Diabetes Summer 2015 by Diabetes New Zealand

Diabetes Summer 2015

Living well with diabetes

It’s DIABETES ACTION MONTH MOVE IT FOR Fitbit MoveMeant Day Know Your Risk The Tamati Coffey interview

FITBIT & NADIA LIM K COOKBOO S Y GIVEAWA

see inside

SUPPORTING ACT How to talk to a loved one about their diabetes

TREATING HYPOS time for a change? THE GOVERNMENT’S FIVE-YEAR PLAN FOR DIABETES

festive food ideas + 10 vital health checks + keeping chickens

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Diabetes: the national magazine of Diabetes New Zealand | Vol 27 no 4 Summer 2015

INSIDE summer 2015 Editorial

Families and children

16 Calendar kids

teve Crew: Together we S are stronger

Diabetes Action Month

6 7 Fitbit MoveMeant Day 22 Know your diabetes risk 23 Diabetes has no boundaries

The Tamati Coffey interview

Cover story

SO: Raising awareness of U diabetes through cycling

Treatment

10 Ten health checks everyone with diabetes should have

COVER PHOTO: USO CYCLING GROUP © JOHN COWPLAND / ALPHAPIX

Research

18 Hypo treatment: Time for a change?

Food and nutrition

20 Ready steady summer:

Healthy holiday eating

Let’s get active

24 Exercise trackers Gardening

26 Chooks in the city Recipes

28 Nadia Lim: A fresh start

Focus

12 The Government’s five-year

Your Diabetes NZ

plan for diabetes

30 Chinese Support Group

Guest column

Diabetes Youth

13 Jonathan Coleman: The

32 John McLaren 2015 award

diabetes health challenge

winners

Care and prevention

The last word

14 Supporting family or friends with diabetes

34 Katie Doyle: Reality check

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

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

EDITO RI A L

STEVE CREW

Together we are stronger NgÄ mihi nui koutou katoa. Welcome to the summer edition of Diabetes, the magazine of Diabetes New Zealand. This month we have embarked on the most ambitious awareness campaign in the history of our organisation. Diabetes Action Month is a high visibility campaign to raise awareness about the diabetes epidemic and compel New Zealanders to be aware of their own risk factors for diabetes.

Throughout November a national roadshow is touring 14 towns and cities throughout New Zealand to promote physical activity and healthy eating as a means to prevent and manage diabetes. The tour includes stops at supermarkets and key community locations. Our Diabetes New Zealand staff and local identities are encouraging the public to go online to assess their risk of developing diabetes with the new awareness tool and participate in fun Action Month activities.

In the past 10 years the number of people with diabetes has more than doubled from 125,000 to 257,000 and a significant number of people in New Zealand have prediabetes.

Recreation facilities and gyms around New Zealand are getting behind Diabetes Action Month. They will host a range of activities and events on Saturday 28 November in their local communities to promote the benefits of physical activity and encourage them to get moving.

From the beginning of this month we introduced a new interactive awareness tool on our Diabetes New Zealand website. By answering a few simple questions about themselves and their lifestyle, New Zealanders can understand their level of risk of developing type 2 diabetes.

Diabetes Action Month is an exciting and engaging campaign with social media competitions, targeted advertising in health service waiting rooms, and widely circulated pamphlets and posters to get our messages out into our local communities.

Diabetes New Zealand is delighted to welcome Fitbit as a key sponsorof Diabetes Action Month. There is a natural alignment between Diabetes New Zealand and Fitbit, a company that aims to empower people to lead healthier, more active lives through a range of activity and fitness tracking products. There is plentiful research available that showcases the importance of making time for physical activity in our everyday lives and there is a proven link between regular exercise and healthy food choices being able to prevent, delay or manage type 2 diabetes and help manage type 1 diabetes. Our Diabetes New Zealand members are part of an influential organisation of people, linked by the cause and unified in the search to find a cure. But we need to do more. We need to unite with the 257,000 people living with diabetes in New Zealand and become part of something much bigger; a powerful group of individuals leading the sector in the key areas of advocacy, awareness and support. That is our challenge! Steve Crew Chief Executive, Diabetes New Zealand

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

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

DIABETES | Summer 2015

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

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

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DIAB E TES A CTI O N MO NTH

TOG ETH ER WE A RE STRO NG ER

Stepping up for diabetes Former TV host Tamati Coffey explains why he is supporting Diabetes Action Month. Nearly 40 Kiwis a day were diagnosed with diabetes in New Zealand last year, according to the Ministry of Health – that’s more than 10,000 people in 2014 alone. One of the aims of Diabetes Action Month is to make people aware that anyone can get diabetes and to help them understand their risk factors. Former broadcaster Tamati Coffey is one of a number of high-profile New Zealanders who have stepped up to support Diabetes NZ’s campaign. Tamati, who has close family members with diabetes, wants to help raise awareness about the condition, particularly among high-risk groups such as Māori and Pacific Islanders. “I think it’s obvious that New Zealand has a huge diabetes problem and it’s affecting a lot of people,” he says. “No-one thinks they will get diabetes in their lifetime. You’re not born with it and people think they are not going to get it. We’re now finding out that’s not the case and lots of people are developing it.

“I want to encourage everyone to go and get tested and find out whether or not they are at risk.”

“Diabetes is a killer and I don’t think people take that seriously enough.”

Tamati was brought up in Lower Hutt, Wellington, but now lives in Rotorua where he owns and runs a bar called Ponsonby Road. He was the much-loved roving weather presenter for Television New Zealand’s Breakfast programme and host of New Zealand’s Got Talent. He is also an aspiring MP and was selected as Labour’s candidate for Rotorua in the 2014 general election.

Tamati is planning to attend the Rotorua roadshow, when Diabetes NZ’s Mobile Diabetes Awareness van visits the town on its national tour around the country during November.

“If I can do something to raise awareness of the risk then I will. I’m very hopeful that as a result of Diabetes Action Month more people will get tested and start on the road to recovery and make an effort to live well,” he says. “Obesity and related illnesses like diabetes are one of the biggest threats to our society today. There is sugar in everything and that doesn’t help. “I have a lot of bigger people in my family and extended family and they are at risk of getting diabetes. “A lot of the risk is avoidable. Taking regular exercise and watching what you eat, the risks can be mitigated.

“Diabetes is a killer and I don’t think people take that seriously enough.” 6

DIABETES | Summer 2015

“When the roadshow comes down I will be there and encouraging people to get involved. I hope other people come along too – they need to be there,” he says. Tamati has also volunteered to do the Diabetes NZ Fitbit Challenge during Diabetes Action Month. He will wear a Fitbit activity tracker for a week and take on other high profile Kiwis to see who can take the most steps. “I work in a bar and we’re constantly on our feet (so I have a built-in advantage) but I still try to go the gym three times a week. In terms of diet, I have to try hard, there are many temptations out there.” * See how Tamati does during his Fitbit challenge by following Diabetes NZ’s Facebook page.

DI AB E TE S A CTI ON MONTH

See our fantastic Fitbit reader giveaway on p25

Move it for Fitbit MoveMeant Day Diabetes NZ has joined forces with Fitbit to get the nation moving. What will you be doing on 28 November 2015, asks National Communications Manager Nicky Steel. We all know that physical activity is something you should do because it’s good for your health. Exercise is especially beneficial for people with diabetes, with plenty of international studies showing physical activity can help prevent, delay or manage type 2 diabetes and help manage type 1. Diabetes NZ wants to highlight the importance of physical activity in reducing the risk of developing type 2 diabetes. We also want people with diabetes to be aware that taking regular exercise will reduce their risk of developing life threatening complications.

This is one reason why Diabetes NZ has teamed up with Fitbit to invite all New Zealanders to join the first national Fitbit MoveMeant Day on Saturday 28 November. Fitbit provides a range of products and experiences that empower and inspire people to lead healthier, more active lives. Their popular and easy to use all-day fitness trackers can chart your steps, calories, distance, sleep patterns, floors climbed, active minutes and continuous heart rate. “Diabetes NZ is partnering with Fitbit and inviting all New Zealanders to ‘join the Fitbit MoveMeant’ to recognise that we are all meant to move, and to embrace an active lifestyle,” explains chief executive Steve Crew. “Incorporating more physical activity into your day has well-recognised health benefits including improving blood sugar and blood pressure

levels, and will help you manage your body weight. It can also help reduce stress levels and help you sleep better.” The Fitbit MoveMeant day will see YMCAs and other sports facilities across the country open their doors and host free, fun activities for people in their local community. Spot prizes (including Fitbits!) will be given away and participants will come away with a Diabetes Action Month pack. To find out about the Fitbit MoveMeant Day location nearest to you, go to the Diabetes NZ website www.diabetes.org.nz. Mark the date on your calendar and please round up your friends and family and encourage them to come along with you. If there are no Fitbit MoveMeant Day events near you don’t let that hold you back. Organise a fun activity of your own! So come on New Zealand – let’s get moving! Join the action on Fitbit MoveMeant Day, 28 November 2015.

Summer 2015 | DIABETES

COV ER S TO RY

UND ERSTAND ING, STRENGTH ENI NG , OVERCO M I NG

ENJOY THE RIDE The USO cycling group helps ordinary people do extraordinary things so they can help their whānau live more healthily. Caroline Wood reports. USO cyclists with Chris Te’o centre at a recent training day.

DIABETES | Summer 2015

PHOTO © JOHN COWPLAND / ALPHAPIX

Ia manuia le ti’eti’ega uila

UND ERSTAND ING , STRENGTH ENI NG , OVERCO M I NG

COV E R STORY

“I

t’s about inspiring our people and setting an example. We can’t wait for someone to come and help, we need to empower our people to do it for themselves,” explains Chris Te’o, the founder of the USO cycling group.

Chris, 49, is driven to help others look after their health after experiencing first hand the risks of loved ones not taking care of themselves and ignoring conditions like obesity and diabetes. He set up the USO men’s cycling group in 2011 after his father passed away three weeks after being diagnosed with pancreatic cancer at the age of 74. He decided he wanted to do something to encourage Polynesian men and women to take more care of themselves and become more aware of the deadly consequences of obesity, diabetes, stroke, heart disease and cancer. These conditions are more prevalent in Pacific Islanders and Māori and evidence shows their health outcomes are worse than Pākehā with the same conditions. Chris’s family is from Samoa. USO means ‘brother’ in Samoan and the cycling group is grounded in the values of understanding, strengthening and overcoming. In February 2016 USO members will set off on their most ambitious ride yet – a 2,000 kilometre ride from Bluff to Cape Reinga stopping along the way for evening hui in local churches, marae and community centres. Riders will share their stories and talk about their journey to better health. “It’s tough to do after a long day’s ride but the riders get a lot from the night meetings with the community,” says Chris. “My mum had type 2 diabetes. She lived with ill-health for 20 years before her death two years ago. She was 69 years old. She was dependent on drugs and so unhealthy for many years but she had so much strength she kept on going. The message for me is about quality of

FIND OUT MORE

USO riders visit a Samoan school during their cycle through the islands. life and enjoying life rather than being sick and unhealthy,” he says. “I just think of my mum and I don’t want to see other people going through the same thing. A lot of our members have family members with type 2 diabetes.” USO started out as a way to raise awareness for cancer, but now the group wants to raise awareness about the risks of non-communicable diseases like diabetes and heart disease. The majority of riders are unfit when they join but quickly turn their health around through cycling. Chris says he weighed 130kg when he started, now he is down to 104kg. “I used to be a meat pie and Coke in the morning kind of guy. Now it’s porridge and toast,” he says. The group is multi-racial and includes riders who are Māori, Samoan, Tongan, as well as members from the Cook Islands and Europeans. While none of them have diabetes, most have family members with the condition. “When I reflect on how dad's illness unfolded it was more the fact that he died a silent death because he didn’t know what to say or do. He was a very

humble man and I think he just didn’t want to burden anybody. That’s why USO encourages our people to be more open about illness and health issues so that they can get the help they need at an earlier stage,” explains Chris. The group’s first ride was from Auckland to Porirua in 2011, and in 2012 they biked from the Cape to Bluff. There were 12 riders. This time the journey is being done in the opposite direction with over 20 riders, plus another 30-40 joining for the shorter legs. USO has been to Samoa twice and also Hawaii. In the islands they make a point of stopping in villages and schools to talk to them about health issues. Chris now works for the Cancer Society as a health promotion coordinator. “USO started with men but now it’s for men and women. We quickly realised good health involves all the whānau, you need to look after the whole family,” he said. “We have become the first Polynesian cycling group to be affiliated to Bike NZ. This could not have been achieved without the hard work of my lifelong friends and joint USO leaders Talalelei and Meriama Taufale, who have great experience in cycling and business management,” adds Chris.

You can support USO and get involved. For more information see: www.facebook.com/USOBikeRide or www.usobikeride.co.nz Summer 2015 | DIABETES

TREATM ENT

COMPLICATION PREVENTI O N

10 health checks

everyone with diabetes should have Your GP or nurse should conduct regular tests for a variety of different diabetes complications. Many people with diabetes simply don’t get the check ups they need, and even if they do the results are often not acted upon. Make sure you get the following checks for good health and to avoid diabetes-related complications.

Have your HbA1c level measured at least once a year, although research demonstrates that having your HbA1c checked every 4–6 months will provide you with the best support for maintaining good blood sugar control. Your HbA1c measures your overall blood glucose control but more importantly provides information about your risk of having a heart attack or a stroke within the next year. Be sure to ask your diabetes healthcare team what your optimal HbA1c target should be over the next 12 months.

Get your blood pressure measured and recorded annually. Ask your healthcare team what your blood pressure target is (achieving this will minimise your cardiovascular risk) and ask for advice on how to achieve it.

2 3

Measure your cholesterol (blood fats) once a year. Again ask for your own target that is realistic and achievable.

Ask for an eye screen for signs of retinopathy every two years. The specialist will check your eyes for any diabetes-related damage to your retina.

Have your feet checked annually. Make sure they check the skin, circulation and sensation of your feet for signs of any damage.

Have your kidney function measured every year. You should have both a urine test for protein and a blood test to measure kidney function.

Get your weight checked and ask them to measure your waist to see if you need to lose weight. You can ask for a Green Prescription to access a free and supported exercise programme in your area.

Having high blood sugar levels causes damage to blood vessels putting you at high risk for heart disease Ask your GP or practice nurse to complete a cardiovascular risk assessment so that you understand your risk of having a heart attack or stroke. Also ask them to review how you can change your lifestyle or medication so that you can reduce your risk.

Smoking contributes to cardiovascular risk. Ask your health team what local support programmes are available for helping you to quit.

Get your teeth cleaned by a dentist or dental hygienist regularly, as people with diabetes are more at risk of gum disease. Also, having gum disease raises your blood sugar levels.

Try to diary regular check ups with your health care team so you can discuss any issues you have with your diabetes, medication or health in general. If you feel able, it’s good to share personal information with your doctor or diabetes nurse, including how you are feeling. *The information in this article was reviewed by Dr Janet Titchener, who specialises in patient-centred diabetes care. She is Clinical Director, GPSI Diabetes, with rooms in St Heliers, Auckland and Havelock North, Hawkes Bay.

DIABETES | Summer 2015

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FO CU S

N ATIONAL ACTION FOR D IABETES

Five-year plan to tackle diabetes The launch of a dedicated national diabetes plan to address one of New Zealand’s most serious health issues has been welcomed as being long overdue. Caroline Wood reports. Over a quarter of a million people have diabetes and this number is steadily rising, with nearly 40 a day being diagnosed in 2014. Worryingly adults are now getting diabetes at a younger age, which means they are more at risk of complications such as stroke, heart and kidney disease and the loss of sensory function in their feet. In October Health Minister Dr Jonathan Coleman launched a fiveyear plan Living Well With Diabetes, which should bring improvements to the diagnosis and management of diabetes nationwide. “The plan sends a loud clarion call to district health boards to give diabetes the top priority it needs to reduce the impact of diabetes in our communities,” says Chris Baty, President of Diabetes New Zealand. “Anyone can get diabetes but sadly those of Māori, Pacific Island and Indo-Asian descent are at higher risk. And worse, they tend to get it younger and are more likely to become disabled and die of it. “Giving people the knowledge to live well with diabetes is essential in tackling the national diabetes epidemic. People don’t know enough to understand there are lots of things they can do to prevent getting type 2 diabetes, and those who have it don’t know enough to understand

DIABETES | Summer 2015

they can be well with it and do not need to develop the devastating complications of the disease.” The five-year plan has been compiled with input from the health workforce and patients. It identifies six priority areas: • preventing high-risk people from developing type 2 diabetes • enabling effective selfmanagement • improving quality services • detecting diabetes early and reducing the risk of complications • providing integrated care • meeting the needs of children and adults with type 1 diabetes. The plan also aligns with other Government initiatives including Healthy Families NZ and Green Prescriptions.

“The number of people with diabetes grew by nearly 40 people a day in 2014” — MINISTRY OF HEALTH Chris Baty said Diabetes NZ applauds the plan’s title ‘Living Well With Diabetes’, and that the plan was developed with considerable input from people who have diabetes and the health workforce who cares for them. “The lifestyle changes needed to manage diabetes are hard things to do and they need to be done every day for a lifetime. Giving people the information and support they need

A copy of Living Well with Diabetes: A health care plan for people at high-risk of or living with diabetes 2015-2020 can be found at: www.health.govt.nz

to prevent, delay or manage their diabetes is at the core of Diabetes NZ’s work. We look forward to continuing to play a key role in the collective drive to harness our national diabetes crisis,” she added. Health Minister Jonathan Coleman said the national diabetes plan provides a clear roadmap for how to tackle one of New Zealand’s greatest health challenges. The plan emphasises the importance of supporting people to manage their own condition. “We want to ensure people with diabetes, or at risk of developing it, have the support they need to live well and access high quality patient-centred services,” he said. Dr Coleman launched the plan at Middlemore Hospital on 16 October with the support of Sir Peter Leitch, who has diabetes and is an ambassador for Diabetes New Zealand.

J O NATH A N CO LEM A N

GU EST COLUM N

The diabetes health challenge As part of Diabetes Action Month, we invited Minister of Health Jonathan Coleman to write a guest column.

We know that people with diabetes do better when they are active participants in their own care, supported by family.

More New Zealanders are living with chronic diseases and diabetes is one of our biggest health challenges. It’s estimated that around 257,000 New Zealanders are currently living with diabetes. We know that people with diabetes do better when they are active participants in their own care, supported by family. We want to ensure people get the integrated support they need to help manage their own health away from hospitals and closer to home. The Ministry of Health has been consulting with key health sector bodies, service providers and people with diabetes on our five-year strategy, which was launched in October (see left). The strategy continues our focus on delivering high quality care and achieving better outcomes for people living with diabetes. It is designed to build on the Diabetes Care Improvement Packages already being delivered by district health boards (DHBs) across the country. The Government introduced the Improvement Packages in 2012 so that DHBs could be more flexible in how they approach diabetes services. In Budget 2013 we allocated an additional $12.4 million over

TO DONATE ES T E B DIA

four years for new or additional diabetes services. DHBs spent time with the Ministry of Health working out how best to use this funding, and the result is a wide variety of innovative approaches – including providing services in communities and closer to home. Diabetes is not treated as a standalone issue. It also links in with other Government initiatives, including the Healthy Families NZ programme, which encourages good lifestyle choices, and the Green Prescriptions programme. There has also been considerable work already done in improving our early intervention, thanks in part to the more heart and

diabetes checks health target. The next quarterly results are due to be published in November, and I hope to see that we have achieved this target for the very first time. In the last five years, health providers have carried out record numbers of heart and diabetes checks – around 1.1 million. The Government is committed to building on these achievements, rising to the challenge of diabetes, and further improving health outcomes for New Zealanders. To do this we need to continue the focus on delivering high quality health services in more innovative and effective ways in the community and closer to home.

Please consider making a donation during Diabetes Action Month. All funds raised go towards Diabetes NZ’s work supporting people affected by diabetes. Call 0800 DIABETES or make a donation online at www.diabetes.org.nz

Summer 2015 | DIABETES

C ARE A N D PRE VE NTI O N

ROCK STE A DY

How to support a family member or friend with diabetes Do you sometimes wonder how you can help a loved one or friend with diabetes? Caroline Wood and Noeline Wedlock look at some do’s and don’ts when it comes to offering help and support.

“If someone is in a state of diabetes burnout, it can be hard to support that person because they may be in denial and not want your help,” says Noeline Wedlock, office manager of Diabetes NZ Otago branch, who has many years of experience helping people talk about their diabetes.

Diabetes is a self-managed and lifelong condition, two reasons why it’s important for friends and family to be involved. Managing a complex condition like diabetes on your own can sometimes be overwhelming and may result in diabetes ‘burnout’ – when a person gives up caring for themselves, for example disregarding their blood sugar levels and neglecting their diet. This can lead to serious health complications.

“It’s important they are in the right frame of mind and ready to receive your support. Otherwise you are going to alienate yourself and they will put up a barrier. I talk to a lot of people who are genuinely worried about a partner, neighbour or friend and are seeking information about diabetes from us. It’s crucial to have resources and be informed but you have to suss out if your

friend or relative is ready to receive that information. “My advice is to go softly. Don’t ram it down people’s throats. Sometimes people are very well meaning but it can have the opposite effect.” One way to start is by asking questions and doing lots of listening (rather than talking), advises Noeline. That way you can gauge whether someone is ready to accept help. “I think it’s important to engage with people. Everyone is at different stages with their diabetes. Ascertain where they are in their journey as this will determine how you can best help them,” she says.

BRINGING DOWN THE BARRIERS Evidence shows that those who have the support of their family and friends are able to better manage their diabetes. Well-controlled diabetes means a person can live a full, long and happy life, whether they have type 1 or type 2 diabetes. Here are some tips for how you can help support someone with diabetes. You don’t need to do all of these things, you can pick and choose according to what feels right for your situation.

DIABETES | Summer 2015

Ask questions Ask your friend or loved one about how they are coping with diabetes and how you can help. The National Diabetes Education Program in the US suggests asking: • Do you ever feel down or overwhelmed about all you have to do to manage your diabetes? • Have you set goals to manage your diabetes? • What things seem to get in the way of reaching your goals? • What can I do to help? (Example: Are there things I can do to make it easier? If you want to be more active, would it help if we take walks together?)

RO CK STE A DY

CARE AND P RE V ENTION

“The most important things I have learned are to be respectful of people’s privacy and feelings… and don’t give up” — NOELINE WEDLOCK

“Don’t assume anything. A person may have had diabetes for many years and still have very little understanding. Or alternatively just because a person is not paying attention to their diabetes does not mean they don’t know about it. They may be very well informed and just need someone who cares to stand alongside them.” When you have established a safe non-judgemental environment with your friend or loved one you can talk about the information you have gathered. You could suggest going together to an education class, a local exercise

programme or cooking classes. They may be ready to tackle one, some or none of these suggestions and that’s ok, just hang in there and let them have control of the situation. Meet for a coffee and don’t talk about diabetes at all. You are still offering support. And it will give them the opportunity to open up to you in the future. “The most important things I have learned are to be respectful of people’s privacy and feelings and don’t give up,” says Noeline.

Learn about diabetes

Make diabetes part of your life

It can be difficult to support a friend or loved one if they are suffering from a disease that you know nothing about. Diabetes, like many other diseases, is complex. From the terminology to the medication, it can be difficult to get to grips with. At the very least, make the effort to find out the difference between type 1 and type 2 diabetes and what HbA1c is all about. Knowing more about diabetes will help take the stress out of the ‘what if’ scenarios you may be worried about.

The state of your loved one’s diabetes depends on his or her everyday life—what diabetes routine to follow, what food to eat, which exercise to do, how to deal with stress. If you lead a healthy lifestyle and you encourage your loved one to join in, you will be helping them towards well-controlled diabetes.

Go to appointments together Ask if you can attend your family member or friend’s appointments and you will get a better sense of what their routine is, the terminology of diabetes, and you can ask their doctor or nurse questions during the visit. Everyone’s diabetes is different and knowing about their diabetes will make it easier to be usefully supportive.

Do something fun together You can offer to attend an exercise or cooking class with your friend or loved one. Find fun things you can do together such as walking, dancing, or gardening. Walking together daily gives you time to talk and stay active. Being physically active is a great way to handle stress. Or you could make a goal of cooking new healthy meals once a week. Include foods such as fruits, vegetables, and whole grains.

NEED MORE HELP? Read about diabetes online. Visit www.diabetes.org.nz or www.idf.org/aboutdiabetes. Join Diabetes New Zealand and receive a free subscription to Diabetes magazine as well as access to a network of local branches, including support groups. Join a diabetes group – in person or online. Check with www.diabetes.org.nz or call 0800 342 238 for your local branch – or ask your GP.

Summer 2015 | DIABETES

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

TOWA RDS A CURE

Calendar kids A group of Otago and Southland children with diabetes volunteered their time to help make a fundraising calendar. Please support them by buying a copy during Diabetes Action Month! You may have heard of the movie Calendar Girls? Down south the folk from Lions Clubs have been working with local children and businesses to come up with a quirky fundraising idea for Diabetes Action Month.

where the kids were photographed building a deck and planting plants. The businesses featured are sponsors of the calendar and include Placemakers, Farmlands and the Mag & Turbo Tyre Centre.

The 10 children who volunteered to model for the calendar ranged in age from 4 to 14 years. Seven have type 1 diabetes and three are at risk of developing it as diabetes runs in their families.

The calendar is hot off the press in time for Diabetes Action Month and organisers hope to raise $80,000 through the fundraising effort.

The kids travelled across Otago and Southland to do the photo shoots – each month’s picture took place in a different business premises, including a tyre yard (pictured) and a landscape construction company,

The money raised will go towards the Spinal Cord Society NZ’s Chasing a Cure for Type 1 Diabetes project. Scientists based at Otago Univesity are using stem cells to try to find a diabetes cure. You can read more about the study in Diabetes magazine’s Winter 2012 issue.

About the project Lions Clubs have formed a relationship with the Spinal Cord Society NZ’s Chasing a Cure project to raise funds to purchase equipment to be used for a human trial aimed to cure type 1 diabetes. The trial aims to use adult stem cells (from bone marrow) to correct the autoimmune response that causes type 1. This trial is a stepping stone towards using adult stem cells to cure spinal cord injury and other autoimmune diseases.

DIABETES | Summer 2015

Ella Butson, of Port Chalmers & District Lions, said: “The parents and children who are involved have been wonderful, travelling from Christchurch, Invercargill, Queenstown, Owaka and Mosgiel to Dunedin, Milton and Gore for the photos. “The business sponsors have been very accommodating, allowing us access to their business premises to take the photos. We seemed to pick the weekends with the worst weather contending with snow, rain and frosts but we have also had a great time working together for the end result and new friendships have been formed amongst us all.”

You can help find a cure for diabetes by buying a calendar. They cost just $10 each or $15 for online orders to cover postage costs. You can order one by contacting Ella Butson on 03 477 7819 or emailing ella@designandgarden.co.nz

Proud Champion Sponsor of Diabetes New Zealand

RES EA RCH

HYPOGLYCAEMIA

Hypo treatment: Time for a change? Do we routinely undertreat hypoglycaemia in New Zealand? Diabetes Clinical Nurse Specialist Lindsay McTavish believes we do and wants the current national guidelines to change.

researching hypo treatments. I have published the results of two clinical studies that were conducted at the Endocrine, Diabetes & Research Centre, Wellington Regional Hospital, with co-researchers Associate Professor Jeremy Krebs and Associate Professor Esko Wiltshire.

There are some long-standing myths about how much sugar is ‘enough’ to treat a hypoglycaemia episode.

I am currently conducting two more studies, one in adults and children using insulin pumps and one in people with type 2 diabetes, who use insulin.

Most international guidelines for treating hypoglycaemia are based on expert opinion rather than hard evidence and differ around the world (see panel). The current New Zealand guidelines state that all adults should use 15g of glucose to treat a hypo. However the evidence from our clinical studies suggests most adults should be using twice as much – 30g – to treat their hypo. My clinical interest is in the management of hypoglycaemia and over the past eight years I have been

I believe we routinely undertreat hypoglycaemia and hope to change New Zealand recommendations using evidence from our clinical studies. Once our current studies are complete, and the results are analysed, we plan to approach the New Zealand Society for the Study of Diabetes and ask it to consider supporting a change to the national guidelines. The policy at Wellington Hospital has already changed and most adult

Hypoglycaemia: “We What routinely in most people” is itundertreat and how hypos is it treated? Blurred vision?

Headache or confusion?

Pale & sweaty?

Pins & needles in your lips or tongue

Thumping heart? Shaky hands? Hungry? Weak knees?

Illustration by Bridget Lydon

DIABETES | Summer 2015 GUIDELINES FROM CCDHB DIABETES SERVICE MAY 2015

patients now receive 30g of glucose instead of the recommended 15g to treat a hypoglycaemic episode.

The evidence for giving more glucose A hypo (hypoglycaemia) is triggered when blood sugar levels fall under 4 mmol/L. For example, too much insulin, too little food, or strenuous exercise can spark a hypo (see panel). The priority is to bring blood glucose levels back up to normal as soon as possible by giving someone something sweet to eat or drink. Previous studies have shown that different kinds of sugars are absorbed at different rates. The most effective treatment is pure glucose. Our recent clinical trials in Wellington involved people with type 1 diabetes (both children and adults). The studies demonstrated that using a weight-based protocol (0.3 grams of glucose per kg of weight) is the most efficient method for treating hypoglycaemia and the resolution of symptoms1,2. Our theory is based on the fact that a person’s blood volume is approximate 7% of body weight. The more blood a person has in circulation, the more diluted the standard (adult) quantity of 15g glucose will become and less effective it will be. Using the weight-based method of working out how much glucose to give explains why 15g of glucose is not enough to treat a hypo in most adults. For example, 15g treats a person who weighs 50kg but it would need 30g of glucose to treat a 100kg person. In both cases this would on average increase blood glucose by only 1.6 mmol/L over 10 minutes.

HYPO G LYCA EM I A

Differing international treatment recommendations

RE SEARCH

What causes hypoglycaemia? Food • Meal delayed • Missed meal • Not enough carbohydrates • Alcohol

• 15g glucose (New Zealand, Australia, Singapore) • 10–20g (UK) • 15–20g (USA) • 15–30g (Europe) The recommendations are for adults and are largely based on clinical opinion and not hard evidence.

Exercise • Unplanned activity • More strenuous activity than expected Medication • Too much insulin/tablets • Dose mistake

In 2013, following the findings of our first study, Capital & Coast DHB increased its ward management hypoglycaemia policy from 15g to 30g glucose solution. This decision was also based on anecdotal evidence that a large number of patients on the wards were requiring a second 15g treatment to resolve symptoms of hypoglycaemia. In a recent hospital audit, we found that using 30g of glucose solution to treat hypoglycaemia provides a much better response than using 15g of glucose solution.

Studies have shown that larger doses of glucose do not cause rebound hyperglycaemia. Rather, rebound hyperglycaemia is the effect of overeating during a hypoglycaemia episode because the event was not treated immediately and appropriately in the first place. New Zealand and international guidelines have been in place for more than 30 years and are not founded on evidence. If healthcare providers now practise in an “evidence-based culture”, isn’t it about time they take notice of the more recent evidence and change their mindset?

References 1. McTavish L, Wiltshire E. Effective treatment of hypoglycaemia in children with type 1 diabetes: a randomised controlled clinical trial. Pediatric Diabetes. 2011; 12: 381-387. 2. McTavish L, Krebs JD, Weatherall M, Wiltshire E. Weight-based hypoglycaemia treatment protocol for adults with Type 1 diabetes: a randomized crossover clinical trial. Diabetic Medicine. 2015; published online Feb 26th.

About the author Lindsay McTavish is a Diabetes Clinical Nurse Specialist with 30 years experience, who is currently working for Capital and Coast District Health Board. Lindsay’s clinical interest is in the management of hypoglycaemia. He has been carrying out research on this topic since 2007 with two clinical studies currently running at the Endocrine, Diabetes & Research Centre, Wellington Regional Hospital. His co-researchers are Associate Professor Jeremy Krebs, and Associate Professor Esko Wiltshire. Professor Mark Weatherall (of Otago University) has helped with the studies’ statistics. He has had two articles published in highly respected international journals and hopes to publish the results of his current research once the studies are completed. To see more about Lindsay’s research on hypo treatment see: www.youtube.com/watch?v=aRyLynIfguI Information in this article is not intended to replace advice by your health professional. Diabetes New Zealand’s recommendation on hypo treatment is for adults to follow the current national guidelines of 15g glucose. If you have any questions about treating hypos, contact your diabetes team.

Summer 2015 | DIABETES

FO O D & N UTRITI O N

HEALTHY HO LI DAY EATI NG

Ready, steady, summer… Holidays are a time to relax, refresh and re-energise. Dietitian Margaret Thorsen offers some thoughts on how to enjoy eating healthily this summer. Our style of eating tends to change over the holidays with more meals away from home. It’s good to plan ahead if you have diabetes so you can enjoy your holiday food without over-indulging.

Christmas Day & special occasions Christmas Day and other special days, such as family BBQs and birthdays, are often accompanied by over-indulging and inactivity. But you can transform the meal from energy-dense to re-energising

by making a few simple changes to the menu. When planning the menu or enjoying the hospitality of others, keep the Diabetes New Zealand’s healthy plate in mind. In fact, it’s a good idea to keep it in mind for all meals over the summer holiday. Load half your plate with the nonstarchy vegetables and salads on offer then serve some – but not too much – of the starchy foods and meats. Take a break before going for seconds and if you are having a second helping focus on the vegetable and salad options. If you’re invited to bring a dish, be creative using some of the delicious seasonal fresh fruits and vegetables, nuts and flavoursome cheeses. Trying a new dressing can take a salad to another level.

Pudding doesn’t have to be dropped from the menu. A single day of less than ideal foods is not the end of the world as long as you are eating healthily the rest of the time. Try minimising the carbohydrates eaten as pre-meal snacks and at the main meal, then you can allow for some carbohydrate with dessert. Take the time to test your blood sugar levels before tucking in. If they are higher than ideal, take a break and head out for a walk. A Christmas dessert option to keep in mind is a “dark chocolate bowl” filled with fresh fruit salad. It looks impressive, doesn’t take long to make and is entirely edible. Decorate with fresh flowers from the garden for a Christmas look.

Make vegetables the focus at your barbecue this summer, using spices and fresh herbs for a punch of flavour.

DIABETES | Summer 2015

H EA LTHY H O LI DAY EATI NG

Menu ideas for picnics and road trips

Think about the route you’re taking and pinpoint the locations you plan to stop. Load the chilly bin and store it in the boot out of easy reach to avoid “grazing” while travelling. It may pay to have a couple of pieces of fruit within easy reach in case you feel your blood sugar levels dropping before you get to your next planned stop. Michael Pollan, prominent author of the book In the Defence of Food, states a couple of principles for healthy eating relating directly to road trips. The first is “Don’t get your fuel from the same place your car does” and the second is “Do all your eating at a table”. These will help you avoid the common pitfalls of a road trip, snacking throughout the day and buying high fat, high sugar foods sold at petrol stations.

Picnics & BBQs Picnics and BBQs are classic summer holiday fare but if burgers or bangers, potato or pasta salads, chippies and fizzy drink are core

LOW

CALORIE SWEETENER Measures spoon-for- spoon like sugar Perfect to use in your favourite food or drink recipes. Add a delicious, sweet taste with fewer calories.

menu items they can also become a carbohydrate and fat trap. Make vegetables the focus. Grill a rainbow of colourful vegetables on the BBQ, cook marinated mushrooms and combine meat and vegetables on kebab sticks. Keep a cap on the carbohydrate content of your meal by choosing one carb option – bread, BBQbaked potato wedges or pasta salad, rather than all three. Add palm-sized serves of lean meat, chicken or fish rather than serving predominantly fattier options like sausages, salami or large serves of meat. Black bean burger patties served with a yoghurt coriander dressing make a flavoursome healthy alternative. Keep up your fluids as this will help you remain alert and avoid raised blood sugar levels through dehydration. Always provide alcohol-free, low-kilojoule beverage options. Filling water bottles for a picnic with chilled tap water is the best place to start. Freezing these before you head out helps give you a cooler option throughout a long drive. Soda water can also make a refreshing drink. For BBQs at home, add sprigs of fresh mint, slices of cucumber or ice blocks with strawberries frozen inside to water for a little flavour and style.

Road trips are often part of a typical Kiwi holiday. If you’re driving, doing some planning around meals and breaks can help keep blood sugar levels in check and therefore help keep you alert for the drive.

FOOD & NUTRITION

NEW

• A tortilla wrap with shredded chicken, tomatoes, cucumber, lettuce and avocado • Wholegrain bread, spicy relish, feta cheese and sprouts • Mini zucchini and kumara frittatas, cooked in muffin tins, paired with a tomato salad • Roast chicken drumsticks and potato salad packed with colourful veges • Beef and bean quesadillas with tomato salsa • A mixture of natural nuts, fresh fruit and vegetables, peanut butter sandwiches, hard boiled eggs, hummus for spreading or dipping, tinned salmon or tuna, cheese, yoghurt, wholegrain crackers • Full, frozen water bottles or a thermos for tea or coffee.

Road trips

For delicious recipes, visit

club

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.co.nz

2015 | DIABETES16/04/2015 21

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DIAB E TES A CTI O N MO NTH

ONLI NE RI S K TO O L

Know the risk Diabetes NZ has developed an online Know Your Risk tool and a Know Your Risk pamphlet especially for Diabetes Action Month. It wants New Zealanders to be aware that everyone is at risk of developing diabetes and that for some people the risk is greater than others. All people need to do is answer a series of quick questions about themselves. They receive a score which indicates their risk level for diabetes and advice on what to do next. Please encourage anyone you know who may be at risk of developing type 2 diabetes to try the tool. The online version can be found at www.diabetes.org.nz/are-you-at-riskof-type-2-diabetes. I am overweight for my height M Yes M No Score – 3 for yes, 0 for no

I’m of Ma¯ori, Pacific Island, South Asian or Middle Eastern descent M Yes M No Score – 3 for yes, 0 for no

I do very little physical activity M Yes M No Score – 3 for yes, 0 for no

I have had a baby weighing more than 9lbs (4kg) or high blood glucose during pregnancy M Yes M No Score – 6 for yes, 0 for no

I often eat foods high in fat M Yes M No Score – 3 for yes, 0 for no

I am between 35 and 64 years of age M Yes M No Score – 1 for yes, 0 for no

There is, or has been, diabetes in my family M Yes M No Score – 3 for yes, 0 for no

I am over 65 years of age M Yes M No Score – 3 for yes, 0 for no

RESULTS Score 0–5: You are at lower risk for having type 2 diabetes now but you may be at higher risk in the future. Score 6 or more: You are at greater risk of having type 2 diabetes. Only a health professional can tell for sure if you have diabetes or prediabetes so please make an appointment to see your doctor for appropriate testing.

REDUCE the risk • Reduce weight if you are overweight • Be active for 30 minutes or more most days of the week • Eat healthy food • Stop smoking • Achieve and maintain good control of your blood pressure and blood cholesterol • Get an annual heart and diabetes check from a health professional

TYPE 2 DIABETES Common symptoms • Unusual tiredness • Extreme thirst • Passing urine frequently • Blurred vision • Cuts or sores that won’t heal • Frequent urine infections or thrush

For more information, check out Diabete NZ’s website www.diabetes.org.nz or email admin@diabetes.org.nz. Diabetes NZ publishes a great range of pamphlets about diabetes care – order online or call 0800 342 238. Please note: This is not a diagnostic tool.

DIABETES | Summer 2015

DI AB E TE S A CTI ON MONTH

Diabetes has no boundaries Every time you take the steps needed to manage your diabetes, remember that you’re in some pretty famous company....

Tom Hanks Prediabetes

Halle Berry Misdiagnosed

Salma Hayek Gestational diabetes

One of the aims of Diabetes Action Month is to raise awareness about the condition and break down the stigma many people feel about having diabetes and telling people they have it. In fact diabetes affects people of all ages, stages and backgrounds. Here are a few high profile Americans that have type 2 diabetes but have not let it hold them back. Each example shows a different aspect of this complex disease. You may be surprised by some of the names on the list.

The Oscar-winning actor had prediabetes before going on to be diagnosed with type 2 diabetes. On David Letterman’s late night talk show in 2013, Hanks explained: “I went to the doctor and he said, ‘You know those high blood sugar numbers you’ve been dealing with since you were 36? Well, you’ve graduated. You’ve got type 2 diabetes, young man’.” Actress Halle Berry was diagnosed with type 1 diabetes 25 years ago at the age of twenty-two. She claimed, in 2007, that she no longer suffered from type 1 diabetes and didn’t need to take insulin any more. Experts have said that the Oscar-winning actress was misdiagnosed and is likely to have had type 2 diabetes all along. She now manages her diabetes with the help of regular exercise and a healthy and balanced diet. Salma Hayek, who reportedly has a family history of diabetes, had gestational diabetes while expecting her daughter Valentina. All women should get checked for gestational diabetes (a kind of diabetes that occurs in pregnancy) when they are 24–28 weeks pregnant. Gestational diabetes usually goes away after delivery but having it can put you at risk of getting type 2 diabetes in later life, so it’s important to make sure your GP is aware of this.

Type 1 vs. Type 2

Billie Jean King Importance of diet

Larry King Avoiding complications

Randy Jackson Family history

The former tennis great says as an athlete she’s always been mindful of diet and exercise. But when she was diagnosed with type 2 diabetes in 2007, she took it to a new level. The hardest change, she says, was cutting back on carbs and sugars. She tells people who are diagnosed: “Just know that you can live a normal, wonderful, terrific, active life.” The American talk show host, who has type 2 diabetes, says it’s definitely controllable. Diabetes makes heart disease, stroke, kidney disease, and other serious health problems more likely – indeed King has had bypass heart surgery. But the risk of complications can be reduced by keeping your blood sugar levels under control, eating healthily and exercising regularly. The former American Idol judge was diagnosed with type 2 diabetes in 2001, when he was obese, a risk factor for diabetes. Jackson was also at risk because diabetes ran in his family, and African-Americans are more likely than whites to get the condition (in New Zealand Ma¯ori, Pacific Islanders and people of Asian descent are more likely to get type 2 diabetes). Jackson underwent gastric bypass surgery, lost 100 pounds, improved his diet, and made exercise a key part of his life.

People with type 1 can’t make insulin and need insulin injections for life or they will die. Most people with type 2 diabetes can survive without insulin but may need to take medications by mouth to control blood sugar. Some will be advised to take insulin as well.

Summer 2015 | DIABETES

LE T ’S G E T A CTI VE

TRACKERS

Exercise trackers Fitness columnist Craig Wise offers some advice on choosing the right activity tracker.

Measuring your activity level has always been a subjective thing. The hard workout of one person is the warm up of another, so how can you monitor and track your activity? There are so many options to choose from and selecting the right one for you is important. The most expensive may not be the most suitable. Just like when you are looking at buying a new car, it’s good to have an idea of what you want. Do you need a station wagon or sedan, two door or four door, petrol or diesel? It’s the same with the range of devices available to measure activity levels. If you are relatively new to exercise and are looking to step up your activity then a basic pedometer is your friend. For most people when it comes to getting started just making those recommended 10,000 steps a day is a great activity goal. You can pick up a good quality pedometer in most sports retailers, they are relatively inexpensive and easy to use – clip them on

DIABETES | Summer 2015

and start walking. No tech know-how required. The downside to the basic pedometer is that they are not the most reliable at accurately tracking every step – knocking them or moving suddenly can be counted as a step – so use them as a guide not as a bible. If you are looking at tracking more than just your number of steps then you are opening an Aladdin’s Cave of possibilities. This is definitely where it is worth having a good idea about just what kind of things you want to track. Some of the top of the range models offer GPS tracking (they can measure how many kilometres you have walked, biked or run), how many floors you have walked up, how many calories you have burned, how you are sleeping. Some models measure your heart rate and include other options to help motivate people to exercise more.

TR ACKE RS

Monitoring your heart rate when you exercise is not new. Heart rate monitors became the trendy thing for top level athletes and sports people in the early 1990s. The practice of heart rate monitoring appealed to cyclists, long distance runners and multisport athletes as a way to use science to improve their training and make it measurable and precise. Twenty years later the heart rate monitor has made it into the mainstream and now you can track much more than just how fast your heart is beating. One of the great benefits of using a heart rate monitor for a beginner is that it teaches you about the body’s reaction to exercise. It is easy to see how your heart rate is increasing or decreasing as you add or decrease your intensity. And on that point it also helps to control the intensity of the exercise level meaning that you can stop before you push yourself too hard. Many basic activity trackers will also gauge calories you have burnt; these are a little subjective but work well as a guide. In terms of measuring your overall fitness, activity trackers are a great motivating tool. When you can see the numbers there is that competitive streak in all of us that wants to take more steps, burn more calories or go longer at a specific heart rate. BUT… It’s important to remember that we can become dependent upon the gizmo and stop listening to our bodies.

LE T ’ S GE T ACTIVE

And here lies one disadvantage of the activity trackers. A number of things can affect how our body is working - from age, gender and genetics to stress, nutrition, hydration levels and medication. As the trackers get more technical, it’s important that they truly give accurate information back. This is where price can make a difference. Sometimes you may need to input data manually. For example telling it when you have drunk water and how much. The other disadvantage is that they can be a bit technical to set up and keep updating with information. For most people a basic activity tracker that combines a pedometer and a heart rate monitor is a great place to start. It can be relatively inexpensive and offer a range of basic options. Bottom line, investing in an activity tracker can be useful but it doesn’t necessarily mean you will lose more weight, be a better athlete or reach your goal if you have one. You still have to get out there and do the work, but at least with one you will know how much work you are doing. For those not wanting to go high tech, there is always the old method of a finger on the pulse and an eye on the clock. *For more information on measuring your resting heart rate and heart rate training zones contact me by email fitnesswithcraig@gmail.com or through my Facebook page www.Facebook.com/CraigWisePT.

Testing the Fitbit Charge HR The Fitbit Charge HR stands out from the crowd by its continuous recording of the wearer’s heart rate. It links to a smartphone with the free Fitbit app that keeps track of your statistics and provides a variety of graphs of your activities. I found the band comfortable to wear and its textured rubber finish looks good on the wrist. It comes in a variety of colours and uses a normal wristwatch buckle. The screen, though small, is easy to read and cycles through the time, your step counter, current heart rate, distance walked, calories burned and flights of stairs climbed. It should come on automatically as you lift your wrist but I found sometimes that worked, other times I had to press the button. The standout for the Fitbit Charge HR is the ability to constantly track my heart rate. When I am running or at the gym, I can see how much time I’ve spent exercising in my fatburn, cardio or peak zone. Wearing an activity tracker has made me more aware of my daily activity. I try to walk a bit further at lunchtime and I now take the stairs more often during my normal office-bound day. Jeremy Wood

Fitbit giveaway Make every beat count with Fitbit’s Charge HR—a wristband with continuous, wrist-based heart rate, all-day activity tracking, sleep monitoring, Caller ID and more. We have three Charge HRs (RRP $199) to give away in this month’s reader competition. To enter please email your name and address to admin@diabetes.org.nz by 1 February 2016 with the keyword FITBIT.

Summer 2015 | DIABETES

GARD EN I N G

CHICKENS ANYONE?

Chooks in the city When Rose Miller bought four heritage hens and took them home to her inner city garden, she found some unexpected health benefits came too. I’ve always wanted to keep chickens. When I was younger and living in a rural area in South Canterbury I looked after six lovely hens but when I moved to Wellington, I didn’t think it would be possible to have chooks. But a couple of years ago, I started digging around online as I’d read an article about keeping backyard chickens in urban areas.

DIABETES | Summer 2015

I was surprised to find it was legally possible to keep chickens in Wellington. As long as my neighbours didn’t complain and I kept the environment clean, it was no problem. Our 1910 villa in the heart of Wellington has a small but perfectly formed cottage garden. Luckily chickens don’t need a huge amount of space. I found a local breeder on TradeMe and got myself four pretty hens at POL (point of lay – around 18 weeks of age). Of course, I’d already sorted out the essentials required for this endeavour: a henhouse and run (found online), a big bag of chicken feed, feeding and

water stations, and a bag of straw for their bedding. The total cost was just shy of $1,000. Having done some online research, I thought it would be pretty straightforward. The only complication I foresaw was getting the chooks to fit in with the rest of our animal menagerie: two young cats and an old border collie. The cats did try out a few stalking moves but soon found our feisty hens to be more than they could handle. Mostly now they hang out quite happily together. And the dog? She’s scared of them, and they barely notice she exists.

CH I CKENS A NYO NE?

I loved the idea of letting them go completely free range but the reality was a great deal of mess and a constant shooing of chooks who were intent on getting inside and eating the dog’s food! A special chicken fence was the key, so now they’re limited to half our small backyard and I get to still grow a few things in the garden where they can’t reach. They still have plenty of space for foraging and hunting for insects and they are very happy hens. Naturally, the main benefits are… the eggs. When they are all laying, we average three eggs a day. We’ve found they stop laying for a few weeks during winter. The eggs last around three weeks out of the fridge. If we have too many then there’s always someone keen for some freebies. Since we’ve had the chooks we’ve only had to buy eggs from the supermarket twice. To get the best eggs from our girls, we buy high protein feed and supplement that with lots of fresh greens, leftover bread (we bake our own), and a herbal powdered supplement. Some studies indicate the nutritional value of eggs from free-ranging hens is greater than supermarket-bought eggs. Whether or not that’s true, their eggs taste great and have a lovely golden yolk.

GARDENING

The chicken poop gets added in to the compost – so good for the garden! And, of course, our hens lead a happy and healthy life. Another benefit I had not foreseen is the exercise I get from looking after them. Every other weekend, I give their coop a good clean, and I often take walks to our nearby park to forage for their favourite weeds: dandelion, milk thistle and chickweed. One day, of course, my hens will stop laying productively – most will lay consistently for five to seven years. It’s a fact I had to consider before we got them. Our chooks won’t be getting “the chop” – they’ll become non-producing pets. We purposely chose heritage breeds – they’re friendly and cute and we know we’ll still be happy to have them around when we stop getting eggs. The chooks can be a bit noisy first thing in the morning, but we don’t get many complaints from neighbours – they get to enjoy the occasional fresh eggs to keep them sweet! Keeping chooks can attract rats, but our two cats keep those in check. We have developed a repertoire of favourite egg dishes and enjoy

trying out new ones. I adore baked eggs (see the recipe on page 29) and roasted vege frittata. But it’s hard to beat simple scrambled eggs on wholegrain toast for breakfast, perhaps with a side of sliced tomato or avocado and some fresh rocket. Of course, there’s a lot more to keeping hens than I’ve told you here. If you’re interested in finding out more about keeping backyard chooks, try www.backyardchickens.com.

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

Summer 2015 | DIABETES

RECI PES

N A DIA LIM

A fresh start Today’s recipes come courtesy of Nadia Lim, Masterchef winner, My Food Bag creator and former diabetes dietitian.

Nude food We have copies of Nadia Lim’s Fresh Start Cookbook (RRP $50) to give away to two lucky readers. Nadia was prompted to write the book to set the record straight about what it means to be healthy and lose weight. It features 100 fresh, colourful recipes and there’s not a diet in sight – just nourishing, simple food that looks and tastes amazing. At the back there are three simple exercise programmes (no equipment required) created by personal trainer Michael McCormack with Nadia’s input. To enter please email your name and address to admin@diabetes.org.nz by 1 February 2016 with the keyword NADIA.

DIABETES | Summer 2015

NA DI A LI M

RECIPES

One-pan Turkish eggs + chickpeas in smoky tomato sauce

Chicken quinoa tabouleh with yoghurt dressing Quinoa is a very high-protein grain, so it has a very low glycaemic index, helping to keep you fuller for longer. You cook quinoa as you would rice. My preferred method is: bring 1 cup quinoa and 1½ cups water with a pinch of salt to the boil in a small pot. As soon as it boils, cover with a tight-fitting lid, reduce to lowest heat and cook for 15 mins. Then turn off the heat and leave to steam for a further 8–10 mins (without taking off the lid). Serves: 1 | Prep time: 5–10 minutes ½ cup cooked quinoa ½ punnet cherry tomatoes, halved ½ Lebanese cucumber, diced 1 spring onion, finely sliced 3 tbsp flat-leaf parsley, chopped 3 tbsp mint leaves, chopped zest and juice of ½ lemon 1 tsp extra virgin olive oil salt and freshly ground black pepper 90g (3/4 cup) cooked shredded chicken, ½ tsp sumac (optional) 2 tbsp natural unsweetened yoghurt Toss cooked quinoa, cherry tomatoes, cucumber, spring onion, parsley, mint, lemon zest and juice, and extra virgin olive oil together. Season with salt and pepper to taste. To serve, gently toss shredded chicken with quinoa tabouleh. If using sumac, mix with yoghurt and drizzle over quinoa tabouleh just before eating. NUTRITION PER SERVE Energy 1918kJ (452kcal), Protein 39.6g, Total fat 14.4g, Saturated fat 3.2g, Carbohydrate 43.3g, Sugars 17.57g

In this dish, the eggs are cooked in the sauce, infusing them with smoky tomato flavour (and saving on dishes!). Chickpeas are full of fibre, vitamins and minerals, and have a low glycaemic index — they make a delicious, healthy change to having bread. Serves: 4 | Prep time: 10 minutes | Cook time: 15 minutes 1 tbsp olive oil 1 diced onion 2 cloves garlic, finely chopped 1 tsp ground cumin 2 tsp smoked paprika 3 tbsp tomato paste ½–1 tsp chilli flakes (optional) 1 x 400g can crushed tomatoes ¼ cup water 1 x 390g can chickpeas, drained and rinsed salt and freshly ground black pepper 4 free-range eggs 30g feta, crumbled ¼ cup chopped coriander or flat-leaf parsley Heat oil in a frying pan over medium heat. Cook onion and garlic until soft, 3–4 minutes. Add cumin and smoked paprika and cook for 1 minute. Stir in tomato paste, chilli flakes (if using), crushed tomatoes, water and chickpeas. Simmer for 4–5 minutes until sauce has thickened. Season to taste with salt and pepper. Use a wooden spoon to create four ‘pockets’ in the sauce and carefully crack one egg into each pocket. Cover frying pan with a lid and steam over low heat for 7–10 minutes until whites are just set but yolks are still runny (or cook a little longer if you prefer a firmer yolk). To serve, spoon some smoky tomato sauce, chickpeas and an egg onto each plate. Crumble over feta and garnish with coriander or parsley. TIP: The chickpea sauce freezes well, so you can simply heat it up and add the eggs for a quick meal. NUTRITION PER SERVE Energy 973kJ (229kcal), Protein 12.3g, Total fat 13.9g, Saturated fat 4.3g, Carbohydrate 14.6g, Sugars 8.58g

Extracted from Nadia Lim’s Fresh Start Cookbook by Nadia Lim, published by Random House NZ, RRP: $50.00. Photography by Tam West

Summer 2015 | DIABETES

YOUR DI A BE TE S NZ

THE CHINESE S UPPO RT G RO UP

Making life a little easier It can be an isolating experience having diabetes, especially if English isn’t your first language. Diabetes Auckland’s Chinese Support Group aims to make life a little easier, as coordinator Susan Li explains. “We started the support group in August 2011 because more and more Chinese people were getting diabetes but because of the language barrier it was

hard for many of them to access information,” explains Susan Li. The group meets every month at the Diabetes Auckland office and guest speakers talk to members about different aspects of diabetes care. It might be an optometrist, dietitian, podiatrist or a nurse specialist, and some of the speakers are Chinese and some are not. There is always a chance for questions and answers after the talks. Most members of the group have type 2 diabetes and don’t speak English very well, says Susan. The

meetings are a chance to meet up with other Chinese speakers to find out about what’s happening at Diabetes Auckland and receive the support of other members in a relaxed atmosphere. “Many people travel long distances to attend the meetings because the language barrier prevents them attending their local branch support group. Members particularly enjoy the sessions with dietitians about eating healthily adapted to suit the Chinese way of cooking,” adds Susan.

Members of the Auckland Chinese Support Group enjoy a light lunch of soup with red and black beans , tofu and seaweed salad, steamed dumplings, corn, and red bean cakes

Diabetes and Healthy Food Choices is available in Chinese. Staying well with Type 2 Diabetes is also printed in Chinese (and Hindi). You can order Diabetes NZ’s free information pamphlets by calling 0800 DIABETES (342 238), emailing info@diabetes.org.nz or from www.diabetes.org.nz

DIABETES | Summer 2015

THE CH I NES E S UPPO RT G RO UP

YOU R DI A B E TES NZ

Rice (米) Rice is the staple for many people around the world. It contains carbohydrate which increases our blood glucose levels and also gives us energy. People with diabetes do not need to avoid rice. Having the right portion at each meal is the key in managing your blood glucose levels. This applies to all types of rice, eg white rice, brown rice, black rice, basmati rice, as they have the same carbohydrate content. As a guide, one small bowl (150g in weight or fist size) of cooked rice per meal gives you energy and helps to manage your blood glucose. If you find it difficult to reduce how much rice you eat, adding whole grains, lentils, nuts and seeds to your rice can help, as well as increasing your vegetable intake. It is important to remember that effective blood glucose management is a combination of healthy eating, being active and having the right amount of medication that suits your lifestyle.

米饭是我们的主食，它会升高我们的血糖，但同时也提供我们身体所需能量。即使患有糖尿病，您也可以食用米饭，但是需要控制每餐米饭的份量。因为无论是白米，糙米，黑米，印度米还是其它的米类,它们都含有相同份量的碳水化合物。一小碗米饭(150克/一个拳头大小份量)每餐，能够提供您身体所需能量，也能帮助您更好控制血糖。如果您减少饭量有困难，我们建议您在米饭中加入杂粮，豆类和坚果，这样可以帮助您更好的控制血糖。您也可以增加每餐蔬菜的份量。要记住：健康饮食、加强锻炼、药物控制，建立一个适合自己的健康的生活习惯，是控制您血糖和糖尿病的最好方法。 Prepared by Zhuoshi Zhang diabetes dietitian and supported by Auckland Regional Dietitians.

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.

Summer 2015 | DIABETES

DIAB E TES YO UTH

MCL AREN AWARD WI NNERS 2 015

Shooting for the stars This year’s John McLaren award winners are seeking excellence in their chosen fields, as Jacqui van Blerk, Diabetes Youth President, explains.

My role within Diabetes Youth New Zealand has many positive aspects but the most rewarding has to be in acknowledging some of the amazing young people we represent. These people have more than just diabetes in common – they share remarkable resilience, determination and self-control beyond their years. Our newest recipients of the John McLaren awards are no exception.

Kapowairua Stephens Kapowairua is a second-year medical student at the University of Otago, who balances the demands of a recent type-1 diabetes diagnosis along with her studies and positions on the Māori Medical Students Association Executive and the Academic Board for the Division of Health Sciences. Six months ago Kapowairua started feeling unwell. “I first started noticing symptoms (tiredness, frequent urination, blurred vision, thirst – you know the deal) in late May. I just put them down to the busy life of medical school. I mentioned it in passing to a friend in the year above me. We joked about how it might be diabetes as the third years had just finished studying it. Three weeks later I went to see a doctor to get a check-up chest x-ray as my lung had collapsed spontaneously the previous December. Right at the end

DIABETES | Summer 2015

of the consult, I told the GP about my ‘symptoms’. One hour later I was in hospital with DKA [diabetic ketoacidosis]. Good to know my friend had been listening in class! “I was offered the option to take time off study for the rest of the year and return to my studies next year. However, I was dead set on not letting diabetes get the better of me and continued on juggling my busy life. The way I saw it, diabetes wasn’t something that would stop me from pursuing my dreams, but something that made me just a little bit different from everyone else. In hospitals and during my placements I find that having a chronic condition is actually advantageous, I feel like I can relate more with patients, especially those with diabetes (always a great way to strike up conversation!).” Essentials for Kapowairua’s diabetes kit include determination and acceptance. “As soon as I accepted that diabetes was a new addition to my life, I was determined that this was not going to stop me. Since I’m not a big jelly bean fan I like to carry around Skittles, I find they do the trick!” she says.

Nathan Sturrock Our second McLaren award winner is Nathan Sturrock, who is studying for a Bachelor of Forestry Science

at the University of Canterbury while also training for an extreme adventure race. Speaking to him highlights the determination and self-knowledge that should see him successfully compete in the 2016 GodZone Pursuit race. “I was diagnosed at seven years old after my parents discovered me gulping down water from the bathroom tap only 30 mins after going to sleep one night. They knew it wasn’t normal and that afternoon my blood sugar level at the doctors was 31.3,” says Nathan. “It was a difficult time for my parents but they did everything they could to support me and encourage me to self-manage my diabetes at my own pace. Routine was very important and being organised ahead of time for meals was key. Mum would come down to school at lunchtime to test and draw up the required insulin or treat the hypos. She’s a good mum.” Nathan says he was determined not to let diabetes make him miss out growing up. He loves sport and while it is sometimes frustrating to have to manage himself carefully when others don’t, he didn’t let it get him down for long. He says that if he ever felt overwhelmed he tried to be more observant about blood glucose patterns and just get on with it.

MCL A REN AWA RD WI NNERS 2 015

DI AB E TE S YOUTH

Kapowairua Stephens and Nathan Sturrock, 2015 John McLaren award winners. “The better I felt physically, the better I felt mentally too. And mum and dad were good at reminding me that sometimes bad days just happen and to not be too hard on yourself,” he says. “The big difference in adventure racing compared to other sports is the variation in intensity of different activities over a long period of time. Before I qualified for a pump at 16 I struggled with sticking to preplanned training sessions as my levels were often unpredictable.

“Getting a pump made a huge difference to training. It meant I could set basal rates for each different activity dependent on the time and intensity. Having diabetes has definitely taught me to be in tune with my body while training and racing, potentially giving me an edge in how well I look after myself over a race.”

THE JOHN MCLAREN AWARDS John McLaren bequeathed a sum of money from his estate to be used by young New Zealanders with diabetes. The awards are given annually and recognise the pursuit of excellence across cultural, academic and sporting fields by young people with diabetes.

Congratulations to Kapowairua and Nathan, worthy winners of the John McLaren award 2015!

Diabetes Youth New Zealand

JOIN YOUR LOCAL SUPPORT GROUP BY VISITING

General enquiries: contact@diabetesyouth.org.nz Phone: (09) 623 2508

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www.diabetesyouth.org.nz Summer Spring 2014 2015 | DIABETES

THE L AS T WORD

K ATIE D OYLE

Reality check American adventurer and blogger Katie Doyle is returning to the US after a year’s working holiday in New Zealand. She reflects on what she has learned along the way. It feels like the perfect way to wrap up my time in New Zealand – combining the routine of my everyday life with my affinity for adventure. I catch the bus up the mountain from Queenstown to experience the last few days of spring skiing. At the skifield, I walk past a few small, white rectangles scattered on the floor and, like the brilliant detective I secretly enjoy pretending to be, think to myself: “Hmm, the scattered pattern and shape of those objects strongly resembles blood glucose test strips after they’ve escaped the closing zip on the case and dropped all over the floor.” I have had similar situations happen to me a few times, usually when I feel like I’m losing at diabetes. It is a reality-checking reminder that

PHOTO: FRANCESCA RYNN

“Living in New Zealand has made me think about diabetes differently.”

I’m not the only one testing my blood sugar on the ski field, and I’m probably not the only person feeling very annoyed at the need to test it when I would much rather be diving into powder all over the mountain. Living in New Zealand has made me think about diabetes differently. It’s not as much of a detriment to my quality of life as I once thought it to be, and I’m much better at accepting the way I deal with my diabetes. I’m not perfect, and I tell myself that I deserve to treat myself kindly, acknowledging how hard I work and the positive things I’ve accomplished. I’ve met a lot of people with type 1 diabetes while I’ve been here: while hiking on Stewart Island, canyoning in the Routeburn, and woofing on the West Coast. They’ve all seemed to be coping quite normally, an attitude to which I sometimes react with incredulity and fascination. Here’s a big secret, guys: even though I’m a bungee jumping, skydiving, heli-skiing person, the demon called diabetes can still

get me down. Day after day, it relentlessly tries to make me feel incredibly defeated. Sometimes diabetes succeeds, but more often, I am just as stubborn. I surround myself with strong people, too. The non-diabetic friends I’ve met here in New Zealand have been considerate and sympathetic, and I’m grateful for them. They ask me if I’m okay in ways that are not condescending, they understand when I need to stop and eat something mid-activity, and they make me laugh when I’m feeling hypoglycaemic in the middle of a hike instead of wallowing in the unpleasant symptoms. This time last year, I was writing articles about how I packed to move to New Zealand and how I planned to navigate my time here with diabetes in tow. Now, it’s once again Diabetes Action Month (we have the equivalent at home in the States) and this time I’m preparing for the World Diabetes Conference, where I’ll meet even more type 1 adventurers like me. Although my working holiday is coming to an end, I know my experience in New Zealand is tied to my relationship with diabetes. I have my work cut out for me for this post-Kiwi life, complete with footnotes. Diabetes will continue to be a challenge – but I hope it will also continue to present me with opportunities and connections that I would never have discovered otherwise. Most importantly, I am working on being nice to myself, no matter where I am in the world. I can’t wait to see what comes next! *Katie is an IDF Young Leader in Diabetes and is representing the US at the World Diabetes Conference in Vancouver at the end of this year.

DIABETES | Summer 2015

Chocolate

Reduced fat* Gluten Free

Vanilla Bean

Full Creamy Taste! No added sugar

No added colours

Contains 9 x 100ml servings per tub

*Compared with standard ice cream with 10% milk fat. CHOCOLATE: Approx. 4.0g of sugar per 100g from dairy. Approx. 5.5g of fat per 100g. VANILLA BEAN: Approx. 4.1g of sugar per 100g from dairy. Approx. 4.9g of fat per 100g.

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

“Sweet...!”

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

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

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