Diabetes Open Hours: Know Your Numbers (& ABCs)

0:00 [Music] hello and welcome everyone my name is 0:05 Kayla runka and I work at diabetes Canada on the knowledge and connections team and I'll be your moderator for 0:11 today I would like to start by acknowledging that I'm calling in today from Toronto and that I am located on the traditional 0:18 indigenous territory of the wendat Hoda nashoni and nishnabeg and the mississaugas at the credit and that 0:25 Toronto is now home to many diverse First Nations Inuit and metis people 0:31 as a health focused organization diabetes Canada recognizes that there is systemic racism within and throughout 0:37 our institutions and that we have the responsibility and the power to create culturally safe and appropriate 0:44 environments of care we are here today as part of our new initiative open hours diabetes open 0:51 hours is our live call-in show especially for you to ask any and all questions regarding you or a loved one's 0:57 lived experience with diabetes the program runs the last week of every other month with a different topic and 1:04 guest expert so be sure to follow us on social or visit the website regularly for updates 1:09 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 1:15 visit with or the information you obtain from your own medical health professional 1:21 so today's theme is know your numbers and ABCs and we're very lucky to have Dr 1:26 harpreet Bajaj here today to answer your questions on blood sugars ups and downs hemoglobin A1c blood pressure and 1:34 cholesterol otherwise known as your ABCs Dr Bajaj is an endocrinologist and the 1:41 medical director of endocrine and Metabolic Research at LMC Healthcare centricity research he is a research 1:48 associate at Mount Sinai Hospital Toronto and an adjunct lecturer at McMaster University 1:54 he is the principal investigator of the Canadian diabetes prevention program a nationwide collaborative effort between 2:01 LMC diabetes Canada and the public health agency of Canada and Dr Bajaj 2:07 currently serves diabetes Canada as the chair of the clinical practice guidelines steering committee 2:13 before we get started just a few housekeeping things please note this session will be recorded and may be 2:19 included as part of our public facing channels including our website and YouTube channel 2:24 please know that we will take all measures to protect your privacy and will not be sharing any names or record 2:29 of the chat or q a features we ask that any comments or reactions you share be 2:35 affirming and positive and that you use this time and this feature as an opportunity to further your learning 2:41 engagement and curiosity and support the same in a respectful way for others 2:46 on the zoom taskbar below you will notice two buttons the chat and the Q a buttons simply click the icon and type 2:53 your question or comment into the space provided since guests will be muted the chat button is an opportunity to 2:59 communicate with each other and share your thoughts and personal anecdotes and stories the chat is visible to others on 3:05 this call but again there will be no use of the chat on the video recording of this session now the other button I mentioned is for 3:12 the Q a this will allow you to post your questions throughout the session confidentially directly to Our Guest 3:18 expert if you would like your question to remain anonymous also if you choose to unmute at any time 3:24 to ask a question that's fine but please know your voice may appear in the recording of the video but your name and 3:30 account image will not lastly the closed caption feature has been activated for this session so 3:35 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 3:43 thanks for the introduction yes let's go all right great so maybe while we're waiting for the first questions to come 3:49 in we can chat about some of the basics so I have only experienced living with 3:54 diabetes through my relationship with my mom um but I do know there are concerns with you know highs and lows and maintaining 4:00 a steady blood sugar level so maybe we could start by just generally speaking about blood sugar it's role in the body 4:07 and what happens for people with diabetes um when they're trying to control those levels 4:13 sure yeah let's start with the basics absolutely and at various points I'll 4:18 try to uh you know give a analogy to how 4:24 we drive a car because many people many Among Us and drive a car right so so 4:30 I'll just try to give analogies to that as we speak during this conversation if 4:38 that's okay um so uh what does glucose do or what 4:44 are the normal levels uh normal as in when we considered uh consider glucose 4:51 not to be a medical problem let's discuss that first 4:56 um so uh glucose in the body is useful to give us energy and there are various 5:04 uh body organs that use glucose they can also use other sources of fuel other 5:12 than glucose as well to maintain that energy and body function so other 5:18 sources of fuel may be fat maybe what we call Ketone bodies there may be some 5:25 other fuel sources that are that are useful as well in in other other organs 5:31 of the body now there is one organ in the body which is the brain that only can use glucose 5:39 as the only fuel so our brain is totally and completely dependent on glucose to 5:47 use and and as a fuel to maintain its function the other organs like heart and 5:53 liver and and kidneys can use other alternative fuel as well other than 5:59 glucose but not the brain is is how it is and so for that reason because it's 6:05 so essential for brains function for that reason our body has many different 6:13 hormone systems to try and maintain the glucose in a good range not in a low 6:19 range not in a very high range in a normal circumstance so one of the main hormones in our body that controls this 6:27 uh the sugar in the normal range is insulin hormone so insulin is is a 6:33 hormone that is released if the sugars are going up or if we eat when the sugars are supposed to be going up the 6:40 insulin is released from the pancreas to try and bring it down into the normal range and the opposing hormone to 6:47 insulin so a hormone that that does opposite the work of insulin to try and 6:53 maintain that balance is glucagon glucagon is also made in the pancreas 6:58 and it uh it kind of you know if your sugar is going too low then the glucagon 7:04 starts going up so that the sugars are maintained in the normal level again there are other hormone systems as well 7:11 in the body that maintain the sugars but it's mostly the insulin and glucagon that counter balance to try and control 7:18 the sugars within that range so then uh what is the normal level of glucose in 7:26 people where we think uh there is not a medical problem uh usually the range is 7:32 between four to six um uh in the morning time in the passing time that we think that the sugars are 7:39 in the normal range and after meals we expect a little Spike but that Spike uh 7:46 up to about eight millimoles per liter is okay uh in a normal person that's 7:52 what we think is the normal range for glucose levels if you will now the the 7:58 analogy to the car you know if we're driving on a highway and I'm not recommending that we drive too fast or 8:04 something of course right but let's think about uh driving on a highway that 8:10 has a hundred kilometer per hour speed limit you know typically you would not get a ticket at least right if if you're 8:19 driving at 110 or 90 or you know somewhere around that range right so so 8:24 that's the analogy to the car driving on a highway is uh you know we try to 8:30 maintain that uh that driving speed around the 100 it doesn't have to be exactly the 100 it may vary in between 8:38 this range let's say 90 to 110 115 so that we are within that safe Zone if we 8:45 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 8:52 those are the ways we we control that so that's the analogy to insulin and 8:58 glucose as well right so those are the two hormones that kind of maintain the glucose in that normal range as such as 9:05 well so I hope that answers your first question yes for sure 9:11 um and then I guess one of the questions that came up was um what kind of things affect our blood 9:18 sugar so if we're looking at maintaining that sort of steady state um where do we need to pay particular 9:25 attention yeah so um and that's a great question um so uh you know even in in people 9:34 without diabetes but also especially in people who live with diabetes uh as well 9:41 um there are many different things that can affect the sugar of course we know eating does and we mentioned that it can 9:48 Spike up to it even even in people without diabetes as well but there are 9:54 other circumstances other than eating for example exercise any kind of 9:59 exercise even um even a moderate to a mild exercise level as well can you know help bring 10:09 down high sugars to a normal range other factors bodily stress 10:16 not sleeping enough or getting not not getting enough sleep can affect blood 10:21 sugars in a in an adverse way so it can raise the sugar as well also the just a 10:27 day and just a time of the day as well because as we are waking up many of our 10:33 hormones uh like the adrenaline hormone the cortisol hormone are are trying to 10:39 ramp up in the morning to try and get us awake and give us the energy boost and 10:45 that itself in the morning can raise the sugar a little bit or or more in 10:50 different people as well so it can vary from person to person 10:55 um then illness can also affect the sugar um so illness as in uh having a fever 11:02 having some infection can increase the sugars then there are some medications 11:07 that can uh that can also Elevate the sugars uh those medications could be 11:15 steroids for example steroid medications that are sometimes uh prescribed for 11:21 asthma or other conditions autoimmune conditions as well or some other 11:27 medications that can sometimes increase their sugars as well um so those are in a nutshell some of 11:34 the conditions that can increase the sugars in a in a person who does not have 11:40 diabetes there's still the insulin and glucagon will try to maintain the sugars 11:45 within the normal range but in people with diabetes of course these all of 11:51 these factors whether it's steroids whether it's you know certain kinds of 11:57 foods or exercise or lack of exercise can play a major role as well with the 12:03 sugar control as well now I said that you know four to six is the normal sugar 12:08 for a person without diabetes for people living with diabetes the target range is 12:16 up to seven for fasting and then the target range for after meal is up to 10 12:23 uh two hours after a meal as well so two hours after a meal we want the spike to 12:30 stay in the single digits not in double digits so kind of like again going back 12:35 to the car analogy okay maybe up to 120 kilometers per hour most people would 12:42 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 12:50 to get as well don't quote me on that okay you get into trouble so that's uh that's 12:56 the car analogy to that okay great um and you you've mentioned a couple times that blood sugar varies throughout 13:03 the day so um the next question is you know 13:09 when do you realize something might need to be addressed how how long can your 13:15 blood sugar be High um before you need to start worrying about maybe making some changes with 13:21 medication or other parts of um those things you've mentioned that impact blood sugar 13:27 yeah so when people with diabetes is I guess what we're talking about about this question and so in people with 13:35 diabetes uh you know once in a while if the sugars go up because we had a treat 13:41 um you know we indulged a little bit that's not when we need to start 13:47 adjusting the medication um of course everybody's uh you know allowed to have their birthday cake or 13:53 or whatever other treat that you like um and and uh you know the uh at least 14:01 the suggestion or request is that we maintain we try to we can try to 14:08 maintain portions uh smaller portions of those streets and maybe even some people 14:14 can try to compensate for having that treat by by reducing other carbs within 14:21 that meal if you will so having less of uh let's say bread or rice or potatoes 14:26 so at it so that it compensates for that piece of cake that you had as well so 14:33 then if if it's just one off we don't need to start increasing or changing medications however if it's a consistent 14:40 daily pattern or most days of the week then we need to start looking at hey 14:46 after dinner is when when the sugar starts spiking more than 10 on most days 14:52 of the week maybe we need to address that the other lab parameter that helps 14:58 us in all of this is called the hemoglobin A1c or the A1C test as we 15:05 call it it's a blood test so it's not that something that we test at home and 15:11 this A1C number uh kind of in a in an easy way it you know to understand it 15:17 it's basically an average of three months of last three months of sugars 15:22 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 15:29 morning or afternoon or night it kind of averages out what my sugars have been 15:35 for the last three months so what was my sugar in February March and now in April 15:41 is what it will tell me and and all of the sugars not just the morning or 15:46 evening sugars but all of the sugars over the last three months how they've been now the normal range for this A1C 15:53 test is less than six percent uh so that's for people without diabetes we 15:59 say normal is less than six if the A1C is between 6 to 6.4 we the diabetes 16:07 Canada guidelines uh say it's uh it's uh it's termed termed as pre-diabetes so 16:13 it's a precursor to diabetes condition that we call as pre-diabetes which means 16:20 that there is a high risk that the sugars can worsen into the type 2 diabetes or range from 16:27 that and then anything more than 6.4 so if we go to 6.5 or above is considered a 16:36 type 2 diabetes so the target as I said for you know after uh if you're doing 16:42 the finger prick or other means of testing your glucose at home we said 16:48 after meal it should be less than 10 fasting it should be less than seven for people with diabetes or A1C test the 16:56 target so that's the first of the ABC's uh Kayla as well the a of the ABCs is 17:04 A1C and the target for most people is less than seven on that ABCs okay 17:12 um and then while we're on that a of the ABCs how frequently should you be 17:17 getting your A1C tested and um does That Vary based on whether you 17:23 have type 1 or type 2 diabetes yeah that's a great question I mean it 17:28 is it needs to be individualized and uh you know you you have to look at various 17:34 factors when you determine how frequently you get it 17:39 um um so maximum uh so every three months 17:45 uh is what we uh what the diabetes Canada guidelines would say uh maximum 17:50 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 17:57 you get it every three months uh that that makes sense uh as well but for some 18:02 people um uh some people who might have uh might not need to have it every three 18:08 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 18:16 individual has diabetes that is very well controlled control on the A1C and 18:22 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 18:29 pressure medications uh that they've been stable on for many many months as 18:35 well so nothing new is changing no new medication was added or or deleted as 18:42 well then you know you can do it every six months as well so it can vary a 18:47 little bit how frequently we should have this blood test but in most people every 18:53 three months but it can uh you know be be relaxed to up to six months if we 19:00 think uh somebody's uh somebody has diabetes that is within the target range 19:07 that we want it to be okay so yes very individual best to work with your personal health care provider on that 19:13 front um just before we move to another um participant question we haven't 19:19 talked about low blood or low blood sugar yet um so maybe we could just spend a minute 19:25 on you know what does that look like and what some of those values are and 19:30 um what people can look out for when they are experiencing a low blood sugar 19:35 yeah so it's very important to understand this so you asked about uh you know Kayla you asked about the high 19:42 sugars and when we should address it I said if it's consistently high is when 19:47 we address it but for low blood sugars even one low blood sugar can be can be 19:53 challenging it can be burdensome it can it can lead to symptoms of low sugars 19:58 and uh you know on the other hand if we think about high sugars many people 20:03 would not have any symptoms even some people uh if they've had high sugars up 20:10 to 15 or even 20 Sometimes some of uh you know individuals may not have any 20:16 symptoms from high sugars on the other hand low sugars can cause a lot of symptoms so what are these symptoms uh 20:24 the first stage of symptoms is basically warning signs of low sugars these 20:30 warning signs could be uh trembling or shivering 20:35 so they could be a heartbeat going very fast so what we call call palpitations 20:41 of the heart right so racing of the heartbeat um they can be sweating they can be just 20:48 a sense of disorientation or hunger as well so those are some of the warning 20:54 signs of low sugar um the second stage if it goes very low 21:00 typically um typically around two or less than two is when people can have other major 21:09 problems with low sugar as well as there can possibly with low sugars people can 21:17 have problems with coma they can have seizures they can have heart arrhythmias 21:23 as well so there can be major problems from low sugars if they go very low 21:30 um so uh so it's very important to uh to understand the low sugars now however 21:37 it's scary right having low sugars sounds very scary with all of what I've 21:42 just said fortunately we we know that which 21:48 medications in diabetes can you know have the have the possibility of causing 21:54 low sugars right so so it's not not all of the medications uh that people might 22:01 be taking for diabetes that can cause low sugars so some of the medications that can cause low sugars are of course 22:08 one is insulin so if somebody is taking insulin to manage their diabetes uh you 22:14 know it's it's absolutely necessary to have a good understanding around low sugars and how to deal with them and how 22:21 to treat the low sugars as well um and then the other medication the 22:27 other class of medications that can have the potential for low sugars is called 22:33 the sulfonuria class so these medications like glycolazide or 22:38 Glyburide or glimepiride are available in Canada and these medications can also 22:45 cause low sugars these medications are used in type 2 diabetes insulin can be 22:50 used in type 1 diabetes can also be used in type 2 diabetes of course insulin but 22:57 so those are the medications insulin or solving ureas that can cause low sugars 23:02 or hypoglycemia okay so both people living with type 1 and those with type 2 23:09 on medications are at risk for low blood sugar yeah so both uh people with type 1 23:16 absolutely because they they are typically on insulin which is uh the hormone that that is deficient in in 23:23 people living with type 1 diabetes and so uh uh that is a risk factor for 23:28 people with type 2 diabetes it's the people who are using um uh either insulin or any of these 23:36 sulfuria medications but these days we are seeing less and less use of the sulfur urea medications and other 23:43 medications outside of sulfonuria or insulin do not cause hypoglycemia and so 23:49 people living with type 2 diabetes if they're using other medications they're not they don't they have a very 23:54 negligible or zero risk of of causing hypoglycemia okay good to know 24:01 um we have a participant question wondering if you can explain 24:07 um what time in range is and if this is a new sort of measure um and its 24:15 importance yeah so so time and range um uh maybe I'll go back to my analogy 24:21 on the on the car driving in this um so um you know that 90 to 110 kind of range 24:28 right so is is where we want to uh keep driving at uh for safety of course and 24:35 so uh time and range is kind of that safety zone if you will uh for managing 24:40 uh blood glucose levels uh so what is that um what is the target for that so 24:47 there's an international consensus on uh CGM so continuous glucose monitoring 24:54 um uh continuous glucose monitoring is not the typical fingerprick but these are sensors that can be put on either 25:01 the arm or the abdomen or other places in the body that continuously monitor 25:07 glucoses for 24 hours so not just a static number when you check your sugars 25:13 with a finger prick but these are sensors that stay on the body just like a tuning they're small quite small and 25:20 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 25:28 depending on the on the device that you're using so on these continuous glucose monitoring devices you can get a 25:37 time and range percentage as to how much uh the person living with diabetes or 25:43 otherwise has their glucose is within the certain range so this International 25:49 Concepts as recommendations suggest using the four to ten millimoles per 25:56 liter range so anything less than four is considered below the range anything 26:01 above 10 is considered above the range so anything between between the 4 and 10 26:08 number is then is then the time in range if you will that's uh that's the green 26:13 zone right so that's where uh that's where ideally uh the the glucose levels 26:20 should be now in people especially people who may 26:26 be using insulin to manage their diabetes we know that glucoses do fluctuate and so the consensus this 26:34 International consensus recommends that 70 of the time and range we maintained 26:40 uh is what the recommendation is so 70 of the time between four to ten uh is 26:46 what the guideline States and then less than four percent below the range and 26:52 then less than uh 25 26 percent above the range of 10 is what the guidelines 26:59 suggests so that's a green zone time and range uh the target for that especially 27:04 in people with diabetes who are who are you know injecting insulin for to manage 27:11 their diabetes uh the recommended goal or Target is 70 in that range 27:21 again to maintain that [Music] sort of stable blood sugar level to 27:27 prevent some of the the side effects of edin and there's actually another participant question similar to that so 27:32 they're wondering if um they're above normal number on a day-to-day basis 27:38 whether it's fasting or post meals if if they're above that range one day does 27:45 damage to the body and organs per se happen sort of that day or is it only 27:51 when it's elevated over a longer period of time yeah that's a very good question and and 27:57 uh you know the answer the response to that it is it is over a long period of 28:03 time so um so um higher glucose levels over time over 28:10 many years is when the damage starts showing up typically about 10 to 15 28:18 years from the diagnosis of diabetes if a person living with with diabetes if 28:25 their glucoses happen above that range or that Target that we we discussed then 28:33 the complications of diabetes 28:38 potentially can happen at that time so it's not just one of higher sugar that 28:45 causes a bodily harm at that point but it's typically over many months and 28:52 years if the glucose are high and just a follow-up question on the 28:58 time and range um someone is wondering whether someone who is using a glucometer and doesn't 29:04 have access to a CGM device um and also assess time and range with 29:11 the glucometer yeah so um before the CGM devices became available we had this uh you know people 29:19 who are doing many different things they would you know one of the methods was to 29:25 check glucose levels seven times in one day we don't typically ask for as a very 29:34 onerous very uh you know it's it's very time consuming and also a lot of 29:40 fingerpricks for that but that's one other way of of checking uh what the 29:46 time and range is so seven times would include you know before and after a meal 29:52 three times a day as well as at middle of the night so midnight kind of blood 29:59 glucose test as well so that can be another way to find uh you know what 30:06 your what somebody's glucose fluctuations are and if the glucose 30:11 fluctuation are within that green zone that we discussed or not typically we 30:17 don't do that and and you know typically um maybe we'll ask to uh alternate 30:25 glucose testing if somebody does not have access 30:30 to CGM unfortunately access is a limitation access and costs are big 30:36 limitations in in CGM use then you know depending on on what medications are 30:44 being used uh their healthcare provider May and discuss whether alternate 30:51 testing alternate as in you know test glucose fasting one day another day 30:58 after breakfast another day after lunch you know to get kind of a sense of where 31:03 the glucose is lie may be a less onerous and less expensive as well as less painful very 31:12 way of glucose testing as well right I can imagine yes there's a couple more 31:18 questions and then maybe we'll move on to the B part of ABC's since we haven't 31:23 discussed the those components yet so one question is around type 2 31:28 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 31:41 get older yeah so that's a good question um so um uh you know in in our 31:49 medical school or or other graduate school um that's typically that the definition 31:57 that we've learned uh for for type 2 diabetes the type 2 diabetes is a 32:03 chronic condition chronic means permanent condition and a progressive 32:08 condition Progressive as in it worsens over time and some studies like Landmark 32:15 study from UK called the UK PDS suggests that the pancreas which makes 32:22 insulin the ability of the pancreas to make insulin after a diagnosis of type 2 32:29 diabetes reduces over time by about six 32:34 percent per year so about six percent or less uh ability 32:40 of the pancreas over uh over a year year by year uh then you can imagine you know 32:45 if six percent times whatever it can lead to fifty percent sixty percent decline over 10 to 15 years right so so 32:53 that's uh uh kind of uh been there and and that's uh that's uh that's how most 33:00 of us uh learned about uh type 2 diabetes Now more recently 33:06 um there has been some suggestions some studies suggesting that uh it's not all 33:13 a downhill slope if you will there is a possibility uh that um uh that some of 33:21 this um uh this downhill progression can be 33:26 reduced at least so that uh slope of reduction slope of worsening of of the 33:33 pancreas to uh ability to make insulin can be reduced one way that has been 33:39 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 33:54 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 34:30 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 34:58 um it's life sustaining for people with type 1 diabetes and that's very important to understand the difference 35:04 between type 1 and type 2. for people with type 2 diabetes 35:10 initially early on within the first few years of type 2 diabetes 35:17 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 35:39 challenges play a role in all of all of what is possible for an individual but 35:48 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 36:01 plus minus or I should say a diet plus lifestyle or health behavior 36:07 modifications plus or minus medications is what is recommended as a 36:12 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]