Diabetes Summer 2014 by Diabetes New Zealand

Diabetes Summer 2014

Living well with diabetes

Cameron Jones MY DIABETES LIFE

TRANSITION TIME A guide to starting on insulin if you have type 2 diabetes

Solo cycle challenge:

Pedalling 2,000kms for diabetes

Mobile health

TEXT MESSAGING GETS THE â&#x153;&#x201D; FOR DIABETES CONTROL

the 5:2 diet + towards a cure + edible flowers

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Diabetes: the national magazine of Diabetes New Zealand | Vol 26 no 4 Summer 2014

INSIDE summer 2014 4 5

From the Chief Executive From the President

Gardening

16 Growing edible flowers

Upfront

Care and prevention

18 Text messaging improves

News, views and research

Focus

10 T ransition time: Type 2 and starting insulin Treatment

diabetes control

Profile

Research

20 Volunteers needed for 5:2 diet study

Community

13 The bionic pancreas

Diabetes Awareness Week

Living with diabetes

21 Ten key messages

14 Tony Hall: celebrating four

decades of powerboat racing

22 Cameron Jones interview 24 IDF global diabetes scorecard 25 Biking 2,000km for diabetes Food

26 Alison Pask:

Community dietitian

28 Recipes: Summer salads Let's get active

30 Summer exercise ideas Diagnosis

32 Things I wish my doctor had told me

The last word

34 EDOR celebrates 10 years

COVER PHOTO ÂŠ South Pacific Pictures

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 342 238 Email: admin@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 342 238 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

Farewell from me The year is drawing to a close and 2015 will mark a new chapter for Diabetes New Zealand. After four and a half years as Chief Executive, I will be moving to a new role in the health sector and handing over to a new CEO who will lead the organisation during the next stage of its development.

major undertaking, but an essential one in terms of building cohesion through a common structure, strategy, policies and procedures. This, in turn, has provided a funding platform to allow us to deliver on a number of things such as relocating and expanding our national office premises, redesigning our magazine, developing a brand new website, partnering with Refract Group and New Zealand Society for the Study of Diabetes to develop healthmentoronline.com, and delivering our national conferences every year.

Reflecting on my time with Diabetes NZ one of the first things that springs to mind is the unique reward of helping to unite a team of a few paid staff and many volunteers to support people living with diabetes. And second, the particular challenges (faced not only by our own organisation but many others in the not-for-profit sector) of building financial sustainability for the medium to long term.

Importantly this funding has also helped us improve the quality of our educational pamphlets, and recently we have had our two most requested pamphlets translated into Chinese. Last month we recorded our largest ever pamphlet distribution figure (over 31,000)!

The restructure of Diabetes NZ that formally started in 2010 was a

A major and significant achievement was working with several other charities and the Ministry of Health to submit New Zealand’s views to the United Nations Summit on NonCommunicable Diseases (NCDs)

in 2011. Our submission was supported and was successful and has paved the way for a worldwide response to non-communicable diseases, including diabetes. With the foundations laid, Diabetes NZ is now poised to move to the next level. We have recently employed a dietitian at national office to provide professional support on nutritional issues, and we are looking to further grow the team to meet the demand for our services. I would like to thank you for your continued support and encouragement. I truly believe there are exciting times ahead for Diabetes NZ and I know I will be handing over an organisation that is in good health and in very good heart. Thank you again. Best wishes

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 Diabetes NZ today for $35 waged (or $27.50 unwaged). Membership includes magazine subscription. Email: admin@diabetes.org.nz or call 0800 342 238 to find out more.

DIABETES | Summer 2014

FROM TH E PRESIDE NT

Let’s not play the blame game A while ago I heard the television show Shortland Street had screened an episode focusing on a mum, encouraged by her kids to go to the clinic because of having blurred eyesight, being diagnosed with type 2 diabetes. I watched the episode on TVNZ On Demand and while it’s good to see serious medical conditions like diabetes featured in the storyline, the way it was handled was disappointing. Even allowing for the ratings requirement of melodramatic TV soaps, the angry ‘blaming and shaming’ simply reinforced the false and widespread perception about what causes type 2 diabetes. Let us be clear – many people with type 2 are no less responsible for getting it than those with acuteonset type 1 (an auto-immune disease). While it is true body size and shape is a modifiable influence in the development of diabetes, it is only one in a much longer list of risk factors that can’t be changed. This

list includes age, ethnicity and family history. If metabolic syndrome (raised blood pressure, increased cholesterol) is a part of a person’s make up, the chances of them developing type 2 are undeniably high – no matter how skinny they are. And there are plenty of skinny people who get diabetes. I admit to frustration at the automatic coupling of a) obesity and b) diabetes. The relationship is far from linear between the two and I think it creates an unnecessary burden of prejudice. Of course those who do carry the immovable risk factors certainly help themselves by losing weight and being physically active. This can at least delay (and possibly avoid) the onset of type 2 diabetes and will reduce the onset of complications. But let’s stop beating up on folk! The burden of diabetes is heavy enough without further unnecessary baggage. And that includes from people with type 1, some of whom can be inclined to virtuousness on account that they did nothing to cause their condition.

because there is too much sugar in our bodies and in their not understanding, they simplistically think it is because we have eaten too much of it! These attitudes are not new. When I was diagnosed as a child in the mid 1960s, people assumed I had diabetes because I had eaten too much sweet food. Back then type 2 was almost unheard of and there seemed a greater awareness of type 1 because people always associated it with having daily injections. And that was horrific to most. Let’s put our energy into educating people positively. It will take time but you know what – we are making progress. Of that I am sure! Keep well and enjoy summer.

Chris Baty National President

We all agree diabetes is complicated and most people simply don’t understand it. They know it happens

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 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

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 a donation 0800 DIABETES (0800 342 238)

Summer 2014 | DIABETES

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UP FRO NT

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NEWS, VIEWS AND RESEARCH

35 M Islet cell transplant milestone

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Western Pacific WP

Increase in diabetes cases worldwide Middle east and north africa MenA

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An American patient Eight per cent of adults in the world have diabetes, south-east asia SeA with type 1 diabetes has according to new20 figures published by the M 24 M International Diabetes become the first person Federation. The number in the world to be of cases continues to rise with an estimated 387 south and central africa AFR aMerica SAcA given an experimental million people having the condition in 2014. This encapsulated beta cell figure is set to climb to beyond 592 million by 2035. replacement therapy The figures are called VC-01TM. The therapy involves putting humancontained in the derived stem cells with the potential to mature and 2014 update of the produce insulin in a protective barrier and implanting WorlD Diabetes Atlas. The them in the body using a minimally invasive procedure. IDF says the latest 46% Once matured it is hoped the encapsulated immature undiagnosed people living figures hide the true with human islets will sense a person’s glucose levels and incidence of diabetes diabetes produce insulin, while the barrier shields them from the because an estimated body’s type 1 autoimmune attack as well as foreign graft 179 million, or almost rejection. The research is being funded by the Juvenile half of all people Diabetes Research Foundation (JDRF), America’s leading with diabetes, are undiagnosed and at a higher risk IDF Diabetes Atlas I Sixth charitable funder of T1 treatment research. For details of developing harmful and costly complications. see www.jdrf.org. The human and economic burden of diabetes in 2014 was enormous. For example, the IDF claims Welcome Margaret (Meg) Thorsen that every 7 seconds a person dies due to diabetes and the equivalent of US$ 612 billion is spent Diabetes New Zealand is treating diabetes. delighted to welcome Margaret Thorsen as National Office’s new dietitian. Margaret’s role NZ’s nurse prescribing project will include helping our staff A New Zealand study of the safety and effectiveness and volunteers provide trusted of diabetes nurse specialist prescribing has nutritional advice. Margaret has concluded it was: “safe, of high quality and worked as a clinical dietitian appropriate, afforded important benefits to in hospital and community specialist diabetes services, was accepted by patients settings, as well as for the Heart and supported by the wider healthcare team.” Foundation. She joined us in November and is based in our national office in Wellington. You can contact her on The study looked at the qualitative results of the initiative, which was first introduced in New (04) 4997143 or email meg@diabetes.org.nz. Zealand in 2011 with 12 diabetes nurse specialists involved in the first stage of the rollout.

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Metformin beneficial for cancer patients Cancer patients with concurrent diabetes had a lower risk of death from any cause if they were receiving metformin, particularly if they had breast, colorectal, ovarian or endometrial cancer.

Commenting on the study endocrinologist Dr Jeremy Krebs said that while the results of observational study were encouraging, a random controlled trial was needed to truly test the hypothesis. “Sadly I can’t see this being conducted as there is very little commercial opportunity to drive funding. I still think metformin should be put in the drinking water along with fluoride!” Diabetes Obes Metab 2014;16(8):707–10

J Clin Nurs 2014;23(15–16):2355–66

Harvard stem cell hope Scientists claim to have discovered how to make huge quantities of insulin-producing cells from stem cells – enough to be transplanted into human patients with type 1 diabetes. It marks the culmination of 23 years of research for Harvard professor Doug Melton who has been trying to find a cure for the disease since his son Sam was diagnosed with type 1 diabetes as a baby. www.harvardmagazine.com/2014/10/melton-creates-beta-cells

Stop press! Check out Diabetes New Zealand's new website www.diabetes.org.nz 6

DIABETES | Summer 2014

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For more information talk to NZMS Diabetes P 0508 634 103 W www.nzms.co.nz E nzms@nzms.co.nz IMS Health Data, Oct 2012 - May 2014. 2 Dexcom G4 PLATINUM Continuous Glucose Monitoring System User’s Guide (LBL-011797) 3Proven waterproof for up to 24 hours at a depth of 3.6 meters. CGM readings may not be displayed when in water. Please note CGM consumables are not currently funded. Always read the manufacturer’s instructions and use strictly as directed. Contact NZMS Ltd for detailed indications for use and safety information. ANM-14-4228A 10/2014 NZ. TAPS NA7466.

UP FRO NT

NEWS, VIEWS AND RESEARCH

Unlocking the root cause of diabetes

Diabetes Awareness Week success

Toxic clumps of a hormone called amylin could be the root cause of both type 1 and type 2 diabetes. The findings raise the hope that a new class of diabetes medicine can be developed to slow down or ultimately cure both types of the disease.

Blue breakfast events in Auckland and Southland were among the many highlights of Diabetes Awareness Week 2014 – offering a chance to promote healthy eating and a fundraising opportunity at the same time. Diabetes NZ Auckland branch’s event took place on the waterfront with the Comvita store. Early morning commuters were offered free smoothies and cereal packets, and encouraged to pop a donation into collection buckets. The branch also organised a Blue Circle of blue tee shirt clad volunteers to photograph for the IDF atlas.

Leading Kiwi scientist Professor Garth Cooper believes his research team has pinpointed the mechanism leading to the development of diabetes. Amylin is a hormone produced by the pancreas alongside insulin. Insulin and amylin normally work together to regulate the body’s response to food intake. However, some of the amylin that is produced can get deposited around cells in the pancreas as toxic clumps, which then, in turn, destroy those cells that produce insulin and amylin. The consequence of this cell death is diabetes. Research published previously by Professor Cooper suggested that this is the causative mechanism in type 2 diabetes. This new research provides strong evidence that type 1 diabetes results from the same mechanism. The difference is that the disease starts at an earlier age and progresses more rapidly in type 1 compared to type 2 diabetes because there is more rapid deposition of toxic amylin clumps in the pancreas. The study was led by Professor Garth Cooper and involved researchers from the University of Manchester alongside his University of Auckland-based research team. The results, based on 20 years of work in New Zealand, suggest that type 1 and type 2 diabetes could both be slowed down and potentially reversed by medicines that stop amylin forming these toxic clumps. Professor Cooper’s group expects to have potential medicines ready to go into clinical trials in the next two years and it is anticipated that these will be tested in both type 1 and type 2 diabetic patients. These clinical trials are being planned with research groups in England and Scotland. The study was published in the FASEB Journal in August. See www.fasebj.org.

Meanwhile down at the other end of the country, Southland branch volunteers also held a Go Blue for Breakfast event followed by guest speaker Jason Shon Bennett, a health researcher, health mentor and author of best-selling book Eat less, live long. The global Go Blue for Breakfast campaign was organised by the International Diabetes Federation to mark this year’s World Diabetes Day on November 14. Other Diabetes NZ branches were out in force awareness raising and fundraising – some in local New World and Countdown supermarkets distributing pamphlets and selling raffle tickets to shoppers. Shortland Street actor Cameron Jones hit the awareness trail on behalf of Diabetes New Zealand (see our profile on p22) and was featured in a range of local and national media. There were also articles about diabetes in major newspapers, on the radio and tv. Diabetes NZ’s National Communications Manager Nicky Steel said Diabetes Awareness Week 2014 had been a great success, commenting: “It’s a testament to the hard work of hundreds of volunteers up and down the country. The week was a wonderful opportunity to get the message out that diabetes can strike any person at any time of life and that if it does touch your family, Diabetes NZ is there to help.”

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DIABETES | Summer 2014

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

FO CU S

T YPE 2 AND MOVING TO INSU LI N

Transition time Many people with type 2 diabetes have a real and deepseated fear of starting on insulin. But experts say the move to insulin can be seen as a positive step with people experiencing more energy, more control and fewer complications. Diabetes nurse specialist Gavin Hendry lays to rest some of the fears some may have about transitioning to insulin therapy.

Lesley was holding the needle looking worried. I said “quickly and smoothly let it go in”. After taking a couple of deep breaths she slid the needle in and immediately her facial expression turned to relief as the realisation dawned – it wasn’t difficult at all. “That didn’t hurt a bit,” she said. Maybe you’ve had diabetes now for quite a few years and your doctor has been saying lately ‘Your blood glucose control is not good enough and it could be time to start insulin’. With type 2 diabetes it is likely that at some point it will become necessary to use insulin. Unfortunately starting insulin is often delayed longer than it should be. The thought of having to inject insulin fills many people with dread. In this article we want to put to rest some of the fears or concerns people may have that tend to delay the commencement of insulin therapy. Let’s look at a few questions you may have.

If I have to go onto insulin does that mean I have failed to look after myself adequately? In type 2 diabetes, as the years progress, the body becomes less and less able to produce the amount of insulin required and needs more help to keep the blood glucose on target. Eventually insulin therapy may be required to control glucose levels adequately.

Why can’t we just treat diabetes with tablets? For tablets like metformin to work properly there needs to be enough insulin supply. They won’t work effectively unless there is a sufficient level of insulin being produced by the body. Insulin can’t be given orally either because it just gets destroyed in the stomach.

DIABETES | Summer 2014

I don’t feel unwell. Why don’t I just continue the way I am and wait until the diabetes gets worse before starting insulin? Even though you may be feeling OK we know that high glucose levels will be damaging your body and increasing the risk of severe health problems occurring. This can happen without symptoms and you may not realise until it is too late and the damage is done. We do know that if we introduce insulin earlier and improve diabetes control, the likelihood of developing serious health problems can be reduced. Why wait? Get treated now and improve your future health.

What are the benefits of moving to insulin? It often surprises people that once they start insulin and improve their glucose levels they find that they feel better and more energised. People often don’t realise that they have been functioning at less than their potential for some time.

I can’t bear the thought of using needles. Aren’t they painful and isn’t it difficult? Fear of needles is very common but most people discover this is the easiest part. The needles for insulin are very fine, small and are hardly felt. They certainly hurt less than lancing your finger to test your glucose level. If you can do that, then taking insulin will be easy for you. Insulin is given using an insulin pen. These devices contain many days of insulin supply. When it is time for an injection the dial is simply turned to the required amount, as discussed with your doctor or diabetes nurse, and administered under the skin.

TYPE 2 A ND M OVI NG TO I NS ULI N

FOCUS

Transitioning to insulin

There is no need to find veins or special places to put it. It is simply injected into the skin on your abdomen. Your doctor or nurse will carefully explain how to do this before you start. After you have done it a couple times you will feel confident about it.

If I start insulin will this mean that I now have type 1 diabetes? Being treated with insulin does not mean you have type 1 diabetes. It is true that everyone with type 1 diabetes must have insulin but there comes a time for many people with type 2 diabetes when they need supplementary insulin in the form of injections too. This is because their own insulin production is insufficient.

BENEFITS

DISADVANTAGES

• Improves energy, health and mood. • Reduces symptoms of high blood sugar, such as the frequent need to urinate. • Cuts the risk of serious complications, for example heart attacks, stroke, amputations, blindness and kidney disease. • Takes pressure off the pancreas by reducing the need for it to produce insulin.

• Raises the risk of having a ‘hypo’. • Can promote weight gain. • Daily injections must be administered. • Could affect employment if you drive for a living. For details see www.nzta.govt.nz.

If I start insulin will that mean I am on insulin for the rest of my life? Once the insulin doses have been adjusted to suit your requirements your diabetes control improves. It would be silly to stop the insulin if it is helping to control your diabetes well. Therefore it is likely that most people will be on insulin for the rest of their lives as long as it is doing a good job.

If you disregard your diet then it is likely that your diabetes will be difficult to control, you will need to take more insulin and you could gain further weight. This in turn can make the diabetes more difficult to control.

What are the side effects of being on insulin? Does insulin increase the risk of hypoglycaemia (hypo)?

Improving blood glucose control to target levels can increase Some people with type 2 diabetes the possibility of having a hypo manage to come off their insulin or (abnormally low blood sugar). It is at least reduce the doses required important that regular blood glucose if they exercise sufficiently and monitoring is performed when you ensure they are eating only small to start insulin so that the right dose of moderate amounts of carbohydrate insulin can be identified. Your diabetes and they lose weight. These lifestyle nurse or doctor should be in regular considerations remain important contact with you while the doses are even when being treated with insulin. being optimised. If someone is having

Fears ill-founded Diabetes New Zealand President Chris Baty (pictured left) advises people with type 2 diabetes not to worry about moving to insulin if that is what their doctor recommends. She said: “Most of the fears or resistance people have about moving to insulin are understandable but worse than reality. Being on insulin doesn’t mean you have type 1 diabetes. Many people think this is a more ‘serious’ diabetes – it isn’t. But this is a real and deep-seated fear. These negative feelings about moving to insulin can make the transition harder. One of the key things to remember is that you will likely feel far better and have more energy on insulin.”

Summer 2014 | DIABETES

FO CU S

T YPE 2 AND MOVING TO INSU LI N

a lot of hypo events then the insulin dose probably needs reducing or a change to a different type of insulin may be recommended. Everyone should also learn about the signs of a hypo, how to treat it and the ways you can avoid it in the first place. In general hypoglycaemia is less common in type 2 diabetes than in type 1 diabetes. Maintaining a regular daily routine also helps to lessen the risk.

Will insulin make me put on weight? When insulin is first started it is quite common for people to experience a small amount of weight gain but this is usually just in the first few months This occurs because the body can process energy more efficiently

when on insulin and less energy will be sitting in the blood unutilised or getting lost down the toilet. The benefits of improved glucose control on long-term health outweigh the small increase in weight that may occur after starting insulin. It is important, of course, that you are not eating more energy than your body needs. Like anybody, including those without diabetes, if you eat more than you need you will put on weight.

How much will being on insulin affect my daily life? Insulin is usually needed at certain times of the day. It is usually easy enough to include this in the daily routine.

Does it make life more difficult or easier? Most people are pleased to find that at last they are using something that has a direct impact on improving their glucose levels. People find they can be much more proactive in controlling their glucose levels and as a result often feel more energised and more able to be active. Once the dose is stabilised and glucose control has improved they generally find that they are feeling better about themselves, their health and life in general. So next time your GP suggests you start insulin, don’t put it off. It’s really not as hard as many might think and it will make a positive difference to your health in years to come.

THE BEST THING I’VE EVER DONE Margaret Murphy, 67, from Dunedin, started insulin therapy about 18 months ago after 10 years living with type 2 diabetes and eventually finding she was unable to keep her blood sugar under control. The tablets weren’t working and she was lacking in energy, was unable to lose weight and was feeling like diabetes was getting her down. On the advice of her GP, she stopped the tablets and moved to five insulin injections a day. At first it was hard and she nearly gave up because she didn’t like the way the change in treatment made her feel unwell. But now, after 18 months, she says it was the best thing she has ever done. She has more energy, has lost weight, walks six days a week and says life is good. “I could never tell with the tablets whether it [my diabetes] was going right or not. Eventually it got to the

DIABETES | Summer 2014

stage where it was completely out of control and the tablets weren’t working”, she said. “I was apprehensive but I felt I couldn’t go on the way I was going. I also worried about what would happen if the insulin didn’t work. “However one year on it was the best thing that ever happened. I have now got the diabetes under control. It’s given me a lot more energy. “I had the energy to change my diet and give up sugar. I’ve lost about eight kilograms. Having more energy also meant I could start walking regularly and I now walk half an hour six days out of seven. “It wasn’t easy at first, my body had to adjust to the insulin and I almost gave up at the beginning, so it wasn’t an instant benefit, it took some months before I started feeling better.”

“I have now got the diabetes under control. It’s given me a lot more energy.” — MARGARET MURPHY

TH E BI O NI C PA NCREAS

TREATMENT

Building an artificial pancreas – can it be done?

A team of researchers is working on the ‘holy grail’ of diabetes treatment – an artificial pancreas that makes automatic decisions about the amount of insulin and glucagon needed to regulate blood sugar, removing the need for patient input. The team led by Dr Steven Russell, of Harvard Medical School, published research following the first worldwide test of the ‘bionic pancreas’ over several days in unrestricted outpatient conditions. The bionic pancreas outperformed an insulin pump, according to the study published earlier this year by the New England Journal of Medicine. The research found people with type 1 diabetes who used the bionic pancreas - instead of manually monitoring glucose using finger prick tests and delivering insulin using a pump – were more likely to have blood glucose levels consistently within the normal range, with fewer dangerous lows or highs. The Bionic Pancreas project is now raising funds to continue its research with plans to conduct further clinical studies in 2016. Dr Russell told Diabetes: “Right now we are doing a multi-centre home-use study at four sites in the US. Volunteers use the device for 11 days while they do their usual routines (home, work, recreation) without any restrictions.

CREDIT: ADAM BROWN DIATRIBE.ORG

The Bionic Pancreas Team is a group of US researchers from Boston University and Massachusetts General Hospital. They have teamed up to try and make automated blood glucose control a reality. Caroline Wood reports.

From right, researcher Dr Steven Russell with Frank Spesia and Colby Clarizia, two participants in a type 1 diabetes trial testing an electronic device called a bionic pancreas – the cellphone-sized device is shown.

We send them off after training and don’t see them again until the end of the study (although we’re there for technical support if they need it). We compare that 11-day period with another period of the same length during which they manage their own diabetes with their pump and we collect data with a blinded CGM [continuous glucose monitor]. We plan to be doing a large pivotal trial by 2016.” Dr Jeremy Krebs, endocrinologist and editor of New Zealand’s Diabetes and Obesity Research Review, says the bionic pancreas project has the potential to make an exciting breakthrough in diabetes treatment. Commenting on the New England study, he said: “Is this the Holy Grail that people with type 1

diabetes have been waiting for – the artificial pancreas? It would seem to have many features that make it very close, such as closed loop, intelligence, tight control with pretty low rates of hypoglycaemia. The combined use of insulin and glucagon makes physiological sense. “This study was testing the device in a real-world setting, but only over a very short period. The next step is of course to establish whether this can be replicated with ongoing use over a longer time period and under more varied and extreme conditions. Cost aside, this is an exciting development in the management of type 1 diabetes.” For more information see http:// sites.bu.edu/bionicpancreas/

What is the bionic pancreas? Engineers from Boston University developed a bionic pancreas system that uses continuous glucose monitoring along with subcutaneous (via the skin) delivery of both rapid-acting insulin (to lower blood glucose) and glucagon (to raise blood glucose) as directed by a computer algorithm. The bionic pancreas automatically makes a new decision about insulin and glucagon dosing every five minutes – that's 288 decisions per day, 7 days per week, 365 days per year. Experts hope the technology can go beyond experimental to one day directly benefit people with type 1 diabetes.

Summer 2014 | DIABETES

LIV ING W ITH D I A B E TE S

TONY'S STO RY

Power boat legend celebrates four decades racing

Tony Hall comes from a family steeped in Kiwi hydroplane racing history. He tells Caroline Wood why he is still competing after nearly 45 years in the sport. Tony Hall has been involved in power boat racing all his life. His first race was on the Wairau River in 1970 at the age of 21 years. No other hydroplane driver in New Zealand has been racing as long as Tony. He is now 65 years old and is still racing at speeds of over 230 kilometres per hour in his boat Foreno Tapware. The Hall family has power boat racing in its blood. Tony’s dad Don Hall was also heavily involved in the spectacular sport, competing against the likes of Sir Len Southward, who drove the stepped hydroplane Redhead in the early 1950s. And Tony’s two sons are also involved in racing. Brendan, 37, races

DIABETES | Summer 2014

Armageddon, while Daniel, 35, shares the driving on his dad’s boat and regularly has the crowds on their feet with his super-fast driving. Tony also has something else in his blood – type 1 diabetes. But it has never for one second held him back. Or made him think twice about being heavily involved in a dangerous sport, where a momentary loss of concentration could have fatal consequences. He said: “I find that I relax when I’m driving the boat. The faster I drive the more I relax. Yes you have to concentrate but you have to do that if you drive at 100kph or 220kph. The main difference is the noise and you certainly notice that. “On race days I make sure that my blood level is between 7 and 10 mmol/L before I climb into the boat but if you have a real hard race you can burn a lot of sugar very quickly. As soon as I take off my helmet, my son looks

into my eyes to check me over. “I always check my blood after a race. And I never hop into the boat without testing my blood sugar first even if it’s for a test run. I have never had a problem in the boat because of my diabetes.” Tony, who lives in Horowhenua Beach, Manawatu, is a life member of the New Zealand Power Boat Association for ‘services to the sport’. As well as competing in racing regattas all over the country, he also trains young drivers new to the sport and is involved in making sure the racing regattas are carried out safely. Hydroplanes are boats that skim across the surface of the water – drivers literally ‘fly’ them across the top of the water like an aeroplane. Hydroplanes only race on rivers, lakes and in harbours – where the waters are calm. Tony has won three national hydroplane race titles and about 15 island titles and has been racing for 35 seasons.

TO NY ' S STO RY

Tony was diagnosed with diabetes when he was 27 years old after a stressful event when his wife got appendicitis and peritonitis while she was pregnant. He said: “The doctors seemed to think I started showing signs of diabetes after the stress. I decided I wasn’t going to let it stop me doing anything I was planning on doing.” So he carried on playing rugby and boat racing. By his early 30s Tony was working in Australia and driving for hours by himself through outback Queensland, Northern Territory and New South Wales. “I just had to learn to control the diabetes really well. If I hadn’t, I would have been dead out there. I have never let diabetes stop me doing what I want to do.” Power boat racing is a hobby

LI V I NG WITH DI ABE TES

for Tony, who has worked at a senior management level in a variety of businesses in Wellington and Christchurch. After four decades racing, does he have any plans for retiring from behind the wheel? Tony reckons he has another two or three years of racing left in him but that will depend on how his health goes. But his son Daniel will carry on racing his boat and take the Hall power boat racing dynasty forward. Tony has a clear message for any young person diagnosed with diabetes – decide what they want to do in life then get on and do it. “Whatever you do it’s important to understand how the diabetes works but also to understand that there is really nothing you can’t do even with diabetes,” he says.

Tony Hall accepts one of his many power boating titles.

LIVING WATER

Summer 2014 | DIABETES

GARD EN I N G

FLOWERS FOR EATING

Edible flowers a feast for the senses CALEND

ULA

CHIVES

NA S

M T U RT I U

RO S E

VIOLA

Try growing edible flowers to add colour, scent and flavour to your summer food and drinks. Gardening expert Rachel Knight explains. Edible flowers to add beauty and flavour to your plate. Flowers have appealed to us since ancient times and we have a long tradition of enjoying eating them. Although a few add flavour, most are purely decorative. We can eat some whole or just sprinkle on a few petals. We can grow them in our garden or gather a few wild ones. Crops that run to seed in the heat of the summer might be over but are often a great source of flowers for the table – some in a vase and others on our plate. Many edible flowers are annuals that we can grow easily from seed. They’ll often re-sow themselves year after year once established. Most herbs have pretty flowers you can eat that taste similar to their leaves. Matching flowers with the flavour of our food works well – mint flowers on peas and rosemary flowers with lamb are good choices. ‘Weeds’ such as clover, dandelion and fennel all have flowers that are good to eat as long as we avoid picking them from plants that might have been sprayed. Flowers are best picked early in the day and eaten as fresh as possible. Sprinkle sparingly raw on a salad or, for a longer life, freezing individual flowers in ice cubes makes chilled summer drinks both pretty and refreshing. Make a floral ice-bowl by freezing petals in water between two nested bowls. It’s a great way to serve fresh fruit as a centrepiece and keep it cold in your floral ice bowl. Whether eating alone or sharing a feast with family, flowers make any food more beautiful and more delicious as a result.

DIABETES | Summer 2014

15 favourite edible flowers 1

Basil – a beautiful spire of white or mauve flowers

Borage – brilliant blue dainty flowers with a hint of cucumber.

Calendula – scatter a few bright orange or yellow petals in a salad or on a saffron risotto.

Chives – pretty purple or white blooms have a mild oniony taste.

Clover – sweet pink or white flowers with a slight suggestion of liquorice.

Coriander – quick to sprout lacy white flowers.

Dandelion – bright but bitter blooms.

Mint – some are stronger in flavour than others but all are definitely minty.

Nasturtium – hot and peppery flowers and buds

Radish – too late for the root? Enjoy a few pale peppery petals.

Rocket – slightly nutty in taste, similar to the leaves, delicately veined.

Rose – choose scented and unsprayed blooms with fragranced petals.

Rosemary – pick a few tiny blue flowers to decorate a dish flavoured with the herb’s leaves.

Sage – similar in flavour to the leaves. Crimson pineapple sage is my favourite flower to eat.

Viola – these multi-coloured friendly faces are easy to grow and scatter on a salad whole.

Diabetes Care

Helping to Manage Your Diabetes

Optium™ Ketone Test Strips

We keep life flowing

Blood Pressure Monitors

SALTER Nutri-Weigh Scales

Sharps Containers. Available in a range of sizes.

Infusion Sets Suitable for all Insulin Pump Brands

Autoject® 2

HYPO-FIT® Gel

Cooling Wallets

Diabete-ezy™ Carry Case

FreeStyle Optium Blood Glucose Test Strips: A Provisional Agreement has been made with PHARMAC to continue funding FreeStyle Optium Blood Glucose Test Strips for eligible users. Funding will continue after 1st March 2013 for those who received both Optium Blood Glucose and Optium Blood Ketone test strips on prescription prior to 1st June 2012.* FreeStyle Optium Blood Ketone Test Strips: Prescription access remains available and continues for all people with diabetes, maximum of 20 strips per prescription, regardless of which meter they use for glucose testing.* FreeStyle Optium Meter: is able to be prescribed for ketone diagnostics where the patient has had one or more episodes of ketoacidosis and is at risk of future episodes. One meter per patient will be subsidised every 5 years.*

PO Box 303 205, North Harbour 0751 0800 106 100 | info@mediray.co.nz www.mediray.co.nz Always read the label and follow the manufacturer’s instructions. Taps No: CH3147

*www.pharmac.health.nz/assets/special-authority-freestyle-optium-test-strips.pdf

C ARE A N D PRE VE NTI O N

THE POWER O F TECH NO LO GY

Text messaging terrific for diabetes control Mobile health is a fast growing area that has the potential to allow people with diabetes greater support and a tool to help with managing their condition. Health psychologist Rosie Dobson, from the University of Auckland, explains how text messages can help people improve poorly-controlled diabetes. The challenging nature of diabetes management has led to the development of new innovations to support people with diabetes. Mobile health (mHealth) is the delivery of health care via mobile phone technology. It is a growing field and being used in a number of health areas such as smoking cessation, weight loss, cardiac rehabilitation and diabetes.

New Zealand innovation Research into diabetes text messaging programmes has shown promising results. This prompted teams from the National Institute for Health Innovation (University of Auckland) and Waitemata District Health Board to develop SMS4BG – Self-Management Support for Blood Glucose – a text message self-management support programme for New Zealand adults with diabetes. SMS4BG works by delivering text messages by mobile phone to people with diabetes. Messages cover a range of topics designed to support a person to self-manage their condition between appointments with their healthcare team. The core messages, available in Māori and non-Māori versions, provide information about diabetes management as well as emotional

DIABETES | Summer 2014

encouragement and support (see panel). People can also choose to receive extra messages on topics such as insulin, diet, exercise, and stress management. Further, there is the option to receive blood glucose monitoring reminders at a frequency determined by the individual. Providing people with a choice of message types and frequency allows SMS4BG to be tailored to individual preferences. Participants do not have to respond to the messages unless they opt to reply with their blood glucose level. There is an accompanying website, where participants and clinicians can view a graph of the blood glucose responses they have sent in.

Trial a success A pilot study to find out whether SMS4BG is acceptable and useful for people with diabetes was carried out last year in Auckland. A total of 42 people with diabetes were recruited through their GP practice, diabetes clinic or a community organisation to take part in the three-month study. Participants had type 1 or type 2 diabetes, were aged 16 to 69 years and owned a mobile phone. To take part participants had to have had an HbA1c result of over 70mmol/mol in the last 12 months. Participant perceptions of the programme were obtained via

There is no quick fix to diabetes but with good management it will have less impact on your life and leave you more time to do the things you enjoy.

semi-structured phone interviews conducted with participants at completion of the pilot. We found that those who used SMS4BG found it to be useful as well as appropriate to them. Many people reported that receiving the messages had a positive impact on how they were managing their diabetes. For example, 77 per cent of people we spoke to reported that they thought the messages increased how often they tested their blood glucose and 82 per cent reported that it had a positive impact on their overall blood glucose control. Many participants also reported a positive impact on their diet, level of exercise, mood and knowledge of diabetes (see right).

Positive HbA1C impact In addition, the findings from the pilot study indicated a positive impact on glycaemic control with a mean decrease in HbA1c from baseline to follow up in those participants for which results were available. Although people were largely positive about the programme, the cost of replying to messages meant that some people were not able to text back their blood glucose results. And some participants said they wanted the programme to go on for longer

THE POWER O F TECH NO LO GY

Kia ora. Control of your glucose levels involves eating the right kai, exercise & taking your medication. Your wha¯nau, doctor & nurse can help you.

Unopened insulin should be kept in the fridge. Don’t use insulin that has changed colour, lumpy, expired, cracked or leaking, has been frozen or too hot.

Above: Examples of text messages sent in study.

and have the option of choosing the timing of their messages. Many participants also wanted the option to be able to text in questions about their diabetes. The findings suggest that SMS4BG is acceptable and useful in supporting self-management in people with poorly-controlled diabetes. Further development of SMS4BG is under way and a trial of its effectiveness in a larger group of patients is planned. We are working on further improvements based on the feedback we received, such as allowing people to choose the timing of the messages. We would like to thank all those involved in the development of the programme and pilot study, staff at the recruitment sites and pilot study participants. Waitemata District Health Board funded the development of SMS4BG and the pilot study.

Further information If you are interested in hearing more about text messaging self-management support tools for people with diabetes please contact Rosie Dobson (r.dobson@auckland.ac.nz) at the National Institute for Health Innovation.

Good management of your diabetes and your future health includes not smoking, call Quitline on 0800 778 778 for support.

CARE AND P RE V ENTION

Hi [name]. Just a reminder it is time to check your blood glucose. Reply with the result.

Study participants liked the text messages… “When in denial it can go on for days on end but daily messages didn’t allow you to do this. They were a constant reminder that you are in charge of your own destiny.”

me ave abetic, g t I i “ s a d ls like A . l o ee r cont etimes f control. m it so n’t have , I can e do ed m s.” you d n i i It rem ntrol th co

“It w he to s lpful, i as ver e y t and ek help remind take family from m ed me a t y gluc he read nd that friend s i o I sh ng se dow n m . I have s of the ould yb b b I did lood g een no lood tin n’t d luco o be se w g hich fore .”

“Diabetes can be a bit lonely and it felt like sometimes you had someone there to cheer you along.”

“It gave me a sense of hope. Prior education focused on the negatives, I was told I would lose my feet and go blind, your messages gave me hope that it doesn’t have to end that way.”

Summer 2014 | DIABETES

RES EA RCH

INTERMITTENT FASTING

5:2 diet study needs volunteers Volunteers are needed for a study of what is known as the 5:2 diet to see if it is safe and effective for people with type 2 diabetes. Pip Cresswell, from the Centre for Endocrine Diabetes Obesity Research, explains. The number of New Zealanders who are overweight has increased significantly over the past few decades. There are many reasons for this but one of the main ones is the increased availability of energy rich foods. Calories are one way of expressing how much energy each food product contains. We know that reducing the number of calories a person eats in a day will result in weight loss if this is continued over time. We also know that diets that require significant caloric restriction over a longer period of time are hard to stick to. For this reason these diets are frequently unsuccessful. Recently there has been interest in studying diets that restrict caloric intake, but do so in potentially more tolerable ways. The 5:2 diet (otherwise known as intermittent fasting) has gained popularity in the media as a way of achieving this, and has been endorsed by a number of celebrity figures. The diet requires participants to restrict their caloric intake to a quarter of the recommended daily intake (500 calories per day for women and 600 calories per day for men) for two ‘fasting’ days of the week. Food intake on the remaining five days is not restricted, however, participants are encouraged to maintain a healthy diet on these non-fasting days.

DIABETES | Summer 2014

“Previous research has shown that even reasonably small amounts of weight loss (3-5kg) can result in significant improvements in diabetes control.” — PIP CRESSWELL

The Centre for Endocrine Diabetes Obesity Research (CEDOR) at Wellington Hospital is looking for participants with type 2 diabetes, who have a BMI of 30 or more, to take part in some research into the 5:2 diet. The study aims to look at the effect on weight and diabetes control of a large reduction in food intake on two days in every week in people with Type 2 diabetes. Type 2 diabetes most commonly occurs when the body becomes resistant to insulin. Insulin is a hormone made in the pancreas and is the most important regulator of your blood sugar levels. We know that being overweight is the most common cause of your body becoming resistant to insulin. Therefore, weight loss is a very important part of treating type 2 diabetes. Previous research has shown that even reasonably small amounts of weight loss (3-5kg) can result in significant improvements in diabetes control.

This study will assess how safe and effective this diet is in people with type 2 diabetes. The researchers are interested in studying the effect on participants’ blood sugar levels on fasting and non-fasting days, changes to diabetes medications that are required when using this diet, changes in weight and hormone levels that are known to be important in weight regulation, and how well the diet is tolerated. If you might be interested in taking part in this trial, which takes place early next year, and can easily come to appointments at Wellington Hospital please contact the researchers on diabetesresearch@ ccdhb.org.nz or (04) 806 2458. The research team is also always keen to hear from people who would like to try out newer diabetes medications which are not available or funded in New Zealand or take part in any of our other research.

CAMPAI G N CO NTI NUES

DI A B E TE S AWA RE NE SS WEEK

Keep spreading the word The following key messages were developed for this year’s Diabetes Awareness Week campaign to help members of the public understand what diabetes is all about – and how Diabetes New Zealand can help. A copy of the yellow poster below is available to download at www.diabetes.org.nz.

DIABETES: WHAT’S THE SCOOP? 1

Anyone can get diabetes – whatever your age, weight, family history – don’t beat up on yourself if it happens.

Nearly a quarter of a million Kiwis have diabetes and at least 50 more are diagnosed every day.

3 4

You can live a full and active life with diabetes. It doesn’t have to control your life but it does need to be managed carefully. If you don’t manage diabetes properly, you can develop serious heart, nerve, kidney and other complications that may affect your longterm health.

Type 1 diabetes is typically diagnosed in younger people but it can develop in adulthood too. It occurs when the body doesn’t produce any insulin and it cannot be avoided or cured. You do not get it by eating too much sugar.

Type 2 diabetes is much more common than type 1 diabetes and affects the majority of the 243,000 people in New Zealand with diabetes.

Type 2 diabetes typically happens when your body doesn’t produce enough insulin to break down the sugars in your blood, causing levels to rise and major organ damage if not treated.

Ten key points YOU should know

You are at more risk of developing type 2 diabetes if you are older, have a family history or are of Pasifika, Māori or South Asian descent.

Being overweight and physically inactive – particularly in those over 45 – are also risk factors for type 2 diabetes.

Healthier eating and regular exercise reduces the risk of getting type 2 diabetes – and cuts the likelihood of complications if you already have it.

JUST DIAGNOSED? Get on the right path today by contacting Diabetes New Zealand. Our friendly staff and volunteers are ready to support you to live well with diabetes. For lots more information and to get in touch with your local branch, go to www.diabetes.org.nz or call 0800 DIABETES (0800 342 238).

Summer 2014 | DIABETES

P RO FI LE

CA MERON JONES

DIABETES | Summer 2014

Kiwi actor Cameron Jones was diagnosed with diabetes as a teenager but has never let it get in the way of living life to the full. The Shortland Street star hit the media trail during Diabetes Awareness Week because he wanted to do his bit to change people’s perception of the condition. Caroline Wood reports.

CA M ERO N J O NES

The first symptoms were mild but looking back, with the benefit of hindsight, Cameron Jones realises they were there. He was starring in a musical and the physical exertion of the dancing was causing him to have what he would later realise were hypos and he would go home and devour all the food in his mum’s pantry. Then he crashed his scooter and ended up with a serious leg infection. Blood tests revealed some anomalies and further testing showed he was in the early stages of type 1 diabetes. He was 16 years old, already an aspiring actor, and very busy in life – exams, sports, acting. Being diagnosed with diabetes was, he says, very overwhelming. “I had never heard of diabetes before but I burst out crying anyway. I didn’t know what it was but I knew it wasn’t good. I knew my life would change and it was too much for me. I also had a huge phobia of needles, I couldn’t inject myself for ages.” Cameron picked himself up and decided he was not going to let diabetes affect his life or his acting ambitions. The talented actor is currently appearing on our TV screens as Shortland Street’s daredevil ambulance officer Dallas Adams. It was a plum role for the 24-yearold to land following a part in Peter Jackson’s The Hobbit, as well as television roles in Passion in Paradise, Rounds and Nancy Wake – A Love Story. Born in Auckland and raised in Hawke’s Bay, Cameron became involved in drama while at intermediate school and went on to win drama awards while at high school in Havelock North. He graduated from Wellington’s Toi Whakaari Drama School in 2012 and spent a semester training at the Stella Adler Academy of Drama in Hollywood, Los Angeles.

PROFILE

“The biggest thing for young people is to not let diabetes get in the way of life. I can’t pretend it won’t change your life but don’t let it stop you doing what you want to do.” — CAMERON JONES

Like his character Dallas Adams, Jones has a passion for adrenalinebased sports and the outdoors. He loves surfing, going to the gym and watching NFL. He’s also passionate about conserving the environment and is involved with an environmental group called Generation Zero, which works to educate people about climate change in New Zealand. This year the talented actor decided he wanted to work with Diabetes New Zealand to help raise awareness of diabetes. He said: “I want other people to know that living with this condition isn’t a life sentence, but I also want people to be aware of how to look after themselves if they do have it. If I can make others aware that all types of people from all walks of life go through this – and that life can still be whatever you want it to be – then I will feel like I am doing a little bit to change the perception of the condition. “I was diagnosed with type 1 diabetes when I was 16 and ever since then I’ve lived with the condition the best way I know how – to the fullest. Originally, I thought it was going to be something that would hold me back and impact on my life in

huge ways, but I’ve learned that with careful management, and by leading a healthy lifestyle, diabetes does not have to control your life.” Learning how to manage his diabetes has been a learning curve for Cameron. He was in denial after his diagnosis and his results weren’t great. It was only last year after completing a DAFNE (dose adjustment for normal eating) diabetes management course that he really got to grips with it – and that has been life changing. “The clinic in Hawke’s Bay was amazing [when I was diagnosed] but then you’ve got to work it all out yourself. I didn’t know how to carb count, it was a lot of guess work and learning from experience. I was never on top of it until the DAFNE course last year.” Cameron says he now has great control after implementing a routine and being diligent in his diabetes care – although he is still learning and adjusting. And his advice for a newlydiagnosed young person? “The biggest thing for young people is to not let it get in the way of life. I can’t pretend it won’t change your life but don’t let it stop you doing what you want to do,” he says.

Summer 2014 | DIABETES

CO M M U N IT Y

ID F GLOBAL D IABETES S CO RECA RD

New Zealand gets a tick for diabetes care More than 100 countries worldwide participated in the International Diabetes Federation’s first global Scorecard survey consisting of 35 questions designed to measure progress on important global diabetes commitments and priorities. The Scorecard contains the views of IDF’s member associations on how far their national governments had progressed by December 2013 and sets the baseline for future monitoring. Diabetes New Zealand, which is a member of the IDF, filled in the survey on behalf of all its members. New Zealand is performing relatively well in most indicators as you can see below. OVERVIEW: New Zealand is performing strongly in monitoring and funds care to a high level. The Member Association reports

significant expectations on primary care professionals to step up and deliver the support needed for an ever-growing number of people living with diabetes. The response would be strengthened by the introduction of preventive policies. A large proportion (34%) of diabetes-related deaths have been prevented due to the relatively high level of investment in diabetes-related health expenditures.

NATIONAL DIABETES PLAN A national diabetes plan is partially implemented and a non-communicable diseases (NCD) programme is in development. The Government has established a high level group with consumer representation to review diabetes specific service issues and requirements. It has also announced a communitybased healthy families initiative to tackle the underlying causes of poor health (including obesity, smoking and excessive drinking).

ACCESS TO CARE The health system universally provides services for early diagnosis, diabetes treatment and prevention of secondary complications; primary prevention services are partially provided. Availability of self-management education is limited but specialised services are provided to a wide range of groups including women and indigenous people. At least 80% of the costs are covered.

MONITORING AND DATA COLLECTION There is a fully implemented framework for diabetes monitoring and surveillance, covering a wide range of indicators. The only exceptions are obesity , premature NCD mortality and physical inactivity.

DIABETES CONSUMER RIGHTS The Member Association is invited to participate in policy developments. The Government has run appropriate information and awareness campaigns.

DIABETES FUNDING The Government allocates specific funding for diabetes, including early diagnosis, treatment and the prevention of secondary complications.

GLOBAL MONITORING FRAMEWORK Adopted.

NEW ZEALAND at a glance (2013) Adult population (20–79 years) Diabetes cases (20–79 years) Diabetes raw national prevalence (%) Diabetes expenditure / person with diabetes (USD) Diabetes related deaths (20-79) Number of people with undiagnosed diabetes (20–79 years)

DIABETES | Summer 2014

3,125,050 342,680 10.97 US$4,040 2,145 169,280

S O LO CYCLE CH A LLENG E

COM MUNITY

Biking 2,000km for diabetes A music teacher is planning to cycle the length of New Zealand to raise awareness of diabetes and raise funds for Diabetes Wairarapa. Peter Caldwell explains. My name is Peter Caldwell. I am fifty-three years old and married to Rebecca. We have a daughter Darrell and two sons David and Andrew. I teach violin and piano to around 35 students in my home town of Masterton, Wairarapa. Around eight years ago I was diagnosed with type 2 diabetes. I often felt tired and exhausted during the day and sensing something was wrong, decided to get a full medical check up including blood tests. Mike Berry, who was my doctor of the moment, later asked me if I had recently drunk large amounts of alcohol to which I replied “Certainly not!” It was then he told me that the reason I was feeling exhausted and tired was because I had acquired type 2 diabetes as the result of my pancreas not supplying enough insulin. I was in shock. I immediately contacted Rebecca, my partner, and told her that if she wanted to change her mind about living with someone with diabetes now was the time to pull out. Happily she didn't and we later married. If I’m conscious of anything, it’s the simple fact that good health for most of us is something we often take for granted. Because I have experienced ill health, I am of the view now, that every day is a gift and one that should not be wasted.

Preparations A Roubaix Elite carbon fibre road bike has been kindly donated for the task by Penny and Todd Hart of Carterton. Penny taught me the principles of diabetes self management. The Eastwood Motor Group in Masterton is providing a support vehicle and covering petrol costs incurred during the ride. I started cycling in 2008, completing the 160km Lake Taupo Cycle Challenge around Lake Taupo in that year. I regularly ride for fitness, particularly as I also enjoy squash. Since June I have been riding up to 200 kilometres a week to get fit. I recently cycled 80 kilometres around the South Wairarapa on a single day. To complete the challenge in a month, building up my endurance is essential. The main difficulty I face in the challenge is ensuring my diabetes management is well maintained.

Sponsorship Sponsorship is easy from as little as 1 cent per km ($20). Donations can be made via www.givealittle.co.nz/member/ cyclefordiabetes. Or pledges can be made direct. Please contact Peter on: marvelousmusic111@gmail.com Facebook: peterjuliancaldwell Twitter: @kiwi_caldwell.

My vision My vision is to bring to local and national attention the fact that many people like myself are affected by diabetes. I also want to show that through good management, weight control and regular exercise people with diabetes can lead normal lives.

The challenge My goal is to cycle from Cape Reinga at the northern tip of New Zealand to Bluff at the southernmost point. The challenge will take place in January 2015. The distance to be cycled is 2066km, with a daily kilometre target of 80km, with occasional rest days. I have travelled the length and breadth of New Zealand by plane, boat, bus, car and train but never on a bike. Being the kind of person who enjoys a challenge I decided to cycle the whole country.

*Peter is seeking a support person with a full licence and specialist cycle mechanical abilities to drive a support vehicle and provide running repairs where necessary. If you fancy seeing a bit of the country and can help with this, please contact him.

Summer 2014 | DIABETES

FO O D

A DAY IN THE LIFE OF A COMMUNITY DI ETITI A N

Helping people make better food choices Alison Pask is a community dietitian who works with people at risk from poorly-controlled type 2 diabetes and cardiovascular disease in areas of high need in Porirua, Wellington. She talked to Susan Fullerton Smith, from the Ministry of Health, about her role. Tell me about the community you work with? I am based in the Cannons Creek community and work across three primary health organisations in Porirua, north of Wellington. The majority of the community is made up of Māori, Pasifika and refugee populations. It’s an ongoing challenge for people to make healthy changes in an environment that’s against them – for instance there are 17 take-away shops and no central supermarket within the Cannons Creek area. My role was created in 2009 and is funded by the Capital and Coast District Health Board. I make it my business to be seen in the community, to build relationships and trust. Flexibility should be my middle name as a lot of my work is done outside the traditional 9am to 5pm working day. I have found the best way to reach my clients is to respond when they need it – whether it’s being a guest speaker at a church meeting on a Saturday night, or attending a 7am home visit before working parents leave for the day. You name the place and I’ll be there.

‘My passion is to help change people’s food choices for better living.’ – ALISON PASK, COMMUNITY DIETITIAN

DIABETES | Summer 2014

A DAY I N TH E LI FE O F A CO M M UNITY DI ETITI A N

FOOD

Hangi in the hood Creating a healthy hangi is one example of how Alison was able to use an innovative and wha¯nau-centric approach to engage a group of at-risk community members. Alison was asked to help a local marae create a ‘healthy’ hangi for a group of overweight men identified within the community. Starting with the physical act of digging the pit, the group joined Alison in the kitchen for a healthy food discussion, helping to cut off fat from the pork, leaving skin on potatoes and preparing salads and vegetables to add to the traditional menu. Alison took full advantage of the lengthy cooking time and captive audience by holding a physical activity class and asking nurses to carry out blood tests and diabetes checks for the group. Some hours later the entire wha¯nau arrived and everyone enjoyed eating the healthy hangi together. The group also negotiated a working bee Koha solution, rather than a traditional food-based contribution. The men were engaged and enthusiastic about having contributed to the day and enjoyed the comfort of having tests and checks take place in a familiar setting. Alison says: “If you ask people what they want, they usually come up with the best framework to ensure a successful, community-appropriate, approach to healthcare.”

What would a typical day look like? I divide my time between multidisciplinary clinical visits, home visits and community education work. A typical day might include working alongside a primary care nurse for a morning seeing people with diabetes and CVD. The afternoon might bring some follow-up paperwork followed by an evening diabetes education session out in the community. I work with support agencies such as Pacific Navigator Networks, community health workers and church groups to ensure the best access to those who need it most.

Give me an example of your patient and wha¯nau-centric approach to diabetes? I have a referral conversation before our first face-to-face meeting so I understand the individual patient

and whānau situation. During home visits I like to meet the cook and shopper of the family as they are the nutritional influencers for everyone living there. I would typically initiate a simple discussion, often starting with ‘what did you eat today?’, or ‘what do you drink when you’re thirsty?’, ‘what colour milk top do you have in the fridge?’ Through this conversational, patient- focused approach, I quickly build up a dietary picture and work in small steps to reach and agree a more balanced picture with the patient. I use a visual approach and can often be found with a large toolkit in my trusty suitcase – it’s full of conversational props including supermarket specials flyers, plastic fruit and coloured milk bottle tops. Conversations are always around the ‘now’ situation and are about how to get closer to a balance. Goal setting in small steps is a key to

success, which might mean asking the question ‘which one of these things could you try over the next few days?’ and puting a plan in place to ensure this is achieved. Then I will follow up with a visit or phone call a couple of days or weeks later. Making use of emails and texts is also vital to ensure I stay in touch with my patients to support them along the way.

What’s the best part of your job? I love meeting people and hearing their stories. I like to focus on the person rather than the disease.

What’s your top tip for people who might be new to diabetes and feeling a bit overwhelmed? Take one small step at a time and celebrate each success. Small changes can make big impacts to your lasting health.

*This is an edited version of a case study first published on the Health and Improvement and Innovation Resource Centre’s website. It features other inspiring stories about diabetes practitioners innovating in their community, see www.hiirc.org.nz.

Summer 2014 | DIABETES

FO O D

E AT FRESH

Summer salads Today we feature two satisfying summer salads. Both recipes contain lots of protein so they will fill you up without piling on the calories. Quinoa salad with chicken, walnuts, and fruit Serves 4 390 calories per serving Total preparation time: 40 minutes Quinoa is a high-fibre, high-protein grain that can be bland when it stands alone, but it marries well with other flavors to make delicious dishes. This recipe also includes walnuts, which are an excellent source of protein, fibre, vitamin E, and omega-3 fatty acids.

Cooking spray Four 110g boneless, skinless chicken breasts ¼ tsp salt ½ tsp freshly ground pepper 1½ cups water ¾ cup quinoa 1 tbsp olive oil 3 tbsp red wine vinegar 1 tsp dijon mustard 1 tbsp fresh orange juice 1 tsp orange zest ¼ cup chopped fresh mint 2 green onions, chopped 1 cup diced apple ½ cup dried cherries 2 tbsp chopped walnuts ½ cup diced red onion

Coat a grill pan or large nonstick skillet with cooking spray and heat over medium-high heat. Season chicken with salt and pepper; cook for 9 minutes, turning once, until no longer pink. Remove from heat and let rest for 2 minutes. Slice into thin strips. While the chicken cooks, pour the water into a medium saucepan and stir in quinoa. Bring water to a boil; reduce heat to medium low, cover, and simmer for 15 minutes. Fluff with a fork and refrigerate for 30 minutes. In a medium mixing bowl, whisk together oil, vinegar, mustard, orange juice, orange zest, mint, and green onions. Stir in apple, cherries, walnuts, and red onion. Combine with quinoa. Divide quinoa among four plates; top with chicken. APPROXIMATE NUTRITION ANALYSIS PER SERVE: Energy 1638kj (390 cals), Carbohydrate 18.5g, Protein 10.5g, Total Fat 8g per serve.

Is the 5:2 diet safe for people with diabetes? The salad recipes on these pages come from The 5:2 Diet Cookbook. The 5:2 intermittent fasting diet, more commonly referred to as the 5:2 diet, has become one of the more popular diet plans in recent years. Studies suggest the diet helps with weight loss and may also reduce insulin resistance, which could help people with type 2 diabetes or prediabetes. However the long-term safety of the 5:2 diet is yet to be determined and studies are being carried out in New Zealand* and elsewhere into the safety of the 5:2 diet in people with diabetes. People using insulin and/or sulphonylurea medication (for example glibenclamide, glipizide or gliclazide) are at increased risk of hypos (low blood glucose) on days that food is limited. If the carbohydrate content in these recipes is small (and if your usual carbohydrate intake is higher) the risk of hypos is increased. As with any diet plan, you should always consult your GP or diabetes health team before making any significant changes to your diet as they could affect blood glucose levels or impact on your medication.

*New Zealand study: Both Wellington and Waitemata Diabetes Services are reviewing the safety and effectiveness of the 5:2 diet for people with diabetes. For details of the Wellington 5:2 diet study see p20. Disclaimer: Diabetes New Zealand does not endorse the 5:2 diet or any other special diet and recommends people talk to their health professional before starting on any kind of eating plan.

DIABETES | Summer 2014

E AT FRES H

FOOD

Tuna and chickpea salad with lemon vinaigrette Serves 4 298 calories per serving Total preparation time: 65 minutes Cans of tuna are a pantry staple that should not be overlooked. For this recipe, you’re asked to use tuna packed in olive oil — be sure to reserve the oil, which will be used to make a tasty vinaigrette. This salad holds up well and will taste even better on the second day, after the ﬂavours have had time to linger together.

1 red onion, halved and cut into thin slices 2 garlic cloves, crushed 3 tbsp olive oil One 180g can tuna packed in olive oil 2 cups undrained canned chickpeas ¼ cup chopped fresh parsley 1 tsp lemon zest 3 tbsp fresh lemon juice 1½ tbsp white wine vinegar ¼ tsp freshly ground pepper

In a medium mixing bowl, stir together onion, garlic, and oil. Marinate for 1 hour at room temperature. Discard garlic; add tuna and its oil, chickpeas, parsley, lemon zest, lemon juice, vinegar, and pepper. Let marinate for 15 minutes before serving. APPROXIMATE NUTRITION ANALYSIS PER SERVE: Energy 1251kj (298 cals), Carbohydrate 11g, Protein 16g, Total Fat 24g per serve.

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Recipes courtesy of The 5:2 Diet Cookbook Mendocino Press (RRP $19.99), available in New Zealand from www.exislepublishing.co.nz.

Summer 2014 | DIABETES

LE T ’S G E T A CTI VE

SUMMER EXERCI S E

Mix it up for maximum benefit The two most important types of activity for managing diabetes are aerobic exercise and strength training. Simon Giannotti explains the benefits of including different kinds of exercise into your weekly routine.

Does your exercise routine consist of just one kind of activity, such as walking or swimming? Experts recommend mixing different kinds of exercise to get maximum health benefit. A comprehensive weekly exercise routine should include a mix of aerobic, strength and flexibility activities. Here is a quick guide to the different types of exercise and how they can help people with diabetes.

• Jogging or running • Roller skating • Moderate to heavy gardening.

Aerobic exercise – helps your body use insulin better

Aim for 30 minutes of moderate to vigorous aerobic exercise on most days of the week. Try not to go more than two days in a row without exercising.

Aerobic exercise is any activity that raises your heart rate, increases your breathing and works your muscles. Here are some examples: • A brisk walk outside – or on a treadmill • Swimming or a water-based exercise class • Fitness, dance or aerobics class eg Zumba • Tennis • Riding a bike – outside or in a gym • Rowing – in a gym or on water

DIABETES | Summer 2014

Aerobic exercise helps your body use insulin better, says the American Diabetes Association. It makes your heart and bones strong, relieves stress, improves blood circulation, and reduces your risk for heart disease by lowering blood glucose and blood pressure and improving cholesterol levels.

Strength training – makes your body more sensitive to insulin and can lower blood glucose Strength training (also called resistance training) is any activity that makes you work and strengthen your muscles using weights, resistance (elastic) bands or your own body weight. Activities include:

S UM M ER EXERCI S E

LE T ’ S GE T ACTIVE

How much exercise is enough? The New Zealand Physical Activity Guidelines outline the minimum levels of physical activity required to gain health benefits and ways to incorporate incidental physical activity into everyday life.

Adults New Zealand adults should be active every day in as many ways as possible. They should do at least 30 minutes of moderate intensity physical activity on most – if not all – days of the week. If possible, add some vigorous exercise for extra health benefit and fitness.

Children and young people (5–18 years) Children and young people should: • Do 60 minutes or more of moderate to vigorous physical activity each day.

• Lifting weights at the gym or at home • Calisthenics or circuit classes that use your own body weight for resistance. • Movements at home using only your body weight, such as pushups, sit ups, squats, lunges, wall-sits and planks, jumping, swinging, twisting or kicking. • Yoga exercises that involve weightbearing or resistance bands. • Pilates equipment classes that use machines to strengthen muscles. • Building work or heavy gardening. Strength training can help people with diabetes lose weight – the more muscle you have the more calories you burn even when your body is at rest. It also makes your body more sensitive to insulin and can lower blood glucose, according to the American Diabetes Association. It helps maintain and build strong muscles and bones, reducing the risk for osteoporosis and bone fractures.

Try to include some type of strength training at least two times per week in addition to aerobic activity.

Flexibility exercises Try to build in some flexibility or stretching exercise to your weekly exercise routine. Stretching helps keep your body flexible, your joints moving, and reduces your chances of injury when doing other kinds of exercise. Activities include: • Any exercise classes that include stretching • Yoga • Pilates • Stretching on your own before and after exercise.

Getting started If you haven’t exercised for a while, start with short bursts of five or 10 minutes a day. For example take a quick walk before or after every meal. Recent studies have shown this can be just as effective as a 30-minute exercise session. Then increase it gradually as your fitness improves.

• Be active in as many ways as possible, for example, through play, cultural activities, dance, sport, recreation, jobs and going from place to place • Be active with friends and wha¯nau, at home, school and in their communities. • Spend less than two hours a day (out of school hours) in front of the television, computers, and game consoles.

Older people The following recommendations apply to all older people in New Zealand, but should be adjusted for each older person according to their individual needs and abilities: • Be as physically active as possible and limit sedentary behaviour. • Consult an appropriate health practitioner before starting or increasing physical activity. • Start off slowly and build up to the recommended daily physical activity levels. *See the Ministry of Health’s website for more details www.health.govt.nz.

Summer 2014 | DIABETES

DIAG N O S IS

D IABETES VOICES

Things I wish my doctor had told me The International Diabetes Federation’s Diabetes Voice magazine reached out to people living with diabetes and asked them to consider the day of their diagnosis and what their doctor told them about diabetes. The following case studies are sometimes shocking and show the impact early doctor-patient conversations can have on a patient’s emotional and physical wellbeing.

CASE STUDY 1: A person with type 2 diabetes John Morrison, 73 years, Connecticut, USA “Sometime in the early 1980s my blood work had indicated ‘diabetes mellitus’, but my physician never said a word. Then, in 1984, a lab test indicated that my blood glucose was in excess of 11.1 mmol/l. My new physician announced that I had diabetes and would need insulin for the rest of my life! He demonstrated how I was to inject myself in my thighs, arms, or stomach with an orange. I left his office with insulin, syringes, and an orange, but no knowledge of diabetes. Blood glucose testing occurred three times a week at my hospital-based physician’s office. Diabetes was never discussed beyond the amount of insulin I needed to inject. I never mentioned my diabetes to anyone and my life of 12-hour workdays went back into gear. I frequently skipped insulin as well as breakfast and lunch. Various medical professionals’ interest in my health status was limited to the question ‘How’s your

diabetes?’ I responded by saying that I didn’t ‘need’ insulin and even ‘I don’t have diabetes’. The real beginning of my education about diabetes care came when I had quadruple by-pass surgery in 2000. I learned the importance of diet, exercise, daily multiple testing of blood glucose, and daily adjustment of insulin. With all the public information about the negative impact that diabetes has on the body’s system, how could I have ignored most of managing diabetes until my heart attack? For me, the answer dates back to 1984. A doctor I liked and trusted told me very little about diabetes. Today, I live with multiple complications. My current experience with six different physicians has taught me the management of my diabetes rests with me. Ironically, the primary educators about my disease have been other people with diabetes and the media, not my physicians.”

What do you wish your doctor had told you? Please tell us about your memories of diagnosis day. Email Caroline Wood editor@diabetes.org.nz

DIABETES | Summer 2014

DI A BETES VO I CES

CASE STUDY 2: A person with type 1 diabetes Elizabeth Snouffer, Editor of Diabetes Voice and founder of www.diabetes247.org “When I was diagnosed with type 1 diabetes in an emergency hospital room in 1976 at age 12, the diagnostic test showed my blood glucose at around 8.6mmol/l. For no apparent reason, I had collapsed at school. After my parents and I were told I had developed type 1 diabetes, the attending doctor took over from the nurse to wheel me to ICU. As he was pushing me through the halls, he told me I would die early if I didn’t take my insulin shots but regardless I would likely suffer blindness and probably amputation. He wheeled me right up to a window of the hospital outpatient diabetic clinic so I could see the victims of diabetes first-hand. I was so unwell I could hardly keep my head up but he forced me to look into the eyes of the man sitting in a wheelchair without one leg and then directed me to gaze at a young woman with bandages on her eyes. On the way to the nurses’ station he informed me I would not be able to have any children and would be lucky if I lived past 35. He also shared a polite version of his insights with my parents the next day. Kids can be intuitive. Even in my weak state, I knew that my experience was odd. Something told me that this thing called diabetes made people crazy. Determined to overcome this dark future with diabetes, I made a personal vow (as I lay alone in the hospital room on that very night) to beat this disease I knew so little about. While many people living with diabetes today are tough and have learned how to manage the ups and downs, the emotional toll can be immense. I admit that coming to terms with the doctor’s words, the horror of complications and similar scare tactics from other medical professionals imprinted scars that took a few years to heal. Once I recovered, I finally became confident enough to find a medical team with compassion. Today, I live without any major complications and I have a beautiful 14-year-old daughter.”

DI A GNOSIS

CASE STUDY 3: A parent of a child with type 1 diabetes Sarah Dyer Dana, New Jersey, USA “In 2010, my then eight-year-old was diagnosed with type 1 diabetes in the intensive care unit of a public hospital in Hong Kong, where my family lived at the time. The attending physician calmly described that my son required insulin to reverse his near unconsciousness state, and that his dependence on insulin was both immediate and permanent. Once stabilised, a caring nurse taught us the now rote tasks of blood checks, carbohydrate counting, and injecting insulin, as well as the basics in handling emergencies. We were warned to maintain a vigilant stance against long-term complications. The firm focus was on how not to die from diabetes. Guidance was scant, however, regarding how he might live well in its presence. As the years have passed, we have had to figure this out on our own. We certainly did not realize how frustrating and often demoralising it would be to relentlessly work to thread the eye of a moving needle. We had believed that success in ‘mastering’ diabetes care was simply a matter of practised skill, discipline and knack for data. Our error was in assuming that mastery was the sole objective, and then life would be otherwise normal. It took a while to appreciate that diabetes transcends medical compartmentalisation, at least it has for us. It has impacted our relationships with one another, with family and friends, and at school. Diabetes emerges whenever we consider new experiences for our child, and when we make both important and minor decisions about our family’s wellbeing and future. It has deeply humbled us, and at the same time, diabetes has afforded us a new dimension through which to appreciate our child’s accomplishments, resilience and compassion toward himself and others. No one could have explained this to us when he was first diagnosed.”

*Reproduced with kind permission of Diabetes Voice – the quarterly magazine of the International Diabetes Federation. You can read it online at www.idf.org/diabetesvoice.

Summer 2014 | DIABETES

THE L AS T WORD

RESEARCHERS TAKE O N DI A BETES A ND O BES ITY

EDOR celebrates 10 years The team at Edgar Diabetes and Obesity Research in Dunedin has been working for more than 10 years to reduce diabetes and obesity and find new ways to treat these conditions. Caroline Wood reports on its work over the past decade. New Zealand holds the unenviable record for having the third fattest population in the OECD after the USA and Mexico. Obesity is a major risk factor for diabetes with its consequent health impacts and massive cost burden. The Edgar Diabetes and Obesity Research (EDOR) centre was set up in the wake of the sharply increasing health burden of diabetes and obesity in New Zealand. Its aim is to reduce the prevalence – and improve the management – of diabetes and obesity by finding new ways to prevent and treat these conditions. Based at the University of Otago in Dunedin, the team is led by some of New Zealand’s top diabetes and obesity researchers including Professor Jim Mann, Dr Kirsten Coppell and Associate Professor Rachael Taylor. Diabetes New Zealand’s Patron Sir Eion Edgar was the founding benefactor of EDOR. The centre includes four core staff and 14 members from eight different departments on the Dunedin and Wellington campuses. Auckland University’s Professor Boyd Swinburn, Professor of Population Nutrition and Global Health, was asked to deliver a keynote speech this year as part of the centre’s celebration of its first decade of research. He paid tribute to EDOR’s work telling Diabetes: “It’s a fantastic achievement, the work they do

DIABETES | Summer 2014

Top team (from left): Assoc Prof Rachael Taylor, Prof Jim Mann, Sir Eion Edgar and Dr Kirsten Coppell

is critically important. We need specialist groups to tackle diabetes and obesity research and the work they have done in this area has been a tremendous boost to New Zealand.” The centre’s achievements include: • National and international recognition of its diabetes and obesity studies. • More than 120 papers published in leading, high impact scientific journals. • A lead role in guideline policy development at local, national, and international levels. Current research includes studies looking at ways of tackling childhood obesity (a key determinant of diabetes), approaches to prediabetes management, blood sugar control in type 1 diabetes (part of an international study), and the role of different kinds of carbohydrate in the management of diabetes. Professor Jim Mann paid tribute to the work of the team over the past decade. He said: “With 10 major studies behind us and another 10 currently under way, we are in a stronger position to further inform the public, policymakers, and the government about what works in tackling diabetes and obesity in New Zealand.”

Landmark EDOR studies Ngati and Healthy: Prevent diabetes project This 2006 Wha¯nau Ora supreme award winner and Health Innovation Award finalist was a collaborative community intervention between Ngati Porou Hauora and EDOR. The study showed that participants appeared to reduce the prevalence of insulin resistance, especially those who made the most marked lifestyle changes. LOADD: Lifestyle over and above drugs in diabetes This research examined if an intensive dietary intervention can further improve glucose, blood pressure, and lipids levels, over and above the effects of recommended drugs. Intensive nutrition treatment achieved an improvement in glycaemic control and body measures in patients with type 2 diabetes who were at high risk of cardiovascular disease. APPLE and PLAY: School intervention programmes for lifestyle and exercise The APPLE study was the first in New Zealand, and one of the first internationally, to show that communitybased initiatives could successfully reduce the rate of excessive weight gain in primary school-aged children. Sixteen schools and more than 900 primaryschool aged children are involved in the randomised controlled PLAY study.

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

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