Sitting is the new smoking…

Maybe you’ve heard this phrase before but it really highlights the need for all of us to optimize our behaviours to become less sedentary. I thought I’d blog about this issue as it relates to diabetes but the issue of physical activity transcends diabetes and is something we all should prioritize.

According to Statistics Canada, less than 15% of Canadian adults meet the physical activity requirements outlined in Canadian guidelines updated in 2011 (

Over the years health professionals have stressed again and again, the need to be physically active. The evidence supporting the benefits for physical activity is abundant. Studies show the health benefits of exercise can include:

  • Improved blood sugar control in patients with diabetes
  • Lower rates of obesity
  • Lower risk of heart disease, stroke and hypertension
  • Lower risk if developing type 2 diabetes
  • Lower risk of osteoporosis
  • Lower risk of premature death
  • Improved mental health
  • As we age – improved independence and mobility

It’s not news to anyone that exercise improves health outcomes but how do we get motivated to be more active? How do we change our behaviours to encourage physical activity? There are numerous barriers to being more active in our society. Cities are often designed with the automobile in mind so something simple like walking to pick up our groceries is often not an option. So many of our jobs, including mine, are spent sitting at a desk. Canadians spend a great deal of time watching TV or working at a screen of some sort. We need to do better as a society. As we often say to patients in the office, it’s not the gap between what we know and what we don’t know, it’s the gap between what we know and what we do that’s the problem. How do we start to change our behaviour?

There is a growing body of literature that is looking at the effects of being sedentary, and in particular sitting, on health outcomes. We’ve been stressing exercise for years to our patients but in addition to that we really have to combat our sedentary behaviour that is so ingrained in our modern culture. So how do we get moving? Here are just a few suggestions:

  • Walk/cycle to the store or the coffee shop instead of jumping in the car.
  • When you move, think about whether your new home location will encourage you to walk vs drive.
  • At work – think about walking meetings. Stand up to take a phone call instead of sitting. Walk at lunch. Start a walking club.
  • Park the car a good distance from your destination and walk the rest of the way.
  • Get off the subway or bus a stop ahead and walk that extra block.

There are a multitude of little things we can do in our everyday lives to be even a little more active. These are just a few suggestions.

Coming back to the idea of motivation – how do we motivate ourselves to get moving, to get off our behinds and do what we already know what’s good for us? There is a lot written recently about “nudge theory”. This theory talks about tiny little things we can do that “nudge” us to make even a small change in our behaviour to achieve a more active life. We know that behaviour change is always challenging especially if it is a big change. The idea with nudge theory is that it if we can make a really small change in our behaviour then we can start to make more small changes and eventually manifest enough change to result in a better health outcome. One of the things that have nudged me to be more active this year is getting a pedometer.

Pedometers have been around for a long time but the newer high tech fitness trackers that are now available bring the concept of tracking activity to a whole new level. If you’re a bit of a gadget lover this may be for you. I actually got this idea from a patient of mine who was trying to keep herself and her diabetic husband more active. It was really working for them and I was inspired. There are a number of activity trackers on the market at the moment. Some of the brands are Fitbit, Nike Fuelband, Jawbone and Garmin Vivofit just to name a few. The new, soon to be available, Apple watch will have a tracking function as well. Most of them clip to your belt/pocket/clothing or you can wear it as a wristband. If cost is an issue you can stick with an inexpensive low-tech pedometer which will track your steps accurately.

Personally I love my device. It tells me how many steps I’ve done each day. I set a personal goal as to how many steps I want to get. It links to my phone and nudges me along to keep active throughout the day. It’s a constant reminder all day that I need to be vigilant against inactivity. It doesn’t let me forget that I need to stay active and keep my health at the forefront of my priorities. These trackers often have a cool feature where you can compare (in real time) your activity with friends and family who also have a similar device. This allows you to tap in to your natural competitiveness and allows your friends to nudge you (or taunt you!) to keep moving. It’s a fascinating phenomenon that starts to happen when you wear these trackers and stay connected with friends and family who are also trying to stay active. It becomes a bit of a high tech support group over time.

I hope this post reminds you to not just stay active (ie exercise) but to combat our sedentary lifestyles every day.

So how do you stay motivated to keep active? What’s your secret? Please share in our comments section so we can learn from one another. We need all the tips and tricks that we can get to stay healthy.

Dr. Bill

To test or not to test?

“How often should I test my blood sugar?”  This is very common questions I get and my answer always is…”it depends!”


Self monitoring of blood sugar (or SMBG as medical people call it) is not a one size fits all approach.  Previously as diabetes educators, we were trained to tell patients to do routine testing but the benefits of that approach have come into question due marginal benefits and significant costs. There has also been studies to show routine testing may be associated with depression and reduced quality of life.

The thinking now is that the frequency of  SMBG should be based on your current diabetes management. This can be broken down into 3 categories;

1. For most patients on insulin +/- other diabetes medications – SMBG should be tailored to fine tune insulin therapy to acheive optimal blood glucose control. If on once daily long acting insulin (i.e. basal insulin) you should be doing no more than 14 tests for the week on average. If on 2+ insulin injections per day, more testing may be required but speak to your diabetes educator to determine an meaningful and realistic schedule.

2. For most patients on diabetes medications (other than insulin) – routine SMBG is not recommended. Periodic testing can be done in certain situations but only if it helps determine a specific course of action. Examples of situations include: changes to medications, having an illness,  diet and/or exercise changes and to confirm a low blood sugar.

3. For most patients who control their diabetes through diet and exercise – routine testing is not required unless you are trying to reinforce diet/lifestyle changes.

Bottom line is test meaningfully…if testing does not change a specific course of action then don’t bother!




Signing the Diabetes Charter of Canada

What is the Diabetes Charter of Canada?

Briefly, the Diabetes Charter of Canada is a document that the Canadian Diabetes Association has created to ensure that all people in Canada, living with diabetes, are treated with the dignity and respect they deserve.  The goal of the charter is also to advocate for equal access to the best possible diabetes care and support, and to improve the health and quality of life for those living with diabetes, their family members and caregivers.

Click on the link above to read and review the diabetes charter in full!

Click on the link below to add your name to the thousands of Canadians who have already signed in support of the Charter.

World Diabetes Day is November 14, 2014 and the Canadian Diabetes Association would like to have 25,000 signatures by them.  Pass this along to family and friends to encourage them to show their support as well!

Sign the Diabetes Charter

Sleep Hygiene

Sleep.  We all wish there were more hours in the day to get everything done, and still get enough of that deep, restful, restorative sleep!  With busy lives and many things on the go at all times, it can be hard to wind down at the end of the day, or even get to bed at a time that we feel is appropriate.

What are the down sides of not getting enough sleep?

Lack of sleep can make it hard for us to concentrate, be productive at work, can affect our driving and even our social life.  Studies have also shown that fatigue can lead to changes in our food take because of the effect that lack of sleep can have on our hormones that regulate hunger!  Often we crave more carbohydrate rich foods, or have an increased appetite when our bodies don’t get enough rest–often leading to overeating or poor food choices.  For those who are chronically sleep deprived, some studies have shown that it may increase the risk of heart disease, stroke, diabetes and kidney disease.

How much sleep do we need?

The National Heart, Lung and Blood Institute recommends that adults aim to get 7-8 hours of sleep per night.

So, then what can we do to help maximize our sleep quality and quantity??

Try to maintain a regular sleep and wake schedule–aim to hit the sack and wake up around the same times every day to get your body into a pattern.

Exercise regularly–it can help you feel more energized during the day, but also help you sleep at night. Try not to exercise 2-4 hours before going to bed.

Avoid or limit caffeine, alcohol and/or nicotine–these stimulants can keep you up and/or disturb your sleep.  Caffeine can last in your body up to 8 hours, so try to avoid having caffeinated coffees, teas, pop (colas or Mountain Dew) or energy drinks in the afternoon or evening hours.

Have a regular sleep routine–find ways to relax and shut your mind off before bed.  Maybe it’s reading, or taking a bath, or doing some meditation or relaxed yoga.  Whatever works for you, stick to it and your body will learn to prepare for sleep.

Consider where you are sleeping–a quiet, cooler, darker room can help you sleep.  Also try to remove any distractions like computers, TVs or other electronics.  Keep your bedroom as a relaxed retreat that you can go to unwind at the end of the day!

Try not to eat a heavy meal too close to bed time or drink large amounts of fluids within 2 hours of going to sleep.  


As I am writing this, I am actually feeling quite sleepy after being out late last night curling and having to be up early for an appointment!  So I certainly need to work on a few of the above!   I hope the tiredness hasn’t caused too many mistakes in this post 🙂



University Health Network Sleep Hygiene Handout

What are Sleep Deprivation and Deficiency?

University of Maryland Medical Centre: Sleep Hygiene