Cheat Sheet

Diabetes For Canadians For Dummies

Early diabetes detection is far and away the best way to limit any damage to your health. Canadians who think they might have diabetes, or are at risk of developing the disease, should closely follow the Canadian Diabetes Association’s (CDA) screening guidelines. If you’ve already been diagnosed with diabetes, however, then you’re not alone: over 2.5 million Canadians are living with the disease today. With the long-term goal of keeping your health in check, it’s important to become familiar with the CDA’s recommended testing schedules and target test results for diabetics. To successfully manage your diabetes, you need to look after yourself through a combination of medical and lifestyle therapies. Find out the basic steps you can take here.

Diabetes Screening Guidelines in Canada

The Canadian Diabetes Association (CDA) recommends that you be tested for type 2 diabetes every three years when you reach 40 years of age, and more frequently and/or earlier if you have one or more of the following risk factors for type 2 diabetes:

  • You have a biological first-degree relative with type 2 diabetes. (A first-degree relative is a parent, sibling, or child.)

  • You are a member of a high-risk population (that is; being of Aboriginal, African, Asian, Hispanic, or South Asian ancestry).

  • You have a history of prediabetes.

  • You have a history of gestational diabetes.

  • You have delivered a large baby.

  • You show evidence of complications associated with diabetes. These include retinopathy (eye damage), neuropathy (nerve damage), nephropathy (kidney damage), or vascular disease affecting the heart (coronary artery disease), brain (cerebrovascular disease), or legs (peripheral arterial disease).

  • You have risk factors for vascular disease such as abnormal lipid levels, high blood pressure, overweight, or abdominal obesity.

  • You have a disease associated with an increased risk of diabetes. Examples of such a disease include polycystic ovary syndrome, acanthosis nigricans, obstructive sleep apnea, certain types of psychiatric disease (bipolar disorder, depression, schizophrenia), and HIV infection.

  • You take drugs associated with an increased risk of diabetes. Examples of such drugs are prednisone, certain types of psychiatric medicines, and certain types of drugs used to treat HIV/AIDS.

You should be immediately tested for diabetes if ever you are having symptoms of high blood glucose (such as thirst, frequent urination, and weight loss).

Target Test Results for Canadians with Diabetes

Monitoring your blood glucose levels day-to-day is critical in order to properly manage your diabetes. The Canadian Diabetes Association guidelines recommend that most adults with type 1 or type 2 diabetes aim for the following readings:

  • Blood glucose before meals: 4.0 to 7.0 mmol/L

  • Blood glucose two hours after meals: 5.0 to 10.0 mmol/L (5.0 to 8.0 if your A1C remains above 7.0 despite having before-meal readings of 4.0 to 7.0 and two-hour after-meal readings of 5.0 to 10.0)

  • A1C level of 7.0 percent or less (up to 8.5 for some individuals)

  • LDL cholesterol of 2.0 mmol/L or less

  • Urine albumin/creatinine ratio (“ACR”) less than 2.0 mg/mmol

  • Blood eGFR equal to or greater than 60 mL/min

  • Blood pressure less than 130/80

Your Personal Test Results Record
Target Test Result Date Date Date Date Date
Blood Pressure < 130/80
A1C < 7 %
LDL < 2.0 mmol/L
ACR < 2.0 mg/mmol
eGFR > 60 mL/min

Recommended Diabetes Testing Schedule for Canadians

For you and your health care team to know whether your diabetes treatment plan is effective, you will need to undertake regular testing. The Canadian Diabetes Association recommends the following testing schedule for most adults with diabetes:

  • A1C: Every three months (up to every six months if your A1C is consistently within target).

  • Blood glucose meter:

    • Not taking insulin: individualized.

    • On one injection of insulin per day: at least once daily.

    • On two injections of insulin therapy per day: at least twice daily.

    • On three injections of insulin per day: at least three times daily.

    • On four or more injections of insulin per day or using an insulin pump: at least four times daily.

  • Lipids: Fasting total cholesterol (TC), HDL cholesterol, LDL cholesterol, and triglycerides (or non-fasting apo B and non-HDL cholesterol) at time of diagnosis and then yearly (more frequently if treatment has been initiated or changed).

  • Urine albumin/creatinine ratio (ACR), blood creatinine, eGFR:

    • Type 1 diabetes: annually if you have had diabetes for more than five years (at least every six months if you have kidney damage).

    • Type 2 diabetes: at the time of diagnosis, then annually (at least every six months if you have kidney damage).

  • Electrocardiogram (EKG): At the time of diagnosis of diabetes if you are older than 40 years of age, (older than 30 years of age if you’ve had diabetes for more than 15 years), if you have evidence of organ damage associated with diabetes, or if you are at increased risk for heart disease. A repeat EKG should be performed every two years if you have type 2 diabetes.

  • Blood pressure: At every diabetes visit.

  • Screening for peripheral neuropathy (with a 10-gram monofilament or tuning fork):

    • Type 1 diabetes: annually beginning five years after the onset of diabetes.

    • Type 2 diabetes: at the time of diagnosis, then annually.

  • Foot examination:

    • By your doctor: at least annually (more frequently if you are at risk of foot ulceration).

    • By you: daily.

  • Eye exam (by an eye specialist):

    • Type 1 diabetes: annually, beginning five years after the onset of diabetes if you are 15 years of age or older (more frequent eye exams may be necessary depending on the presence and severity of retinopathy).

    • Type 2 diabetes: at the time of diagnosis and then every one to two years (more frequent eye exams may be necessary depending on the presence and severity of retinopathy).

Ten Ways to Prevent Diabetes Complications

More than two-thirds of diabetes complications are avoidable when you undertake effective measures to keep your diabetes under control. Stay healthy and lead a full and active life by following these tips:

  • Learn for life. The more you know, the better your odds are of being healthy. Know what you should eat. Know how you should exercise. Know what your blood pressure is and what it should be, what your lipids are and what you are aiming for. Know what the best medicines are and how to safely and effectively use them.

  • Eat healthily. The most important point about a “diabetic diet” is that it is a healthy diet for anyone, with diabetes or without. A diabetes meal plan is a lifelong program of healthy, well-balanced eating. Follow a healthy diet designed by both you and your dietitian and you’ll have an excellent foundation in your plan for good health. Ignore proper nutrition and you’ll be destined to have poor glucose control; indeed, any and all blood glucose-lowering medications (including insulin) are much less effective without a proper diet.

  • Exercise regularly. It’s important to exercise daily (or at least most days of the week), for at least 25 minutes per day. Make exercise as much a part of your life as breathing. The key to success with exercise is finding the type you like and sticking with it; something as simple (and inexpensive) as a daily walk is highly therapeutic.

  • Cut out harmful habits. Smoking is bad enough for a person without diabetes, but if you have diabetes, smoking makes almost every complication more likely to occur. You place yourself at enormous risk of a heart attack, stroke, blindness, amputations . . . the list goes on and on. It’s also important to moderate your alcohol consumption: avoid drinking more than two (for women) or three (for men) units of alcohol a day.

  • Control your numbers. Most people with diabetes don’t know their own numbers, and as a result don’t know when they are above target and won’t know when they need to take corrective action. You need to monitor your blood glucose levels, cholesterol, blood pressure, and kidney function on a regular basis.

  • See your eye doctor. Don’t be misled into thinking that your vision has anything to do with the health of your eyes. Only a skilled eye professional can determine the true health of your eyes.

  • Fuss over your feet. Inspect your feet regularly. Having diabetes means that your feet are at risk of damage including ulcerations, infections, and even gangrene and, potentially, amputation. But these devastating complications are largely avoidable.

  • Master your medicines. Although no one wants to take medicines, you cannot underestimate their importance when it comes to managing your diabetes. These medicines can keep you healthy and even save your life. Most people with diabetes need to take medicines in order to optimize blood glucose, blood pressure, LDL cholesterol, and prevent heart disease, strokes, kidney failure, and pneumonia.

  • Help your doctor help you. Your doctor relies on you to work with her for the common goal of keeping you healthy. Work with your doctor by regularly attending appointments, sharing with your doctor how you are doing with your nutrition program and your exercise, what your blood glucose levels are, what your blood pressure is, if you are missing doses of your medicines or believe you’re having side effects from them, if you’re experiencing symptoms such as chest pain or shortness of breath, numbness or burning in your feet, and so on.

  • Don’t try to do it alone. While your doctor and many other healthcare professionals, including diabetes educators, dietitians, podiatrists, eye specialists, pharmacists, are available to help you, it’s important never to underestimate the importance of your family’s involvement. If someone else in the home does the cooking, take that person with you when you meet with the dietitian. Have family members learn how to help you if your blood glucose level is low. If you can’t inspect your own feet, ask a loved one to look for you.

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