BRAID Research, University of Alberta www.braiddm.ca

1. Standing Strong against Diabetes
Maskwacis Health Services Diabetes Conference,
November 2012
Dr Ellen Toth
University of
Alberta
Maskwacis Diabetes Health Conference 2012, E. Toth

2. Plan for today
 Introduction
 What is diabetes
 Standing Strong
Maskwacis Diabetes Health Conference 2012, E. Toth

3. Dr Ellen Toth
Department of Medicine
University of Alberta – Diabetes specialist
 Doing clinics in Hobbema monthly.. every 2
weeks…. for 10 years
 Because there is a lot of diabetes in Hobbema
 Because it is not easy for people from Hobbema to
get access to good diabetes or other Health Care
Maskwacis Diabetes Health Conference 2012, E. Toth

4. Dr Ellen Toth
BRAID Research: www.braiddm.ca
 Since 1999: “diabetes epidemic in aboriginals” main focus of
work
 SLICK/CHIPP in 2001,
 ACADRE in 2002
 MDSi in 2003
 BRAID since 2002, BRAID kids 2008
 CIRCLE in 2009
 ADSS
 Present grants:
 Pregnancy barriers (Richard Oster)
 Self determination / cultural continuity (Richard Oster and
Davida Reingold)
 Type 2 diabetes in kids (Davida Reingold and Kelli Ralph
Campbell)
 Diabetes and Pregnancy in Hobbema (Lawson Foundation)
Maskwacis Diabetes Health Conference 2012, E. Toth

5. Dr Ellen Toth
Other activities and anxieties
 Medical Lead for Aboriginal Health – Aboriginal Health
Program – Capital Health / AHS /North / Edmonton Zone,
 Medical Director: Aboriginal Diabetes Wellness Program /
Aboriginal Wellness Program
 GRUMP!
 We are NOT winning… well… maybe?????
 Diabetes epidemic
 Pregnancy complicating diabetes
 Mental Health: effects of residential school.
Maskwacis Diabetes Health Conference 2012, E. Toth

6. Authors: Oster, Hemmelgarn, Toth, King, Crowshoe, Campbell
ADSS 2009

7. Rates of high risk pregnancies

8. Diabetes and high risk pregnancies

9. Plan for today
 Introduction
 What is diabetes
 Standing Strong
Maskwacis Diabetes Health Conference 2012, E. Toth

10. What is Diabetes?
• A condition where the sugar in the blood is too high
• A common problem all over the world (1% to 50%)
• A chronic condition with no cure
• A condition that can be managed
• Several types and several “complications”
Maskwacis Diabetes Health Conference 2012, E. Toth

11. Newoyaw: Life map for Living with
Diabetes
ACKNOWLEDGEMENT:
Aboriginal Diabetes Wellness Program
Newo = 4
Miyaw = Body
Newoyaw = 4 Bodies
Mind
Body
Spirit
Emotion

12. How does it happen?
What happens when we eat?
= =
Food Sugar Energy
Food that we eat turns into sugar to be used as energy

13. What happens when we eat?
The Fire-Keeper
(Insulin) brings
the wood (Sugar)
into the Teepee
(Cell) to make a
fire that produces
heat and energy
Wood = Sugar Fire-Keeper = Insulin Teepee = Cell

14. What happens when we eat?
Wood = Blood Sugar Fire-Keeper = Insulin
•Insulin brings the blood
•Blood sugar comes from sugar into the cells
the food we eat •Insulin is made by the
pancreas

15. What happens when we
eat?
Teepee = Body Cell
Fire = Energy
•The body’s cells use the
sugar as energy

16. Why does it happen?
What is Type 2 Diabetes?
When we have diabetes several things are
going on:
- our bodies can release too much sugar
- our insulin is not working properly
- our cells resist insulin
Leaky Liver: Pooped out Cell Resistance:
Too much Pancreas: Not Insulin unable to bring
sugar: enough or Insulin too sugar into the cell
tired

17. What is Type 2 Diabetes?
Leaky Liver Pooped out Cell Resistance
The liver leaks Pancreas The cells don’t
too much The pancreas is not allow insulin to
sugar. Blood making enough bring the sugars
sugars rise insulin. Or the into the cell.
insulin is too tired Blood sugars rise.
and not able to
work properly.
Blood sugars rise.
Maskwacis Diabetes Health Conference 2012, E. Toth

18. What is Type 2 Diabetes?
How can it be managed?
Leaky Liver Pooped out Cell Resistance
The liver leaks
Lifestyle Pancreas
Lifestyle The cells don’t
Lifestyle
too much The pancreas is not allow insulin to
sugar.mainly
Pills, Blood making enough
Pills, diabeta, bring the sugars
Pills, mainly
sugars rise
metformin diamicron, the
insulin. Or into the cell.
metformin
insulin is too tired
gluconorm, januvia Blood sugars rise.
and not able to
Insulin, the work properly.
Insulin, the Insulin, the
needle needle sugars rise.
Blood needle
Maskwacis Diabetes Health Conference 2012, E. Toth

19. Other types of diabetes
Type I Gestational Prediabetes
Also secondary diabetes, eg Conference 2012, E. Toth
Maskwacis Diabetes Health to pancreatitis

20. Type 1 Diabetes
 Formerly known as juvenile-onset
or insulin-dependent diabetes
 Causes: Immune system
damaging cells that make insulin;
viruses and /or environmental
 You need insulin injections for
the rest of your life

21. Gestational Diabetes
 Diabetes during pregnancy.
 Causes: Hormones that help the
baby develop can affect your
own insulin's ability to handle
sugar. This is a type of insulin
resistance.
 Both mother and child are at a
higher risk of developing type
2 diabetes later in life.

22. Pre-Diabetes
Good! Take action! Diagnosis
< or = 6.0 6.1 – 6.9 > or = 7.0
No diabetes Pre-diabetes Type 2 diabetes
Maskwacis Diabetes Health Conference 2012, E. Toth

23. Pre-Diabetes
 Prediabetes can be slowed down or prevented by
proper nutrition, exercise & weight loss. It is a life
time commitment.
 Medication can also help (metformin)

24. Plan for today
 Introduction
 What is diabetes
 Stand Strong
Maskwacis Diabetes Health Conference 2012, E. Toth

25. How might communities
stand strong?
 Prevent diabetes, and pre-diabetes
 Treat diabetes, and pre-diabetes
 Live well with diabetes
 Assess and treat diabetes
complicating pregnancy
Maskwacis Diabetes Health Conference 2012, E. Toth

26. Type 2 Diabetes
Risk Factors
 Overweight / Obese / Inactive
 Aboriginal, Hispanic, African,
Asian
 Family history of type 2
diabetes
 Age
 Previous gestational diabetes
 STRESS
Modified from CDA, Toth

27. How might communities stand strong?
Personally Community Prevent diabetes
Prevent
diabetes
Plan
Mental
Health Diabetes pregnancies,
test and treat
diabetes in
pregnancy
Indian Act Residential
school
E. Toth, 2012

28. What is needed for health?
Access to
quality
health care
Self: genetics,
health beliefs, self
esteem, resources
Family and friends
Community leadership
Social determinants of health
Maskwacis Diabetes Health Conference 2012, E. Toth Toth 2010

29. Questions and discussion
Dr Ellen Toth: 780 - 407- 3636
Ellen.toth@ualberta.ca
www.braiddm.ca