Diabetes A Quiet and Growing Epidemic
Written By Margaret Munro
Rodney Mckenzie was alone in a cabin in northern Saskatchewan when he woke up and realized something was seriously wrong.
“Everything was foggy,” says Mckenzie, recalling the day he began losing his sight five years ago. Luckily it hadn’t snowed and he managed to snowmobile home, sticking to the road he’d come up on.
Next, his kidneys failed and another incredible journey began, this one from his home in Stanley Mission south to Saskatoon. He’s made the 870-kilometre round trip three times a week for the last two years to receive the dialysis treatment that is keeping him alive.
This summer, another loss, as sores festered on Mckenzie’s right foot. Powerful antibiotics couldn’t clear the infection. Fearing gangrene would kill him, doctors amputated the lower half of his right leg. “It’s been kind of hard adjusting to this,” says Mckenzie, 37, his smile cracking as he gestures toward his missing foot.
The grim toll is all thanks to a single insidious disease: diabetes.
As illnesses go it is a quiet one, provoking little of the fear inspired by the H1N1 now dominating the headlines. But diabetes is epidemic and poised to get much worse. More than two million Canadians have the disease and it is estimated another five million — 15 per cent of the country’s population — are “pre-diabetic” and an increasing, and worrying, number of them are young adults, and children.
By the end of September, 78 Canadians with H1N1, or swine flu, had died.
Diabetes-The Silent Mass Killer
Diabetes is linked to close to 40,000 deaths a year in Canada and thousands more people are maimed by the disease, which is overwhelming the meagre medical services in many remote communities. Unchecked, doctors fear the disease will swamp the healthcare system.
This story is part of a Canwest News Service series that has been funded in part by a journalism award from the Canadian Institutes of Health Research.
“I don’t think we are remotely prepared,” says Dr. Karen Yeates, a kidney specialist at Queen’s University in Kingston, Ont., who has a growing caseload of diabetics on dialysis treatment, which rings in at $50,000 to $60,000 a year per person.
Detailed Canadian figures are hard to come by, but the financial implications of the epidemic are “enormous,” an expert panel reported to the Public Health Agency of Canada earlier this year. It estimated diabetes’ medical and economic impact is already costing Canada $17 billion a year.
And the costs are sure to rise, says Dr. Stewart Harris, a leading diabetes researcher at London’s University of Western Ontario, as “the tsunami of complications has yet to hit.” Serious complications, like the ones that have Mckenzie trekking to Saskatoon three times a week, tend to occur 10 to 20 years after diagnosis.
No Magic Pill For Diabetes
Despite growing alarm and dismay in health circles, diabetes gets scant attention compared to diseases like AIDS or flu even though it takes a much higher toll.
“I just wish they’d issue weekly reports on diabetes like they do for the swine flu — how many amputations, how many people going blind, how many kidney failures, how many people dying,” says Darlene Arnault, nurse manager at Stanley Mission, where diabetes rates have soared. “What bothers me most is the acceptance of the disease, as if it’s normal.”
Part of the problem is that there is no microbe to blame for diabetes and no magic pill to cure it.
The disease, which mucks with sugar uptake in the blood, is a slow and insidious killer. It hits the poor and marginalized more often than the affluent and educated. And it tends to sneak up on people as it numbs nerves in the feet, damages retinal cells in the eyes, clogs up the cardiovascular system, cuts circulation and destroys tiny filters in the kidneys.
Mckenzie didn’t believe he was even sick. “I was in denial for a long time,” says the former millwright, as he lies in a Saskatoon hospital bed, blood running from a tube in his wrist to a dialysis machine now doing the job of his kidneys.
Lifestyle Fuels Type 2 Diabetes
Sedentary lifestyles and the modern banquet of food laced with sugar and fat are said to be fuelling the explosion of Type 2 diabetes, which is now the most common form of the disease, affecting nine out of 10 Canadian diabetics.
Genetics also plays a role, with people of Asian, Latin American and African ancestry at increased risk. Aboriginal people are even more susceptible, with rates up to five times the Canadian average.
“It’s a slow-motion emergency, with aboriginal communities leading the way,” says Dr. Jay Wortman, a Metis doctor with Health Canada, which is charting an epidemic that is escalating as Canadians grow older and more obese. The number of Canadians diagnosed as diabetic almost doubled, to close to 2.3 million, in the past decade, and another 200,000 people learn they have the disease each year.
Public health officials and medical specialists like to say Type 2 diabetes is preventable. Their solution sounds simple enough: eat and exercise in moderation. Just 30 minutes of brisk walking a day and losing five to seven per cent of body weight can cut the risk by more than 50 per cent.
Easy to say, much harder to do, judging by the soaring obesity and disease rates.
Easy to say, much harder to do, judging by the soaring obesity and disease rates
Part of the problem is human nature. People did not evolve in a world where food was served up, often in excess, several times a day, says diabetes specialist Dr. Hertzel Gerstein, at McMaster University in Hamilton.
He notes that over the eons humans had to spend energy to get calories — by catching, growing and preparing food. Now the opposite is true, with people having to go out of their way to spend energy — and often money for fitness classes and equipment Ñ to burn off the calorie-laden foods that beckon from almost every corner.
Westernized society “is constantly pushing the abilities of even highly motivated individuals to cope metabolically,” says Gerstein.
One need not look far to see Canadians being encouraged to over-indulge. Tim Hortons drive-thrus serve up doughnuts and coffee, with customers expending no more energy than it takes to hand over the money. McDonald’s is busy luring in thirsty consumers with offers of “any drink, any size” for a dollar. And Kentucky Fried Chicken draws a crowd on Toonie Tuesdays: two pieces of chicken and fries for less than $3.
Doctors also note diabetes can be managed and the worst complications kept at bay if diabetics adopt healthy diets and lifestyles, routinely monitor their blood sugar and take medications as prescribed.
But “self-advocacy” is also critical, and not something that can be prescribed in a bottle.
Mckenzie was 18 when he was diagnosed. He and some friends were fooling around with blood-sugar monitors in a science class and he kept getting high readings. The school nurse sent him off to the local clinic. He was released two weeks later with instructions to check his blood sugar “four times a day, seven days a week.” He was also told to avoid pop, eat wholesome food and give up cigarettes.
Nurse Arnault, in Stanley Mission, used to badger Mckenzie to take better care of himself. “He thought he was invincible,” she recalls.
He seemed to be for years as he travelled and worked across Canada, exhibiting few obvious signs of the disease. Then diabetes caught up with Mckenzie, who now lives in Stanley Mission with his father, who is helping him cope with the loss of his sight, his kidneys and his leg. There are frequent visits from home care workers and his spirited young nephews, who like to push him around in his new wheelchair.
Three times a week he’s up at 5:30 a.m., waiting for the medical van that drives him and other patients to Saskatoon. By noon, he’s plugged into a dialysis machine that takes four to five hours to clear toxins and excess fluids from his blood.
In the more than two years Mckenzie has been making the trip, the drivers have always made it despite blizzards and threat of forest fire. “It’s not like you can really miss dialysis,” says Mckenzie, bantering with the nursing staff removing the tubes from his wrist and compressing his arm until the bleeding stops. The medical van usually has him home by midnight.