What is diabetes?

        Diabetes Mellitus is a chronic disorder in which the pancreas is unable to produce insulin, does not produce enough insulin to meet the body's needs or the body cannot use the insulin that is produced properly.

        Insulin is a hormone produced by the pancreas that is required to ensure the energy we receive from the food we eat is allowed to enter the body cells. When insulin is not available or not working properly, the energy from the food we eat stays in the blood stream and the blood sugar level rises.

        The most common types of diabetes are Type 1 or Insulin Dependent Diabetes Mellitus (IDDM); Type 2 or Non Insulin Dependent Diabetes Mellitus (NIDDM); and Gestational diabetes.

        Type 1 diabetes (IDDM) occurs when the pancreas is unable to produce insulin. It often appears suddenly in early adolescents. However, Type 1 diabetes may occur at any age and affects about 10 percent of all people with diabetes. To manage the condition and stay alive, an individual with Type 1 diabetes requires daily insulin injections, as well as healthy meal planning and regular exercise.

        Type 2 diabetes (NIDDM) is caused when the body is unable to produce enough insulin to meet the body's requirements or the body cannot use the insulin that is produced properly. The majority of people with diabetes, about 90 percent of all people with diabetes, have Type 2 diabetes. An individual with Type 2 diabetes uses exercise, healthy meal planning and, in some cases, oral medications or insulin to control blood sugar levels.

        Gestational diabetes is a condition that develops during pregnancy and appears to disappear once the baby is born. This condition requires careful management of the blood sugar during pregnancy. Women who experience gestational diabetes are at a higher risk to develop diabetes later in life and should see their physicians regularly to check their blood sugar levels.

        Symptoms of Diabetes

        Symptoms of diabetes may vary but the classic symptoms, particularly for Type 1 diabetes include:
        • frequent urinations;
        • unusual thirst;
        • changes in appetite;
        • unexplained weight loss;
        • extreme fatigue;
        • irritability;
        • abdominal cramps;
        • acetone breath.
        In many cases, people with Type 2 diabetes have no symptoms and diabetes is discovered during routine checkups or in connection with another problem.

        Type 1 diabetes (IDDM) is usually diagnosed with severe symptoms and very high blood sugar levels. Additional symptoms may include:

        • frequent infections;
        • blurred vision;
        • cuts or bruises that are slow to heal;
        • tingling or numbness in the hands and feet;
        • recurring skin, gum or bladder infections;
        • itchy skin.

        Complications

        • Four out of every ten people with diabetes will develop complications;
        • Diabetes is the leading cause of new blindness in adults;
        • Diabetes is responsible for 25 percent of cardiac surgery;
        • Diabetes is responsible for 40 percent of end stage renal disease;
        • Diabetes is responsible for 50 percent of all non-traumatic amputations;
        • Diabetes is a leading cause of death by disease in Canada;
        • Diabetes is the disease responsible for the greatest percentage of increase in deaths for women in 1992-93;
        • 40 percent of people with Type 1 diabetes develop nephropathy;
        • 10 to 15 percent of people with Type 2 diabetes develop nephropathy;
        • 90 percent of people with diabetes have peripheral vascular disease.

        Making a Difference

        • Scientific studies have shown (Diabetes Control and Complications Trial) that control of blood sugar levels can prevent a delay in complications;
        • Diabetes requires twenty four hour a day management by the individual. Diabetes education is essential to achieving that responsibility but:
        • 70 percent of people with Type 2 diabetes never receive diabetes education;
        • 30 percent of people with Type 1 diabetes never receive diabetes education;
        • Risk factors for diabetes are identifiable—smoking, obesity, hypertension;
        • 89 percent of people with diabetes have one or more modifiable risk factors for diabetes (78 percent in general population);
        • 32 percent of people with diabetes have three or more risk factors for double prevalence found in non diabetic population;
        • People with diabetes in an unhealthy weight range is double that found in non diabetic population;
        • Prevention options include smoking cessation, weight control, healthy living. Education can assist in helping people modify these risk factors.

        Prevalence of Diabetes

        Overall prevalence of self reported diabetes in Canada is five percent in people 18 to 75 years of age. The prevalence is subjected to age differentials as noted:
         
        MALE
        FEMALE
        18-34 years
        .9%
        		 2.9%
        35-64 years
        		 6.2% 5.9%
        65-74 years
        		 13.2% 12.0%
        The percentage of the total Canadian population diagnosed with diabetes is now believed to be five percent or even higher in certain groups such as the Native population. By including estimates of undiagnosed (and therefore unreported) diabetes, the estimate of all cases is believed to be between seven and 10 percent of the Canadian population.
        Over 1.5 million Canadians have been diagnosed with diabetes. Another half of that number, or 750,000 people, are believed to have diabetes but do not know it.

        Incidence and prevalence of diabetes increases with age. It is estimated that by the year 2004, one in four Canadians over the age of 45 will have diabetes.

        High risk groups (Aboriginal, Hispanic, black American) have higher prevalence rates. For aboriginal people in Canada, the prevalence of diabetes is two to three times higher than the rest of the Canadian population.

        In Canada, the prevalence of diabetes in the native population was quite low 50 years ago. Recently, with decreased requirement for physical activity and increased availability of high-fat, calorie rich foods, both obesity and Type 2 diabetes have increased.

        Canadian data are inadequate. It is difficult to gather accurate statistics on the prevalence of diabetes, their morbidity and mortality and associated costs. The Canadian Diabetes Association (CDA) has set research in the epidemiology of diabetes as a goal for needed investigation.

        There has been the growing impression that the number of people with NIDDM or Type 2 diabetes is increasing rapidly. Recently, a series of worldwide epidemiological studies in diabetes have verified this and led to questions whether diabetes is actually a global "epidemic". An epidemic is a term applied to a disease—infectious or chronic (e.g. diabetes mellitus)—which affects more than three percent of a population in a particular locality at one time.

        In 1985, the World Health Organization (WHO) released global estimates that there were 30 million people with diabetes. In 1993, WHO published global estimates for prevalence of diabetes in 1994 to be 11.5 million adults with IDDM, and 98.9 million with NIDDN. These numbers suggested an emerging epidemic of non insulin dependent diabetes (NIDDM) in all regions of the world.

        Dr. D. McCarty and Professor P. Zimmet of the WHO Collaborating Centre for Diabetes in Melbourne, Australia used the WHO database to estimate the total number of people with diabetes in the world, and make projections of the global burden for the years 2000 and 2010. They suggest that, if present trends continue, prevalence of NIDDM will more than double from 100 million to over 200 million in the next 15 years.