Diabetes Summer 2013 by Diabetes New Zealand

Diabetes Summer 2013

Living well with diabetes

Diabetes care

Juggling act

Type 1 and the challenge of motherhood

A patientâ&#x20AC;&#x2122;s perspective

Nervous about neuropathy?

We have the answers DIABETES ATLAS

The worldâ&#x20AC;&#x2122;s diabetes hotspots

Best foot forward

Walk for diabetes youth

Summer recipes + cycle challenge + grow herbs

Don’t brush it off – use Colgate

Did you know that people with diabetes may be more at risk of gum disease? Colgate Total toothpaste reduces up to 90% of plaque germs that can cause gum disease*.

Visit your dentist regularly and protect your gums with Colgate Total. Colgate Total 12 Hour Protection Toothpaste. With regular brushing, fights gingivitis, cavities, plaque and protects gums. Always read the label and use as directed. If symptoms persist see your Dental professional. Colgate-Palmolive Ltd., Lower Hutt. TAPSPP1101. * Fine, et al. (2006). Journal of the American Dental Association, 137: 1406-1413 CPL MW42186

Diabetes: the national magazine of Diabetes New Zealand | Vol 25 no 4 Summer 2013

INSIDE summer 2013 12 4 5

From the Chief Executive From the President

Upfront

News, views and research

Care and prevention

8 Holiday travel tips 14 Stay safe in the sun Focus

10 Barriers to glycaemic control: A patient's perspective

Families and children

12 Juggling diabetes and a young family

Let's get active

16 First ste ps back to exercise Gardening

18 Growing and using summer herbs

Community

20 Walk for diabetes youth 32 Diabetes Awareness Week 33 In pursuit of excellence World Diabetes Day

21 Global tips for living well with diabetes

22 Diabetes hotspots around

Living with diabetes

24 Diabetes rates continue

26 Mountain bike challenge

the world to climb

Food

28 Simple summer lunches 8

Treatment

30 The pros and cons of

exercising with peripheral neuropathy

The last word

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

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

FRO M TH E CH I EF EXECUTIVE

Going from strength to strength We have been working hard over the past year to make Diabetes New Zealand fit for the future. I am pleased to report we are heading confidently towards our goal of giving every person with diabetes the support they need to live a full and active life. Over the past 12 months, for example, we have provided support to well over 500,000 New Zealanders. We continue to produce four issues a year of Diabetes magazine, which has a circulation of 16,500, and have distributed over 230,000 information pamphlets. More than 280,000 people looked at our website last year. We have also been expanding our networks to increase the visibility of diabetes in New Zealand. Over the past year we have worked with Lions Clubs International,

St John, Fitness NZ, the YMCA, Pharmacy Guild, Pharmacy Brands, Dietitians NZ, Freemasons and the Motor Trade Association, to name a few. We partnered with the Health Promotion Agency and the Heart Foundation to launch a nationwide publicity campaign in June to encourage heart and diabetes checks. And in November we ran another successful Diabetes Awareness Week. This year we were delighted to receive grants from Pub Charity and the Lion Foundation to kickstart a long-term awareness programme that we hope to get further funding for, so it will run over many years. We continued to use our networks to raise the profile of diabetes among ministers, MPs and officials, as well as hosting regular speaker events at Parliament. Our work to develop an online education and support resource with the New Zealand Society for the Study of Diabetes and the Refract Group continues. The first section for nurses has been successfully

released and the area for people with diabetes is being user-tested. As a newly unified organisation, we have been able to manage our funds such that our year-end position has improved on last year, although our ongoing funding remains a challenge. As I draw breath from another busy year, I feel that Diabetes NZ is going from strength to strength. I am enthused by what has been delivered and the promise of what can be. Thank you to our branches, volunteers, staff, advisory council and board for making this possible. Have a great Christmas and New Year. If you are stuck for present ideas, consider giving our new MTA/ DNZ gift card – see diabetes.org.nz.

Joe Asghar Chief Executive

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

SUBSCRIBE today and have four issues of Diabetes delivered straight to your door for just $18 per annum. Diabetes is published by Diabetes New Zealand. Join today for just $35 waged (or $27.50 unwaged) and receive a free subscription to the magazine. Email: admin@diabetes.org.nz or call 0800 369 636 to find out more.

DIABETES | Summer 2013

FROM TH E PRESIDE NT

Reflecting on the past This morning I unpacked the final box after shifting house. I left unpacking my books till last. I have lots of books as I have been a reader all my life and then I worked in publishing. The new house sold itself because of its three large built-in bookcases – after that the rest didn’t matter. As I knew they would, these last boxes of books became a voyage of rediscovery. I was amused to find that over the years I have gathered a few diabetes books despite believing there weren’t many available. There were titles on food (quite a few): travelling with type 1, living with it, being a kid with it, being a parent of a kid with it, pumping, and a few on type 2 as well. My parents bought the oldest book I have – at about the time of my diagnosis I assume, as it was published in 1965. It is called The Diabetic Life, Its Control by Diet and Insulin and Oral Treatment by

Sulphonyl-Ureas by R.D. Lawrence M.A., M.D., F.R.C.P., LL.D. It is the 17th edition, the first edition was published in 1925 when insulin was not long discovered and not yet widely available. Dr Lawrence was the Consulting Physician at Kings College Hospital in London. Apparently Lawrence was known for his diet schemes (the LineRation Scheme, later to become the Lawrence Weighed Diet) based on black ratios (carbs with portion sizes of only 5 gm!!) and red ratios (protein and fats). Certainly when I developed diabetes my diet included a lot of protein, everything was meticulously measured and meal times had to be rigorously observed. Such was the nature of insulin back then. Luckily today we can be more relaxed about what and when we eat and we know more about types of food and the benefits of a good diet. The old doctor was quite enlightened for his time. In his first (1925) preface, he wrote: “I make no apology to doctors for writing a combined book for them and their patients, for the latter invariably come to know a lot about their illness…” Today, 88 years later, too

many doctors still don’t value this knowledge – and too many patients don’t bother to gain the knowledge they need to live well with diabetes! Finally, the good Dr Lawrence said: “…I would point out to diabetics and their friends that they owe their lives to medical research, and it ought to be their duty and pleasure to support it in further progress.” It seems Lawrence was big on research for this plea was a standard inclusion in all his prefaces. His words are particularly pertinent as I reflect on the woeful state of Diabetes New Zealand’s own research fund (the Sir Don Beaven Research and Education Fund) named in honour of another great diabetes physician and researcher. Perhaps branches, families or individuals might consider a donation to it in the spirit of the season? Speaking of which, I wish you all festive tidings – may you have a happy and safe holiday season.

Chris Baty National President

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

Diabetes New Zealand PATRONS: Lady Beattie and Sir Eion Edgar PRESIDENT: Chris Baty CHIEF EXECUTIVE: Joe Asghar COMMUNICATIONS MANAGER: Lisa Woods 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 Email: admin@diabetes.org.nz

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

Call now to make an instant $20 donation:

0900 DIABETES (0900 86369)

Summer 2013 | DIABETES

UP FRO NT

NEWS, VIEWS AND RESEARCH

Blue for World Diabetes Day

Physical activity cuts t2 diabetes risk

Dunedin pulled out all the stops to celebrate World Diabetes Day, organising a special community event and being the only city in New Zealand to light two buildings blue in support of people with diabetes around the world. The Regent Theatre and St Paul’s Cathedral were illuminated blue for a week, following sponsorship from Novo Nordisk. The community event at the Octagon included information displays, exercise classes, celebrity appearances and talks by top diabetes experts including Professor Jim Mann, Assoc Prof Fr ee Patrick Manning, Dr En tr y! Stephanie Farrand, and The Octagon & Community Gallery 20 Princes Street, Dunedin our very own Chris 14th November 11am - 2pm Baty, President of Diabetes NZ. Roche also provided HbA1c testing.

People who walk to work are 40 per cent less likely to have type 2 diabetes, and 17 per cent less likely to have high blood pressure. Cyclists were around half as likely to have type 2 diabetes as drivers. A study by Anthony Laverty from Imperial College, London, looked at 20,000 participants in the Understanding Society study. He concluded: “The protective association between active travel and cardiovascular risk demonstrated in this nationally representative study adds to growing evidence that concerted policy focus in this area may benefit population health.”

Octagon 1100 Zumba Dance 1140 Sporting Celebrities 1200 Sports Action 1215 Children’s Dance & Exercise Routine

Community Gallery - 20 Princes Street 1100 Diabetes Displays & Checks 0100 Diabetes Forum & Questions with Prof Jim Mann - Pre Diabetes Dr Stephanie Farrand - Diabetes Management During Pregnancy Dr Patrick Manning - Treatment of Obesity in Diabetes Chris Baty - Dealing with the Devil, Type 1 Diabetes

Trade and Information displays and Diabetes Checks all day Come and check out our new Diabetes Plan Website!

Find out more at... www.otagodiabetesresearch.org.nz PROUDLY SUPPORTED BY

Dare to dream An international team of 12 people with type 1 diabetes reached the summit of Mount Kilimanjaro, in Tanzania, on September 4 this year. The project, which was sponsored by Sanofi, involved participants from Australia, France, Belgium, Canada, USA, Barbados and Brazil. The aim was to share a positive message about type 1 diabetes and inspire others to achieve their dreams. The expedition’s catch phrase was: strive for control, dare to dream!

App-based glucose monitor launched The ihealth glucose monitor has been launched in New Zealand and is available from local pharmacies. The meter is app based so your readings are loaded directly to a free app and all the results are automatically stored. You can upload them to a cloud (so parents can check up on children remotely) and you can email the results to your doctor. All results are graphed according to WHO standards, and the product is FDA approved. The glucose monitor costs $99.99 and test trips (50 strips) are $19.99. You can see the range at www.ihealthlabs.com.

Thumbs up for fruit, down for juice Eating blueberries, grapes, apples and pears cuts the risk of type 2 diabetes but drinking fruit juice can increase it, a large study has found. Experts from the UK, Singapore and the Harvard School of Public Health in the US examined whether certain fruits impact on type 2. They found blueberries, grapes, raisins, apples and pears were especially protective, while drinking fruit juice could increase the risk of developing the condition by as much as eight per cent. People who ate three standard servings of blueberries a week had a 26 per cent lower chance of developing the condition. The research was published in the British Medical Journal.

Reducing the pain of finger prick testing One of the barriers to frequent testing is the discomfort of the finger prick test. A study looked at the impact of using a numbing device, called CoolSense, to lower pain sensation. The device reduced pain when compared to patients using a placebo, researchers concluded. Dr Jeremy Krebs, Wellington endocrinologist, commented: “This may be a very helpful tool for those for whom pain is the main barrier. However, for many patients the time taken, or the simple hassle factor, is more frequently the reason they don’t test. We still desperately need a non-invasive, real time, inexpensive and reliable way to monitor glucose. Maybe this could be the next challenge for Team New Zealand?”

Seasons greetings and a heartfelt thank you to all our readers and everyone who has supported Diabetes magazine over the past 12 months. We’ll see you again in the New Year – our autumn issue is published on March 14. Wishing you happy holidays from all of us in the Diabetes editorial team.

DIABETES | Summer 2013

ANIMAS VIBE INSULIN PUMP ®

NOW FULLY FUNDED FOR ELIGIBLE PATIENTS Funding for eligible patients is now available for: • Animas® Vibe insulin pumps and cartridges • A wide range of infusion sets • ADR cartridges suitable for use in your Minimed Paradigm pump TM

Ask your doctor if you meet the criteria.

• CGM enabled using latest Dexcom G4TM Platinum technology use continuously for up to 7 days • Free 24/7 technical support - talk directly with our NZ team • Fully waterproof • Full colour screen • Fully customisable food database • Compatible with web based Diasend® software

W www.nzms.co.nz P 09 259 4062 E nzms@nzms.co.nz Dexcom G4TM Platinum indicated for use in patients 2 years of age and over. Please note CGM consumables are not currently funded.

Always read the manufacturer’s instructions and use strictly as directed. NZMS, Auckland. TAPS NA6067

C ARE A N D PRE VE NTI O N

HOLIDAY TRAVEL TRI PS

Plan ahead for a successful trip Frequent traveller Chris Baty says the two most important ingredients for travelling with diabetes are to plan ahead for your trip and to test regularly while you are away. Here is a selection of her best travel tips. Medication • Take enough medication for the entire trip and add some extra just in case. I recommend enough for the time away plus two weeks’ worth. • Ask for a letter from your doctor verifying you are required to carry all the medications you need and a brief explanation (think customs, immigration). Have several copies and keep the original. • Ask your doctor to list all the medications you are on in case you need to see a medical professional while you are away. • Keep the original pharmacy labels on all your meds – make sure they have the same name that is on your passport. • Get vaccinations done early. • See your diabetes specialist or diabetes nurse specialist to get a travel plan for insulin doses across time zones – do this early. Take a detailed itinerary to show them. • Be in good control before you leave. • Carry all supplies with you in hand luggage.

DIABETES | Summer 2013

• Don’t forget to pack the glucose (eg HypoGel, Glucogen). • Know your sick day plans including diabetic ketoacidosis protocols. • Look up requirements for sealed plastic bags and carrying medicines on board a plane – check www.avsec.govt.nz for the latest information. Also check the requirements of any countries you travel through. • Don’t expose insulin to temperature extremes – invest in a good travel kit such as a Frio (see www.medica.co.nz). • Always carry essential supplies with you, including snacks. Invest in a daypack to carry them in.

On board • Exercise. • Wear air travel stockings for circulation and to guard against deep vein thrombosis. • Drink lots of water. It makes you pee and that means you have to get up and move, ie exercise! • Test every two hours – I personally prefer to run a tad higher, it gives me a buffer zone. Record results and doses. • Wear loose-fitting clothing and good shoes. • Take a plastic bag for rubbish (eg used blood strips).

• Have the equivalent of at least one meal (think delayed flights) in processed food – for example muesli bars, crackers, raisins. Don’t forget to declare it. No honey, meat, raw fruit. • No special meals – too few carbs – be selective from your plate. • Don’t be coy – tell people you have diabetes especially if it’s type 1.

Be a good scout (be prepared) • Buy travel and medical insurance and specify your diabetes. • Wear a Medic Alert or some sort of internationally recognised ID. • Try local foods but be sensible – nothing raw or from dodgy outlets. • Check if water is drinkable. Use bottled water for teeth cleaning. • Plan to minimise your risks. If things go wrong, they tend to go spectacularly wrong. • Take a good first aid kit. Think diabetes when packing it – vomiting, diarrhoea, blood ketone sticks, dressings, antiseptic creams, broad spectrum antibiotics, anti-fungal and anti-nausea medications. • If on an insulin pump refer to manufacturers’ guidelines. • Take a spare prescription for glasses. *For more information on travelling safely with diabetes see diabetes.org.nz

Dexcom G4TM Platinum - The Latest Technology in Continuous Glucose Measurement Now Available in New Zealand Do you use insulin? Do you want to improve your glucose control? The Dexcom G4TM updates your glucose level every 5 minutes so you can track your glucose continuously day and night. Monitor your highs, lows and target ranges and how fast you are getting there to help you take the guesswork out of your diabetes management and enable better treatment decisions. • Fully waterproof sensor and transmitter • Full colour screen makes it easier to read • Sensors approved for up to 7 days continuous use • Exceptional accuracy1,2 • Simple calibration rules • Discrete transmitter beams results wirelessly to your receiver up to 6 metres away1 • 24/7 support provided by our NZ team

For more information or to arrange a trial to see the benefits for yourself, please contact us on 0508 634 103 W www.nzms.co.nz P 09 259 4062 E nzms@nzms.co.nz Dexcom G4TM Platinum is not indicated for children under 2 years of age. Always read the manufacturer’s instructions and use strictly as directed. 1 Dexcom G4™ User Guide, May 2012. LBL-011277 Rev 04, LBL-011346 Rev 02. 2 Freckmann G, Baumstark A, Jendrike N, Zschornack E, Kocher S, Tshiananga J, Heister F, Haug C. System Accuracy Evaluation of 27 Blood Glucose Monitoring Systems According to DIN EN ISO 15197. Diab Tech & Thera, Vol 12, No 3, 2010.

FO CU S

DO CLINICIANS NEED TO BE M O RE PATI ENT- CENTRED?

Barriers to glycaemic control:

A patient’s perspective New Zealand researchers asked adults with type 2 diabetes what it felt like to have diabetes in the first study of its kind. The findings suggest clinicians must change their approach if diabetes care is to be improved. Caroline Wood reports. Patients often struggle to comply with expert recommendations on how to keep their blood sugar under control, despite medical advances in diabetes treatment. Research has shown that non-adherence is a key barrier to good diabetes control – patients fail to follow recommended treatments and clinicians fail to adhere to evidence-based clinical guidelines. A study carried out in the Hawke’s Bay aims to shed light on why patient non-adherence may be happening. Lead researchers Dr Ron Janes and Dr Janet Titchener opted for a qualitative study that asked

patients how they feel about their diabetes. The researchers conclude: “We suggest that a key barrier is clinician ignorance of their patients’ fears, beliefs, expectations, context; of what constitutes a positive therapeutic relationship…” “Faced with a worsening diabetes epidemic and increasing health care workforce shortages, clinicians urgently need to understand that it is they, not their patients, who must change their approach if diabetes care is to be improved.” Fifteen participants with type 2 diabetes from the Wairoa area were interviewed in depth about their experiences of living with diabetes from diagnosis to the present day. The findings were published in the Journal of Primary Health Care. It is the first study to set barriers to care within a patient-centred medicine framework. Patient-centred medicine is an approach that sees clinicians

providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensures patient values guide all clinical decisions. Participants expressed fear and guilt about their diabetes (see patient comments right). They believed it was caused by eating too much sugar and was primarily controlled through diet, which is why they felt ashamed for not properly controlling it. Some held the unscientific belief that diabetes was a self-limited illness that would go away with time. This was another reason why participants chose to ignore medical recommendations. One of the key barriers highlighted in the study is a ‘poor clinicianpatient relationship’. The results suggest that clinicians are imposing goals on patients, failing to negotiate mutually-agreed goals, and making identical recommendations to all patients regardless of an individual’s personal circumstances.

Patients complained clinicians ‘simply told them what to do’ 10

DIABETES | Summer 2013

D O CLINI CI A NS NEED TO BE M O RE PATI ENT- CENTRED?

FOCUS

Patient stories Fear about the illness

The diabetes 'police'

At first, I thought, ‘oh here we go, I can’t work, I can’t do anything’.

If you want someone to tell you ‘you have been naughty’, you go to the doctor, or you go to [the nurse].

I thought the end of the world was coming when they said I had to have injections. When I had my first hypo, I hit the ground… I thought, I am going to die here.

Guilt and self-blame I have type 2 diabetes, which is selfinflicted. A good diabetic is one who controls their diabetes …I am not a good diabetic. I have not managed to do anything that I should do.

One participant commented: “It was just that this is what you take when you have got diabetes and just, you know, get on and do it.” Co-author Dr Janet Titchener, a GP with a special interest in diabetes and a senior lecturer at Auckland University, said: “The most important message from this research is that a clinician may know what is best for managing the disease but they don’t necessarily know what is best when it comes to a patient self-managing their diabetes. “We tend to be very directive in our diabetes care and expect patients to change their lives to accommodate the prescribed management regime. But this does not work; and it is pleasing to see that recent diabetes management guidelines from America

Everyone brings the cake...and you know they go, oh, you are the diabetic, don’t give her any, she is a diabetic. They treat us like we are lepers.

Beliefs about treatment I am eating the wrong food… that is why the damn thing is out of order. I have followed everything by the book. I would not eat anything that I shouldn’t have. They say don’t eat this, don’t eat that, so I have done it, but I still have diabetes.

and Europe recognise this. These guidelines ensure clinicians provide comprehensive information about all treatment options, so the patient can make an informed decision. This is a very different approach – a patient-centred approach.” “The danger is that some providers will decide that some patients will not be able to understand such a discussion and withhold information. My belief is that if a person can operate a cell phone or TV control, they can understand options for managing their diabetes. It is my responsibility as a doctor to present it in a way that they can understand it.” The study found that barriers to good diabetes control included

Lack of symptoms meant some did not take their diabetes seriously… It is one of those illnesses that you are not aware of it. You are not aware of the dangers of it, until all of a sudden, bang, it [complications] has happened. It was not until I got sick, I really started to do something about it [diabetes].

Maori cultural beliefs were important to some… The body is tapu… it makes me not like poking holes in it [with needles].

patients’ negative emotional reactions to diabetes, fear of starting medication/insulin, guilt about getting diabetes and not controlling it and shame about having the condition. Underpinning all these barriers was clinician ‘ignorance’ of these fears and beliefs, which prevented them from addressing the barriers. “Overall participants had a poor understanding of diabetes and complained the clinician simply told them what to do,” the researchers conclude. Understanding barriers to glycaemic control from the patient’s perspective by Ron Janes, Janet Titchener, Joseph Pere, Rose Pere and Joy Senor. Read the full study findings at www.rnzcgp.org.nz.

GPSI DIABETES

Summer 2013 | DIABETES

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

MANAG I NG DI A BETES WITH A YO UNG FA M I LY

Juggling act Wrangling preschoolers while keeping on top of diabetes management is a daily challenge for any mum. Mother-of-two Nic Reade, from Auckland, opens the front door to her busy household and explains how she manages to combine having type 1 diabetes, two toddlers, working and studying .

DIABETES | Summer 2013

MANAGING D IABETES WITH A YO UNG FA M I LY

“It’s 8.30am and I’ve already had a 10-minute meltdown from Tui over what I dressed her in, had to naughty step her for drawing on the wall; sorted all of Hugo’s jam, honey and marmite sandwiches into separate, non-touching piles and am printing out behaviour charts in a house so messy it looks like we’ve been burgled. It was tidy when I went to bed last night.” This was a Facebook status I posted recently. What I didn’t mention in the post was that, amid all the hullabaloo, I had a blood sugar which was heading south, and by the time I found a minute to wash the sticky, sweet jam off my hands, I returned a reading of 3.1mmol/l. It was chaos. I’m Nic Reade, a 35-year-old mum to three-year-old Hugo, and two-yearold Tui. I work three days a week and am halfway through a two-year diploma in reflexology. Life is pretty busy. I’ve had type 1 diabetes for 19 years and had to keep militarily precise glucose control during my pregnancies, when I switched needles for an insulin pump. So I’m used to running a pretty tight ship on the blood sugars front. I managed to keep up the thorough testing and dosage adjusting when I only had my son on the scene, but now I have two full-on preschoolers in the house, I would have to say my management of the condition is much more reactive than proactive. Juggling type 1 and toddlers has endless challenges. For starters, your body is still getting back to its postpregnancy rhythm and constitution. As I lose the weight, my insulin requirements change. The sleepless nights, which I naively thought were confined to babies (how wrong I was), created changes in my body’s natural ‘rest and recover’ mode. My willpower on those biscuits in the pantry dissolves after a handful of

nights of broken sleep. Meals for myself have taken a back seat to preparing, feeding and pleading with my kids to eat what I’ve prepared for them. It’s also easy to end up grazing on what they don’t finish. Testing is a party trick I’ve learned to do while bouncing a baby, pushing a pram, driving, carrying two scooters and a nappy bag and any other number of physically tricky situations. And yes, both of my kids have ended up with blood on them at some stage from a finger I’ve not completely stopped from bleeding, Addams-family style.

It’s hard work having any kind of busy life with type 1. Having young kids is a true test, when your time is not your own.

Hypos are probably the toughest part of managing type 1 and looking after small kids. Mums are far more likely to have a hypo due to constant exercise, which can vary from running around the house trying to put a nappy on a toddler before they wee on the floor, to endless lifting and pushing of prams, and spending hours rocking a baby with reflux (an unfortunate reality with my daughter). Of course carrying the baby of a diabetes mum is harder work because they tend to weigh more than your average baby – another of

FAM I LI E S A ND CH ILD REN

diabetes’ cruel little jokes. Treating hypos is another comedy sketch in the making. When my babies were young, I could eat sweets or glucose right in front of them. Then they hit the toddler stage, and all of a sudden they wanted a bit of whatever I was having every time I had a hypo (I call this the ‘mum hiding in the pantry drinking juice’ stage). Following this, they became hip to all the places I stashed my glucose: the buggy, the car, your bedside drawers, the cupboard, the fridge. I’ve caught both of my kids with guilty grins, next to my bed with a packet of dextrose in their hands. Finally, there is always a small niggle in the back of my mind that my offspring may be unlucky enough to inherit this annoying condition of mine. I’m an optimist by nature and often quote the odds of my kids getting type 1 to those who enquire: just four to seven per cent, compared to 0.5 per cent for a child without diabetes in the family. But I will admit to testing the kids’ blood sugars on the odd occasion when I get suspicious of how thirsty they are, or how wet a nappy is. I can’t speak for everyone, but personally, the slight paranoia that one of my children will end up with diabetes as well does sneak in, at times. It’s hard work having any kind of busy life with type 1. Having young kids is a true test – when your time is not your own. And I only have two young ones, a type 1 friend of mine has just given birth to her fifth! But, while it’s hard going, I still have to stop and take my hat off to those mums whose children have type 1. Their job is 10 times harder than any of the rest of us, and mums like me with type 1 can only imagine how hard it is helping littlies with this condition. Keep up the good work r

Summer 2013 | DIABETES

C ARE A N D PRE VE NTI O N

D IABETES A ND H OT WEATH ER

Stay safe in the sun Summer is a fun season with the promise of sunshine, more time spent outdoors and holidays for most of us. But with the warmer weather just around the corner there are some extra considerations for your diabetes care. Melanie Lubeck, Diabetes Nurse Specialist at the Auckland Diabetes Centre, explains how you can stay safe in the sun.

DIABETES | Summer 2013

HYPOS

INSULIN

People are often more active through the summer months and this may increase their risk of low blood glucose levels (known as hypos). If your diabetes treatment includes insulin, gliclazide, or glipizide, you are at risk of hypoglycaemia. People managing their diabetes with dietary measures, acarbose or metformin alone are not at risk.

It is important to remember that while insulin can be kept at room temperature for up to four weeks it should remain under 25Â°C. Give careful consideration to where you store your insulin during summer, especially if you are on holiday, making sure it isnâ&#x20AC;&#x2122;t stored in a particularly hot room or in direct sunlight.

Ensure you have a plan for managing low blood glucose and discuss this with your doctor or nurse. There are also driving considerations so be sure to read through the diabetes and driving fact sheet put out by the Land Transport Safety Authority (see link opposite).

Your car glovebox is never a good place to keep your insulin! In particularly hot temperatures, or when you are having a day at the beach, putting your insulin in a cool pouch such as the Frio packs, which can be purchased online, may be a good idea. Never freeze your insulin.

D IABETES A ND H OT WEATH ER

CARE AND P RE V ENTION

FEET

ALCOHOL

Foot care doesn’t take a break over the summer holidays and if you are going to be spending more time on your feet outdoors it becomes even more important. Good protective footwear is the key and jandals don’t count! If you have lost sensation in your feet from nerve damage it is possible for significant burns to occur, unnoticed, on the soles of your feet from walking on the sand or hot pavements. If you are having problems finding appropriate footwear for summer, talk to your doctor, nurse or podiatrist.

It can be easy to over indulge in alcoholic beverages over the holiday season. The recommended daily intake is only two standard drinks for women and three for men, with at least two alcohol-free days per week. Alcohol can affect your blood glucose levels, including causing hypos. Do not exceed the recommended daily intakes and have your alcohol with a meal to reduce the risk of this occurring. Many RTDs (ready to drink spirits) include sugar so you may need to mix your own so you can use sugar-free soft drink mixers.

Remember to check your feet daily for any blisters, cuts, burns or other changes and see your family doctor immediately if any are noticed. Don’t forget your toes and the tops of your feet when applying sunblock. Remember to moisturise your feet daily.

EYES & SKIN The use of sunglasses and sunblock for UV protection is recommended for all of us, diabetes or not. While UV rays are unlikely to have any impact on diabetic retinopathy (the most common form of eye damage from diabetes), they can cause or worsen other conditions such as cataracts, macular degeneration and pterygium (surfer’s eye). Ensure you have a pair of sunglasses that offer broad spectrum protection. People on sulphonylureas (eg glipizide) should be aware these tablets can increase sensitivity to the sun. Everyone should protect their skin with a sun block of SPF 30 or higher.

HYDRATION & NUTRITION Keeping hydrated in hot weather is important and even more so if your blood glucose levels are already higher than they should be. Ensure you are drinking frequently throughout the day, but avoid the temptation to indulge in fruit juices or soft drinks. Sugar-free soft drinks will not impact on your blood glucose but even these should be enjoyed in moderation. Water is always the best choice but it doesn’t have to be boring – try sparkling water with mint or slices of fresh fruit. Frozen treats like ice creams or ice blocks can be a real temptation over summer. Frozen fruit, such as grapes or bananas, may be fun alternatives but moderation is still important – half a banana or a small handful of grapes would be good portion sizes.

Enjoy a happy and healthy summer! Resources Handling & storage guidelines for insulin www.novonordisk.com.au/media/Novo_Storage_Handling_05354.pdf Diabetes and driving guidelines LTSA www.nzta.govt.nz/resources/factsheets/16/docs/16-diabetes.pdf Diabetes and how to care for your feet http://tinyurl.com/ng7lgop

Is your child’s type 2 diabetes misbehaving? If diet, exercise, or medication is not helping your child with their type 2 diabetes, you may be interested in this research study. It is evaluating an investigational drug for children between 10 and 17 years old to see if it helps control their blood sugar levels. Every child who participates will receive:

n Study-related care for type 2 diabetes n Diet and exercise counseling

n Study medication (may include inactive placebo) n Glucose meter and testing supplies

n All at no cost

Ask a member of our staff today for more information about the potential benefits and risks of study participation and to see if your child may qualify.

CAN YOUR CHILD PARTICIPATE? JUST ASK US. Please contact: Auckland (09) 923 7897 t2dm@auckland.ac.nz Christchurch (03) 3640 448 jinny.willis@cdhb.health.nz

Pediatric Type 2 Diabetes Research Study

20111109-US-ENG

Summer 2013 | DIABETES

LE T ’S G E T A CTI VE

FROM GO TO WH OA

First steps back to exercise You might be new to exercise or perhaps you used to exercise but haven’t for a while. It can sometimes be hard to take that first step back to personal fitness. Personal trainer Malcolm Tester and Wellington diabetes nurse Tess Clarke give some advice on how to get started on your exercise journey. Regular physical activity is important for overall health and wellbeing for anyone with diabetes, regardless of whether you have type 1 or type 2. It can also help control your blood glucose levels. When starting out, the key is to plan ahead, take small steps and set achievable goals.

DIABETES | Summer 2013

Preparation

Start slowly

See your doctor for a medical check up before starting any new exercise regimen. Make sure you tell your doctor if you have any problems that make it difficult for you to exercise, such as issues with your feet, joint problems or pain. It is especially important to tell your doctor if you ever get pain or tightness in your chest.

It’s important to start slowly if you have never been active or you haven’t exercised for a while. Ideally you should be aiming for 30 minutes of moderate intensity activity daily or on most days of the week.

Ask your doctor: • what exercises are safe for me? • are there any activities I should avoid? • are there certain times of the day that I should avoid exercising? • will exercising affect the medication I take for diabetes or other health conditions? As part of your check-up, make sure your doctor looks at your feet. Comfortable, well-fitting footwear is essential for a person with diabetes. Make sure your footwear is appropriate for the type of exercise you are planning. Ask a podiatrist for recommendations if you are unsure. Check your own feet daily and report infections, blisters or sores that are not healing to your doctor or podiatrist immediately.

Try doing three 10-minute sessions across the day if you can’t manage 30 minutes of exercise. Recent research suggests these ‘exercise snacks’ can have just as many health benefits. If any kind of exercise seems too difficult, try to reduce the amount of time you spend sitting. Evidence suggests that reducing sedentary time has important benefits for your health.

FI RST STE PS BACK TO EXE RCI S E

Get moving Engaging in moderate intensity exercise doesn’t require fancy equipment or a big gym. You can go for a short tramp, bike, swim or even just walk up some stairs. You could do something as simple as walking to the shops instead of driving, or taking the kids to the park to kick a ball around. There are also lots of great community exercise groups for people of all ages and abilities. Just go along and have a look before you sign up. You might be amazed by how much more confident you feel about taking part once you know what to expect. If your goal is to reduce your sedentary time, then try some of the following: • stand up every time you talk on the telephone. • stand up and do the ironing or some other household chore while watching TV. • get off the bus one stop earlier and walk to your destination. • at the supermarket park the car on the far side of the car park, as far away from the supermarket door as possible.

Manage your diabetes while exercising If you are starting a new exercise programme, talk to your diabetes nurse before you begin. He or she will help you understand how your body responds to exercise and help you plan ahead to keep your blood glucose from going too high or too low. Frequent testing before, during and after exercise is essential. Exercise will make your body cells more sensitive to insulin and this effect can last for up to 24 hours after you exercise. People with type 1 diabetes, and some people with type 2 diabetes, are at risk of hypoglycaemia during or after exercise. A ‘hypo’ occurs when your blood glucose level drops to 4.0mmol/L or below and this requires immediate treatment. Make sure you always carry some quickacting and long-acting carbohydrate with you when exercising in case you have a hypo.

LE T ’ S GE T ACTIVE

The importance of setting goals Goals are an important part of your exercise plan. They give you something to work towards and are a way of measuring your success. Having a goal can help to keep you motivated and reaching your goal will give you a great feeling of satisfaction. To decide on a goal, think about why you want to exercise. You may want to lose weight, have more energy, get stronger or improve your blood glucose control. It is important that your goal is realistic, measurable and achievable. It could be as simple as checking out a new exercise class or going for your first walk around the block. Increase your goal from once round the block to 10 times round the block over the next six weeks. That’s a great improvement. If you are using a gym don’t be worried about asking for help from a trainer – that’s what they are there for. A trainer will help you set realistic goals and achieve them safely and efficiently. Exercising with a friend is another good way to stay motivated and on track. Take a long-term approach to improving your fitness. Be prepared to have days when you don’t want to exercise. Don’t mistake this for failure, just try again the next day. Have a go at different activities until you find one you enjoy – add variety, mix up your routine and have fun. Malcolm Tester is a personal trainer at Results Room Gym in Wellington. See www.resultsroom.co.nz.

Have a go at different activities until you find one you enjoy – add variety, mix up your routine and have fun. Summer 2013 | DIABETES

GARD EN I N G

SUMMER HERBS

Growing and enjoying edible herbs Invite more herbs into your garden, writes gardening expert Rachel Knight. Herbs enhance both the look and productivity of our gardens. They’re expensive to buy, much better fresh and make the most mundane dish special. A bowl of canned tomato soup is a feast topped with some chopped chives, a bag of salad comes alive with some petal sprinkles and a calming pot of mint tea is a celebration to share. You can mix your herbs and edible flowers in with your vegetable or flower garden or develop a dedicated herb garden. The best place for them is just a few steps from your kitchen, whether that’s in containers or in the soil. Most herbs enjoy a rich, well-cultivated soil. Adding compost will enhance growing conditions, assist drainage and improve water retention. It also feeds the plants as they grow. Herbs enjoy the sunshine but hot, dry conditions can stress plants so they go to seed. Dill, coriander and rocket are particularly fond of doing this. Morning sun and some afternoon shade is the ideal combination for leafy herbs. Full sun is good if you’re growing herbs for their flowers or seeds. Freshly harvested herbs keep well in a jug of water or in a plastic bag in the fridge. For longer term storage freezing is one of the easiest preserving methods for fresh herbs. Dividing chopped herbs into ice cube trays gives easily accessible small portions. Drying works well for bay, rosemary and seeds such as coriander, dill and fennel. Put them in a labelled paper bag and leave for a week or so in a warm, dry place before transferring to airtight jars. A pot of fresh, homemade pesto is worth making when you’ve got lots

DIABETES | Summer 2013

of coriander, rocket, parsley or basil. You can freeze pesto too. Chives, mint, French tarragon and Vietnamese mint will all die back in winter, particularly if you get a frost. Cut back all perennial herbs in autumn and take cuttings or divide plants at the same time. Pot up rooted pieces in potting mix and keep somewhere sheltered until spring when the roots should be established and you can plant them out. Mint needs to be planted in pots buried in the soil if you don’t want it to take over your herb garden.

Salsa verde (green herb sauce) A wonderful, pungent accompaniment to lamb or beef. Don’t worry too much about the quantities in this. Taste it and adjust the flavour at the end. It should be thick and spoonable. It’s best made just before serving to retain its ultra-green vibrancy but you can keep it, covered, in the fridge for a couple of days. One fat clove of garlic, roughly chopped Leaves from ten stalks of flat-leaved parsley and five sprigs of tarragon 20 basil leaves Five anchovy fillets 15 capers One teaspoon Dijon mustard Half a teaspoon sugar A squeeze of lemon juice Two tablespoons extra virgin olive oil Freshly ground black pepper

Choose some perennial herbs that will grow year after year, sow some summer herbs from seed and find space for some flowers that you can pick to eat. A few pots of herbs on your kitchen windowsill may be the ones you use the most. Then invite some friends for a refreshing pot of herbal tea and to swap some herbs from your gardens.

Recommended reading The Cook’s Herb Garden by Mary Browne, Helen Leach, Nancy Tichborne Growing Herbs in New Zealand by Dawn Dunn River Cottage Handbook Number 10 ‘Herbs’ by Nikki Duffy

Breadmaker rosemary focaccia bread Three teaspoons Surebake yeast Three tablespoons olive oil 280ml tepid water 450g high grade flour Half a teaspoon salt Rosemary sprigs, sea salt and olive oil to decorate.

Put everything in a blender or mini food processor. Blend until smooth. Adjust seasoning to taste.

Mix the yeast, oil and water together in a jug (I weigh the water to get the measurement accurate). Whisk together and allow to stand for ten minutes. Put the flour and salt in the breadmaker pan, add the liquid and yeast mixture and set to the ‘dough’ setting. When finished spread into an oiled shallow baking tray, stud with rosemary, sprinkle with salt and a glug of olive oil. Allow to rise again in a warm place for about an hour. Bake in a pre-heated oven at 220°C for about 20 minutes. I divide the dough in half and freeze half for later.

Nutrition (per 100g) Energy 1,574kj; Total fat 35g; Saturated fat 6g; Carbohydrate 4g

Nutrition (per 100g) Energy 1,024kg; Total fat 7g; Saturated fat 1g; Carbohydrate 38g

S UM M ER H ERBS

Chives

Coriander

perennial herbs to grow from cuttings or divided plants Bay Chives Lemon Verbena Mint Oregano Rosemary Sage Tarragon Thyme Vietnamese mint

GARDENING

Rocket

herbs to grow from seed Basil Chervil Coriander Dill Fennel Lemon balm Parsley Rocket Summer savory Wild rocket (arugula)

Thyme

edible flowers for colour and flavour Borage Calendula Chives Cornflower Lavender Nasturtium Pansy / viola Pineapple sage Rocket Rosemary

Summer 2013 | DIABETES

CO M M U N IT Y

WALK FOR D IABETES YO UTH

Best foot forward Organisers need your help to make the first national walk for diabetes youth a success. Caroline Wood finds out how you can get involved. Cities and towns across New Zealand will gather to walk for young people with diabetes next year. It will be a great chance to meet other families, raise awareness in the community, do some fundraising – and above all have some fun. The inaugural national walk on Sunday 16 November is aimed at bringing national public awareness to youth with diabetes, as well as being a signature fundraising event for Diabetes Youth NZ. “The misconceptions about diabetes are boundless, especially when it comes to youth. Our goal is to bring to the forefront the differences between the two different types of diabetes, how it affects our children and the complexities it brings to our families in their everyday lives,” says Renata Porter, President of Diabetes Youth NZ. “Our local organisations work extremely hard. They undertake education, counselling, and activities such as camps and other fun events. Their efforts can only continue and grow with strong support from the community and businesses.”

Walks will be held across New Zealand and people are needed to help organise the walk in their local area. If you are interested, please email walk@diabetesyouth.org.nz, especially if you can help out in Auckland or Wellington.

Q: Where will the walk be held? A: Each participating area of New Zealand will have their own local route. Keep an eye on Facebook, the Diabetes Youth NZ (DYNZ) website or contact your diabetes branches for more information. Q: How long will the walk be? A: The walk in your area will be either 2km or 5km. Q: What will happen after the walk? A: You will be able to meet other people with diabetes and their families. There may also be competitions, food stalls and other fun activities by the finish line. Q: How can my friends and family sponsor me? A: You can fundraise online – see the DYNZ website for a link to your area. You can post a personal link onto your own social media sites such as Facebook and Twitter. Or ask your local branch for collection envelopes. Q: What will my fundraising be used for? A: A total of 80 per cent of the money raised will go straight back into your local area to support

young people with diabetes and their families. The other 20 per cent will be used by DYNZ to help raise diabetes awareness in New Zealand and go towards other national or local projects.

Q: Will I receive anything for my fundraising efforts? A: Every walker will be given a medal at the finish line and if you raise $100 or more you will be sent a ‘Walk for Diabetes Youth’ t-shirt. Your local area may also have prizes for the top fundraisers. Q: Can I still donate even if there isn’t a walk in my area? A: There will be a special DYNZ link on the website where you can make a one-off donation. Alternatively you could contact your local branch and arrange for a special donation to be made. Q: How can I raise more money in my community? A: You could approach your place of work and ask them to match what you have raised, or ask local businesses if they would like to sponsor you – perhaps they could contribute an amount for every kilometre you walk. Have some fun and get creative, every person you talk to will learn something about diabetes!

The event was to have been held on Sunday March 9 but has been postponed to Sunday 16 November to coincide with Diabetes Awareness Week. Here are some frequently asked questions about the Walk for Diabetes Youth.

DIABETES | Summer 2013

To find out more, check www.diabetesyouth.org.nz or go to www.facebook.com/WalkDiabetesYouthNZ

FACEBO O K FRI ENDS

WORLD DI AB E TES DAY

‘How I manage my diabetes’

– global tips for how to stay healthy Accept it and be friends with it!

Eating a balanced diet and doing regular physical activity.

I ask my patients to pay attention to their feet.

Kimia Mosaferi, Iran

Maria Alejandra Casen, Argentina

Rosemarie Pasqualaggi, France

One of my secrets is to grow my own fresh vegetables for consumption and it's not hard using the "Robinson Crusoe" idea.

I try to exercise almost every day. I'm 43 years old and practice taekwando, which helps my mind and body. At the beginning it was difficult, but not any more! Marta Moreno, El Salvador

I have recently completed a Dafne course which has helped me to understand my diabetes.

1. Regular blood check 2. Exercise 3. Eat well 4. Be friends with your diabetes

Kimia Mosaferi, Iran

Zahhra Sajaddpour, Iran

David McCulloch, Belize

1. Eat healthy 2. Exercise daily We count as precisely as possible the amount of 3. Relaxing glucides that our daughter techniques Ysaline eats at every meal. Camille LoParrino, USA This has become a game for the whole family.

Move, move! Then calculate the amount of glucose/insulin. Then try to stick to regular meal times and don't forget your bolus which can change everything. Fatnomas Cinguanteneuf, Czech Republic

Isabella Bonhomme, France

The theme of this year’s World Diabetes Day on November 14 was education and prevention. Here are some tips from some of the International Diabetes Federation’s Facebook followers on how they manage their condition to keep healthy and happy.

Summer 2013 | DIABETES

WO RLD DI A BE TE S DAY

D IABETES H OTS POTS

The global burden of diabetes IDF DIABETES The International Diabetes Federation is engaged in action to tackle diabetes from the local to the global level – from community programmes to worldwide awareness and advocacy initiatives. It has designed a downloadable poster showing the latest global and regional diabetes statistics in an easy to understand, attractive format. You can download it from www.idf.org (key word Diabetes Atlas). The latest figures available at the time of going to print (2012) show that diabetes is increasing in every country worldwide. More than half of those who died from diabetes were under 60 years old and four out of five people with diabetes live in low and middle-income countries. The map shows what’s happening around the world and the location of the world’s diabetes hotspots. *Map courtesy of the International Diabetes Federation

NORTH AMERICA AND CARIBBEAN More healthcare dollars were spent on diabetes in this region than any other 1 in 10 adults in this region has diabetes 10.5%

PREVALENCE

38 M

29.2% UNDIAGNOSED

9.2% 8.3% PREVALENCE PREVALENCE

26 M

45.5% UNDIAGNOSED

50% UNDIAGNOSED

WORLD 371 M people living with diabetes

DIABETES | Summer 2013

More than 371 million

SOUTH AND CENTRAL AMERICA Only 5% of all healthcare dollars for diabetes were spent in this region 1 in 11 adults in this region has diabetes

The num with diab

DI A BETES H OTS POTS

ATLAS

WORLD DI AB E TES DAY

5th edition | 2012 update EUROPE

MIDDLE EAST AND NORTH AFRICA •

1 in 9 adults in this region has diabetes

•

More than half of people with diabetes in this region don’t know they have it

WESTERN PACIFIC

•

1 out of every 3 dollars spent on diabetes healthcare was spent in this region

•

21.2 million people in this region have diabetes and don’t know it

•

1 in 3 adults with diabetes lives in this region

•

6 of the top 10 countries for diabetes prevalence are Pacific Islands

6.7%

55 M

38.6% UNDIAGNOSED

PREVALENCE

10.9%

52.9% UNDIAGNOSED

PREVALENCE

70 M

51.1% UNDIAGNOSED 8.7%

4.3%

8.0%

PREVALENCE

15 M

PREVALENCE

132 M

81.2% UNDIAGNOSED

AFRICA Over the next 20 years, the number of people with diabetes in the region will almost double This region has the highest mortality rate due to diabetes

mber of people betes is increasing

57.9% UNDIAGNOSED

SOUTH-EAST ASIA 1 in 5 of all undiagnosed cases of diabetes is in this region 1 in 4 deaths due to diabetes occurred in this region *all estimates are presented as comparative rates

Half of people with diabetes don’t know

Summer 2013 | DIABETES

WO RLD DI A BE TE S DAY

ID F D IABETES ATL AS

Diabetes rates continue to climb The latest edition of the International Diabetes Federation’s Diabetes Atlas was released on World Diabetes Day. Associate Professor Jonathan Shaw, Associate Director of Australia’s Baker IDI Heart and Diabetes Institute, and Leonor Guariguata, biostatistician at IDF, explain the spread of the diabetes epidemic worldwide. 1. What can we expect from the 6th edition of the Diabetes Atlas? This edition of the Atlas will provide the most up-to-date information on the global burden of diabetes. With more studies from more countries and improved methods of estimating the numbers of people with diabetes, the accuracy of the data continues to improve. The biggest challenge to producing accurate estimates continues to be the significant numbers of countries and areas of the world for which good local information on the numbers of people with diabetes

is absent. This edition will also see the first-ever estimates of the prevalence of diabetes in pregnancy and gestational diabetes. We are seeing an emerging epidemic of high blood glucose in pregnancy that is affecting more and more women with potentially serious consequences if the condition is not diagnosed and managed in time.

2. Which countries or regions are most affected by the diabetes epidemic?  China and India continue to ‘lead the world’ with regard to the (overall) number of people with diabetes. Both countries have seen a 10-20 fold rise in the prevalence of diabetes over the last few decades. But they are far from topping the list of countries with the highest prevalence (percentage of the population with diabetes). This dubious honour remains with a number of the small Pacific Island nations, followed by Middle Eastern and Caribbean countries. Some of the indigenous peoples in North and Central America, Australia and New Zealand have diabetes prevalence similar to that seen in the Pacific Island nations.

3. In your view, what is the biggest global threat in our attempts to tackle the diabetes epidemic?   There is no doubt the relentless changes in lifestyle across the world continue to fuel this epidemic. This is particularly relevant and challenging in the developing world, where the undoubted benefits of many aspects of modernisation make it so much more difficult to tackle the consequences of these changes for diseases like diabetes. Finding ways to continue to lift people out of poverty and bring the gifts of modern technology to every corner of the world is our greatest challenge. A lack of awareness of diabetes for many parts of the world, and the common misconception of diabetes as a rich person’s disease are also fuelling the epidemic and its consequences. 4. We often hear that diabetes is a development issue but what can be done in high-income/developed countries to tackle the type 2 epidemic? Unhealthy patterns of diet and physical inactivity are now ingrained at both a personal and societal level. Addressing these will require

THE RISING GLOBAL COST The latest figures from 2012 show More than

HALF 371 MILLION of people with diabetes are

people have diabetes.

DIABETES | Summer 2013

UNDIAGNOSED

4.8 MILLION people died due to diabetes

More than

US$471

BILLION was spent on healthcare for diabetes.

I DF DI A BETES ATL AS

WORLD DI AB E TES DAY

activity on many fronts, including the provision of widely-accessible diabetes prevention programmes, taxes and subsidies that make healthy food, rather than junk food, the cheaper option; working environments that promote standing rather than sitting; and transport systems and town planning that make walking, cycling and public transport more convenient options than the car. It is likely that to achieve any significant level of success, some of these changes will need to be supported by a regulatory and legislative framework. For countries with high-functioning health systems, the focus needs to be on preventing new cases of diabetes and providing treatment and managing diabetes. Even the most developed countries are failing miserably when it comes to treating people with diabetes. There are so many cost-effective measures we know work, they need to be applied and governments have to lead the way in terms of creating healthy environments with good access to care.

5. What do you view as the next step for diabetes epidemiology research? We need to continue doing simple things such as tracking the numbers of people with diabetes. We also need to continue to monitor the impact of diabetes on the traditional complications such as eye, kidney and heart disease, as well as examining the impact on the more recently recognised complications such as liver disease, sleep disturbance and cancer. Despite years of investigation, we still do not fully understand why social class has such a marked influence on diabetes and its complications. Epidemiological techniques can be very powerful tools in modelling to what extent different interventions will widen or narrow the social health inequalities. New and sophisticated epidemiological study designs are needed to explore some of the newer potential markers of the risk of diabetes and its complications, particularly in the arenas of epigenetics, lipidomics and the microbiome. The causes of the rise in type 1 diabetes is another area that still needs further investigation.

TOP 10 COUNTRIES for people with diabetes (aged 20-79)

1 China 2 India 3 USA 4 Brazil 5 Russian Federation 6 Mexico 7 Indonesia 8 Egypt 9 Japan 10 Pakistan

*Reproduced with kind permission of the International Diabetes Federation. To find out more about the Diabetes Atlas go to www.idf.org. Summer 2013 | DIABETES

LIV ING W ITH D I A B E TE S

MOUNTA I N BI KE CH A LLENG E

The longest night A group of mountain bike enthusiasts decided to celebrate the winter solstice by cycling 12 hours overnight along 138km of Wellington’s wildest tracks. A challenge for anyone but chiropractor Iain Guest decided to do it with type 1 diabetes. He explains the highs (and lows) of the ride. As with many harebrained ideas, the first I heard of this one was over a quiet beer. A group of eight avid mountain bikers wanted to celebrate the winter solstice by embarking on a 138km adventure through the hours of darkness. The chosen route would leave from the north of Wellington, cross into the Wairarapa, down to the coast and around the eastern reaches of Wellington Harbour before heading back to the Hutt Valley for breakfast. Before my diagnosis (at the age of 23), I would not have thought twice about embarking on such an adventure. However, managing blood glucose control while exercising for that period of time, all in a relatively inhospitable environment (no cell phone reception for nearly half of the journey) did make me think twice. After a few night’s deliberation and consultation with the better half (my mentally saner and long-suffering wife), I decided that with good planning it was worth a go. Why let diabetes completely rule my life?

The route the boys took over a long 12-hour night.

DIABETES | Summer 2013

Planning I knew I was fit enough to complete the challenge so thankfully this didn’t need to be factored into the equation. I needed to calculate my energy requirements for an estimated 10 hours on the bike. I figured that an adequate room for error would be to double my estimated energy needs and bring home food rather than run out while on the ride. I’d also need some way of managing any cramps and adequate water supplies as there would be no stops along the way. I would also have to ensure that I made regular stops to take blood glucose readings and carry extra pump consumables so that I could change a cannula if the need arose. I carried two glucogen vials with me and made sure that three other team members were happy using them and recognising the signs of severe hypoglycaemia in case of the worst.

Trip highlights We took off at around 8pm and headed towards the old rail line of the Rimutaka incline, which links Upper Hutt with the Wairarapa. A light drizzle fell but it was warm

enough and there was very little breeze. The eight headlights of the riders bobbed along the track snaking slowly up the incline in the pitch black, as the rest of Wellington settled in for well-earned beer at the end of their working week. We got to the summit and stopped for a photo and snack in the old station shelter. It was a good time to retest. After just over an hour I was comfortably reading 7.6mmol/l. An 18gm carbohydrate muesli bar down the hatch and away we went. The incline track goes through a number of old disused train tunnels, which were eerie in the dark silence as we hurtled down the other side. The Wairarapa side of the incline is a wide track down to the valley floor. It’s hard to express the thrill of 45km/h in the dark on a winding track but it would rate as a high point in the adventure. We rode along the edge of Lake Wairarapa towards the South Coast. At about 12.30am, we decided it was time for ‘lunch’ and it was here that I ran into an unexpected problem. My blood glucose monitor wouldn’t function as the temperature had dropped to about 3ºC. After a short panic I placed it under my armpit

MOUNTA I N BI KE CH A LLENG E

A welcome sight! The Pencarrow Lighthouse.

for a few minutes and was able to warm it up enough to take a reading. This reading was 13.6mmol/l – higher than desirable. I had been over estimating my sensitivity. A correction with a modified bolus with the help of the pump and I was confident that I’d be back on track quickly enough. We pushed on through the toughest part of the challenge. The coastal track had been eaten away by the storm the previous week and in parts we had to push the bikes through very thick sand. The huge southern swell was often crashing below us as we rode along the dunes spraying fine white foam into the moonlit night. It was quite surreal and incredibly peaceful. At about 3:30am everyone started getting colder and a lot quieter. The last few hours had been hard going and we had barely covered any significant distance. We made a longer stop than usual and I tested at 10.3mmol/l. At about 4:30am we found ourselves back on the tar-sealed bliss of the Wainuiomata Coast Rd. But the joy was short lived. A steep climb into the Pencarrow Regional Park soon wiped any smiles off faces and we were back on the gravel and sand. The view of Wellington from the

LI V I NG WITH DI ABE TES

The team at the end of the journey. Iain is at the back, second from the left.

top though was worth stopping for. Passing Pencarrow Lighthouse was a worthy milestone but we only paused to take a few pictures and test the blood glucose again, 8.7mmol/l, right on target. Soon the group was feeling the effects of sleep deprivation and being on the bikes for over 11 hours. We headed onto the Hutt River Trail and regrouped for one final push to the end. I wanted to test again but the monitor was too cold and the guys wanted to keep moving. I felt a little anxious, but assessed my mental state and decided that I wasn’t suffering from hypoglycaemia or the usual fuzzy headedness I experience with very prolonged hyperglycaemia. I decided to push on – with hindsight I should have stopped but I didn’t want to be the hold up. As we rode the final 10km our lights started flickering as they ran out of power and tired legs pushed down on heavy pedals. The speed of the group increased like a horse given its head for home. We climbed steadily to the plateau where the cars had been left and finally, after nearly 12 hours riding, reached the end. I sat on the ground for a few minutes, feeling

neither elated nor relieved, just weary. Eventually I got up and with a handshake and some big grins the boys congratulated each other on a goal achieved. I tested again and was relieved to get a 5.1mmol/l – a little on the low side for post exercise, but now I could carefully monitor it and eat accordingly.

Recovery I slept sporadically during the day. My blood glucose levels soared around 13.6mmol/l and topped out at 18.5mmol/l. I tested positive for ketones all day and struggled to keep them below the threshold limit by hydrating and ensuring my insulin intake was sufficient. The following four days were chaotic from a blood glucose perspective. I swung wildly between hypersensitivity and resistance but managed to maintain a safe enough level of control not to bother the experts. I have my lovely wife to thank for her support in the difficult aftermath of the adventure. So after riding a bike through the night for 138km over a 12hour adventure, what’s next? Well the summer solstice falls on 21 December and a longest day ride is already being whispered about in certain circles…

Summer 2013 | DIABETES

FO O D

4 IN GRED IENTS D IABETES

SIMPLE SUMMER LUNCHES Each of the recipes in Kim McCosker’s first cookbook contained just four ingredients and it became a worldwide phenomenon garnering her a huge following. Fans urged her to write a healthy recipe book for diabetes, which was recently published. It is dedicated to her brother Boo-Boo, who was diagnosed with type 1 diabetes at the age of two. Diabetes Australia has endorsed 4 Ingredients Diabetes and every colourful recipe contains just four ingredients. Diabetes spoke to Kim during a whistlestop tour of New Zealand earlier this year. She said: “I wanted to write a diabetes recipe book because I grew up with my brother who had type 1 and it affected the whole family. I wanted to try to help people get good food onto the table with diabetes in mind. I wanted to show how you can create healthy meals quickly. Eating well doesn’t have to be difficult, it’s about the ingredients you use.” Kim has given us FOUR signed copies of 4 Ingredients Diabetes to give away. See the panel opposite.

DIABETES | Summer 2013

4 I NG REDI ENTS DI A BETES

Salmon patties

Basil & lentil salad

2 eggs 2 x 150g zucchinis, grated 1 x 130g turnip, peeled and grated 1 can (420g) pink salmon, drained and flaked (or tuna)

1 cup (100g) dried brown lentils, washed 2 bunches (200g) fresh basil, washed 1 punnet (250g) cherry tomatoes, halved 1⁄2 (60g) Spanish onion, finely sliced

Serves 4 Into a large bowl, place all the ingredients and season with cracked pepper. Stir well to combine. Using damp or floured hands, roll the mixture into 12 cakes. Refrigerate for 20 minutes. Preheat the oven to 180°C. Line a baking tray with baking paper. Place the cakes on the prepared tray and bake until golden, about 25 minutes, turning halfway through.

Serves 4 Pour the washed lentils into a saucepan. Add 1 1⁄2 cups water and bring to the boil. Reduce the heat and simmer for 40 to 45 minutes, stirring occasionally, until the water is absorbed and lentils are tender. Chill for 15 minutes. Tear the basil leaves from the stems and place in a salad bowl. Add the remaining ingredients and toss to combine. Serve as is, or drizzle lightly with my simple, classic salad dressing.

NUTRITION Energy 894 kJ, Total Fat 9.7g, Saturated Fat 2.8g, Sodium 123mg, Carbohydrate 2.9g, Fibre 1.4g

GIVEAWAY

FOOD

NUTRITION Energy 436kj, Total Fat 0.9g, Saturated Fat 0.1g, Sodium 15.5mg, Carbohydrate 12.2g, Fibre 6.8g

Classic salad dressing

We have four signed copies of 4 Ingredients Diabetes by Kim McCosker to give away. To enter the draw, email admin@diabetes.org.nz using the phrase 4 ingredients in the subject line. Please submit your entry no later than 28 Feb 2014.

1⁄2 cup fresh lemon juice 4 tablespoons extra-virgin olive oil 2 teaspoons Dijon mustard 2 cloves garlic, crushed

*Terms and conditions apply, please see diabetes.org.nz

Energy 734kj, Total Fat 18.3g, Saturated Fat 2.5g, Sodium 50mg, Carbohydrate 2.1g, Fibre 0.3g

Serves 4 Place all ingredients in a screw-top jar, season with sea salt and pepper, and shake well.

™

NUTRITION

Summer 2013 | DIABETES

TREATM ENT

FIND ING THE BAL ANCE

Should I exercise with neuropathy? Exercise can result in considerable benefits if you have peripheral neuropathy but there are also risks for some patients. Dr Jason Gurney, who has written a PhD on the effect of exercise on the progression of diabetic neuropathy, looks at the latest worldwide research and recommendations on exercising if you have neuropathy. It’s been estimated that worldwide a limb is amputated due to diabetic complications every 30 seconds. One of the key complications driving this horrific rate is peripheral neuropathy – nerve damage leading to loss of feeling in extremities, such as toes and feet. Peripheral neuropathy is the most common microvascular complication of diabetes, and is usually the first complication to be experienced by someone with diabetes.

Pain is a powerful incentive for seeking medical help; in the absence of pain (due to sensory loss) those with peripheral neuropathy might not seek medical attention, and foot complications may therefore go unnoticed. For example, an individual with ‘normal’ sensory function who steps on a sharp object will immediately remove it to prevent further pain; however someone with peripheral neuropathy may not realise that they have stepped on the object, potentially making the outcome much worse. It is not uncommon for those with neuropathy (or their families) to discover blood-soaked socks and bed sheets, and only then be alerted to a previously-unnoticed gaping foot wound. Peripheral neuropathy can also affect the performance of lower-limb muscles, which as a result of the condition, may become progressively weakened and ‘atrophied’ (or smaller in size) over time. The neuromuscular changes caused by peripheral neuropathy may have profound consequences to crucial ‘motor’ functions, such as

maintaining balance while walking. The evidence for the effectiveness of exercise as a treatment for peripheral neuropathy is building, but care and caution is needed when considering this treatment option. On the one hand, exercise is considered by world-leading organisations such as the American College of Sports Medicine (ACSM) and the American Diabetes Association (ADA) as a cornerstone treatment of uncomplicated diabetes. However, in the presence of complications (like peripheral neuropathy), there is a very real risk that exercise could make things worse rather than better. For example, tissue on the plantar surface (sole) of the foot may be further damaged through repetitive loading (as experienced during running, for example), which increases the risk of foot ulceration. It’s also possible that exercise could increase the risk of trauma – such as a fall, hypoglycaemia or even a cardiovascular ‘event’ – just by exposing the individual to physical activity levels that are beyond their usual norm. With this in mind, it’s worth looking at the scientific literature to summarise the latest recommendations with respect to exercise and diabetic neuropathy.

Engaging in regular exercise has the potential to result in substantial benefits to those living with peripheral neuropathy. 30

DIABETES | Summer 2013

What is currently recommended? It’s recommended that people with diabetes should perform at least 2.5 hours of aerobic exercise a week at a ‘moderate’ intensity (50-70 per cent of maximum heart rate) as part of their diabetes management, according to a position statement from the ADA published in 2013. It also recommends twice-weekly resistance training – on weight machines, for example – for those with uncomplicated diabetes. Of course, these recommendations come with caveats for those who have severe neuropathy. Since the sole of the foot is at increased risk of ulceration among this group, it is thought that non-weight bearing exercise – via tools such as balance boards and Thera-Band – could be a useful and safe alternative to weightbearing exercise. However this school of thought is evolving, with some research showing that walking at a moderate intensity may not increase the risk of foot ulceration among people with peripheral neuropathy (Lemaster et al., 2003). This is supported by the joint position statement from the ADA and ACSM, where they recommend that those with neuropathy, who do not have a current foot ulcer, can participate in moderate weight-

bearing activity without necessarily increasing their risk of ulceration (Colberg et al., 2010).

What are the possible benefits? Engaging in regular exercise has the potential to result in substantial benefits to those living with peripheral neuropathy. Considerable improvements in glycaemic control, blood pressure, body mass and general muscle strength can be achieved through regular physical activity (Colberg et al., 2010). A recent study of type 2 patients with neuropathy found that a 12-week exercise programme significantly improved blood glucose levels and lower-limb muscle strength (Otterman et al., 2011). In their study, Otterman et al. tailored the exercise programme to each participant – a wise approach from a clinical perspective, since it ensures that the exercises performed suit each individual’s needs and thus minimises the chance that an adverse event will occur.

What should I be aware of? There is universal agreement in the literature that anyone with peripheral neuropathy, who wants to introduce exercise into their routine, needs to be ‘screened’ by a clinician for the presence of conditions

which might make certain exercises too dangerous. Such conditions might include severe neuropathic symptoms, retinopathy, a history of foot ulcers, hypertension, cardiovascular disease, or severe autonomic disorder (ADA, 2013). Such screening won’t necessarily rule out exercise as an option, but may help to indicate which exercises are the most appropriate for the individual. In New Zealand, general practitioners are usually the first port of call for such screening, with additional involvement from diabetes nurses, endocrinologists and podiatrists helping to minimise the risk associated with sudden changes in levels of physical activity (Otterman et al., 2012). Of course, there are also some things that a person living with peripheral neuropathy can do to ensure their own safety when introducing regular exercise into their routine. Checking both feet for wounds or the presence of any hard callouses should be a part of daily routine, while wearing cushioned, correct-fitting footwear (particularly when outdoors) is an absolute must (ADA, 2013). *Dr Gurney is a Research Fellow in the Department of Public Health, University of Otago, Wellington.

What is neuropathy and am I at risk?

1 2

5 6

SHOULD S E WITH PERInumbness, PH ERA L NEURO PATHY? TREATMENT Neuropathy may affect up to I EXERCI Symptoms include You should be screened for 50 per cent of people with tingling or pain in the hands, neuropathy at least once a diabetes. feet, arms or legs. It may also year. Check your feet daily. affect organs, including the Prolonged exposure to Bringing blood glucose heart and sex organs. Some higher than normal glucose levels within normal range is people may not have any levels damages the nerves, essential for prevention and symptoms. causing loss of feeling in treatment of neuropathy. parts of the body. Peripheral neuropathy, which Diet and exercise will also affects the feet, legs, hands and have a role. Talk to your arms, can easily develop into GP or diabetes nurse or ulcers, which if left untreated specialist for advice and can lead to amputation. devise a plan of action together.

Summer 2013 | DIABETES

CO M M U N IT Y

D IABETES AWARENESS WEEK

Don’t go it alone if you have diabetes Diabetes, whether it's type 1 or type 2, is not an easy condition to live with. It is unrelenting in its daily demands and people often report feeling isolated and lonely as they have to deal with their diabetes management by themselves for most of the time. This year Diabetes NZ decided to devote Diabetes Awareness Week to raising awareness of the services we offer to support people with diabetes and their families. The key message was ‘If you have diabetes, we can help.’ To this end, our branches ran local events up and down the country, including information days and stalls, family days, school mufti days and lighting local buildings blue. Our branches got the message out there among tens of thousands of Kiwis. Diabetes NZ also sent diabetes resources to every GP and pharmacy to put up or distribute to their patients and customers. We had an amazing week and the feedback was very positive. Thanks to all of the branches, organisations and individuals who helped make the week a success. Thank you also also to marketing expert Michael Goldthorpe, of Hunch, who helped us create the ideas behind Diabetes Awareness Week.

IF YOU HAVE

DIABETES WE CAN HELP. You don’t need to go it alone. Diabetes New Zealand is here to help. Call 0800 DIABETES or go to diabetes.org.nz to find a helpful branch near you.

How can Diabetes NZ help? National office

Local branches

• Offers support and information to help people take charge of their health and live well with diabetes. • Represents people with diabetes and lobby for better services. • Raises awareness about the challenges faced and the things people can do to avoid diabetes complications. • Raises awareness in the community of what people can do to try and avoid developing type 2 diabetes. • Supports research into diabetes.

• Run support groups where people can meet others who understand the challenges of living with diabetes. • Offer information and education sessions so members can learn more about diabetes. • Organise social events to meet people with similar challenges in a relaxed, fun setting. • In some areas, run supermarket tours to help people learn about food labels and making healthy food choices. • Distribute regular newsletters packed with information about diabetes and what’s happening locally.

Long-term diabetes awareness programme Diabetes New Zealand has a key role to play in raising public awareness about the long-term implications of diabetes. Over 225,000 Kiwis have diabetes and every day 50 more people are diagnosed. And the worst is yet to come with one in five people having pre-diabetes, which can develop into full-blown type 2 diabetes unless they take steps to improve their health. There is a lot that needs to be done on many fronts to address this looming crisis. Diabetes NZ acknowledges its role in this work and believes the first step is to increase public knowledge and awareness. We need to address the national knowledge gap about diabetes and the potential future cost to the country to treat type 2 diabetes and diabetes complications. Diabetes NZ launched a long-term diabetes awareness programme in October with funding from the Lion Foundation and Pub Charity. We developed a campaign platform, and have undertaken a small amount of marketing activity. We are very grateful to these funders for helping us get off the starting block. Our aim is to raise enough funds to sustain the programme over future years to increase diabetes awareness and encourage people to live healthier lives. The campaign takes a light-hearted approach. We feel the use of humour is a good way to get people to let down their guard and be more open to the serious message they may not otherwise hear. For more information check out the website: www.thedangerisreal.co.nz or call Diabetes NZ on 04 499 7145.

If it happened suddenly, you might take it more seriously. Type 2 diabetes isn’t sudden; it’s a slow attacker that you invite in over years of unhealthy diet and exercise. Diabetes can lead to heart and kidney disease, you can lose your eyesight and you may even lose your feet or legs. Don’t become a victim; find out what you can do now to avoid type 2 diabetes later, text DANGER to 515 to find out more.

5716DNZ Diabetes NZ A3 Poster_FA.indd 1

DIABETES | Summer 2013

To find out more:

Text danger to 515

thedangerisreal.co.nz

Diabetes, the danger is real. INSIGHT 5716

Diabetes Awareness Week was all about letting people with diabetes know they are not alone and Diabetes NZ is there to help, as communications manager Lisa Woods explains.

19/09/13 2:39 PM

J O H N M CL A REN YO UTH AWA RDS

COM MUNITY

In pursuit of excellence The John McLaren Youth Awards recognise the pursuit of excellence by young people with diabetes across cultural, academic and sporting fields. Diabetes Youth New Zealand has chosen two teenagers from Auckland as the 2013 award winners. Max Burney and Jack Timings each won $1000.



Max Burney

Jack Timings

Max submitted his entry under the academic category. He used his prize money to attend the International Youth Sports Science Conference in Singapore, which was attended by young people from around the world. Max, 18, is the deputy head boy of Takapuna Grammar School. He enjoys physics and chemistry, and is a keen rower. He said: “I saw this conference as the perfect opportunity to bring my passion for sport and science together. Seeing what developments have been made in the field of sports nutrition was particularly interesting. Having diabetes and playing an intensive sport has made me see firsthand the spectacular benefits of a well thought out and balanced diet.”

Jack submitted his entry under the cultural category. Jack has been chosen to take part in the New Zealand Secondary Schools Choir. The choir, which consists of just 60 pupils, is preparing for a 17-day tour of South America next year. Jack, who is 17 years old and attends Rosmini College, in Takapuna, will be one of the tenor soloists. The choir will attend the International Society of Music Education world conference on music education, in Brazil, which will bring together musicians, researchers, scholars and theorists. The choir will also spend four days in Buenos Aires, Argentina, where they will perform, meet other choirs and hopefully learn to tango! The choir is due to hold concerts in Christchurch and Auckland before leaving.

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Summer 2013 | DIABETES

THE L AS T WORD

D IAMANAGE APP TA KES O FF

Students win innovation prize for diabetes app Two students have won a $10,000 prize after designing a new digital tool to help people simplify their blood glucose management. Cameron Kilgour and Deinika Elston are planning to turn their idea into an easy-to-use diabetes app, called Diamanage, which will help people with diabetes monitor and manage their condition while out and about using their smartphone. The Diamanage app will allow users to search food databases, use an insulin ratio calculator, log their food and daily blood glucose test results, send the result to their diabetes doctor or nurse and locate heath professionals and pharmacies if they happen to find themselves in an unfamiliar place. The idea behind Diamanage arose from personal need. Three years ago, Cameron, 21, was diagnosed with type 1 diabetes. He found it difficult to manage his diabetes and decided to find a solution. He said: “I was struggling after I was diagnosed with things like the carb counting. I always had my smart phone with me and I wanted to develop something that was easy to search that gave me some insulin guidelines and the idea developed from that." Cameron did some research and found that nothing was available that combined all the facets of managing type 1 diabetes. He wanted a mobile solution that would help people manage their diabetes while on the move, with all the information kept in one place.

DIABETES | Summer 2013

Cameron Kilgour and Deinika Elston are developing a new diabetes app.

The first version of the app will cost $18,000 to develop and will be tested with an initial group of 50 people. It will include a diary module and food database, with a charting and exporting function that simplifies the management of glucose consumed and insulin needed. The next versions will add extra functions including healthcare provider locators, prescription and appointment reminder functions. Cameron and Deinika, who are both in their final year of a Bachelors of Applied Visual Imaging at UCOL (Universal College of Learning), Palmerston North, entered Diamanage into Innovate 2013, an entrepreneurship competition. The pair faced stiff competition to win Innovate and scooped $10,000 to help develop their app. The competition includes guidance and expert support on how to turn an

idea into a marketable product and thriving business. They have developed a team of supporters and partners including Peter Vullings, CEO of app developers Pixelthis, and 2011 winner of Master Chef Nadia Lim, who is also a dietitian specialising in diabetes education. Now Cameron and Deinika are getting on with the job of setting up a business to develop and market the app. “We met with an accountant for advice on setting up the business and registering the company and we’re in the process of gathering quotes from app developers,” says Cameron. Created in 2011 by BCC, Innovate has received more than 780 ideas over the past three years. This year 182 entries were accepted.

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