A growing global health problem

So you're finding yourself thirsty all the time — a lot more than usual. Or you've been really, really tired lately. Can't seem to get enough sleep.

Maybe you've dropped a bunch of weight — without even trying. Funny, but these days, it seems you always have to go pee, even when you've just gone.

You dismiss it all as just something you're going through. Something that will pass.

Well, it could be that you've developed a condition that's going to stick around for the rest of your life.

You could be one of the almost 250 million people around the world who has diabetes. A third of those people aren't even aware they have the condition. Forty-six per cent of them are between 40 and 59 years old.

Two million Canadians have been diagnosed with the disease, according to the Public Health Agency of Canada. One in 17 Canadians have been told they have diabetes — 5.5 per cent of all women in the country and 6.2 per cent of all men. Among Canadians between the ages of 75 and 79, 22 per cent have been diagnosed with diabetes. That's 10 times the rate for people between the ages of 35 and 39.

Diabetes — or complications from the disease — now kills 3.8 million people a year or about the same number as HIV/AIDS.

The International Diabetes Federation calls the disease the epidemic of the 21st century. It notes that only 20 years ago, the best information suggested that 30 million people around the world had the disease. The federation expects that by 2025, the number of people living with diabetes will hit 380 million — if nothing is done.

In 1991, the federation and the World Health Organization proposed a World Diabetes Day as a way to bring attention to the escalating incidence of diabetes around the world. It took 15 years for the United Nations to pass a resolution declaring Nov. 14, 2007, the first World Diabetes Day.

The date of what is to be an annual event was chosen to mark the birthday of Frederick Banting. Along with Charles Best, Banting is credited with discovering insulin.

The theme for World Diabetes Day in 2009 was "Understand diabetes: Take control."

In 1999, the federal government pledged $115 million over five years to develop a Canadian Diabetes Strategy. Its goals included developing a health-promotion, disease-prevention strategy for the entire population and improving access to information about diabetes and the effects it can have.

The government has renewed that funding every year since 2004. In a report released on Dec. 7, 2009, the Canadian Diabetes Association called on Ottawa to "renew and enhance" the Canadian Diabetes Strategy as well as the Aboriginal Diabetes Initiative. It also recommended more money for "high-quality, investigator-driven research" like the kind that led Banting and Best to discover insulin. Further, the CDA suggested that the government should give people living with diabetes tax breaks to help offset the cost of their medical expenses.

The report says more than 20 people are diagnosed with diabetes every hour. It estimates that between 2010 and 2020, another 1.2 million Canadians will be diagnosed with diabetes, bringing the total number of Canadians living with diabetes to 3.7 million — or 9.9 per cent of the population. In 2000, 4.2 per cent of Canadians were living with the disease.

The association estimates that diabetes will cost the Canadian economy almost $17 billion a year by 2020.

What is diabetes?

Diabetes interferes with the body's ability to produce or properly use insulin, a hormone that is essential 

for the proper use of the energy contained in the food we eat. You need insulin to process glucose, a sugar that your body requires for fuel. If your body is not producing or properly using insulin, you will have too much — or too little — glucose in your system.

There is no cure for the condition, but diabetes can be controlled through diet or medication. Over time, diabetes can lead to life-threatening and debilitating complications.

There are three main types of diabetes.

Type 1

Occurs when your body makes little or no insulin. There is no known cause for it. You normally find out that you have it while you are a child or an adolescent. For that reason, it used to be called juvenile or insulin-dependent diabetes.

Type 1 diabetes is normally treated through insulin therapy. You take insulin injections to compensate for a pancreas that isn't working properly. The pancreas is the organ that produces insulin in the body.

In January 1922, a 14-year-old Toronto boy, Leonard Thompson, became the first diabetic in the world to receive an insulin injection. The treatment was deemed a success and earned Frederick Banting and J.J.R. MacLeod the Nobel Prize for Medicine the next year.

Type 2

Occurs when the pancreas either does not make enough insulin or makes it but cannot use it properly. Nine out of 10 Canadians with diabetes have type 2 — and 60,000 new cases are diagnosed each year.

Many people don't know they have Type 2 diabetes until they go to the doctor, usually for an unrelated problem.

The condition is usually controlled through diet.

Gestational diabetes

Affects pregnant women. Up to 18 per cent of aboriginal women in Canada and 3.5 per cent of non-aboriginal women will develop the condition during pregnancy.

The condition usually disappears after childbirth, but a woman who has had gestational diabetes faces a higher risk of developing Type 2 diabetes later in life. The condition can also pose a danger to the unborn child and the mother. The child may be born severely obese, putting him or her at a higher risk of having a dangerously low blood glucose level. There is also a risk of severe breathing problems.

Like Type 2 diabetes, gestational diabetes is usually controlled through diet.

What are the symptoms?

The classic symptoms of Type 1 diabetes include:

• Feeling tired. 
• Unusual thirst. 
• Frequent urination. 
• Being hungry. 
• Mood swings.
• Weight loss.
• Blurry vision. 
• Frequent infections.

Symptoms of Type 2 diabetes and gestational diabetes are similar. They include:

• Recurring skin, gum or bladder infections.
• Cuts and bruises that are slow to heal. 
• Itchy skin. 
• Frequent vaginal yeast infections.
• Fatigue, drowsiness or blurred vision. 
• Increased thirst.
• Frequent need to urinate. 
• Tingling in the hands or feet.

Sometimes there are no symptoms.

What are the risk factors?

Risk factors for Type 1 diabetes have not been identified as it's still not clear what causes the disease. But there are many risk factors for Type 2. They include:

• Age. Most cases of type 2 diabetes occur in people 40 and older.
• Obesity, especially if you have an "apple-shaped" body that carries extra weight around the middle.
• A sedentary lifestyle.
• High cholesterol, high blood pressure and a high fat diet.
• Having a family member who has diabetes.
• Gestational diabetes, which leaves you with a 40 per cent risk of developing Type 2 diabetes.
• If you gave birth to a baby that weighed more than four kilograms (about nine pounds), your risk is higher.
• Aboriginal people have a three to five times higher risk than other Canadians.
• People of Hispanic, Asian, South Asian or African descent are also more at risk.

What can I do to avoid developing diabetes?

Diet and exercise. A healthy diet and keeping fit will go a long way towards minimizing your risk of developing diabetes. Limit the amount of fat and sugar in your diet and don't smoke.

It also helps to keep your cholesterol levels within healthy ranges and to maintain a normal blood pressure.

In other words, do all those things you're supposed to do to maintain good health. And hope that genetics is working in your favour.

The International Diabetes Federation says it's critical for parents to ensure their children are eating a healthy diet and exercising. The number of children being diagnosed with Type 2 diabetes is skyrocketing.

What are the major complications associated with diabetes?

Diabetes is a lifelong condition. If left untreated, high blood glucose levels over a long period of time can cause:

• Blindness. 
• Heart disease. 
• Reduced blood supply to the limbs, leading to amputation. 
• Nerve damage. 
• Erectile dysfunction. 
• Stroke.

Diabetes has also been linked to depression. It's estimated that 25 per cent of people who live with diabetes also have symptoms of depression.

The Canadian Diabetes Association says you can greatly reduce your risk of developing the complications associated with diabetes if you "keep your blood sugars as close to normal as possible, maintain your weight at an acceptable level, and live a healthy lifestyle."

What new treatments are scientists exploring?

In August 2007, U.S. researchers said results from a mice study suggested bone cells release a hormone called osteocalcin that may help regulate the metabolism of blood sugar and fat deposits.

Lead author Dr. Gerard Karsenty of New York's Columbia University said current research is focusing on using osteocalcin injections as a method to prevent or eliminate Type 2 diabetes. But experts note that more research is needed before a definitive link between osteocalcin and diabetes can be made. They also said it will be another 10 to 15 years before it is known if the treatment is safe for and helpful to humans.

In December 2006, Canadian researchers linked pain receptors with Type 1 diabetes in a mice study. Lead author Dr. Hans Michael Dosch of Toronto's Hospital for Sick Children said researchers found that pain receptors don't secrete enough neuropeptides — chemical elements found in the brain — to keep insulin-producing pancreatic islets functioning normally. When diabetes-prone mice were given neuropeptides, diabetes was reversed without adverse side effects. The researchers are working to expand their study to include humans.