OPEN YOUR MIND ]
PERSONALHEALTHNEWS.CA
Diabetes Is No Stranger to Canadians
Rick Blickstead
President and CEO,
Canadian Diabetes
Association
Vision care
Diabetic retinopathy is one of the most preventable
complications from diabetes. People with diabetes are
also more likely to develop cataracts at a younger age
and twice as likely to develop glaucoma, but the di-
sease’s effect on the retina is the main threat. Diabe-
tes is one of the most common causes of blindness in
North America. It’s important that people with diabe-
tesmanagetheirbloodsugarlevels,bloodpressureand
cholesterol. Regular eye exams can also greatly redu-
ce the risk of complications or prevent their progress.
Healthy living
For people with diabetes, keeping healthy requires a ba-
lanceofnutritionandphysicalactivityalongwithmedica-
tionifprescribedandmonitoringofbloodsugarlevels.Li-
festyleisariskfactorfortype2diabetesbutfamilyhistory,
ethnic background, socioeconomic status, and environ-
mentalsoplayasignificantpart.Livingahealthylifestyle
canhelpreducetheriskoftype2diabetesoritsonset,even
byasmuchas60percent.Agoodplacetostartisreducing
oreliminatingsugar-sweetenedbeverages,whichstudies
showincreasetheriskofdevelopingtype2diabetes.
Advances in research
Since the discovery of insulin, Canada has been at the fo-
refrontofdiabetesresearch,education,andmanagement
— making it an easier disease to manage today. Advances
intechnologyarealsochanginglifeforpeoplewithdiabe-
tes: insulin pumps are now common and continuous
blood glucose monitors are on the brink of widespread
adoption.Canadianresearchisalsopartoftheworldwide
effort to develop an artificial pancreas, which will deliver
the right amount of insulin exactly when it is needed.
Thanks to the shared commitment of people living with
diabetes and their families, health care professionals, re-
searchers, governments, and many others — people with
diabeteshavetheopportunitytolivefull,healthylives.
2 PERSONALHEALTHNEWS.CA
N
o one needs to be told that diabetes is
serious. The complications and mortal-
ity risk that come with the condition
are well known. What is less commonly
understood, however, is the degree to which diet and
lifestyle can affect individual risk of developing type
2 diabetes.While genetic factors such as ethnicity and
family history play a large role,what you eat (and how
much of it) is the arguably the single biggest factor in
whether you will develop diabetes as an adult.
“Unhealthy eating is the prime risk factor for the de-
velopment of type 2 diabetes,” says Dr. David Cavan,
Head of Policy and Programmes at the International
Diabetes Federation. “We can think certainly of all the
foods we recognize as unhealthy, specifically all those
high-fat,high-sugarfoodsthataresoprevalentinmod-
ern day society, not just in westernized countries, but
alsoincreasinglyinotherpartsoftheworldaswell:fast
food, hamburgers, fries, sugar-sweetened beverages.”
The dangers of drinking your calories
Sugarybeveragesinparticularposeamajorhazard,with
recent studies showing a direct connection between
consuming as few as two servings of sweetened bever-
ages per day and an increased risk of diabetes. “And it’s
not just soft drinks,” says Dr. Jan Hux, Chief Science Of-
ficerattheCanadianDiabetesAssociation.“That’ssome-
thingthatsurprisespeople.Somebodywhousedtodrink
alotofcolamayswitchtoblendedicedcoffeedrinks,but
notknowthatalltheflavourinthosedrinkscomesfrom
a sugary syrup that can deliver nearly as much sugar to
thebodyasyouwouldgetfromasoftdrink.”
With sugar being the prime culprit in unhealthy
diets that can lead to increased diabetes risk, it’s very
important that people be aware of just how much sug-
ar they are getting in their diet, whether in their bever-
ages or in other foods. “Sugar is often hidden in places
youwouldn’texpectit,”explainsInternationalDiabetes
Federation CEO Dr. Petra Wilson. “While most people
are aware that french fries from fast food outlets are un-
healthybecausetheyarehighinfatandsalt,theymight
not realize that they also contain quite a lot of sugar.
Theirgoldencolourinfactcomesfromthefactthatthey
haveasugarsyrupcoatingbeforetheyarefried.”
You can’t eat well without knowing
what you’re eating
The single best way to control the amount of sugar and
other unhealthy ingredients in your diet is to prepare
your food yourself. This is why so many diet recom-
mendations focus on cutting out prepackaged food in
favour of whole foods prepared from fresh ingredients,
particularly fruits, vegetables, and whole grains.
Of course, a healthy diet doesn’t necessarily mean
cutting out sugar entirely. As with all things, the key
is in moderation. Moderation also means focusing on
the most important aspect of any healthy diet: portion
control.“We’vebeeneatingalotofthesefoodsforthou-
sands of years,” says Dr. Cavan. “In themselves they’re
not harmful, it’s when they are eaten to excess. That’s
why portion control is a very important message.”
For those with diabetes, following these guidelines
for a healthy diet becomes one of the three pillars of
their treatment, alongside exercise and medication.
For those without the disease however, especially
those at increased genetic risk, a healthy diet is just as
vital. Prevention is always better than cure.
Celebrity chef and type 1 diabetic,
Chris Smith, sat down with Mediaplanet
to discuss healthy cooking options for
those with diabetes.
Mediaplanet What is your favourite
diabetes-friendly dish to serve your
family and why?
Chris Smith With the holidays fast approach-
ing,I always get the requests for great tasting
desserts. I have included a few recipes that have
the flavors of the season and are also a great ex-
ample of healthy nutritional recipes.
[Editor’snote:visit personalhealthnews.ca
toviewadditionalrecipes]
 
MP What ingredients or foods are most
beneficial for people with diabetes?
CS I recommend to visit with your doctor or
registered dietitian to gain an accurate explana-
tion for each particular individual. With that
said, as a chef, rather than “one” particular
ingredient, I always promote balance and
moderation with each meal. It is the balance of
foods — of fruits,vegetables, lean meats, fresh
fish, plus nuts and grains that over the course of
time show the most beneficial results.
Healthy eating and living an active lifestyle is essential to
reducing the risk of acquiring type 2 diabetes.
Is Your Diet Putting You
at Risk for Diabetes?
Visit personalhealthnews.ca
to view recipes and additional answers
By D.F. McCourt
INSIGHT
Connect.
Learn.
Discover.
World Diabetes Congress
30 November – 4 December
ONSITE REGISTRATION
AS OF 30 NOVEMBER
DAY RATE
$365
STUDENTS
$125
www.wdc2015.org
WDC15-inside-banner-print-3-rtp.pdf 1 10/11/2015 09:39:41
Chris Smith
The Diabetic Chef
ONLINE EXCLUSIVE RECIPES
Apple cranberry strudel bites and more
MEDIAPLANET 3
Read more
online at personalhealthnews.ca.
Understanding a
Complex Disease
How Canadian researchers continue to lead the way
in diabetes care and treatment.
Bringing the
Best Together
in the Fight
Against Diabetes
As the largest freestanding diabetes research facility in
Canada, the Alberta Diabetes Institute at the University
of Alberta brings together some of the world’s leading
diabetes researchers in an environment where passion
and precision merge—integrating state-of-the-art
facilities with scientific expertise to transform exciting
discoveries into life-altering therapies.
The Alberta Diabetes Institute—research
focused on developing real world
solutions for diabetes
Dr. Patrick MacDonald
Canada Research Chair
in Islet Biology,
University of Alberta
HowDiabetesResearches Are
LeveragingAdvancesInTechnology
Michael Riddell, a professor of
Kinesiology and Health Science at York
University, lives and breathes diabetes
research, and knows more than most on
the effects of this disease.
Dr.Riddellhastype1diabetesandisexcitedbynew
researchleadingtobetteroutcomesforpeopleliving
withthedisease.Heiscurrentlystudyingtheeffects
ofexerciseandstressondiabetes.Lowbloodsugarisa
commonsideeffectofinsulin,andthiscanbeexacer-
batedduringexercise.Manypeopledon’trecognize
theyhavelowbloodsugar,whichcanresultinpeople
gettingshaky, weak,confused,disorientated,andif
leftuntreatedcanleadtounconsciousnessanddeath.
Dr.Riddell’steamisintheearlystagesofresearch
intoanewdrugthatwillhelpbuildanaturalre-
sponsewhenaperson’sbloodsugardrops.Addition-
ally,diabetesresearchersaredevelopinganartificial
pancreasthatcancommunicatewithacontinuous
glucosemonitoringmachine,andusesophisticated
programmingtoautomaticallyincreaseorlowerin-
sulinbydetectingexercise,orthetypeofmealsome-
onehashad.Rightnow,accordingtoDr.Riddell,it’sa
bithitandmissondispensingthebestamountofin-
sulinforsomeonewithdiabetes.
“Diabetesisacomplexdisease,buttherehavebeen
someprettyamazingadvancesthroughresearch,”
says Dr.Riddell,“Weneedtodoresearchon
developingnewdrugsandnewtoolsthatpatients
canuseeveryday.Theyliveitminutebyminute,and
thedecisionstheymakeimpacttheirbloodsugar
controlonaconstantbasis.”
INNOVATION
From the discovery of insulin in the 1920s,
Canada has a long history of diabetes
research, playing a leading role in the
global push to better understand and
treat people with diabetes.
“Canada has traditionally punched above its weight
when it comes to diabetes research,” says Dr. Patrick
MacDonald, Canada Research Chair in Islet Biology
at the Alberta Diabetes Institute, Faculty of Medi-
cine and Dentistry, at the University of Alberta.
“There have been some remarkable breakthroughs
in drugs over the last decade that do a much better
job at lowering blood sugar.”
Dr. MacDonald’s work is focused on type 2 dia-
betes, a disease of insulin resistance, which forces
the pancreas to crank out more insulin. Over time,
the pancreas is unable to keep up with the demand
and stops working. “We’ve been able to identify some
important pathways that act like a dimmer switch,”
he says. “We can control how much insulin comes
out when the switch is turned on or dimmed. We are
looking at finding some tricks within the body, so the
right amount of insulin can be generated.”
While it’s possible a drug can be made to turn on the
pathway, it will take some time. In the meantime, Dr.
Macdonaldandhisteamareworkingtolearnhowwecan
prevent the pathway from becoming blocked in the first
place. “We need to understand how genetics and the en-
vironment impact the disease,” he adds. “With more re-
search we may be able to determine the risk of someone
developingdiabetesandintervenebeforeit’stoolate.”
Diabetes is a disease for life
According to Dr. Bruce Verchere, Director of Diabetes
Research at BC’s Child and Family Research Institute,
there is a disturbing increase in the number of children
with prediabetes or type 2 diabetes, much of this in-
crease is the result of obesity in children. “It’s a disease
forlife,andifyougetityoung,youhavethatmuchmore
time for complications to arise,” he says. “Prevention is
the best option, and we need better tools to predict the
diseaseandprevent,orslowtheonsetofbothforms.”
While research has shown that lifestyle interven-
tion — diet and exercise — can delay the progression of
the disease, Dr. Verchere states it is difficult for many
people to practice and maintain. That’s why a lot of re-
search is focused on disease prediction, so doctors
would be able to better understand the early events
going on in the pancreas, and intervene before the
disease is detected.
By Ken Donohue
Dr. Michael Riddell
PhD, Professor and
Graduate Program
Director School of
Kinesiology and Health
Science, York University
Dr. Bruce Verchere
Head, Diabetes
Research, Child & Family
Research Institute,
BC Children’s Hospital
4 PERSONALHEALTHNEWS.CA
Defeating Diabetes
One Punch at a Time
Toronto MMA Fighter Dessi Zaharieva
Tackles Diabetes in the Ring and in the Lab.
By Randi Druzin
D
essiZaharieva’scareerasanelite
athlete almost ended when she
suffered a serious ACL injury
in 2011. After operating on her
knee, a surgeon told her she would have to
give up tae kwon do, the martial art that had
been the centre of her life since childhood.
But Zaharieva, who had been on the Can-
adian national team for four years, was de-
termined to return to the mat and compete
at the next world championships. She sought
the advice of UFC star Georges St. Pierre, who
had bounced back from an ACL injury, and
dedicatedherselftoreturningtotopform.
Not only did she compete at the 2013
International Taekwondo Federation
World Championships
in Bulgaria, but she
also won the bronze
medal in women’s in-
dividual sparring.
“When I’m told I can’t
do something, I find a
way to do it,” she says. She
has proven that time and again.
A challenger enters the ring
When she was in Grade 3, Zaharieva start-
ed drinking copious amounts of water, urin-
ating frequently and losing weight. Her
mother took her to Trillium Health Centre
in Mississauga, On., where tests revealed
she had type 1 diabetes, a serious disease in
which the blood sugar soars to dangerous
heights because of a lack of insulin.
“The doctor showed me how to inject my-
selfwithinsulin,andthefirsttimeIdiditon
my own, he gave me a little trophy,” she re-
calls. “I still have it.”
The little girl didn’t even consider leaving
the martial art she had taken up the year be-
fore, when her father had registered her and
her brother in classes. She pursued her pas-
sion, rising through the ranks of competitors
locally and nationally while facing the chal-
lengeofmaintainingagoodbloodsugarlevel.
In addition to following a strict diet and
exercise regimen to manage her disease,
Zaharieva now uses a blood glucose me-
ter that wirelessly connects to her insulin
pump. Using these two devices in combina-
tion, Zaharieva is able to ensure she gets the
appropriate amount of insulin she needs to
perform at her absolute best.
The 26-year-old athlete wrapped up her
tae kwon do career last year, after com-
peting in three world championships, and
switched to mixed martial arts. While de-
veloping her skills in that arena, she’s cur-
rently recovering from another knee injury
and pursuing her studies.
Making an impact through research
Zaharieva is a PhD candidate in kinesiology
and health science at York University, where
she is doing research aimed at improving
diabetes management and control of blood
sugar levels during exercise in individuals
with type 1 diabetes.
Sheisalsoamotivationalspeakerwhohas
appeared at various conferences and events.
Many people have drawn inspiration from
her accomplishments and from the success
ofotherathleteswithtype1diabetes,suchas
hockey player Max Domi.
In the eight years since he was diagnosed
with the disease, the 20-year-old has been
managing it not just well, but well enough
to establish himself as one of the best young
hockey players in Canada.
The Arizona Coyotes selected him in the
first round of the 2013 NHL draft, and he is
now one of the best rookies in the league.
Fourteen games into the season, he was tied
forfirstontheteaminscoring,with13points.
Domi has to go to great lengths to stay
healthy, but he doesn’t view that obligation as
somethingtobeendured.Heviewsitassome-
thingtobeembraced.“Dealingwithadversity
has made me a stronger person and a better
athlete,”hesays.“Itakealotofprideinthat.”
Zaharieva echoes that sentiment. She is
proud of her success in sports and academia,
but she just shrugs when people express
amazement at how much she has accom-
plished despite her illness. “Sometimes,” she
says, “what seems like a setback or a problem
is a blessing in disguise.”
“When I’m told I can’t do something,
I find a way to do it.”
Photo:Submitted
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6 PERSONALHEALTHNEWS.CA
New Strategies Help Put
the Brakes on Sight Loss
Among Diabetics
F
or the more than two mil-
lion Canadians living with
diabetes, blindness is a ser-
ious risk.And, of those, near-
ly 60,000 have sight impairment due
to diabetic retinopathy, a condition in
which elevated blood sugar levels cause
blood vessels to swell, leading to fluid
leaking into the retina.
It’s the leading cause of blindness
and partial sightedness for those under
age 50. Nearly everyone with type 1 dia-
betes and 60 percent of those with type
2 diabetes develop some form of diabet-
ic retinopathy in the first 20 years after
the onset of diabetes. And, with rates of
disease expected to double between 2010
and2020,apotentialcrisisisathand.
Fortunately, there are plenty of rea-
sons for hope. Increased awareness, ear-
ly diagnoses, more effective treatments,
and successful disease management can
preservehealthysight.
The link between vision
and diabetes
“Diabetes is first and foremost a vascu-
lar disease,” explains Dr. Dennis Rus-
kin, a Toronto-based optometrist and
former President of the College of Op-
tometrists of Ontario.
“The body’s vascular network brings
nutrients and oxygen to all the vital tis-
sues in the body, and diabetes is a dis-
ease that causes those blood vessels to
short-circuit and leak. Eyes are espe-
cially vulnerable to damage, because
they have the highest metabolic re-
quirements of any tissue in the body,
even more than the brain.”
For those with diabetes, the first line
of defence, both as prevention and as
treatment when early signs of the con-
dition appear, is proper management of
blood sugar levels. Fluctuations cause
damage over time to the tiny blood ves-
sels supplying the retina. A healthy diet
—lowinsugar,nutrientdense,withbal-
anced amounts of protein and carbohy-
drate (foods with a low glycemic index
to avoid blood sugar spikes) — helps sta-
bilizesugarlevelsandgoesalongwayin
preserving sight. Add to that mix get-
ting adequate sleep, smoking cessation,
and combatting stress.
Dr. Ruskin also recommends any-
one with diabetes or mild diabetic
retinopathy to undergo a thorough eye
examination once a year that includes
By Michelle Sponagle
a look at what’s happening at the back
of the eye with a test using drops that
enlarge the pupil. Early detection of
potential sight problems is crucial for
successful treatment.
Diabetics should be aware of the ear-
ly symptoms of vision problems: dark
spots, blurred vision, and large floaters
(lines, dots, circles). They have a higher
risk of a myriad of vision problems, from
detached retinas and glaucoma to cata-
ractsanddiabeticmacularedema(DME).
Seeaneyecareprofessionalrightaway.
New frontiers in treating
vision loss
Diabetic macular edema is a serious
cause of blindness in diabetics. “Once
it’s detected, there is a 50 percent
chance of severe vision loss if nothing
is done,” says Dr. Netan Choudhry, Dir-
ector, Vitreoretinal Surgery, with the
Herzig Eye Institute, Toronto.
Thanks to recent progress in treat-
ment and diagnosis, vision loss among
diabetics can be prevented and ad-
dressed. To determine the degree of
DME present, a digital scan of the eye
using optical coherence tomography
allows doctors to measure quantita-
tively the amount of fluid inside the
retina, allowing them to determine the
right course of treatment.
“Therehavebeenbigleapsforwardin
addressing DME,” says Dr. Choudhry. “A
number of new medications can be in-
jectedintotheeyetoabsorbanddissolve
fluid.” New anti-VEGF drugs have been
shown to be effective in reducing vision
loss and may restore lost vision in some
cases.“They’vehadahugeimpactonpa-
tients’ quality of life. Sight loss due to
diabetes is a problem that can be solved
when caught early.”
A decade ago, laser treatment was
the go-to option, but research has
found that injectable medications are
more effective. “We now use lasers as
second line or adjunctive therapy,” Dr.
Choudhry explains.
BothDrs.ChoudhryandRuskinagree
— because of advancements in treat-
ments and diagnostic tools, no diabetic
should have to lose his or her sight be-
cause of diabetes in this day and age.
They both emphasize the need for im-
provedawarenessamongdiabeticsabout
the real possibility of sight loss and the
needforpreventiveaction.
The difference in sight between those with healthy vision (left photo) and those with Diabetic
Retinopathy (right photo).
Science For A Better Life
Dr. Netan
Choudhry
Director,
Vitreoretinal
Surgery,
Herzig Eye Institute
Dr. Dennis
Ruskin
Optometrist
MEDIAPLANET 7MEDIAPLANET 7
If you are a person with diabetes,
one of the smartest things you
can do is be screened regularly
for diabetic retinopathy — a
leading cause of blindness and
a disease that is on the rise due
to an increase in diabetes and
an aging population.
Approximately 12 percent of new cases
of blindness are caused by diabetic
retinopathy. In fact, people with this
eyediseaseare25to29timesmorelikely
than the general population to become
blind within four years.
The longer you have diabetes and the
less controlled your blood sugar is — the
more likely you are to develop diabet-
ic retinopathy. This condition is one in
which glucose sticks to the tiny blood
vessels that nourish the retina, weak-
ening them and possibly causing them
to bleed or leak fluid, distorting vision.
“Wewanttogetontopofthingsbecause
once sugar sticks it doesn’t unstick —
once you get rust underneath your car,
youcannevergetridofit,”saysDr.Peter
Lin, who contributed to the 2013 Can-
adian Diabetes Association (CDA) Clin-
ical Practice Guidelines.
Nearlyallpatientswithtype1diabetes
and 60 percent of those with type 2 dia-
betesdevelopsomeformofdiabeticretin-
opathyinthefirst20yearsaftertheonset
ofdiabetes.Anestimated2.4millionCan-
adianshaddiabetesin2008,anumberex-
pectedtogrowto3.7millionby2018/19.
By Katherine O’Brien
inal exam by someone trained to recog-
nize diabetic eye disease, namely an op-
tometrist or ophthalmologist is recom-
mended. In some cases, this screening
examination may be accompanied by
retinal photography, which captures an
imageofthebackoftheeye,andmaypro-
vide a future reference to compare with
during follow-up visits. CDA guidelines
recommend screenings take place annu-
ally for type 1 diabetes, upon diagnosis of
diabetes,andtheneveryonetotwoyears
for type 2.  In Canada, only 32 percent of
patients with type 2 diabetes meet the
CDA guideline-recommended schedule
ofevaluationfordiabeticretinopathy.
No treatment is needed for nonprolif-
erative retinopathy, unless macular
edema is present, while laser therapy
is used with proliferative or severe non-
proliferative retinopathy. If a hemor-
rhage has led to lost vision, vitrectomy
surgery can restore vision. Most cases
of DME are treated with injections of
medication into the eye.
“In the past, doctors may not have fo-
cused on the eye as much for diabetes be-
cause they were more afraid of heart at-
tacks and strokes, which are much higher
in numbers in people with
type 2 diabetes,” says Dr. Lin, who notes
that the aging population means we are
seeingmoreeyediseaseinCanadianswho
have diabetes. “Our goal [now] is that dia-
betics never suffer from eye disease, kid-
neydisease,heartdisease,orstroke.”
Although controlling blood sugar and
blood pressure significantly lowers the
risk for retinopathy to develop and prog-
ress, you can’t reverse the damage. Still,
“if you eat healthy, exercise, and get your
sugars down — you’ve just reduced fu-
turedamagetremendously,”saysDr.Lin.
How diabetic retinopathy
develops
Initsearlystages,knownasnonprolifera-
tive retinopathy, the blood vessels in the
retina — which acts like a film projector
in the back of your eye,projecting images
to your brain — begin to leak.With prolif-
erative retinopathy, new abnormal blood
vessels replace the old ones, then break
andleakbloodintotheretinaandintothe
centercavityoftheeye,causingfloaters.
Sometimes the leaking fluid swells
the macula (the part of your retina that
helps you to see colour), causing dia-
betic macular edema (DME). “Although
DME most commonly causes reduced
vision, severe proliferative disease is
the condition that can cause complete
blindness,” says ophthalmologist Dr.
Phil Hooper, a lead author on the Can-
adian Ophthalmological Society’s Dia-
betic Retinopathy Guidelines.
Screening is crucial
Dr. Hooper points out that people would
only know they had the condition if they
had central DME or proliferative retin-
opathy. “Otherwise, the disease can be
quite advanced, yet the person is un-
aware there is a problem.” To detect dia-
betic retinopathy early, a regular eye
examination that includes a dilated ret-
Approximately 12 percent
of new cases of blindness are
caused by diabetic retinopathy
Science For A Better Life
Proper Eye
Care Vital
for Diabetics
Peter J. Lin,
MD, CCFP
Director Primary
Care Initiatives,
Canadian Heart
Research Centre
Dr. Philip L.
Hooper, MD,
FRCS
Canadian
Ophthalmological
Society

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  • 1. A SPONSORED FEATURE BY MEDIAPLANET Diabetes D iabetes is a complex global disease with many causes and no known cure. It is es- timatedthatmorethan10millionCanadi- ansarelivingwithdiabetesorprediabetes today. If you don’t have it, there is a good chance someo- ne in your family or circle of friends is affected. Not only is the number of cases growing, so are the serious com- plicationsitcauses.Diabetesisacauseof30percentofall strokes, 40 percent of all heart attacks, 50 percent of kid- ney failure requiring dialysis and 70 percent of all lower limbnon-traumaticamputations. MMA Fighter and type 1 diabetic, Dessi Zaharieva, challenges diabetes inside and out of the ring. p04 Publisher: Ryan Shepherd Business Developer: Ian Solnick Managing Director: Martin Kocandrle Production Manager: Carlo Ammendolia Lead Designer: Matthew Senra Contributors: Rick Blickstead, Ken Donohue, Randi Druzin, Duff McCourt, Katherine O’Brien, Michele Sponagle Cover Photo: Submitted Photo credits: All images are from Getty Images unless otherwise accredited. Send all inquiries to ca.editorial@mediaplanet.com This section was created by Mediaplanet and did not involve Maclean’s Magazine or its Editorial Departments. Please recycle after readingStay in Touch facebook.com/MediaplanetCA @MediaplanetCA @MediaplanetCA pinterest.com/MediaplanetCA YORKU.CA/OPENMIND THIS IS KINESIOLOGY & HEALTH SCIENCE [ OPEN YOUR MIND ] PERSONALHEALTHNEWS.CA Diabetes Is No Stranger to Canadians Rick Blickstead President and CEO, Canadian Diabetes Association Vision care Diabetic retinopathy is one of the most preventable complications from diabetes. People with diabetes are also more likely to develop cataracts at a younger age and twice as likely to develop glaucoma, but the di- sease’s effect on the retina is the main threat. Diabe- tes is one of the most common causes of blindness in North America. It’s important that people with diabe- tesmanagetheirbloodsugarlevels,bloodpressureand cholesterol. Regular eye exams can also greatly redu- ce the risk of complications or prevent their progress. Healthy living For people with diabetes, keeping healthy requires a ba- lanceofnutritionandphysicalactivityalongwithmedica- tionifprescribedandmonitoringofbloodsugarlevels.Li- festyleisariskfactorfortype2diabetesbutfamilyhistory, ethnic background, socioeconomic status, and environ- mentalsoplayasignificantpart.Livingahealthylifestyle canhelpreducetheriskoftype2diabetesoritsonset,even byasmuchas60percent.Agoodplacetostartisreducing oreliminatingsugar-sweetenedbeverages,whichstudies showincreasetheriskofdevelopingtype2diabetes. Advances in research Since the discovery of insulin, Canada has been at the fo- refrontofdiabetesresearch,education,andmanagement — making it an easier disease to manage today. Advances intechnologyarealsochanginglifeforpeoplewithdiabe- tes: insulin pumps are now common and continuous blood glucose monitors are on the brink of widespread adoption.Canadianresearchisalsopartoftheworldwide effort to develop an artificial pancreas, which will deliver the right amount of insulin exactly when it is needed. Thanks to the shared commitment of people living with diabetes and their families, health care professionals, re- searchers, governments, and many others — people with diabeteshavetheopportunitytolivefull,healthylives.
  • 2. 2 PERSONALHEALTHNEWS.CA N o one needs to be told that diabetes is serious. The complications and mortal- ity risk that come with the condition are well known. What is less commonly understood, however, is the degree to which diet and lifestyle can affect individual risk of developing type 2 diabetes.While genetic factors such as ethnicity and family history play a large role,what you eat (and how much of it) is the arguably the single biggest factor in whether you will develop diabetes as an adult. “Unhealthy eating is the prime risk factor for the de- velopment of type 2 diabetes,” says Dr. David Cavan, Head of Policy and Programmes at the International Diabetes Federation. “We can think certainly of all the foods we recognize as unhealthy, specifically all those high-fat,high-sugarfoodsthataresoprevalentinmod- ern day society, not just in westernized countries, but alsoincreasinglyinotherpartsoftheworldaswell:fast food, hamburgers, fries, sugar-sweetened beverages.” The dangers of drinking your calories Sugarybeveragesinparticularposeamajorhazard,with recent studies showing a direct connection between consuming as few as two servings of sweetened bever- ages per day and an increased risk of diabetes. “And it’s not just soft drinks,” says Dr. Jan Hux, Chief Science Of- ficerattheCanadianDiabetesAssociation.“That’ssome- thingthatsurprisespeople.Somebodywhousedtodrink alotofcolamayswitchtoblendedicedcoffeedrinks,but notknowthatalltheflavourinthosedrinkscomesfrom a sugary syrup that can deliver nearly as much sugar to thebodyasyouwouldgetfromasoftdrink.” With sugar being the prime culprit in unhealthy diets that can lead to increased diabetes risk, it’s very important that people be aware of just how much sug- ar they are getting in their diet, whether in their bever- ages or in other foods. “Sugar is often hidden in places youwouldn’texpectit,”explainsInternationalDiabetes Federation CEO Dr. Petra Wilson. “While most people are aware that french fries from fast food outlets are un- healthybecausetheyarehighinfatandsalt,theymight not realize that they also contain quite a lot of sugar. Theirgoldencolourinfactcomesfromthefactthatthey haveasugarsyrupcoatingbeforetheyarefried.” You can’t eat well without knowing what you’re eating The single best way to control the amount of sugar and other unhealthy ingredients in your diet is to prepare your food yourself. This is why so many diet recom- mendations focus on cutting out prepackaged food in favour of whole foods prepared from fresh ingredients, particularly fruits, vegetables, and whole grains. Of course, a healthy diet doesn’t necessarily mean cutting out sugar entirely. As with all things, the key is in moderation. Moderation also means focusing on the most important aspect of any healthy diet: portion control.“We’vebeeneatingalotofthesefoodsforthou- sands of years,” says Dr. Cavan. “In themselves they’re not harmful, it’s when they are eaten to excess. That’s why portion control is a very important message.” For those with diabetes, following these guidelines for a healthy diet becomes one of the three pillars of their treatment, alongside exercise and medication. For those without the disease however, especially those at increased genetic risk, a healthy diet is just as vital. Prevention is always better than cure. Celebrity chef and type 1 diabetic, Chris Smith, sat down with Mediaplanet to discuss healthy cooking options for those with diabetes. Mediaplanet What is your favourite diabetes-friendly dish to serve your family and why? Chris Smith With the holidays fast approach- ing,I always get the requests for great tasting desserts. I have included a few recipes that have the flavors of the season and are also a great ex- ample of healthy nutritional recipes. [Editor’snote:visit personalhealthnews.ca toviewadditionalrecipes]   MP What ingredients or foods are most beneficial for people with diabetes? CS I recommend to visit with your doctor or registered dietitian to gain an accurate explana- tion for each particular individual. With that said, as a chef, rather than “one” particular ingredient, I always promote balance and moderation with each meal. It is the balance of foods — of fruits,vegetables, lean meats, fresh fish, plus nuts and grains that over the course of time show the most beneficial results. Healthy eating and living an active lifestyle is essential to reducing the risk of acquiring type 2 diabetes. Is Your Diet Putting You at Risk for Diabetes? Visit personalhealthnews.ca to view recipes and additional answers By D.F. McCourt INSIGHT Connect. Learn. Discover. World Diabetes Congress 30 November – 4 December ONSITE REGISTRATION AS OF 30 NOVEMBER DAY RATE $365 STUDENTS $125 www.wdc2015.org WDC15-inside-banner-print-3-rtp.pdf 1 10/11/2015 09:39:41 Chris Smith The Diabetic Chef ONLINE EXCLUSIVE RECIPES Apple cranberry strudel bites and more
  • 3. MEDIAPLANET 3 Read more online at personalhealthnews.ca. Understanding a Complex Disease How Canadian researchers continue to lead the way in diabetes care and treatment. Bringing the Best Together in the Fight Against Diabetes As the largest freestanding diabetes research facility in Canada, the Alberta Diabetes Institute at the University of Alberta brings together some of the world’s leading diabetes researchers in an environment where passion and precision merge—integrating state-of-the-art facilities with scientific expertise to transform exciting discoveries into life-altering therapies. The Alberta Diabetes Institute—research focused on developing real world solutions for diabetes Dr. Patrick MacDonald Canada Research Chair in Islet Biology, University of Alberta HowDiabetesResearches Are LeveragingAdvancesInTechnology Michael Riddell, a professor of Kinesiology and Health Science at York University, lives and breathes diabetes research, and knows more than most on the effects of this disease. Dr.Riddellhastype1diabetesandisexcitedbynew researchleadingtobetteroutcomesforpeopleliving withthedisease.Heiscurrentlystudyingtheeffects ofexerciseandstressondiabetes.Lowbloodsugarisa commonsideeffectofinsulin,andthiscanbeexacer- batedduringexercise.Manypeopledon’trecognize theyhavelowbloodsugar,whichcanresultinpeople gettingshaky, weak,confused,disorientated,andif leftuntreatedcanleadtounconsciousnessanddeath. Dr.Riddell’steamisintheearlystagesofresearch intoanewdrugthatwillhelpbuildanaturalre- sponsewhenaperson’sbloodsugardrops.Addition- ally,diabetesresearchersaredevelopinganartificial pancreasthatcancommunicatewithacontinuous glucosemonitoringmachine,andusesophisticated programmingtoautomaticallyincreaseorlowerin- sulinbydetectingexercise,orthetypeofmealsome- onehashad.Rightnow,accordingtoDr.Riddell,it’sa bithitandmissondispensingthebestamountofin- sulinforsomeonewithdiabetes. “Diabetesisacomplexdisease,buttherehavebeen someprettyamazingadvancesthroughresearch,” says Dr.Riddell,“Weneedtodoresearchon developingnewdrugsandnewtoolsthatpatients canuseeveryday.Theyliveitminutebyminute,and thedecisionstheymakeimpacttheirbloodsugar controlonaconstantbasis.” INNOVATION From the discovery of insulin in the 1920s, Canada has a long history of diabetes research, playing a leading role in the global push to better understand and treat people with diabetes. “Canada has traditionally punched above its weight when it comes to diabetes research,” says Dr. Patrick MacDonald, Canada Research Chair in Islet Biology at the Alberta Diabetes Institute, Faculty of Medi- cine and Dentistry, at the University of Alberta. “There have been some remarkable breakthroughs in drugs over the last decade that do a much better job at lowering blood sugar.” Dr. MacDonald’s work is focused on type 2 dia- betes, a disease of insulin resistance, which forces the pancreas to crank out more insulin. Over time, the pancreas is unable to keep up with the demand and stops working. “We’ve been able to identify some important pathways that act like a dimmer switch,” he says. “We can control how much insulin comes out when the switch is turned on or dimmed. We are looking at finding some tricks within the body, so the right amount of insulin can be generated.” While it’s possible a drug can be made to turn on the pathway, it will take some time. In the meantime, Dr. Macdonaldandhisteamareworkingtolearnhowwecan prevent the pathway from becoming blocked in the first place. “We need to understand how genetics and the en- vironment impact the disease,” he adds. “With more re- search we may be able to determine the risk of someone developingdiabetesandintervenebeforeit’stoolate.” Diabetes is a disease for life According to Dr. Bruce Verchere, Director of Diabetes Research at BC’s Child and Family Research Institute, there is a disturbing increase in the number of children with prediabetes or type 2 diabetes, much of this in- crease is the result of obesity in children. “It’s a disease forlife,andifyougetityoung,youhavethatmuchmore time for complications to arise,” he says. “Prevention is the best option, and we need better tools to predict the diseaseandprevent,orslowtheonsetofbothforms.” While research has shown that lifestyle interven- tion — diet and exercise — can delay the progression of the disease, Dr. Verchere states it is difficult for many people to practice and maintain. That’s why a lot of re- search is focused on disease prediction, so doctors would be able to better understand the early events going on in the pancreas, and intervene before the disease is detected. By Ken Donohue Dr. Michael Riddell PhD, Professor and Graduate Program Director School of Kinesiology and Health Science, York University Dr. Bruce Verchere Head, Diabetes Research, Child & Family Research Institute, BC Children’s Hospital
  • 4. 4 PERSONALHEALTHNEWS.CA Defeating Diabetes One Punch at a Time Toronto MMA Fighter Dessi Zaharieva Tackles Diabetes in the Ring and in the Lab. By Randi Druzin D essiZaharieva’scareerasanelite athlete almost ended when she suffered a serious ACL injury in 2011. After operating on her knee, a surgeon told her she would have to give up tae kwon do, the martial art that had been the centre of her life since childhood. But Zaharieva, who had been on the Can- adian national team for four years, was de- termined to return to the mat and compete at the next world championships. She sought the advice of UFC star Georges St. Pierre, who had bounced back from an ACL injury, and dedicatedherselftoreturningtotopform. Not only did she compete at the 2013 International Taekwondo Federation World Championships in Bulgaria, but she also won the bronze medal in women’s in- dividual sparring. “When I’m told I can’t do something, I find a way to do it,” she says. She has proven that time and again. A challenger enters the ring When she was in Grade 3, Zaharieva start- ed drinking copious amounts of water, urin- ating frequently and losing weight. Her mother took her to Trillium Health Centre in Mississauga, On., where tests revealed she had type 1 diabetes, a serious disease in which the blood sugar soars to dangerous heights because of a lack of insulin. “The doctor showed me how to inject my- selfwithinsulin,andthefirsttimeIdiditon my own, he gave me a little trophy,” she re- calls. “I still have it.” The little girl didn’t even consider leaving the martial art she had taken up the year be- fore, when her father had registered her and her brother in classes. She pursued her pas- sion, rising through the ranks of competitors locally and nationally while facing the chal- lengeofmaintainingagoodbloodsugarlevel. In addition to following a strict diet and exercise regimen to manage her disease, Zaharieva now uses a blood glucose me- ter that wirelessly connects to her insulin pump. Using these two devices in combina- tion, Zaharieva is able to ensure she gets the appropriate amount of insulin she needs to perform at her absolute best. The 26-year-old athlete wrapped up her tae kwon do career last year, after com- peting in three world championships, and switched to mixed martial arts. While de- veloping her skills in that arena, she’s cur- rently recovering from another knee injury and pursuing her studies. Making an impact through research Zaharieva is a PhD candidate in kinesiology and health science at York University, where she is doing research aimed at improving diabetes management and control of blood sugar levels during exercise in individuals with type 1 diabetes. Sheisalsoamotivationalspeakerwhohas appeared at various conferences and events. Many people have drawn inspiration from her accomplishments and from the success ofotherathleteswithtype1diabetes,suchas hockey player Max Domi. In the eight years since he was diagnosed with the disease, the 20-year-old has been managing it not just well, but well enough to establish himself as one of the best young hockey players in Canada. The Arizona Coyotes selected him in the first round of the 2013 NHL draft, and he is now one of the best rookies in the league. Fourteen games into the season, he was tied forfirstontheteaminscoring,with13points. Domi has to go to great lengths to stay healthy, but he doesn’t view that obligation as somethingtobeendured.Heviewsitassome- thingtobeembraced.“Dealingwithadversity has made me a stronger person and a better athlete,”hesays.“Itakealotofprideinthat.” Zaharieva echoes that sentiment. She is proud of her success in sports and academia, but she just shrugs when people express amazement at how much she has accom- plished despite her illness. “Sometimes,” she says, “what seems like a setback or a problem is a blessing in disguise.” “When I’m told I can’t do something, I find a way to do it.” Photo:Submitted
  • 5. poweredbyaccuracy.ca GET THE POWER OF ACCURACY. Accuracy you can trust® TM see www.bayer.ca/tm-mc GET A FREE* CONTOUR® NEXT meter. Ask your Pharmacist today *with the purchase of CONTOUR® NEXT Test Strips POWERED BY ACCURACY. Achieving remarkable things requires remarkable accuracy. It’s what inspired us to make our most accurate blood glucose meter. MAX DOMI 2015 World Junior Champion
  • 6. 6 PERSONALHEALTHNEWS.CA New Strategies Help Put the Brakes on Sight Loss Among Diabetics F or the more than two mil- lion Canadians living with diabetes, blindness is a ser- ious risk.And, of those, near- ly 60,000 have sight impairment due to diabetic retinopathy, a condition in which elevated blood sugar levels cause blood vessels to swell, leading to fluid leaking into the retina. It’s the leading cause of blindness and partial sightedness for those under age 50. Nearly everyone with type 1 dia- betes and 60 percent of those with type 2 diabetes develop some form of diabet- ic retinopathy in the first 20 years after the onset of diabetes. And, with rates of disease expected to double between 2010 and2020,apotentialcrisisisathand. Fortunately, there are plenty of rea- sons for hope. Increased awareness, ear- ly diagnoses, more effective treatments, and successful disease management can preservehealthysight. The link between vision and diabetes “Diabetes is first and foremost a vascu- lar disease,” explains Dr. Dennis Rus- kin, a Toronto-based optometrist and former President of the College of Op- tometrists of Ontario. “The body’s vascular network brings nutrients and oxygen to all the vital tis- sues in the body, and diabetes is a dis- ease that causes those blood vessels to short-circuit and leak. Eyes are espe- cially vulnerable to damage, because they have the highest metabolic re- quirements of any tissue in the body, even more than the brain.” For those with diabetes, the first line of defence, both as prevention and as treatment when early signs of the con- dition appear, is proper management of blood sugar levels. Fluctuations cause damage over time to the tiny blood ves- sels supplying the retina. A healthy diet —lowinsugar,nutrientdense,withbal- anced amounts of protein and carbohy- drate (foods with a low glycemic index to avoid blood sugar spikes) — helps sta- bilizesugarlevelsandgoesalongwayin preserving sight. Add to that mix get- ting adequate sleep, smoking cessation, and combatting stress. Dr. Ruskin also recommends any- one with diabetes or mild diabetic retinopathy to undergo a thorough eye examination once a year that includes By Michelle Sponagle a look at what’s happening at the back of the eye with a test using drops that enlarge the pupil. Early detection of potential sight problems is crucial for successful treatment. Diabetics should be aware of the ear- ly symptoms of vision problems: dark spots, blurred vision, and large floaters (lines, dots, circles). They have a higher risk of a myriad of vision problems, from detached retinas and glaucoma to cata- ractsanddiabeticmacularedema(DME). Seeaneyecareprofessionalrightaway. New frontiers in treating vision loss Diabetic macular edema is a serious cause of blindness in diabetics. “Once it’s detected, there is a 50 percent chance of severe vision loss if nothing is done,” says Dr. Netan Choudhry, Dir- ector, Vitreoretinal Surgery, with the Herzig Eye Institute, Toronto. Thanks to recent progress in treat- ment and diagnosis, vision loss among diabetics can be prevented and ad- dressed. To determine the degree of DME present, a digital scan of the eye using optical coherence tomography allows doctors to measure quantita- tively the amount of fluid inside the retina, allowing them to determine the right course of treatment. “Therehavebeenbigleapsforwardin addressing DME,” says Dr. Choudhry. “A number of new medications can be in- jectedintotheeyetoabsorbanddissolve fluid.” New anti-VEGF drugs have been shown to be effective in reducing vision loss and may restore lost vision in some cases.“They’vehadahugeimpactonpa- tients’ quality of life. Sight loss due to diabetes is a problem that can be solved when caught early.” A decade ago, laser treatment was the go-to option, but research has found that injectable medications are more effective. “We now use lasers as second line or adjunctive therapy,” Dr. Choudhry explains. BothDrs.ChoudhryandRuskinagree — because of advancements in treat- ments and diagnostic tools, no diabetic should have to lose his or her sight be- cause of diabetes in this day and age. They both emphasize the need for im- provedawarenessamongdiabeticsabout the real possibility of sight loss and the needforpreventiveaction. The difference in sight between those with healthy vision (left photo) and those with Diabetic Retinopathy (right photo). Science For A Better Life Dr. Netan Choudhry Director, Vitreoretinal Surgery, Herzig Eye Institute Dr. Dennis Ruskin Optometrist
  • 7. MEDIAPLANET 7MEDIAPLANET 7 If you are a person with diabetes, one of the smartest things you can do is be screened regularly for diabetic retinopathy — a leading cause of blindness and a disease that is on the rise due to an increase in diabetes and an aging population. Approximately 12 percent of new cases of blindness are caused by diabetic retinopathy. In fact, people with this eyediseaseare25to29timesmorelikely than the general population to become blind within four years. The longer you have diabetes and the less controlled your blood sugar is — the more likely you are to develop diabet- ic retinopathy. This condition is one in which glucose sticks to the tiny blood vessels that nourish the retina, weak- ening them and possibly causing them to bleed or leak fluid, distorting vision. “Wewanttogetontopofthingsbecause once sugar sticks it doesn’t unstick — once you get rust underneath your car, youcannevergetridofit,”saysDr.Peter Lin, who contributed to the 2013 Can- adian Diabetes Association (CDA) Clin- ical Practice Guidelines. Nearlyallpatientswithtype1diabetes and 60 percent of those with type 2 dia- betesdevelopsomeformofdiabeticretin- opathyinthefirst20yearsaftertheonset ofdiabetes.Anestimated2.4millionCan- adianshaddiabetesin2008,anumberex- pectedtogrowto3.7millionby2018/19. By Katherine O’Brien inal exam by someone trained to recog- nize diabetic eye disease, namely an op- tometrist or ophthalmologist is recom- mended. In some cases, this screening examination may be accompanied by retinal photography, which captures an imageofthebackoftheeye,andmaypro- vide a future reference to compare with during follow-up visits. CDA guidelines recommend screenings take place annu- ally for type 1 diabetes, upon diagnosis of diabetes,andtheneveryonetotwoyears for type 2.  In Canada, only 32 percent of patients with type 2 diabetes meet the CDA guideline-recommended schedule ofevaluationfordiabeticretinopathy. No treatment is needed for nonprolif- erative retinopathy, unless macular edema is present, while laser therapy is used with proliferative or severe non- proliferative retinopathy. If a hemor- rhage has led to lost vision, vitrectomy surgery can restore vision. Most cases of DME are treated with injections of medication into the eye. “In the past, doctors may not have fo- cused on the eye as much for diabetes be- cause they were more afraid of heart at- tacks and strokes, which are much higher in numbers in people with type 2 diabetes,” says Dr. Lin, who notes that the aging population means we are seeingmoreeyediseaseinCanadianswho have diabetes. “Our goal [now] is that dia- betics never suffer from eye disease, kid- neydisease,heartdisease,orstroke.” Although controlling blood sugar and blood pressure significantly lowers the risk for retinopathy to develop and prog- ress, you can’t reverse the damage. Still, “if you eat healthy, exercise, and get your sugars down — you’ve just reduced fu- turedamagetremendously,”saysDr.Lin. How diabetic retinopathy develops Initsearlystages,knownasnonprolifera- tive retinopathy, the blood vessels in the retina — which acts like a film projector in the back of your eye,projecting images to your brain — begin to leak.With prolif- erative retinopathy, new abnormal blood vessels replace the old ones, then break andleakbloodintotheretinaandintothe centercavityoftheeye,causingfloaters. Sometimes the leaking fluid swells the macula (the part of your retina that helps you to see colour), causing dia- betic macular edema (DME). “Although DME most commonly causes reduced vision, severe proliferative disease is the condition that can cause complete blindness,” says ophthalmologist Dr. Phil Hooper, a lead author on the Can- adian Ophthalmological Society’s Dia- betic Retinopathy Guidelines. Screening is crucial Dr. Hooper points out that people would only know they had the condition if they had central DME or proliferative retin- opathy. “Otherwise, the disease can be quite advanced, yet the person is un- aware there is a problem.” To detect dia- betic retinopathy early, a regular eye examination that includes a dilated ret- Approximately 12 percent of new cases of blindness are caused by diabetic retinopathy Science For A Better Life Proper Eye Care Vital for Diabetics Peter J. Lin, MD, CCFP Director Primary Care Initiatives, Canadian Heart Research Centre Dr. Philip L. Hooper, MD, FRCS Canadian Ophthalmological Society