Type 2 Diabetes: Living with the Disease Daily in Quebec

In Quebec, approximately 900,000 people live with a diagnosed type 2 diabetes, and it is estimated that several hundred thousand others have it without knowing it (Diabète Québec, 2023). The diagnosis changes a life, but not as dramatically as many initially imagine. Type 2 diabetes is manageable. Not easily, not perfectly every day, but with the right tools and structured follow-up, most people with diabetes lead full and active lives.

What's changing is vigilance. Constant vigilance, integrated into daily life, which ends up becoming second nature for many.

What happens in the body

Type 2 diabetes is a metabolic disease characterized by chronic hyperglycemia, meaning a persistently high blood sugar level. Unlike type 1 diabetes, which is an autoimmune disease in which the pancreas no longer produces insulin, type 2 diabetes develops gradually from insulin resistance. The pancreas still produces insulin, but the cells no longer respond to it properly. Over time, the pancreas becomes exhausted from compensating, and insulin production also decreases.

Chronically high blood sugar levels progressively damage blood vessels and nerves. This is the source of long-term complications: cardiovascular disease, kidney failure, peripheral neuropathy, retinopathy, and an increased risk of infections and poor wound healing. These complications are not inevitable. They are largely preventable with adequate blood sugar control and regular medical monitoring.

Blood Sugar Management in Daily Life: Understanding Targets

Glycemic targets for a person with type 2 diabetes without major complications are generally a fasting blood glucose between 4.0 and 7.0 mmol/L and a blood glucose two hours after a meal between 5.0 and 10.0 mmol/L (Diabetes Canada, 2023). The HbA1c level, which reflects the average blood glucose of the last two to three months, is targeted below 7.0%% for most individuals, with targets adjusted according to age, duration of diabetes, and comorbidities.

These targets are not absolute. An elderly person with other chronic illnesses will have less strict goals than a young adult in generally good health. It is the doctor or the NP who personalizes the targets according to the patient's actual situation.

Food, the first lever of control

No food is strictly forbidden for type 2 diabetes, but how you eat directly influences post-meal blood sugar. Carbohydrates have the most direct impact on blood sugar. Their quantity, quality, and distribution throughout the day are important factors. Complex carbohydrates with a low glycemic index, such as legumes, whole grains, and most vegetables, raise blood sugar more slowly than refined sugars and ultra-processed foods.

The distribution of meals throughout the day is also important. Skipping a meal to compensate for another creates significant glycemic variations. Regular, reasonably-sized meals spread throughout the day stabilize blood sugar better than large, spaced-out meals. Consultation with a nutritionist-dietitian can be invaluable for adapting these principles to the individual's practical reality and preferences.

Physical activity as medicine

Physical exercise directly and immediately improves insulin sensitivity. A 30-minute walk after a meal can significantly lower postprandial blood glucose. In the long term, regular physical activity improves HbA1c, lowers blood pressure, improves lipid profile, and contributes to weight management, all of which reduce the risk of cardiovascular complications in people with diabetes.

The recommended goal is 150 minutes of moderate-intensity aerobic activity per week, spread over at least three days. Muscle strengthening, two to three times a week, is a useful complement to aerobic training. For those starting from scratch, even 10 minutes a day is a valid starting point.

Structured medical follow-up

Regular monitoring is an integral part of diabetes management. In practice, this includes an HbA1c measurement every three to six months depending on glycemic control stability, an annual lipid panel, blood pressure measurement at each visit, creatinine and urine albumin-to-creatinine ratio to monitor kidney function, and a regular foot examination to detect early signs of neuropathy. An annual eye exam is recommended to screen for diabetic retinopathy.

Frequently asked questions about type 2 diabetes

Can type 2 diabetes be cured?
The term remission is more appropriate than cure. In some people, significant weight loss and major lifestyle changes can maintain normal blood sugar levels without medication. This remission is not guaranteed and requires ongoing monitoring, as the risk of relapse persists.

Do all type 2 diabetics end up taking insulin?
No. Many people manage their diabetes with oral medications or non-insulin injectable agents for years. The need for insulin depends on the progression of the disease, the response to treatments, and the patient's preferences in agreement with their doctor.

Is type 2 diabetes hereditary?
Genetic factors play a role, but lifestyle habits are often more decisive. Having a diabetic parent increases the risk, but does not make diabetes inevitable, especially if preventive measures are taken early.

Can you drink alcohol with type 2 diabetes?
Moderate consumption, especially when accompanied by a meal, is generally tolerated, but alcohol can cause hypoglycemia in people taking certain medications. This is something to discuss with your doctor or NP, taking into account your current treatment.

When to consult a healthcare professional

If you have recently been diagnosed with type 2 diabetes, if you find your blood sugar control difficult to maintain, or if you are experiencing unusual symptoms such as episodes of hypoglycemia, numbness in your feet, or blurred vision, you should consult a doctor without waiting for your next scheduled appointment.

A doctor or a specialized nurse practitioner can review your treatment plan, adjust your glycemic targets, and refer you to support resources tailored to your situation. An in-person or virtual consultation teleconsultation at one of our Omicron Clinic in Quebec allows for immediate access.

 

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