Bitter sweet

TORONTO DOCTOR Jeremy Gilbert is on the front lines of the battle with diabetes as a physician at Sunnybrook,as well as a professor in the department of endocrinology and metabolism at the University of Toronto.

You must be a treat around Halloween — what’s your sweet indulgence?

Cookies.

What is the difference between Type 1 and Type 2 diabetes?

Type 1 diabetes, the issue is that antibodies attack the pancreas so it can no longer make insulin. Type 2 diabetes,there are two problems: the body is resistant to the insulin, and they don’t make enough of the insulin. Both, technically, can come on any time.

But Type 2 is generally something that comes along later in life, right?

Well, that is the general concept,but there are a lot more kids and adolescents getting Type 2 diabetes.

Why?

That’s because of insulin resistance that is brought on by obesity. Because there are more obese kids and adolescents, there is more Type 2. SickKids has actually opened an entire Type 2 diabetes clinic.

So why is there such a rise?

There is an obesity epidemic going on right now.

Well, how can I make sure my kid stays out of that clinic?

The most important thing would be proper diet and exercise and limiting the amount of sedentary activity and promoting exercise — hockey, running, biking, anything like that. Also proper food choices, avoiding fast food, pop.

What are some of the warning signs?

Symptoms of high blood sugar include fatigue, blurry vision, thirst and excess urine output. If you have any of the risk factors for diabetics, you should let your family doctor know so he or she can check you.

So how do I know if I’m in that high-risk group?

So there are certain patients more prone to get diabetes than others, certain ethnic groups, Aboriginals and Southeast Asians or those with a strong family history of diabetes. If you had diabetes during pregnancy.

What foods are best to avoid?

That’s a bit complicated. Obviously foods with a lot of sugar have a high-glycemic load that would contribute to higher sugar levels, and carbohydrates also contribute. Making proper choices in carbs makes a difference — whole wheat is better than white bread, for instance.

Are some forms of diabetes hereditary?

Yes, there is a very rare type of diabetes, single gene, that is inherited, but that is less than one per cent of patients with diabetes.

But with respect to Type 1 and Type 2 diabetes, if there is a parent or sibling, there is a high risk of getting it.

I’ve heard vitamin D might be helpful, true?

There is up-and-coming research about whether vitamin D affects diabetes or not, but the jury is still out.

Do you take it?

I do.

What about other natural alternatives such as cinnamon and green tea?

And chromium (another natural health option) also is on the list. My feeling on that is that they probably don’t harm, but they probably don’t have a huge sugarlowering effect.

What’s the latest research?

It’s in insulin pumps. Instead of having needles, you actually wear a pump that gives you insulin all the time. That is where all the coolest research is. It’s called “closing the loop.”

Basically, you have a loop of sugar to insulin that needs to be matched. The new technology, in theory, mimics a normal pancreas.We’re not quite there, but that is where all the big development is.

And how close are we to finding a cure?

I think there is a lot of research going on, but I don’t hear anything in current articles about a cure coming out. The main focus is on Type 1, closing the loop.

 

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