We offer virtual consultation to help patients whose physical limitations make travel to the clinic impossible
Lifestyle therapy is always the first choice when working to maintain healthy blood sugar levels in patients with diabetes. This includes developing a carefully tailored exercise program in which the patient increases their effort gradually to get the exercise they need, while keeping exertion at a sustainable level. This process can be made easier and more effective by referring patients to a fitness coach who can help them develop a program that is just right for their needs and abilities.
Diet is another very important part of lifestyle therapy. Ideally, patients living with diabetes will have well-balanced meals with smaller portions of all foods, and healthier, high fiber carbohydrates (sugars and starches). Carbohydrate-containing foods like white rice, white bread, white flour, baked goods, instant cereals, potatoes and tropical fruits increase blood sugars quickly. Wholegrain carbohydrates, parboiled or basmati rice, pasta, noodles, waxy or nugget potatoes, sweet potatoes/yams, split peas, lentils & beans cause blood sugar to increase more slowly and to a smaller extent. Dairy products, vegetables, non-tropical fruit and proteins are also healthy choices in making balanced meals that result in improved blood sugar control.
Lifestyle therapy alone often proves inadequate to achieve stable management of diabetes. In that case, medications may be required to achieve the desired control over blood sugar levels. The principle of treatment with medications involves a stepwise escalation: medication is added stepwise, starting with lifestyle therapy until blood sugar targets reached. In general, medication is only stopped if it is not effective, if unacceptable side-effects occur, or if treatment with insulin leads to acceptable control. An exception is metformin, which is never stopped (see below). Default drug recommendations at the time of writing are based on availability in the Canadian market, effectiveness (efficacy combined with compliance) and price. Once daily therapies are preferred over twice daily therapies. Before breakfast therapies are preferred over therapies taken at other times of the day.
The cost of medications is a concern for most people. Many of the drugs used in management of diabetes are covered by PharmaCare, provided you meet certain criteria for coverage. With a family income of up to $30,000, the patient is directed to the PharmaCare threshold and approved medications are covered (See Fair PharmaCare Calculator at https://www.google.ca/search?q=pharmacare+threshold&rlz=1C1CHBF_enCA741CA741&oq=pharmacare+threshold
If family income is $30,000, then the patient is directed to PharmaCare threshold, and the required drugs are covered. If the family earns $50,000, a total of $1000 must be spent to reach your PharmaCare threshold before PharmaCare payments begin. Most BC residents do not reach their PharmaCare threshold.
For a full price list of drugs commonly used to treat diabetes as of 2017, please see: https://docs.google.com/spreadsheets/d/1k_1Zpl0AUUJmd