Clinical
DIA B ETE S: W HAT TO WATC H F OR I N YOU R C L I N I C
M
any chiropractors have patients with diabetes. You may also have patients
who do not yet know that they are diabetic or who are at risk of developing
diabetes. Chiropractors can play a crucial role in helping these patients by
keeping an eye out for early indicators and risk factors, and making them aware of
complications when they are observed in your clinic.
Diabetes in Ontario
The prevalence of diagnosed diabetes
among Ontarians has increased from
3% in 1994 to 10.2% in 2012. Prevalence
is increasing worldwide, but Ontario
is a particular hotspot. One reason
for this is that diabetes risk rises with
age, and Ontario’s population is aging.
Improvements in diabetes treatment and
the resulting longer life expectancy have
also contributed to these higher rates.
Types of Diabetes
Type 1 (Previously ‘Juvenile
Diabetes’)
Type 1 diabetes is an auto-immune
disease where the pancreas stops
producing insulin. Insulin is a hormone
which helps the body to regulate glucose
levels in blood. Type 1 diabetes is not
caused by nutrition or lifestyle. It is not
currently preventable and its cause is
unknown.
People with type 1 diabetes require
insulin therapy. Insulin was discovered by
Frederick Banting in 1921 at the University
of Toronto and mass production began
in 1922. His first patient, Elizabeth Evans
Hughes, died in 1981 at the age of 73.
Insulin therapy has enabled many people
with type 1 diabetes to live long lives —
some of your senior patients may be
among them.
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SPRING 2015
While it is commonly thought that
all people with type 1 diabetes were
born with it, the average age of onset is
between five and nine years old and it can
also develop in young adulthood.
Type 2 (Previously ‘Adult-Onset
Diabetes’)
90% of the 1.1 million Ontarians with
diabetes have type 2 diabetes. In this
type, the pancreas may not be producing
enough insulin or the body may not be
using the insulin properly. The latter is
known as insulin resistance.
Type 2 diabetes risk factors include:
∞∞ Having a parent or sibling with
diabetes,
∞∞ Being of Aboriginal, Hispanic, South
Asian, Asian, or African descent,
∞∞ Having given birth to a baby that
weighed more than four kilograms
(nine pounds) at birth or having had
gestational diabetes (diabetes during
pregnancy),
∞∞ Having been diagnosed with
prediabetes (impaired glucose
tolerance or impaired fasting glucose),
∞∞ Having high blood pressure, high
cholesterol or other fats in the blood,
∞∞ Being overweight, especially if that
weight is mostly carried around the
stomach,
∞∞ Having been diagnosed with polycystic
ovary syndrome, Acanthosis nigricans
(darkened patches of skin), psychiatric
disorders (schizophrenia, depression,
bipolar disorder), or obstructive sleep
apnea, and,
∞∞ Having been prescribed a
glucocorticoid medication by a doctor.
Management of type 2 diabetes may
or may not include insulin therapy. It
may also include a combination of oral
medications, weight regulation, nutrition,
exercise and stress management.
While the type 2 diabetes is usually
diagnosed in patients over age 40, it can
also be seen in children. A recent study in
Vancouver noted a higher rate of type 2
than type 1 among children with diabetes.
This increase in type 2 diabetes in children
has not yet been seen in Ontario, but this
may be due to missed diagnoses.
Gestational Diabetes
Hormones from the placenta may make
pregnant women resistant to their own
insulin, mimicking type 2 diabetes.
Gestational diabetes affects up to 13% of
pregnancies in Ontario.
Diagnosis usually occurs at 24 to 28
weeks of pregnancy, and 50% of patients
require insulin therapy. If a woman has
delivered a baby that weighed over nine
pounds, this indicates that she may have
had gestational diabetes.
20% of women with gestational
diabetes will have developed type 2