Diabetes Autumn 2016 by Diabetes New Zealand

Diabetes Autumn 2016

HELLO DIABETES, MY NEW FRIEND Adrienne back on top after brush with death

Living well with diabetes

GOODBYE METFORMIN? Kiwis first in world to trial new treatment CHILDREN AT RISK

Report highlights diabetes care concerns

How much exercise is enough for a healthy lifestyle? Highlights from the World Diabetes Congress

the importance of sleep + autumn recipes + latest technology

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Diabetes: the national magazine of Diabetes New Zealand | Vol 28 no 1 Autumn 2016

INSIDE autumn 2016 Editorial

Families and Children

14 NZMJ report: Child diabetes

Busy year ahead

Upfront

Diabetes NZ news

Technology

Dexcom G5 launch

Cover story

drienne McCarthy: Hello A insulin, my new friend

services falling short

Your Diabetes NZ

16 Highlights from Diabetes Action Month

Gardening

18 Setting up a worm farm Diagnosis

Diabetes on my mind

19 D eb Connor: Memories of diagnosis day

10 Shannon Walsh:

Letâ&#x20AC;&#x2122;s get active

Helping others helped shake depression

Focus

12 The COMPLEMENT study: COVER PHOTO: ADRIENNE MCCARTHY. ÂŠ HAGEN HOPKINS

game changer for type 2?

20 Five simple activity goals Diabetes abroad

22 World Diabetes Congress 2015, Vancouver, Canada

Care and prevention

24 The importance of sleep The Ruby McGill column

26 On a quest to master diabetes Food and nutrition

27 New guidelines for healthy eating

28 Recipes: Vegetarian delights Community

30 Ruth Jeffrey: Kepler Challenge Diabetes in History

32 1916: Diabetes 100 years ago The last word

34 Helen Berstone Diabetes magazine EDITOR Caroline Wood editor@diabetes.org.nz PUBLISHER Diabetes New Zealand DESIGN AND PRINTING Kraftwork, Wellington ADVERTISING John Emmanuel john@affinityads.com or 09 473 9947 MAGAZINE DELIVERY ADDRESS CHANGES Freepost Diabetes NZ, PO Box 12 441, Wellington 6144 Telephone 0800 342 238 Email: admin@diabetes.org.nz ISSN 1176-4406 Disclaimer: Every effort is made to ensure accuracy, but Diabetes NZ accepts no liability for errors of fact or opinion. Information in this publication is not intended to replace advice by your health professional. Editorial and advertising material do not necessarily reflect the views of the Editor or Diabetes NZ. Advertising in Diabetes does not constitute endorsement of any product. Diabetes NZ holds the copyright of all editorial. No article, in whole or in part, should be reprinted without permission of the Editor.

Join Diabetes NZ and receive 10% discount on any product at www.diabetesauckland.org.nz/shop. Membership also includes a free subscription to Diabetes magazine, regular newsletters and support from your local branch. It costs just $35 per year ($27.50 unwaged). Call 0800 342 238 or visit www.diabetes.org.nz.

EDITO RI A L

FROM THE PRESID ENT

Busy year ahead Welcome to 2016 and my first term as President of Diabetes New Zealand. Our organisation is significantly different to the one I joined 15 years ago. We have transitioned into a modern unified organisation with a growing national presence. We need to build on this and grow our capability and capacity to ensure we can continue to provide services, information and support to our communities across New Zealand. Like many other Non-Governmental Organisations we face the challenges of declining membership and a highly competitive funding environment. We need to develop and implement strategies to better manage both of these issues. This year we will undertake a review of our membership structure. We recognise the importance of our current structure to branches, and of branches to our current members. So the aim of the review will be to identify what other types of membership we should consider

to enable us to expand both our age reach and our ethnic reach. As well as looking at membership, we will continue to build on the existing relationship between Diabetes NZ and Diabetes Youth NZ and explore alternative ways of linking with the community. On this topic, you may be aware of the new Diabetes NZ Facebook page. This is well worth a look as it is updated daily with interesting information, stories and news. We will also work on developing links and relationships with New Zealandâ&#x20AC;&#x2122;s diverse ethnic communities to ensure we are offering something culturally appropriate (and of value and use) to them. I am encouraging branches to reach out to groups in their communities that are not currently engaging with our organisation and start the conversation. I recently visited the Diabetes Auckland branch and was impressed with the level of knowledge it has of the diverse groups within their community and the range of programmes offered that meet the cultural needs of these groups. Building capacity and capability at branch level will be a focus for 2016/17. Excellent programmes

and resources are offered across our branches, big and small. These need to be shared and opportunities for collaboration on new initiatives maximised. I envisage establishing processes that will help this happen. I congratulate the Diabetes Action Month team on the success of the Roadshow in November, a fantastic example of national collaboration in action, even though the van couldnâ&#x20AC;&#x2122;t visit every area for logistical reasons this time. As well as working collaboratively, we need to ensure our people have the skills and knowledge they need to do what they do. Looking at training needs and opportunities for both volunteers and staff is also on my to-do list. Funding is an issue at all levels of our organisation, as is the case for all charities. During 2016 we will review our funding application processes to ensure that they are the most efficient and effective possible at branch and National Office level. I am encouraged by the passion and dedication of our volunteers and staff and look forward to celebrating our successes. Deb Connor National President, Diabetes New Zealand

See our website for advice, tips and ideas on how to live well with diabetes: www.diabetes.org.nz

Diabetes New Zealand PATRONS: Lady Beattie and Sir Eion Edgar PRESIDENT: Deb Connor CHIEF EXECUTIVE: Steve Crew DIABETES NEW ZEALAND INC. NATIONAL OFFICE: Level 7, 15 Murphy Street Thorndon, Wellington 6144 Postal Address: PO Box 12 441, Wellington 6144 Telephone 04 499 7145 Fax 04 499 7146 Freephone 0800 342 238 Email admin@diabetes.org.nz G www.facebook.com/diabetesnz

DIABETES | Autumn 2016

Diabetes New Zealand is a national organisation that supports people affected by diabetes. We work to raise awareness, educate and inform people about diabetes, its treatment, management and control. We offer local support to individuals with diabetes through a network of diabetes branches across the country. We also support research into the treatment, prevention and cure of diabetes.

Call now to make a donation 0800 DIABETES (0800 342 238)

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UP FRO NT

DIABETES NZ NEWS

Our diabetes champions

Some of FABruary's high profile ambassadors at the Auckland launch

The following people were given Diabetes New Zealand awards at last year's AGM and conference.

FABulous for fitness Diabetes New Zealand is the proud partner of the FABruary 2016 campaign. FAB stands for Fight Against Bulge and the campaign aims to raise awareness of the obesity epidemic and its healthrelated risks. During February the campaign’s high profile ambassadors signed up to make pledges in three areas – food, physical activity and beverages. Research shows that making lifestyle changes in these areas can help prevent or delay type 2 diabetes and can lead to longer, healthier lives. This year’s Ambassadors were from the world of sport and entertainment. They included: Malakai Fekitoa, DJ Forbes, Manu Vatuvei, Sam Charlton, Nickson Clark, Jerry SeuSeu, Kara Rickard, Jerome Ropati, Ali Lauitiiti, and Tofiga Fepulea'i.

See the Ambassadors’ pledges and read more about the campaign on our website www.diabetes.org.nz/ Fabruary. Next year (February 2017), we will be inviting all of New Zealand to join in with FABruary and to make their own pledges. But for this year, you can start by doing two important things: • introducing some small steps through your food and beverage choices and increasing your physical activity. • helping the FABruary Ambassadors raise much-needed funds to support Diabetes New Zealand and the 257,000 people with diabetes in New Zealand. *Go to https://givealittle.co.nz/ fundraiser/fabruary2016

Welcome Nicky Nicky Katsanos is our new National Business Manager based at Diabetes New Zealand’s National Office. She is a chartered accountant and member of the NZ Institute of Chartered Accountants. We’re delighted to have her on board!

Survey winners The winners of Diabetes New Zealand’s “Thank you for keeping in touch with us” survey are: Natasha Black of Te Anau; Malcolm Rowsell of Glenfield, Auckland; Kalyani Sengupta of Manukau, Auckland. They each receive a Fitbit.

DIABETES | Autumn 2016

Dale (left) has been a member of the Diabetes NZ Otago branch committee for 28 years, including several terms as President and Vice President. She doesn’t have diabetes but has given countless hours of her time to branch activities, volunteering for events, fundraising, committees, conferences and projects. Dale’s association with Ngai Tahu has been invaluable and allowed the branch to have engagement and a relationship with local Māori health providers. Her branch summed up her contribution as “total dedication by a remarkable lady.” Jennifer (left) is a founder member of Diabetes NZ Wanganui branch and has been a member for nearly 40 years, including 25 years as a committee member, and is currently its Patron. Jennifer drives people to branch meetings, organises speakers, talks to other community groups about diabetes, and helps man regular diabetes stalls. She has also taken on the role of archivist, being responsible for keeping documents that record the branch’s history. Past President Chris Baty was awarded Life Membership of Diabetes NZ in recognition of the huge contribution and many hours of service she has given in her time as President. And the Sir Charles Burns Award (on insulin for 50 years or more) was given to Lois Myshrall, a Northland Branch Life Member. Lois has been injecting herself with insulin daily since January 1961.

Competition winners The lucky winners of our summer issue giveaway competitions were: Fitbit Charge HR – Linda Thorne, Auckland; Isaac Hanlen, Rotorua; Kelley Muriwai, Mt Roskill, Auckland. Nadia Lim’s Fresh Start cookbook – Adrienne Todd, Christchurch; Sarah Sowen, Nelson.

TH E NEW DEXCO M G 5

TECH NOLOGY

DEXCOM G5 Mobile launched in New Zealand The “revolutionary” Dexcom G5 Mobile is now available in New Zealand. The new Dexcom G5 Mobile is the first glucose meter of its kind in the world. Dexcom says it's the only mobile-connected continuous glucose monitoring (CGM) system available that doesn't need confirmatory fingerpricks for treatment decisions. It can be used by adults and children as young as two years of age. The device offers wireless Bluetooth® technology that allows glucose information to be displayed directly onto a smart phone, freeing users from the need to carry a separate receiver and giving greater convenience and discretion. Hugh Plowright, spokesman for NZMS Diabetes, which launched the Dexcom G5 Mobile in New Zealand in February, said one of the major benefits of the system is that it allows users freedom from their daily fingerprick testing regime. Now users only need two fingerpricks per day, for calibration purposes, as dosing decisions can be made directly from their CGM results. “This has huge benefits, allowing users to discreetly and easily manage their diabetes throughout the day and night,” he said. The Dexcom G5 Mobile CGM also features Share technology that lets users select up to five designated recipients, or ‘followers’ who can remotely monitor the patient's glucose information and receive alert notifications from almost anywhere for an added circle of support. Kevin Sayer, President and Chief Executive Officer of Dexcom, said: “The Dexcom G5 Mobile CGM System lets users see and treat their diabetes in a whole new way – right on a smart device and without the need to perform confirmatory finger sticks for treatment

decisions. It’s dynamic glucose information when you want it and where you want it. “The device is changing the landscape of diabetes management, offering users greater convenience, flexibility and discretion than ever before.” Continuous glucose monitoring is considered the most significant breakthrough in diabetes management in the past 40 years. The traditional standard-of-care for glucose (blood sugar) monitoring has been a finger prick meter. NZMS said the per annum costs of running a Dexcom G5 Mobile depend on how often a user wears the system. For someone using it nonstop it would come to $8,980 annually. This is beyond the means of most New Zealand families, says Jacqui van Blerk, President of Diabetes Youth (pictured). Ms van Blerk said the device's running costs should be made more affordable so more people could benefit from the breakthrough technology. “I feel strongly that people should be aware of how useful the technology can be for management, especially in kids, but it needs to be more affordable.” Some families have started Givealittle pages to raise funds so they can afford a Dexcom G5 Mobile to help them manage their child’s diabetes. An NZMS spokesman said: “As with any leading edge technology advancements often don’t come as cheaply as we’d like. Together with Dexcom, NZMS Diabetes is working hard to provide Dexcom G5 Mobile at the best possible price. Reimbursement is available for blood glucose meters and insulin pumps and

Dexcom G5 Mobile is available at a special introductory price for Diabetes readers of $2005, saving $274. Offer available until 4 April. Call NZMS Diabetes on 0508 634 103 between 9am-5pm weekdays to access this limited time offer.

we are working towards it being provided for this life-changing new technology too. “Dexcom and NZMS Diabetes’ long-term goal is to reduce the price of CGM as much as possible.” NZMS said making the technology available in New Zealand and making sure doctors and the government were aware of its potential costsaving benefits (through better diabetes management), were the first steps in this process. “We’ve already seen a huge amount of interest from New Zealanders eager to start enjoying the benefits of Dexcom G5 Mobile and in time we hope to see this available for everyone, without cost being a factor.”

Autumn 2016 | DIABETES

COV ER S TO RY

AD RIENNE McCA RTHY

Adrienne McCarthy learned to embrace her diabetes after a brush with death. She made significant lifestyle changes and hopes her story will inspire others to do the same. By CAROLINE WOOD.

HELLO DIABETES, MY NEW FRIEND 8

DIABETES | Autumn 2016

A DRI ENNE Mc CA RTHY

DRIENNE McCARTHY didn’t realise the implications of the diagnosis for her long-term health when she was diagnosed 10 years ago. Unaware of the diabetes education available, she carried on with her normal lifestyle, not realising this would come back to haunt her years later. It took a medical crisis in 2013, when Adrienne nearly died, for her medical team to review the management of her type 2 diabetes. They suggested she move from tablets to injecting insulin. Adrienne quickly embraced her “new friend”– the insulin pen, as well as making some lifestyle changes and taking diabetes seriously. Adrienne, 57, who lives in Wellington, was diagnosed in 2006. She was working for the Department of Corrections at the time. Her employer was offering health checks, including a finger prick test for diabetes. To Adrienne’s surprise it was sky high. At the time Adrienne didn’t understand what the diagnosis meant in terms of her health. “It wasn’t a wake up call, I didn’t have a clue about diabetes or what it meant in terms of my long-term health. After the diagnosis I was put on half a metformin tablet and I just carried on with my life. I wasn’t given a kit to test with.”

PHOTO © HAGEN HOPKINS

Adrienne bought her own test kit but didn’t check her blood sugar levels regularly, just when she was feeling unwell. “When I was first diagnosed I wasn’t aware of, or offered, any form of education. I didn’t realise it was a chronic disease. I just thought it was something I had, like others in my family. I didn’t know it could affect your kidneys, liver or eyesight. Adrienne’s family has experienced a lot of type 2 diabetes. Her dad developed diabetes at the age of 80 and died two years later with diabetes contributing to his death. Her

paternal aunt and three cousins have diabetes. Her maternal aunt had type 2 as well as Adrienne’s nana. “My family is riddled with diabetes, it’s been surrounding me all my life but nothing clicked. They made no big deal about it. There was little discussion about the side effects or ongoing problems. I just thought it was nothing. I just had to take a pill and it would all be all okay,” added Adrienne. “It took me until 2013 before the penny dropped.”

“I just thought diabetes was nothing. I just had to take a pill and it would all be all okay.” In 2013 Adrienne was living in Wellington and she went to the doctor with a swelling on her chin. She was taking high doses of medication for her diabetes but when the doctor ordered blood tests her blood sugars were through the roof. This was thought to be due to an infection. Three days later Adrienne was admitted to hospital with pancreatitis. The specialist made the call to remove her gall bladder. But her health problems continued for months. She was in and out of hospital over the winter and at one point nearly died after another pancreatitis attack, the same day she was discharged from hospital. By this time her body was so weak, she had to take a further four months off work to recover. The turning point came when Adrienne, while in hospital, was prescribed insulin for her diabetes and immediately felt much better. She found injecting less painful than finger prick testing and over time she had more energy and felt less tired. Adrienne was also offered a place on a six-week diabetes course. It was the first real diabetes education

COV E R STORY

she had had in 10 years. She says her Wellington GP, Kilbirnie Central Surgery, where she goes for diabetes checks and ongoing support, have been “fantastic”. Injecting with insulin has resulted in more energy, a better quality of life and the desire to raise awareness about diabetes among her work colleagues, friends and especially her daughter and grandson. She said: “Given our family history, my son, daughter and grandson are at risk”. My daughter and little grandson both live with me. I want to do the right things and lead by example.” Over the past 12 months Adrienne has been watching what she eats and using portion control to lose weight. She has also been doing more exercise, like using the stairs at work and walking from home to the railway station, and practises yoga. Adrienne is sharing her story in the hope it will inspire others to be more aware of diabetes if they don’t have it – and to actively manage their condition if they do. She’s been through some tough times but has come through it all and is now feeling good about the future.

Diabetes awareness expo A chance meeting with a staff member from Diabetes New Zealand on a flight back to Wellington led to the beginning of an idea. Adrienne, who works at the New Zealand Qualifications Authority, in Wellington, encouraged its Health and Safety Committee to organise a wellbeing expo, which included diabetes awareness events. Diabetes NZ National Office and Diabetes Wellington helped Adrienne organise the expo and offered resources to help her with awareness raising around type 2 diabetes. More than 200 people attended the wellbeing expo, which was held at the NZQA offices last year. They were able to access information about diabetes, prediabetes, and ways to reduce health risks through lifestyle changes and healthy eating. *Contact Diabetes NZ on 0800 342 238 if your workplace is interested in organising a wellbeing workshop/expo.

Autumn 2016 | DIABETES

DIAB E TES O N MY MI ND

SHANNON WA L S H

Helping others Social entrepreneur Shannon Walsh reveals how his struggle with diabetes led him to setting up a charitable enterprise that helps other charities raise much-needed funds. Shannon Walsh is a successful businessman, entrepreneur and supporter of good causes, who lives in Auckland with his wife and two sons. He enjoys his work and loves long-distance ocean swimming and spending quality time with this family. But 13 years ago Shannon was in a very different mental space. He was struggling with depression and had never felt comfortable with the fact he had type 1 diabetes, a lifetime condition that impacted on the way he wanted to live. “I had some mental health issues related to my diabetes. I became very worried and focused around my disease. I sought help and during cognitive therapy my psychologist talked about focusing outside myself. “He said why don’t you do more for charity? That got me thinking. What are some of the barriers to charitable

giving? How can I use my skill sets and money to do something more interesting and big? Something more than just donate to charity.” Shannon set about doing just that. He came up with the concept for myDroplet and built an online giving platform that would offer choice, meaning and ease of use for people who want to donate to charity but are time poor. For a few years the idea went on the backburner, while Shannon was busy with other ventures. Then the opportunity came along to employ his sister-in-law on the project and the website was launched in September last year. It is run by a charitable trust and is totally not for profit. Shannon and his wife Sarah cover the cost of running the website so 100% of the donations go to charity. Trust is an important component of myDroplet. Each of the charities featured, including Diabetes NZ, has been carefully researched and evaluated by the myDroplet team, which includes an accountant and a lawyer. People donating money have complete control over when, where and how much they give.

Shannon Walsh decided to focus on helping others rather than worrying about his diabetes. Shannon, 43, says he is delighted that something good came out of his experience with diabetes-related depression. He was 13 years old when he was diagnosed with type 1 and he never really accepted it. Now he has a much better relationship with his diabetes. “Setting up myDroplet absolutely helped. It took the focus off myself. I focused on something else, a good thing, and that undoubtedly made a difference. I think the concept of focusing outwards helped me and it may help other people in a similar position. “Diabetes has helped me be a better person. It’s led me in a particular direction in life. I now try to think of diabetes in a positive way as something that has led me down a path that I would otherwise not have taken.”

DONATE TODAY! myDroplet makes giving easy and provides choice for people who want to make a donation whether it’s a child giving 50c from their pocket money, a regular donation to mark a loved one’s memory, or a feel-good birthday gift, when your friend picks the charity and you set the amount. Diabetes NZ has been selected as one of myDroplet’s registered charities. Please share the link with your friends and family. You can be guaranteed that 100% of your donation will go to Diabetes NZ. If we all give just a bit, the combined impact can be far-reaching. Research has shown that the power of giving makes people feel happier and more connected to others. MyDroplet is definitely worth a visit to help find your happy place – see www.mydroplet.org.nz

DIABETES | Autumn 2016

Dexcom G5 Mobile is here See and treat your diabetes in a whole new way

Make treatment decisions without confirmatory fingerpricks.*

View your CGM results directly on your compatible smart device.^

Share your CGM data with up to 5 followers, even when they’re far away.

Dexcom G5® Mobile gives you glucose readings every 5 minutes so you can see your highs, lows and how fast you’re getting there. Better yet, customisable alerts and alarms help you respond quickly to or avoid potentially dangerous hypoglycaemic events.

Special limited time offer for Diabetes readers Standard

Special offer

Saving

$2279

$2005

$274

Transmitter Receiver Box of 4 sensors Offer is valid until 4 April 2016. Prices include GST.

For more information or to order contact us between 9am-5pm, Mon - Fri on 0508 634 103 W www.nzmsdiabetes.co.nz

E nzms@nzms.co.nz

*If your glucose alerts and readings do not match your symptoms or expectations, you should obtain a fingerprick. A minimum of two fingerpricks a day is required for calibration. ^To view a list of compatible devices, visit www.dexcom.com/compatibility. Dexcom G5® Mobile is not currently indicated for children under 2 years of age. Not compatible with Animas® Vibe® insulin pump. Always read the manufacturer’s instructions and use strictly as directed. Please note a 1.75% surcharge applies to payments made by credit card. No surcharge applies to payments made via direct bank transfer.

FO CU S

TH E COMPLEMENT STUDY

GAME CHANGER? Kiwi patients are the first in the world to receive a potentially landmark experimental treatment for type 2 diabetes. Caroline Wood talks to some of those involved. Patients in Auckland, Wellington, and Dunedin are the first in the world to receive a new treatment for type 2 diabetes. They are taking part in a landmark study that, if successful, has the potential to change patients’ lives. The COMPLEMENT study is the first in-human trial of an experimental new therapy developed by an American company. The procedure involves using a medical device to change nerve signals to the liver and other organs using a technique similar to that carried out by cardiologists treating heart patients (see panel).

Researchers are hoping that disrupting the liver’s nerves – in a one-off, two-hour procedure – will lead to a gradual reduction in a patient’s blood sugar levels, potentially removing the need to take medication to control their condition. The trial is being led by some of New Zealand’s top endocrinologists and cardiologists in Auckland, Wellington, Christchurch and Dunedin. So far 16 patients have undergone the procedure and it is hoped the study can recruit a total of 30 patients. Professor Patrick Manning and Professor Gerard Wilkins carried out the first-in-the-world procedure on a man in his 40s in December 2014 and another four since then. Commenting on the significance of the trial, Prof Manning said: “It would be an exciting treatment option for people with type 2 diabetes. If the procedure is successful it would mean that people with type 2 diabetes may

American scientist Dr Bobby Azamian developed the liver nerve catheterisation technique. His company Metavention is running the first ever in-human trials in New Zealand.

What is Metabolic Neuromodulation Therapy? This one-time procedure involves passing a catheter through the femoral artery in the right groin into the artery that leads to your liver. This simple catheterisation procedure is commonly used by doctors to deliver a number of cardiovascular treatments, which is why cardiologists are part of the trial team. Radiofrequency energy is then passed through the end of the catheter into the wall of one of the liver arteries to disrupt the nerves that lead to the liver and other metabolic organs. The procedure takes about an hour and is done under conscious sedation.

DIABETES | Autumn 2016

Why are the liver nerves important in type 2 diabetes? The nerves in the liver arteries play an important role in the regulation of blood sugar levels. Previous research has shown that disrupting the nerves in the liver arteries may return the liver and other organs of the metabolic system to a more normal state and help take more sugar out of the blood when the blood sugar level is high (Am J Physiol Endocrinol Metab 290 E19 2006). As a result, diabetes may be better controlled after having this procedure.

The new treatment for type 2 diabetes involves changing nerve signals to the liver and other organs in an effort to improve blood sugars to more normal levels.

TH E CO M PLEM ENT STUDY

not need to take as many or any medications to successfully control their blood glucose levels.

of Metavention, the American company which is undertaking the trial.

“The main aim of the first phase of the study is to show that this is a feasible and safe procedure in humans. Although the results will not be formally analysed until the end of the study, based on the data from our site there do not appear to be any serious unexpected safety concerns with the procedure.

“Diabetes is a substantial and growing problem in New Zealand and worldwide. As doctors we see patients all the time with the disease who are frustrated with the limited treatment options. The drugs currently available don’t provide a good long-term solution for patients and have safety and compliance issues. Our goal is to come up with a safe, effective, one-time therapy targeted at the underlying causes of the disease.”

“As to whether the procedure is effective at lowering blood glucose levels this information is not available to us at present but will hopefully become so during this year. “It has been very rewarding to be at the centre of potentially groundbreaking medical treatment. This study has brought together numerous medical experts and has shown that we are capable of successfully conducting landmark studies here in New Zealand. Of course we are also indebted to the patients who have volunteered to take part in the study.” One of those patients is Chris Fogarty, 63, who lives in Dunedin and who underwent the procedure about six months ago. He has had type 2 diabetes for seven years and is hoping that by taking part in the trial he will avoid having to move to insulin injections in the future. He hasn’t had any official results yet but says: “My blood sugar levels are dropping and my HbA1C has dropped by 10-15 percent. It’s not brilliant but it’s improved. They said that if it works, it would be a gradual process.”

The procedure they developed to disrupt the liver’s nerves, and hopefully reduce blood sugar, showed promising results in animal testing, he said. Explaining why the first-ever inhuman trial is taking place here rather than the US, Dr Azamian said New Zealand had medical experts with the right experience needed to carry out the procedure

FOCUS

Chris Fogarty is one of the first patients in the world to receive the procedure that if successful will offer the first potentially drug-free treatment for type 2 diabetes. and a relatively straightforward Ethics Committee approval process. The study is about halfway along and results are not yet available, but are expected in 2017. The diabetes world awaits the results with interest.

VOLUNTEERS NEEDED FOR STUDY Who is eligible? Patients aged 18–70 years who have blood sugar (HBA1C) between 58 mmol/mol ,and 86 mmol/mol, and are on metformin are potential candidates for trial participation. Interested patients should contact one of the study centres listed below.

What centres and doctors are involved?

Chris is encouraging his friends at his local diabetes gym class to consider joining the trial.

The COMPLEMENT Study is being led by some of New Zealand’s leading endocrinologists and cardiologists: Dr Rinki Murphy and Professor Mark Webster at Auckland City Hospital; Dr Brandon Orr-Walker and Dr Wil Harrison at Middlemore Hospital; Professor Jeremy Krebs and Dr Scott Harding at Wellington Hospital; Professor Russell Scott and Dr James Blake at Christchurch Hospital; and Professor Patrick Manning and Professor Gerry Wilkins at Dunedin Hospital.

Dr Bobby Azamian is co-founder, President & Chief Medical Officer

*To find out more call the COMPLEMENT study information line on 0800 004 626. Autumn 2016 | DIABETES

FAM I LI ES A N D CH I LD RE N

NZMJ REPO RT

Child diabetes services

falling short

Child diabetes services are falling short in New Zealand when compared with other developed countries. This was the conclusion of a recent study by three leading diabetes specialists for the Clinical Network for Children with Diabetes in New Zealand on behalf of the Paediatric Society of New Zealand. The study highlighted the fact that many paediatric centres lack dedicated dietitians and psychologists to support the families of children with type 1 diabetes. It also found the staffing ratios for endocrinologists, paediatricians and nurses were well below the International Society for Paediatric and Adolescent Diabetes (ISPAD) standards. Anecdotally we know that access to specialist diabetes support, such as a psychologist or dietitian, varies by region across New Zealand. Over time, there has been an increase in the complexity of diabetes management in childhood. However, in some areas access to advances in diabetes technology such as insulin pump therapy and continuous blood glucose monitoring is reduced due to inadequate staffing levels. This results in an inequality in the provision of care and education for children with diabetes. Diabetes Youth NZ is concerned that the current inadequate staffing ratios are putting specialist clinicians under

DIABETES | Autumn 2016

pressure and at risk of exhaustion. Unless these resource issues are addressed, as the number of children with diabetes continues to rise, the standards of care are likely to fall. The study, which was based on surveys from 2012, was published late last year in the New Zealand Medical Journal (Jefferies, Owens, & Wiltshire, 2015). The Ministry of Health’s updated diabetes strategy recognises the need for additional resources and states the “plan also addresses the important needs of children and adults with type 1 diabetes to ensure they have the support of experienced, multidisciplinary teams and receive intensive support at different stages of their lives when required.” (Ministry of Health, 2015, p. iii)

PHOTOS: TIFFANY WINDER ILLUSIONS PHOTOGRAPHY (FACEBOOK.COM/ILLUSIONS)

Children are being put at risk of long-term health issues because of under-resourced paediatric diabetes services. Diabetes Youth NZ president Jacqui van Blerk explains.

• a “shopping list” of insulins, blood glucose and ketone test strips, glucagon injections, pump supplies • Special Authority details (for pump funding and consumables), especially noting the expiry dates • Carer Support Renewal forms • a diary of blood glucose readings and hypoglycaemic events since the last clinic • a diary of any medical incidents since the last clinic • information regarding school or early childcare settings • a list of any additional questions relating to medical care, diet, technology etc.

As parents and caregivers, we need to ensure that we hold the Ministry to these goals, and take any concerns we have to our local parliamentary representatives so that our voices as consumers are heard.

Finally, we shouldn’t fail to acknowledge the efforts of our local district health board diabetes teams – they are doing an amazing job with stretched resources.

Families can gain the maximum benefit from attending their quarterly clinics by ensuring they are adequately prepared with the following items:

*Make your voice heard. If you have a concern about your local diabetes service, contact your local Member of Parliament and/or your local branch of Diabetes NZ..

NZM J REPO RT

FAM I LI E S A ND CH ILD REN

What needs to happen? Chief executive of Diabetes New Zealand Steve Crew said he was concerned that in many areas of New Zealand specialist care for children and teenagers with type 1 diabetes is overstretched, with hospital-based staffing resources less than ideal. “In spite of this those currently working in the field are acknowledged for doing a fantastic job given the challenges they face. Workforce planning for managing current and future demand on the services for children with type 1 is essential as demand on these services is sadly increasing alongside the demand for adult services,” he said. “Diabetes New Zealand and Diabetes Youth NZ will continue to work closely with the clinical networks to provide pastoral support and resources via social media, targeted youth camps and the provision of newly-diagnosed packs

to help and support children with type 1 and their families. “Workforce planning needs to address medical, nursing and allied health needs within the entire diabetes sector at a national level.” What child diabetes services can families expect to receive (and ask for)? This is set out in the Ministry of Health’s new diabetes strategy: “People with type 1 diabetes are likely to maintain a relationship with health services throughout their lives. Ideally they should have the support of an experienced, multidisciplinary team, including secondary care specialists. At different stages of their lives – for example, during pregnancy and in older age – people will need more intensive support. Older people face particular challenges for managing diabetes and may need greater support in areas

such as insulin therapy, treating eye problems and caring for oral health. “Health services that support people to self-manage their condition well can reduce the personal burden of the disease. A person’s team needs to include people with expertise and experience in insulin pumps and continuous glucose monitoring when required. With their reliance on insulin for survival, people with type 1 diabetes are particularly interested in having technology they can use to make their self-monitoring and management easier and more effective. “International guidelines recommend that children and young people and their adult carers should be offered 24-hour access to experienced advice.” *Living well with Diabetes (Ministry of Health, 2015, p. 24)

STUDY REVEALS SHORTCOMINGS Three of New Zealand’s top diabetes specialists, writing in the New Zealand Medical Journal, said inadequate diabetes care would have a significant impact on the short and long-term health of children with the disease. Type 1, or insulin-dependent diabetes, is one of the most common chronic medical conditions in New Zealand, with about 2,500 children suffering from the condition. Endocrinologists Craig Jefferies, Neil Owen and Esko Wiltshire undertook the study on behalf of the Paediatric Society of New Zealand, Clinical Network for Child and Youth Diabetes. They said type 1 diabetes required intensive management

by specialists, including paediatric doctors, nurses and allied health workers. Staffing at the 20 district health boards was compared to international standards and found that most clinical services providing care for children with diabetes were significantly underresourced. It showed there were few specialists, such as paediatricians or endocrinologists. The report also found that only three centres offered psychology services or a social worker. The report’s lead author, Craig Jefferies, told RNZ’s Morning Report programme that most children needed a good clinic base, a

specialised doctor, nurses and dietitians, as well as a social worker and psychologist – but there was poor funding for many of these areas. “Long term, we know that the diabetes incidence is increasing by about three to five percent a year across the country. I think we’re just going to start to outstrip our ability to set these kids up well,” he said when the report was released. See: “Care of children and adolescents with diabetes in New Zealand District Health Boards: Is the clinical resourcing ready for the challenge?” New Zealand Medical Journal 128(1424).

Autumn 2016 | DIABETES

YOUR DI A BE TE S NZ

D IABETES ACTI O N M O NTH

ACTION FOR

Campaigning in communities

Diabetes

Our awareness van travelled to 14 towns and cities around the country, helping people learn their diabetes risk and encouraging them to make exercise and healthy eating part of their daily routine. The roadshow visits were a great success and allowed Diabetes NZ to reach different communities including families, students and older people. Even the Minister of Health Hon Dr Jonathan Coleman, pictured below, checked his risk for diabetes when the van stopped in at parliament. Feedback from the Horowhenua roadshow was typical. They said the event was an overwhelming success. “What an awesome afternoon. Thank you guys, everyone in Levin is talking ‘Diabetes’ today. Word is getting around.”

National communications manager Nicky Steel rounds up the highlights of the first ever Diabetes Action Month.

With the catchphrase ‘Join-theMoveMeant’, Diabetes NZ launched Diabetes Action Month last November to encourage Kiwis to learn their risk factors for type 2 diabetes and embrace some simple lifestyle changes to reduce their risk. With more than 250,000 people living with diabetes and one million at risk of getting it, diabetes affects us all. The campaign emphasised the importance of choosing healthier food options and increasing physical activity to prevent or manage type 2 diabetes and to help people with type 1 diabetes live well and manage the condition. At the Diabetes Action Month campaign launch, Diabetes NZ Chief Executive Steve Crew said: “As a nation we pay our part in diabetes healthcare, but now we need to play our part.”

The Diabetes Awareness Roadshow team spreads the word in Wellington (top left), while Health Minister Dr Jonathan Coleman assesses his diabetes risk.

Assessing the risk factors Everyone is at risk of diabetes, but some people are more at risk than others. To help people understand their diabetes risk, Diabetes NZ developed a simple interactive tool, which is available on our website: www.diabetes.org.nz. People can go online and identify the diabetes risk factors relevant to them. They include age, family history, ethnicity, amount of physical activity and smoking. The more risk factors you have, the greater your risk of diabetes. There are obviously some factors that can’t be changed, for example you can’t change how old you are. However there are some you can

DIABETES | Autumn 2016

influence, for instance, whether you smoke or not, or whether you are physically active. During Diabetes Action Month, 3,400 people used the tool (either online or via a pamphlet specially printed for the campaign). A high proportion discovered they had a risk of developing diabetes. All were advised to see their GP as soon as possible and were offered information showing which risk factors they can change and how small steps to a healthier lifestyle can bring positive results.

DI A BETES AC TI O N M O NTH

YOU R DI A B E TES NZ

Stepping up for diabetes Throughout November Diabetes NZ Fitbit MoveMeant Challenge participants were busy trying to outstep each other. This was a fun, social media-driven initiative featuring a group of well-known New Zealanders who committed to doing 10,000 steps a day and competing to record the most steps. All had a personal connection to diabetes or were concerned about the rising incidence of the disease in New Zealand and wanted to help raise awareness. They included: Health Minister Dr Jonathan Coleman, Bronagh Key, Irene van Dyk, Shortland Street actors and even our own Steve Crew. See page 21 to find out who won the challenge!

World Diabetes Day One of the reasons for the campaign being in November was because 14 November is World Diabetes Day. This was a fantastic opportunity to highlight that diabetes is a global issue and to showcase the international symbol for diabetes, the blue circle, by using blue hula hoops for hooping and as frames for photos. Pictured here posing in the hoop are Wellington Mayor, Celia Wade-Brown, and Diabetes NZ Chief Executive, Steve Crew. FAIRFAX NZ

ents Branch ev

Diabetes NZ branches organised a wide range of events around the country in November, including the South Canterbury branch’s annual duck race, pictured above, that was highly successful in raising diabetes awareness as well as much needed funds.

International Diabetes Federation (IDF) Young Leader Emily Wilson played her part in raising awareness by riding up and down Treble Cone Ski Area’s steep 7-kilometre gravel access road – the equivalent height of Mt Everest.

Getting Kiwis moving Our final Diabetes Action Month event took place on Saturday 28 November, with a huge number of sporting or recreational facilities around the country opening their doors free of charge on Diabetes NZ Fitbit MoveMeant Day.

While the sun has set on Diabetes Action Month 2015, we at Diabetes NZ are already hard at work ensuring we continue to shine a light on issues affecting people with diabetes and our key messages for Kiwis – to eat healthier and get more active.

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GARD EN I N G

WORM FARMS

The easy way to minimise kitchen waste Rachel Knight explains how to turn kitchen waste into liquid gold with a little wriggly help. A worm farm can turn our kitchen waste into valuable and nutrientrich fertiliser for our garden with only a little care and in a small space. Kitchen waste comprises a significant portion of our household waste output – and a particularly smelly one. If you want to reduce the amount you send to landfill and enhance the fertility of your garden, then a worm farm is well worth considering if you don’t have space or enough material to justify a compost heap. A worm farm is usually kept outdoors. Worms can process anything that was once living – 250 worms will eat about 250 grams of food in a couple of days. Kitchen scraps such as vegetable and fruit trimmings and tea bags make up the bulk of the worm food. As worms don’t have teeth, ‘food’ needs to be damp and soft for worms to process it. The smaller it’s chopped, the more quickly it will disappear. Avoid bones, meat and fish, oil and fat. Small quantities of onion and citrus are fine, just don’t overload the system. Damp paper, card and tissues also go down well. A light sprinkling of lime every month or so keeps it from getting too acidic and adds calcium. Choose your design of worm farm to suit your space and budget, and based on how much waste you have to process. You can often buy second-hand worm farms or use crates or bins bought cheaply from op shops. Some people use an old bath, with a corrugated iron cover to create a cheap, large processing unit, but stacking bin designs are more compact and make harvesting worm castings easier.

DIABETES | Autumn 2016

The ‘Hungry Bin’ is the ultimate in convenience and efficiency but comes at a price. You’ll need an initial population of compost worms to start your worm farm off as well. Worm numbers will build up naturally if the food supply and moisture levels are right. The worm farm will produce ‘vermicast’ worm castings – a dark, sweet-smelling mixture you can add to potting mix in tubs or when raising seeds or sprinkle on the soil. It is rich in nutrients and beneficial microorganisms which improve the soil and enhance plant growth. The worm farm ‘tea’ – the liquid that drains from the worm farm – is similarly potent. Use it as a liquid feed diluted 10:1 with water to the ‘colour of weak tea’. Make sure your worm farm can drain freely and keep out the rain. Worms will drown in waterlogged bedding and it will be smelly. It can also smell if you overfeed when the worm population is becoming established and the food goes mouldy. Use the worm tea when it’s as fresh as possible to maximise its value. Most of us can take responsibility for dealing with some of our waste with only a little effort and we’ll be rewarded with a healthier garden, sweeter smells in our rubbish bin and a clearer conscience. For more information see www.hungrybin.co.nz www.wormsrus.co.nz www.compostshop.co.nz Your local council may also offer advice and resources for minimising your kitchen waste.

DEB CO NNO R

DI A GNOSIS

Knowing what I know now Deb Connor found out she had diabetes three weeks before her wedding. The President of Diabetes NZ shares her memories of diagnosis day. It was December 1999 and three weeks before her wedding day when Deb’s life path took a dramatic turn. She hadn’t been feeling well for two weeks and had lost a lot of weight, to the point where her wedding dress had to be taken in. Her friend’s husband had just been diagnosed with type 2 diabetes and she realised her symptoms were similar. So Deb popped into a local pharmacy and did a $5 finger prick test. It was 31 (normal blood sugars are 4-5). “I didn’t know what it meant. The pharmacist said I should go and see a doctor. I said I would on Monday. He said no, I think you should go now.” It was a Friday evening. The pharmacist helped her see an emergency GP. She told her to ‘be careful’ over the weekend before seeing her own doctor. So Deb attended a cousin’s wedding and drank rum and coke! “I didn’t know what diabetes was, I didn’t know when the doctor

said be careful, what she meant”, recalls Deb. “I now know I should have been sent straight to the emergency department.”

Medical specialists don’t have diabetes, they don’t know what it’s like to live with it. But people with diabetes do, they understand the realities of day-to-day living. She went to her own doctor on the Monday and she made an appointment with Dunedin endocrinologist Jim Mann. The first thing he did was test her blood sugar (it was still 31) and immediately started her on insulin. And that was it, she had been diagnosed with type 1 diabetes. “I was in a bit of shock. I knew I was going to have to inject insulin for the rest of my life but I knew nothing else. My wedding was only three weeks away and I couldn’t sit and dwell on it. I had too much to do. “I had a dry wedding, I was too scared to drink. Injecting through a wedding dress was also a challenge.”

Deb bought her first test strips from Diabetes NZ’s Otago branch on the day she was diagnosed. She became a member then and 18 months later, while pregnant with her daughter, was quickly co-opted onto the committee, where she has remained ever since. Deb knows first hand the benefit of having branch support. “Medical specialists don’t have diabetes, they don’t know what it’s like to live with it. But people with diabetes do, they understand the realities of day-to-day living and that’s where the branches have most strength, offering practical help and support.” Deb’s diagnosis led to her changing career direction – working in the health sector instead of law or teaching economics. She is currently completing a Masters degree in public health. “Now I’m an expert in my own diabetes and I know what works for me in terms of what I can eat, even drink. For instance I can drink the odd red wine and it doesn’t really impact on my blood sugars, I’ve learned about my own body through trial and error. “It doesn’t impact on me all that much, or I don’t let it. It doesn’t have a negative impact on my life, in fact it’s probably offered more opportunities than restrictions.”

Deb Connor was elected President of Diabetes NZ in November after being a Board and Advisory Council member for five years. She has been a Diabetes Otago committee member for 14 years, including as Vice President and President. Deb’s ‘other life’ sees her working at the Southern District Health Board as a Business and Performance Excellence Facilitator, specialising in the health of older people. She lives with her husband and 14-year-old daughter on a rural property near Outram, outside Dunedin.

Autumn 2016 | DIABETES

LE T ’S G E T A CTI VE

NEW GUID ELINES

Five simple activity goals Our fitness expert Craig Wise explains the Government’s five new exercise guidelines and offers some tips on how to put them into action. To keep us on our toes – quite literally – the Government has released a series of new guidelines for activity. So let’s have a look at what they recommend and how you can fit them into your life.

Sit less, move more! Break up long periods of sitting

Many of us spend our days in sedentary roles, often sitting at our desks from the time we arrive at work until lunchtime and then again until it’s home time. The only time we leave our desks is to get a coffee or food (which we eat sat back at our desks). And when the workday is done, heading home exhausted from the day of sitting at our desks, we then spend the evening watching the TV. One of the largest studies ever carried out, involving 800,000 people, found that those who are sedentary have twice the likelihood of dying from a heart attack or stroke. The answer is to sit less and move

more – try setting a timer to remind you to leave your desk and walk around, even for a quick lap of the office, and remember to get away from your desk at lunchtime. Ask to try a standing desk at work. And if you are enjoying an evening sitting in front of the TV get up and be active during those annoying ad breaks. In a study from Australia, researchers asked 70 healthy adults to sit for nine hours. Every few hours they had to eat and their blood sugar and insulin levels were tested. Then they did it all over again, this time taking regular activity breaks. The study found that just by standing and walking every 30 minutes participants reduced their blood sugar levels by 38 percent and their insulin levels by 26 percent (MC Peddie et al, Am J Clin Nutr. 2013).

It’s never too late to start exercising. Older people living with chronic health conditions, including diabetes, are getting a new lease on life thanks to a specialised exercise rehabilitation clinic run by staff and students from the Waikato Institute of Technology.

DIABETES | Autumn 2016

NEW G UI DELI NES

LE T ’ S GE T ACTIVE

Challenge winner takes 156,000 steps for diabetes One of our key words during November 2015 was ‘action’ and Andrew Barnes, Founder of Perpetual Guardian, certainly took this literally as our action man of the month. The inaugural Diabetes NZ Fitbit MoveMeant Challenge was launched during Diabetes Action Month to help promote the importance of physical activity in our everyday lives and as a way of controlling and managing type 1 and type 2 and preventing or delaying type 2. The three pools of competitors employed their Fitbit activity trackers in a weekly challenge to find the ultimate stepper of the week and Andrew quite rightfully claimed first place in his pool, outstepping other challengers such as Minister of Health Dr Jonathan Coleman. The top two places in each pool progressed to the finals week which saw Andrew competing against Jacinda Ardern (MP), Sophie Devine (NZ Black Caps), Hilary Poole (CEO of Netball NZ), Laura Thompson (Actress Shortland St) and Jacob Rawiri (Actor Shortland St). It was a line-up of formidable challengers but Andrew was determined to retain his position at the top of the steps and managed to stride past Sophie in the home straight with an incredibly impressive first place result of 156,000 steps. All-in-all, the challenge was a great success and congratulations go to Andrew and all of the challengers for their efforts and also for helping to promote critical messages to get our nation to step up and get moving!

Do at least 2.5 hours of moderate (or 75 minutes vigorous) physical activity spread through the week

Two and a half hours sounds like a long time to be active but, spread over seven days of the week, it is only 22 minutes a day – that’s not so bad is it? And those 22 minutes don’t have to be done in one go. Do 10 minutes in the morning or evening plus a nice brisk walk during your lunchtime and you are well and truly on your way to achieving the goal.

For extra health benefits aim for five hours of moderate (or 2.5 hours of vigorous) physical activity spread though the week

The previous guideline’s 2.5 hours of exercise per week recommendation is the bare minimum that the

Government believes everyone should do. To really make a difference to your life in terms of seeing health benefits and feeling the best then increasing this to five hours is the way to go. If you think five hours is too much then work up to it, adding a little to your everyday activity (walk a little further, do an extra length of the pool – whatever your activity is).

Do muscle strengthening activities on at least two days each week

You don’t need to rush out to join the gym or buy exercise equipment at home. Incorporating some resistance training into your weekly activity has numerous health benefits but there are a range of bodyweight activities that you can do at home or the park that will help you tick this one off your list.

A walk to the local park, some body weight exercises there, and then a brisk walk home will see you meeting this recommendation and the one above – and double up as some quiet mental health time too.

Doing some physical activity is better than doing none

There isn’t a lot more to be said – a little activity beats nothing! Start small and work your way up. Take small consistent activity bites and the changes will come – soon it will be just a part of your life. *If you have a question about exercise and diabetes, email editor@diabetes.org.nz and Craig will answer it.

Autumn 2016 | DIABETES

DIAB E TES A B ROA D

WORLD D IABE TES CO NG RESS

Going global

It’s the biggest meeting of the diabetes community in the world and Diabetes NZ was there. Karen Reed and Emily Wilson report back on their experiences. This truly global diabetes meeting brought together 8,500 delegates from 178 countries to share, discover and connect with others in the global diabetes community. Diabetes New Zealand’s chief executive Steve Crew was there as part of the 26-strong Kiwi delegation which included five other Diabetes NZ representatives. They attended a highly praised programme that included 220 hours of scientific sessions with presentations from over 400 top speakers and more than 1,000 posters and 300 e-poster presentations during the event.

DIABETES | Autumn 2016

KAREN REED, Diabetes NZ Vice President and IDF Champion As Diabetes New Zealand’s IDF Champion I was privileged to be able to attend the World Diabetes Congress held in Vancouver for five days during early December 2015. Doctors, nurses, scientists, researchers, other health professionals, and policy makers intermingled with people with diabetes and young leaders. There were six different streams of presentations, discussions and workshops and an exhibition area where leading pharmaceutical companies manned stands alongside diabetes advocacy organisations. It was a truly exhilarating mix. Despite the cultural and economic diversity amongst the countries represented, there was a feeling of

unspoken camaraderie undeniably strengthened by the fact that in one way or another we were all facing a common issue – diabetes. My background is in medical research so I was keen to catch up on as much of that side of things as I could fit in. New and exciting avenues of research are opening up (eg in stem cell research) while much work proceeds slowly and steadily on many longterm ongoing projects (eg diabetes prevention programmes). I attended a number of sessions and a workshop centred on peer-support programmes and I came back to New Zealand feeling inspired about the many potential ways we could serve our people with diabetes better, supporting the clinical care provided by our health professionals. I believe peer support is key for our organisation, and something that we could do better. Many of our branches provide peer support almost without realising it. It can take many forms and may occur as something tangible – a support group for example. Or it may

WO RLD DI A BETES CO NG RESS

“Despite the cultural and economic diversity amongst the countries represented, there was a feeling of unspoken camaraderie undeniably strengthened by the fact that in one way or another we were all challenging a common issue – diabetes.” — Karen Reed, Diabetes NZ Vice President

occur incidentally by way of a chat on the phone as the result of an enquiry about information leaflets. There is now a growing body of research that demonstrates the effectiveness of peer support as an adjunct to medical care for people with diabetes. And there are a number of different models of peer support that could potentially be adapted to the New Zealand context. It was evident that the issues we face here in NZ with regards to rising numbers of all types of diabetes, health care resources, availability of medication and supplies, and issues around public health policy are similar to those faced by other developed countries. We are not alone, which is why so much of the work of the International Diabetes Federation is important and we should be supporting and sharing it. As IDF Champion for Diabetes NZ, I encourage you to join me in promoting and advancing the activity of the federation. * You can find out more about the International Diabetes Federation at www.idf.org

DI A B E TE S ABROAD

EMILY WILSON is the IDF Youth Leader for New Zealand. She joined other successful candidates from around the world to attend the Young Leaders in Diabetes training programme held in Vancouver ahead of the World Diabetes Congress.

The first week was an amazing experience meeting another 130 passionate young people living with diabetes from all around the world. We all shared a common goal – to reduce the burden of diabetes on a global scale. It was a real eye-opener and inspiration to learn what other young leaders have been working on. Some are running their own charities and providing access to insulin and education programmes in developing countries, for example T1International in the UK. The seminars on advocacy and practical sessions on how to go about getting sponsorship and plan events for our own diabetes projects were very informative. Some interesting debates were around whether we should advocate for diabetes as a whole or differentiate between type 1 and type 2 when trying to change policies and lobby governments. There are many misconceptions and stigmas associated with type 2 diabetes that hinder efforts to improve health outcomes for those affected. Perhaps the diabetes community could be more effective if we worked together to unify a message that will ultimately improve the lives of all people living with diabetes. There is also mounting evidence to support a person-centred approach to the care and management of diabetes. This approach is all about creating a treatment plan with active patient engagement, a focus

on what works rather than what doesn’t. The opening ceremony for the World Congress was a major highlight. All the leaders were dressed in their country’s colours and flags. We had the opportunity to walk on stage to showcase the Young Leader programme and what we aim to achieve. The same day a few of us did an exercise session in the park, run by two Young Leaders who use exercise to educate people on how to live well with diabetes. DASH and Diathlete are two amazing programmes that are working very well in the US and UK. The knowledge I gained, especially around the topic of advocacy, will be useful for my projects in the coming years. I plan to work closely with Diabetes Youth NZ providing more support for those families and siblings with type 1 children. I also want to continue to educate the public on diabetes through my own adventures, empowering more at-risk groups, such as young adults, to manage it well and to support those in my community by developing our local support groups. The trip was one of those lifechanging experiences that I am very grateful to have been given. It has left me slightly overwhelmed but with a massive network of likeminded friends who will support each other in our deep commitment to making a positive impact in the diabetes world.

Autumn 2016 | DIABETES

C ARE A N D PRE VE NTI O N

THE IM PO RTA NCE O F S LEEP

How might diabetes affect your sleep? Having diabetes can impact on your nights as much as your days. It can stop you getting the sleep you need in a number of different ways. Professor Merlin Thomas explains. Diabetes can indirectly affect your sleep pattern by causing you to need to get up and go to the toilet, often many times during the night. This is known as nocturia. Healthy kidneys are able to make more concentrated urine overnight. This means that most adults do not need to get up more than once, if at all. However, getting up more frequently at night is a common symptom of diabetes and a common cause of disrupted sleep. Nocturia can sometimes be a sign of poor glucose control during the night. When glucose levels get too high, glucose spills over into your urine, which increases the amount of urine you will make. This is most noticeable at night, when you should normally be making less. Most people donâ&#x20AC;&#x2122;t test their glucose levels at night (as they are asleep) so it can be hard to detect. But when glucose control is improved, this symptom can quickly go away. So it is always worthwhile pointing it out to your diabetes care team and asking their advice. Damage to the kidneys or the bladder associated with diabetes may also cause you to get up frequently in the night. Many people with type 2 diabetes benefit from bladder retraining and/or taking medications in the evening to reduce the irritability of their bladder. Passing more urine at night can also be a sign of problems with your heart. Again, instead of making less urine during the night, some people with impaired heart function (known as heart failure) make more. This is to enable them to clear the extra fluid from their body that has accumulated in their legs during the day, but comes back into their system when they lie down. This is treated by diuretics â&#x20AC;&#x201C; medication to increase the amount of fluid lost into the urine through the day, making less of a burden at night. Sometimes, low glucose levels (hypoglycaemia) at night can also cause you to wake up. To protect against hypoglycaemia, the body has a number of defence mechanisms that trigger warning symptoms to

DIABETES | Autumn 2016

THE I M PO RTA NCE O F S LEEP

alert you that things are awry. One of them is to wake you up and make it hard to go back to sleep until you have eaten. Again, hypos can’t occur in the majority of people with type 2 diabetes because their body is able to make enough glucose in the event that levels fall. However, in some people with type 2 diabetes who take medications that increase their insulin levels (sulphonylureas and meglitinides) or are injecting insulin itself, hypos can occur at night. Type 2 diabetes is also associated with increased levels of stress and mental illness, including depression and anxiety disorders. These can significantly affect the quantity and quality of your sleep. The health of your feet also affects how well you sleep. It is not unusual for people with type 2 diabetes to experience pain in their feet (due to ulcers, infection, nerve damage and/or vascular disease).

Pain from these foot problems is often worse at night (or even limited to night-time) as the feet are elevated, warm and partly compressed by the bedclothes. Each has a specific treatment that includes medication and/or surgery; in addition, simple things such as using a bed cradle can keep sheets and blankets from touching your sensitive feet and legs. Some people with type 2 diabetes experience an unpleasant ‘crawling’ feeling in their legs at night, accompanied by a tremendous urge to move. This is known as restless legs syndrome. It is often dismissed as something due to your diabetes, back problems or ‘just nerves’. However, a number of different medications are now available to tackle this real problem, once it is recognised for what it is. Another problem that can keep you up at night is leg cramps,

CARE AND P RE V ENTION usually affecting the calves but also sometimes the thighs or the feet. These cramps can be intensely painful and last up to several minutes before subsiding. This is followed by a deep muscle ache that can last up to a few hours. Leg cramps are more common in people with type 2 diabetes, especially older people, those with kidney problems or poor circulation. Again, this is not a problem that should be simply put up with. In those with troubling or frequent cramping, symptoms can be reduced by using verapamil or diltaizem (commonly prescribed as blood pressure-lowering medications). Vitamin B complex may also be helpful in some people. Quinine, the active ingredient in tonic water, may also be useful in some people although its effects are quite variable.

Extracted from Understanding Type 2 Diabetes by Professor Merlin Thomas, a Kiwi living and working in Australia at the Baker IDI Heart and Diabetes Institute. You can buy his excellent and easy-to-read guide to managing diabetes at www.exislepublishing.co.nz RRP $32.99 (audio and e-book also available).

Order our free Diabetes NZ information pamphlets Go to www.diabetes.org.nz and download the order form or call us on 0800 342 238 ALSO AVAILABLE FREE TO HEALTH PROFESSIONALS

Autumn 2016 | DIABETES

THE RU BY M CG I LL CO LU MN

Welcome to our new columnist Ruby McGill, who lives in Upper Hutt, Wellington, with her husband and five-year-old daughter. The couple run a plumbing business and Ruby works 30 hours a week as an instructional designer for a company called Wavelength.

On a quest to master diabetes

’VE ALWAYS CONSIDERED diabetes to be a balancing act. The aim of the game being to defeat the highs and the lows, arriving somewhere in the middle. Surely it can’t be that hard? For just over 16 years I’ve played the game pretty well, with only a few minor hiccups. However just over 12 months ago I noticed my diabetes was becoming unhinged. I’d recently turned the big 3-0, bought a new home, launched a plumbing business with my husband, facilitated adult learning at the bank during the day and raised an energetic four year old. Needless to say life was busy, chaotic, fun and challenging. Just the way we like it! However after three continuous nights of low blood sugars and broken sleep, I was unable to function at work. I realised I had to master diabetes quickly. If not, the world I was working so hard to build was going to unravel. I tried not to think about the consequences – disturbed sleep,

DIABETES | Autumn 2016

exhaustion, being unable to contribute at work, and the terrifying fact that it’s the people closest to me that bear the brunt of it all. Not to mention other frightening complications such as kidney disease, blindness, blood vessel and nerve damage, gum disease and infections. Diabetes sure is glamorous! After a severe hypo, where I was convinced my blood sugars would continue to drop during the night and I wouldn’t wake up, I decided to call in the big guns. It was time to start exploring an insulin pump. Unfortunately it wasn’t as simple as just asking for an insulin pump. There were a number of hoops I had to jump through gathering information, before Pharmac would consider funding an insulin pump. Alternatively you can pay for a pump yourself, however with an initial cost of $8,000–$12,000 and ongoing consumable costs, this wasn’t an option for me. I worked closely with the diabetes team at Lower Hutt hospital, tweaking my insulin and fine tuning my carb ratios and diet and still my

blood sugars were all over the place. So in May 2015 we submitted an application to Pharmac to fund an insulin pump. It was declined. Refusing to give up, we appealed the decision. It meant I had to stop putting on a brave face and make sure Pharmac truly understood the effects this disease was having on my health and wellbeing. I began writing, as did my mum. We had nothing to lose. You can see our letters to Pharmac at my blog www.masteringdiabetesnz.com Four weeks later I received the green light. Funding approved! I’d been given a chance to try an alternative way of controlling my diabetes. On 19 August 2015 I began using a pump, the first step in my quest to finally master diabetes (surely it’s possible). Come and join me on my journey. I certainly don’t have all the answers, but I’m hoping to learn from the vast number of people either affected by diabetes or helping people who have diabetes around the world. Fingers crossed, people learn from me too.

NEW G UI DELI NES

Eating for good health

FOOD & NUTRITION

NEW

LOW

The Ministry of Health has released new guidelines for healthy eating.

Eating statements for New Zealand adults

CALORIE

1. Enjoy a variety of nutritious foods every day including:

SWEETENER Measures spoon-for- spoon like sugar

• plenty of vegetables and fruit • grain foods, mostly wholegrain and those naturally high in fibre • some milk and milk products, mostly low- and reduced-fat • some legumes, nuts, seeds, fish and other seafood, eggs, poultry (eg chicken) and/ or red meat with the fat removed.

Perfect to use in your favourite food or drink recipes. Add a delicious, sweet taste with fewer calories.

2. Choose and/or prepare foods and drinks: • with unsaturated fats instead of saturated fats • that are low in salt (sodium); if using salt, choose iodised salt • with little or no added sugar • that are mostly ‘whole’ and less processed. • If you drink alcohol, keep your intake low. Stop drinking alcohol if you could be pregnant, are pregnant or are trying to get pregnant.

4. Buy or gather, prepare, cook and store food in ways that keep it safe to eat If you are struggling to maintain a healthy weight, see your doctor and/or your community health care provider.

What is different? The guidelines are considered more practical, giving useful tips and guidance on making healthier choices. There is a new emphasis on more whole and less processed foods including vegetables, fruits, lowand reduced-fat dairy, and whole grains, and eating more protein from plant foods, fish, and seafood. In terms of fats, the guidelines focus less on the amount eaten and more on the quality and type used, such as swapping saturated fat with unsaturated fats. *For more information see www.health.govt.nz – search term Eating and Activity Guidelines for New Zealand Adults

3. Make plain water your first choice over other drinks.

For delicious recipes, visit

club

Autumn 12032015_Equal Strip_59x242.indd 1

.co.nz

2016 | DIABETES16/04/2015 27

1:40 pm

RECI PES

WHOLEFOOD KITCHEN

Vegetarian delights As the nights draw in, try one of these tasty and healthy vege dishes.

Julia and Libby's Wholefood Kitchen Eating the right type of food is vital to feeling healthy, as food gives us energy. To Julia and Libby, the right diet is one free of processed foods, with an emphasis on wholefoods. In Julia and Libbyâ&#x20AC;&#x2122;s Wholefood Kitchen they bring together their best recipes and tips for living a healthier life. The book is full of energy-rich, nutritious recipes with lush photographs by Lottie Hedley. There is also a chapter on nutrition, explaining the importance of vitamins and minerals, and recipes for making your own natural beauty products to keep your skin healthy. Recipes extracted from Julia & Libby's Wholefood Kitchen by Julia and Libby Matthews, published by Penguin NZ, RRP: $50.00. Photography by Lottie Hedley.

DIABETES | Autumn 2016

WH O LEFO O D KITCH EN

Mushroom bolognese A rich, hearty vegan bolognese that is full of flavour. Add grass-fed minced beef for a non-vegan option. 1 onion, diced 1 stalk celery, finely diced 1 carrot, finely diced 1 tbsp coconut oil* 500g Swiss brown mushrooms, quartered 4 cloves garlic, crushed 1 cup water 2 x 400g cans chopped tomatoes ½ tsp chilli powder 1 tsp dried oregano salt and pepper, to season 500g gluten-free spaghetti** 1 cup baby spinach

RECIPES

Sweat onion, celery and carrot with ½ tablespoon coconut oil in a saucepan over a medium heat, until veges are soft and clear. Brown mushrooms and garlic in a frying pan with remaining coconut oil for 2 minutes. Add water, tomatoes, chilli powder and oregano to the pan with onions, celery and carrot. Bring to the boil and reduce heat to a simmer. Simmer for 20–30 minutes. Add mushroom mixture and simmer for another 10 minutes. Season to taste with salt and pepper. Fill a saucepan with water, season with a pinch of salt and bring to the boil. Add spaghetti, reduce heat to a simmer and cook uncovered for 15 minutes, or until pasta is just soft. Transfer to a colander and let excess water drain off. Serve mushroom bolognese on a bed of spaghetti and baby spinach.

APPROXIMATE NUTRITION PER SERVE Serves 8. Energy 1120jK, Total Fat: 3g, Carbohydrate: 48g, Fibre: 4g.

Feta and pea falafels These falafels are moist and bursting with beautiful flavour. Chickpeas are rich in soluble and insoluble fibre that will keep you feeling full and less likely to snack between meals. They are also a fantastic source of vegetarian protein that is low in calories. FALAFEL 1 cup frozen green peas, thawed 400g can chickpeas, rinsed and drained 1 organic egg 1 tbsp ground cumin ½ cup fresh coriander ¼ cup parsley 1 cup gluten-free breadcrumbs** 2 spring onions, finely chopped 100g feta, crumbled 1 tbsp sesame seeds 1 tbsp coconut oil* DRESSING ¼ cup tamari 2 tbsp extra virgin olive oil 2 tbsp lemon juice 3 tbsp water 1 clove garlic, minced ¼ cup finely chopped fresh coriander

TRY TH IS NEW PRODUCT!

In a food processor combine peas, chickpeas, egg, cumin, coriander, parsley and breadcrumbs. Pulse until it forms a coarse paste. Transfer mixture to a bowl and stir in spring onion and feta. To make the dressing, whisk all ingredients together in a bowl and set aside. Place tablespoons of falafel mixture onto a tray, flatten and sprinkle with sesame seeds. Heat coconut oil in a frying pan and cook falafels for 1–2 minutes each side, turning carefully as the mixture is quite soft. Serve with dressing on the side.

APPROXIMATE NUTRITION PER SERVE Serves 4. Energy 1418jK, Total Fat: 18g, Carbohydrate: 29g, Fibre: 6g.

DIETITIAN TIP: *Coconut oil is not recommended for people with diabetes, or at risk of developing it, because of the high saturated fat content. We suggest using olive oil instead. **Regular spaghetti and breadcrumbs are also suitable for those who do not need gluten-free options. — Teresa Cleary, Diabetes NZ Dietitian

Autumn 2016 | DIABETES

CO M M U N IT Y

TAKING IT TO THE LIMIT

The Kepler Challenge is the premier mountain running event in New Zealand. It is an ‘ultra’ marathon with competitors running the 60km Kepler Track, in Fiordland, in one day. The distance for a normal marathon is 42km.

ADVENTURE IN THE CLOUDS Ruth Jeffery, 49, took up running six years ago to control her weight and get fit. Since then she has run 18 marathons, not letting the fact she has type 1 diabetes get in the way. Ruth completed one of New Zealand’s ‘ultra’ marathon mountain running races – the 60km Kepler Challenge – in December. Here she describes the experience.

mountains). It had seemed like a good idea months ago when I entered. Now running 60km with a 1,350m climb in the middle seemed rather daunting. Nervously I check my insulin pump for the millionth time – set for minus 60 percent for 10 hours. I do a last glucose check and am relieved to see a reading of 8.1. Perfect.

The forecast was horrible. According to Metservice we could expect gale force winds of 70kph and snow to 800m. Headwinds, of course, and we were climbing to 1400m. What on earth had possessed me to enter this event?

I adjust my running pack which is filled with the compulsory gear (layers of thermals, waterproof jacket and over-trousers, hat and gloves and survival blanket), as well as enough snacks to last me till doomsday, glucose meter and testing strips, glucose tablets and water and a glucagon kit – just in case. Thankfully I have trained carrying all this gear, so I am used to the weight.

I lined up with the 450 runners who were mad enough to decide that running the Kepler Track in one day was a good idea (it’s normally a tough three-day tramp over the

The hooter sounds and we are away. The flat run around the edge of Lake Te Anau gives way to a knarly steep climb up to the Luxmore Hut. The temperature drops as we climb

DIABETES | Autumn 2016

and the wind picks up. I stop to put on a few layers and munch on a muesli bar. From training I know that eating about 20g of low GI carbohydrate per hour works well for me. Luxmore has the first ‘aid’ station where we can help ourselves to bananas, oranges, lollies and muesli bars, so I have half a banana and an electrolyte drink. I try to test my glucose – but it’s too cold for the meter. As I feel fine I decide to just carry on. It is windy, drizzly and cold across the open tops. We are now over 1,000m and still climbing into a stiff headwind. I eat more to compensate for the conditions (and to lighten my pack!). The views are stunning – complete with a rainbow below us. Finally I reach the top – it’s all downhill from here, and it should be easier. But stairs, switchbacks and steep downhill running are exhausting and I start to wonder if I will ever get to Iris Burn (the halfway mark).

TA KI NG IT TO TH E LI M IT

COM MUNITY

Ruth’s top training tips 1.

Remember you’re an “athlete” first and a person with diabetes second, and that you’re out to have fun.

2. During training try different foods/ gels/sports drinks to find out what you can tolerate and how they affect your blood glucose levels. Then out of nowhere I see Santa Claus! He and his Elf shout encouragement as we cross the half-way mark, and tell us there is Christmas cake at the next aid station. At the aid station I stop to check my glucose – but still too cold so I give up again. The last 30km are pretty gruelling. At each aid station I eat a little more… both rewarding myself for the effort (who knew a jetplane lolly could be so tasty?) and ensuring I don’t go low. At 50km I have now reached new territory – I have never run this far, or for this long. But it’s only 10km to go and I manage to pick up the pace. I can smell that cold beer that’s waiting for me.

3. Test frequently when training – it helps you recognise if you’re feeling lousy because you’re going hypo (low) or hyper (high) versus lousy because you’ve run 30km and you’re tired!

4. Train in all weather conditions – you need to know how hot or cold will affect you (I go low quicker when it’s hot). And you never know what the weather will be like on the day.

5. Good glucose control the day before

Eight hours and 24 seconds after starting I cross the finish line. I’m exhausted but buoyant. My meter has finally warmed up and my BG is 7.9. Perfect.

an event really helps – you don’t want to start an event dehydrated and tired from being high, or tired from a night-time hypo.

Welcome to Diabetes magazine Our mission is to help you live well with diabetes. Every issue of Diabetes includes: • Trusted expert advice • Latest research and treatment options • Inspiring personal stories • Delicious diabetes-friendly recipes • Lifestyle advice on food, exercise, travel • Spotlight on children and diabetes

SUBSCRIBE today and have four issues of Diabetes delivered straight to your door for just $18 per annum. Diabetes is published by Diabetes New Zealand. Join Diabetes NZ today for $35 waged (or $27.50 unwaged). Membership includes magazine subscription. Email: admin@diabetes.org.nz or call 0800 342 238 to find out more. Autumn 2016 | DIABETES

DIAB E TES I N H ISTO RY

1916

Treating diabetes 100 years ago To mark the 100th issue of the New Zealand Diabetes and Obesity Research Review, the publication’s editors decided to look for scientific research papers about diabetes and obesity from 100 years ago. The results of some of the studies may surprise you! Delving into the past was an enjoyable experience for Professor Jeremy Krebs, Clinical Leader of Endocrinology and Diabetes at Wellington Hospital. He provides expert commentary on the studies profiled in the monthly online Diabetes and Obesity Research Review. “It has been a fascinating exercise, with some beautifully written papers, intriguing insights from very limited clinical data and a realisation that in 1916 it was considerably easier to get published in the New England Journal of Medicine than it is today. I hope you enjoy my dabble into the past as much as I did,” he says in his commentary for the special 100th issue in December. The following studies were published in two leading American and British medical journals of the time. Remember the year is 1916, and insulin had not yet been discovered as a treatment for type 1 diabetes.

DIABETES | Autumn 2016

1. The ‘rational’ diet

2. Casein and cream

Summary: This 1916 paper discussed dietary regulation and provided recommendations for the treatment of obesity, based on the premise of the ‘combustions’ (burning) of surplus body fat and preventing its re-accumulation.

Summary: This author described a dietetic treatment for ‘certain cases of diabetes mellitus’, which involves consumption of small amounts of casein (a milk protein) and cream, mixed with water, every two hours. With the acknowledgement that he had only been treating patients with this regimen for 12 months at the time of reporting, author RT Williamson, in the British Medical Journal, claimed that the urine of his patients had remained free of sugar for months.

JK comment: It is remarkable that 100 years ago when obesity was not the major public health problem that it is today, dietary advice for those individuals who were obese was not dissimilar to the present. In this beautifully written article in the Boston Medical and Surgical Journal, Edward Cornwall, a physician, writes about the use of a ‘rational diet’. Notably fruit and vegetables feature highly – “Include plenty of fresh fruits and vegetables in the diet, in order to supply full rations of the body salts and vitamins; but use careful selection so as to include only fruits and vegetables which are comparatively free from objectionable qualities, such as indigestibility, possession of purin or oxalic acid content, and offensiveness to the patient’s idiosyncrasies”, Dr Cornwall writes. So not a lot has changed with regard to dietary prescription in 100 years. We have done the rounds of altered macronutrient composition, but the fundamental principle of calorie restriction, with plenty of fruit and vegetables, remains the central core. So it begs the question, why is the world still getting ever more obese when such knowledge has been around for 100 years? Just maybe education alone doesn’t work! Reference: N Engl J Med (published as Boston Med Surg J) 1916;175(17):601–2

JK comment: In this paper, treatment of diabetes with a low-carbohydrate, high-fat and high-protein preparation is described. The main focus of the dietary management of diabetes in the early 1900s was through very strict carbohydrate restriction. It is intriguing that this has come full circle with a current resurgence in interest in this approach. In 1915 in the pre-insulin era, this was by necessity for those with type 1 diabetes. Currently the interest has been more for those with type 2 diabetes, although we have recently published on the use of less restricted low-carbohydrate diets in type 1 diabetes. Reference: BMJ 1915;1:456

3. Fasting treatment Summary: This 1916 paper discusses a treatment regimen for diabetes involving fasting, typically for 14 hours twice weekly as a means of cleansing the alimentary tract, and a diet that does not entirely eliminate starch. The author, John Hume, summarised four random cases from his notes that typified the results obtained.

1916

DI AB E TE S I N H ISTORY Living with diabetes 100 years ago would have been a life-threatening condition

Bartrum family group in 1916. Tesla Studios: Negatives of Wanganui and district taken by Alfred Martin, Frank Denton and Mark Lampe (Tesla Studios). Ref: 1/1-021987-G. Alexander Turnbull Library, Wellington, New Zealand. http://natlib.govt.nz/ records/23227652

JK comment: In this paper, John Hume gives an account of the management of what appears to be type 2 diabetes, given the ages of the patients described, using intermittent fasting. Isn’t it fascinating how the wheel turns full circle as this has again become a popular strategy for weight management? Perhaps Hume was the original claimant to the 5:2 diet: “If a small quantity of sugar persists I recommend two fasts each week of about fourteen hours, and find this quite sufficient to prevent the other symptoms of the disease from manifesting themselves and to allow the patient to attend to his duties”, he says. Hume talked about the variability of urinary glucose levels; “In my opinion this is due to the condition of the bowel, as I have invariably found the sugar content of the urine high when the bowel was loaded; after it was cleared by

aperients a reduction in the amount of sugar was apparent. … As early as three days after commencing treatment, I have invariably found alleviation of the symptoms, the thirst much less, the craving for food not nearly so pronounced…”. This rapid improvement in glucose metabolism is similar to that observed with very low calorie diets and bariatric surgery. … Certainly the idea of intermittent fasting was clearly already established 100 years ago. Reference: BMJ 1916;2:160

4. Observations on blood sugar Summary: This 1916 paper, by OF Rogers Jr, sought to determine the prognostic and therapeutic relevance of determining blood sugar levels in patients with diabetes. The author notes that new methods were available to take blood that required relatively small samples. Before then testing blood

sugars was largely impractical due to the large volumes of blood that needed to be drawn. JK comment: It is rather taken for granted in 2015 that we can easily measure blood glucose level, and that people with diabetes have small, portable devices that can measure their blood glucose level from a very small drop of blood in a matter of seconds. We have evidence that doing so helps to facilitate improved glucose control, at least in type 1 diabetes, and that this is very much a routine part of care. It is easy to forget that such a luxury is a relatively new phenomenon. In this paper there is an interesting discussion about the early measurement of blood glucose level and its place in the management of diabetes. Once again, this is fascinating reading. Reference: N Engl J Med (published as Boston Med Surg J) 1916;175(5):152–6

*Studies from the NZ Diabetes and Obesity Research Review, a monthly digest of global research studies. Subscribe for free: http://www.researchreview.co.nz/nz/Clinical-Area/Internal-Medicine/Diabetes-Obesity.aspx

Autumn 2016 | DIABETES

THE L AS T WORD

HELEN BERNSTONE

Relationships Helen Bernstone has

had her ups and downs with diabetes after being diagnosed 18 years ago in London. She explains life abroad with diabetes and the challenges of bringing her ‘friend’ under control.

“I have recently retired from full time employment as I am now 72 years of age. I returned to New Zealand in 2014 after working overseas for around 20 years. I had begun to notice that my sugar levels were becoming a bit harder to control, I was getting some aches and pains but most of all I moved back as I had four beautiful grand daughters here in Auckland and I wanted to be closer to them. My journey with diabetes began 18 years ago, when I developed type 1 or as it was then labelled ‘viral diabetes’. I had the recognised symptoms of gasping for water, loss of weight and poorer eyesight. I was put on to insulin at the St. Georges Hospital diabetes clinic in London. After my diagnosis I was employed in early childhood teacher education in London, Qatar, Singapore and south Australia. My previous life had been in New Zealand working in a variety of educational positions.

Relationships Relationships come and go and I should know, I've had several but you know what there has been only one that has stayed with me and we have been together for 20 years Such a long long time and what’s more she has stated that she will stay with me until I die. How lucky am I, I hear you say. Her name is Diabetty but we are so close I call her DiaB. Extract from Helen's poem.

DIABETES | Autumn 2016

I had to re-establish the drugs etc needed for my diabetes in each country I settled. Qatar was the most challenging and Singapore the most expensive. Every country in the end would prescribe the same drugs but it all took time to work out the equivalent as they all had different brand names for each. I have had periods where it has been ‘tight control’ but mainly not. Now I don't work full-time any more, I have established this desired control. The relief is

wonderful. Being a teacher/ lecturer/co-ordinator of various events and so on I always made sure my sugar levels were higher than I would have wanted in case they dropped during a class or meeting and I needed some sugar. Therefore my blood sugar levels were all over the place. I have always been a keen snow skier and to my delight discovered that Mt Ruapehu ski fields give me a free season pass now I’m over 70. Whoopee!!! I also love Queenstown and Meribel in France and in Doha it was the Lebanon Beirut ski slopes. I have worked out at the gym five or more times a week and have done that since I was around 40 years of age. I am now free to test much more regularly and I am what you could tentatively call contented. I don’t want to be too contented though as I see myself as a ball of energy and I need to ensure I’m using each ball (leisure, work, family, home maintenance, friends, study) to its fullest extent. Sometimes the size of these energy balls varies depending on the challenges I have set myself. A more recent addition to this list of energy balls has been one for diabetes. I now believe I have a comfortable relationship with my diabetes with only a hint of eye damage as the only degenerative symptom thus far and being a diarist I just felt like recording where I stood with this thing – diabetes. So I wrote a poem called “Relationships” to describe how I feel about my diabetes.

GlucaGen® HypoKit

Glucagon (rys) hydrochloride

Make sure it’s there when they need it* GlucaGen® HypoKit is used to treat severe hypoglycaemia in people using insulin or taking tablets to control diabetes, who have become unconscious. Available from pharmacy with or without a prescription.

Patient support available The HypoHelp website and app are an important resource for patients at risk of hypoglycaemia and includes a free expiry date reminder service for patients with a GlucaGen® HypoKit. Download the app for free at www.hypohelp.co.nz Also available at Google Play or iTunes.

*Refer to full indications below

GlucaGen® HypoKit is a Pharmacist Only Medicine that is funded through the PHARMAC with a prescription, or available for purchase without a prescription (normal pharmacy charges apply). Ask your Healthcare Professional if GlucaGen® HypoKit is right for you.

Before prescribing, please review full Data Sheet available at www.medsafe.govt.nz GlucaGen® HypoKit. (glucagon [rys] hydrochloride). Presentation: Each pack consists of a vial containing lyophilised glucagon 1 mg (1 IU) as hydrochloride and a glass syringe pre-filled with 1 mL water for injections. Indications: Therapeutic: Treatment of severe hypoglycaemic reactions in persons with diabetes mellitus treated with insulin or oral hypoglycaemic agents. To prevent secondary hypoglycaemia, oral carbohydrate should be given to restore hepatic glycogen following response to treatment. The treatment of sulfonylurea-induced hypoglycaemia differs from severe insulin-induced hypoglycaemia due to the possibility of secondary hypoglycaemia - it is preferable to use intravenous glucose (see full Product Information/ Data Sheet). Medical consultation is required for all patients with severe hypoglycaemia. Contraindications: Hypersensitivity to glucagon or lactose, phaeocromocytoma, insulinoma or glucagonoma. Precautions: Glucagon will have little or no effect when the patient is fasting or is suffering from adrenal insufficiency, chronic hypoglycaemia or alcohol-induced hypoglycaemia. When used in endoscopy or radiography, caution should be observed in diabetic patients, or elderly patients with known cardiac disease. Glucagon is instable in solution, it should be used immediately after reconstitution and must not be administered by intravenous infusion. May cause allergic reactions in latex sensitive individuals. * Interactions: Glucagon is an insulin antagonist. When given in large doses, glucagon may potentiate the anticoagulant activity of warfarin. Glucagon can reverse cardiovascular depression of profound ß-blockade (see full Product Information/Data Sheet).* With indomethacin, glucagon may lose its hyperglycaemic effect or even produce hypoglycaemia. Adverse Effects: Nausea; vomiting. Dosage and Administration: The glucagon solution should be prepared immediately before use. Dissolve powder in accompanying solvent and administer by subcutaneous or intramuscular injection. Therapeutic: Adults and children above 25 kg - administer 1 mg; Children below 25 kg - administer 0.5 mg. (Jan 2015).

*Please note change(s) in Product Information/Data Sheet. Novo Nordisk Pharmaceuticals Ltd., G.S.T. 53 960 898. PO Box 51268 Pakuranga, Auckland, New Zealand. NovoCare® Customer Care Centre (NZ) 0800 733 737. www.novonordisk.co.nz ® Registered trademark of Novo Nordisk A/S. TAPS(DA) 1545RB McK336045/Diabetes NZ 03/15.

GlucaGen® HypoKit Glucagon (rys) hydrochloride

A 24-hour insulin that I can take once a day? 2

“Sweet...!”

Lantus® (insulin glargine) is now fully funded for Type 2 diabetes mellitus patients requiring insulin.1,2 For thousands of Kiwis, this will be something to smile about. Lantus® is a long-acting basal insulin. ‘Basal’ is a term used to describe the slow, steady release of insulin needed to control your blood glucose between meals and overnight. Lantus® provides a continuous level of insulin over 24 hours, similar to the slow, steady (basal) secretion of insulin provided by the normally functioning pancreas. This means that only one dose of Lantus®, given at the same time each day, is needed for 24-hour basal control. 2,3 How is Lantus used in people with Type 2 diabetes? In Type 2 diabetes, Lantus is given by subcutaneous injection once daily and can be used in combination with oral diabetes medications and/or with short or rapid acting insulin as instructed by your doctor. 2,4,5 Talk to your doctor about whether Lantus® could be right for you.

References: 1. February 2012 Pharmaceutical Schedule Update, Pharmac. 2. Lantus Data Sheet, August 2010. 3. Goykham S, et al. Expert Opin. PharmacoTher 2009; 10(4):705-718. 4. Fulcher G, et al. AMJ 2010; 3(12):808-813. 5. Nathan D, et al. Diabetes Care, 2009; 32:193-203. Lantus® is a Prescription Medicine that is part of the daily treatment of Type 1 & Type 2 diabetes mellitus. Do not use if allergic to insulin glargine or any of its ingredients. Precautions: for subcutaneous (under the skin) injections only, do not mix or dilute. Close monitoring required during pregnancy, kidney or liver disease, intercurrent illness or stress. Tell your doctor if you are taking any other medicines, including those you can get from a pharmacy, supermarket or health food shop. Interactions with other medicine may increase or decrease blood glucose. Side Effects: hyper or hypo glycaemia, injection site reactions, lipodystrophy (local disturbance of fat metabolism). Contains insulin glargine 100U/ml. Use strictly as directed and if there is inadequate control or you have side effects see your doctor, diabetes nurse or educator. For further information please refer to the Lantus® Consumer Medicine Information on the Medsafe website (www.medsafe.govt.nz). Sanofi, Auckland, freephone 0800 283 684. Lantus® is fully reimbursed when prescribed by a medical practitioner. Pharmacy charges and doctors fees apply. TAPS PP1903

GLA 12.02.001