When it comes to the reality of diabetes in the North, Chisasibi physician Darlene Kitty has her thumb on the pulse of the problem.
In fact, at the time of our interview Dr. Kitty could give the exact number of diabetes sufferers in Eeyou Istchee: “Of the nine villages up here we have 1,363 patients who have diabetes,” she reports.
That’s 15 per cent of the James Bay Cree population over the age of 15, compared to a rate of fewer than five per cent for the rest of Quebec. What is mind-boggling is the fact that as recently as 1983, the Cree had a diabetes rate of only 1.9 per cent.
The numbers are indeed alarming but what has caused them to jump in the last 25 years is the dramatic change in lifestyle, says Dr. Kitty. “In 1983 the communities were still relatively isolated, there was not much non-native food coming in. People still lived mainly on the traditional foods and they went out to the bush much more than they do now so they were much more active.”
The influx of foods containing white or refined sugars was like a frontal assault on Cree health. “Our bodies can’t cope as well,” Dr. Kitty observes. “It’s our genetics; our bodies are built for survival,” and refined sugars were never part of that plan.
As a result of this change in lifestyle and diet, she says, “we are more obese, overweight or obese and that leads to higher insulin levels in the body and less sufficient use of the glucose because of that.”
Still, swift action has been taken to address the situation and could prevent more disastrous results. “All of us, the physicians and nurses, have become more aware of the problem and we are testing more and more.”
Kitty theorizes that the greatly increased testing in the north might be another factor in the sudden spike in reported diabetes cases.
Early testing equals better outcomes
Diabetes can often have complications, particularly in those who are not diagnosed early enough. Catching someone when they are pre-diabetic (or borderline) can make a huge difference.
“We can avoid the associated risks of high cholesterol, high blood pressure, coronary artery disease and the complications associated with diabetes like retinopathy [an eye disease that can cause decreased vision and blindness], nephropathy [leaky kidneys] and other ones like that.” When someone is pre-diabetic, they already have a heightened “fasting blood sugar,” and are on their way to becoming a diabetic. However, because of the rigorous screening, Kitty and her colleagues are now catching more people in pre-diabetes than diabetes. People are often pre-diabetic for five to 10 years before they actually become diabetic.
Currently, the average age of diagnosis, at 42, is much earlier for the Cree than it is for the general Quebec population (64).
The Canadian Diabetes Association defines a diabetic as a person who has “a fasting plasma glucose level of 7.0 mmol/L or higher.” Being pre-diabetic is when someone’s blood sugar is being tested at the 6-7 range.
“We have learned that we can manage these people by teaching them healthy diet, monitoring their blood sugar even though they are not officially diabetic yet. We can prolong the onset of diabetes by being more aggressive when they are pre-diabetic.”
Cree women are more susceptible to diabetes than men. Among Cree diabetics, 62 per cent are women. Dr. Kitty believes that “obesity plays a role” in this anomaly and that, “as women, we tend to have higher levels of insulin in our bodies. We also tend to keep the weight on after we’ve had babies.”
A less-discussed form of diabetes is gestational diabetes, when a woman develops the disease during pregnancy. Usually the disease will go away when the mother delivers her child but other risks are involved with gestational diabetes. Up to 60 per cent of women who have gestational diabetes will eventually become a type two diabetic.
Gestational diabetes also leads to higher rates of having bigger babies, in turn causing problems with vaginal delivery. “Mothers have higher rates of C-sections and they are more prone to infection,” says Dr. Kitty. She also stressed that “if there is uncontrolled diabetes in pregnancy, even the babies can have heart defects.”
A positive outlook
Dr. Kitty is able to remain optimistic because of the aggressive response that is now being organized to this massive health threat. “I see a big focus on prevention and education. I feel encouraged by that and I think my colleagues do too.”
The lifestyle that is recommended to diabetics is quite simple: exercise and eat sensibly, something that’s not always easy in today’s fast food nation. At mealtimes Kitty recommends her patients follow what she calls “the plate method.”
With the plate method, half of the plate should consist of vegetables, one quarter of the plate should be protein and the last quarter is reserved for starches.
As serving sizes tend to vary, Kitty recommends that the serving of protein should be “about the size of your palm.” As for the starch portion or complex carbohydrate, “if you have something with lots of white sugar it will increase your blood sugar quickly. But if you have a starch like in pasta, rice, baked potato, the starch is slowly broken down and don’t increase your sugar quickly.”
Eating foods that slowly raise the blood sugar as opposed to making it spike like white sugar is what is recommended to diabetics to help control their blood sugar levels.
Eventually, with exercise, medication and proper nutrition as prescribed by a medical expert, most diabetics will stabilize. The most effective medicine in the battle against diabetes, however, is education and the earlier the better.
“It has to start early. There are even some people under the age of 15 who are already type 2 diabetic and we see a growing number of overweight and obese children in the clinics and the villages.”
She recommends getting kids involved in sports and teaching healthy lifestyle choices formally and by example.
“We have to see what happens with the kids because they are going to be the diabetics in 10 to 20 years,” Kitty concludes. “If you are aggressive with the youth now, educating them and also their parents, I hope that the rates will be coming down instead of going up.”