Banting and Best 100 Years On

THE 100TH ANNIVERSARY OF INSULIN Banting and Best literally gave life to type 1 diabetics

Every Canadian school kid learns the names Banting and Best. July 27th marks the one-hundredth anniversary of the reason why. On that date in 1921, surgeon Dr. Frederick Banting and his assistant, medical student Charles Best, isolated insulin in their lab at the University of Toronto. The duo first successfully isolated the hormone in dogs, inducing diabetes symptoms, which were eliminated in the canines by insulin injections.

On November 14th of that year, the Toronto Daily Star headline proclaimed “Toronto Doctors on Track of Diabetes Cure.” Two months later, Banting and Professor John Macleod prepared treatment for the first human subject, 14-year old Leonard Thompson.

Prior to insulin, diabetes was a fatal disease. Scientists were honing in on the role of the pancreas in the digestive system, its malfunctioning being the suspected cause. The only solution at the time was to adopt a low carbohydrate, high fat and protein diet, which delayed mortality for the short term only. We know it today as the controversial Keto diet, in which low carb consumption causes blood sugar levels to drop and forces the body to convert fat to energy.

Leonard Thompson had been diagnosed with Type 1 diabetes three years prior to being admitted to Toronto General Hospital. The poor fellow was drifting in and out of a diabetic coma and weighed about 30 kilos. His dad agreed that the experimental insulin treatment was his only hope. His condition improved dramatically, and Leonard survived another 13 years.

The University of Toronto issued royalty-free licenses to pharmaceutical companies to produce insulin. Banting and Macleod won the Nobel Prize in Medicine, the first Nobel awarded to any Canadian in any field.

Diabetes occurs in two ways. Both relate to how the body struggles to control the level of glucose (sugar) in the blood. Type 1 accounts for roughly 10 per cent of cases and develops early in life, but can also occur in adults. It requires the introduction of insulin

into the body either by injection or the use of an insulin pump because the body does not produce its own supply.

Type 2 is far more common. The body cannot supply enough insulin, or does not properly use what it does supply. In some instances, insulin production may stop altogether. Type 2 can be triggered by lifestyle factors, like excessive weight, poor diet, and lack of exercise. Contrary to what might seem obvious, consuming refined sugar is not a direct cause of diabetes, although there is an association with negative effects on the liver or increased weight. Fructose found in fruits and vegetables is not linked to increased risk.

In both diabetes types, dangerously high blood glucose levels can lead to serious complications, like eye damage, high blood pressure, increased risk of heart disease and stroke, and nerve damage that can require amputation. In both types, a healthy diet, proper weight control, and exercise are key to controlling the condition and reducing the risks. Early warning signs in both types include lack of energy, persistent thirst and the need to urinate frequently, blurred vision, frequent or recurring infections, cuts and bruises that are slow to heal, and tingling in the hands or feet.

Like other chronic diseases, monitoring and control are a daily habit, and come with special needs and inconveniences. A blood glucose meter is a simple and reliable tool for checking the ups and downs of levels. A quick jab to the finger produces just enough of a sample for analysis. Other less accurate monitors can take a sample from the palm or arm to reduce the sting. A person with diabetes has to eat regularly to keep an equilibrium between rising glucose levels and the counterbalance of insulin intake. A chocolate bar or cookie

MAX DOMI COURTESY CANADIEN DE MONTRÉAL If a super elite athlete like Max Domi can train, . . . and get on the ice and win games, then he is living proof that Type 1 diabetes can be managed and conquered.

Giving up your Right to Sue?

Major e-scooter companies like Bird and Lime in Ottawa require users to agree to their lengthy user agreements terms before riding. Users may not always take a closer look before clicking to ride.

By choosing to ride an e-scooter, you could be waiving your right to any potential claim against the company, even for defective machines. These tricky conditions could potentially leave a rider without any protection if their scooter is defective, injuring themselves or another. You may also agree to resolve any legal disputes through a final arbitration and waive your right to file a lawsuit in court.

Will Ottawa Ban E-Scooters?

Recently, the City of Toronto council unanimously voted to opt-out of the e-scooter pilot, citing concerns with safety and accessibility. Toronto’s e-scooter ban will continue to apply to both “pay for use” as well as privately owned e-scooters.

On their website, The Accessibility for Ontarians with Disabilities Act Alliance (AODA) hailed Toronto’s decision as a “victory”. AODA has been working steadily to oppose lobbyist efforts to increase the use of e-scooters. They cite that the e-scooters endanger public safety, particularly seniors and people with disabilities. Blind people cannot tell when the e-scooters (which are silent) whiz by at high rates of speed. When left unattended on sidewalks, the scooters also pose tripping hazards for blind people and accessibility issues for wheelchair users. AODA also believes that e-scooters will impose costs on taxpayers for additional law enforcement, OHIP expenses for e-scooter injuries and resulting lawsuits.

Ottawa has seemingly taken measures to address the public’s safety concerns. According to Ottawa Transportation Committee Chair Tim Tierney, these measures include a duty on e-scooter vendors to pick up misplaced scooters in a short window of time or potentially lose the opportunity to be included in the next pilot program. There is also a “two-strike system” for riders who leave e-scooters outside of designated drop-off areas resulting in bans.

It remains to be seen whether Ottawa will follow Toronto’s lead in opting out of the e-scooter pilot program. Ottawa is continuing to participate in the pilot, creating a by-law to regulate e-scooter use, and e-scooters are set to roll out again in 2021 n

accompanies the person wherever they go, providing a little boost if hypoglycaemia occurs and an energy crash comes on. If kept in check, the only outward sign of diabetes may be a little bruising resulting from even a modest bump against a hard surface. Otherwise, an active life can be fully enjoyed with care and good habits.

Dexcom is a company that develops, manufacturers and distributes glucose monitoring systems for diabetes management. Their products differ from the occasional jab method by continuously tracking glucose levels 24 hours a day, taking and recording regular measurements to indicate glucose direction and rate of change. Data like this helps the user manage glucose highs and lows, and see the impact that meals, exercise and illness may have on glucose levels. It’s easier to plan snacks, meals, or more demanding activities when changes are mapped into patterns rather than snapshots.

Continuous monitoring devices employ a tiny sensor wire that gets inserted just beneath the surface of the skin where it comes in contact with the interstitial fluid. An adhesive patch holds the wire in place so the sensor can measure glucose levels. A small, reusable transmitter connects to the sensor and sends real-time readings wirelessly to a read-out device. The G6 CGM System is compatible with Android, Apple, and Huawei phones, or an optional Dexcom receiver.

Living with a chronic disease requires constant devotion to health practices. There’s also the anxiety that comes from knowing that even the most vigilant individual cannot have 100 per cent control over the outcomes from one day to the next. But, like any complex problem, the more data that comes in more often, the better the chances for success. In this way, the Dexcom G6 CGM System is a game changer, and if your game is hockey, then you’ve got a better than fighting chance to beat the odds.

Max Domi is a 26-year-old left winger for the NHL Columbus Blue Jackets. He’s swift and agile and built like a cinderblock wall. He’s also a person who lives with Type 1 diabetes, and Max credits the Dexcom G6 CGM System with saving his game. He’s become a Dexcom warrior. “Just as I would invest in what I have to do for the hockey side of things . . . I’m investing just as much, if not more, in my own health and ensuring that my sugar levels are as stable as they need to be to perform at my highest level,” Max says in a Dexcom video. “I probably had to prick my finger 10 to 20 times a day, but once I got my Dexcom G6 I was able to fully take control of every variable I had control over.”

If a super elite athlete like Max Domi can train, train some more, attend practice, travel with his team, and get on the ice and win games, then he is living proof that Type 1 diabetes can be managed and conquered. “I couldn’t necessarily tell you that I’d be at the top of my game without being able to monitor my glucose levels,” Max says. “Dexcom is making this disease so much more manageable for everyone.”n

To view Max Domi’s inspiring video and to learn more about Dexcom products, go to: www.dexcom.com/ en-CA

Mathew Voss with his sister Catalaya and brother Noah.

LEGISLATORS CALL FOR diabetes assistive devices funding for families like the Voss’s

Cindy and Ben Voss live in Saskatoon with their three beautiful children. Mathew just turned 13 and is in Grade 7, Noah’s 11 in Grade 5, and daughter Catalaya just turned 9 and is in Grade 3. Together they are the epitome of a happy family. Mathew was 10 years old when he started to exhibit what turned out to be early signs of Type 1 Diabetes. An athletic growing boy, Mathew was a competitive swimmer and full of energy, spending his leisure time training at the pool, which mum and dad thought might have been the explanation for a bit of weight loss. It was during a family vacation that something else came to light.

Mathew would make a couple of trips to the bathroom every night, which was new behaviour, but having had a tall glass of water or milk before hitting the sack was a reasonable explanation and a change of routine seemed to solve the problem. It was while everybody was heading off on a cruise, waiting in the airport in fact, when Mathew was making several trips to the bathroom. Cindy told Ben that, “Mathew looked different to me and I was worried something was wrong,” an observation of subtlety that only a parent could make. Off they went and boarded the ship, and once again there seemed to be a correlation between Mathew’s consumption of liquids and trips to the bathroom.

It was upon returning home and at a swim meet that Mathew’s energy and speed appeared to wane. Symptoms can creep in, and what feels normal can gradually change. Mathew insisted that he felt fine, but made four trips to the bathroom that night. A visit to the family doctor and a ketone test came next. Type 1 Diabetes was suspected, so she ordered further blood work which confirmed the diagnosis. “The next day, our lives changed,” Cindy says.

The news required Mathew to immediately leave school to meet with an endocrinologist who was waiting at the hospital. “We were so scared. Of course all we wanted to know was, how can we get rid of this?” Cindy recalls. “When we were told there is no cure, our next question was can we give Mathew our pancreas to which we were told no.” What followed were days of tests, sleepless nights, finger pricking, training, more tests, fear, and upheaval. The trepidation came at having to administer insulin injections, of getting them just right. “I remember wondering as my hands were shaking how I was going to be able to do this at home without a nurse’s set of eyes and expertise.”

Diabetes is one of those conditions that requires an equilibrium between the body’s needs and the replacement of what the body cannot provide. Needs are determined by regular tests several times every day for the rest of a person’s life. Drawing blood from the finger is quite literally a constant pain and a trauma. New continuous glucose monitors like the Dexcom make living with diabetes much more manageable, as it can map trends and sound the alarm when necessary, perfect for an athletic boy like Mathew who loves so many activities.

“Now that Mathew wears a Dexcom he can do all these things and we know he gets the alarms and so do we. We can monitor him very closely and we do this especially when we know he is active to prevent any dangerous situations,” Cindy says.

MPP Taras Natyskak recently tabled a bill in the Ontario Legislature, calling for OHIP coverage of devices like the Dexcom. Diabetes Canada tweeted its support on April 2. “We commend… Natyshak for tabling his private members’ bill 272 that would see continuous and flash glucose monitors covered under the assistive devices program.”

The bill was rejected by the Ford government, in effect, according the Natyshak, “condemning more kids to more finger pricks…condemning more people to live with less freedom, and more health emergencies caused by Diabetes.”

For the Voss family and so many other Canadians who live with diabetes, devices like the Dexcom not only save lives, but raise the quality of life of the wearer and those who stand by them n