Diabetes Autumn 2015
Living well with diabetes
Living the dream ONE MAN, HIS BIKE & THE WORLD AT HIS FEET
DIABETES DISTRESS
and how to avoid it
Which diabetes app? CHECK OUT OUR GUIDE
driving with diabetes + activity trackers + volunteering
GlucaGen® HypoKit
Glucagon (rys) hydrochloride
Make sure it’s there when they need it* GlucaGen® HypoKit is used to treat severe hypoglycaemia in people using insulin or taking tablets to control diabetes, who have become unconscious. Available from pharmacy with or without a prescription.
Patient support available The HypoHelp website and app are an important resource for patients at risk of hypoglycaemia and includes a free expiry date reminder service for patients with a GlucaGen® HypoKit. Download the app for free at www.hypohelp.co.nz Also available at Google Play or iTunes.
*Refer to full indications below
GlucaGen® HypoKit is a Pharmacist Only Medicine that is funded through the PHARMAC with a prescription, or available for purchase without a prescription (normal pharmacy charges apply). Ask your Healthcare Professional if GlucaGen® HypoKit is right for you.
Before prescribing, please review full Data Sheet available at www.medsafe.govt.nz GlucaGen® HypoKit. (glucagon [rys] hydrochloride). Presentation: Each pack consists of a vial containing lyophilised glucagon 1 mg (1 International Units) as hydrochloride and a glass syringe pre-filled with 1 mL water for injections. Indications: Therapeutic: Treatment of severe hypoglycaemic reactions in persons with diabetes mellitus treated with insulin or oral hypoglycaemic agents. To prevent secondary hypoglycaemia, oral carbohydrate should be given to restore hepatic glycogen following response to treatment. The treatment of sulfonylurea-induced hypoglycaemia differs from severe insulininduced hypoglycaemia due to the possibility of secondary hypoglycaemia - it is preferable to use intravenous glucose (see full Product Information (PI/Datasheet)). Medical consultation is required for all patients with severe hypoglycaemia. Contraindications: Hypersensitivity to glucagon or lactose, phaeocromocytoma, insulinoma or glucagonoma. Precautions: Glucagon will have little or no effect when the patient is fasting or is suffering from adrenal insufficiency, chronic hypoglycaemia or alcohol-induced hypoglycaemia. When used in endoscopy or radiography, caution should be observed in diabetic patients, or elderly patients with known cardiac disease. Glucagon should not be administered by intravenous infusion. Interactions: Glucagon is an insulin antagonist. When given in large doses, glucagon may potentiate the anticoagulant activity of warfarin. Glucagon can reverse cardiovascular depression of profound ß-blockade. With indomethacin, glucagon may lose its hyperglycaemic effect or even produce hypoglycaemia. Adverse Effects: Nausea; vomiting. Dosage and Administration: The glucagon solution should be prepared immediately before use. Dissolve powder in accompanying solvent and administer by subcutaneous or intramuscular injection. Therapeutic: Adults and children above 25 kg - administer 1 mg; Children below 25 kg - administer 0.5 mg.
Novo Nordisk Pharmaceuticals Ltd., G.S.T. 53 960 898. PO Box 51268 Pakuranga, Auckland, New Zealand. NovoCare® Customer Care Centre (NZ) 0800 733 737. www.novonordisk.co.nz ® Registered trademark of Novo Nordisk A/S. TAPS(DA) 4614RB McK33589/Diabetes NZ 02/15.
GlucaGen® HypoKit Glucagon (rys) hydrochloride
Diabetes: the national magazine of Diabetes New Zealand | Vol 27 no 1 Autumn 2015
INSIDE autumn 2015 4 5
uest column: Diabetes G NZ Chairman Pat Waite From the President
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Living with diabetes
15 Bari Tamihana: from denial to acceptance
Upfront
Profile
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16 James Lambie on biking
News and views
Focus
25,000km for diabetes
Opinion
10 Diabetes distress –
Technology
18 Which diabetes app?
24 Katie Doyle
Community
Gardening
Food and recipes
14 Lions Clubs New Zealand 22 Volunteering: give some time
20 Edible school gardens
be kind to yourself
for diabetes
26 Tips for sustainable change 28 Reader recipe: healthy homemade muesli
Care and prevention
29 Driving safely with diabetes Let’s get active
30 Activity trackers and the benefits of walking
Diabetes abroad
32 Heng Pei Yan, Singapore 16
EDITOR Caroline Wood email: editor@diabetes.org.nz DESIGN AND PRINTING Kraftwork, Wellington MAGAZINE DELIVERY ADDRESS CHANGES Freepost Diabetes NZ,PO Box 12 441, Wellington 6144 Telephone 0800 342 238 Email: admin@diabetes.org.nz ISSN 1176-4406 Disclaimer: Every effort is made to ensure accuracy, but Diabetes New Zealand Inc. accepts no liability for errors of fact or opinion. Information in this publication is not intended to replace advice by your health professional. If in doubt, check with your own doctor, nurse, dietitian, or health care professional. Editorial and advertising material does not necessarily reflect the views of the Editor or Diabetes New Zealand Inc. Advertising in Diabetes does not constitute endorsement of any product, and no advertiser may use publication of an advertisement in the magazine to support the marketing of any product. Copyright of all editorial is held by Diabetes New Zealand Inc. No article, in whole or in part, should be reprinted without permission of the Editor.
Treatment
34 Telemedicine clinic launch
Not yet a member of Diabetes New Zealand? Call 0800 342 238 now to join or visit www.diabetes.org.nz Membership includes a free subscription to Diabetes magazine
GUEST CO LU M N
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FROM THE CHAIRMA N
A gift from my dad In thinking of what I would write for this column my mind went back to my childhood. My father was a polio sufferer and my memories as a child were of a family living on a sickness benefit and dad being in and out of hospital as the after effects of his illness, which is now called post-polio syndrome, became evident. In his case he developed leukaemia. However my column is not about my dad but what living with him has taught me about life. From my very earliest memories, I recall waking up each day and wondering how dad would be. Some days the sickness became too much and he would be overcome with depression and angry with us for no other reason than he was ill. I learned that the best way to handle these days, at least for me, was to
be upbeat and try to transfer my positivity to him. I could usually find something to take his mind off his situation, whether it was joke or a story. I became good at finding things that interested him – cars for example, which we both loved. Dad died many years ago now but the lessons I was gifted have stayed with me to this day. I learned I could directly impact the attitudes of those I meet and work with. I learned that positivity can be transferred and each day without fail, when asked how I am, I respond with a smile and “I am feeling great thanks”. I learned the culture of an organisation, whether it is a home, office or factory, is directly related to the person in charge and how quickly the mood of a room can change with a smile and a positive attitude. Just like waking each morning and sensing the situation in our kitchen at home, I learned to instantly sense a negative environment, which became very useful when I had roles that involved leading branch teams
across the country. I learned that a ready smile opens doors and usually generates a smile back. When we were called to the hospital, no matter how sick dad was, we were always greeted with a smile. I learned from him that no matter how bleak things look there is always someone else worse off and I have learned to be thankful for what I have – the things that really matter – good health, a loving wife and a family I am proud of. These are the lessons that life has gifted me. You will all have lessons and experiences that have changed your life, I am sure. When I think about it, I am a better person because of my father. There is so much to be thankful for.
Pat Waite Chair, Diabetes New Zealand
Welcome to Diabetes magazine Our mission is to help you live well with diabetes. Every issue of Diabetes includes: • Trusted expert advice • Latest research and treatment options • Inspiring personal stories • Delicious diabetes-friendly recipes • Lifestyle advice on food, exercise, travel • Spotlight on children and diabetes
SUBSCRIBE today and have four issues of Diabetes delivered straight to your door for just $18 per annum. Diabetes is published by Diabetes New Zealand. Join Diabetes NZ today for $35 waged (or $27.50 unwaged). Membership includes magazine subscription. Email: admin@diabetes.org.nz or call 0800 342 238 to find out more.
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FROM TH E PRESIDE NT
Hopeful of a bright future As you can imagine I see a lot of diabetes research data and information. Recently I read a newly published study that looked at blood glucose control and death rates in type 1 diabetes. It found that people with type 1 diabetes had a higher risk of premature death compared with the general population. Not surprisingly the higher the HbA1c, the greater the risk. I appreciate this is not information those with type 1 want to hear. I know the feeling – I live with it myself. I often need to have a stern talk with myself when reading these papers to ensure I retain perspective. When one is not a scientist used to processing such data, it is easy to read ‘they are twice as likely to die’ as being a cue for planning one’s own funeral. But then I look again to realise ‘twice as likely’ is usually twice of a low rate like two percent, and I put the plans on hold and get on with living.
The theme of improved outcome being closely linked with better control is common to most of what I read. The really exciting bit is the growing number of technological enhancements enabling the achievement of that so much more readily. At the 2013 IDF World Congress I attended a lecture entitled Childhood Diabetes: from death sentence to normal life expectancy and was excited to learn that those diagnosed today with type 1 can expect to live close to a normal life span. The presenter said that diagnosis in the mid-60s indicated a life expectancy of only 17 years. The fact that it is now normal is spectacular! The sort of things that have made the difference are diabetes selfmanagement; self-blood glucose monitoring; the HbA1c test; blood pressure and lipid control; and intensive insulin therapy. We continue to see significant advances in treatment of type 1. A little boy from Western Australia was recently fitted with an artificial pancreas. It even has the ability to predict hypos. Imagine the confidence one would have never having to worry about hypos again!
More and more people are now pumping and some use continuous glucose monitoring. There are apps for our smart phones and insulins are becoming even more sophisticated. The motivation for and the benefit of such pursuits is better control and making life more liveable. There is no denying the complexity of diabetes or of how demanding it is to live with but there is every reason to be hopeful of a bright future. In the absence of a cure I can be happy with treatment advancements and new technologies. Look at it this way – had I been born 40 years earlier, death was certain as insulin was not yet readily available. So just imagine how our world may look 40 years into the future! Now that is exciting. Keep well.
Chris Baty National President
See our website for advice, tips and ideas on how to live well with diabetes: www.diabetes.org.nz
Diabetes New Zealand PATRONS: Lady Beattie and Sir Eion Edgar PRESIDENT: Chris Baty ACTING CHIEF EXECUTIVE: Margot Fraser-Jones NATIONAL COMMUNICATIONS MANAGER: Nicky Steel DIABETES NEW ZEALAND INC. NATIONAL OFFICE: Level 7, Classic House, 15 Murphy Street Thorndon, Wellington 6144 Postal Address: PO Box 12 441, Wellington 6144 Telephone 04 499 7145 Fax 04 499 7146 Freephone 0800 342 238 Email admin@diabetes.org.nz
Diabetes New Zealand is a national organisation that acts for people affected by diabetes. We work to raise awareness, educate and inform people about diabetes, its treatment, management and control. We offer local support to individuals with diabetes through a network of diabetes branches across the country. We also support research into the treatment, prevention and cure of diabetes.
Call now to make a donation 0800 DIABETES (0800 342 238)
Autumn 2015 | DIABETES
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UP FRO NT
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NEWS AND VIEWS
Get your free flu jab
DNZ welcomes Kim Holden
Young people with diabetes are one of the patient groups being urged to get this year’s flu vaccine, which is free of charge for any child or adult with type 1 or type 2 diabetes. National Influenza Specialist Group spokesman and virologist Dr Lance Jennings said: “We know younger people who have an ongoing medical condition such as diabetes or asthma, are often unaware that they are at risk from influenza. They possibly believe they are fit and healthy and therefore, not in need of an influenza vaccination. Unfortunately, this group is particularly vulnerable to the complications of influenza because of their underlying condition and is more likely to be admitted to hospital when suffering from influenza than the general population.”
Diabetes New Zealand is delighted to welcome Kim Holden in the newly created role of Diabetes Regional Educator. Kim’s role is to provide information, education and advice to people with diabetes and others including families, community groups, workplaces and the general public, as part of a pilot programme focusing on the lower North Island. Kim, who has a background in nursing and has experience in health education and prevention, is based in Wellington as part of the Diabetes NZ national office team. You may spot her out and about on the roads in the new Diabetes NZ-branded car. You can contact Kim on 0800 DIABETES (342 238) or kim@diabetes.org.nz.
The flu vaccine is not due to be available until April this year due to a change in strains and a complex manufacturing process, which will take longer than usual. The strains for the 2015 Southern Hemisphere influenza vaccine are: A/Californian/7/2009 (H1N1) A/Switzerland/9715293/2013 (H3N2) B/Phuket/3073/2013. The A/Switzerland and B/Phuket are new strains for 2015. Dr Jennings says the bad flu season developing in the United States, and possibly in Europe, was caused by an influenza A (H3N2) strain which had ‘drifted’ or changed and was, therefore, not included in the Northern Hemisphere flu vaccine. He said: “We had this strain in New Zealand at the end of our winter last year, so some people have already been exposed to it. We believe the vaccine currently being formulated for New Zealand should offer good protection against the circulating H3N2 strain.” Around 1.2 million doses of influenza vaccine were used in New Zealand in the 2014 season. The highest uptake was among people 65 and over. The subsidised season ends on July 31, 2015.
Diabetes Youth conference Final preparations are being made for the first of its kind Youth Family Conference with an exciting lineup of diabetes professionals, parents and inspiring young people with diabetes. The aim is to have a complete learning and sharing experience with lots of breakout sessions and plenty of opportunities to learn and connect. To find out more about the event, which is taking place in Nelson from 20-22 March, see www. diabetesyouth.org.nz/2015-diabetes-youthfamily-conference.
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DIABETES | Autumn 2015
Peter nails it Music teacher Peter Caldwell, from Masterton, successfully completed his 2,000km cycle ride the length of New Zealand in 32 days, raising $3,500 for Diabetes NZ Wairarapa branch. We revealed in our last issue how Peter, who has type 2 diabetes, decided to challenge himself by cycling from Cape Reinga to Bluff to raise awareness and funds for diabetes. Well done to Peter for completing the ride and making many new friends along the way – and surviving those scorching January temperatures.
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Ask your doctor if you meet funding criteria for insulin pump therapy.
For more information talk to NZMS Diabetes P 0508 634 103 W www.nzms.co.nz E nzms@nzms.co.nz IMS Health Data, Oct 2012 - May 2014. 2 Dexcom G4 PLATINUM Continuous Glucose Monitoring System User’s Guide (LBL-011797) 3Proven waterproof for up to 24 hours at a depth of 3.6 meters. CGM readings may not be displayed when in water. Please note CGM consumables are not currently funded. Always read the manufacturer’s instructions and use strictly as directed. Contact NZMS Ltd for detailed indications for use and safety information. ANM-14-4228A 10/2014 NZ. TAPS NA7466.
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UP FRO NT
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NEWS AND VIEWS
Diabetes Youth President steps down Renata Porter, President of Diabetes Youth New Zealand, is stepping down after two years at the helm and five years serving on DYNZ’s governing committee. She will stay on as immediate past president and act as a youth liaison between DYNZ and other organisations. She said: “I’ve been juggling leading the organisation, trying to represent youth on several national committees (with the additional work and travel commitments) and my own job (the one that actually pays the bills). The committee has agreed this is a tremendous amount of work for one person to tackle and it is looking forward to splitting up those roles after the election. “While I’ve enjoyed my time with DYNZ, it’s someone else’s turn to bring in new ideas and initiatives. At the National Youth Conference in Nelson this March, there will be elections at the AGM and one of those roles will be for the next President.” Renata said she was proud of the work the DYNZ committee had done over the past two years, especially the introduction of the Newly Diagnosed Packs and teen diabetes camps. She was also proud of changes to the way the committee works – spreading the workload so each member was able to take responsibility for a workstream and be proud of what they accomplished. Renata said she was disappointed the national fundraising walk had not come off but hoped that it would happen in the future. “The thing people have to realise about organisations like ours is we depend heavily on volunteers. We all juggle family (with at least one person who has type 1 diabetes), jobs and other commitments, along with what we wish to accomplish for DYNZ and all the families we represent. The reality is that we can’t do everything and by that nature, we end up not being able to please everyone,” she added. “I want to thank all of those who have been encouraging, supportive and most of all patient as I found my way as President. I also wish to thank the committee members who have worked very hard over the last year – Steph Mills, Carrie Hetherington, Lynda Lamb, Lyndal Ludlow, Jaqui Van Blerk and Pete Duncan. It’s been a wonderful five years.
Reader’s letter Dear Editor I must thank our President Chris Baty for her insightful article in the summer edition of Diabetes magazine. I have put up with the assumption that type 2 diabetes is only caused by obesity for some 60 years, the inference being that somehow it is all my own fault. For most of my young manhood, including when I was diagnosed, I weighed some 57kgs and now – at 91 years old – I am still only 70kgs. Hardly the stuff of obesity. You say Chris you are frustrated by the automatic coupling of obesity and diabetes. However I must tell you that even in our own magazines any story about type 2 always includes obesity in the same breath, thus giving further life to the inference that while type 1 people deserve empathy, type 2s have brought it on themselves. Thank you again Chris for giving the other side of the story. Alan Irvine, Auckland
*See Renata’s article about the benefits of becoming a diabetes volunteer on p22.
GPSI DIABETES
Now with rooms in Auckland and Hawkes Bay
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DIABETES | Autumn 2015
Monitor your child’s glucose levels from the comfort of your own bed 1
Introducing the Dexcom G4® Platinum Continuous Glucose Monitor The Dexcom G4® Platinum updates glucose levels every 5 minutes so you can track your child’s glucose continuously day and night. Monitor their highs, lows and how fast they’re getting there from the comfort of your own bed1 for added peace of mind.
For more information or to arrange a trial to see the benefits for yourself, please contact us between 9am5pm, Mon - Fri on 0508 634 103 W www.nzms.co.nz P 09 259 4062 E nzms@nzms.co.nz Dexcom G4TM Platinum is not currently indicated for children under 2 years of age. Always read the manufacturer’s instructions and use strictly as directed. 1 Dexcom G4® Platinum transmitter range is 6 metres. Dexcom G4™ User Guide, May 2012. LBL-011277 Rev 04, LBL-011346 Rev 02.
FO CU S
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STRESS, D ISTRESS AND HbA1c
Be kind to yourself Living with a chronic condition is demanding and new research shows that ‘diabetes distress’ can have a big impact on emotional and physiological well-being. Auckland health psychologist and researcher Anna Friis explains. Living with diabetes can be tough – there are no days off from the routines essential for good glycaemic control, and 24-hour vigilance is often required. Unsurprisingly many people at times feel distressed by the demands of healthy selfcare. Emotional difficulties can add a further complication to diabetes management, making healthy blood glucose control more elusive, and providing a target for further self-criticism. Emerging research suggests that the emotional difficulties frequently experienced in diabetes – and often mistaken for depression – are in fact signs of distress specifically related to the experience of life with diabetes. So-called ‘diabetes distress’ appears to be surprisingly prevalent and often goes undetected in patients – yet in itself is linked to many of the same problems associated with depression, such as lack of motivation and poorer adherence to medication and lifestyle prescriptions.
findings are supported by a growing number of published studies in Diabetes distress refers to one’s emotional responses and reactions to the diabetes literature indicating that high levels of distress among life with diabetes. This compares to people with diabetes correlated the more generalised experience of depression, characterised by feelings with poorer metabolic outcomes. of sadness and hopelessness, as well One explanation for the finding may as physical and cognitive symptoms. be that diabetes distress is related to the specific behaviours that likely A recent study by myself and impact on metabolic control, such colleagues among patients at as difficulty adhering to medication, Waitemata District Health Board’s diet or exercise prescriptions. On Diabetes Clinic at North Shore the other hand, depression may be Hospital, showed that more than related to more of a generalised half of the 110 patients included in low mood, which likely affects the study had clinically significant a broader range of behaviours levels of diabetes-specific distress, and functioning over and above ascertained by asking just two brief those that are diabetes-related. screening questions (see below).
What is diabetes distress?
Of interest in this study was that it was diabetes distress, and not depression, that better predicted HbA1c results. Results showed that the higher people’s perceived distress, the more poorly controlled was their diabetes as indicated by HbA1c measurements. These
Do I have diabetes distress? A brief screening tool called Diabetes Distress Scale -2 is used to screen for clinically significant signs of distress by asking just two questions: (1) “How distressing has it been to feel overwhelmed by the demands of living with diabetes?” (2) “How distressing has it been to feel that you often fail with your diabetes regime?” Respondents answer on a six-point scale ranging from 1 –‘ not at all distressing’, through to 6 ‘very distressing’. If you are scoring a 3 or above on either of these questions, maybe talk to your doctor or health provider.
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DIABETES | Autumn 2015
The importance of self compassion Of particular interest with this study was that while higher distress was associated with higher HbA1c, this finding was only true for people who scored low on a scale designed to measure their general level of self-compassion (being kind to yourself ). People who were higher in self-compassion, on the other hand, appeared to be protected against the effects of this distress on their HbA1c, suggesting the capacity to treat oneself more kindly when things feel tough, reduced the body’s responses to that distress. Self-compassion in the context of the scale measured one’s tendency to be kind to oneself in the face of difficulties, to recognise that difficulties are part of being human, and to avoid being absorbed by negative thinking or rumination.
STRESS , DI STRESS A ND H b A 1c
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FOCUS
“Results showed that the higher people’s perceived distress, the more poorly controlled was their diabetes as indicated by HbA1c measurements.”
Although our investigation was the first of this nature, and needs replicating with further studies, my colleagues and I suggested three possible interpretations for this effect: first, when people who are high in self-compassion experience distress about their diabetes selfmanagement, they may be less likely to engage in self-criticism and unhelpful behaviours such as isolating and getting stuck in negative thinking. A degree of self-compassion may help patients avoid getting caught in a ‘downward spiral’ of thoughts and behaviour that makes it even harder to take care of themselves. Studies have shown that self-compassion leads to increased self-improvement motivation, possibly because people who are higher in self-compassion are less likely to beat themselves up
with self-criticism if they don’t quite achieve the goals they have set. Second, people high in selfcompassion have been found to take greater responsibility for their problems and be less overwhelmed by difficulties, suggesting they are more likely to take care of themselves when ill. For diabetes patients, it may be that ‘taking care’ of the self includes behaviours associated with good metabolic control such as maintaining regular physical activity, appropriate dietary choices, and regular self-monitoring of blood glucose. Finally, it may be that people who are kinder to themselves are less physiologically aroused or physically ‘stressed’ by feelings of distress. Potentially, therefore, the practice of self-compassion might provide a kind of buffer on the physical processes by which distress impacts on HbA1c.
Practising self-compassion According to Dr Kristin Neff, the author of the ground-breaking book Self-compassion: Stop Beating yourself Up and Leave Insecurity Behind, self-compassion “provides emotional strength and resilience, allowing us to admit our shortcomings, motivate ourselves with kindness, forgive ourselves when needed, relate wholeheartedly to others, and be more authentically ourselves, qualities that would be helpful in living with diabetes”. Self-compassion is essentially the opposite of self-criticism and beating yourself up – common practices among diabetes patients who are encouraged to achieve ‘near normal’ glucose control and who have daily opportunities for self criticism (I’m too high, I’m
Autumn 2015 | DIABETES
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STRESS, D ISTRESS AND HbA1c
Do You Have Type 2 Diabetes? We are enrolling adult volunteers now
Help us explore pathways to diabetes management If you have type 2 diabetes, find out if you qualify for a clinical research study of an investigational oral diabetes medication.
too low, I’m not testing, not eating properly, not exercising… the list goes on). Interestingly, the research shows that self-criticism is associated with less motivation whereas self-compassion predicts more motivation, possibly because we are less afraid of our own negative self-talk if we don’t quite meet our goals, and are therefore more likely to keep trying to achieve these. In a nutshell, while it is very normal to struggle with difficult feelings at times, if these are starting to feel overwhelming, consider if you are making it worse by harsh criticism of yourself, or getting caught up in a spiral of negative thinking. Maybe it’s time to consider treating yourself more kindly when things feel particularly tough. This might entail doing for yourself the very things you would suggest to someone you dearly care about who had come to you with the same difficulties. See some suggestions below. *For further information on the study referred to in this article, see Friis, A, Johnson, M, Cutfield, R, & Consedine, N. (in press). Does Kindness Matter? Self-compassion buffers the negative impact of diabetes-distress on HbA1c. Diabetic Medicine.
You may be eligible if: • You have a confirmed diagnosis of type 2 diabetes, AND • You are age 30 or older and have had a heart attack or stroke, or other heart or vascular problem If eligible to participate, you will be seen by a study doctor and receive study-related testing and study medication at no cost. Once enrolled, you may be reimbursed for parking and travel expenses.
For more information, please contact: Name:
Rose Clarke Phone number:
0800 4Trial – 0800 487 425
Tips for practising self-compassion The simplest way to manifest self-compassion in daily life is to discover how you already care for yourself, and then remember to do these things when life becomes difficult. When these actions are taken with the intention to comfort and meet our needs, they are a form of self-compassion.
• Physical – soften the body
E-mail address:
rose@sctrials.co.nz Institution:
Southern Clinical Trials Waitemata Ltd
How do you care for yourself physically? For example exercise, massage, warm bath, cup of tea. Make time for these when things get tough.
• Mental – reduce agitation How do you care for your mind, especially when you’re under stress? For example, meditate, watch a funny movie, read an inspiring book.
• Emotional – soothe and comfort yourself
CANVAS-R
How do you care for yourself emotionally? For example, pet the dog, write a journal, cook.
• Relationships – connect with others Janssen Research & Development, LLC
How or when do you relate to others in a way that brings you genuine happiness? For example, meet with friends, send a birthday card, play a game.
• Spiritual – commit to your values 28431754DIA4003-NZE02 Site NZ00021 Version 1.0 27SEP2013
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DIABETES | Autumn 2015
What do you do to care for yourself spiritually? For example, pray, walk in the bush or on a beach, help others.
Diabetes Care
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FreeStyle Optium Blood Glucose Test Strips: A Provisional Agreement has been made with PHARMAC to continue funding FreeStyle Optium Blood Glucose Test Strips for eligible users. Funding will continue after 1st March 2013 for those who received both Optium Blood Glucose and Optium Blood Ketone test strips on prescription prior to 1st June 2012.* FreeStyle Optium Blood Ketone Test Strips: Prescription access remains available and continues for all people with diabetes, maximum of 20 strips per prescription, regardless of which meter they use for glucose testing.* FreeStyle Optium Meter: is able to be prescribed for ketone diagnostics where the patient has had one or more episodes of ketoacidosis and is at risk of future episodes. One meter per patient will be subsidised every 5 years.*
PO Box 303 205, North Harbour 0751 0800 106 100 | info@mediray.co.nz www.mediray.co.nz Always read the label and follow the manufacturer’s instructions. Taps No: CH3147
*www.pharmac.health.nz/assets/special-authority-freestyle-optium-test-strips.pdf
CO M M U N IT Y
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LIONS CLUBS NZ
Linking up for diabetes Lions Clubs New Zealand has been working with Diabetes NZ to help people with diabetes. Caroline Wood reports. “It’s been a good two-way street,” says Murray Dear, past President of Diabetes NZ and current President of Diabetes NZ’s Waikato branch. “They support us by providing volunteers for our fundraising and we go and talk to their members and provide support and information about diabetes”. Diabetes NZ Waikato and their local Lions Club successfully joined forces during Diabetes Awareness Week last year and in 2013 and have developed a mutually-beneficial relationship, says Murray.
For many years Lions Clubs NZ has raised awareness about diabetes. Its mission statement on diabetes is ‘to conduct and support local and large-scale effort leading to the control and treatment of diabetes and its complications through education, prevention and research’. Last year Diabetes New Zealand signed a Memorandum of Understanding with the Lions Clubs to further strengthen the relationship. Former Chief Executive Joe Asghar said at the time: “This is a meaningful milestone because it gives us a solid foundation and framework for joint activities at a community level. We hope this will see partnerships being developed between Lions Clubs and our branches and volunteers that will raise awareness about diabetes.” Mandy Hebben is the Lions Clubs’ diabetes coordinator. Her job is building relationships with Diabetes NZ branches across the country. There are already strong relationships in Auckland, Waikato and Wellington. For example, Lions Clubs are supporting Diabetes Auckland to raise money through this year’s Round the Bays and Elvis in the Park events. Mandy said “My role is to help raise diabetes awareness throughout New Zealand and to work together [with Diabetes NZ] wherever we can.” * Mandy is keen to hear from any diabetes branches who would like to be put in touch with their local Lions Club. You can contact Mandy on hebben@xtra.co.nz
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DIABETES | Autumn 2015
PHOTO BY ROBIN HODGKINSON – PIXEL INDUSTRY
“During the past two World Diabetes Days, the Lions took round the buckets for us. We struggle to get volunteers for these sorts of activities and it increases our manpower quite significantly,” he said. “I go to Lions Clubs meetings and talk about the work we are doing and how they can help us. We can also provide information to their members about diabetes. We have a good working relationship. I’m always very happy to go and talk to them.”
Diabetes Auckland volunteers team up with Lions Clubs volunteers to make a blue circle for World Diabetes Day 2014.
Lions serve the community Lions are ordinary people from all walks of life who enjoy getting together and doing good things. Lions volunteers work on projects to improve their local communities and protect the environment. And they enjoy friendship and fun while doing so. Lions Clubs New Zealand is part of a global organisation with 1.4 million members in 208 countries and geographic regions. As it says on its website: “With this much manpower, it’s no wonder that Lions Club members can achieve extraordinary things, every day.”
FROM D ENI A L TO ACCEPTA NCE
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LI V I NG WITH DI ABE TES
My diabetes journey Social worker Bari Tamihana, of Tauranga, says he was in denial when he was diagnosed with type 2 diabetes more than 30 years ago. Then he met a diabetes nurse whose advice changed his life. Bari, who is now in his sixties and has five children, shares his story.
“
I am going to speak about diabetes and my journey with it. Diabetes has been called the silent killer because you feel well and probably would not know you have it until you are tested. I was still playing rugby, tennis and diving when I was diagnosed. I was very active. Then, in the late 1980s I was walking passed a diabetes stand at the A&P Show in Te Puke. A lady there said: “Excuse me, would you like to have a blood test done?” Why not, I thought, anything concerning health for free is a pretty good deal. I didn’t think I had diabetes but no harm in finding out for sure. A few weeks later I received a
letter asking me to undertake a sugar tolerance test. The results showed I had type 2 diabetes and like most people who find they have diabetes, I went into denial. I did nothing about it for years then little things started happening, things like excessive thirst, going to the toilet several times during the night (that is not the case now), being unable to concentrate properly (some people say I am like that anyway). I decided to see my doctor and was put on medication. But I was not compliant. I had an issue with the knowledge regarding diabetes being given in a language that nurses would be familiar with,
not me. I guess I was really in a grieving mode as well, saying why me? Feeling sorry for myself. I started work at Tauranga Hospital and began taking my condition seriously especially when I noticed people were losing limbs as a result of diabetes. I spoke with a diabetes nurse specialist and the information she gave me – not to mention the nagging – galvanised me to action. As a result, I only have one type of medication. I have seen many of my whānau lose the battle with diabetes. Many because of non-compliance, it’s pretty sad really. One said: “I’m gonna die anyway so I may as well eat what I like” and carried on eating fast food. I manage very well by exercise and eating the right food and other stuff in moderation. I am still mobile and able to ride big motorbikes. I used to drink soft drinks but have thrown that away and now use water even with meals. My weight has remained constant for the last two plus decades. I took part in a two-year research programme looking at new types of medication. The driver for me is the chance of my kids and their kids getting diabetes is very high and this programme could benefit them and all Māori and everyone else with diabetes. Diabetes need not be a death sentence. Just follow advice given by a professional. It is not hard.
”
Bari Tamihana pictured here with his mokopuna Te Hataterehapaerau.
*Our thanks to diabetes nurse specialist Wanda Ormsby, of Tauranga, for encouraging Bari to tell his story in the hope it will inspire others.
Autumn 2015 | DIABETES
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P RO FI LE
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B IKING 25, 000KM FOR D IABETES
A great distance James Lambie is cycling from the United Kingdom to New Zealand, raising funds for Diabetes New Zealand and a UK diabetes charity as he goes. The software engineer, 38, of Dunedin, is working remotely to help fund his journey. Caroline Wood finds out more.
It is an incredibly ambitious 25,000km cycle ride across some of the most inhospitable terrain on the planet. James Lambie set off last August and has already pedalled 6,000kms through Western Europe and made it to Turkey. He has travelled through 17 countries and completed a quarter of his trip codenamed ‘A Great Distance’. And did we mention he has type 1 diabetes? In fact that is one of the main motivations for the journey – he is raising funds for Diabetes NZ along the way. Speaking to Diabetes, James explained that he hopes his journey will inspire other people with diabetes to live their dreams. “I was living in the UK and starting to feel like it was time to return home. I started planning this journey a few years ago after my parents gave me a book titled Long Ride for
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DIABETES | Autumn 2015
r…
so fa The route
James’ route so far has included Croatia, Serbia, Bosnia and Herzegovina, Macedonia, Greece, and Turkey.
a Pie, by fellow Kiwi Tim Mulliner. That planted a seed that grew very fast, and it wasn’t long before I phoned my parents and told them I was coming home… by bike.
for and by myself. At the last minute I decided I wanted to give something back to the community and also inspire people with diabetes to get out there and live their dreams.”
“I built a bike that I thought would last the journey and set a leaving date for October 2012. In June 2012, I was diagnosed with type 1 diabetes, spending 24 hours in hospital to lower my blood sugar level. My first question to the nurse who came to teach me how to inject myself was: “Can I still cycle around the world?”
James took a break from cycling over winter and in March was due to resume his journey through Turkey to Georgia, Armenia, Iran, Uzbekistan, Turkmenistan, Kyrgyzstan, Tajikistan and China. Then he plans to cycle through Cambodia, Thailand, Malaysia, Indonesia, Australia and back to New Zealand.
“The plan initially was to do the ride
BI KI NG 25, 0 0 0 KM FO R DI A BETES
TROUBLE IN MACEDONIA An extract from James’ blog I know you’ve all been waiting for some diabetes-related snippets, so you’re in luck here. Before the climb began I was starting to have some doubts about whether we’d make it to the top of the pass before the sun began to sink behind the mountains to the west. I knew it was possible but the way I was feeling I didn’t think I could do it physically. With all the cycling I had done so far in the last three months, this was a strange thought to have. I’d cycled close to 5,500km, camped in a forest which is home to Europe’s largest bear population, asked strangers if I could
sleep in their garden and stopped to urinate near a CAUTION: MINES sign. I should not have been worried about a 14km climb up Mt Galičica, and even if the sun did go down, we’d be able to find a small space at the edge of the road to camp and then continue the next day. What I was experiencing here was an extraordinarily high blood sugar level. Above a certain level, high blood sugar causes feelings of fatigue, extreme doubt and what I guess is ‘despair’. I complained and complained to Matt [my cycling buddy] about the situation I thought we were facing, and full credit goes to him for not really listening to me. I told him to go on ahead, rested my head on my handlebars, and had a little cry. Tough guy. By this time I’d worked out that I was suffering from
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high blood sugar and wasn’t just being a baby. I knew I had to inject insulin and tried to work out how much I’d need to bring the level down safely, without it dropping too quickly. That’s not an easy calculation to make when you just want to start feeling normal again. After injecting a few units of fastacting insulin I began to climb. With Matt cycling on ahead I had nowhere to air my frustration so managed to channel it in to simply riding the bike. The beginning of the mountain was a hard climb and I felt like I was putting a lot of effort in, but soon got into a good rhythm and my pace started to pick up. The insulin took effect very quickly and I was soon feeling strong, light and confident. This was the difference between normal blood sugar and high blood sugar: confidence versus despair.
Check out www.agreatdistance.org to see how James is doing and most importantly to DONATE to support Diabetes New Zealand! Autumn 2015 | DIABETES
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TECH N O LO GY
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A GUID E TO FIND ING TH E RI G HT A PP
Which diabetes app? Can an app help you manage your diabetes? James Nuttall, of the Auckland Diabetes Centre, has carried out research into the burgeoning number of apps designed for people with diabetes. He offers some tips on choosing the right one for your needs. Smartphones and tablets may not be for everyone, but many people in New Zealand now own one. Apps are one reason why smartphones are smart, and for people with diabetes, there are thousands of apps designed for diabetes management and tens of thousands for supporting a healthy lifestyle. So, can these diabetes apps help you manage your diabetes better than you already are? Just as there is no diabetes management plan that suits everyone, there is no one app that will suit everyone. Knowing how you want the app to help you and what you want to use it for are important to consider when deciding if an app will support your diabetes management. From our research at the Auckland Diabetes Centre in a small group of people with type 1 diabetes, most did not know what is available and would be more likely to use apps if given guidance. To help you decide if an app can help you manage your diabetes, I have highlighted and compared the main features of five popular apps in the table (opposite). These are not the ‘best’ available apps because no app has been proven to be better than another. You will find many websites with lists of the best diabetes apps, these are often not
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very helpful as many of these apps are not available in New Zealand and they are generally reviewed at face value. Since there are so many apps, I included the names of similar apps where possible to provide you with other options if these do not work for you.
What do these apps do? Most diabetes apps include functions for health monitoring (such as blood glucoses, medications, weight) and providing nutrition information (carbohydrate counting, healthy recipes, calorie counting). In a recent survey conducted in Waitemata DHB, the main reasons why people with diabetes are using apps for diabetes management are: tracking diabetes data, accessibility and convenience, carbohydrate counting and insulin calculations.
Food tracking If your main goal is managing food intake, there are many apps that can help with this. Most of these apps focus on encouraging you to record what you eat and tell you how many calories, carbohydrate and other nutrients are in the foods you eat. One example, MyFitnessPal, is the most downloaded health and fitness app in New Zealand. This app focuses on weight loss as its main goal through calorie counting, which can be an effective tool for weight management. However, many people with type 1 diabetes use this app for carbohydrate counting. One issue with doing so is that most of the food data is entered by users and this information is not checked for accuracy. For this reason, I would not recommend this as the first app people use for carbohydrate counting. However, an experienced carbohydrate counter may be able to
spot when there is a major error with a food product, which could allow this app to be used safely.
Blood glucose monitoring If you are looking to use an app as your main method of blood glucose monitoring, then finding an app that is easy to operate should be the priority. One benefit of the tracking functions of these apps – compared to a log book – is they often have colourful graphs, charts and the ability to set reminders. One issue is that entering data on a daily basis can become tedious and the ease of doing so varies greatly between apps. Some apps attempt to overcome this by using gamification, in essence making a game out of monitoring your diabetes. One example, mySugr Companion, uses a diabetes monster that you tame each day by logging enough information into the app to score 50 points.
Lack of New Zealand apps There are very few apps for healthy eating or diabetes management developed here in New Zealand. This means even fewer use a New Zealand food database such as EasyDietDiary. At Auckland DHB we run a programme called DAFNE (Dose Adjustment For Normal Eating) for people with type 1 diabetes. But there are exciting new apps in the pipeline with Foodswitch and the upcoming Saltswitch, as well as a healthy-eating app for type 2 diabetes, which is being developed by dietitian Zhuoshi Zhang as part of her PhD. For people with type 1 diabetes who want a New Zealand-made app, one of our DAFNE graduates at Auckland DHB has developed his own diabetes management app called Type 1 – with a New Zealand carbohydrate counting database included.
A G UI DE TO FI NDI NG TH E RI G HT A PP
A major drawback of diabetes management apps is the lack of rigorous testing or scientific evidence showing they help improve blood glucose levels. If you are happy with your diabetes management and already have access to sources of information you
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TECH NOLOGY
and health apps. Our aim is to provide patients and health professionals with some guidance around what is available, how well they achieve their aims and who these apps can benefit. Watch this space!
trust, then apps may not provide you with much additional benefit at this stage. As a dietitian working with people who have diabetes, I see the important role health professionals have in providing the best advice around apps. My colleagues and I will continue to review nutrition
Pros and cons of five popular diabetes apps
Most useful for Platform Food database Export records via email Reminders/ warnings
Carbs & Cals
RapidCalc
$7.99
$7.99
MyFitnessPal Free
Technical people who want the calculations built into most insulin pumps. Apple only
Comparing food products with a visual scale.
UK and US foods, with food photos and users can add own meals/recipes. No
None
Yes, includes only NZ Yes, includes entries None food products by company and users
Yes
No
No
Reminders for basal NA insulin doses and postmeal blood glucose recording. Blood glucoses with NA graphs and summary. Carbohydrate in grams or portions. Rapid and basal insulin doses.
Reminders for meal No (Pro version – for logging, warning logging) when you eat far too few calories. NA Blood glucoses with graph and summary. (Pro version – insulin pump basal rates)
Yes – complex. NA Includes: carbohydrate count with ratios; blood glucose target; insulin on board; exercise/activity; alcohol and recent hypo. No Traffic light scale for comparing similar food products. Insulin bolus Foodeye (Apple, calculator (Android, Free) $4.20), Insulin calculator (Apple, free)
NA
No
Nutritional allowance based on personal variables. Calorie Counter by FatSecret (Apple & Android, free), EasyDietDiary (Apple, Free)
No
Blood glucoses (Android version only, no summary); carbohydrate in grams and portions; rapid and basal insulin doses.
Rapid acting insulin dose suggestion (for people with type 1 diabetes)
Yes – basic, can include a correction dose.
Nutrition analysis
Nutritional allowance based on personal variables. Figwee Portion Explorer (Apple, $2.59) – has no diabetes section
Apple and Android
People who want to track their food and exercise to manage weight. Apple, Android and website
mySugr Companion Free (pro version $28.36)
Visual people who want to estimate their nutritional intake. Apple and Android
Monitoring functions eg blood glucose, weight, meds
Similar apps
FoodSwitch New Zealand Free
Yes
People who want to monitor variables influencing their diabetes. Apple and Android
Yes
On Track Diabetes (Android, Free) Social Diabetes (Apple & Android, free), Dario (Apple & Android, free)
Autumn 2015 | DIABETES
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GARD EN I N G
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ED IBLE SCHOOL GARD E NS
Love of gardening starts young Gardening expert Rachel Knight explains why she has been helping local children grow their own food at school. Many schools have gardens where teachers, students and their families can enjoy growing things to eat. Kids love getting outside. Finding something delicious to eat as a result is a bonus. Even those who don’t like to eat vegetables may make an exception if they’ve harvested them themselves. If you can spare an hour or two to help out at your local school garden you are sure to be made very welcome. Our love of gardening and nature often starts when we’re young. Not all of us are fortunate enough to have a garden at home, which makes a school garden an even greater asset to our schools and their communities.
1 Growing soil
6 Summer planning
Clear summer crops from the garden if they’ve produced their last crop or gone to seed. In their place sow mustard or lupin seeds as ‘green manure’. Water well if it’s dry.
Order or buy seeds. Swap seeds you’ve bought or saved. Store all seeds somewhere dry in an airtight container.
2 Hunting for pests Go on a slug and snail hunt. In the day lift up bricks and turn over planks or on a damp night go spotting with a torch.
3 Compost building If you’ve got lots of weeds, think of weeding as ‘compost building’. Fill a bucket or wheelbarrow with weeds to layer with lawn clippings and kitchen scraps on the compost heap. Turn existing compost heaps with a fork, watering any dry spots.
4 Windowsill herbs Buy some parsley, coriander and rocket seedlings and plant them in bigger pots filled with potting mix on your kitchen or class room windowsill.
5 Winter planting Sow broad bean seeds in pots. Plant out winter green seedlings (cabbage, broccoli and kale). Sow garlic in the garden mid-May.
7 Creating more rhubarb Lift and divide existing clumps of rhubarb. Replant with a wheelbarrow full of compost under each one.
8 Herb styling Give perennial herbs a haircut (sage, thyme, mint, chives, rosemary and tarragon). Take cuttings from the plants or divide them if you want more for the garden or to sell.
9 Loving fruit Plant new fruit trees, prune existing fruit trees, berries and vines.
10 The best bit – harvesting! Pick pumpkins, corn, onions, tomatoes, cucumbers, lettuce and other greens and share a delicious salad or make a filling soup. Preserve what you can’t use or store in a cool, dry, mouse-free place.
In autumn, there’s often a bit more moisture in the soil and most of the summer crops will be over. Before winter comes, it’s a great time to invest in the activities in the school garden that will set things off well when spring comes. Here are 10 ideas for autumn activities to enjoy each week in the school (or home) garden. Children at Strathmore School (now Kahurangi), in Wellington, show off some of their vege harvest.
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ADV ERTO RI A L
PARTICIPANTS NEEDED FOR DIABETES TREATMENT TRIAL Volunteers are needed to take part in a study of an investigational procedure to treat type 2 diabetes. The COMPLEMENT Study is a First In Human study that is being undertaken in four hospitals in New Zealand. It aims to collect information about a new treatment for type 2 diabetes using a medical device called the Metabolic Neuromodulation System. Treatment with the device is intended to help regulate blood sugar levels in patients whose diabetes is not well controlled, despite treatment with multiple medications. The medical device delivers low-level radiofrequency energy through the wall of the blood vessel to the liver to disrupt the nerves that lead to the liver. Previous research has shown that disrupting these nerves may lead to a lowering of blood sugar levels, which may help to achieve better diabetic control. The COMPLEMENT Study is being led by expert endocrinologists and cardiologists: Dr Rinki Murphy and Professor Mark Webster at Auckland City Hospital, Dr Brandon Orr-Walker and Dr Wil Harrison at Middlemore Hospital, Professor Russell Scott and Dr James Blake at Christchurch Hospital, and Professor Patrick Manning and Professor Gerry Wilkins at Dunedin Hospital. Study coordinators are available to answer common questions about how to take part: Jan Burd at Auckland City Hospital, Diane Caveney at Middlemore Hospital, Julie Cook and Jinny Willis at Christchurch Hospital, and Mary Blok and Marguerite McLelland at Dunedin Hospital. What can I expect if I participate as a volunteer? All study participants will be treated with a one-time procedure that involves passing a catheter through the femoral artery in the right groin into the artery that leads to your liver. This basic catheterisation procedure is very common for physicians to deliver a number of cardiovascular treatments. Am I eligible? Participants can be male or female, and have type 2 diabetes treated with metformin and at least one other tablet. Participants should not be taking insulin, have diabetes that is already well controlled, or have kidney failure or liver damage. Applicants will be screened and those with high blood sugar levels and meeting other study criteria will be eligible. What will happen to me during the trial? You will first be asked to see the study doctor for a series of baseline tests to determine if you are qualified to participate in the study. Once the results of the tests are reviewed, you will be scheduled for the investigational procedure. After an overnight stay in the hospital for the procedure, you will return to the hospital for follow up appointments with the study doctor at 30, 90 and 180 days after the procedure. I would like to participate. How can I do that? Please see the advertisement on this page and contact the coordinator at the hospital closest to you. Enrolment has begun, and the researchers hope to have 30 total participants by December 2015.
VOLUNTEERS WANTED FOR TRIALLING A NEW TREATMENT FOR TYPE 2 DIABETES DO YOU HAVE TYPE 2 DIABETES and TAKE METFORMIN AND AT LEAST ONE OTHER TABLET TO CONTROL YOUR DIABETES and DO NOT TAKE INSULIN? If yes, you may be eligible to participate in a clinical research study of an investigational procedure for diabetes being conducted at Auckland City Hospital, Middlemore Hospital, Christchurch Hospital and Dunedin Hospital. The procedure is similar to a coronary angioplasty so this will be conducted by a cardiologist. Who cannot take part? •
If you have certain medical conditions such as kidney failure or liver damage
•
If your diabetes is already well controlled (your HbA1c is below 64mmol/mol)
Transport costs will be reimbursed If you would like to know more, please contact: JAN BURD (Auckland City Hospital) (09) 307 4949 Extn 24365 JBurd@adhb.govt.nz
DIANE CAVENEY (Middlemore Hospital) (09) 276 0044 Extn 2821 Diane.Caveney@ccrep.org.nz
JULIE COOK or JINNY WILLIS (Christchurch Hospital) (03) 364 1096 / (03) 378 6259 or (03) 364 0448 Julie.Cook@cdhb.health.nz or Jinny.Willis@cdhb.health.nz
MARY BLOK or MARGUERITE MCLELLAND (Dunedin Hospital) (03) 474 0999 Extn 8084 cardiology.research@otago.ac.nz This study has Ethics Committee approval (HDEC Reference: 14/NTA/102)
Autumn 2015 | DIABETES
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CO M M U N IT Y
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VOLUNTEERING GOOD FO R TH E S O UL
Give some time for diabetes If you have a little time this year why not consider volunteering for your local diabetes branch? Renata Porter has been a volunteer for five years and president of Diabetes Youth for two years. She argues that volunteering is good for the soul and offers some tips on how to get the most out of it.
Volunteering. The backbone to any charitable organisation. Some would argue that being a volunteer is food for the individual soul. Either way you look at it, volunteering can benefit both organisation and individual. There are Diabetes New Zealand and Diabetes Youth branches across New Zealand. All of them depend on volunteers to develop projects, run events, assist members, fundraise and complete a myriad of administrative tasks. Volunteers play an essential role in serving the community and play a pivotal part in helping an organisation reach its communal goals.
Why should you volunteer? It’s good for you – experts say volunteers are happier and healthier than non-volunteers. Establishing a meaningful volunteer role can allow you to bring joy into your life. Elevated moods and emotions, like optimism, can strengthen your immune system. You learn and gain experience – you will not only learn a lot about yourself, you will gain knowledge and experience about the community, government and the health system. You can make a difference – no matter what activity you choose and how much time you offer, every volunteer makes a difference in someone’s life.
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Tips for would-be volunteers
Why do charities need volunteers? Extra resources – charities like Diabetes NZ run on very tight budgets and volunteers provide a valuable service that might otherwise need to be dropped or reduced. Strengthen the community – volunteers help support families and youth, assist schools and brings people closer together. Bring specialised skills and a fresh perspective – volunteers bring new ideas and energy that can often enrich an existing programme. New projects also benefit from the specialised skills volunteers can offer.
Be realistic – everyone is busy these days and sometimes it’s easy to overcommit. If you only wish to volunteer a few hours a month, state that very clearly up front. Charities are grateful for any time you can offer, so don’t feel like you have to sign up for large amounts of time. Be open – most people have a very good idea about the skills they bring to the table, however it’s OK to look at volunteering as a way to gain experience. Let the charity know that you wish to learn and gain experience in a particular area or that you are just open to any new opportunity. Be honest – volunteer because you want to, not because you were talked into it. The same goes for the activities you volunteer for, speak up and say what you are interested in and decline what you are not interested in. Be vocal – charities have most to gain from your ideas and suggestions. Share them, nothing is too small or too big. We all have something to learn and gain from each other.
How to volunteer You can volunteer as little or as much time as you want. Branches would love to hear from anyone who wants to help, including people who don’t have diabetes, and young people. Volunteers are also urgently needed to join the committees that run local branches. You can find a list of branches under the ‘Contact us’ section on either www.diabetes.org.nz or www.diabetesyouth.org.nz. Or feel free to call National Office in Wellington on 04 499 7145 and they will point you in the right direction.
VO LUNTEERI NG G O O D FO R TH E S O UL
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COM MUNITY
MAUREEN LONSDALE
REBECCA RYDER
How long have you been a volunteer? I started when I was around 17. I was the secretary of a basketball association. I’ve volunteered in many ways like Plunket when my kids were small and then with diabetes when my daughter was diagnosed.
How long have you been a volunteer? About 20 years, mostly in sport but more recently in health (diabetes). I started when my child was diagnosed with type 1 diabetes, when I helped to re-establish a local youth group.
What makes a good volunteer? Someone who is committed, reliable and honest. They have to be able to keep things confidential too. They should only give as much as they are able and not get so engrossed that nothing else matters. There needs to be balance in their life too.
What makes a good volunteer? People should play to their strengths and have willingness to ‘give their time’. Part of the enjoyment is seeing other people benefit from what you do. They have to enjoy being part of a team. Volunteers who have been around a while need to be willing to step aside when new people arrive and bring new ideas.
volunteer Diabetes Health Trust Tauranga
volunteer Diabetes Youth Taranaki
Why is it important for branches to have volunteers? If you didn’t have volunteers, you wouldn’t have branches. It’s as simple as that. Volunteers add credibility to a branch. Everyone makes a difference no matter how much or little time they can offer. Volunteering has changed quite a bit since I started. There is a new breed of volunteers, more is done online. Is that bad? No, but I feel we are going to start missing that face-to-face interaction. In a way it’s good because so much can be done online and you don’t have to wait for a meeting to happen but we need to make sure there is a balance. How does being a volunteer affect you? If I hadn’t been a volunteer, I would have been a little mouse in the corner. People don’t believe it but I am shy, I like to be in the back watching. My strength is being a cog in the wheel, getting people to unite and work together.
Why is it important for societies to have volunteers? It’s important because they come from a grass roots level. They have a passion and enthusiasm that is different from a paid employee. They are there and involved because it’s what they believe in. How does being a volunteer affect you? I like to keep busy and I really enjoy the role of being a volunteer. I have learned so much. What would you tell someone who is considering volunteering? Get involved and play to your strengths. Make it easy for yourself, don’t take on too much and be up front about your time. You also have to respect others’ opinions.
“Volunteers are the most important resource charities have. Please consider giving your time – the community will benefit and you will be better for it.” – RENATA PORTER Autumn 2015 | DIABETES
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OPINI O N
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K ATIE D OYLE
PHOTO BY NICO VORSTER, SKYDIVE FOX
Doing it despite diabetes
Katie Doyle is an American writer and videographer who chronicles her travels from wherever she happens to be on her blog Where in the World is Katie Doyle? She is currently living in New Zealand and blogging about diabetes, travelling and other topics. Katie, who has had type 1 diabetes since 2003, is a guest blogger for the American Association of Diabetes Educators and has volunteered at the international Children with Diabetes Friends for Life Conference.
For better or for worse, does diabetes motivate me? I know I’m not alone in asking myself this question and the answer is far from straightforward. I love to try new things. I jump at the chance to live in another country, try a new sport, or do pretty much anything that will give me a good story to tell. But sometimes I feel under pressure – to run a marathon, sign up for a month trekking through the wilderness, or get a job in Antarctica. To do anything that’s hard. I’m currently living in the beautiful South Island, and the sheer amount of planning that went into getting here from the United States motivated me to make the move. After negotiating with insurance companies, being the friendliest, smiley-est pharmacy customer, and politely but firmly
asserting my needs while travelling, I managed to bring enough insulin and pump supplies to last me six months to one year in New Zealand. I’m feeling secure about being able to take care of myself, and stay healthy, so I can enjoy every day in this spectacular place – and enjoy it I have. I’ve caught some whitebait, gone snorkelling, tramped along the Routeburn track, and seen lots and lots of sheep. My friends are amused when I worry myself over all of the possible life choices I have. They tell me to relax and focus on whichever adventure is at hand. When I take a moment for some self-reflection, I wonder whether I choose to do these things simply to prove that I can do them in spite of having diabetes. The idea there exists something – anything – I somehow could not accomplish
Check out Katie’s website www.kadoyle.com and follow @katie_ _doyle on Twitter
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K ATI E D OYLE
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OPINION
solely because of diabetes devastates me. To make up for that hypothetical thing, my irrational self wants to take on every challenge I possibly can!
Now that I’ve been travelling for a while and figuring out what makes me happy (and adrenaline-filled activities like heliskiing, skydiving, and mountain climbing do just that), I’m getting easier on myself.
PHOTO BY CAROL BRAVO
So why do I lie awake at night wondering how much insulin I would need to bring with me for an attempt to summit Mt. Everest, thinking of how I would keep it at the correct temperature, and devising ways to carry all of my pump supplies with me? Because I’m afraid diabetes will win. If I decide that I have no interest (or only a little bit of interest) in scaling the world’s tallest, coldest mountain, does that mean I lose and diabetes is officially the deciding factor in everything I do? A societal focus on having perfect control and producing perfect numbers pressures people with diabetes. If our self-care is criticised and we’re always being told that we’re failing, it’s no wonder it’s so easy to get competitive with ourselves. We need to prove that we can have impeccable self-management while going above and beyond everyday life requirements to be extraordinary humans, right?! I think it just needs the affirmation at the end. It took me a long time to realise this line of thinking makes it impossible for me to feel good about any of my decisions, let alone my diabetes.
PHOTO BY SAM WESTLAKE
The reality is, my rational self interjects, that it’s 2015. Diabetes doesn’t prevent you from doing anything at all in your day-to-day life. It’s true: I wake up, go for a run, go to work, meet or make some friends, enjoy life. Putting a few large scoops of sugar in my morning coffee is probably not such a good idea. A low or high blood sugar right before a meeting or important phone call is annoying. But that’s really it.
Top: Katie spent last winter heliskiing in the French Alps. Bottom: The views of Fox Glacier and the Tasman Sea were well worth the trek up Mt Fox before the clouds rolled in. Left: Katie jumped into her New Zealand adventure with a skydive over the West Coast at Fox Glacier. I have met people with diabetes all over the world, including here in New Zealand. When I encounter someone who’s travelling the world, just like me, and that person is also asking where the nearest refrigerator is so they can store their insulin, it’s as if the weight of diabetes suddenly becomes lighter. Sharing our stories about living life with diabetes and discussing ways to better manage ourselves (and tackle challenges like the Routeburn track) help us deal with our condition, and it’s nice to make a new friend or two while we’re at it.
Before my must-live-life-in-spite-ofdiabetes plans become too dramatic, I usually rein in my thoughts and remember that my life is fine. When deciding whether I’m going to move halfway around the world or apply for a job in Antarctica, I ask myself if these things fall in the category of “What I want to do.” If not, I can live with less self-criticism. If they make it onto the list, great! I’ll figure out the diabetes-related details later. A version of this article was originally published on DiabetesDaily.com on 26 January 2015
Autumn 2015 | DIABETES
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FO O D & RECI P E S
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TIPS FOR SUSTAI NA BLE CH A NG E
Step change to a healthier lifestyle What can you do to work towards a healthy lifestyle? Diabetes New Zealand’s new dietitian Meg Thorsen gives some simple tips on turning good intentions into reality. Summer is a magical time. It sparkles like fairy dust with infinite potential and good intentions. By autumn the challenges of New Year resolutions can be making their presence known. Or perhaps you have been recently diagnosed with diabetes and are wondering how to take on board what can seem like a mountain of lifestyle changes. Here are some ideas to help you achieve your specific goals.
HERE TO HELP Dietitians are health professionals trained to help people make healthy lifestyle changes that last for the long term. We asked six diabetes dietitians to give their top tips on how to introduce lasting lifestyle changes. For more information about how a dietitian can help you, or to locate a dietitian in your area go to www.dietitian.org.nz.
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Plan ahead Planning is key to the success of any project, turning a vision into reality by breaking it down into manageable steps and finding solutions to potential barriers. If introducing carbohydrate counting, have a booklet with the carbohydrate content of different foods close to hand. Putting together a rough meal plan for the following day will help you learn and apply new information. If the 3pm energy low is a difficult time and you find it hard to resist the temptation of a sweet snack, it may help to have a look at your ‘food day’. Did you eat breakfast? Did you get to have a sit-down lunch break and what did you eat? Could you prepare an appealing snack to help you through the stretch between lunch and
Soana Muimuiheata Consultant dietitian ProCare Health Auckland Ask yourself what you eat and drink, how much you are eating at each meal and at what times of the day. Be practical in the changes you are trying to make, so they work with whatever else is happening during your day. Remember regular meals are important. Try to get your family on board with the healthy changes you are making. A healthy diet for someone with diabetes is healthy for everyone.
dinner? Having a solid eating plan in place for the day helps you get through times like these without it becoming a matter of willpower.
Take small steps Making a few small changes at a time helps each one become more achievable. Write a list of all the changes you would like to make. To get started, choose two or three that are relatively easy to achieve. Get these successes under your belt, then add one or two more that may take a little more work.
Be SMART Whether you have type 1 or type 2 diabetes, having SMART goals (specific, measurable, attainable, results, timeframe) is the way to go. A goal of reducing sugar in the diet can be broken down into more specific steps and will look different for every person.
Teresa Cleary Diabetes NZ Auckland branch dietitian Planning is the key to succeeding with your healthy lifestyle. Take time to plan out a weekly menu for the family and do as much preparation of the meals ahead of time as possible. An example could be taking time the night before to prepare a healthy lunch for the following day. Bircher muesli prepared the night before, refrigerated and served with seasonal fruit makes a cool summer breakfast treat.
TI PS FO R S USTA I NA BLE CH A NG E
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FOOD & RECIPES Hamish Johnstone
People with type 2 diabetes may have a goal of halving the amount of sugar added to hot drinks each week for four weeks. People with type 1 or type 2 diabetes may aim to have one piece of fruit at each main meal throughout the day. Having a SMART food or lifestyle goal in mind helps keep the motivation up and gives you a measure of success so you know when to celebrate.
Give claps not slaps Congratulate yourself for your successes. It’s too easy to focus on things when they don’t go according to plan and overlook all of the changes that have gone well over the day or week. Putting yourself in a positive mindset helps you feel better about the changes you’ve made and keeps you motivated.
Have fun Surrounding yourself with likeminded people helps make any change easier. Get your family and friends on board. Have fun experimenting with new foods or head out on an outdoors adventure. Swap recipes with others who enjoy healthy food. Find a friend who loves being active and head out for a regular catch up while fitting in a walk, ride or other activity. Whatever your initial drive for change, be it a New Year’s resolution, a recent diagnosis of diabetes or a general desire for a healthy lifestyle at any time of the year, these tips can help you take a bite out of a healthy lifestyle and make it an everyday part of your life.
Diabetes New Zealand healthy plate
Diabetes dietitian, Auckland Move every day. Don’t skip meals for weight loss or diabetes. Eat heaps of non-starchy veges, a good amount of fruit and keep the saturated fat intake low. Carbs are not the enemy, include them in your meals, try lower GI where you can. Avoid fad diets. Making little changes can make all the difference to your control, just keep heading in the right direction. Type 1: get your ratio on and tune in your CHO counting. Type 2: keep the meals regular r
Alison Pask Porirua community dietitian Do you use food to cope with emotional issues such as disappointment, boredom, anger or even success? If this is the case learn what triggers you to use food as an emotional crutch and identify healthier ways to cope that do not involve food. Solutions will vary and could include going for a walk instead of heading for the fridge. Some people find drinking a glass of water is a good first step followed by cleaning their teeth, as a fresh mouth often prevents the further desire for food.
Elaine Chong South Auckland Dietitian specialising in diabetes in pregnancy Cook fresh. Eat fresh. Think balance. Not diet. Use the healthy plate concept (left) to prepare balanced meals.
James Nuttall
Vegetables
Auckland Diabetes Centre dietitian Be your greatest supporter. Try making a list of your goals for the week. Reflecting on your achievements at the end of the week will reinforce your good efforts and can help you successfully maintain your lifestyle changes. Remind yourself of all the beneficial lifestyle changes you have made so far. Concentrating on where you are going wrong can be demotivating, deflating and can potentially derail your planned changes. Autumn 2015 | DIABETES
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FO O D & RECI P E S
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LOW- CA RB BREAKFAST
READER RECIPE: Healthy homemade muesli Phil Letford, from Hamilton, was inspired by the International Diabetes Federation’s healthy breakfast campaign we featured recently to give us his no-added sugar, lower-carb healthy muesli recipe. Makes 30 serves (80g or 2/3 cup per serve).
340 grams whole oats 1 kg rolled oats 100 grams coconut thread 90 grams wheat germ 160 grams sunflower seeds 170 grams flax seeds 170 grams sesame seeds 120 grams oat bran 300 grams canola oil
Mix all the dry ingredients in a large bowl. Add the oil and mix thoroughly. Microwave the mixture: A total of 15 minutes on high (900 watt microwave). Stir well every three to four minutes of cooking time. Allow to cool and enjoy! Serving suggestions • Add chopped raw fruit or berries for added sweetness. • Serve with low-fat milk and/or unsweetened probiotic yoghurt.
APPROXIMATE NUTRITION PER SERVE Energy: 1579kJ; Total fat 23.3g; Saturated fat 4g; Carbohyrate 31.5g; Sugar 1.1g; Fibre 67.g.
A note from Phil: I have been making my breakfast muesli for a number of years and you may be interested in the home-grown recipe I use. The cooking of the muesli in the microwave makes it easy. Since I went onto the basal bolus insulin regimen and started carb-counting a few years ago, I have kept a detailed record of the ingredients I use. The quantities do not need to be exact but by weighing the ingredients, I can calculate the amount of carbohydrate in each serving. For example 100 grams of the cooked muesli has 39.1g of carbohydrate. There is no added sweetener of any sort – I just add raw fresh fruit when serving. You will have noticed that there are no nuts in the recipe. This is because I have a nut allergy. Nuts, such as hazelnut or chopped cashews, would probably enhance the muesli. ™
Share your favourite healthy recipe with other Diabetes readers Email editor@diabetes.org.nz
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DRIVI NG TI PS
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CARE AND P RE V ENTION
Drive safely with diabetes Newly diagnosed? If your diabetes has just been diagnosed and your treatment is still being adjusted, you may not be fit to drive just yet. Check with your doctor.
Young drivers Remember it is your responsibility to drive safely. If you have an accident the courts are not going to be lenient because you have diabetes. They expect you to manage your low/highs. Ask your doctor to provide a letter to support your licence application showing that you have your diabetes under control and are safe to drive. Some clinics have a pro-forma letter.
When you shouldn’t drive If you have a mild hypoglycaemic (low blood sugar) episode, Diabetes NZ recommends you don’t drive for at least an hour. If you have a
severe hypoglycaemic episode (when you need someone else’s help, you shouldn’t drive for 24 hours).
Long-term complications Your driving ability could be affected by long-term complications of diabetes, such as eyesight deterioration and the loss of normal sensation in your feet. Have annual check ups to keep tabs on this.
Licence conditions Sometimes a driver with diabetes may be issued with a licence that has certain conditions attached. The conditions will depend on: • the type of licence (classes and endorsements) • how the diabetes is controlled • whether the driver has any history of hypoglycaemic attacks • how carefully the driver follows
their medication schedule • an assessment of the extent to which the driver suffers from the medical complications that are commonly associated with diabetes. The New Zealand Transport Authority decides the licence conditions, having regard to the Medical Aspects of Fitness to Drive booklet, and in consultation with NZTA’s Chief Medical Advisor.
Passenger services and heavy vehicles People with type 1 diabetes are generally not considered fit to drive heavy trade vehicles, taxis, buses and other related vehicles. The NZTA may, in exceptional circumstances, grant a licence after consultation with your general practitioner and diabetes specialist. If a licence is granted to drive any of these vehicles, then strict conditions are likely to be imposed.
Test – if you are under 5 don’t drive! If your diabetes is well controlled, you can drive a private car safely. However, there are times when you need to take precautions:
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Always have meals and snacks before and during long journeys. It’s safest not to delay meal times. Take regular, short breaks from driving. Check your blood sugar levels regularly. If you feel your blood sugar is low, stop driving and treat it with a quick acting sugar, eg three glucose tablets. Follow this up with a plain muesli bar or biscuits. Wait until the sugar has started to work before you start driving again.
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Keep a supply of plain muesli bars, biscuits, glucose tablets, dried fruit and long-lasting fruit juice in your pocket or in the glove box. Don’t delay treating low blood sugar levels. The brain becomes confused when blood sugars reach low levels. Be aware of your warning signs. Although a mild hypo may not seem to impair your driving, it’s vital to act before your judgement is affected.
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If you sometimes experience hypoglycaemia unawareness (hypos without warning signs), it may be unwise for you to drive. You should discuss this with your doctor or diabetes nurse specialist.
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Remember that changing a car tyre or pushing a car could result in low blood sugar levels. Be prepared! If you have diabetes, alcohol can be particularly dangerous because it can cause hypoglycaemia or worsen its effects. We recommend that people with diabetes avoid consuming even small amounts of alcohol if they’re going to drive.
For more information see diabetes.org.nz
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LE T ’S G E T A CTI VE
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ACTIVIT Y TRACKE RS
Stepping out
Can walking 10,000 steps a day improve fitness, mental wellbeing, blood pressure and a host of other health benefits? Caroline Wood investigates. I was given a Fitbit activity tracker (aka ‘smart’ pedometer) for Christmas. It may have been my husband giving me a not-too-gentle hint that I needed to be more active, or perhaps he secretly wanted one himself. Anyway I put it on and was immediately hooked. Each day I check on how many steps I’ve done and whether I’ve achieved the magic 10,000 steps a day recommended by the manufacturer. If I haven’t, I will often try to do a quick stroll around the block before bedtime to get the satisfaction of meeting the target. It links wirelessly with my computer and downloads the data onto simple charts so I can compare my activity levels day by day. I can
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see how many ‘floors’ I’ve climbed, how many calories I’ve expended and how many kilometres I’ve walked. I now know that 10,000 steps is the equivalent of 8km (or 5 miles in old money). I can even sleep with it on and it will record how often I wake up and how efficient my sleep is. No surprises I gave my husband a Garman Vivofit activity tracker for his birthday and he is hooked too. Now it is a matter of honour – who has racked up the most steps today? Active Living Strategic Advisor Stephanie McLennan, of Sport Waikato, laughs when I tell her this story. She says that pedometers – smart or otherwise – work really well for people who like setting themselves goals and charting their progress. They can be a great little tool for feedback, monitoring, reminding, motivating and challenges. “I think the simple pedometer, or any fitness tracking device or gadget, is
fantastic if it’s going to help people be more active and there are some people who like the challenge. I know some families [who use them] and it’s the only reason they get moving because they are competitive and want to do more steps.” Penelope Scott, Health Promotion Manager at the Cancer Society Otago and Southland, who has done a lot of research into pedometers agrees: “It does help motivate people. It is quite a useful tool, they won’t appeal to everybody but a lot of people find them useful.” Most of us only walk about 5,000 steps a day because we live and work in a world where it’s often easier and faster to drive, take the lift or email someone rather than get up and walk. Experts say the key to using a pedometer or activity tracker is to a) increase your base daily activity – aiming for 10,000 steps a day is good and b) ensure your
AC TIVITY TR ACKE RS
daily activity includes some moderate ‘huff and puff’ exercise, however many steps you are taking a day. Stephanie agrees with this advice. She suggests working out a baseline measure by wearing a pedometer for at least two weekdays and one weekend day (without changing your routine) and recording the number of steps. Once you have the baseline recorded, you should aim to increase the number of steps you take every day. “I have had a lot of success with pedometers helping people to lose weight. They start off saying I’m too busy and then they do 2,500 extra steps a day. I reckon they are great as long as people have some coaching and strategies for using them.” Stephanie says pedometers don’t generally measure intensity and it’s important to include some brisk walking or other physical activity that gets your heart rate up as well – ideally 30 minutes most days of the week.
Walking 2,000 steps is the equivalent of:
20
minutes light walking
10
minutes pushing a lawnmower OR light impact aerobic dancing
9
minutes running OR biking at 16km an hour OR slow swimming OR rowing at 100 watts
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LE T ’ S GE T ACTIVE
Walking 10,000 steps a day – the importance of intensity Health experts, the media and activity tracker manufacturers generally recommend people aim to walk 10,000 steps a day. This is easy to remember and gives people a goal to aim for. But what is the evidence that 10,000 steps give you health benefits? Research shows that walking 10,000 steps a day is a good starting point or goal but to maximise health benefits 2,000– 4,000 of the steps should be done at a brisk pace (Harber et al, 2006). The Harber study compared two groups of people with type 2 diabetes. One group walked 10,000 steps a day at a selfselected pace, the other group undertook a traditional (moderate
10
intensity) exercise programme. Both groups reduced their blood pressure but the traditional group reported the greatest change. Harber concluded that walking at low intensity may not provide the health benefits that can be achieved with higher intensity programmes. The 10,000 step walking programme was a good starting point, he said, but to increase the effectiveness a person must add some higher intensity activity to their exercise programme. *Cardiovascular and type 2 diabetes risk factor response to a traditional fitness and 10,000 step exercise program. Harber V, Bell G, Rodgers W and Courneya KS, 2006. Medicine and Science in Sports and Exercise.
tips to increase your step rate
The benefits of regular walking include: feeling less tired and having more energy, sleeping better, feeling more confident and less stressed, having better heart health (including cholesterol and blood pressure), helping to maintain a healthy weight, stronger bones and improved mobility. Here are 10 ways to increase your daily step rate:
1 Take the stairs instead of the lift. 2 Walk to work, get off the bus a stop early and walk the last section, or park your car then walk around the block before going to work.
3 Park your car further from work or the shopping centre or supermarket. 4 Use the toilet block on another floor and take the stairs. 5 Walk around your office while on the phone. Make a trip to the printer after every print.
6 Get some friends together and walk during tea breaks or lunch time. 7 Take messages to people in your office instead of sending an e-mail. 8 Walk your children to school or the park. 9 Actively play with your children/grandchildren. 10 Walk to the mail box instead of picking up the mail as you drive in or out.
Source: Sport Waikato
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HENG PEI YAN , S I NGA PO RE
Diving, diabetes and me In the latest in our occasional series about people living with diabetes in different countries around the world, Carrie Hetherington interviews Heng Pei Yan, 28, a school teacher and enthusiastic scuba diver from Singapore. How old were you when you were diagnosed with type 2 diabetes? Did you go straight onto insulin? I was only 10 years old. My blood sugar was checked at a clinic and they immediately referred me to the hospital A&E. I went straight onto insulin.
Does anyone else in your family have diabetes? I think my condition is linked to family history because my grandmother and my father are both type 2.
What kind of insulin do you take? I was using Humulin N and R when first diagnosed. I was using Humalog for a short period of time and then the doctor added in metformin. I only progressed to Glargine and Novorapid when I went to university and now I’m on Levemir and Novorapid, continuing with the metformin. I switched to an insulin pump last year and my readings have been great.
What is it like living with diabetes in Singapore? I would say the cost is rather high. Healthcare in Singapore is not free of charge but it is subsidised by the Government. For a moderately high dosage insulin user (about 84 units per day), it is rather
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expensive as it can hit the midhundreds [of New Zealand dollars] for three months’ supply – just for the insulin. Medication can only be purchased from the hospital’s pharmacy through a doctor’s prescription, while the rest of my diabetes supplies can be purchased from general pharmacies.
Is there much of a stigma for people with diabetes in Singapore? I would not say that there is a stigma in Singapore for people with diabetes. I do get some stares and looks when I test or jab myself in public. I guess it’s just human nature to be curious about what I’m doing, though I have never been stopped. Diabetes is one condition, which is slowly gaining wider understanding from the general public in Singapore.
What is your day job? I am a secondary school teacher of maths and science.
You’re currently doing your masters – what will your thesis focus on? The course is about communicating science to the general public and my students. But for my thesis, I’m focusing on citizen science and conservation. I intend to create assessment tools for volunteer nature guide training workshops.
And do you find it easy to manage your blood sugars within the classroom? Are your students curious about what you do? I do not bring my blood glucose meter into class. Lessons last for about an hour, maximum 1.5 hours and I have breaks in between classes to check myself. I did share with one of my classes about my condition as we were covering non-communicable diseases. They could not believe that I have diabetes.
Have you ever had a hypo in the classroom and had to pause teaching? It has never happened before and I hope it stays this way!
Now, your most exciting hobby is diving! What made you become so fascinated with it? I had always wanted to learn to dive since my undergraduate days but it was rather pricey for a poor student to take an open-water diving course. The swimming test also put me off the idea as I was not a good swimmer. I
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DI AB E TE S ABROAD
In her free time Pei Yan likes diving and visiting inter-tidal reefs around Singapore. only got my diving certification two years ago and I have never stopped diving since! In December last year, I also went to Indonesia for a dive photography workshop. One of my passions is underwater cinematography.
Is there are a particular blood glucose range you would like to be within before you go under the water? I was advised to keep my blood glucose range at least 8 mmol/l or higher before diving. Usually it’s not a problem to keep it within those levels. I always test before I enter the water, so if it falls below that level, I can eat some snacks before safely jumping in.
Do you let your fellow divers know about your diabetes? I have a friend, whom I dive often with in Singapore waters, who knows about my
condition. She is also at a high risk for diabetes so she understands what it means to have a hypo. We are dive buddies, so we’re always together in the water.
Diabetes care is expensive in Singapore Have you ever felt low while you’re under the sea? Never. In fact, I’m more on the high side when I’m diving – but I do get delayed hypos on some occasions. I do wonder what it feels like to be low when diving.
You’re an advocate for Singapore with the International Diabetes Federation – what kind of changes would you like to see in your country? Reflecting upon the many connections I made with young leaders who have diabetes from around the world, their stories made me thankful. I am thankful that I live in a country with high standards of healthcare and a system in place – although healthcare services are not free and insulin is not very cheap. One change that I hope to see would be more insurance choices for people with diabetes. It is rather depressing to hear from your financial adviser that an application has been rejected due to a pre-existing medical condition, or that I am not able to sign up for a plan due to my pre-existing medical condition. Of course there are many other changes I would like to see (for example better awareness, lower costs, diabetes education). We are not a perfect society but changes can be made slowly.
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TREATM ENT
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NEW TELEMED ICINE CLI NI C
Eliminating distance barriers to diabetes care Young Central Otago diabetes patients will no longer have to travel hours to attend appointments in Dunedin after the launch of a paediatric telemedicine clinic at Dunstan Hospital, as Melissa Garry explains. Families will save up to eight hours travel time to see a diabetes specialist thanks to a new clinic pioneered by Southern District Health Board. Instead of having to travel to Dunedin children will be seen at Dunstan Hospital – with a video link to paediatric endocrinologist Dr Ben Wheeler, who will be in Dunedin. In Dunedin, Dr Wheeler is able to review their test results and discuss treatment and any issues with the patients via the video link. In Dunstan, diabetes nurse specialist Sharon Sandilands examines the patients, downloads information from glucose meters and insulin pumps and prescribes medications with dietitian Nicky McCarthy offering diet advice in the same clinic session. Patients Sam Harry and her sister Kate attended the first clinic in January. Mum Jo Harry is delighted with the way the new clinic is being run.
Dr Ben Wheeler takes his first clinic with patient Sam Harry (left), mum Jo Harry (centre) and patient Kate Harry (right).
“As a family living in a rural area the clinic is really convenient and makes a huge difference. It takes the pressure off the family especially in travel time to Dunedin and it also means that we don’t have to take as much time off work and school,” she said. “The nurse carried out all the girls’ checks and our appointment was with the same doctor, the only difference is that it was via video link. The girls are on insulin pumps and Dr Wheeler is able to see the girls’ results (which they download onto a website) and discuss any treatment with us. It’s fantastic, the same care but just nearer home.” The clinic will save up to eight hours travel time for families every time a patient needs to attend a clinic, which is usually at least four times a year depending on the patient’s needs. Patients will
Telemedicine is the use of telecommunication and information technologies in order to provide clinical health care at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. SOURCE: WIKIPEDIA
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now be able to attend the local Dunstan clinic and usually only have to travel to Dunedin Hospital for an appointment once a year. Dr Wheeler said: “The first clinic was a great success. The parents and children were happy to be seen closer to home and we’re able to provide the same high quality of care without the need for the patients and their families to travel.” Dr Wheeler added that similar clinics are now being considered for Oamaru and Timaru. The telemedicine clinic was made possible by funding awarded through the ‘Southern Innovation Challenge.’ The clinical team pitched their idea to a panel of judges and received the funding to purchase the camera and speakers to enable the new clinic to be set up. Southern DHB Chief Medical Officer, Dr David Tulloch commented: “I’m delighted the clinics have started and how well they have gone. This is a great example of Southern DHB providing the right care in the right place at the right time and giving patients better access to healthcare.”
Chocolate
Reduced fat* Gluten Free
Vanilla Bean
Full Creamy Taste! No added sugar
No added colours
Contains 9 x 100ml servings per tub
*Compared with standard ice cream with 10% milk fat. CHOCOLATE: Approx. 4.0g of sugar per 100g from dairy. Approx. 5.5g of fat per 100g. VANILLA BEAN: Approx. 4.1g of sugar per 100g from dairy. Approx. 4.9g of fat per 100g.
A 24-hour insulin that I can take once a day? 2
“Sweet...!”
Lantus® (insulin glargine) is now fully funded for Type 2 diabetes mellitus patients requiring insulin.1,2 For thousands of Kiwis, this will be something to smile about. Lantus® is a long-acting basal insulin. ‘Basal’ is a term used to describe the slow, steady release of insulin needed to control your blood glucose between meals and overnight. Lantus® provides a continuous level of insulin over 24 hours, similar to the slow, steady (basal) secretion of insulin provided by the normally functioning pancreas. This means that only one dose of Lantus®, given at the same time each day, is needed for 24-hour basal control. 2,3 How is Lantus used in people with Type 2 diabetes? In Type 2 diabetes, Lantus is given by subcutaneous injection once daily and can be used in combination with oral diabetes medications and/or with short or rapid acting insulin as instructed by your doctor. 2,4,5 Talk to your doctor about whether Lantus® could be right for you.
References: 1. February 2012 Pharmaceutical Schedule Update, Pharmac. 2. Lantus Data Sheet, August 2010. 3. Goykham S, et al. Expert Opin. PharmacoTher 2009; 10(4):705-718. 4. Fulcher G, et al. AMJ 2010; 3(12):808-813. 5. Nathan D, et al. Diabetes Care, 2009; 32:193-203. Lantus® is a Prescription Medicine that is part of the daily treatment of Type 1 & Type 2 diabetes mellitus. Do not use if allergic to insulin glargine or any of its ingredients. Precautions: for subcutaneous (under the skin) injections only, do not mix or dilute. Close monitoring required during pregnancy, kidney or liver disease, intercurrent illness or stress. Tell your doctor if you are taking any other medicines, including those you can get from a pharmacy, supermarket or health food shop. Interactions with other medicine may increase or decrease blood glucose. Side Effects: hyper or hypo glycaemia, injection site reactions, lipodystrophy (local disturbance of fat metabolism). Contains insulin glargine 100U/ml. Use strictly as directed and if there is inadequate control or you have side effects see your doctor, diabetes nurse or educator. For further information please refer to the Lantus® Consumer Medicine Information on the Medsafe website (www.medsafe.govt.nz). Sanofi, Auckland, freephone 0800 283 684. Lantus® is fully reimbursed when prescribed by a medical practitioner. Pharmacy charges and doctors fees apply. TAPS PP1903
GLA 12.02.001