April 4, 2007

Waking up to diabetes

By Suzanne Taylor
staylo73@uwo.ca

Pauline Nanni couldn't be bothered to eat healthily and exercise regularly. She was a busy elementary school teacher. She relied on Wendy's hamburgers and fries to get her through the days. After work, her two or three helpings of dinner included lots of rice and potatoes, loaded with butter and salt.

At five foot five and weighing 197 pounds, the London native knew she was overweight. She tried different exercise programs, but never stuck with them. Even though her husband tried to encourage her with his own healthy lifestyle. Even though her family physician, Dr. Edmond Clark, warned her she needed to lose weight as her blood pressure crept upward. Even though her brother suffered his first heart attack when he was 39 and died when another struck during a round of golf when he was 55.

For years, none of it was enough to motivate Nanni, a mother of two, to change.
Then about a year ago, Nanni got a call from the nurse at Clark's office, the day after her physical exam.

"Pauline, have you ever had high blood sugar?"

"No, I don't think so," Nanni replied, not at all nervous about where the conversation was headed.

"Well, you do now," the nurse said. Nanni asked what that meant. "Well, you probably have diabetes," came the reply.

Still unfazed, Nanni thought there was some mistake. "Oh, no - I don't have diabetes," she said.

Photo by Suzanne Taylor

Pauline Nanni lost 50 pounds after being diagnosed with type 2 diabetes a year ago and feels healthier than ever before. But she's not the typical diabetic.

But she did. A few days later, on March 30, 2006, Nanni went back to get retested. Sitting in Clark's office afterward, Nanni was told her body could no longer use insulin to extract energy from food the way a healthy person's does, that complications from high blood sugar levels could eventually lead to blindness, heart disease or kidney failure. As it finally started to sink in, Nanni tuned out until she no longer heard the words coming out of Clark's mouth.

She was 55, the same age her brother had been when he died, and she was scared.

Like one in 22 Canadians today, Nanni was diagnosed with type 2 diabetes - the kind that can often be prevented, or at least delayed, through healthy eating and exercise. As the population grows more obese, it's a disease more and more Canadians face. If current trends continue, one in 11 Canadians will have type 2 diabetes in 10 years.

Despite the growing number of cases, diabetes care in Canada is far from exemplary, according to new findings by the Health Council of Canada. It found fewer than half of family physicians refer their diabetes patients to support services like nutrition and exercise counselling. In fact, more than half say they don't even know whether these services are available in their communities.

As Nanni would prove, those services can make a big difference in a patient's prognosis. She considers herself lucky that Clark referred her to counselling, and can't understand why all doctors aren't doing the same for their patients. "It's just a referral. It's just a minute of their time."

Ruth McManus, a diabetes physician at St. Joseph's Hospital in London, pointed out that diabetes care in Canada has come a long way in the past 20 years, but acknowledged more doctors should be referring patients to a health care team to help manage the disease. Unfortunately, she said, there simply aren't enough dietitians and nurse practitioners to go around. On top of that, people aren't willing to drive very far to get to those resources. While Nanni was only 10 minutes from the services that helped her, other diabetics who have to go farther may not make the effort.

Having worked in diabetes education for 30 years, Pam Colby is all too familiar with the lack of resources. She's a registered dietitian and certified diabetes educator at the Lawson Diabetes Centre in London.

Photo by Suzanne Taylor

Pam Colby is one of the diabetes educators at the Lawson Diabetes Centre in London, which provides care for 30 to 40 new patients each day.

The Lawson centre sees about 30 to 40 new referrals each day, equipped with a staff of only seven nurses and seven dietitians, some of whom are part-time. That means space in the centre's ABC program, a series of classes for newly diagnosed diabetics that educates them on everything from the basics of the disease to customized meal plans, is limited. Recently, staff had to increase the capacity from 12 to15.

But even if the programs are there for them, Colby said only about 30 per cent of London's family physicians refer patients to the Lawson centre, as Clark did for Nanni, in the first place. She's not sure why the other 70 per cent don't, but realizes if they did, she and her co-workers would be overwhelmed.

And because there aren't enough staff to give patients the personalized attention they'd like to, Colby said, "we also have to give them the message that this is their disease process. They have to be the person who guides their ship."

Pauline Nanni is one diabetic who took that message to heart.

After delivering the diagnosis, Clark made an appointment for Nanni with Marilyn Campbell, the registered dietitian he has access to because he belongs to a health service organization, a network of doctors who agree to make certain services available to their patients. Nanni met with Campbell the next day, and took the first step in learning how to manage her disease.

That same day, Nanni drove to a pharmacy to get the meter she would eventually use three or four times a day to test her blood sugar levels. But standing there at that moment, listening to the pharmacist explain how to use it, all she could think was, Oh my God, I can't do this.

At home that night, Nanni was afraid to eat anything, afraid to use her new meter. But after dreaming her body was dripping blood, she awoke the next day and realized she needed to take control of her health.

Nanni saw Campbell again the next week, and the week after that, before starting classes at Lawson two weeks after being diagnosed. She attended the ABC classes and learned about diet and exercise. She began walking every day, 50 minutes in Springbank Park, no matter the weather or her schedule, although she admits it's easy to make time now that she only teaches a few days a week.

During the first few weeks, Nanni lost 11 pounds. Within a few months, her cholesterol, blood pressure and blood sugar levels all returned to normal. She started feeling healthier, stronger. She'll never forget something Campbell told her during their first consultation: "If you do this, and you get on this way of eating, you will be healthier, having diabetes, than most of the population walking around. If you're faithful to it."

Faithful doesn't begin to cover it. Nanni has a log book where she records every meter reading, complete with notes that explain elevated levels ("cake mix - licked bowl"). She reads articles and reports to stay informed. And she carries her meal plan with her so she knows exactly what, when and how much to eat.

Photo by Suzanne Taylor

Nanni carries her diabetic meal plan with her and keeps track of her blood sugar levels in log books.

These days, Nanni has tuna and salmon wraps for lunch. At dinner, half her plate consists of vegetables, a quarter of it carbohydrates and a quarter protein. She sees Campbell every three months. She's due for a "tune-up" class at Lawson on April 20. She's lost 50 pounds and only takes pills to control her cholesterol and blood pressure, instead of the insulin or other medications many diabetics take.

Everyone is pleased with Nanni's progress. "It's extremely satisfying," said Campbell. "I can give advice, but the patient has to do it. And people like Nanni are just a delight to work with, because they take the information you give them and run with it."

Colby remembers Nanni's time at Lawson, and said while many of the centre's patients make progress, Nanni is a shining example of how far that progress can take a person when they have access to support services.

Nanni's husband of 34 years, John, couldn't be happier with her transformation either. As the cook of the family, he's made some changes, too, like baking fewer of the apple pies his wife found so delicious. "If she can go without it, so can I," he said. "You're in it together."

John admits he's worried about what the future may hold, but is confident in his wife's discipline. "She seems to be the master of her destiny . . . It's just a matter of maintaining that kind of lifestyle."

It's a lifestyle Nanni says she has no intention of giving up, because she knows diabetes is a progressive disease and things might not always be this - relatively - easy.

"I'll try to do this as long as I can. If I need medication, I need it. You just deal with that when it comes."

"My brother died when he was 55 and I was diagnosed with diabetes when I was 55. Instead of dying like he did, I had a wake-up call," she said. "At least I had a chance to wake up."