People like me who live with diabetes have a lot to celebrate today. It was 100 years ago that insulin was discovered and purified by a group of Canadian scientists, including the University of Alberta’s James Collip. That discovery commuted the death sentence of a diabetes diagnosis into a life sentence of living with a chronic illness. The daily grind of finger pricks, carb counting and planning ahead—a dozen daily decisions to keep feeling well in the short term and avoid serious problems like vision loss, kidney failure, amputation or heart failure over the long haul—is no fun. But thanks to that breakthrough back in 1921, and myriad other advancements since then, it is possible to live a long and healthy life with diabetes.
Here in Alberta, people with diabetes have a lot of help. The Alberta Diabetes Institute was formed at the U of A in 2007 to focus on preventing, treating and, ultimately, curing diabetes. It’s a facility with labs for clinical trials, nutrition and exercise research. It’s also a brain trust of more than 50 diabetes researchers, not just in medicine but also in law, life sciences, pharmacy, kinesiology and public health.
They are responsible for big breakthroughs—such as the famous Edmonton Protocol, which has set the worldwide standard for islet cell transplants—and also for our understanding of the complex balancing act between nutrition, exercise and medication required for people like me to manage our diabetes every day. I feel blessed that all three of my diabetes specialists over the years have been ADI members, meaning they could wander down the hall to collaborate, stay on top of the latest knowledge and translate it into the best care possible.
I’m just one of the 25 per cent of Albertans who have pre-diabetes, Type 1, Type 2 or gestational diabetes. Mine is Type 1, an autoimmune disorder that destroys the cells that make insulin. It often comes on in younger people—for me, I was 17.
Managing diabetes every day is kind of like sitting on a three-legged stool, balancing what to eat, how and when to exercise, and how to adjust medication. Get one of them wrong and your blood sugar can plummet or spike, risking organ and brain damage, even death. The researchers at ADI are helping people like me make sure we keep that balance every day.
Helping people eat well
High blood sugar makes you feel tired, thirsty and grumpy, and can put you into a dangerous condition called ketoacidosis. When my blood sugar goes too low, I get shaky and I have trouble making decisions, like whether it’s time to take some of the sugar pills I keep with me wherever I go.
Knowing how to keep my blood sugars in the normal range comes from years of experience and great teaching from my diabetes team, which includes an endocrinologist, a nurse and a dietitian. I’m lucky because my diabetes is not “brittle,” meaning completely unpredictable and impossible to manage. I’ve never had a low or a high blood sugar that I couldn’t treat by myself and, thankfully, I’ve never wound up unconscious or been rushed to hospital.
Without even realizing it, I’ve been tapping into the collective knowledge that’s constantly being pushed forward by researchers like those at the Alberta Diabetes Institute, including some who literally wrote the book on living well with diabetes.
People like human nutritionist Catherine Chan, professor in the Faculty of Agricultural, Life & Environmental Sciences, who was until recently the scientific director for the Alberta Health Services Diabetes, Obesity and Nutrition Strategic Clinical Network, which connects research and real-world care for Albertans. Chan’s own mother was told she had Type 2 diabetes about 20 years ago, so she changed her diet and started using a stationary bicycle. Now in her 90s, Chan’s mom still manages her diabetes without medication.
Chan has devoted her career to helping people decide what is best to eat and supporting them to make good choices consistently. She helped write the chapter on nutrition in the Diabetes Canada Clinical Practice Guidelines, considered among the best in the world for its scientific rigour. She and colleague Rhonda Bell are also co-authors of the Pure Prairie Eating Plan, four weeks’ worth of menus that translate the recommended guidelines into practical recipes and shopping lists using foods that are readily available in Alberta.
“When you’re trying to cope with having a chronic disease, in the context of the rest of your life, sometimes it’s just more convenient to grab a burger,” said Chan. “Without privileges such as good incomes and stable jobs, access to healthy foods becomes a question of health equity for people living with diabetes.”
Mounting evidence shows that a combination of weight loss, achieved through diet and exercise, plus early medication could even trigger remission in some people with newly diagnosed Type 2 diabetes. Chan is involved with a number of research projects to test this theory.
“While cure is too strong a word, it would reduce the human suffering by a lot, as well as the burden on the health-care system,” said Chan.
Optimizing physical activity
Here’s an example of the kind of daily decision-making involved in having diabetes. Last Saturday morning, I went for a four-hour bike ride. I cut my breakfast insulin by a third in anticipation of the workout, but it took us longer to get organized than I expected, so by the time we were ready to roll, my blood sugar had spiked. I felt lousy, but took some extra insulin to correct it and set off. After an hour of cycling I tested again and my blood sugar was back to normal. After another hour of riding my blood sugar was slipping lower … luckily we were just pulling up to an ice cream shop, so I had a scoop. By the time we finished our ride, my blood sugar was right in the sweet zone. Nailed it!
Balancing exercise is the specialty of another ADI member I have to thank for shaping my care: Normand Boulé, professor and associate dean of graduate studies in the Faculty of Kinesiology, Sport, and Recreation, who collaborates with a team of exercise physiologists in the ADI’s Physical Activity Diabetes Lab.
Boulé is part of the group behind the physical activity recommendations in the Diabetes Canada Clinical Practice Guidelines (which incorporate work done at the U of A) showing how a variety of activities such as resistance training, swimming and simply getting up from your desk once an hour can enhance the benefits of the moderate aerobic exercise that was once recommended on its own.
“We are no longer trying to see if exercise is good for people with diabetes, because we know there are benefits,” Boulé said. “Now we’re trying to optimize exercise interventions to make them more effective.”
“It’s good to have options,” he noted, pointing out that exercise is prescribed for people with diabetes not just for weight control but also for the immediate psychological (hello, endorphins!) and longer-term physical benefits, such as improved heart health.
In one current study, Boulé is looking at whether working out before breakfast is better than later in the day for people with Type 2 diabetes who experience a morning spike in their blood glucose.
Boulé and other ADI members are also working with researchers in Montreal and the United Kingdom to delve further into how diet and exercise can be combined to sustain remission for those with Type 2 diabetes.
”We hope that with the addition of exercise we won’t have to make the food restrictions as severe, making the intervention more effective and more sustainable,” said Boulé.
Identifying barriers to care
And then there are those long-term complications I keep mentioning. My personal worst nightmare is losing my eyesight. For Padma Kaul, it’s heart problems. The U of A epidemiologist and professor in the Faculty of Medicine & Dentistry is involved in several major studies to examine the impact of diabetes on Canadians’ heart health.
The Canadian Institutes of Health Research has funded her project to bring together data from Denmark and Alberta to examine the impact of pregnancy factors, including diabetes during pregnancy, known as gestational diabetes, on the mother’s long-term cardiovascular health. A second study follows Albertans aged 50 to 80 for a 10-year period to see how often they are screened for diabetes, how many develop diabetes, how many are prescribed medication and what impact their blood sugar levels have on their future heart health. Kaul is also looking at which prescription drugs women take when they're pregnant, including diabetes medicines, and how they affect the health of both mothers and their babies.
“My role is to flag where we have problems and try to understand what barriers patients face,” said Kaul, who studies population-level health trends. She is also co-director of the Canadian VIGOUR Centre, Heart & Stroke Chair in Cardiovascular Research, and Canadian Institutes of Health Research Chair in Sex and Gender Differences in Diabetes.
Even before all the results come in, you can be sure she will be sharing her learning and best advice with her colleagues at the Alberta Diabetes Institute, that critical mass of basic scientists, clinical researchers, population health experts and social scientists who are all seeking—and passing on—the best care for patients like me.
“Albertans should feel confident knowing there’s a whole community of researchers here working for them to try to address some of the knowledge gaps and to improve their health outcomes,” Kaul said.
To me, that’s worth celebrating.
This month, the University of Alberta celebrates 100 years since Canadian scientists, including U of A biochemist James Collip, discovered and purified insulin, making it possible to live with diabetes. Since then, research breakthroughs at the U of A have continued to make life better for people living with diabetes and their families. Today, with support from partner organizations and donors such as the Allard Foundation, DRIFCan and the Alberta Diabetes Foundation, we are closer than ever to a cure. Read more about diabetes research.