Even if you don't have diabetes, chances are a family member, friend or coworker lives with the disease. The rates of Type 1 and Type 2 diabetes are rising rapidly in Canada. According to Canada's National Diabetes Surveillance System, by 2012 close to 2.8 million Canadians will have been diagnosed with the disease, an increase of 25 per cent in just five years.

The truth is, you can live well with diabetes. But what that means at age 20 may differ from at age 50. Of course, the general guidelines – eating regular well-balanced meals, limiting sweets and high-fat foods, exercising and keeping your weight down – help at every stage of life. But as circumstances change, it makes sense for you and your loved ones to fine-tune your diabetes strategies.

By making careful lifestyle choices at each stage of life, you can curtail complications from diabetes, such as heart and kidney disease, and even cancer. "You have to be your own advocate 24 hours a day, every day of the year," says Shawn Shepheard, chair of the Canadian Diabetes Association's National Advocacy Council. This guide will get you through.

Childhood
What's the deal here?
Even toddlers can have Type 1 diabetes. "The most important thing is synchronizing their insulin requirements with their schedules and food," says Dr. Celine Huot, a pediatric endocrinologist at Montreal's Sainte-Justine University Teaching Hospital.

What will help?
• Give your child's day care or school easy to understand instructions – not a scary-looking 20-page report – for taking blood glucose readings and administering insulin.
• Check your child's logbook for recurring low or high blood sugar at school or day care. You may need to tweak his meals or insulin when he's away from home.
• If your kid is old enough to do his own glucose checks but drops the ball, treat it as you would any misbehaviour. A responsive, supportive parenting style has been linked to better quality of life in kids with diabetes.

Red alert:
The biggest danger is low blood sugar (hypoglycemia), which can quickly progress to a life threatening breakdown of body fat. Make sure every caregiver, teacher and soccer coach knows the signs.


Page 1 of 5 – Discover how young adults can effectively deal with diabetes on page 2.
Adolescence
What's the deal here?
Puberty hits with all its hormones, as does a taste for independence, in your growing child.

What will help?
• Growth and sex hormones can raise your adolescent's insulin requirements, while changes in sleeping habits and school lunchtimes make it challenging to stay on schedule. More frequent blood glucose checks may be needed.
• Your teen is taking over her diabetes management, but she still needs support and supervision from a parent, especially when under stress. Be ready to step in and offer help at exam time.
• If your teen uses insulin and is learning to drive, she should follow the Canadian Diabetes Association's driving guidelines, including measuring blood glucose before getting behind the wheel.

Red alert:
Kids this age may experiment with alcohol. Make sure your teen knows that she may experience low blood sugar several hours after imbibing. "Their buddies may think they're drunk and not realize they're hypoglycemic," says Dr. Ian Blumer, a diabetes specialist in Ajax, Ont., and coauthor of Diabetes for Canadians for Dummies (John Wiley and Sons, 2009).

Leaving home
What's the deal here?
"Young adults have hectic lives, juggling responsibilities associated with academic life, work and social activities," says Calgary Co-op pharmacist Ryan Keller, a certified diabetes educator.

What will help?
• If you've moved out of town for school or a job and are away from your longtime health-care team, you can still email them your questions or set up appointments over the holidays and spring break.
• Finances may be limited, but try to put a cap on the fast food and processed frozen dinners. A balanced diet doesn't have to have a big price tag.
• You may be reluctant to let your boss know you're diabetic, but if you choose to share this information, your employer will be more likely to understand when you need breaks to snack or test your blood sugar. Plus, your colleagues will know to be on the lookout for any signs of hypoglycemia.

Red alert:
It's common for diabetes management to slide for a couple of years at this life stage. "If that went on indefinitely, it would be a real health risk," says Blumer. High sugar levels over the long term can lead to serious complications. What counts is that you don't stray far and eventually get back on track.


Page 2 of 5 – Diabetic and pregnant? You'll find what to be aware of before and during your pregnancy on page 3.
Pregnancy
What's the deal here?
If their glucose isn't kept within a tightly controlled range, moms-to-be with diabetes run health risks to both themselves and their unborn children.

What will help?
• Before you get pregnant, get an A1C test, which measures the severity of your blood sugar spikes. Blumer also recommends starting a daily regimen consisting of a multivitamin and five milligrams of folic acid for three months before conceiving.
• Diabetes pills (such as those that help lower blood glucose) aren't safe during pregnancy and may need to be discontinued temporarily and replaced by insulin. Your insulin requirements can triple during pregnancy, so be sure to do your glucose checks.
• You should also get eye exams, kidney tests and nutritional counselling to ensure the best possible outcome for you and your baby.

Red alert:
Four to 20 per cent of pregnant women develop gestational diabetes, a form of the disease that crops up only during pregnancy. It's as threatening as pre-existing diabetes, so all women should be screened early in pregnancy, especially if they have risk factors such as obesity or polycystic ovarian syndrome. Gestational diabetes increases your – and your baby's – odds of getting diabetes down the road.

Postpartum and motherhood
What's the deal here?
You're exhilarated to be a parent – and exhausted. "Often, you start to neglect your diabetes because you're devoting time and energy to your family," says Blumer.

What will help?
• If you're a breastfeeding mom, you may be at risk for low blood sugar. Keep nursing – it's best for the baby – but do glucose tests more frequently, take more insulin if needed and enjoy a healthy snack before each feeding session.
• Make time to manage your diabetes, even if it means enlisting more child care. "It's not being selfish," says Blumer. "It's the opposite, because you have to stay healthy for your family."
• Your kids are more likely to get Type 2 diabetes if you or their father has it – and if it affects both parents, your children's odds of getting the disease are one in two. But you can make a difference early in their lives by modelling good eating habits and plenty of physical activity.

Red alert:
If you had gestational diabetes but it disappeared after you gave birth, you need yearly diabetes screening, especially before trying for another pregnancy. You don't want a diagnosis of Type 2 diabetes to get missed when you're trying to conceive.


Page 3 of 5 – If you're stressed out often, read page 4 to see how your stress levels can affect your diabetes.
Major stress
What's the deal here?
Midlife comes with its own trials and tribulations, such as career changes, trouble with the kids or divorce.

What will help?
• If your energy is sapped and your attention is elsewhere, you're more likely to miss meals, forget medications and have trouble sleeping. Talk to a mental health professional or diabetes educator about coping skills and strategies.
• Don't drop your workouts. Not only will a bout of exercise help you manage your blood sugar, it will lift your mood so you can cope with stress.
• Connect with a diabetes support group. "Diabetes is a lot harder to handle on your own," notes Shepheard. "Go out, volunteer and meet other people living well with diabetes."

Red alert:
Stress can trigger the release of hormones that raise your blood sugar, and have other unpredictable effects. You may need more frequent testing during tough times.

Body changes
What's the deal here?
As you progress through life, so does your body. You may be dealing with weight changes, menopause and a host of new health concerns.

What will help?
• Your metabolism slows naturally with age, making it easier to pack on the pounds. This added weight will increase your body's resistance to insulin, so as you get older, step up your exercise and calorie-cutting to compensate.
• You may begin to notice complications such as high blood pressure and high cholesterol. And men can experience erectile dysfunction. Talk to your doctor about testing and treatment.
• Some women experience blood glucose changes with menopause. You may need to monitor your blood sugar more closely.

Red alert:
Most Canadians with Type 2 diabetes are first diagnosed in their 40s or 50s. A third of those with diabetes don't know they have it, even while the disease is causing damage. Screening is important for everyone over age 40.


Page 4 of 5 – Find out three things you should know about diabetes on page 5.
Retirement
What's the deal here?
Successful diabetes management depends on a regular schedule. When you retire from your job, your timetable is turned on its head.

What will help?
• When you were working, you woke up and ate at specific times. Why not set yourself a new schedule to stick to?
• Your proximity to the kitchen may tempt you to graze throughout the day, which wreaks havoc on your blood sugar. "A consultation with a registered dietitian is usually advisable," says Keller.
• Going on a cruise? How's your self-control? "They feed you a lot," says Keller. "If you eat whatever you want but reduce your portion sizes, you can usually control your glucose levels."

Red alert:
Don't get caught short! When you travel, bring more pills or insulin than you think you'll need. Ask your pharmacist for a printout of your prescription medications before you go, and consider carrying a doctor's note if you fly with syringes.

Senior years
What's the deal here?
Age-related health issues, including vision problems, decreased dexterity and dementia, can make managing diabetes more difficult.

What will help?
• Explore easier to handle glucose meters and insulin-delivery devices. Some tools have oversized number displays, for example. Instead of syringes, seniors may find it easier to use preloaded insulin pens.
• Older men with diabetes often depend on their wives for meal preparation and health-care management. If they become widowed, they may need more family support for nutrition and diabetes control.
• Seniors may need assistance with regular foot inspections. This is an important part of diabetes care, since any injury to the foot can result in a serious infection.

Red alert:
As your loved one ages, his medications to control blood pressure or cholesterol can have new and dangerous effects. "Some drugs can cause hypoglycemia, and the risk of hypoglycemia increases exponentially with age," says Keller. Keep a close eye on drug interactions and side-effects whenever a prescription changes.

3 things you should know about diabetes
1. If you have prediabetes (higher-than-normal blood sugar), you're more likely to get Type 2 diabetes? If you reduce your blood glucose levels now, you can prevent diabetes altogether.
2. Gaining weight after your first pregnancy boosts your risk of gestational diabetes in your second? Try to keep off those postpregnancy pounds.
3. Watching more than two hours of TV a day increases your odds of developing Type 2 diabetes. Get off the couch!

Brush up on the latest in diabetes prevention at canadianliving.com/november.

This story was originally titled "Living Well with Diabetes" in the November 2011 issue. Subscribe to Canadian Living today and never miss an issue!

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