Diabetes Spring 2012 by Diabetes New Zealand

Diabetes Spring 2012

Living well with diabetes

Special report

Now our children have Type 2 diabetes

Get active this spring 6 diabetes myths

Should I eat a low GI diet? Blood pressure Q&A

Gardening: Back step veges

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EA WZ

L AND

DE NTAL AS S O CI A TI O N

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APPROVED

Diabetes: the national magazine of Diabetes New Zealand | Vol 24 no 3 Spring 2012

INSIDE spring 2012 4 5

Care and prevention

From the President

Upfront

21 Diabetes foot care 24 Six diabetes myths

Community

From the Chief Executive

& reader giveaway

News, views and research

Physical Activity

30 The new face of Diabetes

Spring into action

New Zealand

32 Dedicated to diabetes

Focus

Research

10 Special Report: Now children are getting Type 2 diabetes

Living with diabetes

12 Kelsey's story

26 MÄ ori and Pacific Island

Gardening

14 Gowing edible greens on

27 NZ study: Type 1 diabetes

Food

Treatment

your doorstep

Special report

13 Call for national paediatric diabetes register

children most at risk of Type 2 diabetes

16 Should I eat a low GI diet? 18 Recipes â&#x20AC;&#x201C; A taste of Spring

in children doubles

28 High blood pressure: the silent killer

Diabetes Youth

33 President's report The last word

34 Diabetes response dog

Subscribe to DIABETES magazine and receive a free issue when you first subscribe. Call 0800 369 636 or go to our website for details.

EDITOR: Caroline Wood email: editor@diabetes.org.nz DESIGN AND PRINTING: Kraftwork, Wellington MAGAZINE DELIVERY ADDRESS CHANGES: Freepost Diabetes NZ, PO Box 12 441, Wellington 6144 Telephone 0800 369 636 Email: membership@diabetes.org.nz ISSN: 1176-4406 Disclaimer: Every effort is made to ensure accuracy, but Diabetes New Zealand Inc. accepts no liability for errors of fact or opinion. Information in this publication is not intended to replace advice by your health professional. If in doubt, check with your own doctor, nurse, dietitian, or health care professional. Editorial and advertising material does not necessarily reflect the views of the Editor or Diabetes New Zealand Inc. Advertising in Diabetes does not constitute endorsement of any product, and no advertiser may use publication of an advertisement in the magazine to support the marketing of any product. Copyright of all editorial is held by Diabetes New Zealand Inc. No article, in whole or in part, should be reprinted without permission of the Editor.

Not yet a member of Diabetes New Zealand? Call 0800 369 636 now to join or visit www.diabetes.org.nz Membership includes a free subscription to Diabetes magazine

FRO M TH E PRES I DENT

Bring on the no. 8 wire One thing I have learned is there are some things about life and living that are truisms – older and wiser being one of them. Another is the KISS principle – Keep It Simple Stupid. Things can quite reasonably seem very complex but the solution needn’t be if we apply the KISS principle. Often the best solutions are the least likely and can be the result of innovative or lateral thinking. Innovative thinking is what Kiwis are known for. It’s referred to as our ‘no. 8 wire mentality.’ In an earlier life, when I was an educator, I did wonder if an unintended result of formal education was to eliminate the creative thinking which underpins innovation. I am reminded of this concern sometimes when dealing with very highly educated people! I have been doing some research lately on consumer input into the development of health services and processes – how it can be worthwhile and make a difference! ‘Patient-centred’ care is a current focus in health service development but is it truly patient-centred? It is for those who have been part of its development but if there has been no patient involvement, surely that

makes it someone else’s version of patient-centred. There are lots of good reasons to involve consumers in the development of new services – just as there are many good reasons for involving the staff who will deliver them. For it to be worthwhile consumers need to be involved from the concept stage, not part way through after the brief has been determined. The advantages of this level of engagement are obvious. All parties have a better understanding of the others’ needs; more heads from different perspectives increase the likelihood of best solutions; and there is less risk of the wood being lost sight of for the trees. There are also greater opportunities for innovative thinking and, above all, a shared responsibility for making the solution effective. And something else – my observations make me believe there is less likelihood of ‘pointy head’ results and a greater chance of effective solutions at a lower cost. It strikes me the enormous challenges of delivering better health outcomes in the face of diminishing financial resources, increasing expectations and an aging population might best be served by bringing more no. 8 wire mentality to bear, and that we as consumers can add real value. Shame on the District Health Boards (DHBs) that have abandoned their Local Diabetes Teams or their equivalent. Not only

diabetes nz supplies www.diabetessupplies.co.nz 4

DIABETES | Spring 2012

are DHBs required to have Local Diabetes Teams but under the new Diabetes Care and Improvement Plans, they have a mandatory evaluation role to play. Local Diabetes Teams must have consumer input. It seems that with time their role has become misunderstood and yet they are needed more than ever. Do you have a Local Diabetes Team? Is there consumer input into your diabetes services? It would be a good thing to check out. Maybe you could think about involvement through your local branch of Diabetes New Zealand because one of the things we are keen to achieve is greater, more effective, consumer advocacy. Input into the provision of services would be a good manifestation of this. While we are working on this at national level, local involvement is crucially important. Please do share your efforts with us via an email or at regional hub meetings. You and I have an important role to play and I encourage your greater involvement. Apathy simply means more of the same but we can achieve so much more of greater value by working together. Keep well, as we welcome the renewal of spring.

Chris Baty National President

Diabetes NZ Supplies is a registered charity 100 per cent owned by Diabetes New Zealand. All profits we make go directly back into helping people with diabetes. We provide a wide range of useful products from pedometers to diabetes-friendly foods. We also supply blood glucose testing strips directly to your door. See the website for details.

Call us (Monday to Friday, 8–5pm) on 0800-Diabetes (0800 342 238)

FROM THE CHIEF EXECUTIVE

The challenge ahead Diabetes New Zealand is part of a large nongovernmental and charity sector that plays a significant role in improving health outcomes for patients. As one of over 25,000 charities across the country competing for limited resources in a time of increasing expectations, it is timely that the Health and Disability NGO Working Group has published a report suggesting that communitybased groups are often marginalised in planning and development discussions with health service providers. This means many aspects of primary care services continue to function with little coordination with the community-based sector. This is likely to lead to gaps in care, duplication of effort, and confusion for people with diabetes and health care professionals. Some of the barriers that make it difficult for community-based organisations to collaborate with

health service providers include funding and time constraints. Relationship building is not seen as important and is often the first thing to suffer when resources are tight. And sometimes there is simply a lack of knowledge about who to work with. Having said all of this, there are always opportunities to improve communication and coordination with local health service providers. Our community-based services provide vital functions that sit alongside those offered by health providers. We very much see the need to build relationships with health providers so people affected by diabetes can receive joined-up care. This is all the more important since Diabetes New Zealand staff and volunteers are often working with those who need help most. Diabetes New Zealand and other community-based organisations can help reduce demand pressures on primary care health services by supporting people to better selfmanage chronic conditions. Our activity in the health education and promotion arena can also prevent illness and complications from developing.

At the time of writing, Pharmac had just released its decision on the supply of blood glucose meters, test strips and insulin pumps. Diabetes New Zealand supports the decision to fund insulin pumps. This is an important step forward in helping people with diabetes manage their condition more easily. But we, along with many others who worked very hard to oppose it, are deeply disappointed that Pharmac is going to introduce a sole supply model for meters and test strips. Given the decision is going ahead, we will now do all we can to ensure implementation runs in such a way as to limit the impact on people with diabetes. This includes ensuring those tasked with implementation understand the deep complexities and challenges that come with managing diabetes. We want to ensure comprehensive support will be provided during the changeover period.

Joe Asghar Chief Executive

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

Diabetes New Zealand PATRON: Lady Beattie PRESIDENT: Chris Baty CHIEF EXECUTIVE: Joe Asghar COMMUNICATIONS MANAGER: Lisa Woods DIABETES NEW ZEALAND INC. NATIONAL OFFICE: Level 3, Revera House, 48-54 Mulgrave Street, Thorndon, Wellington 6144 Postal Address: PO Box 12 441, Wellington 6144 Telephone 04 499 7145; Fax 04 499 7146 Email: admin@diabetes.org.nz

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

Call now to make an instant $20 donation:

0900 DIABETES (0900 86369)

Spring 2012 | DIABETES

UP FRO NT

NEWS, VIEWS AND RESEARCH

Antibodies reverse Type 1 diabetes

Infection link to T1 diabetes

Scientists have used injections of antibodies to rapidly reverse the onset of Type 1 diabetes in mice genetically bred to develop the disease. Two injections maintained disease remission indefinitely without harming the immune system. The findings, published in the journal Diabetes, suggest for the first time that using a short course of immunotherapy may be of value for reversing the onset of Type 1 diabetes in recently diagnosed people.

Israeli researchers looked at children aged 2-18 years diagnosed with Type 1 diabetes between 2004 and 2008, checking their medical records to see if they had had an infectious disease one or two years prior to diagnosis. They compared the results with a matched group of children who didn’t have diabetes. They found that the rate of systemic viral infections was significantly higher in the year before the onset of Type 1 diabetes, compared with the previous year. No difference was found in the control group. This unique association was limited to viral diseases and to patients diagnosed with Type 1 at a young age. Researchers concluded that Type 1 diabetes occurring in toddlers was characterised by a relatively low incidence of viral disease two years prior to diagnosis and a much higher incidence in the 12 months before diagnosis.

Researchers from the University of North Carolina School of Medicine used antibodies that bind to proteins known as CD4 and CD8. In some of the recently diagnosed mice, blood sugar levels returned to normal within 48 hours of treatment. Within five days, about 80 per cent of the animals had undergone diabetes remission, reversal of clinical diabetes. The team is now planning to test antibodies that will work on the human version of the CD4 and CD8 molecules. Source www.breakthroughdigest.com

Exercise frequency study Patients with Type 2 diabetes were asked to exercise for either 30 minutes a day or 60 minutes every second day, and their blood sugar levels were monitored. All 30 subjects were given the same diet during the study period. Both groups significantly reduced their blood sugar levels and there was no significant difference between the two groups. Researchers suggest doctors should give patients the flexibility to decide whether they want to do 30 minutes of daily exercise or 60 minutes every other day. This may make it more achievable for many to fit exercise into their daily routines. Source: Diabetes Care

Source: Pediatric Diabetes

Drug delivery breakthrough ‘Smart’ injectable nanotherapeutics that deliver drugs directly to the pancreas could one day provide a cure for Type 1 diabetes. Drug efficacy increased 200-fold during in-vitro studies, which means much smaller amounts of a drug can be used, reducing potentially harmful side effects. More research is needed before the nanotechnology can be tested in a clinical setting, says the research team from the Harvard University’s Wyss Institute for Biologically Inspired Engineering and the Children’s Hospital Boston. The team used using a unique ‘homing’ peptide molecule to create ‘smart’ nanoparticles that can seek out and bind to the capillary blood vessels in the islets of the pancreas that feed the insulinproducing cells most at risk during disease onset. Source: Wyss Institute

Selenium link to T2 diabetes Doctors may soon be able to determine the risk of a patient developing Type 2 diabetes – by measuring the amount of selenium in their toenail. Higher levels of toenail selenium were associated with lower incidence of diabetes in a study of initially healthy individuals, according to US and Korean researchers. The study involved 3,630 women and 3,535 men, who were free of Type 2 diabetes during the 1980s. By 2008 researchers found that 780 of them had the condition. They concluded that patients with higher toenail selenium levels were at lower risk for Type 2 diabetes. Source: Diabetes Care

DIABETES | Winter 2012

NEW S , VI EW S A ND RES EA RCH

U PFRONT

$4m for organ donation

Meter changeover begins

The Government is investing an extra $4 million over four years to encourage more organ donations, which could lead to more transplants for people with diabetes who have kidney failure. Some of the money will be spent on exploring the option of establishing a national donor exchange scheme, where doctors can mix and match donors and recipients. More than 600 people are currently waiting for kidney replacements.

September marks the start of Pharmac’s six-month transition period for people to swap over to a CareSens blood glucose meter and test strips. Pharmac will also begin funding the Animas 2020 insulin pump this month.

Obesity group’s NZ meeting The Australian and New Zealand Obesity Society (ANZOS) is holding its 2012 Annual Scientific Meeting in Auckland from 18-20 October. The meeting is the first to take place in New Zealand and will focus on the theme ‘For Our Children’s Children’. The meeting aims to bring together those involved in obesity research, treatment or public health initiatives to improve the management and prevention of obesity in Australasia. It is a great way to network and share experiences. Visit www.anzos2012.com for more information.

NZ expert recognised Leading obesity expert Professor Jim Mann has been given a prestigious international award in recognition of his research into diabetes and nutrition. The European Association for the Study of Diabetes and its Diabetes and Nutrition Study Group awarded him the inaugural Himsworth Award in Athens, Greece, last month. Prof Mann is director of the University of Otago’s Edgar National Centre for Diabetes and Obesity Research.

Pharmac announced last month it was going ahead with its controversial proposal to shake up the public funding of diabetes blood glucose meters and test strips – saving $10 million a year. It has set the following timetable: • 1 September 2012: Pharmac begins funding CareSens II, CareSens N and CareSens N POP meters. Funding for currently-funded meters and strips (FreeStyle Lite, On Call Advanced, Freestyle Optium, Accu-Chek Performa) continues. Patients can begin transition to CareSens brand meters. • 1 December 2012: PHARMAC ceases funding meters other than the CareSens brand (funding for other test strips continues). • 1 March 2013: PHARMAC ceases funding the FreeStyle Lite, On Call Advanced, Freestyle Optium, and Accu-Chek Performa blood glucose testing strips with some exceptions (see its website for details) • 1 March 2013: Sole supply of CareSens meters and strips begins. Detailed information is available on www.pharmac.govt. nz/diabetes or call 0800 66 00 50 (9am - 5pm Mon-Fri).

Medicines e-library launched The New Zealand Formulary has been launched offering a onestop medicine website for doctors. The Formulary is an online medicines information resource for healthcare professionals across primary and secondary care. Previously doctors had to look for medicines information in a number of places and sometimes this information was out of date. The Formulary is expected to make the process of prescribing, dispensing and administering medicines easier and safer for patients. See www.nzformulary.org for more details.

Winter 2012 | DIABETES

P HYS I CA L A CTI VITY

WALKING

Spring into action Spring is a great time to assess your exercise routine – or lack of one. Try some of these Diabetes tips for enjoying the benefits of walking. Why walk? Walking is easy, fun and free. Anyone can do it and it is great for helping to control blood sugar. Like any regular exercise, walking will reduce your risk of heart disease. It also burns calories, which can help you control your weight and feel healthier and more energetic.

Walk with a friend The days are getting longer and warmer: Hook up with a friend and arrange a regular day and time to go for a power walk (or gentle stroll). You could try lunchtime or in the evening after dinner. If you ‘book’ a set time each week for exercising with your friend, you are more likely to go even on those days when you feel like you can’t be bothered.

Walk when you can Recent research shows that exercising 30 minutes every day, or 60 minutes every other day, were both just as effective for blood sugar control. It’s great if you can exercise every day but for some people that is not possible. So don’t beat yourself up if you miss a session, just do a double dose the next day.

Walking is easy, fun and free. 8

DIABETES | Spring 2012

Get a pedometer

Set a goal

It really does make you want to walk more. There is nothing like having a live record of how many steps you are taking attached to your hip to motivate you to take the stairs or walk to the shops instead of driving. You can buy a pedometer for $12 from www.diabetessupplies.co.nz

Start off slow and as you build up your fitness and stamina, start making some goals. Walk to work on a Friday, start training for a fundraising walk, plan a walking holiday – whatever motivates you to keep doing it and get fitter. Who knows what you will end up achieving?

Get into the habit If you decide to walk at the same time every day, or schedule a particular day to go for a walk, you are more likely to remember to do it. Put it in your diary or set an alarm on your phone to remind you. Just writing it down might help you remember. Once you’ve got into the habit it’s much easier to motivate yourself on the days it’s raining.

Choose the right footwear

Get help

Make sure you keep hydrated while walking. Drink before and after you walk and take a drink bottle with you. Carry as snack as well in case you need it. After walking you may need to eat more carbohydrates than usual. Listen to your body, note any signs or symptoms and consult your doctor with any questions.

Talk to your doctor or diabetes team before embarking on any new exercise if you have health conditions or haven’t exercised for a while. Talk to them about how your insulin requirements may change with exercise. Find a mentor, someone with diabetes who has done it already, and talk to them about the benefits.

Properly fitting shoes are important for people with diabetes. So too are a good pair of socks that wick away moisture. For tips on how to care for your feet, see Care and Prevention on p21/22. You can buy great socks online at www.diabetessupplies. co.nz

Listen to your body

Test regularly See the impact your walking is having on your body and hopefully it will motivate you to keep going and include walking as part of your daily schedule.

ANIMAS 2020 INSULIN PUMP NOW FULLY FUNDED FOR ELIGIBLE PATIENTS Funding for eligible patients is now available for: • Animas 2020 insulin pumps and cartridges • A full range of infusion sets • ADR cartridges suitable for use in your Minimed Paradigm pump Ask your doctor if you meet the criteria.

• Smart features on the pump no need to rely on a separate device • Fully waterproof • Full colour screen • Fully customisable food database • Compatible with web based Diasend software

W www.nzms.co.nz P 09 259 4062 E nzms@nzms.co.nz

Always read the manufacturer’s instructions and use strictly as directed. NZMS, Auckland. TAPS PP2688

FO CU S

CH ILD REN AND TYPE 2 D IABETES

Now our children are getting Type 2 diabetes It was virtually unheard of 20 years ago but today more than 300 children in New Zealand are thought to have Type 2 diabetes. Caroline Wood reports on a worrying trend. Children as young as 12 are being diagnosed with Type 2 diabetes – increasing the risk they will have serious health problems in adulthood. New figures compiled for Diabetes suggest 100 children aged 10-14 years have Type 2 diabetes – one in 10 of all new paediatric cases. A further 213 teenagers aged 15-19 are believed to be living with the condition.

SPECIARLT REPO

Type 2 in children was hardly seen 20 years ago but the number has been rising around the world, in line with increasing obesity rates. The numbers are still relatively small but doctors are concerned because Type 2 diabetes progresses more rapidly in children and is harder to treat. Children with Type 2 diabetes also have a higher risk of developing diabetes complications in later life, such as heart attacks, blindness and kidney failure. Mum-of-two Michelle Gurden, from Greymouth, was shocked when her youngest daughter Kelsey, 12, had an off-the-chart blood sugar reading last year. Kelsey had no symptoms and had not been feeling unwell.

“We’re not sure why 20 years ago you never saw Type 2 diabetes in children. It’s being reported round the world now. Over the long-term I think they will be a major burden to the health system.” — Dr Craig Jefferies

Dr Brandon Orr-Walker, the Ministry of Health’s National Clinical Director for Diabetes

Dr Jeremy Krebs, Wellington endocrinologist

Mrs Gurden, who has had diabetes since her late 20s, checks her family regularly at home. “I did a random test on her one day and her blood sugar level was so high I booked an appointment with my doctor the next day. When we got there he told us we needed to get to the hospital straight away,” she said. “She wasn’t unwell, she was fine, she didn’t have any symptoms and it was only by good luck that I did the test. “It was a huge shock to start off with but she came to accept it and now it’s part of her life and she’s not letting it stop her. She’s worked really hard to learn about diabetes and change her diet.” Dr Brandon Orr-Walker, the Ministry of Health’s National Clinical Director for Diabetes, said that based on the best available data, an estimated 10 per cent of children under 15 being diagnosed with diabetes have Type 2. “What is most concerning is that we know Type 1 diabetes is increasing two to three per cent per annum all around the world for reasons we do not understand. If Type 2 can come

DIABETES | Spring 2012

CH I LDREN A ND TYPE 2 DI A BETES

Type 2 in children tougher to treat The first major US study of Type 2 diabetes in children has found the condition progresses more rapidly and is harder to treat than adultonset diabetes. Researchers looked at 699 American children aged 10 to 17 over four years. It found the usual oral medicine (Metformin) stopped working in half the patients within a few years and they had to add daily injections of insulin to control their blood sugar. “It’s frightening how severe this metabolic disease is in children,” said Dr David M Nathan, an author of the study and director of the diabetes centre at Massachusetts General Hospital. The results of the study A Clinical Trial to Maintain Glycemic Control in Youth with Type 2 Diabetes were published earlier this year by the New England Journal of Medicine. from almost nothing to 10 per cent now, it means it is climbing faster than Type 1. “It’s still the minority but it’s telling us something about the future. It’s telling us the kind of problems people experience with diabetes as adults are now occurring in the childhood years.” Dr Orr-Walker, who is also Clinical Head of Endocrinology and Diabetes at Auckland’s Middlemore Hospital, added: “Children with Type 2 diabetes are presenting with associated problems, such as high blood pressure and cholesterol. “If you get Type 2 diabetes at 90, it’s not going to prematurely affect your heart, at 40 it will impact on your quality of life and longevity. But if you get it at 10 or 15 years old it will be a heavy burden on your health, quality of life and mortality, and you are unlikely to live to 80.” Professor Esko Wiltshire, Associate Professor at the Department of Paediatrics and Child Health at the University of Otago, agrees: “Often the children we see with Type 2

diabetes already have complications when they present. It’s much more difficult to treat them, it’s a reflection of the fact it’s been going on for a while before they were diagnosed. “It’s these complications that are responsible for people going on dialysis, going blind or having heart attacks in their 30s.” “But I have some young patients with Type 2 who are extremely well. I have quite a few children who take their medication, change their lifestyle and they have normal blood sugar levels.” Professor Wiltshire said he believed obesity was the reason behind the increasing number of children with Type 2 diabetes. “Obviously genetics are a big component but it can’t be responsible for the change, you don’t get a change in genetics in 20 years. Genetics are important but they are not responsible for the increase. “There is almost certainly under-diagnosis, particularly of the number of children with prediabetes,” he added.

Read Kelsey’s story in her own words, see p12. Doctors calling for a national paediatric register, see p13. New Kiwi research on diabetes in children, see p26.

FOCUS

Experts ‘fear for the future’ Doctors are warning that rising numbers of children with Type 2 diabetes could put massive pressure on health budgets in coming years. Little research has been carried out into Type 2 diabetes in children and doctors do not know exactly how many young people have the condition. A recent New Zealand study revealed a five-fold increase in the number of under-15s diagnosed with the condition from 1995-2007 in the Auckland region. Published in Pediatric Diabetes, the Starship Hospital study concluded the annual incidence rose to 2.5 children in every 100,000 over the 13-year period. Lead author Dr Craig Jefferies, Clinical Director of the Paediatric Endocrinology Service at Starship Children’s Hospital, said his service was diagnosing five to 10 children a year with Type 2 diabetes. Most of the children are of Ma¯ori, Pacific Island or Indian origin. Dr Jefferies says there are clear risk factors – being Ma¯ori or a Pacific Islander, going through puberty, being overweight, having a strong family history of diabetes and a mother who had gestational diabetes in pregnancy. “We’re not sure why 20 years ago you never saw Type 2 diabetes in children. It’s being reported round the world now. Over the long-term I think they will be a major burden to the health system,” he said. Commenting on the Auckland study in NZ Diabetes and Obesity Research Review, Wellington endocrinologist Dr Jeremy Krebs said: “This study further increases my fear for the future of diabetes in this country. The appearance of Type 2 diabetes in children and adolescents highlights the importance of childhood obesity and the need to address this. “The rise in incidence over a relatively short period of time in this young group is alarming. Although perhaps of more concern is the difficulty in facilitating good glycaemic control in this population over time. This certainly mirrors my personal experience.”

Spring 2012 | DIABETES

LIV ING W ITH D I A B E TE S

KELSEY' S STO RY

Nothing is going to stop Kelsey Kelsey was 12 years old when she was diagnosed with Type 2 diabetes. Since then she has changed her lifestyle, is eating healthily and doing lots of sport. Recently the West Coast Juvenile Trust Fund gave Kelsey a reward for her hard work. Here Kelsey Gurden tells her story in her own words. When I was first diagnosed with diabetes in July 2011, I was only 12 years old. I was scared at first, but the nurses and doctors were great and really nice. I spent two days in Greymouth Hospital, and then I got transferred to Christchurch Hospital, where I spent another five days being assessed. I was finally diagnosed with Type 2 diabetes. I had two teams of doctors and nurses working with me, but the main people I saw were Neil Owens, Dr Ferguson, Tina and Courtney the dietitian.

While I was in Christchurch Hospital, they all helped me a lot and taught me ways to lose weight and eat healthy. Six months on I have lost six kilograms and my blood glucose levels have dropped heaps. My food eating habits have changed, I am not eating food in between meals, I have cut out all the greasy, fatty, sugary foods from my diet, and replaced them with vegetables, fruit and meat. I have had lots of support from my mum, dad and Hayley my sister, from my best friend Brittany and from the people at Christchurch Hospital, Greymouth Hospital and from Diane Fairhall the diabetes nurse for Greymouth. Diabetes has changed my life, but hasn’t stopped me doing the things I love most. Kelsey Gurden, Greymouth Age 13.

Kelsey and mum Michelle.

Family pull together Mum Michelle Gurden, who also has diabetes, said: “The whole family has got behind Kelsey, we decided to change our diet, not just for Kelsey but for the whole family. We have cut out all the takeaways we were having and fizzy drinks. We are eating more fruit and vegetables. Kelsey is back into doing the sports she loves, swimming and netball, and we are all healthier. “I’m very proud of her. She was very upset when she got told, she said I don’t want to go to hospital, I just reassured her that things would be fine and it was the best thing for her. “She is still living life to the full, she’s not going to let anything get in her way. “Diabetes does run in our family but we have a very supportive family and friends, we couldn’t have done it without them. “People need to be aware that it is out there. My advice to other parents is to take your child along to the doctor if you are worried and get them checked out before it’s too late.” Kelsey’s diabetes clinical nurse specialist is Diane Fairhall, who is based at Greymouth Hospital. She helped arrange the prize for Kelsey to reward her hard work. She said: “Kelsey has had really good support from her family. It’s not easy to lose weight like that. I think she’s done really well, she’s so enthusiastic about it and she’s done a lot of it by herself. She’s got good control now, is managing her weight and doing lots of sport.”

DIABETES | Spring 2012

CH I LDREN A ND TYPE 2 DI A BETES

S P ECI AL REPORT

Call for national register to track children with diabetes A national database should be set up to improve the quality of care for children with diabetes. Caroline Wood reports. Doctors are calling on the Government to set up a national paediatric register for children with Type 1 and Type 2 diabetes. Diabetes specialists say the register would allow doctors to track young patients over their lifetime, look at what medication and treatment they receive and analyse their long-term outcomes. It would also help health professionals plan appropriate diabetes services, including deciding whether young people at high risk should be screened for Type 2 diabetes. The Ministry of Health has what it calls a ‘virtual diabetes register’, which records the number of children and teenagers with diabetes but doesn’t record whether they have Type 1 or Type 2, or any

detailed clinical information. There were 2,439 children with diabetes at the end of 2011 in New Zealand. Based on the data it holds, the Ministry estimates up to 319 young people aged 10-19 years have Type 2 diabetes. The number is based on prescribing patterns of Metformin in 2011. Paediatric diabetes specialists say they need better and more detailed information about young people with both Type 1 and Type 2 diabetes. Dr Craig Jefferies, Clinical Director of the Paediatric Endocrinology Service at Starship Hospital, said: “We need to set up an on-going paediatric diabetes register. This would give us real time information about each patient and how they are responding to treatment.” Professor Esko Wiltshire, Associate Professor at the Department of Paediatrics and Child Health of the University of Otago Wellington, agrees: “It would give us good

SPECIARLT REPO

information about what’s happening in terms of numbers and it would, if developed properly, give us information about what leads to the best responses in terms of treatment and how to manage them to get the best outcomes.” Ministry of Health National Clinical Director for Diabetes Dr Brandon Orr-Walker said childhood diabetes is one of the priority areas for the Ministry’s National Advisory Group on diabetes. He said the Ministry was concerned about the issue and looking at ways to improve the quality of data kept on young people with diabetes. Representatives of the group have met with the National Health Board IT team for preliminary discussions about a national paediatric diabetes register. “My personal view is that it would be a good initiative to help improve the care of children with diabetes,” Dr Orr-Walker said.

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Spring 2012 | DIABETES

GARD EN I N G

BACK STEP SAL AD

Growing edible greens on your doorstep You don’t need a massive garden to grow your own veges, as Wellington gardening expert Rachel Knight explains. Some of the most successful edible gardens I’ve seen are small ones. Small enough to be close to where we spend our time, small enough for us to care for them and small enough for us to pick and consume all the produce. The best example of this is a ‘back step salad’. A container full of greens or herbs so close to your back (or front) door that you’ll remember to water it, be bothered to pick it and enjoy seeing it each time you pass. The size and shape of container doesn’t matter. Bigger, deeper pots need less watering and can be home to more crops, but they’re heavier to move, take up more space and need more potting mix to fill them. One of my favourite containers is a polystyrene crate because of its stability, lightness and zero cost. Buckets, large flower pots, half-wine barrels and planter boxes are also great. If you don’t like working at low levels, you can raise containers on a table or sit them on bricks or old tyres, as long as they’re somewhere they won’t be blown or knocked off.

You’ll be asking a great deal from a small space, so don’t skimp on the soil. A 40-litre bag of potting mix (about $10) will fill a polystyrene crate. If you have some well-rotted homemade compost you might fill it with that instead. I usually still add a top layer of potting mix so I know I won’t get any competition from weeds. Garden soil is usually too heavy and not nutrient-rich enough for container gardening. Potting mix contains slow-release fertiliser to feed your plants, but rain and watering tend to wash those nutrients out of the soil. You’ll get better crops for longer if you feed weekly with a liquid fertiliser or worm or seaweed ‘tea’. Choose a spot that’s as close as possible to your kitchen, is open to the rain and gets plenty of sunshine. Make sure your containers are

Here are some crops I’ve successfully grown in containers: HERBS: chives, coriander, mint, basil, parsley SALAD GREENS: rocket, lettuce, spinach, mizuna, mesclun* ROOTS: spring onions, carrots, radishes, beetroots, turnips * Mesclun is a blend of salad leaf varieties sold in a single seed packet.

DIABETES | Spring 2012

level and have drainage holes in the bottom. Starting with seedlings speeds things up but seeds are cheaper and allow you a greater choice of varieties. You may need to protect your seedlings from birds, cats and other predators. I plant eight lettuce seedlings in a polystyrene crate and pick a few leaves from each at a time. You could sow seeds more thickly and harvest them as ‘baby leaves’. Be selective and start small with perhaps one container for greens and another for herbs. You’ll be surprised how much you’ll be able to harvest from a limited space with a little watering and feeding. Enjoy the freshness, convenience and satisfaction of your own back step salad.

Rachel Knight Rachel is an enthusiastic gardener, writer and cook. She enjoys helping other people grow things to eat and runs vegetable gardening courses from her home during summer. Originally from Chester in the UK, she moved to Wellington with her husband Paul in 1996. They live in Ohariu Valley on a property they share with their labrador, Misty, a pet rabbit, Jim, and a few cows, chickens, ducks and pheasants. Rachel writes the gardening and cooking blog The Kitchen Garden (www.thekitchengarden.co.nz).

Julia is Co Founde r & Director of Dollop Puddings

Julia Crownshaw A Chelsea NZ Hottest Home Baker Judge says... “I’m often asked what to do when baking for someone on a low GI diet - use Chelsea LoGiCane™, it assists in helping to keep energy levels balanced to provide sustained physical and mental performance, it keeps you feeling satisfied for longer, so no need to snack. You can use Chelsea LoGiCane™ Sugar anywhere you would use ordinary sugar, its easy! It’s a natural sugar from 100% sugarcane, which is made to retain more of the natural goodness of the molasses with a slower and more sustained energy release even when baked. If you’re looking for a low GI homemade muesli with a great taste, using LoGiCane™ is a wonderful option”.

For my recipes and tips on using LoGiCaneTM Sugar visit:

www.chelsea.co.nz 81642LGI.DIA

Make a Moment with Chelsea Spring 2012 | DIABETES

FO O D

TH E GI D EBATE

Should I be eating a low GI diet? Research suggests following a low GI diet can improve diabetes management. But not all low GI foods are good for you and other factors such as portion size are just as important. Auckland dietitian Amy Liu explains the pros and cons of low GI. What is the Glycaemic Index? The Glycaemic Index (GI) is a ranking of how quickly carbohydrate foods are digested and absorbed in your body and therefore how quickly your blood glucose levels rise after eating them. Foods that are quickly digested such as white bread have a high glycaemic index (GI) and will give a rapid increase in blood glucose levels. Foods that are ‘slowly digested’, or low GI, for example lentils and dense wholegrain bread, will give a slower increase in blood glucose levels. Unfortunately people often get confused because a high GI food can be healthier than a low GI food. For example, a baked potato has a high GI, whereas potato chips have a medium GI. The baked potato is lower in fat and salt, making it a healthier choice. Likewise chocolate and ice cream are low GI but high in fat and sugar. When it comes to diabetes the most important thing to consider is portion size. Just because something is low GI, like chocolate, it doesn’t mean you should eat lots of it. It is still important to eat a balanced diet with a wide variety of different kinds of food.

DIABETES | Spring 2012

What are the benefits of slow-acting carbs?

How do you recommend I get the benefit of GI?

Low GI foods can help prevent erratic blood glucose levels by balancing out the ‘highs and lows’ and may assist with weight management due to increased satiety and fullness. It can also mean people don’t feel the need to snack between meals. Eating the right kind of slow-acting carbs can improve blood cholesterol, reducing the risk of heart disease.

The best way to get the maximum benefit of the Glycaemic Index is to choose healthy and balanced low GI foods. Healthy food choices are those that are low in fat and sugar, high in fibre and less processed. Healthy low GI foods include low-fat milk, yoghurt, wholegrain cereals, wholegrain bread, legumes and most vegetables. You can add protein to lower the overall GI of the meal. For example grilled chicken with fettuccine pasta and salad. People often ask me about sugar. Although sugar is medium to low GI (white sugar has a GI of 68, while low GI sugar is 50), I recommend the amount of sugar eaten should be small.

Does anything else affect blood glucose levels? Different individuals have different glycaemic responses to food. There are many other factors that influence blood glucose levels, including the total quantity of carbohydrates consumed, the type of carbohydrates, the overall fat content of the meal, the preparation and timing of the meal. Your dayto-day blood glucose control and physical activity (duration, intensity and whether it was planned or unplanned) also impact on blood glucose levels.

Lower the overall GI of a meal by adding chicken and vegetables to a pasta meal.

Table: Examples of some low, medium and high GI foods. Low GI

55 or less

Wholemeal bread, porridge; most fruits and vegetables; macaroni; pasta; legumes, such as chickpeas and kidney beans; nuts; milk; dried apricots; roasted peanuts.

Medium GI

56–69

pita bread; basmati rice; boiled potatoes; grapes; fresh pineapple; raisins; cranberry juice; digestive biscuits; toasted crumpet; regular ice cream.

High GI

70 and above

white bread; bagels; rice cakes; watermelon; most white rice; processed breakfast cereals; glucose.

THE G I DEBATE

FOOD

What about low GI foods and Type 1 diabetes? A balanced diet with low GI foods is recommended for people with Type 1 diabetes. Studies have shown that people with Type 1 diabetes were able to improve their blood glucose control significantly and reduce the amount of insulin they need to take over the long term. I recommend patients monitor for hypoglycaemia and treat hypos with rapid-acting (high GI) carbohydrates followed by a low GI food item. Very low GI meals, with a high fat content, may require quick-acting insulin but talk to your health professional for more information.

How strict should I be? A healthy low GI diet can help with blood glucose levels, weight management and reduce the risk of chronic diseases. I recommend my patients make small changes at a time. This way, they can keep these lifelong changes as they slowly blend into their everyday life. If your present eating pattern includes very few low GI foods, try to introduce these gradually and monitor the effects on your blood glucose levels.

How can I tell whether a food is low in GI? You can look for a certified GI symbol on the label or go to www.glycemicindex.com to search the database of GI values. Consumer also has some useful information at www.consumer.org.nz/ reports/glycaemic-index/the-gi-of-common-foods. Unfortunately GI values are not always listed on food labels. Individual foods have to be tested in a laboratory and these tests are ongoing.

MAKE THE SWITCH High GI

>>>>

Lower GI

Breakfast Cereals Processed cereals, for example cornflakes, rice bubbles.

Traditional rolled oat porridge or cereal such as Special K Original, Guardian, Healtheries Bircher Muesli.

Bread Soft white bread, scones, bagels, gluten-free, French bread, Turkish bread.

Heavier, dense wholegrain bread such as Burgen, Vogels, Molenberg, Tip Top Goodness 9 Grains, Bakers Delight Soy and Linseed Loaf. Fill sandwiches with protein and salad.

Vegetables Kumara, potatoes.

Baby new potatoes. Legumes such as lentils or beans. Non-starchy vegetables, such as broccoli and red pepper.

Pasta Corn and rice pasta.

White or wholemeal pasta.

Rice White rice.

Basmati rice.

Snacks Scones, muffins, biscuits. Rice cakes and crackers.

Raw fruit (limit to 1–2), Burgen Mixed Fruit Bread, wheat-based crispbread.

Desserts Fruit pies, cheesecake.

Low-fat yoghurt, frozen yoghurt, fresh fruit salad (limit to 1–2 fruit per snack). Spring 2012 | DIABETES

FO O D

RECIPES

A taste of Spring Now the days are getter longer, many of us will want to start cooking and eating lighter dishes using some of the fresh new produce in the shops (or your garden). Thanks to Amy Liu for her scrumptious salmon fish cakes and healthy chicken stir-fry recipes.

Salmon fish cakes INGREDIENTS 160g or 3 medium new potatoes (preferably boiled but can also be steamed or microwaved) 210g tin salmon (drain and remove skin and bones from salmon) or you can use the same amount of tinned tuna 1 tablespoon mayonnaise 2 teaspoons finely chopped parsley 2 small egg yolks ½ onion, finely chopped or grated Salt and pepper COATING 1 egg 1 tablespoon milk 2 tablespoons (25g) plain flour Rounded ½ cup or 50g dry breadcrumbs 1 tablespoon (20ml) oil, for frying Serves 3–6 NUTRITION PER PATTY: KJ: 778, Carbohydrate: 13g, Fat: 10g, Protein: 11g.

Cut the cooked potato into cubes, or use a masher to roughly mash and allow to cool. Use a fork to go through the salmon or tuna in order to break it up while leaving pieces. Combine salmon, potato, mayonnaise, parsley, egg yolk, onion, salt and pepper into a bowl. Refrigerate mixture for about 30 minutes to firm up. Coating: Place egg and milk into a small bowl and beat together with a fork. Shape cooled mixture into six balls and lightly coat each ball with flour. Roll a ball in egg and milk mixture then coat with breadcrumbs, flattening the ball slightly to form a patty shape. Repeat with remaining balls. Heat oil in a frying pan. Cook patties over medium heat for a few minutes on each side, until patties are golden brown and cooked through. Serve with 1 teaspoon of mayonnaise and garnish with a salad consisting of lettuce, tomato and cucumber. Makes six patties. Allow 1–2 per person.

Chicken stir-fry 220g diced chicken (skinless) 1 clove of garlic (finely sliced) 1 small onion (finely sliced) 2 carrots (boiled, cooled and sliced) 1 cup sliced mushrooms ½ cup chopped mixed vegetables, eg red pepper, asparagus, sugarsnap peas, snowpeas ½ cup chopped broccoli Serves 2 NUTRITION PER SERVE: KJ: 1293, Carbohydrate: 40g, Fat: 3.4g, Protein: 32g.

DIABETES | Spring 2012

Heat a frying pan and spray lightly with oil. Stir fry the onion, garlic and chicken for a few minutes. Add vegetables and stir fry until done. Season with salt and pepper to taste. Serve with 1 cup of cooked rice per person.

www.ilovemysocks.co.nz

Best foot forward It’s important to care for your feet if you have diabetes especially if you have a high risk of getting foot-related complications. Podiatrist Judy Clarke explains. Everyone who has diabetes should get their feet checked regularly, at least once a year. Historically this is an area of diabetes screening that has a low completion rate. Podiatrists are concerned that people may not get their feet checked regularly now that the national Get Checked programme has ended. They are working with District Health Boards to ensure there is a continued emphasis on foot screening. Keep a close eye on your feet, check them regularly and report any changes to your podiatrist or GP. People with diabetes, who have the following characteristics, are at high risk of developing foot complications: • • • • • • • • • •

peripheral vascular disease previous foot ulceration or amputation structural foot deformity older age (>70 years) Māori or Pacific ethnicity longer duration diabetes smoking other diabetic complications, for example retinopathy renal impairment/dialysis continual use of inappropriate footwear.

Foot checks should begin immediately after a person has been confirmed with diabetes. Depending on a person’s risk factors, they will need to be checked every three to six months – or sooner if they develop problems. Here is a questionnaire (overleaf ) to fill in and give to your podiatrist, GP or practice nurse. It will help them assess your risk factors and advise on a care plan for your feet. The questionnaire can be filled in by anyone – from someone who has been newly diagnosed to someone who has had diabetes for a long time. Today is always a good day for a foot WOF!

Spring 2012 | DIABETES

C ARE A N D PRE VE NTI O N

LOOKING A FTER YO UR FEET

DIABETES FOOT CARE QUESTIONNAIRE Taking care of your feet is an important part of diabetes care. Please answer the following questions about your feet and how you care for them. Take this questionnaire to your next appointment with your podiatrist, GP or practice nurse. NAME

DATE

History of foot problems:

Do you ever walk in your bare feet?

How long have you had diabetes?

________________

1Type

months 1

________________

years.

1Yes 1No

Do you wear shoes without socks? Yes No

1Type 2

Have you ever had a sore or cut on your foot or leg that took more than two weeks to heal? Yes No

Do you ever check your shoes for foreign objects or torn linings? Yes No

Have you ever had a foot ulcer? Yes

Foot care:

1 1

1No

Have you had an amputation of a toe, foot or leg? Yes No

If yes date: ____________________________________________

Can you reach and see the bottom of your feet? Yes No

Do you check your feet?

1Yes 1No

If yes how often? Daily

Current foot or leg problems: Do you have an ulcer, blister or sore on your feet now? Yes No

Do you have any callouses or hard skin on your feet? Yes No

Do you have any: Numbness Tingling Pins and needles Tightness Rest pain Cramps Night pain

2-6 times a week If I have a problem

1Yes 1Yes 1Yes 1Yes 1Yes 1Yes 1Yes

1No 1No 1No 1No 1No 1No 1No

1No 1No 1No 1No 1No 1No

DIABETES | Spring 2012

Do you cream your feet regularly? Yes No

Do you cut your own nails? Yes

1No

If no then who does this for you?

1Yes 1Yes 1Yes 1Yes

1No 1No 1No 1No

Have you ever been given any education on how to look after your feet. Who by? Podiatrist Practice Nurse GP Other

Thank you for completing this questionnaire.

1Yes 1No

Do you dry well between your toes? Yes No

Family member Caregiver Foot care nurse Podiatrist

1Yes 1Yes 1Yes 1Yes 1Yes 1Yes

1No 1No 1No 1No

Do you wash your feet daily?

Footwear: Do you wear: Jandals Sandals Running type shoes Slip ons Custom made shoes Other

Once a week

1Yes 1Yes 1Yes 1Yes

1No 1No 1No 1No

Making the change to CareSens meters? We’re here to help.

Ask us a question

If you’re a New Zealander with diabetes, and would like to continue to use subsidised blood glucose meters and test strips, it’s important to change to CareSens blood glucose meters and test strips by 1st March 2013 (when CareSens will become the only fully funded option for blood glucose monitoring). Changing your meter can be surprisingly easy and is free of charge: simply ask your doctor or diabetes nurse to write you a prescription at your next appointment. Meantime, if you have any questions, or to find which CareSens meter is right for you, please ask your health professional or phone our tollfree helpline on 0800 GLUCOSE (0800 458 267). You can check out our Frequently Asked Questions page at www.caresens.co.nz. We’re here to help make the change to CareSens as easy as possible.

Before using CareSens, please read the instructions in the Owner’s Manuals, Quick Guides and Package Inserts. Always read the pack insert/ user manual, and follow the manufacturer’s instructions and the advice provided by your health professional/diabetes nurse. Pharmaco (NZ) Limited, Auckland.

TAPS: DA2512AY

4 July 2012

C ARE A N D PRE VE NTI O N

D IABETES FO R DUM M I ES

Six diabetes myths There is a lot of information out there about diabetes and sometimes it can be hard to tell what’s right and what’s wrong. Today we bust some myths that could lead you down the wrong path. The following edited extracts are from the new Australian edition of Type 2 Diabetes For Dummies. We have five copies of the book to give away. See the following page for details.

Following treatment perfectly yields perfect glucose levels

Although you can achieve normal blood glucose levels most of the time if you treat your diabetes properly, you can still have times when, for no apparent reason, the glucose isn’t normal. When you consider that so many factors can determine the blood glucose level at any given time, this variation should hardly be a surprise. These factors include: • • • • • •

Your diet Your exercise Your medication Your emotional state Other illnesses The day of your menstrual cycle (if a woman)

The miracle is that the blood glucose is what you expect it to be as often as it is. Don’t allow an occasional unexpected result to throw you. Keep on doing what you know to be right, and your overall control will be excellent.

Eating a slice of cake can kill you

Some people can become fanatical when they develop diabetes. They think that they must be perfect in every aspect of their diabetes care and can drive themselves crazy with their belief that they must follow the ‘perfect diet’ all the time. Doctors and your diabetes care team now understand that a little sugar in the diet isn’t harmful. They also appreciate that some regular ‘treat’ foods can be helpful in keeping you motivated to keep eating well for the majority of the time. The bottom line is that occasional dietary lapses aren’t harmful. No-one is perfect — not even your diabetes care team, and not even you! Don’t feel the need to have a perfect diet all the time.

DIABETES | Spring 2012

You can tell the level of your blood glucose by how you feel

Actually, this is a very common myth that people tell us all the time. To look at this scientifically, a research study was conducted whereby people with diabetes were hooked up to glucose and insulin intravenous lines so researchers could manipulate their blood glucose levels. Participants were ‘given’ a particular blood glucose level and asked to say what it was. The number of correct answers was pretty bad — most people couldn’t even accurately tell if they were hypoglycaemic (blood glucose too low) or hyperglycaemic (blood glucose too high)! The moral of the story: Test your blood glucose at your required intervals, and especially if you think you are high or low. Guessing may lead you in exactly the wrong direction with your treatment, which causes more problems.

Diabetes ends spontaneity

You may think that your freedom to eat when you want and come and go as you please is gone once you have diabetes. This myth is far from the truth. Do you have to give up eating out if you have diabetes? Of course not — it’s one of life’s great pleasures! Newer oral agents for Type 2 diabetes allow you to eat when you want and anticipate that the blood glucose levels are going to remain within or close to target range. Should you dance the night away even though you have diabetes? Of course you should! Oral medications are unlikely to need adjustment for these occasional situations. Can you travel where you want with diabetes? Most certainly. You just need to plan your trip in advance.

DI A BETES FO R DUM M I ES

CARE AND P RE V ENTION

You can buy Type 2 Diabetes for Dummies from Diabetes New Zealand Supplies for $22.99 including delivery. Go to www.diabetessupplies.co.nz

Needing insulin means you’re doomed

Many people with Type 2 diabetes believe that once they have to take insulin, they’re on a rapid downhill course to death. This is not true. Once you’re using insulin, it probably means that your pancreas has conked out and can’t produce enough insulin to control your blood glucose, even when stimulated by oral drugs. But taking insulin is no more a death sentence for you than it is for the person with Type 1 diabetes. The majority of people with Type 2 diabetes eventually end up needing insulin injections. If the recent jump in the number of new medications used to manage diabetes is any indication of things to come, this may soon become a thing of the past; however, for now, if you do require insulin try not to be afraid or anxious about it. People with Type 2 diabetes who truly need to be on insulin often find once they have taken the plunge to start insulin that they feel much better and making the change was actually a good thing.

Most diabetes is inherited Although Type 2 diabetes runs in families, the condition doesn’t come out in every family member. Whether you develop Type 2 diabetes or not can depend on such things as body weight, level of activity and other factors. Parents shouldn’t feel guilty or blame themselves if their child or adolescent develops diabetes. Feeling guilty only makes it harder to care for and live with your child who has diabetes. Talk to your doctor or diabetes care team about feelings of guilt, anger or frustration.

Reader giveaway Whether already diagnosed or with prediabetes, Type 2 Diabetes for Dummies teaches you how to maintain a healthy lifestyle and good blood glucose control so that you can prevent long-term complications and live a full and active life. Author Professor Lesley Campbell is Director of the Diabetes Centre at St Vincent’s Hospital, Sydney, a leading centre of diabetes research and management. Co-author Alan L Rubin, M.D. is a top American diabetes specialist. We have five copies of the Australian edition of Type 2 Diabetes for Dummies to give away. All you have to do is email us with your name and address. The names of the winners will be drawn out of a hat. Email to admin@diabetes. org.nz with your entry using the phrase ‘Diabetes for Dummies’. Please submit your entry no later than 31 October 2012.* *Terms and conditions apply, please see www.diabetes.org.nz

Winter readers’ competition: The lucky winners of Nadia’s Kitchen were Lorna de Silva, of Opotiki, and Michael Spierling, of New Plymouth. If you missed out, you can still buy a copy of the recipe book at www.diabetessupplies.co.nz

Spring 2012 | DIABETES

RES EA RCH

D IABETES IN CHILD REN

Ma¯ori and Pacific Island children most at risk of Type 2 diabetes Type 2 diabetes is more likely to strike Māori and Pacific Island children and is harder to treat in young people, according to a groundbreaking Auckland study. Caroline Wood reports. Māori and Pacific Island children have an ‘exceptionally high’ risk of getting Type 2 diabetes. Researchers from Starship Children’s Hospital studied the incidence, clinical features and treatment of Type 2 diabetes in 54 children under 15 years old from 1995-2007. They found the annual incidence of new cases increased five-fold over the 13-year period from 0.5 cases per 100,000 to 2.5 per 100,000. The incidence of children with Type 2 diabetes in Auckland is higher than Britain’s rate of 0.6 per 100,000 because it reflects the ‘exceptionally high’ risk among Māori and Pacific Islanders, say researchers. Of the 54 subjects, 90 per cent were of Pacific Island or Māori ethnicity. The average age at presentation was 13 years. There were more girls than boys and 68 per cent had at least one parent with Type 2 diabetes.

DIABETES | Spring 2012

The majority of children were diagnosed ‘incidentally’ after presenting with other conditions, such as high blood pressure or obesity. Others had classic diabetes symptoms that were diagnostically hard to distinguish from Type 1. “We cannot exclude the possibility that some of the increase in incidence over time represents a greater awareness of the risk of Type 2 diabetes at younger ages,” say the report’s authors. “More importantly there was no routine population-based screening for diabetes in children or adolescents during the period (or at present) and it is likely that the incidence of asymptomatic Type 2 is higher than our figures suggest ie we may be seeing the tip of the iceberg,” the report concludes. The study, published in May, is one of the first to systematically document the increasing number of children with Type 2 diabetes in New Zealand. The results show the number of cases climbing rapidly from 1995 to 2003 and then levelling off, raising the possibility that the underlying epidemic of obesity may also not be worsening rapidly. “If this is correct, it may be an early sign of success of intensive public health campaigns for healthy eating,”

says the report. “However the trend over the total study period suggests that the incidence of Type 2 diabetes in Auckland children may continue to rise, particularly in Māori and Pacifica children,” it concludes. Approximately half the patients were symptomatic and treated with insulin from diagnosis. The rest were given lifestyle interventions and/or Metformin. The report says that initially the insulin therapy worked well but there was a rapid deterioration after 12 months. Researchers concluded that management among young people was “challenging” and “long-term metabolic control remains poor with current medical treatment.” Lead author Dr Craig Jefferies, Clinical Director of the Paediatric Endocrinology Service at Starship Children’s Hospital, commented: “I think they have an aggressive form of Type 2 diabetes and they are often poor at taking their medicine. Lifestyle changes don’t work in this group.” Source: The incidence, clinical features and treatment of type 2 diabetes in children <15 yr in a population-based cohort from Auckland New Zealand, 1995-2007. Authors: Craig Jefferies, Philippa Carter, Peter W Reed, Wayne Cutfield, Fran Mouat, Paul L Hofman and Alistair Jan Gunn.

DI A BETES I N CH I LDREN

RE SEARCH

Type 1 diabetes in children doubles There has been a large rise in the number of children diagnosed with Type 1 diabetes in Auckland – but researchers are struggling to explain why. Caroline Wood reports. The incidence of children diagnosed with Type 1 diabetes in Auckland has doubled over the past two decades. There were 10.9 cases per 100,000 population in 1990/91, rising to 22.5 per 100,000 in 2009. Researchers carried out a retrospective review of 884 patients under 15 years, who had been diagnosed with Type 1 diabetes in the Auckland region over a 20-year period. Twenty-three children were diagnosed in 1990/91, compared with 60 new cases in 2008/09. There was an increase in the mean age at diagnosis from 7.6 years in 1990/91 to 8.9 years in 2008/09. The rise in the number of new Type 1 diabetes cases did not occur evenly among age groups – it was threefold greater among older children (10–14 years). The incidence of new cases was highest in New Zealand Europeans throughout the study period in all age groups. The study, which was published in June, concluded that even after allowing for population increases, there had been a progressive rise in the incidence of new cases. “The reasons underpinning the considerable increase in incidence over the study period are unclear. This may reflect an actual change in the Type 1 diabetes incidence in patients <15 yr. Alternatively, it may reflect an earlier age of onset without change in incidence over all ages, so that greater numbers of people are being diagnosed

with Type 1 diabetes in adolescence rather than in young adulthood. “This would be consistent with the ‘accelerator hypothesis’, which suggests that an increasing rate of obesity is a primary driver for an earlier age of diabetes onset,” say the authors in the report. “Although we cannot rule out a similar phenomenon in Auckland, we did not observe an increase in Body Mass Index (BMI) among children recently diagnosed with Type 1 diabetes, or an association between BMI and age at diagnosis. In fact, we observed an actual increase in age at diagnosis, which is inconsistent with the ‘accelerator hypothesis’. “Thus, our data suggest a true increase in the incidence of Type 1 diabetes in the Auckland region, and not changes driven by increasing adiposity.” Source: Increasing Incidence and Age at Diagnosis among Children with Type 1 Diabetes Mellitus over a 20-Year Period in Auckland (New Zealand). Authors: José G.B. Derraik;  Peter Reed;  Craig Jefferies;  Samuel W. Cutfield;  Paul Hofman ; Wayne S. Cutfield.

When you shop with Diabetes NZ Supplies, you’re supporting yourself and those around you! We provide easy online shopping for a wide range of useful products – from pedometers to diabetesfriendly foods, blood glucose testing meters and strips, books, information pamphlets and more. And look out for our monthly specials!

diabetes nz supplies www.diabetessupplies.co.nz 0800-Diabetes (0800 342 238) Monday to Friday, 8.30–5pm

Taking care of our members so they can take care of themselves. Spring 2012 | DIABETES

TREATM ENT

HIGH BLOOD PRESSURE

The silent killer Having diabetes increases your risk of developing high blood pressure. Dr Bob Smith explains why it matters and how you can treat it. Your body’s blood pressure is good – without it we could not stand up or walk – but like many things in life having too much, or too little, is bad. Our bodies have very good systems for controlling blood pressure within quite a narrow range. The kidneys play a major role. They contain special cells that register when a person’s blood pressure is low. The cells release a hormone called renin, which activates a complicated reninaldosterone-angiotensin system, which ‘tells’ the body to retain salt and water, thereby raising blood pressure. The autonomic nervous system also protects us from low blood pressure by releasing hormones, like adrenaline, which have a constricting effect on small arteries – thus when we stand up the effects of gravity are corrected for, and we do not faint. But things can go wrong and these protective systems can be damaged, or become excessive, and set our blood pressure ‘controls’ too high.

DIABETES | Spring 2012

What’s bad about high blood pressure? First the heart has to work harder against increased resistance and becomes thickened and may eventually wear out, resulting in heart failure. Second the arteries are subjected to increased strain, resulting in wear and tear, the thickening of artery walls or the development of weaknesses in artery walls, leading to aneurysm formation or rupture. Observations over many years have confirmed that raised blood pressure increases the risk of heart failure, heart attacks, strokes, kidney damage and more – the higher the pressure the higher the risk. From the 1940s observations on the effect of treating high blood pressure have confirmed that these increased risks can be reduced and even abolished. High blood pressure is not a disease like malaria or tuberculosis that we have or do not have – rather it is a risk factor, which can be detected and dealt with. High blood pressure is usually free of symptoms. Therefore we need to have regular blood pressure checks, according to your doctor’s advice, and treatment if it is too high.

What should my BP be? There is no one magic figure for what is too high but successive international committees have come up with lower and lower goals. For a fit young person 120/80 might be the goal but there could be benefit from being a bit lower and there may not be much harm from being slightly higher. Older people need somewhat higher blood pressures –140/90 might be the goal. This has to do with greater stiffness of their arteries and because older people tolerate low pressures less well – being more liable to falls and to damage if they do fall.

Why does this affect people with diabetes? Because diabetes is also a risk factor for many of the problems listed above, the combination of the two conditions is particularly bad. Because the kidney is affected in diabetes, there is greater likelihood of high blood pressure with diabetes. The benefits of treating high blood pressure in diabetes have been proven in a number of studies. Even when renal impairment has occurred, there is a definite benefit in treating high blood pressure.

H I G H BLO O D PRESS URE

TREATMENT

How do we treat it? Lifestyle improvements should usually be tried first (see panel). It is important to reduce your salt intake to prevent or lower high blood pressure. The earliest drug treatments had horrible unwanted effects because they blocked many actions of the autonomic nervous system but newer, more selective agents like beta blockers are mostly welltolerated. Calcium-channel blockers are sometimes prescribed – they also work on blood vessel walls to reduce resistance. Diuretics alter the kidney’s handling of salt and water and are often the first choice of agent – in small doses they do not raise blood sugar levels. The ACE (angiotensinconverting enzyme) inhibitors and the ATAs (angiotensin II antagonists) work on the kidney’s blood pressure controlling system and are particularly useful in diabetes. New surgical interventions are being developed. We should watch with interest the renal denervation treatment currently being trialled. Doctors are using radio waves to destroy some of the ‘overactive’ nerves in the kidneys that cause blood pressure to rise.

Ways to give We depend heavily on donations, legacies and membership fees to help us do our work. Please help us educate and support people with diabetes so they can live well with it.

Dr Bob’s top tips for a healthy lifestyle •

Control your blood sugar.

•

Achieve a good balance between work, play, rest and sleep.

•

Give yourself adequate opportunity to reduce stress.

•

Take regular, sensible, age-appropriate exercise.

•

Eat healthily (five serves of veges and fruit daily, lots of fibre and whole grains, low sugar, low fat, low salt, low alcohol.

•

Watch your salt intake – it is hidden in all sorts of foods including some cereals and bread.

•

Keep your body weight near ideal.

•

Do not smoke and give it up if you do.

•

Visit your doctor regularly and get your blood pressure checked.

How can you help? • • • • •

You can make a regular donation or a one-off donation. You can call 0900 86369 to make an instant $20 donation. You can sponsor a special event such as Diabetes Awareness Week. You can sign up to payroll giving. You can leave us a bequest in your will.

A third of money donated can be claimed back as a tax refund. Donations are tax-deductible up to the donor’s full annual income. Visit www.ird.govt.nz for more information. Please talk to us to discuss your donation options. Call Freephone 0800 369 636 or email fundraising@diabetes.org.nz

Spring 2012 | DIABETES

CO M M U N IT Y

NEW GOVERNANCE STRUC TURE FO R DI A BETES NZ

The new face of Diabetes New Zealand Today we introduce 14 people working hard to make a difference for people with diabetes. They are the members of Diabetes New Zealand’s new Board and Advisory Council set up following March’s historic vote in favour of unification.

The Diabetes New Zealand Board The Board is responsible for the governance of Diabetes New Zealand. Its eight members will set the organisation’s strategic direction, monitor its performance and approve its budget. It will recognise and support the new Advisory Council, and foster communication across the whole Diabetes New Zealand family.

Pat Waite (Independent member) – Chair Pat Waite has worked within the banking and finance industry in New Zealand, Asia and Australia for over 30 years. In 2001 he was appointed a non-executive director of Public Trust and, from 2003–07 was its Chief Executive. He is a Fellow of the New Zealand Institute of Chartered Accountants and was their President in 2003. He was most recently Interim Chief Executive for Diabetes NZ and then Surf Lifesaving New Zealand.

Elizabeth Hickey (independent member) – Deputy Chair Liz Hickey is a company director. She is a chartered accountant and was a partner in a large accounting firm for 13 years. She has previously served on the board of Diabetes Auckland. Liz is Vice President of the New Zealand Institute of Chartered Accountants and is also a director of Southern Cross Medical Society.

Chris Baty (President of Diabetes New Zealand) Chris Baty has been involved with Diabetes New Zealand for many years, including serving as President for more than three years. Chris led Diabetes NZ during the recent unification process. Previously she served many years on Diabetes Auckland’s Board before becoming involved

DIABETES | Spring 2012

at a national level. Chris enjoyed a successful business career in media and publishing. She was a magazine editor and writer and has media sales, marketing and senior business management experience.

concentrating largely on diabetesrelated projects. She moved from the UK to New Zealand in 2004, joined Diabetes New Zealand Rotorua in 2007, and has been President of the society since 2009.

Jo Fitzpatrick (Independent member)

Deb Connor (Advisory Council member)

Jo Fitzpatrick is a former Director (CEO) of the Women’s Health Action Trust and is currently on the Board for the Organ Donation New Zealand Advisory Committee and Auckland Women’s Health Council. She is a member of the Health IT Board Consumer Forum. She is an Advisory Committee member on the Long-term Conditions Shared Care Pilot Project.

Rae Ah Chee (Advisory Council member) Rae Ah Chee has been a Diabetes NZ Auckland board member for six years, the last two as Chairperson. He has been in business for over 40 years running a successful catering company.

Karen Reed (Advisory Council member) Karen Reed’s first job was in a research laboratory at Oxford (UK) looking into the genetics of Type 1 diabetes. She continued to work in a research environment for some years. She then became a freelance medical writer,

Deb Connor was a member of the previous Diabetes New Zealand Board for two years. She is a past President of Diabetes Otago having served on the committee for 10 years. She also served as co-chair of the local diabetes team for a number of years –standing down to sit on the Diabetes New Zealand Board in 2010. Deb is currently working as a Project Facilitator for the Southern District Health Board and is a qualified Project Manager.

Hayden Vink (Advisory Council member) Hayden Vink joined the committee of Diabetes Youth Wellington in 2001 and assisted with the planning and running of local activities such as family camps. He has been a committee member since 2003, and President of Diabetes Youth New Zealand since 2010. He was Diabetes Youth New Zealand’s rep on the previous Board. Hayden worked as an account director and strategist at one of New Zealand’s leading design agencies before starting Tailor, a digital design and development business, in 2010.

NEW GOVERN A NCE STRUC TURE FO R DI A BETES NZ

COM MUNITY

Advisory Council The new Advisory Council is made up of diabetes experts from across the sector, including two elected directly by individual members. The Council will advise Diabetes New Zealand on how it can improve life for people with diabetes at a local level and ensure it better meets the needs of people affected by diabetes. A full description of the Advisory Council’s role can be found in the new Diabetes New Zealand Constitution under Rule 11. See www.diabetes.org.nz.

Chris Baty (Chair of the Advisory Council and President of Diabetes New Zealand)

Christine Warren (Lower North Island Regional Hub Representative)

Rachel O’Brien (representing the Pacifica sector of the diabetes population)

See above.

Christine has been on the committee of Diabetes Horowhenua since shortly after joining in 2005 and its secretary since 2006. She is a registered Community Nurse, and a full-time carer for her eldest son.

Rachel O’Brien is a registered nurse. She is currently working for Compass Health as a Pacific Clinical Navigator targeting Pacific people with longterm conditions. In 2004, Rachel worked as an outreach nurse with Pacific communities, delivering health promotion (with a focus on diabetes). Rachel was on Access Radio for 10 years promoting health education to the Tongan community. She helped form Diabetes New Zealand Pacific Wellington.

Pat Bent (Vice-chair) Pat Bent is the current Vice-President of Diabetes New Zealand and was a member of the previous Diabetes NZ Board for five years. She has over 30 years experience in the not-for-profit sector and is currently a support group/event coordinator for Diabetes NZ Waikato.

Murray Dear (Upper North Island Regional Hub Representative) Murray Dear is a retired bank manager and an Associate of the New Zealand Institute of Management. He has held governance roles at a local and national level for the past 15 years, including six years on the previous Diabetes New Zealand board - two as Vice President, three as National President and one as Immediate Past President. Murray is President of Diabetes New Zealand Waikato.

Deb Connor (Lower South Island Regional Hub representative) See above.

Gina Berghan (representing the Maori sector of the diabetes population) Gina Berghan works for the Poutiri Trust, which has played a lead role in establishing Pouwhenua clinics across the Bay of Plenty regions, bringing expert services to rural communities. She facilitates training for whānau and other health practitioners in chronic disease management. She is a member of the Bay of Plenty Local Diabetes Team and Te Rōpū Mate Huka ō Aotearoa, the Māori Diabetes Collective of New Zealand.

Dr John Wilson (appointed by the New Zealand Society for the Study of Diabetes) Dr John Wilson is an endocrinologist at Wellington Hospital and is a Representative of the New Zealand Society for the Study of Diabetes.

Hayden Vink (representing the youth sector, appointed by Diabetes Youth New Zealand) See above.

Rae Ah Chee (Elected member) See above.

Karen Reed (Elected member) See above.

Left: The new Board and Advisory Council of Diabetes NZ get down to business.

Spring 2012 | DIABETES

CO M M U N IT Y

OUR PEOPLE

Dedicated to diabetes New Life Member – Andy Archer Andy Archer’s contribution to diabetes over the past 16 years has been extraordinary. So it is fitting that in May he was given the top honour of Life Membership of Diabetes New Zealand. Andy is a partner in Ernst and Young and his legal and chartered accountancy skills have always been in great demand. He is known throughout Diabetes NZ as a man of great integrity, fairness, and intellect. His analytical and robust thinking is much valued by those who have worked with him. For the last three years Andy served on the Board of Diabetes New Zealand, chairing the Finance and Risk Management Committee and the Governance Project Team. He worked tirelessly getting Destination

Unity over the line, patiently communicating with societies and answering myriad questions. Andy first joined Diabetes Auckland's governance team in March 1996. He became their Vice President in 1997 and was appointed President in March 2000, an office he held for six years. During that time, Auckland forged ahead in leaps and bounds. It more than doubled its services and staffing, provided awareness raising and prevention activities and delivered education courses across Greater Auckland, from Wellsford to Pukekohe. Andy oversaw a major reconstruction of Nesfield House, Diabetes Auckland's building, and presided over the re-opening by the Prime Minister in 2006. He also set

up Diabetes Auckland's Endowment Fund, which he chairs to this day. At a national level Andy served on the Board of the International Diabetes Federation Regional Congress. The Life Membership award recognises Andy’s invaluable contribution to Diabetes New Zealand over the past decade and a half.

Obituary: Malcolm Watson, OBE

Tribute to Hugh Green

Distinguished Life Member of Diabetes New Zealand, 1923–2012

Auckland philanthropist and diabetes supporter Hugh Green died in July at the age of 80. Mr Green gave $1 million in 2006 to the Auckland Medical Research Foundation to set up a fund to support diabetes and breast cancer research.

Malcolm’s medical career was just part of a very full life that also included distinguished service in the Naval Reserve, achieving the rank of Commander, and being awarded with the Volunteer Reserve Decoration. He served in Vietnam, was an Elder of the Presbyterian Church, and President and Fellow of the Hutt Rotary Club. Malcolm was also a photographer and family man. Malcolm’s commitment to providing care to people with diabetes was extraordinary. Three years as sole medical registrar at Hutt Hospital and an involvement in their diabetes clinic led to a lifelong commitment to caring for people with diabetes. A member of the medical panel of “The New Zealand Diabetic Association” he was always active in the debates and contributed to the establishment of NZSSD. It was his role as Chief Medical Officer of the AMP Society that led to the nearly half million dollars contributed by AMP to the Diabetes Foundation and the resulting funding of nine AMP research fellows. He also spent a period as Honorary Physician to Government House. Malcolm was recognised by the diabetes community both locally and nationally with the award of life memberships of both Diabetes New Zealand (1990) and the Wellington Diabetes Society. His legacy to diabetes care in New Zealand is the nine AMP Fellows, many of whom continue his work. Russ Finnerty and Dr Bob Smith

Andy Archer with Chris Baty.

DIABETES | Spring 2012

The philanthropist, who had diabetes himself, was a long-time supporter of Diabetes Auckland providing capital equipement, including a car and van, to the organisation. The former businessman also gave generously to a host of other causes. Diabetes Auckland General Manager John Denton paid tribute to Mr Green: “He was a great supporter for more than 15 years, providing sponsorship and attending key events like fundraising dinners and auctions.”

PRES I DENT' S REPO RT

I can’t quite believe it’s September already – this year has flown by! The Diabetes Youth New Zealand Committee has been busy working on various things at national and local levels, but there are three big things in particular I wanted to update you on.

Destination Unity As you will no doubt be aware, the motion to proceed with the ‘Destination Unity’ merger was passed by majority vote at the Diabetes New Zealand Special General Meeting earlier this year. Following on from this, three of the four separately incorporated youth societies – Wellington, Nelson and Southland – have decided to become branches under the new structure. In line with the discussion and resolution passed at the Diabetes Youth New Zealand AGM in February, we have been working closely with Diabetes New Zealand on a plan for a new youth ‘arm’ within Diabetes New Zealand that will ultimately mean Diabetes Youth NZ no longer needs to be a separate organisation. The key parts of this plan are: 1. Establishing a Youth Advisory Council that will sit underneath Diabetes New Zealand’s main Advisory Council, and be made up of youth reps from around the country. 2. Employing a National Youth Coordinator to work alongside the other staff in national office 3. Retaining a ‘youth’ brand under which we can run youth-specific activities and develop youth-specific resources. The Committee is confident that with the successful implementation of this plan, and the ongoing energy and enthusiasm of our youth volunteers and branches from around the country, this new structure will allow us to be stronger and more effective than ever before.

DI AB E TE S YOUTH

Diabetes New Zealand Conference and AGM A couple of us attended the Diabetes New Zealand Conference and AGM in Wellington in May. In my view, this was probably the best conference I have been to in terms of atmosphere – everyone seemed to be in a really positive mood and keen to ‘get on with things’ now that the big decisions had been made around Destination Unity. I am proud to be Diabetes Youth New Zealand’s representative on the newly-formed Advisory Council. I was also elected to the new Diabetes New Zealand Board by Advisory Council members to serve as one of four Advisory Council representatives. I am delighted to be able to play a key part in shaping the new organisation. I will do my best to ensure the needs and interests of youth are always taken into account in every area.

Pharmac Karen Foster and I spent a great deal of time writing submissions and meeting with Pharmac in relation to its blood glucose meter and testing strips proposal. Karen and I worked quickly to prepare Diabetes Youth New Zealand’s original submission. Our committee members attended Pharmac workshops around the country, and were closely monitoring things like the Facebook group set up to discuss the issues. Ultimately, we were invited to meet with Pharmac and participated in two meetings/workshops with them. We have worked in a constructive manner at all times and I can assure you that Pharmac is well aware of the concerns that we – and thousands of other New Zealanders living with diabetes – raised. Whatever the final decision, we are committed to ensuring that any changes to the status quo are implemented with the minimum of impact to our constituents. We have said we will continue to work constructively with Pharmac, regardless of whether we agree with all (or part) of the final decision. Thanks to all of you who have assisted us with our advocacy efforts in relation to this issue, and please don’t hesitate to get in touch if you have any questions.

President Diabetes Youth New Zealand

Diabetes Youth New Zealand

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THE L AS T WORD

D IABETES RESPO NS E DO G

A very special hound Uni’s story has captured the nation’s imagination after featuring in a raft of news stories and on national TV. The young German Shepherd is training to become New Zealand’s first diabetes response dog. Trainer Melanie Donne gives us an update on his progress. Uni is part-way through his training programme and is working to compete the Canine Good Citizenship foundation level, then he will start on his public access training – learning to negotiate public places, such as escalators, slippery floors, being taught not to chase things or jump on people. Alongside this rigorous training, he is doing scent detection work – learning to detect when people with diabetes are about to have a hypoglycaemic attack. It’s a long hard road to get a dog properly trained as a diabetic response dog. Uni has been training every day for 90 minutes since the police donated him to the Kotuku Foundation at the end of last year. He won’t be ready to be matched with someone until he has passed all the tests. He is doing very well and he’s definitely on the way. We are now accepting expressions of interest from people who would like Uni to be placed with them. We are conducting a very brief telephone interview and correspondence to see if they are suitable applicants. They will be placed on a list and contacted once Uni has finished his training. At this point they will be asked to fill in the forms and go through the formal selection process. It is very important we match the right person with Uni. A lot of people

DIABETES | Spring 2012

love the idea of a dog but don’t realise how much responsibility and work is involved in having one, especially an assistance dog. The concept of using a dog’s formidable scenting abilities in a range of bio-detection roles is not new. Scientists don’t know exactly how dogs can detect hypoglycaemia. It is thought they can sense pheromones in human skin and breath that are released in hypo and hyperglycaemic episodes. Response dogs are 90 per cent accurate in warning of impending hypoglycaemia – an amazing 15-30 minutes in advance of any glucose monitoring or alarm technology. Brenda is one hopeful applicant: “I have been a Type 1 diabetic for 28 years after being diagnosed at a young age. I’ve always had to rely on others to come to my rescue during a hypo. To even be considered for a diabetic response dog in the future is just so amazing, it’s hard to put it into words to be totally honest.

For me it means that I can take back control of my life, knowing there is always someone at my side that can alert me prior to collapse, especially as I live alone.” Another hopeful, Jason said: “I have had Type 1 diabetes since the age of 14 years and spent many years struggling with the condition. Over the years I have had many life-threatening episodes and hospitalisation and now I have no warning of low blood sugars. I feel a dog that has the ability to recognise changes in my body chemistry would restore my confidence and provide me with a better quality of life.”

Melanie Donne founded the national charity Kotuku Foundation Assistance Animals Aotearoa in 2006 to train dogs to help people with disabilities. For more information, to make a donation, or contact Melanie, go to: www.hotfrog.co.nz/Companies/ Assistance-Animals-AotearoaKotuku-Foundation

Dog-darn good: Melanie Donne (right) with Uni and advising dog trainer Marika Bell.

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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