Diabetes Canada Guidelines 2018 - Diabetes And Pregnancy

With no less than 42 (!) recommendations, this is the longest chapter in the 2018 Diabetes Canada Clinical Practice Guidelines.  That's because there is a lot to say about management of not only diabetes predating pregnancy, but also gestational diabetes (diabetes that develops in pregnancy).

As a summary of this chapter is beyond the scope of a blog post due to its length,  I have picked out some of the key pearls to share here.


1.  Key Messages for women with diabetes who are pregnant or planning a pregnancy - this is a completely new section, and a must read not only for women with diabetes, but also women at risk for gestational diabetes.

2.  Contraception for women with diabetes is ESSENTIAL, until both the woman and her health care providers agree that she is safe and ready for pregnancy. There are many steps to be taken that must be in place before any attempts at pregnancy. This includes having good and stable blood sugar control, ensuring no unsafe medications are on board, vitamin supplementation, and eye checks.

3.  A1C target pre pregnancy should be 7% or less, and ideally 6.5% or less if it can be achieved safely (without low blood sugars).

4.  A1C target during pregnancy should be 6.5%, and ideally 6.1% or less if it can be achieved safely (without low blood sugars).

5.  Folic acid 1mg should be started 3 months pre pregnancy, and continued until at least 12 weeks of pregnancy (the 2013 Guidelines recommended more)

6.  Women on metformin or glyburide for type 2 diabetes with good control can continue these medications until pregnant.  Once pregnant, it is recommended to switch to insulin. (the previous guidelines recommended that all women with type 2 diabetes should be switched to insulin and stabilized on insulin prior to pregnancy). Metformin use during pregnancy in women with type 2 diabetes is currently under active study.

7.  Recommendations for appropriate weight gain in pregnancy are based on pre pregnancy BMI.

8.  Screening for gestational diabetes is recommended for all women at 24-28 weeks of pregnancy, with the preferred method being a 50g glucose challenge as the initial test.  Women who are at increased risk of gestational diabetes should have blood testing for diabetes at the first pregnancy visit.

9. For women with gestational diabetes, testing for diabetes after pregnancy remains essential.

10.  New recommendations for fetal surveillance and timing of delivery are provided.

I emphasize again that there are many other changes and expansions of recommendations in this chapter of the guidelines - anyone practicing in this area of diabetes care is encouraged to embrace the chapter in its entirety.

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www.drsue.ca © 2018

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Diabetes Canada Guidelines 2018 - Physical Activity

There is a ton of great, new information in the 2018 Diabetes Canada Physical Activity guidelines chapter.  Here are some of the highlights:


1. Avoid prolonged sitting. Try to get up briefly every 20 to 30 minutes.  Bluntly put, this is because we now know that habitual, prolonged sitting is associated with an increase risk of death and major cardiovascular events (eg heart attack).

2. While it is still recommended to engage in 150 minutes per week of aerobic exercise and at least 2 sessions per week of resistance exercise if possible, it is now recognized that smaller amounts of activity still provides some health benefits. Something is better than nothing!

3.  Make use of strategies that increase motivation, such as setting specific physical activity goals, and using self monitoring tools (eg a pedometer that counts steps). (My editorial comment - some of these devices can also remind you to get up if you've been sitting for too long.)

4.  Medical clearance: It was previously recommended that anyone with diabetes who is about to begin a program more vigorous than walking should have medical clearance first.  This has been relaxed a little - now, this need for clearance is more focussed on middle aged and older people who wish to undertake prolonged or very vigorous exercise, and of course, anyone with symptoms suggestive of cardiovascular disease.

People with more advanced diabetic eye disease should be treated and stabilized before vigorous exercise, and people with severe diabetic nerve disease in their feet/legs should inspect their feet daily and wear appropriate footwear.   It is also recommended to ideally see a qualified exercise specialist before starting strength training (eg weights) to avoid injury.

5.  There is a great list of suggested strategies to help people with type 1 diabetes reduce the risk of lows with exercise.


Bonus Practical Stuff: 

Resources for people with diabetes: (scroll down to Exercise) - including info on how to plan and maintain physical activity, videos on resistance exercises, and more!

Resources for health care providers: under 'Management' - scroll down to 'Physical Activity and Diabetes' - tools including how to write an exercise prescription


Enjoy - and have fun!

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2018

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New 2018 Diabetes Canada Guidelines - Nutrition Therapy

It's hard to know how to eat right - there is a lot of conflicting information out there, and unfortunately lots of claims that have no scientific backing nor evidence of long term success.
Eating well with diabetes is no exception.

Thankfully, we have the Diabetes Canada Clinical Practice Guidelines to give us evidence based recommendations on healthy eating with diabetes.

The updated Nutrition Therapy chapter in the 2018 Guidelines contains a lot of great information.   I really encourage interested readers to snuggle up with a cuppa to read the whole chapter, but let's go through some of the key points here:

1.  Nutrition therapy can reduce hemoglobin A1C (the diabetes report card) by 1-2% (that's as much as 1-2 diabetes medications!)

2.  The proportion of carbs vs protein vs fat should be flexible within the recommended ranges, and will depend on individual treatment goals and preferences.

3.  Eating low glycemic index foods instead of high glycemic index foods helps to improve diabetes control.

NEW: Aim for a fibre intake of 30-50g per day, with 10-20g coming from soluble fibre, to improve blood sugars and cardiovascular risk.

4.  Added sugars should be MAXIMUM 10% of total daily caloric intake.

5.  Intensive health behaviour interventions in people with type 2 diabetes can improve weight, fitness, diabetes control, and cardiovascular risk factors.

6. NEW: People with diabetes should be encouraged to choose the dietary patterns that best align with their values, preferences, and treatment goals. (check out the new sections on ethnocultural diversity in Canada, and on Ramadan, as well!)


Here are some of my favourite Key Messages For People With Diabetes: 

1.  Try to prepare more of your meals at home, using fresh and unprocessed ingredients.

2.  Prepare meals together and eat as a family. This is a good way to model healthy food behaviours to kids and teens, which can help reduce their risk of developing overweight or diabetes.

3.  The best strategy is one that you can maintain long term.

4.  With prediabetes and newly diagnosed type 2 diabetes, weight loss is the most important and effective dietary strategy if you have overweight or obesity.  A weight loss of 5-10% may help to normalize blood sugars.

5.  Diabetes friendly eating habits can improve blood sugars and decrease the risk of cardiovascular disease, including:

• select whole foods instead of processed
• avoid sugar sweetened beverages
• pay attention to both carbohydrate quantity, and quality (low glycemic index instead of high)
• considering learning how to count carbs
• preferred dietary fats are unsaturated - maximum saturated fats has now been increased to 9% of total calorie intake (previously 7%) - and avoid trans fats completely
• choose lean animal protein, and eat more vegetable protein

The data for many different diets/patterns of eating is reviewed, with many different types of diets being suggested for an improvement in type 2 diabetes control, including Mediterranean, vegetarian, and DASH diets, as well as diets that include pulses (eg beans), vegetables, fruits, and nuts.  The details of what is in these diets is provided in the chapter, and available data in type 1 diabetes is reviewed as well.  At the end of the day, the key is to choose a healthy way of eating that is in keeping with individual preferences, as this gives the greatest likelihood of being able to follow it long term.

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2018

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