Diabetes Spring 2015
Is diabetes in YOUR family tree? Jump into
DIABETES ACTION MONTH
Living well with diabetes
RAWIRI EVANS
from couch potato to MÄ ori Ironman
diabetes food heroes + daily footcare tips + spring vege garden
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Diabetes: the national magazine of Diabetes New Zealand | Vol 27 no 3 Spring 2015
INSIDE spring 2015 4 5
From the Chief Executive From the President
Upfront
6 8
News in brief
16
Diabetes Action Month
Focus
10 Jumping into a healthy new lifestyle
Profile
12 Technology, diabetes and me: Richard MacManus
Interview
14 Dr Bryan Betty: Behind the COVER PHOTO: RAWIRI EVANS. PHOTO Š NICOLA EDMOND
scenes at Pharmac
Families and children
Research
Your Diabetes NZ
20 Is diabetes in your family tree?
27 Branch news
Care and prevention
Living with diabetes
22 Healthy feet
28 How times have changed
Food
Let’s get active
24 Diabetes food heroes 26 Recipe: Falafel
30 Making fitness fit your life Community
16 Emily Wilson: IDF Young
32 Mollie Kainuku: Going the
Gardening
Diabetes Youth NZ
Leader 2015
18 Spring sowing: zucchini and squash
extra mile
24
Treatment
19 Diabetic macular oedema
33 Jacqui van Blerk The last word
34 What causes diabetes?
Diabetes magazine EDITOR Caroline Wood editor@diabetes.org.nz PUBLISHER Diabetes New Zealand DESIGN AND PRINTING Kraftwork, Wellington ADVERTISING John Emmanuel john@affinityads.com or 09 473 9947 MAGAZINE DELIVERY ADDRESS CHANGES Freepost Diabetes NZ,PO Box 12 441, Wellington 6144 Telephone 0800 342 238 Email: admin@diabetes.org.nz ISSN 1176-4406 Disclaimer: Every effort is made to ensure accuracy, but Diabetes NZ accepts no liability for errors of fact or opinion. Information in this publication is not intended to replace advice by your health professional. Editorial and advertising material does not necessarily reflect the views of the Editor or Diabetes NZ. Advertising in Diabetes does not constitute endorsement of any product. Diabetes NZ holds the copyright of all editorial. No article, in whole or in part, should be reprinted without permission of the Editor.
Join Diabetes NZ and receive 10% discount on any product at www.diabetesauckland.org.nz/shop. Membership also includes a free subscription to Diabetes magazine, regular newsletters and support from your local branch. It costs just $35 per year ($27.50 unwaged). Call 0800 342 238 or visit www.diabetes.org.nz.
FRO M TH E CH I EF EXECUTIVE
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Building our membership Ngā mihi nui koutou katoa. It has been four months since I joined the team at Diabetes New Zealand. One of my first priorities has been to get out and about and visit our branches and offices. I wanted to listen to and acknowledge your ideas and concerns, and meet the people that have made Diabetes New Zealand an organisation I wanted to join. I can report back that I have met many of our Diabetes NZ members and have been to numerous branch committee meetings and regional AGMs. I want to thank you all for your warmth and hospitality. I am delighted with and appreciative of your commitment and determination. This financial year we have established an aspirational annual plan. Given the huge growth projection for people living with diabetes in New Zealand, it is vital that we plan for this future.
Diabetes NZ undertook a significant ‘unification’ mission in 2011. This project has been reasonably successful in achieving its original objectives but it has meant that for the last four years, the major strategic focus has been on national unification and consolidation. One of the areas needing immediate focus is building our membership. Going forward, the identification and development of national and branch initiatives that support and benefit current and potential members is critical. Over the next few months, with your help, we will be considering what we need to start, stop or keep doing to deliver the benefits our members want, and the type of membership structure we need. We also need to consider a range of developments for implementation over the next two to five years, to ensure we can continue to deliver the best possible outcomes to our members from the resources we have available to us. This is an incredibly exciting time for Diabetes NZ. On another note, the International Diabetes Federation has launched The Framework for Action on Sugar. The framework proposes 12 clear
measures that demonstrate the IDF’s commitment to continuous engagement with national governments and the World Health Organisation with the aim of stemming the relentless rise in cases of type 2 diabetes. Diabetes is anticipated to affect 592 million people worldwide by 2035, a 53 percent increase on existing cases. If you would like to read the report, please go to www.idf.org and search Framework Sugar. Diabetes NZ will launch an exciting new Facebook page in September. Please look us up and press “like” – and send to your friends and colleagues. Finally, I would like to take this opportunity to reflect on the recent tragic passing of Ashburton branch member Carol Hill. The upcoming AGM/Conference in November would have been her 20th as branch president. Carol was a valued member of Diabetes NZ and we mourn her loss. Nāku noa, nā. Steve Crew Chief Executive
See our website for advice, tips and ideas on how to live well with diabetes: www.diabetes.org.nz
Diabetes New Zealand PATRONS: Lady Beattie and Sir Eion Edgar PRESIDENT: Chris Baty CHIEF EXECUTIVE: Steve Crew NATIONAL COMMUNICATIONS MANAGER: Nicky Steel DIABETES NEW ZEALAND INC. NATIONAL OFFICE: Level 7, Classic House, 15 Murphy Street Thorndon, Wellington 6144 Postal Address: PO Box 12 441, Wellington 6144 Telephone 04 499 7145 Fax 04 499 7146 Freephone 0800 342 238 Email admin@diabetes.org.nz G www.facebook.com/diabetesnz
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DIABETES | Spring 2015
Diabetes New Zealand is a national organisation that supports people affected by diabetes. We work to raise awareness, educate and inform people about diabetes, its treatment, management and control. We offer local support to individuals with diabetes through a network of diabetes branches across the country. We also support research into the treatment, prevention and cure of diabetes.
Call now to make a donation 0800 DIABETES (0800 342 238)
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FROM TH E PRESIDE NT
Delivering the right message This is my hurrah column for Diabetes. I am stepping down as National President of Diabetes NZ at the end of October after six-and-a-half years of working for all people with diabetes in New Zealand. I have had the privilege of sharing the task with others doing the same whether from Diabetes NZ, health providers or policy makers. My steepest learning curve has been getting familiar with the health system and its structure. It is a complex beast, each cog in the wheel having its own engine to drive. The system is dynamic and fascinating, yet maddening, but having a health system flexible enough to meet different population and condition needs is a complicated requirement! When one is at the table of policy or service development and presenting the ‘consumer’ point of view, it can be lonely and scary as our view can be different from that of health providers and managers. But our end goal is mostly shared, which is to improve things for people with diabetes. I fervently believe consumer input is essential in the creation and delivery of health services, especially for long-term conditions like diabetes. If no one listens to how best healthcare can be delivered so people benefit from it, nothing will change. In the delivery of good diabetes care the focus must be on wellness; NOT sickness. We need support, advice and help to live well with our diabetes to prevent us becoming sick.
If we do what we have always done, we are going to get what we have always got. We need to do more to prevent diabetes where we can and help people avoid the lifelimiting complications of diabetes. I am frustrated by a government that refuses to address the environmental aspects of our obesity rates. By insisting it is all to do with what an individual person eats or drinks and how active they are is not only making this an ‘individual-only’ problem and responsibility, when it is not, it is negating the environmental influences we all live in. Society, led by government, determines how we work, the places we live, the food choices we have and learn and so on. While individuals do have responsibility it could be more effectively exercised in a supportive environment.
People do not choose to be unwell – just like they do not choose to have diabetes. But they need to understand how to be well with diabetes. This brings me to our responsibilities in keeping well as individuals with diabetes. I favour a system that partners with and supports us to do the things we have to do every day. What is demanded of us is far harder than quitting smoking ever was. We need to receive the diabetes message in a way that we see ourselves in the story living well with it. While the message will be the same the story will be different given diabetes can affect any and every one. People do not choose to be unwell – just like they do not choose to have diabetes. But they need to understand how to be well with diabetes.
A health service that has listened to those it serves is more likely to deliver care that will improve outcomes. That delivery might look different. For example, good diabetes management tips delivered by ‘expert patients’ or via peer supporters who work in partnership with the usual clinical providers. That other person with diabetes who encourages healthier eating or goes with the newly diagnosed for a walk each day chatting about what matters to them might engender greater change than a doctor or nurse can. Technology has a role – a daily phone call to listen and encourage or a texting service reminding you to get active. Our reality is that there are well over quarter of a million of us with diabetes. The growing demands on our health system cannot be met. Health service delivery has to get smarter, and so do we. For some of us, that demands we step up. We all know what we need to do and yet many don’t. The doctors can’t solve this but together we can help each other – enormously. Diabetes NZ has a huge part to play in this via their support groups and just by being there as a knowing and friendly voice on the end of the phone. I wish the organisation well in its work supporting those with diabetes, keeping them well. This must mean Diabetes NZ’s stories are of relevance to everyone. This is the new challenge for the organisation. E noho rā. Chris Baty National President
Spring 2015 | DIABETES
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UP FRO NT
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NEWS IN BRIEF
World Diabetes Day
New child diabetes group
The International Diabetes Federation has published an online World Diabetes Day Guide, a practical guide to the world’s largest diabetes awareness campaign. The tool can be viewed and downloaded on the dedicated World Diabetes Day website.
A working group has been established that brings together a team of professionals from the South Island health sector with a focus on child and adolescent diabetes care. The aim of this group, which includes a consumer representative, is to improve care across the South Island for young people with diabetes, in particular type 1 diabetes. Its establishment is part of a wider strategy to establish a regional approach to diabetes service planning, and to achieve consistency in standards and provision of diabetes care.
Focused on the role healthy eating plays in helping to manage type 1 diabetes and both manage and prevent type 2 diabetes, the guide outlines how you can get involved and includes key messages, supporting facts, figures and graphics. Consult the guide throughout the year for updates, get involved and help IDF ensure that healthy eating is a right, not a privilege. See www.idf.org.nz
Quarter of a million Kiwis have diabetes More than 257,000 New Zealanders have diagnosed diabetes, according to the Ministry of Health. An estimated 5.8 percent of the population is thought to have diagnosed diabetes – 257,776 Kiwis as at December 2014, according to the Virtual Diabetes Register. Māori make up more than 14.4 percent of the total (slightly higher than the proportion of Māori that make up the population – 14.1 percent in the 2013 population census), while Pacific people make up 11.8 percent, (7 percent of the 2013 population). Indian people make up 6 percent (3.5 percent of the 2013 population). The figures suggest the number of people with diagnosed diabetes has more than doubled in nine years. In 2005 an estimated 125,000 people had diagnosed diabetes, according to a report by the Government’s Health Committee (Inquiry into Obesity and Type 2 Diabetes in New Zealand, 2007) with an estimated 90 percent having type 2 diabetes.
Diabetes NZ conference and AGM 2015 Diabetes NZ’s conference and AGM 2015 is now fast approaching and with its theme of Act Today to Change Tomorrow it promises to deliver something for anyone affected by diabetes. The conference will be held in Wellington at the James Cook Hotel Grand Chancellor from midday Friday 30 October to midday Sunday 1 November 2015. The AGM will be held during the weekend at 1pm on Saturday 31 October. Visit www.diabetes.org.nz for the conference programme and registration information.
Chair Dr David Barker, Clinical Leader for Children’s Health Southern District Health Board, said: “This will help to ensure that young diabetes patients receive high quality, accessible and equitable care.” Noeline Wedlock, from Diabetes NZ Otago branch, is the consumer representative on the group, which plans to meet monthly.
Welcome Sue Brewster Diabetes New Zealand is delighted to welcome Sue Brewster in the newly created role of Business Development Manager. Sue comes from a sales and marketing background and has been in the not-for-profit sector now for over 10 years with her most recent role being with Surf Life Saving Northern Region as Commercial Manager and Acting CEO. Sue’s role is to develop funding relationships and partnership opportunities to achieve a sustainable future for Diabetes NZ. She’ll be based in her home city of Auckland, but is part of our Diabetes NZ national office team. You can contact Sue on 027 569 7777 or email sue@diabetes.org.nz.
World’s largest health study A New Zealand neuroscience team from AUT University is launching what could become the world’s largest ever health study. The research, which tackles the mounting toll of non-communicable diseases, including diabetes, is tapping into the power of mobile technology to gain vast amounts of international data and vital epidemiological insights. Entitled Reducing the International Burden of Stroke Using Mobile Technology (RIBURST), the study will be conducted through the mobile app, Stroke Riskometer™, which allows users to assess their individual stroke risk on a smartphone or tablet. Researchers hope that the findings will significantly reduce the devastating impact of conditions such as stroke, diabetes, dementia and heart disease. For more details see: www.news.aut.ac.nz.
G Check out Diabetes New Zealand on Facebook: www.facebook.com/diabetesnz 6
DIABETES | Spring 2015
GlucaGen® HypoKit
Glucagon (rys) hydrochloride
Make sure it’s there when they need it* GlucaGen® HypoKit is used to treat severe hypoglycaemia in people using insulin or taking tablets to control diabetes, who have become unconscious. Available from pharmacy with or without a prescription.
Patient support available The HypoHelp website and app are an important resource for patients at risk of hypoglycaemia and includes a free expiry date reminder service for patients with a GlucaGen® HypoKit. Download the app for free at www.hypohelp.co.nz Also available at Google Play or iTunes.
*Refer to full indications below
GlucaGen® HypoKit is a Pharmacist Only Medicine that is funded through the PHARMAC with a prescription, or available for purchase without a prescription (normal pharmacy charges apply). Ask your Healthcare Professional if GlucaGen® HypoKit is right for you.
Before prescribing, please review full Data Sheet available at www.medsafe.govt.nz GlucaGen® HypoKit. (glucagon [rys] hydrochloride). Presentation: Each pack consists of a vial containing lyophilised glucagon 1 mg (1 IU) as hydrochloride and a glass syringe pre-filled with 1 mL water for injections. Indications: Therapeutic: Treatment of severe hypoglycaemic reactions in persons with diabetes mellitus treated with insulin or oral hypoglycaemic agents. To prevent secondary hypoglycaemia, oral carbohydrate should be given to restore hepatic glycogen following response to treatment. The treatment of sulfonylurea-induced hypoglycaemia differs from severe insulin-induced hypoglycaemia due to the possibility of secondary hypoglycaemia - it is preferable to use intravenous glucose (see full Product Information/ Data Sheet). Medical consultation is required for all patients with severe hypoglycaemia. Contraindications: Hypersensitivity to glucagon or lactose, phaeocromocytoma, insulinoma or glucagonoma. Precautions: Glucagon will have little or no effect when the patient is fasting or is suffering from adrenal insufficiency, chronic hypoglycaemia or alcohol-induced hypoglycaemia. When used in endoscopy or radiography, caution should be observed in diabetic patients, or elderly patients with known cardiac disease. Glucagon is instable in solution, it should be used immediately after reconstitution and must not be administered by intravenous infusion. May cause allergic reactions in latex sensitive individuals. * Interactions: Glucagon is an insulin antagonist. When given in large doses, glucagon may potentiate the anticoagulant activity of warfarin. Glucagon can reverse cardiovascular depression of profound ß-blockade (see full Product Information/Data Sheet).* With indomethacin, glucagon may lose its hyperglycaemic effect or even produce hypoglycaemia. Adverse Effects: Nausea; vomiting. Dosage and Administration: The glucagon solution should be prepared immediately before use. Dissolve powder in accompanying solvent and administer by subcutaneous or intramuscular injection. Therapeutic: Adults and children above 25 kg - administer 1 mg; Children below 25 kg - administer 0.5 mg. (Jan 2015).
*Please note change(s) in Product Information/Data Sheet. Novo Nordisk Pharmaceuticals Ltd., G.S.T. 53 960 898. PO Box 51268 Pakuranga, Auckland, New Zealand. NovoCare® Customer Care Centre (NZ) 0800 733 737. www.novonordisk.co.nz ® Registered trademark of Novo Nordisk A/S. TAPS(DA) 1545RB McK336045/Diabetes NZ 03/15.
GlucaGen® HypoKit Glucagon (rys) hydrochloride
DIAB E TES A CTI O N MO NTH
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1 – 3 0 NOVEM BER 2 015
DIABETES warning signs
Some Kiwis have diabetes but don’t know it.
Time to take action Diabetes NZ is launching its inaugural Diabetes Action Month in November, as Nicky Steel explains. Diabetes is New Zealand’s largest and fastest-growing health issue. The number of people officially diagnosed with diabetes has just topped 257,000, according to recently released Ministry of Health figures. Worryingly some people are thought to have diabetes but are undiagnosed, which puts them at risk of developing serious health complications, such as stroke, heart attack, blindness, kidney and nerve damage. And many others have prediabetes and are at risk of developing type 2 diabetes. The scale of the problem is clear. Over a quarter of a million Kiwis have diagnosed diabetes. This number has more than doubled over the past nine years. And let’s not forget their families and loved ones, who are also affected by this life-long condition. No-one is immune to diabetes, it can strike at any age, any time, any person. Type 1 diabetes is an autoimmune condition and cannot be cured or avoided. But the majority of people in New Zealand have type 2 diabetes which can be controlled, delayed, or in some cases, prevented, through lifestyle changes such as weight management, healthy eating and increased activity.
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DIABETES | Spring 2015
Diabetes NZ is worried about the scale of the problem. So this year we are launching our inaugural Diabetes Action Month, extending the previous Diabetes Awareness Week, and incorporating World Diabetes Day on November 14. It will take place over four weeks, from 1–30 November, which will give us more time to bring attention to diabetes and promote ways people with diabetes can stay well. We also want to highlight risk factors and how to reduce the risk of developing diabetes. Diabetes NZ’s Chief Executive Steve Crew says: “Living with diabetes has serious life-long implications for the health of every individual with the condition. It also imposes a significant cost, around $600 million each year, on our national health system. With more and more people developing diabetes, this cost is projected to steadily rise. “It’s clear that we need to take action now to help New Zealanders reduce their risk of developing diabetes, to find those people who have undiagnosed diabetes, and to help people who have diabetes to manage their condition so they can stay well and live full and active lives.” Diabetes NZ is planning to make Diabetes Action Month a major event in the calendar that will help raise awareness about both diabetes and Diabetes NZ, as well as supporting our traditional November branch fundraising drive.
• Feeling tired and lacking energy • Feeling thirsty • Going to the toilet often • Getting infections frequently • Getting infections which are hard to heal • Poor eyesight or blurred vision • Often feeling hungry These warning signs are not always present so it pays to get checked. There’s a quick and easy test for diabetes that also detects prediabetes. See your GP or practice nurse.
DIABETES risk factors
Family history
Lack of exercise
Unhealthy eating
Being overweight
WE NEED YOUR HELP We’re giving a ‘shout out’ to people in our local communities to help us raise awareness during November. We are planning national events and our 20 branches will be holding their own activities. If you want to find out what’s happening in your area get in touch with your nearest branch see www.diabetes.org.nz for contact details.
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FO CU S
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RAWIRI EVANS
“I just want to encourage people to take a risk and not be afraid. The world is theirs for the taking, just go for it.�
Rawiri Evans prepares a healthy meal with the help of his granddaughter Anahera Ford.
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DIABETES | Spring 2015
RAWI RI EVA NS
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FOCUS
From idle to Ironman Rawiri Evans tells his story to Caroline Wood in the hope it will inspire others to jump into a whole new lifestyle –whatever their age and circumstances.
But two years ago, things weren’t looking so great for Rawiri, who lives in Wainuiomata and has four children and ten mokopuna. He was not looking after himself, he was overweight and not doing any exercise.
Rawiri Evans, 55, would probably consider himself an unlikely diabetes champion and role model. For many years he didn’t look after himself, he didn’t exercise or eat healthily and he let his diabetes get out of control.
The turning point came in January last year, as Rawiri, who works as an alcohol and drug practitioner for Care NZ, explains: “I’m on a trust board for a charity and they decided to do a triathlon for people with disabilities. I decided I would go in as part of the team and do the cycle leg, so I went and bought a push bike and that is what started it.”
But this all changed two years ago, when Rawiri was persuaded to do a triathlon – after years of being a couch potato. One thing led to another and now he is preparing for his first Half Ironman, having completed nine other triathlon events. Rawiri has lost 40kg and reduced his daily insulin by 75 percent, shocking his doctor Brenda Smith with this latest (fabulous) blood test result and prompting her to contact us here at Diabetes to let us know about Rawiri and his story. “She said she couldn’t believe the blood test results, the difference was massive. She told me ‘I don’t know what you are doing but keep doing it,’ and she started to adjust my medications,” says Rawiri.
At about the same time Rawiri was given a serious pep talk by his diabetes team at Hutt Hospital, who were worried about his unhealthy lifestyle. “Hazel Phillips from the diabetes team at Hutt Hospital helped turn me around. She told me that I needed to make radical changes in my life or I would be in trouble. But I don’t think she ever thought I would go this far. “When I finished the first event, she said: “What’s the next one?” and I got the bug. Since then I have done about nine triathlons and I have dropped the team and now do them solo. He did his first Half Ironman last November. “I never thought I could
do it on my own. But I thought I would give it a crack,” he says. “It was a sense of achievement, it’s more about that sense of getting across the finish line and actually achieving something even though you know you have got everything against you healthwise. “I love competitive sport but it’s about combining that with managing my diabetes, the bonus is that it’s helping me achieve both. The change has been remarkable.” When he started training, Rawiri was on 120 units of insulin a day. Now he is down to 30 units and only has to inject once a day. He now weighs 90kg and his risk of stroke has dropped dramatically. “My next goal is to go back to just metformin. Hazel said if I keep going I can go back to just taking metformin.” Rawiri is currently preparing for his first Ironmāori, in Napier this December, where he will have to swim two kilometres, bike 90km and run a half marathon – 21km. His two-year goal is to travel to China and run the Great Wall. “I just want to encourage people to take a risk and not be afraid. The world is their’s for the taking if they want it. Just go for it.”
How did Rawiri do it? Nutrition and hydration are key when training for endurance events, says Rawiri. He now follows a high protein, low carb diet. He got rid of bread and drinks water (after previously drinking fizzy cola by the bottle). Rawiri’s wife started out at a gym and they put her on a diet. That’s what started the whole family changing their diet and they now enjoy eating healthy meals together.
Spring 2015 | DIABETES
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P RO FI LE
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RICHARD MACMANUS
Diabetes diagnosis led to new career Wellington-based writer Richard MacManus is a former technology blogger turned author. After a shock diabetes diagnosis eight years ago, he decided to combine his love of technology with health and publish a book on self-tracking. “It was out of the blue. I was 36 and there was no family history at all. It was a shock. I was running a technology blog, things were ramping up at work, it was a busy time,” recalls Richard MacManus, founder of technology blog ReadWrite.com.
the benefits and risks of selftracking and looks at the tools and techniques being used, how self-tracking is revolutionising the health and wellness industries and how the medical establishment is adapting to these new trends.
Things were taking off with his blog. Richard was recognised as a leader in explaining what was next in technology and what it meant for society. His type 1 diabetes diagnosis in 2007 happened to coincide with the emergence of health-related apps and, naturally, Richard started experimenting with what were then pretty basic apps that weren’t very user friendly.
“What I found really useful was using the tracking data to understand my own body. I didn’t understand how blood sugar was affected by food and I didn’t know how to control it. I found out about the low carb diet and that was how I started using MyFitnessPal.
Over the following years the health tracking apps improved significantly to the point that Richard believed the potential impact merited a book on the subject and last year he published Trackers: How Technology is helping us Monitor and Improve our Health.
“Activity trackers like Fitbit helped me understand how exercise and food impacted on my blood glucose levels. Then there are tools to check blood sugar levels and insulin pumps that synch with apps. Although, unfortunately, the more sophisticated diabetes apps aren’t available yet in New Zealand.”
In the book Richard explains
“The value of all this technology for
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DIABETES | Spring 2015
me is that I am in control of my diabetes and my health.” Richard predicts that in the future health tracking will become part of everyday life and will take place quietly in the background as people will wear tracking devices like the Apple Watch that will automatically download real time information about a person’s health, such as heart rate, blood pressure, blood glucose and diet. He also predicts that there will be a linking of health platforms – so diabetes, fitness and diet data will link up seamlessly and patients will be able to combine this with the data their doctor collects about them – blood tests, blood pressure etc. “I found that technology tracking helped me manage my diabetes and I wanted to write the book to help other people do the same,” he explains. In Trackers, Richard looks at a digital health revolution that will strike a chord with many people with diabetes. He explains how people are working to solve real health problems with new technology. “MacManus is a masterful storyteller who weaves the human element into how we actually interact with this technology with sometimes mixed results, despite the hype,” said one reviewer. Richard is now working on his first novel.
GIVEAWAY
What is self tracking?
We have a copy of Trackers by Richard MacManus (RRP $30) to give away to one lucky reader. Please email your name and address to admin@diabetes.org.nz by 1 November 2015.
Self-tracking is the practice of measuring and monitoring your health, activities or diet through technologies such as smartphone apps, wearables and personal genomics, empowering you to take control of your day-to-day health.
Monitor your child’s glucose levels from the comfort of your own bed 1
Introducing the Dexcom G4® PLATINUM Continuous Glucose Monitor The Dexcom G4® Platinum updates glucose levels every 5 minutes so you can track your child’s glucose continuously day and night. Monitor their highs, lows and how fast they’re getting there from the comfort of your own bed1 for added peace of mind.
For more information or to arrange a trial to see the benefits for yourself, please contact us between 9am5pm, Mon - Fri on 0508 634 103 W www.nzmsdiabetes.co.nz
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Dexcom G4TM PLATINUM is not currently indicated for children under 2 years of age. Always read the manufacturer’s instructions and use strictly as directed. 1. Dexcom G4® PLATINUM transmitter range is 6 metres. Dexcom G4™ User Guide, May 2012. LBL-011277 Rev 04, LBL-011346 Rev 02.
INTERV I EW
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D R BRYAN BETTY
Behind the scenes at Pharmac He tells me he spends a lot of his time helping patients with diabetes at his practice, which has a high proportion of Māori and Pacific Islanders. Many of them have issues with diabetes control and are facing the health consequences. It’s clear he knows first hand the challenges facing doctors when it comes to having the right tools to help people manage their diabetes.
Pharmac’s new Deputy Medical Director Dr Bryan Betty explains why the agency is reviewing sole supply arrangements for blood glucose meters and what this could mean for consumers. Caroline Wood reports. Pharmac is reviewing the kind of diabetes care – blood glucose meters and medicines – it funds for the more than 257,000 people with diabetes in New Zealand. The resulting decisions could have a huge practical daily impact on people with both type 1 and type 2 diabetes. So when the opportunity arises to meet Dr Bryan Betty, who is charged with leading the review, I jump at the chance. Dr Betty has recently been appointed Pharmac’s new Deputy Medical Director, and is also its Medical Director for Primary Care. We meet at the agency’s central Wellington offices but it is quickly apparent he is not a deskbound civil servant. In fact Dr Betty is also a GP who works two days a week in one of the most deprived areas in the country – Cannons Creek, Porirua, north of Wellington.
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Dr Betty says that Pharmac’s review of arrangements around the supply of blood glucose meters – and a separate process looking at whether new medicines for type 2 should be funded (see below) – are priority areas for the agency over the next two years. The decision to move to a sole supplier of blood glucose meters – CareSens – in 2011 was controversial in its implementation with some claiming the new meters weren’t accurate and others unhappy about the limited choice of meters and their features. Fast forward to 2015 and the sole supply agreement for CareSens is coming to an end and Pharmac has begun a further commercial process for the supply of blood glucose meters and test strips. But this time they have pledged to do it differently – more slowly, more thoroughly and with more consumer and doctor input into the process. Some may want the process to move more quickly – it will take 18 months with a decision unlikely until after June 2016 – but Dr Betty says Pharmac wants to do the review properly and take its time to consult over – and test – any new meters. “We want to make sure we are doing a very transparent and thorough process. We are aware of the concerns during the implementation
process last time. We think this time we have a very thorough process, we’re taking our time and we are aware of the needs and requirements of the end users,” he explains. “Once decisions are made, we have an implementation team. We have learned the lessons of what happened last time and how we can improve that [implementation] process.” Dr Betty says that the CareSens meters have performed well technically with a very low failure rate (with 1 in 4,000 or 0.025 percent having a technical problem) but he won’t be drawn on their functionality, saying this is part of the review. “Everything is being looked at and we can’t say what will happen at the end of the process – whether there will be a single, dual or more suppliers,” he says. What features will they include? Will technological features and usability be factors? Dr Betty won’t comment on this other than to say that usability and the ability to link up wirelessly with health tracking apps and the cloud would “certainly be one of the aspects we’re looking at”. Dr Betty says no decisions have been made and he is determined the review will be thorough and transparent. “We are very aware of the health implications of having diabetes and the impact on people’s lives. It’s a major health issue and staff here at Pharmac really want to do their best in terms of getting the best health outcomes and equitable access to medication.” *CareSens meters and test strips will continue to be funded until the review process is completed. You can keep up to date on progress by checking www.pharmac.health.nz.
DR BRYA N BETTY
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I NTERVIEW
ON NEW MEDICATIONS
ON METERS Pharmac’s sole supply contract with CareSens ended on 1 July 2015 but funding of the meters continues until Pharmac reaches any new agreements. The review of blood glucose meters will include the following steps: 1. Expressions of interest from meter manufacturers – to find out what meters/technology are currently available internationally. 2. Potential meters will be lab-tested first to see if they are suitable for use in New Zealand. 3. End-user testing will be carried out by health professionals, such as diabetes nurse specialists and pharmacists. 4. A request for proposals, including pricing, from suppliers interested in supplying them. 5. User testing with consumers, both type 1 & 2, including all age groups from the young to the elderly.
DIABETES NZ’S POSITION Pharmac launched a consultation about the provision of meters earlier this year and Diabetes NZ made a detailed submission on behalf of members reiterating its position that “sole supply arrangements for blood glucose meters and strips do not enable the varying needs of our population to be met. We advocate strongly that this approach be abandoned.”
Pharmac is seeking information from drug suppliers on four new classes of diabetes drugs currently not funded in New Zealand. They include: • DPP4 inhibitors • GLP-1 • SGLT-2 •C ombination DPP4/metformin treatments Some of the medicines are already available in other countries. This doesn’t mean they will be funded in New Zealand – there are many hoops to jump through before that can happen. First the drug application or drug information will be reviewed by a panel of independent diabetes clinicians, who will look at the evidence around their use and make recommendations on which (if any) should be funded – and the order of priority. Then the recommendations have to go through further independent panels and committees before a decision is made to fund any of them.
THE BUDGET Last year (2014) Pharmac spent more than $63 million on diabetes care – its fourth highest line of spending. The lion’s share – $41 million – was spent on insulin, including the new classes of insulin now being funded. Pharmac spent another $4m on metformin, the first line of treatment for people with type 2 diabetes. The remainder – approximately $18 million – was spent on funding diabetes ‘hardware’ including insulin pumps for those who qualify, and CareSens blood glucose meters and test strips.
NZ’s most popular insulin pump1
ON INSULIN PUMPS There has been a lot more access to insulin pumps with 1,000 pumps now funded by Pharmac. Since the funding rules changed in 2012, only 50 applications have been turned down. Since 2012 there has also been better access to a broader range of new generation insulins, which has been a good step forward for patients, says Dr Betty.
Funded for eligible patients P 0508 634 103 W www.nzmsdiabetes.co.nz 1. IMS Health Data, Oct 2012 - March 2015.
Spring 2015 | DIABETES
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FAM I LI ES A N D CH I LD RE N
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EMILY WI L S O N
It’s been a roller-coaster year for outdoor adventurer and sports instructor Emily Wilson, who has just been named an International Diabetes Federation Youth Leader for New Zealand. Nicky Steel talks to Emily about her recent diagnosis and what she hopes to achieve in the role.
Improving the lives of young people affected by diabetes Emily Wilson received some news in May that would change not only her end-of-year plans but also, potentially, her future life plans. Emily got the call to say her application to the International Diabetes Federation’s Young Leader in Diabetes (YLD) programme had been successful and she would be off to Vancouver in November to join other successful candidates from around the globe.
CREDIT: XPD.COM.AU
The Young Leaders in Diabetes programme runs from 23 November to 5 December and forms part of the World Diabetes Congress. In Vancouver, Emily, 24, will have the chance to meet some of the world’s most motivated young diabetes leaders and share her experiences and plans for helping others with diabetes in her home country. She will represent New Zealand in Vancouver, and Diabetes NZ and Diabetes Youth NZ are clubbing together to meet Emily’s travel expenses.
Emily Wilson takes part in the ropes section of the XPD Adventure Race in the Flinders Ranges, South Australia.
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“I’m super excited, I’m over the moon,” says Emily. “I’m extremely keen to get involved in helping people with diabetes and I see this programme as a great way to learn the skills and make the connections I need to help me achieve this.”
Emily, who lives in Wanaka, only found out in November last year that she has diabetes. She is waiting on test results to confirm her diagnosis and whether it is MODY (Maturity Onset Diabetes of the Young), a very rare form of diabetes that is different from type 1 and type 2 diabetes and runs in families (see panel). Since diagnosis day she has been trying to better control her blood glucose levels and learn as much as she can about her condition, so she can continue to race in multisport and adventure races, which she’s passionate about. Emily fully understands the health benefits of exercise and wants to help others realise these benefits too. “I get a lot of satisfaction and joy from seeing people in our community – especially children – getting out there, being active, pushing their limits and having lots of fun,” she says. “At university I studied physical education, specialising in exercise physiology for my thesis. I began to realise that my real passion and interest is in trying to minimise the prevalence of diseases like diabetes and obesity and reduce the negative impact these diseases have on the
EM I LY WI L S O N
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FAM I LI E S A ND CH ILD REN
Emily Wilson and team mate on the Annette Plateau, Mt Sealy, during the Godzone Adventure Race NZ. PHOTO: ANDREAS STRAND
health care system and on people’s quality of life.” Emily’s day jobs include being a lifeguard, swim instructor, aqua-fit instructor for the elderly, school holiday and after-school care coordinator and sports events organiser. She also works for Wanaka Community Networks. “Through these job roles I get to make a positive impact on people’s health and lifestyles and I absolutely love it,” she says. “I know I still have so much I want to achieve, my athletic career has only just started and I don’t want to miss out on anything. Now I have diabetes it’s given me the kickstart I needed to try and make a real difference. “Being a Young Leader in Diabetes, will enable me to help the diabetes community in my local Diabetes NZ branch, as well as around New Zealand, and even internationally.” The IDF Young Leaders in Diabetes Programme is aimed at improving the lives of young people affected by diabetes worldwide, among other things through the development of tomorrow’s leaders in the diabetes community. The first programme was launched in Dubai in 2011, when 70 young people with diabetes from
around the world came together for YLD leadership training and to attend the World Diabetes Congress. Diabetes columnist Katie Doyle has also been chosen to go to Vancouver as a Diabetes Young Leader, representing her home country of the United States. Emily’s voice will be a powerful addition to those of the other YLDs. “I want to be a part of the change toward a future where people living with diabetes can be in control of their lives and feel empowered to do anything they set their mind to,” she says. “I want to be better informed about the most effective approaches to managing diabetes for others and myself. I want to be able to compete at the highest level of my sport and get the best out of myself and my life. In this way, I’d like to be a role model for others living with this illness.” Emily’s mantra is that knowledge and education are power, which is why she’s excited to be part of the YLD programme. It is clear she is shaping up to be a great role model and future leader for people with diabetes in New Zealand.
MATURITY ONSET DIABETES OF THE YOUNG (MODY) MODY is a rare form of diabetes, which is different from both type 1 and type 2 diabetes, and runs strongly in families. MODY is caused by a mutation (or change) in a single gene. If a parent has this gene mutation, any child they have has a 50 percent chance of inheriting it from them. If a child does inherit the mutation they will generally go on to develop MODY before they’re 25, whatever their weight, lifestyle, ethnic group etc. The key features of MODY are: • being diagnosed with diabetes under the age of 25. • having a parent with diabetes, with diabetes in two or more generations. • not necessarily needing insulin. MODY is very rare compared with type 1 and type 2 diabetes – experts estimate that only one to two percent of people with diabetes have it. But because MODY is so rare, doctors may not be aware of it, so it’s estimated that about 90 percent of people with it are mistakenly diagnosed with type 1 or type 2 diabetes at first. Source: diabetes.org.uk
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GARD EN I N G
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SPRING SOWING
Summer’s most wanted Gardening expert Rachel Knight explains how to grow zucchini and squash. Zucchini are one of the three most wanted summer crops in our edible gardens (together with tomatoes and beans). Hot weather and long days produce these succulent fruits in high summer. It seems as if we wait forever before they start producing. Our enthusiasm for them can often lead us to plant too many and we end up with a glut. It’s a nice problem to have and shows we’ve had success and good growing weather. Zucchini belong to the large and varied ‘cucurbit’ family – together with cucumbers, squash, pumpkins and melons. Summer squash are very similar in taste and texture to zucchini and are generally eaten fresh in summer, whilst the skins are soft and the fruit small and sweet. Winter squash are allowed to mature and their skins harden before being stored for winter like pumpkins. Wait until soil temperatures are above 15°C before buying zucchini and squash plants, possibly until November depending on where you live. If you want unusual varieties you’ll probably need to grow them from seed. Why have green zucchini when yellow, striped or flying saucer squash are just as easy to grow? Sow a couple of seeds about half a centimetre deep in a pot filled with potting mix. Pinch off one seedling if both grow so that the remaining seedling is undisturbed. When you plant out into the garden, cut the bottom off a large flower pot and push it into the soil around each plant. Remove pots after a couple of
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weeks once the plants’ root systems have developed. Cucurbits are hungry and thirsty. Having their feet in compost keeps them happy and a layer of mulch around the plants suppresses weeds and conserves water. A 10-litre watering can of water a week per plant is a good guide depending on weather and soil conditions, and a weak liquid feed is even better. I’ve had great success putting a tyre on the soil, filling it with compost and planting a squash or zucchini in the centre. If you’re short of space they will grow in a 70-litre rubbish bin with drainage holes in the base, as long as you can remember to water daily. They’ll also grow well on your old compost heap provided it’s in a sunny spot. Pick fruit when they are small and succulent. I prefer yellow ones as they’re easier to spot amongst the leaves. Don’t struggle to use ones that get too big. Toss them on the compost heap and enjoy some youngsters in a few days. Planting extra plants at Christmas will extend your season as the early plants will succumb to mildew as the weather gets cooler. Summer squash and zucchini can be sliced, diced or grated. Barbecued, roasted or stir-fried. Incorporated into cakes, fritters and meatloaf. Stuffed, eaten raw or picked with their flowers still attached and deep fried in a delicate batter. The variety of recipes can tell us much about our love for this versatile vegetable and the generosity with which it provides for our table.
Varieties to try Zucchini Gold Rush – yellow glossy fruits and compact habit Zucchini Safari – green striped cylindrical fruits Squash Rondini or African Gem – deep green summer squash the size of a tennis ball Squash Sunbeam – yellow patty-pan squash
DI A BETI C M ACUL A R O EDEM A
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TREATMENT
Avoiding blindness if you have diabetes Everyone with diabetes – type 1 or type 2 – is at risk of developing some kind of eye disease. We talk to Dr Dianne Sharp about diabetic macular oedema. New Zealand doctors have a new tool to combat vision loss in people with diabetes following the approval of Bayer’s EYLEA (afilbercept) for the treatment of diabetic macular oedema in adults. It is one of several treatment options available for people who develop the condition, which can lead to blindness. Diabetic macular oedema (DME) may develop from an eye condition called diabetic retinopathy, which is a complication of type 1 and type 2 diabetes and has been identified as one of the leading causes of permanent vision loss in workingage people with diabetes. Macular Degeneration New Zealand Chair Dr Dianne Sharp explains: “Everyone with diabetes – both type 1 and type 2 – is at risk of developing some form of diabetic eye disease with potential sightthreatening complications. Good management of diabetes with wellcontrolled HbA1c around 53mmol/ mol reduces the risk of all diabetic complications including diabetic retinopathy. Diabetic macular oedema is the most common cause of vision loss in people with diabetes and treatment options – restoring central vision – are life-changing for our New Zealand patients.” Dr Sharp added: “For many patients this may allow them to return to
work, keep their driver’s licence, and be able to read, watch TV and recognise faces. Retaining central vision is critical to daily living.” While there is limited data showing current numbers of people suffering from diabetic macular oedema in New Zealand, it has been estimated that diabetic retinopathy affects about one in four people with diabetes, becoming more likely as the duration of the disease increases. The underlying cause of diabetic retinopathy and diabetic macular oedema (DME) is damage (caused by abnormal blood glucose levels) to the blood vessels feeding the retina (the lining of light-sensitive cells along the back of the eye). DME occurs when blood vessel leakage affects the macula, the centre of the retina that facilitates the pinpoint vision that allows us to read and recognise faces. Symptoms of DME can include blurred or double vision, the appearance of blank or dark spots, colours appearing washed-out and distorted lines. If it is left untreated, it can eventually lead to severe vision loss. “The approval of EYLEA for those living with DME provides treating doctors with another tool to combat vision loss in their patients, which is so important in supporting our aim of helping New Zealanders maintain their independence,” says Dr Sharp. EYLEA works by blocking the triggers (known as VEGF) believed to play a key role in the breakdown of the blood-retinal barrier and the development of abnormal,
leaky blood vessels in the retina. Treatment involves one injection per month for the first five consecutive months, followed by one injection every two months. It is not funded by Pharmac and a prescription charge and normal doctor’s fees apply. The symptoms for DME are similar to early macular degeneration but an eye specialist may identify some retinal changes before any symptoms are evident. As with macular degeneration, DME treatment can restore vision and prevent vision loss but treatment is less effective when the retinal changes are longstanding. Time lost is vision lost! You can find out more about macular degeneration and take a test to see if you show any signs of a macular condition – go to www.mdnz.org.nz. Everyone with diabetes should have their eyes tested, or be in a regular screening programme, depending on the type, duration and severity of their disease. Your GP will advise what is most appropriate for you. *Dr Dianne Sharp is an Ophthalmologist at Retina Specialists, Parnell and Greenlane Clinical Centre, Auckland. Her areas of expertise include diabetic eye disease screening and management.
Spring 2015 | DIABETES
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RES EA RCH
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GLOBAL TRIALNET STUDY
Is type 1 diabetes part of your family tree? Participants in TrialNet studies are contributing to a research that could help prevent or cure diabetes. Research scientist Dr Jinny Willis, of the Don Beaven Medical Research Centre, explains.
More people have type 1 diabetes than ever before. The rate of diagnosis is increasing worldwide, including in New Zealand. Currently, there’s no proven way to slow down or prevent type 1 diabetes, which is where TrialNet comes in. Type 1 Diabetes TrialNet is a network of clinical centres dedicated to the study, prevention, and early treatment of type 1 diabetes. Launched in 2004, TrialNet has more than 200 study locations around the world, including the United States, Canada, Europe, Australia, and New Zealand. Type 1 diabetes is an autoimmune disease that happens when the immune system attacks and destroys the body’s insulin-producing cells. The risk for type 1 diabetes can be inherited – if you have a relative with type 1 diabetes, your chances of being diagnosed with the disease are
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DIABETES | Spring 2015
15 times greater than for a person with no family history of the disease. Although the symptoms of type 1 diabetes may seem to appear suddenly, research has found the potential risk can be detected years before symptoms appear. As part of the autoimmune process, the body produces proteins called autoantibodies, which react against molecules in the cells of the pancreas in a similar way to an antibody being produced to fight a bacterial infection. The presence of autoantibodies can identify an increased risk for type 1 diabetes up to 10 years before symptoms appear. TrialNet offers a blood test for these risk markers through a research study called Pathway to Prevention. We are looking for people to take part in the screening study (see the panel about how to participate).
Participants in TrialNet research are closely monitored for the earliest signs of type 1 diabetes. We have found that many participants who have been diagnosed as part of the study did not have any diabetes symptoms. Early diagnosis makes it possible to avoid dangerous complications that can occur when diabetes goes undetected and may also help the body make insulin for a longer period of time. Screening also identifies relatives who may qualify for additional TrialNet studies, including prevention trials (see right). There are a lot of gaps in our understanding of how diabetes occurs and develops over time. Participants in TrialNet screenings or studies are contributing to research that could help prevent or cure this disease one day.
G LO BA L TRI A LNET STUDY
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RE SEARCH
New Zealand participants needed for TrialNet Who can have the test? TrialNet offers screening to people: • aged 45 years and younger with a parent, brother, sister, or child with type 1 diabetes • aged 20 years and younger with a niece, nephew, aunt, uncle, grandparent, half-brother, halfsister, or cousin with type 1 diabetes. In both cases the family member with type 1 diabetes needs to have been diagnosed before the age of 40 years. To date, more than 2,000 relatives have been screened in New Zealand.
What is involved? A single non-fasting blood test is required. The study visit will take about 30 minutes and includes answering a few simple questions about yourself and your family history of diabetes. It is not necessary to visit a TrialNet site to have the screening test. The blood sample can be collected virtually anywhere in New Zealand that
offers regular blood tests, such as your medical practice or local community laboratory. You will need to read and sign an informed consent form prior to the blood test. Blood samples are shipped to the TrialNet laboratories once per month. The results are reported to the clinic in around 4-6 weeks.
insulin the pancreas is producing. Monitoring through blood tests at six or 12-monthly intervals is available. Alternatively, you may be able to join research studies testing ways to delay and prevent the disease, such as the Oral Insulin trial (see below).
What happens if the test is negative?
There are TrialNet sites in all four major New Zealand cities. If you have any questions or are unsure about whether to have your family screened, we will be happy to answer your questions and provide more details. You can also find out more about TrialNet by visiting the website: www.diabetestrialnet.org
Testing negative for autoantibodies does not mean you will never get diabetes, but the chances are much lower than if you tested positive. However, it is still possible that you could develop autoantibodies in the future and those whose test results are negative will be offered the opportunity to get screened every year until age 18.
What happens if the test is positive? A positive test is confirmed in a second sample. Individuals with a positive test for autoantibodies are offered extra testing to check glucose levels and to see how much
TRIALNET PREVENTION STUDIES Participants in TrialNet who test positive for autoantibodies may be eligible to take part in further studies – two prevention trials and one follow-up study involving regular monitoring. Oral Insulin Diabetes Prevention Study The TrialNet Oral Insulin Diabetes Prevention Study is investigating whether giving insulin by mouth (in a capsule) will delay or prevent type 1 diabetes. The use of oral insulin has already been tested in a previous diabetes prevention trial (DPT-1). To date five New Zealand participants have been recruited to the study. CTLA4-Ig (Abatacept) prevention trial Abatacept is a medication that has been shown in a previous TrialNet study to preserve insulin production in people newly-diagnosed with type 1 diabetes. The current study is testing whether abatacept can help delay or prevent the onset of type 1 diabetes. This study will commence in New Zealand sites later this year.
How do I get involved?
New Zealand TrialNet Sites Auckland (09) 373 7599 ext. 87897 Christchurch (03) 364 0448 or (03) 3640 860 Dunedin (03) 474 7644 or (03) 474 0999 Wellington (04) 806 2458
NEW-ONSET TRIALNET TRIAL LIFT (Long-term Investigative Follow-up Trial) Individuals who are diagnosed with type 1 diabetes in any of the TrialNet studies can continue to be followed up regularly through the LIFT study. This trial will measure insulin production after consumption of a standard glucose drink or a standardised mixed meal. This study will open for recruitment in New Zealand sites in the near future.
Spring 2015 | DIABETES
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C ARE A N D PRE VE NTI O N
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FOOT CA RE
Community foot clinic takes off Diabetes NZ Waikato Branch has teamed up with Arthritis New Zealand and Pfizer to offer a low-cost foot clinic for the local community. Caroline Wood reports. Pam Banks, 77, hadn’t had her feet checked for at least two years. Like many people she was too busy and couldn’t afford the cost out of her pension. Luckily she was persuaded to attend a new community foot clinic near her home in Hamilton, where the podiatrist noticed that Pam had limited sensation in her feet, a symptom of sensory neuropathy. She was referred to the hospital podiatry service for further help. Pam, who has type 2 diabetes and arthritis, says she is very grateful for care she received at the clinic, which cost her just $10. “They were so helpful and friendly. I’m so grateful I was invited to come along otherwise I would just have neglected myself,” she said. Diabetes NZ Waikato Branch and Arthritis New Zealand teamed up last year to launch a joint community foot care clinic for the Hamilton region, including surrounding rural areas. They obtained funding from Pfizer, initially for three months, and engaged a qualified podiatrist to hold the monthly clinics in the Diabetes NZ branch office. The clinic is open to people with diabetes, arthritis, or both conditions. The first three clinics were fully booked with a waiting list before the three-month pilot began. Those who attended were given specialist advice on how to manage their feet, as well as checks and treatment. A Diabetes NZ field officer and Arthritis New Zealand educator also attend the clinic and chat
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The Clinic Eligibility: The clinic is open to anyone with diabetes or arthritis who has concerns about their feet and hasn’t had a recent foot check. Cost: $10 for Diabetes NZ Waikato Branch members and members of Arthritis New Zealand and $20 for everyone else. Location: The Diabetes NZ Waikato Branch office in Hamilton Bookings: Contact – Trevor Fredericks 07 829 4538 to participants to check for any underlying health issues. During the three-month pilot 14 people were referred back to their doctor or hospital podiatry service as a result of this extra layer of screening. Everyone with diabetes should have their feet checked annually. The cost of podiatry care and lack of accessible information are cited as barriers to people having regular foot checks. Murray Dear, Diabetes NZ Waikato Branch President, said: “This partnership provides a service to people who are slipping through the gaps. The annual diabetes review should include a foot check and anyone with any foot issues should be referred to a podiatrist, but I suspect this is not always happening.” An Arthritis New Zealand review of the three-month pilot concluded:
“Such a service not only helps people manage their health but also acts as a valuable way of screening for those at risk of serious footrelated issues.” Trevor Fredericks, Arthritis Educator for the Waikato, said many people with arthritis also have diabetes and that untreated foot problems can lead to osteoarthritis. “The clinic is popular partly because it is low cost and also because of the relaxed non-medical atmosphere: it’s very friendly and gives people attending a chance to socialise,” he said. Pfizer has now extended its funding through to the end of 2015. Both Diabetes NZ and Arthritis New Zealand hope to keep the clinic going after that date.
FO OT CA RE
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CARE AND P RE V ENTION
A FOOT CARE GUIDE
A 10-step daily footcare guide for people with diabetes 1 Wash your feet every day with soap and warm water 2 Dry your feet completely, especially between the toes 3 Apply moisturiser to your feet – but not between the toes 4 Check your feet for cuts, blisters, sores, bruises or anything unusual 5 Keep your toe nails trimmed – ask someone to help you if you need to 6 Wear clean, well-fitting socks that aren’t too big or too small 7 Keep your feet warm and dry 8 Never walk barefoot outside or inside 9 Make sure your shoes fit comfortably 10 Don’t wear shoes that rub or feel too small
Clinically Tested Padded Socks. (CTPS). Ideal for people with diabetes, at low risk and feet that hurt. Over the counter foot protection for people with diabetes! Designed for feet with no/low risk of immediate ulceration and that require or would benefit from clinically-tested padding.
CTPS Health Padds are uniquely designed to protect the feet of people with diabetes. Illustration of the strategic padding. Exclusive Thorlos CTPS Feature: Engineered padding which reduces foot pressure and helps to reduce pain caused from thinning fat pads.
Key messages • Check your feet daily • Ensure you have your feet checked at your annual diabetes check up • You should be referred to a specialist podiatrist if you need help with your feet
Feet sensitivity It is also useful to check the sensitivity of your feet. Briefly and gently tap your toes with your finger and see whether you can feel the touch of your finger with your toes. Do not use any sharp or hot objects to test for sensation in your feet. If you notice reduced sensitivity in your toes, notify your doctor. Numbness or reduced sensitivity in the feet is a common symptom of sensory neuropathy, which can make it harder to feel when damage is occurring to the foot.
26%
51%
Less Pressure*
Less Foot pain**
*Diabetes Care, vol. 12, 653-55, 1989
** Foot, Clinical Foot Science, Vol. 1, 1992, 175-77
Research*
Padding clinically shown to:
> Reduce foot pain > Reduce pressures > Reduce blisters > Reduce moisture Thorlos are the only padded socks we know of with evidence based benefits established by independently conducted peer reviewed, published clinical research. Thorlos Therapeutic Soft tissue protection for feet demonstrated by peer-reviewed, published research* is what makes Thorlos CTPS socks different. UD SP O N RO R SO
P
*www.IPFH.org/Resources/Research
OF
For more information on how to care for your feet, see the pamphlet on our website, or order from us on 0800 342 238
Thorlos Padds with properly fitted and appropriate footwear (and orthoses if necessary) will provide you with unimaginable comfort.
Our promise is Your feet will feel better For further information email info@beattiematheson.co.nz or phone 0800 526 776
Spring 2015 | DIABETES
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FO O D
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H E A LTHY CHOICES
Diabetes food heroes Diabetes NZ’s dietitian Meg Thorsen gives her pick of some great (and low cost) foods to choose if you have diabetes.
Eggs •
Quick and versatile to prepare, affordable and with a long shelf life, eggs are an essential item to keep in your cupboard. They are also a nutrient rich source of protein and 11 vitamins and minerals. One egg a day (or up to six a week) is fine for most people. In fact, a recent study suggests up to four eggs a week has a protective effect against diabetes.
•
Regardless of how many eggs you eat, cooking, style and garnishes will have an effect on your overall health. Choose scrambled, boiled or poached eggs over fried eggs or a bacon and egg pie. Serve with wholegrain bread and mushrooms, tomatoes or spinach rather than sausages and hash browns.
•
Start the day with a poached egg on whole grain toast and pan-seared tomatoes. Pre-boil eggs with dinner for a grab-and-go addition to your next day’s lunchtime salads and sandwiches. Whip up an omelette with a couple of eggs, leftover potatoes, or rice and fresh vegetables for a quick and nutritious meal.
A cup of tea Not technically a food but drinking green or black tea may help prevent diabetes, or if diabetes exists, may help lower blood glucose levels, according to a growing body of evidence. Active compounds in tea may result in lower blood sugar levels, but simply switching to a regular sugar-free cup of tea will have a positive effect on weight and blood sugar levels. Staying hydrated will also help improve diabetes management. Being dehydrated will raise blood sugar levels, potentially harm your kidneys and increase risk of nerve damage.
•
•
If you are looking for a twist on the good old cup of tea, try a mint green tea, and add a small amount of cinnamon. Have a jug of citrus iced tea waiting in the fridge.
Chickpeas With a high fibre and protein content, chickpeas also have a low glycaemic index. These qualities mean chickpeas, and other legumes, can help improve blood sugar, lipid and insulin levels for individuals with type 2 diabetes. They can also lower blood sugar in people with type 1 diabetes but they do contain carbohydrate so they need to be considered when carbohydrate counting.
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Dried chickpeas can be soaked, precooked and stored in the freezer. • • •
Canned chickpeas provide an affordable addition to salads or casseroles. Turn your chickpeas into falafel patties for a meat free lunch or dinner. Roast on the BBQ or in a pan with a range of spices for a tasty snack.
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FOOD
Beetroot A slice of beetroot in a hamburger has always been a New Zealand classic but beetroot can give us so much more. Not only can they be grown at almost any time of the year, starting in spring, but every part of the plant can be used. We should all be trying to eat fruit and vegetables from ‘every colour of the rainbow’ and beetroot is great for ticking the sometimes harder to achieve ‘purple box’. In addition to containing a wide range of vitamins and minerals, beetroot is a rich source of dietary nitrate, which may have potential cardio-protective properties including lowering blood pressure. Some studies suggest an antioxidant in beetroot can also help lower glucose levels and increase insulin sensitivity, although the amount in one beetroot would be insufficient to see a therapeutic result.
Beetroot can be used in many different ways: • Use beetroot leaves instead of spinach in salads, stir-fries, stews or quiches. • Grate into salads, roast or use as a base for a healthy beetroot dip. • For the more adventurous, use in juices or smoothies, and in baking.
Barley Many articles talk about oats and quinoa being super food alternatives to wheat and rice-based dishes. Barley has many of the same qualities as these foods but less of the spotlight. Similar to oats, barley is a rich source of the soluble fibre beta-glucan which can help lower total and LDL cholesterol. The protein content of barley is only slightly less than quinoa, which along with its high fibre content can help maintain blood sugar levels within a healthy range. Barley forms part of your quarter plate of carbohydrate foods and needs to be considered when carbohydrate counting.
•
• •
Add pearl barley to minestrone soups instead of pasta or rice. Use in casseroles instead of potatoes. Use as a base for risotto or pilaf.
Living well with diabetes • Eat lots of fruit and vegetables • Choose sugar-free beverages • Be active every day
Spring 2015 | DIABETES
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FO O D
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RECIPE
NEW
LOW
CALORIE SWEETENER Measures spoon-for- spoon like sugar Perfect to use in your favourite food or drink recipes. Add a delicious, sweet taste with fewer calories.
Falafel These falafel make a great meal or snack. Cook them and put them in lunch boxes or keep the mix frozen for a quick meal.
©2015 MERISANT COMPANY 2, SARL. EQUAL IS A TRADEMARK OF MERISANT COMPANY 2, SARL.
Serves 6
SERVING TIP These falafel would be delicious served in a wholemeal pita bread topped with salad leaves or spinach, grated carrot and/or beetroot and a dollop of unsweetened yoghurt.
For delicious recipes, visit
club
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DIABETES |1 12032015_Equal Strip_59x242.indd
.co.nz
Spring 2015
With thanks to our friends at the Heart Foundation for permission to use this recipe. You can find more heart-healthy recipes at www.heartfoundation.org.nz/ healthy-living/healthy-recipes/
WHAT YOU WILL NEED 2 cups dry chickpeas 2 slices wholegrain bread 5 cloves garlic 1 tsp baking soda pinch chilli powder 1 cup coriander, chopped ½ medium onion, diced 1 tsp ground cumin ½ tsp ground paprika METHOD Cover the chickpeas in plenty of cold water and leave to soak overnight. Drain the chickpeas thoroughly. Heat oven to 225°C. In a food processor place the drained chickpeas and all other listed ingredients. Blend well until a smooth paste is formed. At this point you can freeze the mixture for later use. Form the mixture into 1 tablespoon sized balls and flatten slightly. Place falafel on a lightly greased baking tray. Bake falafel in oven for approximately 10-15 minutes or until lightly browned and cooked through.
NUTRITION PER SERVE Total energy 441kJ, Total fat 1.7g, Sat fat 0.2g, Carbohydrate 14.9g, Sugar 1.4g, Sodium 430mg
16/04/2015 1:40 pm
NEW S RO UND- UP
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YOU R DI A B E TES NZ
A tribute to Carol Hill Carol Hill had planned her dream holiday in Greece for a long time, and was so looking forward to the cruise around the Greek Isles and then on to Croatia. But it was not to be – when on an evening out in Santorini, she was hit by a motorbike and then spent the next month in hospital with multiple fractures. Sadly she was unable to recover from another operation and passed away on 10 July. Her death has been a devastating blow to her family and the community of Ashburton where she was a popular, confident and vibrant person. For our branch we have lost an enthusiastic and passionate President who would have been presenting her 20th report at our AGM in August. Prior to that role she was our Secretary for about five years. At her funeral Carol was described as “the glue that held her family together”, that also applied to our branch, where she organised and
took part in activities for Diabetes Awareness Week, arranged many of the speakers, and was always a voice for us with the local media. It was a pleasure to have her presented with Life Membership in 2007. Carol attended many annual diabetes conferences and was the life and soul of them with her friendly and colourful appearance. She was a Regional Representative for many years, so was kept very busy with all the paperwork that comes with such a role. It was no surprise to others that she was awarded first a Diabetes NZ award and a few years later Life Membership. A crowd of more than 500 mourners gathered to farewell this lovely lady and she would have enjoyed the several toasts that we made later in the day. Our branch left lots of yellow and black balloons at her graveside, a colourful touch on such a sad day. Following the eulogy that Christine Harrison, our diabetes nurse
Diabetes resource now in Hindi बेहतर जीवन डायबबटीज के साथ 2 प टाइ
Diabetes New Zealand is pleased to announce that our popular pamphlet Staying well with type 2 diabetes has been translated into Hindi.
South Asian communities are among those at higher risk of developing diabetes. Ministry of Health statistics show that 15,395 New Zealanders of Indian ethnicity have diabetes. Five years ago the number was 9,931. This represents an increase of over 1,000 every year for the last five years. Worryingly this number is forecast to keep on rising. diabetes new zealand
Diabetes NZ Communications Manager Nicky Steel said: “The positive news about type 2 diabetes is that for most people, it’s possible to manage their disease and stay well. Staying well with type 2 diabetes is an excellent resource for anybody with diabetes or wanting to know more about it.” *To order your free copy in Hindi, Chinese or English, phone 0800 DIABETES (0800 342 238), or email info@diabetes.org.nz, or go to www.diabetes.org.nz and search for ‘Staying well with type 2 diabetes’.
specialist, and Lynne Taylor, from Christchurch, gave, Barnaby Bee was placed on her coffin. We extend our deepest sympathies to the Hill family and all of her many friends. Rest in peace Carol, we are missing you very much. Joan Healey, Diabetes NZ Ashburton Branch
Auckland fundraiser success Thank you to all who came along to the Auckland branch fundraising Dinner at Euro Bar & Restaurant on 16 June. The event sold out and they raised an amazing $48,000 on the night, which will go towards the Mobile Diabetes Awareness Service Van and HOPE (Healthy Options = Positive Eating) programme in the community. The Auckland branch would like to offer a special thank you to Simon Gault, Mark Sainsbury and Tony Loughran, who donated their time on the evening, and the Prime Minister John Key and his wife Bronagh Key for giving their support. The Auckland branch needs volunteers to help support Team Diabetes at the Auckland marathon on November 1. It is also seeking people to help with its annual collection at Countdown stores around the city on World Diabetes Day, Saturday 14 November. Please email volunteer@ diabetesauckland.org.nz if you can help.
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LIV ING W ITH D I A B E TE S
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PETER HO G G
How times have changed Diabetes management has come a long way since the 1970s, as Peter Hogg, Life Member Diabetes NZ South Canterbury branch, recalls. I was diagnosed with type 1 diabetes about 45 years ago at the age of 29. Looking back now it seems like it was another world as people used pens or typewriters to write with. Today we have moved on to texting and computer keyboards. Tablets were always things that you swallowed when you were sick. My first insulin injection was given with a glass syringe that had to be sterilised every day in a pot of water like a boiled egg. What an incredible invention the plastic disposable syringe was. The instructions
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were that they were only to be used once and then disposed of, carefully breaking off the needle first. I remember thinking this was a waste of resources and I used my syringes for a number of days before disposing of them. Now we have insulin pens and again what a marvellous invention.
Lumpy insulin Insulin has been re-mastered as a pure laboratory manufactured product over the last few decades. In the 1970s insulin was obtained from the pancreas of cattle and pigs via abattoirs around the country. It was quite common for your long-acting insulin to be a little lumpy at times with fat floating around in the vial. Thankfully we have moved on from those dusky days. Testing your urine for sugar was the only option available in those
times as blood glucose testing meters for people with diabetes were not around. You would collect your sample and pour some of the liquid into a plastic tube then drop a Clinitest tablet into it. Then you would hold this ‘witch’s brew’ as it fizzed and bubbled until the tablet had dissolved. At this point it was time to estimate the degree of sugar in your urine. This was done by matching the Clinitest's colour chart with the colour of the settled ‘brew’ in the container. There were shades of blue, green, orange and brown. If the colour was at the blue end the result was low sugar and if at the orange-brown end the result was high sugar. This method was at the best an indication of what your ‘blood glucose’ had been a few hours ago. Blood glucose meters had not been introduced at that time and it was
PETER H O G G
not until the 1980s that the first blood glucose meters were made available to people with type 1 diabetes in New Zealand.
Testing with the brick The first blood glucose meters, like early mobile phones, were almost the size of a brick and nearly as heavy. These were state-of-the-art electronic devices in their day and every diabetic wanted one – a bit like having the latest iPhone. They were not designed to fit into your pocket, or a handbag if you were a lady, but owing to their size there was little chance of misplacing or losing them. Doing a blood glucose test with those early devices was not as quick as the modern day equivalent and it took around two minutes ‘waiting time’ for your drop of blood to react with the chemicals on the strip to get a result.
Getting your sugar fix Treating ‘hypos’ in the early days was looked forward to by many, as packets of Heards glucose lollies or Scottish shortbread biscuits, kept for the occasion, would come out of the kitchen cupboard to ‘treat your low
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sugar level’. A friend of mine on the committee of our diabetes society used to love getting hypos at home, especially after gardening, when he would shakily come inside and his wife would promptly make him a couple of slices of thick toast spread with butter and honey. He would relax afterwards in his armchair feeling completely guilt free. I too would often overdo the ‘treatment’ for a hypo and consume so many calories it would take up to 24 hours for my blood glucose to return to the ‘normal range’.
Looking after yourself today These days, you usually discover that your blood glucose is low either by how you feel or by routine testing. How you feel is not always the best method, particularly if you ignore those first signs thinking to yourself that you’ll ‘come right’, or ‘I’ll be OK until my next meal.’ That is when it can become dangerous, especially if you are behind the wheel. If you can treat yourself, your first action would be to take three glucose tablets as soon as possible. Resist sweet biscuits, chocolates or icecream as they have lots of calories
LI V I NG WITH DI ABE TES
and fat to consume and take longer for the glucose to be absorbed into your blood stream. If you need further information on treating hypos, Diabetes New Zealand has an excellent online guide – see www.diabetes.org.nz (search term: Living with type 1 Diabetes).
Enjoy life Keeping diabetes under control means just that – lose control and suffer the consequences. We don’t need to be reminded of all the ugly things that people with diabetes can get by not looking after themselves. None of us are perfect but try to keep your ‘highs and lows’ to a minimum by keeping to a wellbalanced meal plan with regular exercise. Test your blood glucose at least six times a day and always have a packet of Dextro tablets close at hand for those unexpected ‘lows’. If you have any problems, talk with your GP or diabetes nurse specialist: they are there to help you. Enjoy life as much as you can – we only have one.
Order our free Diabetes NZ information pamphlets Go to www.diabetes.org.nz and download the order form or call us on 0800 342 238 ALSO AVAILABLE FREE TO HEALTH PROFESSIONALS
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LE T ’S G E T A CTI VE
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MAKING FITNESS FIT YO U R LI FE
How much exercise is enough? Our new fitness columnist Craig Wise explains how to fit being physically active into a busy schedule.
It is incredible that in our modern lives, which are full of gadgets and gizmos designed to save us time, we are busier than ever and more time poor. As a fitness professional, one of the excuses I hear most often from people who are not active is that they simply don’t have the time. So how much time do we actually need to spend being active – 20 minutes? 30 minutes? An hour? Current guidelines state that an average adult aged 19 to 64 years old requires 150 minutes of moderately intensive exercise each week. Exercising 150 minutes each week may sound like a lot (that’s two and a half hours, longer than some movies). In reality that is only 30 minutes a day five times a week – and if you increase the intensity of the activity then you can bring that
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number down even more. While 30 minutes of activity a day may not be music to your ears, it is health to your body and you will thank yourself in the long run. Meeting that 30-minute daily threshold will help most people maintain their weight and reap the benefits of lowering possible heart disease risk, helping control of blood sugar levels in diabetics and controlling high blood pressure. My whole philosophy has always been about making activity fit into your lifestyle. I know that 30 minutes a day is still hard to find with work and family commitments but there is good news: it’s a secret but I will share it with you. You don’t need to do it all at once. It’s about what works best for you, as long as you’re doing some form
M A KI N G FITN ESS FIT YO U R LI FE
of physical activity at a moderate or vigorous effort for at least 10 minutes at a time. That means you only have to do three moderate bursts of activity for 10 minutes at a time to reach your 30-minute a day target. You don’t need to spend hours at a gym but you do need to get your heart pumping. Now that’s not so bad is it?
So what counts as moderate activity? Moderate intensity aerobic activity means you’re working hard enough to raise your heart rate and break a sweat. An easy way to tell if you are at this level is that you will still be able to talk, but not sing along with the song on the radio. This type of activity includes mowing the lawn, brisk walking, water aerobics or line dancing. Even dancing whilst you vacuum the house counts! Of course if you are feeling adventurous you could step it up and replace some of that moderate intensity activity with something a little more vigorous. The best thing about this is that it will decrease the amount of time you need to find to be active. As a general rule 1 minute of vigorous-intensity activity is about the same as 2 minutes of moderate-intensity activity. So that means you only need to find 15 minutes a day to do some vigorousintensity activity.
How do you know if you are being vigorously active? Vigorous intensity aerobic activity means you’re breathing hard and fast, and your heart rate has gone up quite a bit. As for singing your favourite song, you won’t be able to do that, and when it comes to my singing that’s probably a good thing. This sort of activity includes jogging and swimming, martial arts or a team sport such as netball or basketball. If you haven’t been very active lately,
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LE T ’ S GE T ACTIVE
increase your activity level slowly. You need to feel comfortable doing moderate intensity activities before you move on to more vigorous ones.
Being active doesn’t mean having to do the dreaded ‘E’ word – it’s not all about exercise. Encourage yourself to be physically active by doing things you enjoy. Make a list of things you like to do that are active, and find ways to fit them in. Finding a friend or family member to get active with is often a good way to start as it gives you accountability or in some cases someone to compete with. Something is always better than nothing and starting out if you have been inactive for some time is always the hardest part. Take small steps and build up to those 150 minutes. Doing activity that requires moderate effort is safe for most people. If you are unsure about stepping it up to something more intense, be sure to talk about the types and amounts of physical activity that are right for you either with your doctor, or if it is an organised activity such as a fitness class or team sport, speak with the instructor.
Now stop reading and start moving… If you need help tracking your activity, contact me by email address or through my Facebook page and I can send you a copy of my activity tracker and more examples of activities that you might like to try.
Craig Wise, fitness columnist Welcome to our new columnist Craig Wise, who is a qualified fitness professional with experience of working with people from all walks of life – from rugby players trying to break into the top grades to morbidly obese people trying to get off the couch without puffing. Craig is the owner/operator of Craig Wise Personal Training and is a husband and father of two toddlers, which means he knows about the challenges of fitting a healthy lifestyle around the demands of family life. This is where his philosophy about making fitness ‘fit your life’ comes from. He specialises in working with people with lifestyle diseases such as diabetes, hypertension and obesity. Craig wants to help people with diabetes be more active, which is why he volunteered to write for Diabetes. Check out Craig’s Facebook page www.facebook.com/ CraigWisePT or email fitnesswithcraig@gmail.com.
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MOLLIE K AINUKU
IMAGE COURTESY OF THE WAIRARAPA TIMES-AGE
CO M M U N IT Y
Going the extra mile Mollie Kainuku talks to Katie Doyle about winning the Queen’s Service Medal for her services to diabetes. “We wanted to give her the diabetes medal, but she doesn’t have diabetes,” jokes Finlay Sutherland, president of the Wairarapa branch of Diabetes New Zealand, “Mollie doesn’t know the words: ‘No, I can’t do it’,” he adds. He’s referring to retired diabetes nurse Mollie Kainuku, from Taueru in the Wairarapa, who was awarded a Queen’s Service Medal in June for her services to diabetes. For more than three decades Mollie has been a champion for patients with diabetes. She’s a person who takes on life’s challenges wholeheartedly, juggling her passion for diabetes care with her large vibrant family and other obligations. She is immersed in the community and is deeply loved – just ask anyone who knows her. “When I walk through the supermarket, everyone knows me, because I did type 1, type 2, gestational, the whole works. My former patients actually come and seek me out. They might go overseas but when they come back to New Zealand they make a point
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of coming to see me, to follow up on what I’m doing and let me know what they’re doing,” she says. Mollie began nursing in 1969 working as a night supervisor and then a diabetes nurse at Wairarapa Hospital. She went on to provide specialist diabetes nursing services for the Wairarapa District Health Board from 1995 to 2012. Mollie made herself available, often unpaid, on a 24-hour, seven-day-a-week basis to help patients, including shopping and helping solve complex family and social issues. While Mollie was initially surprised at being chosen for the Queen’s Service Medal, she’s been taking time to reflect on her life’s work. Stories about her patients flow out in a natural rhythm, like each one has become lodged in her nursing psyche. “Some of the young girls I looked after, now they’ve got about three children and they’re all good mothers. About a week ago I went to the supermarket and met up with one of my boys who I looked after when he was 15 – his little boy was in school uniform! I couldn’t believe how time had flown. They’ve thrived, and their parents thrive, and they’re good parents, and are bringing up good, healthy children, and it’s really great.”
Mollie’s reputation throughout the Wairarapa community as a straighttalking advocate for patients and their families is rooted in those first meetings in the hospital room, post diagnosis. Her attitude toward helping people with such a fickle disease is simple: “You can’t give up on them,” she says. “I’d just make a rapport with them. The parents are in tears, and usually the child is better than the parents because they’re not grieving. They’re feeling a lot better then, because they’ve had insulin, they’re heaps better, they’re not sick anymore –so it’s about getting a really good friendship going.” This close relationship lies at the heart of Mollie’s nursing philosophy. She emphasises the importance of having the whole family work together to foster a healthy environment. “The people that did the work best, they had the whole family on board. Even someone’s little five year old was quite important, because they might be the one giving dad the marshmallows when he went low,” she explains. Since her retirement, Mollie continues to be involved in Diabetes NZ Wairarapa Branch as a volunteer and Patron.
It’s going to be okay – really I read somewhere that you don’t truly understand fear until you become a parent… and this must be amplified tenfold when your child is diagnosed with a life-threatening condition. For our children’s sakes though, we try to conquer that fear to enable them to live their lives to the fullest extent. Some days are easier, while others stand out in gut-wrenching detail – the first time you read a 1.7 on the blood glucose meter, and realise it’s not a ketone test, or when you grab the glucagon injection in the throes of a hypo fit… Initially, adrenalin gets you through the worst, and then you start to adapt to the new reality. After a while, things just can’t be as scary as before, because now you understand a bit better how they work, and how to control the situation.
We see this happen time and again – it’s the fear of the unknown that is the hardest to overcome – not knowing how painful that fingerprick or injection is going to be, not knowing how long it might take to get glucose levels back to normal, or what unseen damage might have occurred in a moment’s inattention. Knowing the full extent of the ‘whatifs’ can become crippling … and it takes real courage to look past the fear. But we must! As we encounter the normal milestones of our children’s lives, we are forced to take a breath, trust in the systems we have in place to protect them, and let life happen. We pack them off to school with care plans and carb-counted lunch boxes, and stand on the sidelines as they start participating in team sports. We let them take charge of their BG tests, flinching when the third test strip in a row flashes up an error message and suppressing the urge to grab the kit and get the darned test done! We put the ‘freefoods’ at kiddie-level in the fridge and pantry, and hope that they will remember to ask us to bolus for carbs, while trying not to hyperventilate when the packet of jelly beans we left tucked in the spare kit are gobbled up within seconds – that’s going to take all night to sort out, but who needs sleep anyway?!
Amid the mayhem of school and sports, we suddenly discover a whole new set of challenges – parties and playdates! It used to be so easy – you hung around at birthday parties, supervising portions and administering insulin and Kleenex as appropriate! Playdates were an opportunity to drink coffee or wine with another harassed mum, while toddlers clambered in and out of the conversation. Now the little minimes are dropped off at each other’s homes, and are quite possibly going to have little tea parties all of their own! Suddenly your own fears pale into insignificance next to those of the parents who tentatively offer to take on your little hooligan for an hour or two. Breathe deeply – teach them [the parents] enough to let them feel confident that they can administer a BG test, or juice box as needed. Have a quick chat about what they plan to eat, and keep the cellphone charged! It’s going to be okay, really – and they might even have her back again!
Jacqui van Blerk President Diabetes Youth NZ You can contact Jacqui via email: president@diabetesyouth.org.nz
Diabetes Youth New Zealand
JOIN YOUR LOCAL SUPPORT GROUP BY VISITING
General enquiries: contact@diabetesyouth.org.nz Phone: (09) 623 2508
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www.diabetesyouth.org.nz
WHAT CAUSES DIABETES?
LIN U S IN your body needs insulin to transform glucose into energy
GLUCOSE ENERGY LIN INSU
when the pancreas doesn’t produce insulin it is TYPE 1 DIABETES
LIN U S N I when the pancreas doesn’t produce enough insulin (or the insulin cannot be processed)
it is TYPE 2 DIABETES
3 when insulin is less effective during pregnancy, it is GESTATIONAL DIABETES
Type 1 diabetes develops rapidly when the immune system destroys insulin-releasing beta cells in the pancreas. Scientists are unsure of the reasons why type 1 diabetes develops in some people and not others. It may occur after a viral infection. Genetics, gestational and infant nutrition may also play a part.
Type 2 diabetes develops slowly over years and is usually (but not always) associated with excess body weight and lifestyle factors. Repeat consumption of high calorie foods and low activity levels increase the body’s insulin ‘resistance’. This means the body can’t produce enough insulin (or cannot process enough insulin) to turn glucose into energy. This leads to high glucose levels in the blood.
Type 2 diabetes is the most common form of diabetes making up 90 percent of all people diagnosed with the condition.
During pregnancy women need two to three times more insulin than usual due to changes in hormones and the needs of the foetus. Gestational diabetes occurs when this increased demand for insulin isn’t met and the body is not able to return blood sugar levels to normal. High blood sugar levels in pregnancy can have an adverse effect on the unborn baby and can also lead to complications with childbirth.
PREDIABETES occurs when someone has raised blood glucose but not at levels high enough to be diagnosed with type 2 diabetes. The good news is that changing the diet and raising activity levels can reduce blood glucose levels to normal and prevent someone going on to develop full blown type 2 diabetes.
* This poster was created by the team at Diabetes magazine to help raise awareness of the different kinds of diabetes. You can download this poster at www.diabetes.org.nz. Graphics courtesy of the International Diabetes Federation.
Chocolate
Reduced fat* Gluten Free
Vanilla Bean
Full Creamy Taste! No added sugar
No added colours
Contains 9 x 100ml servings per tub
*Compared with standard ice cream with 10% milk fat. CHOCOLATE: Approx. 4.0g of sugar per 100g from dairy. Approx. 5.5g of fat per 100g. VANILLA BEAN: Approx. 4.1g of sugar per 100g from dairy. Approx. 4.9g of fat per 100g.
A 24-hour insulin that I can take once a day? 2
“Sweet...!”
Lantus® (insulin glargine) is now fully funded for Type 2 diabetes mellitus patients requiring insulin.1,2 For thousands of Kiwis, this will be something to smile about. Lantus® is a long-acting basal insulin. ‘Basal’ is a term used to describe the slow, steady release of insulin needed to control your blood glucose between meals and overnight. Lantus® provides a continuous level of insulin over 24 hours, similar to the slow, steady (basal) secretion of insulin provided by the normally functioning pancreas. This means that only one dose of Lantus®, given at the same time each day, is needed for 24-hour basal control. 2,3 How is Lantus used in people with Type 2 diabetes? In Type 2 diabetes, Lantus is given by subcutaneous injection once daily and can be used in combination with oral diabetes medications and/or with short or rapid acting insulin as instructed by your doctor. 2,4,5 Talk to your doctor about whether Lantus® could be right for you.
References: 1. February 2012 Pharmaceutical Schedule Update, Pharmac. 2. Lantus Data Sheet, August 2010. 3. Goykham S, et al. Expert Opin. PharmacoTher 2009; 10(4):705-718. 4. Fulcher G, et al. AMJ 2010; 3(12):808-813. 5. Nathan D, et al. Diabetes Care, 2009; 32:193-203. Lantus® is a Prescription Medicine that is part of the daily treatment of Type 1 & Type 2 diabetes mellitus. Do not use if allergic to insulin glargine or any of its ingredients. Precautions: for subcutaneous (under the skin) injections only, do not mix or dilute. Close monitoring required during pregnancy, kidney or liver disease, intercurrent illness or stress. Tell your doctor if you are taking any other medicines, including those you can get from a pharmacy, supermarket or health food shop. Interactions with other medicine may increase or decrease blood glucose. Side Effects: hyper or hypo glycaemia, injection site reactions, lipodystrophy (local disturbance of fat metabolism). Contains insulin glargine 100U/ml. Use strictly as directed and if there is inadequate control or you have side effects see your doctor, diabetes nurse or educator. For further information please refer to the Lantus® Consumer Medicine Information on the Medsafe website (www.medsafe.govt.nz). Sanofi, Auckland, freephone 0800 283 684. Lantus® is fully reimbursed when prescribed by a medical practitioner. Pharmacy charges and doctors fees apply. TAPS PP1903
GLA 12.02.001