Diabetes Autumn 2012
Living well with diabetes
We are golden: Celebrating 50 years of Diabetes New Zealand
DIABETES YOUTH Watch out for the little guys
Gardening and diabetes The emotional rollercoaster of diagnosis
“I lost 30kg and no longer take medication” One woman’s remarkable story
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Diabetes: the national magazine of Diabetes New Zealand | Vol 24 no 1 Autumn 2012
INSIDE autumn 2012 Food
Letters to the editor
26 Dear dietitian: nutrition special
Upfront
16 Favourite food memories 18 Recipes: Classic 1960s with a
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Community
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From the President From the Chief Executive News, views and research
Focus
10 C elebrating 50 years of Diabetes New Zealand Care and prevention
12 The emotional rollercoaster of diagnosis
Living with diabetes
24 Type-1 Sanofi cycle team 30 Ted MacDougall
16
modern twist
15 Diabetes New Zealand Conference
19 Life Education Trust 28 World Diabetes Congress
Diabetes Youth
31 President’s report 32 News and events 33 Watch out for the little guys The last word
34 Sandra Greig’s story
Physical activity
20 Community gardening good for diabetes
Treatment
22 How times have changed
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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 369 636 Email: membership@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.
Not yet a member of Diabetes New Zealand or your local diabetes society? Call 0800 369 636 now to join or visit www.diabetes.org.nz Membership includes a free subscription to Diabetes magazine
FRO M TH E PRES I DENT
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Pharmac should reconsider sole supply After years spent writing, editing and publishing magazines, I should know the challenges of penning a column that is as relevant and interesting at the time of publication as when it was written. But I don’t, so here I am thinking… when my visit to Pharmac with Joe Asghar, our CEO, just before Christmas springs to mind. I appreciate Pharmac’s willingness to meet on issues of importance to people with diabetes. Of course we don’t always agree and sometimes I leave feeling they don’t really get what it is like to live 24/7 with a disease with high demands. They are not alone in this of course. Naturally much of our discussion focused on the RFP (request for proposal) for diabetes management products under consideration at the time. It covered blood glucose and ketone meters and strips, insulin pumps and consumables, and rapidacting insulins. While Pharmac asked for proposals for insulin pumps and consumables it offered no guarantee there would be funding. At the time of writing, a decision on the funding of pumps is still awaited. This document also referred to sole supply options, and preferred rapidacting insulin for first line treatment. Such references made for unease
and Diabetes New Zealand wrote to this effect to Pharmac on behalf of people with diabetes. For chronically ill people, whose lives are entirely dependent on treatments and medicines, without which death is certain, a real vulnerability exists. I tried to convey this in Pharmac’s offices that day as we discussed things like supply chains and the isolation of New Zealand from these and the rest of the world. But I left feeling I hadn’t succeeded. Nor, as these things are not easily measured or scored, do I have confidence that Pharmac’s evaluation systems have any ability to take them into account. Perhaps you have to live it to really know it. But what if the whole country was affected by supply chain disruption and we were all using a single product? It is not entirely beyond possibility despite the best efforts to avoid such scenarios. Indeed, while there, I picked up the latest Pharmac Annual Report and I noticed a section that reported on ‘out of stocks’. They obviously do happen but while the document reassures the reader that ‘stock management is covered in contracts with suppliers’, this is obviously cold comfort. Contracts don’t solve the problem if a medicine is unavailable! They only describe liability (and who pays) while the patient’s immediate situation is no different. I also noted in the same report that Pharmac saved an impressive $76.2 million in the year, largely
diabetes nz supplies www.diabetessupplies.co.nz 4
DIABETES | Autumn 2012
through ‘effective negotiation and procurement initiatives’ with suppliers. Money saved in this way is re-invested in broadening access to medicines. However the combined spend on diabetes-related medicines in the new or extended access category was only 1.9 per cent of the total category spend. One of the main sources of savings is negotiation on older medicines and I feel certain that diabetes as a sector is not enjoying many benefits of the savings it has undoubtedly yielded. I am aware there are treatments available that many believe should be offered to New Zealanders. These include insulins and hypoglycaemic agents for the treatment of Type 2 diabetes. I would like to think people with diabetes in New Zealand could reasonably expect access to current treatments. With the focus on sole supply, I am sorry to say I have lessening confidence this is possible. Yours, in good diabetes care and management.
Chris Baty National President * At the time of going to press, Pharmac issued a consultation paper on the sole supply of blood testing strips and meters. For latest details, see our website www.diabetes.org.nz
Diabetes NZ Supplies is a registered charity 100 per cent owned by Diabetes New Zealand. All profits we make go directly back into helping people with diabetes. We provide a wide range of useful products from pedometers to diabetes-friendly foods. We also supply blood glucose testing strips directly to your door. See the website for details.
Call us (Monday to Friday, 8–5pm) on 0800-Diabetes (0800 342 238)
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FROM THE CHIEF EXECUTIVE
Reflections on 2011 As we launch into 2012 I can’t help but reflect on the challenges and achievements of the past 12 months. As an organisation with limited government financial support what has been delivered has been significant. Our relationships, standing and credibility with other NGOs, funders, ministries and ministers, and pharmaceutical companies has improved. We have had a continuing involvement in policy development and projects to improve the services for people with diabetes. We have reached overseas and started conversations with Diabetes Australia and Diabetes UK to develop best practice standards. We have been working through the New Zealand Society for the Study of Diabetes, diabetes nurse specialists, dietitians and podiatrists to improve access to relevant information. We have built relationships with many others including the Diabetes
Projects Trust, Te Roopu Mate Huka O Aotearoa, Freemasons NZ, Life Education Trust, Kidney Health and the National Health Board. These relationships allowed us to work across a variety of areas on behalf of people with diabetes. There have been a number of changes at National Office. We have brought accounting functions for Diabetes New Zealand and Diabetes New Zealand Supplies in house. Our contract editor and designer have responded to your suggestions to improve the look and feel of Diabetes. Our communications activities have raised awareness about Diabetes New Zealand. We have continued to deliver support to the unification programme, train field officers and other staff, as well as run regular events at Parliament to inform MPs on the needs and challenges for people living with diabetes. We are operating in challenging times. We are one of over 25,000 New Zealand registered charities competing for resources. Over the past year we have seen increased demand for our services, coupled with a drop in income and the
value of our assets. Donations and funds are harder to come by, and we have seen difficulties in attracting volunteers. At a time when doing more with less is the catchphrase we will have to be (and be seen to be) an organisation that works to consistent standards and practice if we are to secure funding and contracts to provide services and support. As Diabetes New Zealand moves into its 50th year we find ourselves facing a diabetes epidemic with no national diabetes plan. Still, we remain steadfastly committed to pushing this issue to the fore and making real gains for people with diabetes. We will be working hard to ensure that the voices of people with diabetes are heard. While we have a challenging road ahead, we are helped enormously by the foundation stones laid by Diabetes New Zealand over the past 50 years that will take us solidly into the future.
Joe Asghar Chief Executive
See our website for advice, tips and ideas on how to live well with diabetes: www.diabetes.org.nz
Diabetes New Zealand PATRON: Sir Eion Edgar PRESIDENT: Chris Baty CHIEF EXECUTIVE: Joe Asghar COMMUNICATIONS MANAGER: Lisa Woods DIABETES NEW ZEALAND INC. NATIONAL OFFICE: Level 3, Revera House, 48-54 Mulgrave Street, Thorndon, Wellington 6144 Postal Address: PO Box 12 441, Wellington 6144 Telephone 04 499 7145; Fax 04 499 7146 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 societies across the country. We also support research into the treatment, prevention and cure of diabetes.
Call now to make an instant $20 donation:
0900 DIABETES (0900 86369)
Autumn 2012 | DIABETES
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NEWS, VIEWS AND RESEA RCH
Nutrition label gets green light A simple colour-coded front-of-pack ‘traffic light’ system helps consumers make healthy food choices, according to a study from the Edgar National Centre for Diabetes Research, at Otago University. Researchers compared the traffic light system, used voluntarily in the UK, with the Nutrition Information Panel, mandatory in New Zealand since 2002. They found using a green-yellow-red colour code for low, medium and high salt levels was the easiest-tounderstand way of highlighting healthier food.
LOW FAT LOW SATURATES MED SUGAR HIGH SALT
Dr Rachael McLean, one of the study’s authors, said: “We believe the simple colour-coded message of the traffic light labels makes them easier to understand than the more detailed information in the other labels tested.” Food labelling in New Zealand is currently being reviewed with the aim of introducing clearer front-of-pack food labels by the end of 2012. Details on the kind of labelling system to be used, and whether it will be mandatory, are due to be announced in June.
Birth defects risk in mums with diabetes The risk of a baby having a birth defect quadruples among mothers with diabetes, according to research carried out by Newcastle University and published in Diabetologia. The study analysed data from 400,000 pregancies and found that the risk of birth defect went from 19 in every 1,000 births for women without diabetes to 72 in 1,000 births for those with the condition. Researchers say that sugar levels in the run up to conception were the most important risk factor, which could be controlled. Women should try to reduce their HbA1c levels to 43 mmol/mol before trying to have a baby, they advise.
Left: Sainsbury’s brand in the UK have voluntarily adopted the traffic light colour coding on their products’ nutrition information panels.
Glucose levels in teardrops tested Researchers looking for a non-invasive alternative to finger pricking have been seeing if they can accurately measure glucose in a person’s tear drops. Using rabbits, researchers used a needle-type electrochemical sensor on tears collected via a capillary tube. A strong correlation was seen between tear and finger-prick blood glucose levels. Commenting on the research Dr Jeremy Krebs said: “It certainly has the potential to overcome the finger prick barrier but only time will tell if it will become a useable clinical tool.” Source: Diabetes & Obesity Review
B12 vitamin deficiency and metformin A new study has argued that people who have developed Type 2 diabetes and are taking the oral drug metformin to treat it should take more than the recommended daily allowance of vitamin B12. The research, which was published in Diabetes Care, assessed data from the National Health and Nutritional Examination Survey (NHANES) in the United States between 1999 and 2006. The data showed the prevalence of B12 deficiency was greatest for people with Type 2 diabetes taking metformin compared with those with Type 2 diabetes but not taking metformin, and those without diabetes. Source: diabetes.co.uk
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DNA link to diabetes in poorest parts of city A study has found that people from the most deprived parts of Glasgow were more likely to develop diabetes and cardiovascular problems in later life. A study by scientists at the University of Glasgow compared the DNA of people in the Scottish city’s most deprived and affluent areas. They found people from the poorest parts had DNA that made them more likely to develop diabetes and cardiovascular problems. The findings help explain why Glaswegians have higher levels of ill health than those in other parts of the UK. To read the full study, go to: www.gla.ac.uk.
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NEWS, VIEWS AND RESEA RCH
Four new genes linked to diabetes
Beta cells grown in the lab
Researchers have found four new genes linked to Type 2 diabetes after analysing 50,000 genetic variants across 2,000 genes linked to heart and metabolic function. The findings were published in the American Journal of Human Genetics following the largest genetic study of its kind into Type 2 diabetes. Multiple genes and environmental factors interact with Type 2 diabetes.
We depend heavily on donations, legacies and membership fees to help us do our work. Please help us educate and support people with diabetes so they can live well with it.
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Type 1 diabetes begins when the body’s immune system attacks its own insulin producing beta cells. Previously, beta cells have only been available from human or animal donors. This has meant that beta cells have been in short supply, even for research purposes. Production of beta cells from the new method described could open doors for more research into beta cells to be possible. www.diabetes.co.uk
The results offer valuable insight into the genetic risk for Type 2 diabetes in multiple ethnic groups and could help lead to new treatments, say the researchers.
Ways to give
Researchers from the University of Pittsburgh have discovered new ways to grow human beta cells in the laboratory – opening up potential new avenues for research. Beta cells are usually very slow to divide within the body, which is one reason why Type 1 diabetes is able to develop very quickly.
Bacteria linked to diabetes risk
Actor loses weight after pre-diabetic diagnosis
The bacteria Helicobacter pylori, which causes ulcers, has been linked to a higher risk of developing Type 2 diabetes, according to a study published in Diabetes Care.
The 30 Rock actor, Alec Baldwin, radically changed his eating habits after being told he was pre-diabetic and at risk of developing Type 2 diabetes.
Researchers followed 782 diabetesfree individuals over a 10-year period and found that those who had been infected with Helicobacter pylori were 2.7 times as likely to develop diabetes. The findings suggest a potential role for antibiotic and gastrointestinal treatment in preventing diabetes, claim the researchers.
He told Access Hollywood: “I gave up sugar. I lost 30 pounds in four months. It’s amazing. I do Pilates and spin, but I don’t do as much yoga as I’d like. But sugar was the real killer for me – that was the problem.”
How can you help? • • • • •
You can make a regular donation or a one-off donation. You can leave us a bequest in your will. You can call 0900 86369 to make an instant $20 donation. You can sponsor a special event such as Diabetes Awareness Week. You can sign up to payroll giving.
A third of money donated can be claimed back as a tax refund. Donations are tax-deductible up to the donor’s full annual income. Visit www.ird.govt.nz for more information. Please talk to us to discuss your donation options. Call Freephone 0800 369 636 or email fundraising@diabetes.org.nz
FO CU S
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GO ING FOR GOLD
Dedicated to diabetes Diabetes New Zealand is celebrating its 50th anniversary this year. Much has changed since 1962 when the organisation was born following a meeting in the basement of a Wellington library. Caroline Wood reports. In the decade leading up to the early 1960s, small groups of enthusiastic volunteers across New Zealand offered varying degrees of local support to people with diabetes. There was no national voice to lobby the government for improvements in the health system or to give a single voice to champion for people living with diabetes. Founding member John Reid recalled in Bee Dawson’s book Dedicated to Diabetes: Diabetes New Zealand 1962–2002 that the local Wellington diabetic group was made up of sincere and concerned people all willing to work hard but with no idea of what to do. In it he says the group’s efforts often focused on relatively trivial areas, such as shortages of special diabetic foods. However they realised there must be other similar groups throughout New Zealand and thought they should combine to become more effective. Contact was made with other diabetic groups in Auckland and Christchurch and it was agreed that a national body be set up.
THE DIABETIC ASSOCIATION OF NEW ZEALAND (INCORPORATED)
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The conference agreed the organisation be called the Diabetic Association of New Zealand. It was to change its name in 1985 to the New Zealand Diabetes Association and then to Diabetes New Zealand in the late 1980s. A fee of two shillings per member would yield approximately 70 to 80 pounds to help fund the new association. It was the first time a nationally co-coordinated approach had been taken to diabetes support education.
The Medical Panel, later to become the New Zealand Society for the Study of Diabetes, was established in 1963. In the same year, the association also established a research fund with an initial balance of £310. Member societies were expected to contribute funds to this annually.
1974
1989
Russ Finnerty reads the original minute books from 1962 at National Office.
key issues. Education, especially in relation to diet, was another issue. And so was research – this was perceived as a chance to create some medical miracle.”
The forerunner of Diabetes magazine, the NZ Diabetic Review, was established in 1962 with 1,000 copies being produced at a cost of £25 13s 6d. The first editor was Neville Martin. He became the first paid employee of the Diabetic Association of New Zealand and in 1969 was paid the princely sum of $30.
John Reid was made Secretary of the new association and served from 1962 to 1964, when he became President. He was quoted in Dedicated to Diabetes as saying: “At the outset it was acknowledged that awareness and prevention would be
The group that met at Wellington Public Library on Saturday 17 February 1962 was small but enthusiastic. The establishing conference was attended by representatives of diabetes groups
1962
in Auckland, Waikato, Wellington, Nelson, Marlborough, Canterbury and Otago. Mr F Bodley, the President of the Wellington Diabetic Association, was appointed Chairman.
The newly-formed association took tentative first steps but over the next five decades it grew to make a significant contribution to improving the lives of people with diabetes. Russ Finnerty, President of Diabetes New Zealand in 1987 and again in 2002, first joined the association in 1974 holding a number of leading roles since. He said: “The biggest difference over 50 years is the professionalism of national office, it has given us credibility in our lobbying of government, it gives us a real voice. It’s able to present a better and more complete picture of what diabetes is really all about. “The main achievements of DNZ
1996
NEW ZEALAND DIABETES ASSOCIATION INC
DIABETES NEW ZEALAND INC.
Diabetes New Zealand
2007
G O I NG FO R G O LD
The first national children’s camps were held at Wainui, Banks Peninsula, in 1968 providing children with diabetes a new-found independence away from their families. New societies were set up around the country, extending the support network for individuals with diabetes. Fundraising drives were launched to raise money. The first Diabetes Awareness Week was launched in 1976 following a successful awareness week run by Auckland’s society. Diabetes Youth was set up in 1991 to support children and young people with
FOCUS
diabetes. The mail order diabetes products company Diabetes Supplies Limited was also established in the 1990s to supply blood testing materials to people with diabetes. Diabetes New Zealand is now a dynamic organisation with 11,700 members and a national office in Wellington supporting 36 local diabetes groups throughout New Zealand. COURTESY HOCKEN LIBRARY, UNIVERSITY OF OTAGO
over the past 50 years include a better supply of medical services, the introduction of the Get Checked programme, better delivery systems, for example insulin pens, and the introduction of new and better insulins.”
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Over the past half a century, thousands of hard-working volunteers across the country have worked tirelessly for people affected by diabetes by raising awareness, educating and informing people about diabetes, its treatment, management and control. We salute their efforts while recognising there is still so much work to do. What will the next 50 years bring?
An early cover of NZ Diabetic Review (Vol 1, No 4, May 1963) the forerunner of Diabetes magazine. It was first published 50 years ago by the newly formed Diabetic Association.
this role is part-time for 3.5/10 (14 hours per week), with the remainder of the hours covering General Medicine position, Auckland City Hospital, to make a full-time position. You must have the appropriate post graduate qualification or Fellowship in the relevant area and hold or be eligible for specialist registration with Medical Council of New Zealand (www.mcnz.org.nz). ADHB provides acute and tertiary clinical services for the population of central Auckland, a tertiary referral service for the greater Auckland region and a National Transplant Service. General Medicine, the core of the medical inpatient service, is very well supported by the range of tertiary services that you would expect from New Zealand’s largest hospital complex. ADHB is the largest clinical research facility in New Zealand, engaging in work that attracts funding and participation here and overseas. We are ideally looking for a Diabetologist who would like to divide their time between Diabetes and General Medicine. You will have wide experience in all areas of clinical diabetes – ideally including adolescent, renal and foot experience and a desire to share this knowledge across General Medicine. The Diabetes component of
For more information, please contact either: Dr Paul Drury, Clinical Director, Auckland Diabetes Centre on pauld@adhb.govt.nz Or Dr Robyn Toomath, Clinical Director General Medicine on rtoomath@adhb.govt.nz and quote job
For the biggest health sector job board in New Zealand visit www.kiwihealthjobs.com
www.aucklandhealthjobs.co.nz
FREEPHONE 0800 733 968
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D EALING WITH DI AG NO S I S
The emotional rollercoaster of diagnosis Shock, anger, grief, fear – some or all of these emotions are often felt on diagnosis, whatever your age. Award-winning Starship nurse Rosalie Hornung helps children and teenagers accept and manage their diabetes. She explains the emotions experienced when a loved one is first diagnosed and answers some common concerns.
The time after diagnosis is a very difficult time for families. Parents sometimes suppress their feelings of helplessness and overwhelming grief to avoid their own emotions or because they feel too embarrassed to admit how they are feeling. Parents need to recognise their vulnerable state and be mindful of their own needs in addition to the needs of their child and their siblings.
Shock “Diabetes! What on earth…?” Families are often completely shocked when they are first told their son or daughter has Type 1 diabetes. Some families seem to put emotions aside and slip into a feeling of non-reality, where the news hasn’t quite sunk in, relying heavily on automatic instincts to keep going. Parents have explained feelings of wanting to curl up in a ball, unable to stop crying – all of this is completely normal.
Denial “There must have been some kind of mistake…where can we get a second opinion?” The news to families can be so overwhelming that it seems impossible to believe. Families will often question the validity of test results, the possibility of tests being mixed up or misinterpreted. Children in denial may express their feelings by avoiding finger-pricks, injections, or avoiding interactions with diabetes team members. This is a normal reaction and is so common that it is accepted as part of the process of dealing with the diagnosis of diabetes. “When my child was diagnosed, I kept waiting for somebody to come through the door saying: ‘So sorry, we have made a terrible mistake, actually your child doesn’t have diabetes after all’. But nobody came to say it and gradually we had to adjust to this new life of testing and injections,” – a parent on their child’s diagnosis. Denial provides space for individuals to cope with the shock of the diagnosis. It can protect families against becoming overwhelmed with depressive thoughts and makes way for the acceptance of information a little bit at a time. Feelings of denial will be replaced by feelings of acceptance eventually.
Anger “Why me, why my child?” The crisis of a new diagnosis will put stress on family relationships. Families can be angry and looking for somebody to blame, finding themselves becoming irritable
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and losing their temper often. Families may find themselves being angry with members of the diabetes team or with other family members. Families need to remember that these kinds of reactions are a normal part of acceptance of the diagnosis. Everyone in a family will move through these feelings at a different rate and it is important families understand that people deal differently with their feelings. Feeling tearful and crying a lot, or keeping busy and ‘getting on with life’, are both appropriate ways of coping and should not be judged. There are multiple ways of coping with different situations and the diagnosis of a child with diabetes is no different. Siblings may feel neglected and have feelings of resentment towards their brother or sister for the increased attention that the diabetes demands. Loving support and reassurance is needed to support relationships between siblings.
“He is almost 10 – surely he should be doing most of this stuff himself?” The responsibility of day-to-day diabetes tasks in childhood ideally needs to be owned by parents/carers until the child is 16 years old. It is so much more than a question of physical ability. To share the burden of diabetes management is to share the emotional load and families need to be counselled in a team approach to care. This means everybody in a family having a valued role and responsibility.
Sadness “I feel so sad my child has diabetes, I wish it were me instead. Will I always feel like this?” There will always be feelings of loss after the diagnosis of diabetes. Families grieve the loss of a healthy child just as they would a death in the family. The period of mourning can last for some time and all individuals will vary with this. Mood can vary from being very sad and upset to being moderately depressed.
Fear “How will I be able to look after my child, what will the future hold?” Families are commonly flooded by fears for their newly-diagnosed child. Families worry about their child’s survival, the impact of the diabetes on future goals and ambitions. Much of the fear is based on the unknown and will be addressed over time as families grow into living alongside diabetes. “How will I ever cope with this?” The period after diagnosis can be an emotional rollercoaster for families. During the ‘downs’, feelings of grief, fear, denial and hopelessness can be reignited. Autumn 2012 | DIABETES
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During the ‘ups’, confidence and a sense of control may dominate. These erratic swings are normal and commonly experienced but eventually there will be more ups and fewer downs as the emotional journey takes a turn. Taking time and talking to others – family, friends, members of the diabetes team – will help with working through feelings of shock and confusion. Children will be experiencing the same or similar feelings as their parents and will need somebody to talk to. Children will want their parents to listen as soon as they are ready to talk about how they are feeling. Every family with a newly-diagnosed child should seek the help of a psychologist or social worker to talk through the emotions they are feeling.
Confusion “But my child will grow out of diabetes – yes?” Children never ‘grow out of diabetes’. Nor does it ever develop into Type 2 diabetes. “My child is sucking his thumb again – why is this happening?” There is no reason to be concerned if a child ‘regresses’ after the diagnosis of diabetes. Toddlers may ask for a bottle instead of a cup, or revert to crawling instead of walking. Older children may wet the bed. This regression is an accepted reaction to stress and will be temporary. Children in this state need much support and loving attention to support them through this phase of adjustment. “Will I catch it too?” Siblings of a child with a new diagnosis of diabetes will also need to have their feelings and fears acknowledged and understood. Simple explanations of diabetes will allay fears around the misunderstanding that people can
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“Things will get better” — ROSALIE HORNUNG catch diabetes or some other illness. Diabetes cannot be caught from another person. It is not contagious.
“What will other kids think of me now I have diabetes?” School age children may harbour fears about feeling different to their peers. This can lead to a reluctance to share information about their condition and management needs and further exacerbate feelings that life is completely dominated with unpleasant regimens and routines.
Guilt “What have I done wrong, I should have done something to stop this, my grandmother had diabetes, oh my god, is this my fault?” Parents naturally want to protect their children from harm. Often parents mull over what they might have done differently to change things. Type 1 diabetes is a chronic auto-immune disease where the body’s own immune system progressively destroys the insulin producing beta cells within the pancreas. The environmental triggers that start this process of beta cell destruction remain largely unknown. In a person with diabetes the blood glucose level rises because of the lack of insulin. There is currently no treatment proven to prevent or stop diabetes from developing in children.
“Is this happening because I have done something bad?” Children can feel guilty too, sometimes feeling that the diabetes is a punishment for something bad they have done. Type 1 diabetes in childhood is not caused by eating too much sugar or any other foods. Siblings may feel guilty that it was not them who got the diabetes or may wonder if they have somehow caused the diabetes due to an argument or physical conflict.
Facing the future “My family is not coping, where can we get help?” Diabetes is a condition that is ideally cared for by a team of specialists – doctors, diabetes nurse educators, dietitians, social workers, psychologists and hospital ward staff. Families of children with Type 1 diabetes are the most important part of the diabetes team. If you or your child is not coping, ask your diabetes team for help, they are there to assist. Things will get better with the right family and professional support.
Rosalie Hornung Rosalie trained in Melbourne, Australia. Her 20-year career in nursing includes 10 years based in paediatric diabetes. Rosalie has worked in professional, clinical and research-based nursing posts around the world, including Melbourne, Sydney, Newcastle (UK), London, Toronto and New Zealand. She holds a masters degree in Nursing; a first-class honours degree in Applied Science, Nursing; and a postgraduate Diploma in Diabetes Education and Management. She joined the Starship team in Auckland in 2003. Her current professional area of interest is adolescent health. Over the past six years she has worked to establish an effective Adolescent Transition Service for Starship in collaboration with Young Adult Clinics throughout Auckland. She was awarded the Eli Lily Diabetes Partnership in Diabetes Award (Diabetes Nurse Category and overall winner) in 2008.
D IABETES NEW ZEA L A ND CO NFERENCE 2 012
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Looking to the future The 2012 Diabetes New Zealand conference promises to be bigger and better than ever before. And three lucky people qualify for free registration. Organisers have pulled out all the stops to present an exciting and varied programme of events for this year’s Diabetes New Zealand conference and 50th AGM. The conference will focus on current and future developments in diabetes and features a full programme of talks, workshops and social events. The conference, which takes place in Wellington from 25 to 27 May, 2012, has an impressive line up of speakers. To help celebrate Diabetes New Zealand’s 50th anniversary, the organisation is offering FREE registration for three lucky people. They are looking for: • the person who started insulin closest to 17 February 1962 • the person with Type 1 or Type 2 diabetes born closest to 17 February 1962
• a child with Type 1 diabetes born closest to 17 February 2007. One of the highlights of the threeday event will be the reception at Government House celebrating the 50th anniversary of Diabetes New Zealand. It will take place at 4pm after the AGM. Transport to and from Government House will be provided. Later that day the conference dinner will be hosted by Diabetes New Zealand and Diabetes Youth. Guest speakers will include sprint cyclist Stephanie McKenzie, who featured in the Spring issue of Diabetes. A full conference programme follows on the Saturday and Sunday, with lots of opportunity to mix and mingle with a who’s who in the world of diabetes. Conference manager Russ Finnerty said: “We have listened closely to what members asked for and come up with a great programme that focuses on current and future developments in every area of diabetes.” There are workshops on sex, pregnancy and diabetes control; alcohol; leaving home and finding
independence with diabetes. There will be plenty of sessions on food and nutrition. Master Chef winner Nadia Lim will be leading a session on how to make food more exciting. Dr Peter Moodie, Medical Director of Pharmac, will give a talk Trends in Diabetes Pharmaceutical usage in New Zealand. Other keynote speakers include Professor Jim Mann, who will talk about Fat, Fallacies and Facts. There will also be talks on future developments in diabetes treatment. The closing speaker will be our patron Sir Eion Edgar, talking about where we have come from and where we are headed. The theme of Diabetes New Zealand’s 50th birthday dinner on the Saturday night is ‘That Golden Feeling’ with a strictly sixties dress code. You need to get in quick as places are limited. Early bird discounts are available until 31 March.
Got to www.diabetes.org.nz for the full programme, cost and registration details. Don’t forget to apply for a free registration if you think you may qualify.
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BACK I N THE DAY
Favourite food memories from 50 years ago
The year was 1962. The Cold War was at its height with the Bay of Pigs crisis; President Kennedy set the goal of landing a man on the moon; the Beatles made their debut recording Love Me Do. Fifty years on and some of us will have forgotten what we used to eat; others will be too young to remember. Once I started to think about food in the 1960s my childhood memories flooded back. Everyone I spoke to had their own favourite food memories but how many of the recipes we used then are still on our daily menus today? Many of the recipes my mother and grandmother used had been passed on to them from friends and family. I still have my grandmother’s handwritten Christmas pudding recipe. It makes three large puddings. The ingredients have not changed but the utensils have. It is much easier to boil your puddings for six hours when you have a copper!
Collecting shellfish at Muriwai beach, 1964.
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A favourite recipe for Orange and Coconut Cake comes from a 1960s church cook book, now very dogeared and dirty with more than a few pages missing. There would have been no cake suitable for someone with diabetes in the 1960s and most of the recipes from that period would not have provided the lowsugar, low-fat diet recommended for people with diabetes today. Recipe books for people with diabetes would have been difficult to find in the 1960s, which inevitably meant the choice of food was limited and different from other family members. While many of us may grumble about our weekly shop at the supermarket, it is far easier now than in the 1960s… or is it? Supermarkets were still new 50 years ago. Our groceries came from the local Four Square shop run by the Hoggs family (father and son). They knew us all by name, most families had an account there, but it was difficult to sneak a K Bar or something that was not on the list on the account! There was also a weekly trip to the local butcher and the greengrocers at the bottom of the hill. The variety of foods was much more limited in those days. There were no freezers full of frozen convenience foods to tempt
us, no time-consuming choosing between the five different varieties of frozen oven chips. Meat, potato and vegetables made the standard evening meal. Fruit and vegetables were seasonal and I have vivid memories of my mother spending hot summer days bottling fruit and making jam when fruit was plentiful and cheap. Cases of stone fruit would be sent down on Newmans’ buses from friends in the Hawke’s Bay. The taste of bottled apricots during the winter months was wonderful and homemade raspberry jam remains a favourite. But both were a ‘no no’ for people with diabetes due to the amount of sugar used in them. Even Watties tinned fruit was out for people with diabetes because fruit in natural juice was not available in those days, only ‘fruit in syrup’. Vegetables like beetroot and beans were also preserved for use later in the year. Frozen vegetables were available – in the 1950s Watties were the biggest frozen food producers outside the USA – but household freezers were not common in the early 1960s. If you did not have a freezer there was always freeze-dried ‘Surprise Peas’, cooked in two to three minutes. Today a key part of healthy eating for people with diabetes is low-fat dairy produce. But in the 1960s milk PHOTOGRAPH BY GREGORY RIETHMAIER, NATIONAL PUBLICITY STUDIOS COLLECTION, COURTESY OF ARCHIVES NEW ZEALAND
Our diet has changed hugely since the sixties. Fifty years ago food was simple and plentiful but life much harder for those with diabetes. Wellington dietitian Ann Gregory takes a trip down memory lane.
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FOOD
Changing food fashions
Rice and pasta were not available in the varieties there are today. Rice was more commonly used to make puddings rather than being served with the main course. White bread was normal for sandwiches, no granary or seed breads. I can remember being the only child with brown bread sandwiches when my mother discovered ‘Nysoy’ bread. Pots of fruit-flavoured yoghurt were not available until the late 1960s. Tetra packs of fruit juice were a long way off, cordial in a drinking bottle being the standard ‘back in the day’. Without the number or variety of restaurants that there are today, eating out was also very different. No KFC, Pizza Hutt or McDonald’s: they did not arrive in New Zealand till the 1970s. A holiday treat was being taken out for roast chicken and trifle.
and cream were delivered to the gate in glass bottles and paid for by milk tokens. Two types of milk were available then, pasteurised ‘silver top’ and homogenised ‘silver and blue striped top’. Low-fat cheese and cottage cheese were not common. A friend whose father owned a grocery store remembers him cutting pieces off a large block of either Cheddar or Colby but no lower fat Edam. Margarine was only available on prescription. In the 1960s people with Type 1 diabetes, or Type 2 needing medication (there were no tablets), had to limit the amount of carbohydrate eaten and were encouraged to have protein snacks, such as cheese and crackers, to ensure an adequate energy intake. The same amount of carbohydrate had to be eaten at a meal each day to match the insulin, the amount being calculated using a portion system. People with diabetes were not allowed sugar, or sugar-containing
We did not have the coffee culture that we have today. Tea was the preferred hot drink. Instant coffee was not introduced in New Zealand until the 1960s when coffee bars also started to appear serving ‘Cona’ coffee. Some things have not changed: Hokey Pokey ice cream and Jelly Tips are still available. Kiwi classics such as Afghans, Anzac biscuits and ginger crunch are still favourites and bacon and egg pie can still be found in most café cabinets.
Shopping at Woolworths Supermarket in 1964.
PHOTOGRAPH BY JOHN LE CREN, RAILWAYS COLLECTION, COURTESY OF ARCHIVES NEW ZEALAND
Looking through the kitchen cupboards I realised many of the ingredients would not have been in my mother’s cupboard. No tarragon vinegar, balsamic vinegar or extra virgin olive oil for French dressing. Condensed milk salad dressing was the norm for salads.
foods, at all. So it wasn’t much fun if you were a child attending a birthday party! The variety of sugarfree foods was limited; no low sugar jams were available in the shops so you had to make your own. Some older people with diabetes talk about using the ‘red and black line system’ to manage their diabetes, involving weighing and measuring all their food. Not like today when the insulin can be adjusted to match the food being eaten. Dietary recommendations now allow people with diabetes to have a small amount of sugar as part of a healthy meal pattern. Children with diabetes can eat the same as their friends at birthday parties as long as their insulin adjusted to manage their blood sugars. In the last issue of Diabetes, one of the people who attended the Survivors’ Tea Party was reported as saying it is a lot easier now than it was 50 years ago. From the dietary point of view, I agree.
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Classic 1960s with a modern twist Recipes by Ann Gregory.
Coronation Chicken Coronation Chicken was one of my mother’s favourite special occasion dishes that she made for summer dinner parties and many charity luncheons. It was originally created by Constance Spry and Rosemary Hulme for the Queen’s Coronation as it was thought to be suitable for all the different races attending. The original recipe used mayonnaise and cream. Here I have substituted plain yoghurt and low-fat mayonnaise.
Brown Betty My grandmother believed we needed to have a pudding after our main meal. Most were fruit or milkbased with an occasional steamed syrup pudding. This was one of my favourites. I now realise it was a good way to use up stale bread and excess fruit! It does contain sugar but fits within the guidelines for a small amount of sugar as part of a healthy meal pattern. I have used apples but any fresh fruit may be used.
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INGREDIENTS 500g chicken breast without skin (two large) 1 tbsp vegetable oil 2-3 tsp curry powder (depending on your preference) 1 tbsp tomato paste 100mls of red wine (you can replace with chicken stock but it will not have the same flavour) 1 bay leaf 2 tbsp lemon juice 4 canned apricot halves 75 mls of reduced fat mayonnaise 200mls unsweetened plain yoghurt Salt and pepper Serves 4 NUTRITION PER SERVE: KJ: 1,496, Carbohydrate: 11.6g, *Fat: 13g. * Fat content may differ depending on the brand of low-fat mayonnaise and yoghurt used.
INGREDIENTS 450g cooking apples 100g bread crumbs (I used a mixture of white and wholemeal for a nutty flavour) 50g soft brown sugar 15g butter ½ tsp ground cinnamon ½ tsp ground ginger Serves 4 NUTRITION PER SERVE: KJ: 719, Carbohydrate: 34g, Fat: 3g
METHOD Heat the oven to 180°C and bake the chicken, covered, in the oven for 30 minutes or until tender. Remove from the oven and leave to cool. Meanwhile finely chop the onion. Heat the vegetable oil in a small saucepan and add the onion. Cook on a medium heat for three minutes until the onion is soft and translucent. Add the curry powder, tomato paste, red wine, bay leaf, and lemon juice. Lower the heat and simmer uncovered for about 10 minutes until reduced. Strain, discard the onion and bay leaf, and leave the liquid that remains to cool. Puree the apricots in a blender or by chopping finely and passing through a sieve. Place in a bowl and mix in the strained sauce, yoghurt and low-fat mayonnaise. Season with salt and pepper and, if necessary, extra lemon juice. Dice the cooled chicken and fold into the sauce. Serve with salad. METHOD Heat the oven to 200°C. Wash and core the apples then chop or coarsely grate them. Mix the spices with the sugar. Grease an ovenproof pie dish. Press a third of the bread crumbs in the dish, add half the apple and sprinkle over half of the sugar and spice. Repeat the layers, finishing with the breadcrumbs. Dot the remaining butter on top. Bake for 30 minutes or until the fruit is soft and the top golden brown. It is delicious served by itself but can be served with a spoonful of yoghurt or custard made with low-fat milk.
See our Letters to the Editor nutrition special on pages 26–27 for more ideas and advice on food and recipes.
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Working Together: Life Education Trust and Diabetes New Zealand The Life Education Trust’s schools programme helps educate children about healthy lifestyles. The Trust has started working with Diabetes New Zealand to try and combat diabetes and obesity in young people. The human body is magnificent! It’s an incredibly complex machine – the most complex machine we’ll ever operate. This complexity and helping children understand how the human body operates is a key philosophy of the Life Education Trust. Teaming up with Diabetes New Zealand to increase children’s awareness of the factors in developing Type 2 diabetes is a logical fit and a great example of two organisations working together for a common goal. “It’s really important to Life Education to work closely with organisations like Diabetes New Zealand to ensure we are promoting consistent messages to our youth,” says John O’Connell, Life Education Trust Chief Executive. The Life Education programme is a specialist health resource for schools offering 19 modules and 41 different lessons delivered from their mobile classrooms. Specialist teachers work with schools to support their health curriculum, teaching children about healthy eating, relationships, self esteem and covering topical issues such as drugs and bullying. Behaviours developed during childhood and early adolescence are predictors of adult behaviour.
“Our mobile classrooms attended 1,350 schools nationwide and visited over 220,000 children during 2011, that’s nearly half the primary and intermediate aged children in New Zealand.”
In 2008 the New Zealand Council for Educational Research conducted an independent evaluation of the Life Education programme. It found that many children post Life Education visits change aspects of their lifestyle to make it healthier. Two commonly mentioned changes were eating more fruit and vegetables, or watching less TV and doing more physical activity. Of the schools surveyed 99 per cent said the programme ‘reinforces key messages about health and the programmes fit with the school programmes and curriculum’ and 97 per cent said ‘Life Education gives students knowledge about health and their bodies.’
The food and nutrition strand with five modules targeting school children from years 1–8 educates them about a prevalent Type 2 diabetes indicator – obesity. “Our food and nutrition lessons teach about reading nutritional panels, understanding the energyin-and-energy-used connection and look closely, with students, into the sugar, fat and salt content of foods,” added Mr O’Connell. Life Education first started in New Zealand in 1987, when founder Trevor Grice brought the programme from Australia after seeing the immense benefits it brought there. It initially launched with two mobile classrooms, one in Auckland and one in Christchurch. Today the 43 mobile classrooms are a familiar sight – from the Far North to Southland.
Diabetes New Zealand estimates For more information on the the number of people diagnosed Life Education Trust check out with diabetes exceeds 200,000 www.lifeeducation.org.nz (predominantly with Type 2 diabetes). There are also about 100,000 people who have diabetes but have not yet Learning about the human body is fun. had it diagnosed. “More alarming for us is the prevalence of Type 2 diabetes being diagnosed in children. We hope we can assist Diabetes New Zealand through education to combat this rising issue,” says Mr O’Connell.
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BACK TO BASI CS
Sowing the seeds of change Our grandparents knew the benefits of gardening, it is good for the body, soul and pocket book. With smaller plots and less time, community gardens are springing up across the country. Richard Main and Kate Smallman, from the Diabetes Projects Trust, explain.
The Apna Vitika community garden is a Hope ’n’ Help Charitable Trust initiative, supporting the health and wellbeing of the Punjabi community in Papatoetoe, South Auckland. The garden sprang from humble beginnings in 2009 when the trust was seeking ways of engaging members in a health programme, specifically targeting diabetes and obesity. They sought the help of Vani Sankara, project manager for South Asian Health at Counties Manukau District Health Board, and Richard Main, project manager of Gardens4Health. Trust members Indu Bajwa, Karnal Singh, Kalwant Singh and Rita Singh obtained start-up funding for their community gardening project, which also includes cooking, nutrition and fitness classes. They started to dig the ground on private land in Papatoetoe donated for the project. The garden was named Apna Vitika which means ‘our garden’ in Punjabi.
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PHOTOS: MANUKAU COURIER
The Apna Vitika community garden is thriving. By the end of summer rows of plump green cabbages, eggplant and bitter melon were interspersed with mounds of fragrant coriander. All were ready to pick after weeks of pampering by members of the local community. They will soon be turned into delicious Indian curries.
Members of Apna Vitika garden project
Indu Bajwa explained: “In the Punjabi community, people were becoming less active, and there was limited opportunity for recreational activity, to grow food and there were language issues. Stress levels were growing, over eating was common and diabetes rates were increasing.” In response, the Hope ’n’ Help Trust developed a Health is Wealth vision, to improve nutrition, increase physical activity and reduce the incidence of diabetes. The garden project enabled participants to learn a range of food-growing techniques. They were also given language support so they could identify culturally appropriate plants and seed sources. Now they are able to grow their own fresh food with advice and support from the Gardens4Health team. The programme has proven to be transformational for members of the community who are out in the garden every week, guided by Rita and Karnal. Between 40 and 50 local people have been involved in the garden over two years. There is also an outreach scheme supporting 20 backyard gardens growing a range
of vegetables, herbs and fruit trees including cultural crops such as Eggplant (Brinjal), Bitter Melon (Kerala) and Coriander (Dhania). “Gardening, fitness, nutrition and cooking classes continue to be part of the daily lives of participants. More than 500 people have directly and indirectly benefited from the health initiative,” adds Indu, who gives regular updates on the garden on her weekly slot on Radio Spice, a local radio station. The Gardens4Health team continues to work alongside the trust, offering advice, support and guidance in conjunction with other Diabetes Projects Trust services, such as ‘Healthy Eating On A Budget’. The aim is to grow a network of linked Gardens4Health community gardens and sow the seed for change in communities across the Auckland isthmus. You can contact Gardens4Health on 09 273 9650. There is lots of useful information about community gardens and other diabetes-related projects on the Diabetes Projects Trust website: www.dpt.org.nz
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Garden project grows healthy communities Huhana had been up in Northland for the Christmas holidays. She had diabetes that was not well controlled, but she noticed her blood sugar levels were almost normal while on holiday because she had been gardening most days. On her return to Auckland she became involved with a community garden and was planning to start a garden at her home. Huhana is a good example of someone who has discovered a love of gardening and is enjoying the benefits it can bring, not only to her health but to her bank balance and social life too. The Gardens4Health initiative is only two years old but it has already helped establish more than 40 community gardens across Auckland. Gardens4Health grew out of a community gardening pilot set up by the Counties Manukau District Health Board. The aim was to increase physical activity, improve nutrition, and build communities socially and culturally. The Diabetes Projects Trust, a community organisation based in South Auckland, took over the management of the programme in 2009. At the beginning there
begun to realise you can sustain your food needs by growing healthy kai in a community garden. There are economic benefits but also health, social, psychological and environmental ones as well.”
were just 12 community gardens in the Counties Manukau area. But funding sources increased and the programme spread across Auckland. By the end of last year there were 43 community gardens with Gardens4Health involvement, covering the Waitemata, Auckland and Counties Manukau district health board areas. Full-time project manager Richard Main, of Diabetes Projects Trust, said: “We have seen a 150 per cent increase in demand for our services, that shows the level of interest in community gardens. “I think people are struggling because of the economic downturn, life has become more difficult for a lot of people and food prices have gone up. People have
Gardens4Health doesn’t own or run gardens, it assists others to set up their own gardens and supports them to run them in a sustainable manner. The degree of support and input from garden to garden varies considerably, and may change over time as the needs of the community garden change.The service currently offers start-up advice, support to garden mentors and coordinators, funding advice, budget reality checks, gardening advice, workshops, access to supplier networks and links to other gardens. Research suggests that gardening is an great tool to help combat obesity and related disorders, such as diabetes, cardiovascular disease, and some forms of cancer. Community gardens are also seen to bring many other benefits, not just for health – there are social, financial, and environmental gains as well.
How to start a community garden Scope
Plan
Decide
Have a look around and see what is happening in your own community. Speak to people who are already running a community garden. You will need to estimate costs including land, wages and materials. Speak with your local council to see if they can offer advice and help. Find local people to help and support the project. Look at different venues and do an assessment of water, drainage, sun and soil composition.
Organise a community group and set up a committee. Decide on a name for the garden, with a vision and foundation principles. Make a budget and resource requirements. Formalise an agreement with the land owner that includes lease and liability costs. Define health and safety policy. Plan the development of the garden. Organise training and workshops, also working bees and open days for the community.
Get support from a garden mentor to help plan the concept of the garden. You will need to agree on the garden approach – will it be organic, biodynamic, permaculture, bio intensive, natural farming or a cultural garden? There is a lot to think about, but it is worthwhile. Have fun and enjoy the experience. Eat and share the produce, you might even grow enough to sell!
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THEN AND NOW
How times have changed (for the better) in 50 years Retired Wellington diabetes physician Dr Bob Smith, who practised medicine for nearly 50 years, looks at how diabetes treatment has changed by comparing 1962 with today.
Terminology Then: In 1962 people would say you had ‘diabetes’ (meaning Type 1) or ‘mild’ diabetes – a label that referred to the way it was treated (with diet alone or with tablets that had become available in the previous decade). But really there was never anything ‘mild’ about diabetes given the complications. The names used then were ‘juvenile-onset diabetes’ and ‘maturity-onset diabetes’. These became insulin-dependent diabetes and non-insulin-dependent diabetes in the 1970s. Now: Type 1 and Type 2 diabetes respectively. There are undoubtedly even more sub-types of diabetes and I believe a better variety of treatments will be developed as the specific causes are better understood.
Monitoring Then: The goal was to be blue. This referred to a urine test with Benedict’s solution and a messy boiling process. A blue colour meant the urine was sugar-free; orange or, heaven forbid, brick red meant the urine was loaded with sugar. Things became easier and less messy when Clinitest tablets became available. Various tape or strip forms of urine testing were developed later. But urine tests were not all that useful; they might tell how bad things were but not how good, or how low. During the 1970s home blood sugar testing became possible using a drop of blood on a strip. Early methods were rather clumsy and slow. Now: Who could imagine using anything but blood glucose strips? Now it is possible to do a quick test at any time and virtually anywhere. Moreover the meters that read the result can be computerised to give all sorts of useful analyses of the results. Some people have used continuous blood glucose monitoring which has helped
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adjust treatment. Maybe the dream of a long-term implantable monitoring device might one day make finger pricking a thing of the past.
Treatment goals Then: In the 1960s insulin was commonly used once or, at most, twice a day. People who’d been started on tablets were often reluctant to accept insulin even when their control was poor. It was not generally recognised that good control was important in reducing the impact of complications. This changed following research in the 1970s that proved good blood glucose control really did matter. Blood pressure control was also proven to be important. Now: The use of multiple daily injections or pumps has become increasingly acceptable. But it does require a lot of ‘buy in’ by the person with diabetes, (or their parents if very young), to reap the benefits and minimise the risk of hypoglycaemia.
Treatment means Then: Glass syringes and glass and steel syringes (who remembers the BS1619 syringes?) were used and reused. They were boiled to sterilise them; a great fiddle which was often ignored. There was also poor understanding of how to vary doses to correct for wayward blood glucose results and the emphasis was on a rather more strict diet than most people found acceptable. The early syringes had large needles, the needles became blunt or developed a nasty hook on the tip. It was no wonder that people with diabetes preferred fewer injections. Now: There has been real improvement in syringe and needle design. Disposable plastic syringes with very fine needles have taken most of the pain out of inserting the needle. Newer insulins have avoided the unsightly hollows that disfigured some people, and the newer insulins have made adjustments for meal and exercise a much easier task. For those with Type 2 diabetes there is an increasing array of new tablets, which ought to make for better tailoring of individual treatments for different people.
Complications Then: After the wonder years when insulin was able to keep people alive, there came the disillusionment
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TREATMENT
“The advantages of becoming a member of Diabetes New Zealand should be made apparent to everyone with diabetes – this is even more true in 2012 than it was in 1962.” DR BOB SMITH that there were still nasty things happening to people with diabetes. Visual impairment, nerve damage, heart and blood vessel disease and kidney damage were big problems that brought much suffering and shortened life expectancy. Ketoacidosis was much feared but little was known about it. Now: Great progress has been made in dealing with problems and, more importantly, we have learned that prevention is possible with good control and that early detection, by regular checks, can lead to early treatment and greatly improved outcomes.
Education Then: Diabetes education was almost all done in the hospital. After a patient was diagnosed with diabetes, he or she might stay in the hospital for one to two weeks and have a smattering of education from the nurses on the ward who focused on testing and injection technique. There were also dietitians who provided useful information on healthy meals and tried to meet the challenge of the unsatisfactory food choices that some people made. Dosage adjustment was down to doctors and some were renowned for chewing the ears of people who made changes to their own doses. During the 1970s diabetes nurse educators became established with the attainment of lots of skills and knowledge. Now: Diabetes education is mainly done in the clinic setting and often in the community. Specialist diabetes nurses have flourished because they are the most relevant health professionals in the lives of most people with diabetes. Dietitians continue to promote healthy eating and exercise, often in the face of strong societal and commercial pressures to eat unhealthily!
Diet Then: Patients had to eat a certain number of calories from different food groups. This didn’t leave a lot of room for people to include their favorite foods. Sweets
were considered bad to eat. People on insulin had to eat the right number of calories to match their insulin intake. Now: Patients can create meal plans around what they like and don’t like. Sweets are just like other carbohydrate foods and can be worked into meal plans. Patients can also make meal plans for certain needs, such as losing weight or lowering cholesterol. Now insulin is adjusted to match the amount of food taken.
Emotions Then: Health professionals recognised the effects of emotions, such as a patient being devastated after their diagnosis, but didn’t have the training to help the patient very much. Now: Diabetes educators are trained to help patients learn to live with diabetes. Patients are encouraged to learn at their own pace and to identify when they are ready to make changes that will help their diabetes.
Awareness and support Then: Patients sometimes didn’t want anybody else to know they had diabetes. They didn’t want to talk about diabetes and were often fearful of losing their jobs if they disclosed this diagnosis to their employers. The idea that people with diabetes were a valuable resource for other people with diabetes was slow to take off. Doctors were often concerned that bad advice would be given especially as the right approach for one person might not be right for another. Now: Patients are encouraged to talk about having diabetes with their family, friends, and co-workers. They are also encouraged to bring a support person with them to diabetes education classes. The advantages of becoming a member of Diabetes New Zealand should be made apparent to everyone with diabetes – this is even more true in 2012 than it was in 1962.
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RID E OF A LI FETI M E
Men in lycra don’t let diabetes slow them down A cycle team of world-class athletes have brought their story of hope and inspiration to New Zealand. Caroline Wood reports. Team Type 1-Sanofi is an international professional cycling team with a difference. They don’t let anything slow them down, including diabetes. Five riders flew into Wellington in late January to compete in the 25th New Zealand Cycling Classic in Manawatu, the country’s premier cycle race. They also appeared at several public events around the country as part of their outreach programme to inspire and educate people about good diabetes management. Based in the United States, Team Type 1 began as a grassroots initiative to motivate people to take control of their diabetes. It grew to become a professional programme for athletes with diabetes, including a men’s cycling team, which is hoping to compete in the 2012 Tour de France. Team Type 1 now includes athletes with and without diabetes, but all bring the same positive diabetes message. CEO and founder Phil Southerland met co-founder Joe Eldridge at a college bike race in 2003. They both had Type 1 diabetes. Their friendship grew but Phil became frustrated with Joe’s lacklustre approach to diabetes. So he proposed a bet whereby the person with the highest blood sugar had to pay for dinner.
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For three months Joe paid for dinner but slowly he began to learn how to play the diabetes ‘game’ and was able to get his blood sugar under control. The insight was a lifesaver for Joe and he began to realise that anyone can be a competitive athlete when they manage their diabetes successfully. Impressed by Joe’s transformation, Phil started to think about how he could use his story and their friendship to inspire others with diabetes to do the same. He had a vision to unite everyone with diabetes and inspire them to take control of their condition. This dream turned into Team Type 1. And to get the idea off the ground the pair decided to ride across America. They did it in 2005, competing in the Race across America with a team of riders with Type 1 diabetes. Since then the team has won the race four times and currently holds the record for the fastest trans-continent crossing in just 5 days, 9 hours and 5 minutes. As well as competitive cycling, the team attends hundreds of diabetes-related events to provide hope, inspiration and education around the world. For example, in Rwanda recently they donated 35,000 test strips and 400 blood glucose monitors to children who otherwise wouldn’t have access to vital diabetes supplies. The team came second in the New Zealand Cycle Classic, a five-day race through Manawatu, which saw the winning riders average more than 40km per hour. More than 100 riders, including the New Zealand Olympic
team, battled tough winds and an aggressive field to complete the fivestage race, riding about 100 km per day. They still found time to meet members of the public around the country, including Auckland and Wellington, doing one-minute cycle challenges with members of the public and answering questions at a lunch with the diabetes community in Wellington, including Katrina Shanks MP, who was standing in for the Minister of Health, Tony Ryall. Team Type 1-Sanofi includes riders from around the world. Of the 23-strong cycle team, five have Type 1 diabetes. But they all take part in the community programme after the races, which aims to inspire people with diabetes to keep good control over their HbA1c levels.
Fabio Calabria (24) Australia
Rubens Bertogliati (33) Switzerland
RI DE O F A LI FETI M E
Rider Fabio Calabria (24) competed in his native Australia at the national championships in early January. Then he came to New Zealand to represent Team Type 1 here. He has had diabetes for 12 years. He said: “The team contacted me in 2007, it was an opportunity to get involved in a really good programme that has a charitable side. It is really special to have a team that has a greater message than just racing bikes. “Our key message is that with good control and good management, you can do whatever you want to do. If you have a dream you can follow it. “People get put off when they are first diagnosed and think it will limit their lifestyle but that’s not the case at all. It’s really nice to meet children and their parents and be able to say to them, look, I have had diabetes for 12 years and I have never been admitted to hospital, never had a near death experience, and I am racing professionally every day.
Joey Rosskopf (23) USA
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“We want to show that it’s possible to have a normal life, even an extraordinary one, when you have diabetes. With diabetes everything is possible.” RUBENS BERTOGLIATI “The key to good diabetes management is to control the condition, not to let it control you. Constant monitoring and a healthy lifestyle are key. Like Phil Southerland always says, you need to be CEO of your own body.” Fellow team member Rubens Bertogliati (33) of Switzerland, who doesn’t have diabetes, said: “We want to show that it’s possible to have a normal life, even an extraordinary one, when you have diabetes. With diabetes everything is possible.” American rider Joey Rosskopf (23) added: “We hope to inspire people,
Aldo Ino Ilesic (28) Slovenia
LI V I NG WITH DI ABE TES to support the message that there’s no reason to let diabetes hold you back from becoming a professional athlete.” The team has four doctors at its disposal, including two with backgrounds in endocrinology. The cyclists are constantly monitored for their health and have to keep their HbA1C levels at about 6.5 to be allowed to race. There is a strong diabetes control and management ethos in the team. Managers say that if an athlete can control his levels, he or she will race better as a result. Racers use continuous glucose monitors and team members are adept at spotting hypo signs in their fellow riders. The team races 350 days a year and the pace is relentless.
Keep up with Team Type-1 online: http://teamtype1.org and find them on Twitter and Facebook
Kiel Reijnen (26) USA
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LE T TERS TO THE E D ITOR
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NUTRITI O N S PECI A L
Dear dietitian… Knowing what to eat can be tricky when first diagnosed. Here we publish some readers’ questions on food and nutrition. Thanks to dietitians Teresa Cleary and Alison Pask for answering their questions. Please keep your letters coming: Email them to editor@diabetes.org.nz I have been reading your article on breakfasts in a recent Diabetes magazine and would like to know whether soy milk (lactose free) is a suitable thing for someone with Type 2 diabetes (controlled by Metformin) to use, especially on cereal. Soy milk can be substituted for cow’s milk if you choose. However there are two important considerations. Firstly the fat content – use a reduced-fat soy milk. The second consideration is the calcium content. Cows milk is a rich source of calcium – an important nutrient for healthy bones and teeth. The calcium content of soy milk is variable. Look for a calcium-fortified soy milk and compare the calcium per 100ml with that of trim milk. I have only recently been told I have Type 2 diabetes and I am wondering if there is a mixture of grains I can make up to be able to cook fruit cakes? I am 82 years old and am on diet alone. No medications. I do like muffins and I would like to make my own. I know I have to cut down on sugar and fats but it is the flour I am wondering about. I cook with wholemeal but am wondering if there is anything else I could use? Hoping you can help me. There are several things to consider when adapting recipes for diabetes. The most important issue to consider is serving size. All baking will contain carbohydrate – from the flour, dried fruit and sugar – so it is important to limit the number of servings and keep the size small. It is the total amount of carbohydrate eaten in a meal that impacts on blood glucose levels – not just the sugar content.
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Reducing sugar (rather than eliminating it and replacing with sweetener) is sufficient and produces a better quality product. A good guide is to use a quarter cup of sugar to combine with one cup of dry ingredients (for example, flour or oats). The amount and type of fat used in a recipe is as important as the amount of sugar. Where possible reduce the amount of fat and use a better type of fat (margarine or oil) in place of butter. Using a combination of white and wholemeal flour will increase the fibre content – you don’t have to switch to only wholemeal flour.
Hi I am diabetic Type 2. I am obese and struggle to lose weight. I find different diets contradicting each other leaving me totally confused. A friend has recommended the ‘dukan-diet’, fast results, quantity not a concern (as long as protein). What's your advice please? I am on tablets. A healthy meal plan for people with diabetes should achieve several things: • A wide variety of nutrients and foods to provide all your nutrition needs. • Weight maintenance or slow weight loss if needed. Aim to achieve a five to 10 per cent loss of your current weight. • Some (but not too much) quality carbohydrate at each meal – very important with some tablet medication. • A good intake of fibre mainly in the form of wholegrains but also from fruit, vegetables and legumes. • A moderate amount of ‘heart-friendly’ fats. Moderate amounts of protein are useful to help you from feeling too hungry. Aim to include protein in breakfast (milk, yoghurt, eggs or baked beans) as well as lunch, with a smaller serve at dinner rather than a large protein part to your dinner meal only.
N UTRITI O N S PECI A L
If you are on tablets from the sulphonylurea class (for example glipizide, gliclazide) make sure you have some carbohydrate at each meal to avoid having your blood glucose level drop too low. Choose less processed, wholegrain varieties of carbohydrate (porridge, natural muesli, wholegrain bread, legumes, fresh fruit). They tend to be more filling and satisfying than highly-processed varieties (rice bubbles, corn flakes, white bread).
I have Type 2 diabetes. At this stage (and hopefully for ever) I am managing with diet and three-monthly checks. In your Spring issue you mention peanut butter as an acceptable topping but with substitutes. I thought peanut butter was a definite no-no for those watching their weight and diabetics. I am rather confused. Are you able to ‘un-confuse’ me? Peanut butter can be eaten by people with diabetes. Ask your dietitian to help incorporate peanut butter into your daily meal plan as it can add extra flavour and moisture to your food, especially when used as a topping on dense grainy bread. Peanuts and peanut oil are one of the oils recommended for good health. The majority of the fat is monounsaturated or commonly referred to as ‘heart-friendly’ oil. These oils help to protect against heart disease.
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LE T TE RS TO TH E ED ITOR
The 2011 New Zealand guidelines for people with Type 2 diabetes recommend nuts are eaten regularly up to 30 grams per day. This is one serving of nuts or seeds each day. One serving is 1 dessertspoon of nuts or 1 dessertspoon of peanut butter. As all fats and oils are high in energy, eating too much will contribute to weight gain. For weight control use one serve of peanut butter to replace one serve of other oils or spreads you usually use. Read the ingredients list on the label carefully and choose a peanut butter without added sugar. A study published in The Journal of the American Medical Association, conducted by researchers at the Harvard School of Public Health, reported eating 1 tablespoon of peanut butter or other nuts five times a week cuts the risk of developing Type 2 diabetes by 20 to 30 per cent.
If you need further help, your practice nurse or GP may be able to refer you to a diabetes dietitian. There is lots of information about healthy food choices on Diabetes New Zealand’s website. Go to: www.diabetes.org.nz/ food_and_nutrition/healthy_food_choices_and_tips.
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CO M M U N IT Y
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WORLD D IABETES CON G RESS
Unity brings strength The 2011 World Diabetes Congress in Dubai was a chance for health professionals and lay people from around the world to come together to talk about diabetes. John Denton and Marguerite Durling, from Diabetes Auckland, represented Diabetes New Zealand. It is an uplifting experience to attend a World Congress. We observed other countries wrestling with similar issues to those faced in New Zealand, often countries not lucky enough to enjoy the sort of health system we have here. It was a privilege to represent New Zealand. We were assisted financially through a new scheme whereby the International Diabetes Federation (IDF) paid the air travel, accommodation and registration for two people from each country to attend. We were among 14,600 people – researchers, doctors, other health staff and lay people – who gathered at this Congress, held in the World Trade Centre Dubai last December. There was the usual multi-stream programme covering clinical science, education and care, global challenges in health, epidemiology, and life with diabetes. There was also the Global Village, where each country had a stand, including New Zealand. Only a small number of delegates came from New Zealand: Dr Brandon Orr-Walker (advisor to the Government on diabetes and head of diabetes for Counties-Manukau DHB), Sir Peter Gluckman (government science advisor) and ourselves. The Congress was presided over by Jean-Claude Mbanya from the Cameroon, President of the International Diabetes Federation for one more year.
Marguerite Durling and John Denton in Dubai for 2011 World Diabetes Congress.
Lessons for New Zealand from the Congress • Unity brings strength. Unity of vision and action is essential. Globally and locally, we need to end fragmentation. • Education and prevention have become central issues. Neither can be addressed without greater awareness about diabetes – by government, local authorities, corporates and the public. • There must be ‘health’ in all policies. • We must involve youth more. Childhood obesity has become a major issue and childhood Type 2 is on the rise. Youth represents the future. • Research progresses but real answers are not yet in sight medically. Lifestyle change remains central.
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There do seem to be significant advances in the ‘artificial pancreas’ project, linking pumps and continuous glucose monitors together. • The diabetes problem needs to embrace all partners that share the downstream consequences of diabetes (heart, blindness, kidney-failure, amputations etc) so we may work collectively to address this pandemic. • New Zealand is up there with leading countries of the world in terms of diabetes management. Some of our societies are offering world-class programmes in prevention, education and support.
NEW S A ND VI EW S
General Council meeting Before the start of the Congress, there was a meeting of the General Council of the IDF which we attended. This was like the AGM of the Federation, when reports were tabled and officers elected. Prof Mbanya has one more year of his three-year term to serve. New Zealand was allocated five votes at this meeting. Dubai proved a fine place to hold this Congress – warm (except for freezing air-conditioning in some places), ultra-modern, welcoming, with fantastic facilities. It is amazing how Dubai has transformed itself from a small pearl town of 40,000 people before oil was discovered in 1969 to a world-class city of two million people today with unbelievable architecture. However, wealth does not come without problems and 19 per cent of the UAE’s population now has diabetes, one of the highest prevalences in the world. The IDF has 220+ member associations (including Diabetes New Zealand) in 160 countries. It comprises two million individual members – that’s a lot of power it can muster. It therefore has global reach. The IDF has exercised considerable influence at the World Health Organisation and United Nations. It recently succeeded in getting a major UN resolution on NonCommunicable Diseases passed at the September summit in New York, signed by 193 countries, including New Zealand. The Federation requires and requests New Zealand and the Diabetes New Zealand family to become ‘foot-soldiers for diabetes’. “We need to keep people with diabetes involved at all levels. We need to create a mass movement,” Professor Mbanya said. There is a need to stimulate public outrage with the present lack of attention to diabetes and to call governments to account. It has taken decades to build this epidemic. It will take years to turn things around. In the last two years, the world has shifted. Nevertheless, the President warned, the road ahead would be long.
Other activities We participated in the President’s reception, the IDF 5km run/walk sponsored by Novo Nordisk and the closing party’s drinks (water or diet Coke!). Separately, we caught the lift (taking 60 seconds exactly) to reach the 122nd of more than 162 floors within the world’s tallest building. The next Congress is to be held in Melbourne, 1–5 December 2013. A strong New Zealand attendance, including Youth, needs to be encouraged.
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COM MUNITY
Heather Conland In January, Diabetes New Zealand farewelled Heather Conland, the Operations Manager at National Office. After nearly seven years at Diabetes New Zealand, Heather has decided it is time to relax and enjoy retirement, although she notes she will probably end up looking after the grandchildren, so maybe it won’t be quite so quiet! As all who have worked with Heather will know, she has made a significant contribution to Diabetes New Zealand over the years and has seen through some significant changes, including the start of Destination Unity and a new database system to help the organisation more effectively capture and manage information. “Heather has been absolutely wonderful to work with. Her experience, knowledge and cheerful attitude will certainly be missed. We wish her all the best for her retirement,” says Joe Asghar, Diabetes New Zealand Chief Executive.
Emma Burling Emma Burling has joined Diabetes New Zealand as administration and membership coordinator. She has a varied background, having most recently worked as an Advisor for the Energy Efficiency and Conservation Authority, and prior to that, the Department of Conservation. As well as the environment, Emma is very passionate about health, and continues to study in the field. She is excited to have made the move into a healthrelated organisation and is really looking forward to working for Diabetes New Zealand. Emma was educated at Massey University and has a Bachelor of Arts (Psychology) and is working towards a Postgraduate Diploma of Public Health. She also has certificates in Therapeutic Massage and Human Nutrition.
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LIV ING W ITH D I A B E TE S
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TED ’ S STO RY
Ted MacDougall: 61 years on insulin and still fighting fit When Ted MacDougall was first diagnosed with Type 1 diabetes, he nearly fainted when he saw the size of the needle he was about to endure. The year was 1951 and syringes were glass and BIG. He was diagnosed at the age of 15 years old while at boarding school in Auckland. He was in a bad way and it took two weeks of hospital treatment before he was stabilised by doctors. Things have changed a lot since then and Ted, now 76, has kept up with all the medical advances the last six decades have brought. He learned to use an insulin pump 12 years ago and the terror of the over-sized needle is long behind him. The builder turned kiwi and avocado grower lives in rural Te Puke and his local diabetes society says he sets a great example to those who seek out his advice about how to manage diabetes. He lives an active and healthy lifestyle and has never had
any serious diabetes complications. He said: “Get a pump, that’s my main advice, whatever the cost, it’s expensive but cheap for the convenience. Test six times a day and learn about the condition, understand it, educate yourself.” When Ted was first diagnosed 61 years ago, he knew nothing about diabetes and it was a shock that he would have to inject himself twice a day with insulin. Blood sugar testing was a real ordeal until the introduction of blood testing strips. He has nothing but praise for his doctors, particularly the late Dr Henley, of Auckland, who helped him get in control of the condition when he was first diagnosed. Margaret Rex-Benner, of Diabetes Tauranga, said: “He keeps remarkably good health and leads an extremely active lifestyle. He may be encountered climbing on
“Test six times a day and learn about the condition, understand it, educate yourself.” TED MACDOUGALL
Te Pare hills, shifting an electric fence, picking avocados or pruning kiwifruit. Ted has always been an advocate to other people with diabetes who are impressed by his example of healthy eating and exercise.”
Long-term survivors help unlock the mysteries of Type 1 Diabetes People who have survived 50 years or more with Type 1 diabetes are being studied to see what factors allow them to avoid the serious consequences of diabetes.
The second phase of the research focused on 550 medallists who have been taking part in detailed questionnaires and tests, including genetic testing.
The long-term study, which began seven years ago, is being carried out by the Joslin Diabetes Centre in the United States, on 500 of their ‘medallists’ – people who have been taking insulin for more than 50 years.
The findings suggest that 40 per cent of the medallists have factors or genes which are protecting them from developing diabetic eye disease.
Researchers characterised genetic, environmental, psychological and physiological factors that may contribute to survival. The first phase of the research, published in 2007, showed the majority of medallists had controlled their blood sugar levels very well and 50 per cent had avoided serious complications.
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Surprisingly, over 66 per cent of medallists appear to still produce some insulin. This finding suggests that some Type 1 diabetic patients may still make insulin even after 50 years of diabetes. This raises the possibility that many Type 1 diabetes patients have protection from beta-cell destruction. For details of the study go to www.joslin.org.
Hi everyone I am writing this update on the eve of several big events: our 2012 Family Conference and AGM, and the Diabetes New Zealand Special General Meeting regarding ‘Destination Unity’ and the future of our organisation. I will have more to say about both of these things in due course, but for now I’d like to take the opportunity to thank all those who supported and attended our conference, and who have helped us with our planning for Diabetes Youth New Zealand’s future. In January I was delighted to help judge the 2011 John McLaren Youth Awards. The late John McLaren bequeathed a sum of money from his estate to be used by young New Zealanders with diabetes. These funds were used to establish the John McLaren Youth Awards, which recognise the pursuit of excellence across cultural, academic and sporting fields by young people with diabetes. The awards provide financial assistance to youth with diabetes to enable them to attend sporting, academic, and cultural events at a national and/or international level. This year three awards of $1,000 were made. This is now the third year I have been involved with judging, and it is one of the highlights of my year to read through the applications we receive from all around the country. It is impressive and inspiring to see what young people can and do achieve, despite the daily challenges they face living with diabetes. Once again, the standard
of entries received this year was very high, and it was extremely difficult to select the three winners for 2011. In no particular order, they are: Emmeline Carroll, of Christchurch Emmeline is 13 and a keen and talented BMXer. She will use her award money to help her attend a junior development programme in Auckland, and the BMX nationals in Rotorua at Easter. Samuel Chadwick, of Christchurch Sam is 16, and has represented Christchurch in two sports: volleyball and soccer. He intends to use his award money to help him represent New Zealand at the Australasian State Volleyball champs in Australia in July. Brydon Harrington, of Invercargill Brydon is 16 and is dedicated to advancing her swimming career. She intends to use her award money to help her attend the national age group champs in Wellington in March. Congratulations to this year’s winners, and also to everyone else who applied. We hope to update you on the achievements of the 2011 recipients in future issues of the magazine. We are also considering bringing the 2012 awards forward to July this year. Please check with your local society and/or our website for details as we confirm them. Best regards
President Diabetes Youth New Zealand
Diabetes Youth New Zealand General enquiries: contact@diabetesyouth.org.nz Phone: (09) 623 2508 Do you have a story idea? Contact editor@diabetes.org.nz JOIN YOUR LOCAL SUPPORT GROUP BY VISITING
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DIAB E TES YO UTH
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NEWS AND EVENTS
Diabetes Youth Taranaki Family Camp at Te Wera (Forest) Valley Lodge Ironwoman, teacher and diabetes educator Heidi Jane James visited the annual Taranaki family camp with her husband Mark, much to the enjoyment of the children who attended. Heidi Jane James does world ironman races because she can and doesn’t let diabetes hold her back. She and husband Mark were an inspiration to the families who learned so much from talking with this remarkable young couple, who talked about their life, training and racing as athletes. Their down-to-earth approach as they explained how they both work together as a team to ensure Heidi’s tight diabetes control and the management of their busy lives as athletes was great encouragement and a valuable lesson for the Type 1 children, their siblings and parents. The camp took place in November last year in a remote part of Taranaki called Te Wera Forest. Heidi Jane said: “I was lucky enough to meet Jane Roguski (a parent) on Facebook a couple of months ago and she suggested I should come and help out. The children ranged in age from four to 12 years. Most were on multiple daily injections but two of the children were on insulin pumps like me.
Camp fun: Children and their families gather for the Taranaki camp (top) while Heidi Jane James tries out water sliding (bottom)
“The camp was an opportunity for parents to talk together about issues and for children to get to know each other. Some of the activities we did at the camp were eeling, water slide, fireworks, rope course, tyre ride and flying fox. Everyone had heaps of fun! I can’t wait for next year!”
What’s been happening at Diabetes Youth Nelson? Welcome to 2012! I hope everyone has had a fantastic New Year and you are all ready for the year ahead. Diabetes Youth Nelson has had a busy couple of months. Back at the beginning of November we had our AGM where two of our long-standing committee members stood down. Matt Roberts, our president, decided it was time to hand the reins over to someone else. He held this position enthusiastically and was an invaluable part of Diabetes Youth for many years. Chris Wensley, our secretary, also stood down. She was also on the committee for many
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years and has worked tirelessly over this time. Matt and Chris have been the core part of Diabetes Youth in Nelson and have left very big shoes to fill. David Sturrock graciously accepted the nomination as our new President and has taken on this role fantastically. I was elected as secretary and have been enjoying learning the role and look forward to the exciting opportunities ahead. The rest of the committee has stayed on and we appreciate all the support they have given us as these changes have been happening. Pauline Tout and Helen Norrish
have also agreed to stay on as our Health Professional Representatives and we are very grateful. Some of our members had a great afternoon at Happy Valley Park in the middle of November. The afternoon was enjoyed by all the families involved. By the time you are reading this we will have had our big event for the year, our family camp at the end of February. We had 80 people registered. It is fantastic for our children to have so many of their peers together for one weekend. Stephanie Mills Secretary Diabetes Youth (NZ) Nelson
S UPPO RTI NG FA M I LI ES
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DI AB E TE S YOUTH
Watch out for the little guys Diabetes in children is especially challenging because they can’t manage the condition on their own. Their parents and caregivers must be there every step of the way to help and support them on their diabetes journey. And this can be very stressful, emotionally and financially draining. Diabetes Youth was set up to help parents and children, supporting them through every step of the journey from diagnosis onwards. There are an estimated 4,000 young people with Type 1 diabetes in New Zealand. And yet there is low public awareness and poor understanding of the condition in children. Ironically because of the publicity around Type 2 diabetes, many people muddle up the conditions. So parents have to put up with remarks like “Well, he will grow out of it won’t he?” or “Did she eat too much candy when she was little?” One problem is that the ‘little guys’ don’t fit into the Type 2 diabetes stereotype – they look ‘too well’. Mum Renata Porter knows this only too well. She has two teenage children with diabetes. She says there are three main challenges to overcome: First parents have to educate themselves all about diabetes so they can help their child manage the condition. Then they have to deal with their child’s (and possibly their own) stress and anxiety. Finally, they have to deal with the problem of low public awareness and misunderstanding about the condition. She said: “When your child is
“When your child is diagnosed, there is a tremendous amount of information to learn extremely quickly, this continues for several years after diagnosis. Parents may decide to give up work to help their child adjust, or reduce their work hours.” — RENATA PORTER
diagnosed, there is a tremendous amount of information to learn extremely quickly, this continues for several years after diagnosis. Parents may decide to give up work to help their child adjust, or reduce their work hours. This can lead to financial woes. “There is considerable stress and anxiety experienced by both parents and child. For example the child may worry about how they are going to manage at school. Some schools may not be able to cope and this can lead to a gap in care. “My kids live their lives in two to three hour increments and they make a decision based on their blood sugar level, what they have eaten, how much they have exercised.” Many parents get up every three hours in the night time to check on their children, which can lead to long-term health problems because of the disrupted sleep patterns. Despite the challenges, parents are
able to help their children lead full and healthy lives. Diabetes Youth aims to help them do this through a range of education and support resources. On diagnosis families are given a Parents Manual, which has lots of useful information and provides a vital resource at home. Diabetes Youth also developed The School Pack to help give teachers and schools a basic understanding of diabetes. The pack was originally designed by teachers and paediatricians to assist with the education and understanding of diabetes, when a teacher has a child in the class with diabetes. Family camps, where children get together and have fun with other young people, are extremely popular and are run across the country. Regional youth groups also run other educational courses and events.
For information and contact details of how to contact your local Diabetes Youth group, go to the website: www.diabetesyouth.org.nz
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THE L AS T WORD
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SHOCK TACTICS WO RK
I lost 30kg and dropped four dress sizes A Wellington woman was able to stop her diabetes medicine after adopting a radical new healthy lifestyle. Caroline Wood found out how she did it.
coming to see me and asking how I’ve done it.
Sandra Greig went on a strict diet and lost 30kgs after her doctor sat her down and said her blood sugar level of 20 was so high she ‘should be dead.’
Sandra has a sign on her desk that says ‘I do because I can, I can because I do, I want to because you said I couldn’t…’ She says this is how she has lived her life and survived to tell the tale.
“My doctor’s shock tactics worked. Don’t laugh it off if your doctor says something like this to you, my advice is to stop and listen and do something about it.”
The 63-year-old took immediate action, going on a strict diet and pumping iron at the gym every day with a personal trainer. Within five months she had lost the 30kg, dropped several dress sizes and stopped taking her tablets (Metformin).
Sandra’s diet before Breakfast: Cereal, two bits of toast, coffee Morning tea: A packet of biscuits Lunch: Macaroni cheese, toast, fruit and a hunk of cake
That was more than four years ago and Sandra has kept off the weight, she now wears size 16 instead of size 26 and has stuck to a healthier diet and lifestyle. And she has no regrets, although it was tough at the time. Sandra is a five-term councillor on Wellington Regional Council, President of Hutt Grey Power, a keen genealogist with three children and two grandchildren. She has beaten cancer earlier in life and survived the loss of three other children. She says her doctor’s shock tactics in 2007 worked. “I’d been on holiday, eaten myself silly and weighed 120kg, I’ve always been big. I was drinking a lot of water and my doctor sent me for tests. My blood sugar level was 20, it should be 6.2. He said you’ve got to lose 30kg, my husband and I laughed
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Afternoon tea: Something sweet Dinner: Meat and veg and pudding Before bed: Cocoa and another packet of biscuits
And after… up our sleeves at that. “But really, I was in panic mode, it scared me silly and I decided there was only one way to do it, so I went on a strict diet and started exercise. I went to the gym every day, it’s boring and everyone else is young but I stuck at it, doing weights, going on the running machine. I started walking a lot and then running. I’m down to 90kg and my doctor is happy. “I had more blood tests in 2003 and was able to stop the Metformin. I am down to an average blood sugar level of 5.4. I have had lots of people
Breakfast: A large plate of porridge and coffee No morning tea Lunch: Two slices of wholegrain bread with cheese or jam and a piece of fruit No afternoon tea Dinner: Homemade vegetable soup, no bread, one piece of fruit. Sandra says she occasionally gets a craving for salt and will eat a handful of chips (but not the whole packet as before). She doesn’t eat lollies or packets of biscuits any more and after a few weeks lost the cravings for them.
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If you are having issues with hypoglycaemia (low blood glucose) with another form of insulin, don’t wait – talk with your doctor. Ask if switching to LANTUS®, as part of your diabetes treatment plan, might help. LANTUS® has these features: • A 24-hour action of insulin to provide blood sugar control with just one shot a day, at the same time each day1 • No pronounced peak which means there is less risk of nocturnal hypoglycaemia than some other insulins1,2,3
Lantus is used to treat Type 1 and Type 2 diabetes patients and is now reimbursed for all Type 1 and certain Type 2 patients.4 Ask your doctor if Lantus is right for you. References: 1.Lantus Data Sheet. 26 August 2010 2.Home et al. Diabetes, Obesity and Metabolism 2010, 12:772-779 3.Pieber TR, et al. Diabetes Care 2000;23:1137-42. 4. NZ Pharmaceutical Schedule. August 2010. 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-aventis new zealand, Auckland-Freephone 0800 283 684. Lantus is fully reimbursed when prescribed by a Medical Practitioner for patients that meet special criteria. Ask your Doctor if you qualify. For all other patients Lantus is an unfunded medicine. Pharmacy Charges and Doctors fees apply. TAPS PP9089 nzgla10.09.002
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