In medical practice today, diabetic ketoacidosis results in a fatal outcome for 10% of patients, and in the hyperosmolar non-ketoacidosis syndrome 50% die. Thrombotic complications account for a considerable proportion of the deaths of these patients and cerebral manifestations are characteristic of their hyperosmolar state. A strategy which leads to improved management and survival of these severely decompensated patients remains to be found. Recommendations for management of these patients are presently controversial because the aetiology of their cerebral disturbance is ill-defined. This thesis describes novel alterations in blood from patients with ketoacidosis which are particularly associated with the development of the hyperosmolar state. The combination of these abnormalities with other factors present, leads to an unique summated effect on the flow properties of blood during severe diabetic decomposition. Subsequently impaired perfusion could therefore account for the depressed conscious level, strokes and fatal thrombotic phenomena commonly associated with diabetic ketoacidosis. The biochemical alterations underlying the blood abnormalities were studied both in humans and in animals with severe diabetic ketoacidosis. The findings which emerged from the study are particularly relevant to planning treatment and monitoring the pathophysiological response of vital tissue in these patients. It is possible that we can reduce the mortality of these serious medical conditions and improve the outlook for the diabetic individual if we elucidate the underlying pathophysiological changes and adjust treatment accordingly.

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The purpose of this study was to explore associations between early-life factors and the development of youth onset type 2 diabetes mellitus (T2DM). Until 1990, T2DM was seldom reported in youth, however rates of youth onset T2DM are rising worldwide. This retrospective case-control study utilized repository data housed at the Manitoba Centre for Health Policy to review perinatal exposures of Manitoba youth with and without T2DM. The mean age at time of diagnosis was 13.1 years and 61% of youth onset T2DM cases were female. The majority of youth with T2DM resided in rural areas at time of diagnosis. This study found a 14-fold increase in the risk of youth onset T2DM when the mother had pre-gestational diabetes, and 6.5-fold increase in that risk if the mother had gestational diabetes. Breastfeeding was found to be protective, and a lower income quintile at time of birth was found to be more significantly associated with the development of youth onset T2DM than increasingly higher income quintiles . The findings emphasize that efforts aimed at preventing T2DM in youth must begin in the pre-conception period and continue throughout pregnancy.

Type 2 diabetes mellitus (T2DM) is recognized as a worldwide epidemic that is particularly problematic among indigenous populations. Canada’s Aboriginal population experiences rates of T2DM up to 5.3 times higher than the non-Aboriginal population. Stress plays a role in both the development and maintenance of T2DM and stress is prevalent in the commonly disadvantaged Aboriginal population. I hypothesized that, due to its stress reduction effects, a mindfulness-based intervention (MBI) could lead to health improvements for Aboriginal adults with T2DM. I also proposed that an MBI would be appropriate for, and acceptable to, Aboriginal people whose healing traditions incorporate aspects of mind, body, and spirit and conducted a mixed methods investigation to determine the effectiveness, acceptability, and suitability of an MBI in Aboriginal adults with T2DM. I recruited participants from urban and rural centres in Manitoba, Canada who took part in an 8-week, mindfulness intervention. Effect sizes and the results of a repeated measures analyses of variance revealed that participants (N = 11) experienced significant and clinically important reductions in blood sugar and blood pressure as well as improvements in emotional health. A thematic analysis on the qualitative data obtained through semi-structured interviews revealed that the participants overcame several challenges to participate, valued the lessons, practices, and perceived benefits of the program, and found the MBI culturally acceptable. Taken together the results support the feasibility of an MBI for Aboriginal adults with T2DM, making it a promising alternative for improving the health and lives of many Canadians.

Gestational Diabetes (GDM) is considered a high-risk pregnancy. Nutrition management plays a critical role in GDM management. How women with GDM make food choice decisions and how they follow dietary advice have not been fully investigated especially how stress and anxiety during a GDM pregnancy influence dietary management. This study used a mixed methods approach. Qualitative and quantitative data were collected concurrently and analysed together to answer research questions on factors that affected women with GDM at 26-38 gestational weeks in making food choice decisions, the stress and anxiety that they experienced, and the barriers that they encountered when following dietary advice. The results showed: 1. Despite of the dietary recommendations from the healthcare professionals, food choice decisions were still strongly influenced by individual factors such as personal food preference, cravings, and hunger. Women sought information from different sources to adapt to the dietary changes, especially when the health services information provided was too general, and when some of the dietary advice conflicted with their eating habits. Difficulties in dealing with cravings, food portion size, hunger, and eating out led to a sense of decreased control and to stress and frustration. 2. The GDM diagnosis triggered stress in some women. Women who were on insulin were more likely to experience dietary management related stress compared to the ones on diet treatment only. Anxiety was explained as the fear of the macrosomia and labor complications. These kinds of fear could be aggravated by abnormal blood glucose readings and hence triggered some emotional breakdown and coping actions. 3. Underlying beliefs such as behavioural, normative, and self-efficacy beliefs can produce barriers to following dietary advice. Other factors such as environmental constraints and lack of knowledge added more challenges to following dietary advice. Quick adaptation to dietary management in a short time period was not easy for women with first time diagnosed GDM and created emotional distress, often leading to unhealthy dietary coping strategies. The above results concluded that women with first time diagnosed GDM faced challenges of quick adaptation of dietary behavioral changes in a limited time frame. These challenges were rooted in the expected health behavior changes that are often in conflict with the individual’s behavioral, normative, and self-efficacy beliefs. Stress and anxiety generated in the process of GDM management sometimes led to altered dietary behaviors to cope with blood glucose control.

Previous research has demonstrated that those who perceive they have high perceptions of control generally have better health outcomes, including diabetes. The purpose of this research was to gain a better understanding of factors associated with perceived control in a Manitoba First Nations community. Data were collected using questionnaires in a community-based participatory research study between June 2011 and February 2012. Logistic regression was utilized to determine factors associated with perceived control over diabetes prevention and the prevention of diabetic complications. Many participants reported they had little or no control over the prevention of diabetes (47.8%) or diabetes complications (42.0%). Factors associated with high perceived control over diabetes prevention included having dyslipidemia, reporting hearing gossip about yourself and experiencing racism. Factors associated with high perceived controllability of preventing complications included having ≥ grade ten education, having dyslipidemia, reporting high chronic stress, and high perceived negative impact from residential school.

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