RecruitingType 2 Diabetes · Overweight and Obesity
A Study of Eloralintide in Participants With Obesity, or Overweight Without Type 2 Diabetes
Sarnia & Hamilton, Ontario
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Diabetes means the level of sugar, or glucose, in your blood stays too high because your body cannot make enough insulin or cannot use the insulin it makes. It can feel like constant thirst, extra trips to the bathroom at night, and tiredness that does not lift, or it can cause nothing you would notice for years. There are two main types, and they behave differently.
Diabetes is not one condition. In type 1 diabetes, which accounts for 5% to 10% of cases in Canada, the immune system damages the cells that make insulin, so insulin has to be given every day. In type 2 diabetes, which accounts for 90% to 95% of cases, the body responds less and less well to its own insulin over time. Type 2 usually develops slowly and often causes no symptoms early on, which is why it is frequently found on a blood test done for another reason.
It is also not caused by eating sugar, and it is not a matter of personal discipline. Type 1 is an immune condition and nothing in a person’s diet brings it on. Type 2 is shaped by genetics, age, family history and ancestry alongside the parts of daily life that can be worked on, and it becomes much more common with age: 25.7% of adults aged 65 to 79 and 31.7% of adults aged 80 and older in Canada live with diagnosed diabetes. Body weight is one part of the picture for type 2, and weight is covered separately on our weight conditions page.
All forms share one feature, blood glucose that stays higher than it should. What causes that differs, and so does the care.
Type 1 is an autoimmune condition. The immune system, which normally goes after infection, turns on the beta cells in the pancreas that make insulin and destroys them. Once enough are gone the body makes little or no insulin of its own, and insulin has to be given every day from then on.
It was once called juvenile diabetes, because it is most often found in children and young adults, but it can begin at any age. Why the immune system behaves this way is not settled: inherited susceptibility, family history and some environmental trigger are all part of current thinking. Nothing a person ate or failed to do brings type 1 on. Symptoms usually build over days or weeks rather than years, because the last insulin producing cells fail quickly once the reserve is used up.
In type 2 the pancreas still makes insulin, at least at first, but the body responds to it less and less well. That state is called insulin resistance. The pancreas compensates by making more, and after some years it cannot keep up. Blood glucose then drifts upward, often with nothing you would notice.
Because of that quiet start, type 2 is often picked up on a blood test done for another reason, or after a complication has begun. It used to be called adult onset diabetes, a name now dropped because it is diagnosed in younger people as well.
Gestational diabetes is high blood glucose first found during pregnancy. Hormones from the placenta make the body less responsive to insulin as pregnancy goes on, and in some people the pancreas cannot make the extra insulin to keep up. It rarely causes symptoms, so it is found through routine screening: a sweet drink and a blood sample a set time later, with a full glucose tolerance test if that is higher than expected. Blood glucose usually returns to its previous range after the birth, but having had gestational diabetes raises the chance of type 2 later, so follow up testing is part of Canadian care.
Symptoms in type 1 often arrive over days or weeks and are hard to ignore, while type 2 can be silent for years. That difference is one reason the two types are found in different ways.
Some risk factors cannot be changed:
Others can often be worked on, usually with support from a health care team, and they apply mainly to type 2:
A family doctor or nurse practitioner diagnoses diabetes with a blood test. Four are used, and the choice depends on your symptoms and whether you can fast.
The A1C test measures how much of the hemoglobin in your red blood cells has glucose stuck to it. Red cells live about three months, so the result reflects your average blood glucose across roughly that period rather than the moment the blood was taken. You do not need to fast for it. Pregnancy, anaemia and certain inherited hemoglobin variants make A1C less reliable, and a clinician will use a different test in those cases.
A single blood sample taken after you have had nothing except water overnight. It shows where blood glucose settles when no food is coming in, which mostly reflects how much glucose the liver releases and how well insulin holds that in check.
A sample taken at any point in the day, without regard to when you last ate. Its value is speed: when symptoms are already clear it can be done on the spot.
This test looks at how your body handles a measured load of sugar rather than at a single moment. You fast overnight, a first sample is taken as a baseline, and you then drink a standard sweet solution at the lab. Further samples follow over the next few hours, and you stay at the lab in between. The pattern is what matters. When insulin is working normally, blood glucose rises after the drink and comes back down briskly. When insulin is short, or the body is not responding, the rise is higher and the fall is slower, which can reveal a problem a single fasting sample misses.
If the picture points to type 1, particularly in a younger person or someone losing weight quickly, autoantibody tests look for the immune markers involved, and a C-peptide test shows how much insulin the pancreas is still making. Referral to an endocrinologist or a diabetes education centre follows.
No test is read on its own. A clinician interprets the result alongside your symptoms, your other results and your history, and a result in the diabetes range is usually repeated on a separate day unless symptoms already make the picture clear. Cut-off values are not set out here, because what a result means depends on the test and on the person.
Insulin is a hormone made in the pancreas, a gland sitting behind the stomach. Glucose comes from carbohydrate foods such as bread, rice, pasta, potatoes and fruit, and passes into the blood through the small intestine. The liver releases glucose of its own as well, mainly between meals and overnight.
When the pancreas senses blood glucose rising, it releases insulin. Insulin works like a key at the surface of your cells, letting glucose in to be used for energy, and it tells the liver to store what is not needed. If the pancreas cannot make enough, or the body stops responding, glucose stays in the bloodstream instead of reaching cells, and over years that raised level damages blood vessels in the eyes, kidneys, nerves and heart.
People with type 1 need insulin from diagnosis onward, because their own supply has gone. Some people with type 2 come to need it too, sometimes for a period such as a serious illness or a pregnancy, and sometimes long term. Needing insulin in type 2 is not a sign that someone did something wrong. It reflects the way the condition changes over time.
Insulins are grouped by how quickly they start working and how long they keep working. All are given by injection or by pump, because insulin is a protein and would be broken down in the stomach if swallowed.
Which are used, how they are combined, and how they are delivered, by pen, by pump, or by an automated system that adjusts against a glucose sensor, is worked out between a person and their diabetes team. Amounts are individual and are not something a page like this can set out.
Clinical research for Diabetes is enrolling. See the current studies
Care covers blood sugar, but also blood pressure, cholesterol, kidneys, eyes and feet, because those are where the long-term effects show up. Insulin is essential in type 1. In type 2 the plan is usually built up over time. Depending on your type, your targets and what else you live with, a health care team may discuss:
Coverage for medicines, supplies and monitoring technology varies by province and by private plan, which shapes what is realistic for each person. What fits you is a decision for you and your own care team, and nothing here is a recommendation about any specific treatment.
Most of diabetes care happens between appointments, which is why Canadian diabetes education centres exist and why dietitians, nurses and pharmacists are part of the team. It usually covers:
These are things a care team builds with you over time, not a checklist to work through alone.
Blood glucose that stays high over years damages blood vessels: the small ones supplying the eyes, kidneys and nerves, and the large ones supplying the heart, the brain and the legs. These complications remain common in Canada, which is why routine care checks all of them, and why blood pressure and cholesterol are managed as closely as blood glucose. Not everyone develops them.
Diabetes can affect the eyes through cataract, glaucoma and diabetic retinopathy, in which the small vessels at the back of the eye leak, close off or grow abnormally. Early retinopathy causes nothing you would notice, so it is found by examining the back of the eye rather than by symptoms. That is what retinal screening programs are for.
The kidneys filter blood through a vast number of tiny units built from very small vessels. High blood glucose damages those filters over years, so they leak protein that should stay in the blood and clear waste less well. There are almost no symptoms early on, so it is found on tests instead: a urine test looking for a protein called albumin, alongside a blood test of kidney function. Care focuses on blood glucose and blood pressure, and on medicine classes used to protect the kidneys. If kidney function falls far enough, dialysis or a transplant enters the discussion. There is more on our chronic kidney disease page.
High blood glucose damages the small vessels supplying the nerves, and the longest nerves, those running down to the feet, are usually affected first. That produces numbness, tingling, burning or pain in the feet and lower legs, and later sometimes the hands, in a pattern often described as stocking and glove. Some people have pain, others quietly lose sensation with no pain at all, and lost sensation carries its own danger, because an injury can go unnoticed. Balance and muscle strength can be affected too. Care covers blood glucose management alongside treatment aimed at the pain itself. There is more on our peripheral neuropathic pain page.
A diabetic foot ulcer is an open sore, most often on the ball of the foot or under the big toe, and, where footwear rubs, on the sides of the foot, the tops of the toes or the heel. Two problems combine. Reduced sensation means a blister, cut or pressure point may not be felt at all, and narrowed vessels mean less blood and oxygen reach the foot, so what does form heals slowly and can become infected. That is why foot checks and professional foot care are part of Canadian diabetes services, and why a foot sore that is not healing is seen about promptly rather than watched.
Alongside the changes that build over years, two problems can come on within hours, and both are easier to handle when recognised early, including by the people around you.
Low blood glucose affects people taking insulin, and people taking certain other glucose lowering medicines. Most oral medicines used in type 2 do not cause it on their own. It can follow a missed or delayed meal, more activity than usual, alcohol, or a mismatch between the medicine taken and the food eaten.
Early signs include shakiness, sweating, pale skin, a racing heart, hunger, anxiety, and tingling around the mouth or in the fingers. As it deepens there may be confusion, slurred speech, drowsiness or behaviour that seems out of character, and severe low blood glucose can lead to a seizure or loss of consciousness. Some people who have lived with diabetes for many years stop getting the early warning signs, which their care team will want to know about.
Low blood glucose is treated straight away with a fast acting sugar, then rechecked and treated again if it has not come up. Care teams set out in advance what a person uses and how much. For severe episodes there is glucagon, a hormone that prompts the liver to release stored glucose, and family or coworkers are often shown how to give it. Call 911 if the person cannot swallow safely, has a seizure, or does not wake up.
Blood glucose running high for hours or days brings back the familiar symptoms: heavy thirst, frequent urination, tiredness and blurred vision. Infection, other illness, missed insulin, and a failed pump or infusion set can all push it up.
Diabetic ketoacidosis, usually shortened to DKA, sits at the far end of this. When there is not enough insulin to move glucose into cells, the body burns fat for fuel instead, and burning fat produces acids called ketones. As ketones build up, the blood turns acidic. DKA is most associated with type 1, and for some people it is how type 1 is first found, but it also occurs in type 2. Signs include heavy thirst and urination, nausea and vomiting, stomach pain, deep or rapid breathing, breath with a sweet or fruity smell, weakness and confusion. DKA needs hospital care.
A second emergency, hyperosmolar hyperglycaemic state, occurs mainly in older adults living with type 2: blood glucose goes very high with severe dehydration and confusion, usually without the ketones. Both are treated in hospital.
Blood sugar targets are still not reached by many people in Canada, complications of the eyes, kidneys, nerves and heart remain common, and there is no way yet to stop type 1 diabetes from developing in people at risk. Studies now recruiting include immune therapies and beta cell replacement for type 1, including stem cell derived islet transplants, newer once weekly insulins, oral and combination incretin therapies, dual and triple receptor agonists, and closed loop insulin delivery algorithms. Others look at remission of type 2 diabetes through structured nutrition programs, and at kidney and heart outcomes in people who already live with complications.
Each of those is tested in clinical studies before it becomes ordinary care. Taking part is voluntary, you give informed consent before anything begins, and you can withdraw at any time without affecting the care you get from your own doctor or your diabetes team. Joining a study does not mean giving up your current treatment, and no one can say in advance whether a study will help you personally.
This page is written in plain language for people considering clinical research. It is general health information, not medical advice, and it does not replace a conversation with your own doctor or nurse practitioner.
In type 1, the immune system damages the cells that make insulin, so insulin must be given every day, and about three quarters of people with type 1 in Canada are diagnosed before age 20. Type 2 develops when the body responds less well to insulin, usually in adults over 40, and is managed with a combination of lifestyle measures, oral medicines, injectable medicines and sometimes insulin.
No. Prediabetes means blood sugar is above the usual range but below the level used to diagnose diabetes, and the Public Health Agency of Canada reports that over 6% of adults in Canada have it. It is a signal for closer follow up with your family doctor and a discussion about what to monitor.
Coverage varies a great deal by province and territory, and by whether you have private insurance. Diabetes Canada reports out of pocket costs ranging from under $100 to several thousand dollars a year, depending on the type of diabetes and the supplies used. Your diabetes education centre or pharmacist can help you find out what your province covers.
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