Diabetes Winter 2015 by Diabetes New Zealand

Diabetes Winter 2015

DIAGNOSIS DAY

Readers tell their stories

SUGAR & DIABETES: Whatâ&#x20AC;&#x2122;s the story?

Living well with diabetes

MADISON JOHNSON

Diabetes, modelling & me

BACK TO SCHOOL

Tips to keep your child safe

gout campaign + history lessons + safe exercising

GlucaGen® HypoKit

Glucagon (rys) hydrochloride

Make sure it’s there when they need it* GlucaGen® HypoKit is used to treat severe hypoglycaemia in people using insulin or taking tablets to control diabetes, who have become unconscious. Available from pharmacy with or without a prescription.

Patient support available The HypoHelp website and app are an important resource for patients at risk of hypoglycaemia and includes a free expiry date reminder service for patients with a GlucaGen® HypoKit. Download the app for free at www.hypohelp.co.nz Also available at Google Play or iTunes.

*Refer to full indications below

GlucaGen® HypoKit is a Pharmacist Only Medicine that is funded through the PHARMAC with a prescription, or available for purchase without a prescription (normal pharmacy charges apply). Ask your Healthcare Professional if GlucaGen® HypoKit is right for you.

Before prescribing, please review full Data Sheet available at www.medsafe.govt.nz GlucaGen® HypoKit. (glucagon [rys] hydrochloride). Presentation: Each pack consists of a vial containing lyophilised glucagon 1 mg (1 IU) as hydrochloride and a glass syringe pre-filled with 1 mL water for injections. Indications: Therapeutic: Treatment of severe hypoglycaemic reactions in persons with diabetes mellitus treated with insulin or oral hypoglycaemic agents. To prevent secondary hypoglycaemia, oral carbohydrate should be given to restore hepatic glycogen following response to treatment. The treatment of sulfonylurea-induced hypoglycaemia differs from severe insulin-induced hypoglycaemia due to the possibility of secondary hypoglycaemia - it is preferable to use intravenous glucose (see full Product Information/ Data Sheet). Medical consultation is required for all patients with severe hypoglycaemia. Contraindications: Hypersensitivity to glucagon or lactose, phaeocromocytoma, insulinoma or glucagonoma. Precautions: Glucagon will have little or no effect when the patient is fasting or is suffering from adrenal insufficiency, chronic hypoglycaemia or alcohol-induced hypoglycaemia. When used in endoscopy or radiography, caution should be observed in diabetic patients, or elderly patients with known cardiac disease. Glucagon is instable in solution, it should be used immediately after reconstitution and must not be administered by intravenous infusion. May cause allergic reactions in latex sensitive individuals. * Interactions: Glucagon is an insulin antagonist. When given in large doses, glucagon may potentiate the anticoagulant activity of warfarin. Glucagon can reverse cardiovascular depression of profound ß-blockade (see full Product Information/Data Sheet).* With indomethacin, glucagon may lose its hyperglycaemic effect or even produce hypoglycaemia. Adverse Effects: Nausea; vomiting. Dosage and Administration: The glucagon solution should be prepared immediately before use. Dissolve powder in accompanying solvent and administer by subcutaneous or intramuscular injection. Therapeutic: Adults and children above 25 kg - administer 1 mg; Children below 25 kg - administer 0.5 mg. (Jan 2015).

*Please note change(s) in Product Information/Data Sheet. Novo Nordisk Pharmaceuticals Ltd., G.S.T. 53 960 898. PO Box 51268 Pakuranga, Auckland, New Zealand. NovoCare® Customer Care Centre (NZ) 0800 733 737. www.novonordisk.co.nz ® Registered trademark of Novo Nordisk A/S. TAPS(DA) 1545RB McK336045/Diabetes NZ 03/15.

GlucaGen® HypoKit Glucagon (rys) hydrochloride

Diabetes: the national magazine of Diabetes New Zealand | Vol 27 no 2 Winter 2015

INSIDE winter 2015 4 5

From the Chief Executive From the President

Upfront

6 8

News, views and research New Zealand news and events

Focus

10 Madison Johnson: John

McLaren award recipient

Diagnosis

14 Readers’ D-day memories and lessons learned

16 Dan Howarth volunteers in Africa, Israel and India

Treatment

17 Free diabetes clinic helps

people with uncontrolled type 2 diabetes

Care and prevention

12 Gout and its relationship with diabetes

18 DESMOND drives better type 2 diabetes care

Diabetes abroad

Food

24 Sugar and diabetes: What’s the story?

Katie Doyle

27 Recipe: Beef goulash

20 Celebrating my dia-versary

Let’s get active

Families

22 Settling a child with diabetes into school

28 Exercising safely with type 1 diabetes

Diabetes in history

30 Key discoveries of the 19th century

Research

32 Smart insulin study Diabetes Youth NZ

33 Jacqui van Blerk: If it’s to be, it’s up to me

The last word

34 Record breaking Win and her 80 years on insulin

COVER PHOTO: MADISON JOHNSON. See page 10. PHOTO GEORGIA HEMBROW © WIXII

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

Change vital for success Ngā mihi nui koutou katoa. It is my privilege to write my first column for Diabetes magazine. I’d like to start by introducing myself. I was born in Kawerau in the Eastern Bay of Plenty. My foray into the health sector began as a volunteer ambulance officer in my home town. This was followed by a role as an intensive care paramedic in Wellington. I have always enjoyed management positions and worked in several including Hospital Manager, Wairarapa Hospital; General Manager Corporate Services, Aotea Pathology; Chief Executive of Eastern Bay Primary Health Alliance (PHO) and Group Manager Hospital Operations/ acting Chief Operating Officer at Waitemata District Health Board. I am married to Colleen and we have

two adult sons. Our oldest is in the construction industry in Brisbane, where he works on large projects such as supermarkets and shopping malls. Our youngest is an officer in the Royal New Zealand Navy. We also have a spirited fox terrier called Marco. As the new Chief Executive of Diabetes New Zealand, I am humbled to lead an organisation that helps people live well with diabetes. Diabetes is the largest and fastest growing health issue in New Zealand. It affects thousands of people, in particular our Māori and Pacific communities. It’s tremendously exciting to be part of the Diabetes NZ team that works with all our communities and key stakeholders for diabetes education, advocacy and supporting research. I was reading my predecessor’s column in our Summer 2014 issue of this magazine. Joe Asghar talked about uniting a team and the challenges of being a financially sustainable organisation. I want to acknowledge Joe’s tireless leadership and guidance during his tenure.

In what are fairly tough and resource-constrained times the one thing we can all expect is change. We talk about change a lot, but it is change that will enable us to succeed. We owe it to those who went before us, to ourselves, and those who follow us, to make the changes needed. If we continue to do the same things, we will fail. We will let ourselves down. I don’t want that and I am sure you don’t either. I will be aiming to get out and visit our branches and offices over the next few months. I want to listen and acknowledge your concerns, ideas and meet the people that have made Diabetes New Zealand an organisation I wanted to join. We are heading into an exciting time for our organisation. The Board has a clear vision and I know that if we all work together, the small changes will amount to something big. Steve Crew 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 | Winter 2015

FROM TH E PRESIDE NT

Our mutual support Recently I was invited to a celebration to mark the quarter century of a Diabetes NZ support group. The group, on the North Shore, is part of Diabetes NZ – Auckland Branch. I realise this group is not the only one to have achieved such longevity but I was pleased to attend because it is the most extraordinary achievement and all those involved in it – be it as a leader, administrator or attendee – deserve the highest accolades. Peer support is about sharing experiences between those living with similar issues and challenges. It is about exchanging the information borne of experience and offering mutual support in the doing of that. The expertise of personal experience is unique, valid and largely unacknowledged. Sharing and discussing this knowledge of understanding encourages others’ self-belief. It feeds our confidence and helps us believe we can manage better for ourselves. It is empowering. When it doesn’t seem

possible that any day can be good, discovering others know this too makes it easier to make the effort to do better. Diabetes is forever. It challenges us daily and is an unforgiving task master. It can be overwhelming and is surely one of the hardest things ever demanded of anyone. This brings me back to diabetes support groups. They epitomise Diabetes NZ’s unique point of difference. We exist to support and inform each other about living well with diabetes. We are the experts who know the nitty gritty of daily life with it; we are the ones who can say with true conviction – ‘Yeah, having this is the pits!’ But amongst us also will be someone who, when the going gets just too tough, can also say ‘Yep, I’ve been there and I told myself tomorrow would be better. And it was.’ Support groups come in many forms and can even include branch committees. They may not be intended as support groups but I guarantee that every time there is a meeting some of the members will discuss their diabetes. The discussion alone offers and engenders support. Supporting and informing each other

about the experience of diabetes is – in my opinion – our most important function. Of course we can never provide clinical information, nor must we, but branches do well to encourage and manage effectively, as a first priority, their support activities. In finishing I wish to acknowledge that the same person has led the North Shore diabetes support group from its inception in 1990 and I congratulate Sue Pearson for her loyalty, service and commitment. A few of the members have been there all along with her and they too deserve acknowledgement. On behalf of Diabetes NZ I extend my warmest praise and thanks to all those making great efforts to ease the way of others living with diabetes. I have no doubt that they too draw support and inspiration from their fellow travellers. Diabetes unites us and we give as much as we gain in sharing the learning. There are laughs to be had for there is always humour to be found in life. While we may have diabetes, life is for living and our job is to enjoy it. Chris Baty National President

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

Diabetes New Zealand PATRONS: Lady Beattie and Sir Eion Edgar PRESIDENT: Chris Baty CHIEF EXECUTIVE: 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

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)

Winter 2015 | DIABETES

UP FRO NT

NEWS, VIEWS AND RESEARCH

Metformin anti-cancer effect

Risk modelling success

Japanese researchers think they may have found a reason why there is an observed 30-40 percent decrease in the cancer risk of patients who take metformin. The study found the diabetes drug helped the body reject tumours by supporting immune cells. Researchers from Okayama University tested the effects of dissolving metformin in the drinking water of mice with leukaemia and confirmed complete rejection of the tumours. Renal and skin cancers also responded to the treatment, and low doses similar to diabetes prescription concentrations were still effective for tumour rejection. Read more www.prweb.com/ releases/2015/03/prweb12590754.htm

Researchers in New Zealand have developed a predictive risk model for all-cause mortality in patients with type 2 diabetes. The aim is to help doctors identify and manage patients with the highest risk of adverse outcomes, including death. The study used primary care data from a large multi-ethnic group of nearly 27,000 Kiwi patients and followed their progress over an average of nine years. Three different predictive models for a five-year risk of death were initially developed and compared using demographic and clinical information for each patient.

Fizzy drink study Drinking water or unsweetened tea or coffee in place of one sugary drink a day can reduce the risk of type 2 diabetes, according to research published in the journal Diabetologia. The research is based on the EPIC-Norfolk study, which included more than 25,000 men and women aged 40–79 years living in the UK.

The final model, which also included markers of renal disease, proved to give the best assessment of a patient’s risk of death. Ethnicity was a major factor with Māori and people of Asian descent at higher risk of death than European patients. The study by Tom Robinson et al was published in the journal Diabetes Research and Clinical Practice. Read more: www.hiirc.org.nz/page/54340/.

Researchers found that there was an approximately 22 percent increased risk of developing type 2 diabetes per extra serving per day habitually of each of soft drinks, sweetened milk beverages and artificially sweetened beverages consumed. Dr Nita Forouhi, of the Medical Research Council Epidemiology Unit, who led the study, said: “The good news is that our study provides evidence that replacing a habitual daily serving of a sugary soft drink or sugary milk drink with water or unsweetened tea or coffee can help to cut the risk of diabetes.”

Compound prevents type 1 Scientists have successfully tested a potent synthetic compound known as SR1001 that prevents type 1 diabetes in animal models of the disease. The study focuses on the possibility of preventing the initial devastation caused by the immune system – stopping the disease before it even gets started. “The animals in our study never developed high blood sugar indicative of diabetes, and beta cell damage was significantly reduced compared to animals that hadn’t been treated with our compound,” said the Scripps Research Institute’s Dr Laura Solt, lead author of the study, which was published in the journal Endocrinology in March. Read more: www.scripps.edu/news/ press/2015/20150317solt.html.

DIABETES | Winter 2015

Cognitive decline in midlife This US study looked at cognitive decline in a group of 13,000 diabetes patients aged 48-67 years. Cognitive decline over 20 years was greater in: i) participants with diabetes versus those without; ii) participants with prediabetes versus those with a normal HbA1c level; iii) participants with poorly controlled diabetes versus those whose diabetes was controlled; and iv) participants with a longer diabetes duration. Commenting on the study, by Rawlings AM et al, Wellington endocrinologist Dr Jeremy Krebs said: “This longitudinal observational study highlights an interesting and important area that has not been well described or studied. There is a clear and progressive trend of greater cognitive decline with increasing HbA1c level from within the normal range through to poorly controlled diabetes. This is obviously an area ripe for further research.” Read more: www.ncbi.nlm.nih.gov/ pubmed/25437406

Monitor your child’s glucose levels from the comfort of your own bed 1

Introducing the Dexcom G4® Platinum Continuous Glucose Monitor The Dexcom G4® Platinum updates glucose levels every 5 minutes so you can track your child’s glucose continuously day and night. Monitor their highs, lows and how fast they’re getting there from the comfort of your own bed1 for added peace of mind.

For more information or to arrange a trial to see the benefits for yourself, please contact us between 9am5pm, Mon - Fri on 0508 634 103 W www.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.

UP FRO NT

NZ NEWS AND EVENTS

Blood glucose meter review

Act today, to change tomorrow

Pharmac has launched a consultation on the future procurement of blood glucose meters and test strips following the controversial move to a single supplier in 2011. It says it wants to consult more widely with stakeholders and users before making any recommendations on the future funding of meters – and whether to retain a single supplier. In March it sought specific feedback on a number of questions including the functions that a meter or strips must provide, their usability and the best way to test potential meters in reallife situations, accuracy and any other related issues.

What can you do to help mark World Diabetes Day? Now is the time to start planning special events to raise awareness and funds to help people with diabetes. It takes place on Saturday 14 November and this year’s theme is ‘Act today, to change tomorrow’. You can find out more at www.idf.org/wdd.

Diabetes New Zealand submitted a detailed six-page submission on behalf of members, reiterating its position that: “sole supply arrangements for blood glucose meters and strips do not enable the varying needs of our population to be met. We advocate strongly that this approach be abandoned.” The sole supply period for the funded CareSens meters and test strips ends on 1 July 2015 but this will be extended while the review is taking place. Pharmac expects the process to take more than 18 months with a decision not likely until after June 2016. You can read Diabetes NZ’s full submission at www.diabetes.org.nz.

Diabetes New Zealand’s annual awareness campaign will take place from 12-16 November. Diabetes NZ branches will be holding activities around the country over this period. If you have a fundraising idea or want to help out, contact your local branch or email admin@diabetes.org.nz.

Diabetes NZ Conference and AGM 2015 The Diabetes New Zealand Conference will be held from 12 noon Friday 30 October to 12 noon Sunday 1 November. The AGM will be on Saturday 31 October during the conference. The venue is the James Cook Hotel, Wellington. For details see www.diabetes.org.nz or email admin@diabetes.org.nz.

Diabetes Youth conference update

Obituary: Dan Duggan MBE (1933—2015)

Children and families living with type 1 diabetes had a great networking and informative weekend with 140 delegates from across New Zealand attending Diabetes Youth NZ’s conference in Nelson. Renata Porter stepped down as President during the AGM and Jacqui van Blerk was voted new President.

Diabetes NZ mourns the recent passing of Daniel (Dan) Duggan. Dan was the Convener of the inaugural meeting of Diabetes Horowhenua in 1997 and at that meeting, became its first President. He held this role until 1999, when he stepped down to become Secretary, and in 2002 he also took on the role of Treasurer. Dan eventually relinquished these responsibilities in 2007.

There were workshops, which kept everyone very busy, and a dinner and quiz on Saturday evening. This was a great chance to relax, chat and share. Sunday was a morning of keynote speakers and panels, which everyone became very involved in. Speakers included a fantastic range of professionals, scientists and people who live every day with diabetes. The next conference is scheduled for March 2017, says organiser Steph Mills. Competitive cyclists Stephanie Mckenzie (left) and Hamish Beadle with conference organiser Stephanie Mills.

DIABETES | Winter 2015

In its early days, Dan was the leading light of Diabetes Horowhenua. During this time, he contributed much of the Society’s funding from his own pocket, and regularly attended national diabetes conferences and regional meetings. Dan’s love for his family was boundless and his strong social convictions involved him in many community and volunteer services. In 1989 Dan was made a member of the Order of the British Empire for his services to the trade union movement. Dan was born in Wanganui and died peacefully in April 2015 at Kandahar Home, Masterton, surrounded by his family. Dan’s obituary notice kindly asked that in lieu of flowers, donations be made to Diabetes New Zealand by phoning 0800 369 636 FREE, or via mail: Freepost Diabetes NZ, PO Box 12441, Wellington.

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FO CU S

MA DISON’ S STORY

Diabetes isn’t limiting me 10

DIABETES | Winter 2015

M A DI S O N’ S STO RY

Madison Johnson, 18, from Auckland received one of last year’s John McLaren Youth Awards. Today she explains her love of maths, modelling and how diabetes has helped her get to where she wants to be.

“ PHOTO GEORGIA HEMBROW © WIXII

I started primary school as a small full-fringed five year old with a matching pink drink bottle and lunch box. A week or so later and I was taking two matching pink drink bottles and coming home still complaining of being thirsty. Mum took me to the doctor and I was diagnosed with type 1 diabetes. When the nurse went to inject me with my first dose of insulin I remember asking, “Can’t I just do it myself?” I have maintained this can-do attitude through out my nearly 14 years of having diabetes. I hope to pass this idea on to inspire other people with diabetes to see that having this condition is as an opportunity to make the most of – rather than something to hold you back. I spent the weekend in Starship Hospital before going back to school on Monday like nothing had changed. If anything I thought I was pretty lucky, hey I got to eat lunch in the office and play games on the nurses’ computer. I was also very lucky to have a wonderfully supportive community that made it all so easy, especially my amazing parents. Since being diagnosed, diabetes has become second nature to me; I can’t say I know any different really. “Doesn’t that hurt?” is almost a daily question as I quickly prick my fingers and inject into my stomach at lunch without a flinch or second thought. My nana reminded me the other day of an article I wrote for the New Zealand Herald six years ago when I was 12. It was about campaigning

for the development of pig cell transplant. Here’s a little snippet: “To all those people complaining about pigs having to die for this cure, have you stopped to think where your roast pork dinner comes from? Try walking in my shoes, testing blood sugars four to five times a day, injecting at every meal and never going on spontaneous trips to the dairy with friends. Then you may realise what a dream come true this pig-cell transplant could be for people with type 1 diabetes.” Admittedly, I may have only written this piece to win a prize, but the sentiment is still dear to my heart.

This illness has taught me about responsibility, being mature and health conscious. Counting carbs, calculating ratios and adjusting insulin doses have become a daily routine, which introduced me to numbers from an early age, and where I believe my passion for accounting has originated. I have never let this illness limit me, if anything I have been grateful for the opportunities it has opened up. The amount of camps, day trips and friends I have gained through diabetes has outweighed any negatives and I wouldn’t change a thing. Family camps, ski trips, zoo days, and more! I would like to thank everyone who has been involved in making these events possible, especially the doctors and nurses who gave up their valuable time to attend. I think anyone with diabetes is a bit special, so camps away were some of the highlights of my childhood. In a weird way, going on diabetes camps feels like a break from diabetes – everyone is doing the same thing, so

FOCUS

it feels normal. I wouldn’t be who I am today without these experiences. My favorite, the ski weekend, is where I discovered my love for snowboarding and went on to represent my school in the North Island Snowboarding Competition 2014. This illness has taught me about responsibility, being mature and health conscious. Counting carbs, calculating ratios and adjusting insulin doses have become a daily routine, which introduced me to numbers from an early age, and where I believe my passion for accounting has originated. At high school I found I really enjoyed accounting and business studies, they came naturally to me. I worked hard and came first in these two subjects for all three years of NCEA, as well as achieving a first in geography and Spanish for level 3 and 1 respectively. I am now at the University of Auckland completing a Bachelor of Commerce majoring in Accounting. Winning the John McLaren Youth Award has been one of my proudest achievements. I think people can forget how diabetes can make life just that little bit harder during exam times and I’m glad it has not held me back or limited my academic abilities. I have used the award to fund a laptop for university, which has been a necessity, and I use it daily to take notes and to complete my studies. Two years ago I was shopping in a small boutique in Matakana when the owners asked me if I would like to model for them. From there I sent my photos to 62 Models who signed me a week later. Since then I’ve done several jobs for companies just as Tourism New Zealand and Huffer. It’s been such an amazing experience and something I had always dreamed of as a little girl. I am grateful for the opportunities I have had and I am looking forward to what the future brings.

Winter 2015 | DIABETES

C ARE A N D PRE VE NTI O N

D ON’ T G ET TRA PPED BY G O UT

Gout and its relationship with diabetes A major campaign has been launched to encourage Kiwis to get checked if they think they have gout, Caroline Wood reports. New Zealand leads the world in a condition that is debilitating and incredibly painful – gout. Gout often occurs alongside other chronic conditions like diabetes and heart disease (dubbed the ‘gout trifecta’). Unfortunately for the people who get this ‘trifecta’ the return is pain, loss of mobility, the inability to work and poor health. It is thought two-thirds of patients are untreated, undertreated or mistreated and Arthritis New Zealand is calling on GPs to look for gout as part of diabetes and heart disease testing. Gout is caused by too much uric

acid in the blood and affects joints, causing sudden attacks of pain, often coming on overnight. The skin over the joint may also become red and shiny. It can affect any joint but initially it often appears in the big toe or another part of the foot. Fortunately, once diagnosed, gout can be well managed with effective medication and lifestyle changes. Former butcher Bob Shaw, 75, of Whangerei, was diagnosed with gout in his early fifties and with type 2 diabetes about eight years ago. He says he struggled to control the painful gout attacks until recently.

“I didn’t realise the pain in the ball of my foot was gout and I just put up with it for a long time. Finally it got really bad and I went to my doctor and he did a blood test and my uric acid was really high. I tried diets and medication but it didn’t make much difference. Then recently I went to see an Arthritis New Zealand Arthritis Educator and she put me on a new regime. And it’s the best I’ve felt for a long time.” Arthritis New Zealand says gout and its partners – diabetes and heart disease – are major contributors to the shortening of life in New Zealand.

Six things you probably don’t know about gout

1 2

Gout is a form of arthritis – it’s the second most common form of arthritis in New Zealand. Gout is caused by too much uric acid in the blood. High levels of uric acid can turn into crystals that are very sharp, like needles, and make your joints very painful. Gout often occurs in the big toe and also in the knees, elbows, wrists and fingers.

High uric acid is caused by people’s genes, their weight or kidney problems. Contributing factors include food and drink – things like meat, seafood, beer and fizzy drinks.

DIABETES | Winter 2015

Gout is three times more common in men than women. Māori and Pasifika men are genetically more likely to get gout and at a younger age – it’s estimated 14 percent of Māori and Pasifika men have it.

You can help control gout by losing weight, eating healthy food and staying away from alcohol and fizzy drinks.

If you have gout, you’re in good company. Famous people who suffered from gout include Sir Isaac Newton, Sir Laurence Olivier, King Henry VIII and Jim Belushi.

D ON’ T G ET TRA PPED BY G O UT

CARE AND P RE V ENTION

“We call it the ‘gout trifecta’ – diabetes, gout and heart disease,” says Sandra Kirby, CEO of Arthritis NZ. “Gout can increase your chances of developing type 2 diabetes, but having diabetes also appears to increase your risk of developing gout. “Some preliminary research has suggested that insulin resistance may possibly play a role in the development of gout and that elevated levels of uric acid may also worsen insulin resistance. Gout and diabetes have a number of risk factors in common, so it’s not unusual for the two conditions to co-exist,” she added.

Say Goodbye to Gout. Free your patients of Gout and reduce kidney & cardiovascular damage. Adenuric (febuxostat) is the only

Gout Preventer to block both uric acid pathways.

NEEMIA TIALATA’S STORY Former All Black and Hurricanes prop Neemia Tialata, 32, knows first-hand how painful and debilitating gout can be. After experiencing severe pain in his foot, he was diagnosed with gout at the age of 20. “I didn’t believe that someone as young as me could get gout and I didn’t know that Māori and Pacific people, men in particular, are more likely to get it.” Neemia controls his gout with daily medication and makes sure he doesn’t eat and drink Gout: The Facts too much of some things that can trigger a gout attack, including shellfish, beer and red wine. Don’t get trapped by gout!

“I’ve been able to stay on top of my gout and continue my rugby career, so anyone who thinks they may have gout should see their doctor.”

You can learn how Neemia lives and plays with gout by visiting the Arthritis New Zealand website: www.goutnz.org.nz.

Switch to fully funded* Adenuric and say goodbye to Gout.

*Special Authority criteria apply. Adenuric® (febuxostat 80mg and 120mg film coated tablets) is a Prescription Medicine, consult your doctor [or other registered healthcare practitioner] to see if this medicine is right for you. Adenuric is a fully funded medicine if you meet certain criteria. Normal Dr visit fees apply. Use only as directed. If symptoms persist or you have side effects, see your doctor. Further information is available from your health practitioner or Consumer Medicine Information available at www.medsafe. govt.nz. Adenuric is used to treat chronic hyperuricaemia (high uric acid levels in the blood) in patients with gout (including a history, or presence of, tophus and/or gouty arthritis). Adenuric has benefits and risks. Do not use if you are allergic to febuxostat or other ingredients of Adenuric®. Begin taking Adenuric® after a gout attack has stopped, if you have a gout attack while taking Adenuric® it is important to keep taking your Adenuric® as directed. Caution if you have heart, kidney, liver or thyroid problems, a serious allergy to allopurinol, cancer that affects uric acid levels or lactose intolerance. Side Effects may include: Common (>1%) gout flares, headache, diarrhoea, nausea, rash, localised swelling (oedema). Te Arai BioFarma Limited, Auckland 0800 TE ARAI (832 724) www. tearaibiofarma.com. ADENURIC™ is a trademark of Teijin Limited, Tokyo, Japan. TAPS DA155OLG

Winter 2015 | DIABETES

DIAG N O S IS

A DAY TO REMEMBER

D-DAY memories We asked readers to send in their recollections of diagnosis day. Here Sandy Garman and Gabriele Abeltshauser recall the moment they found out they had diabetes.

Type 1 diabetes, Sandy Garman, 62, Warkworth I was 17 years old. On my first holiday back home from teacher’s college I had yet another urine infection and another dose of thrush. I had lost a lot of weight and developed an obsession for sweet things. I wondered why I was constantly lethargic. I almost failed a compulsory fitness test and swimming test we were required to pass in those first few weeks at college. No one could tell me why I was feeling this way. My parents were visibly shocked at my appearance when I arrived home and so it was yet another trip to our family doctor, who was enjoying an afternoon cup of tea and two chocolate biscuits as I was ushered in for my appointment. This time he too was shocked by my altered state and ordered a urine test there and then. The test tube came back bright orange. “There’ll be no more of these for you,” he said as he took another bite of biscuit. “You have diabetes and you will need to be admitted to hospital immediately. You will have to give yourself an insulin injection

DIABETES | Winter 2015

for the rest of your life”. But he did add that if I was careful I might live until I was 50. It was all delivered in a very blunt manner, or so it felt.

I was told very little in those early days and I didn’t really ask. I was young. I just wanted to get on and live a normal life. My mother was in a state of shock but I was overjoyed and relieved to find out that at last I had a reason for why I was finding life such a struggle. It didn’t seem too bad. At least I was going to live until I was 50 and that seemed like an age away anyway. And giving myself an injection every day and not eating chocolate biscuits – well I was sure I could manage that, although the injection bit did seem a bit scary. But I wasn’t going to die.

I spent the time going home on the bus comforting my mother who cried. She was much more upset than I was. I just knew I would have to get on with it the best way I could. By next morning I was learning to inject a lemon and then I was injecting myself, which I dreaded at first. Soon it became as easy as cleaning my teeth! I had juvenile diabetes – now known of course as type one. I followed the diet sheet religiously. I soon felt so much better I didn’t want to eat all that sweet stuff. I was told very little in those early days and I didn’t really ask. I was young. I just wanted to get on and live a normal life. I have been lucky. I am 62 now. My last set of blood test results was excellent and I have no other complications. I have learned so much living with diabetes. It hasn’t been easy at times, but I’ve lived my life every day in the best way I can and I’m a great believer that what you do every day counts. And best of all I have made it well past 50. Every year is a bonus and I mean to keep beating the odds!

A DAY TO REM EM BER

DI A GNOSIS

Type 2 diabetes, Gabriele Abeltshauser, 59, Nelson I had a heart attack at the age of 49. In 2008, at one of my regular medical check ups, the doctor said something wasn’t right and I would have to have a blood glucose test. I just looked at her – I had never had a problem before [with the tests], didn’t have any symptoms and no one in my family has diabetes. When they told me I had type 2 diabetes, it was as if someone had hit me with a hammer. I felt fine and my diagnosis was a total shock. My doctor said my blood glucose was still at the lower range so I didn’t need insulin. She said: “You have the option to try for the next three months to keep it under control with diet and exercise, or I can give you some low dose medication.” I already had a lot of medication for my heart and I didn’t want another pill. My husband calls me stubborn, my friends call me determined, but I wanted to do it myself. I wanted to see if I could keep it in check by changing my diet and exercising more. That was seven years ago and I still don’t need any medication. It wasn’t easy. I thought I was already living a healthy life – I had changed my diet and exercised more after my heart attack but it wasn’t enough. So I changed my diet again, quite radically. I cut out sugar completely – I didn’t eat chocolate, biscuits or anything sweet. The shock of my diagnosis was so large, it didn’t bother me in the slightest to cut out sugar. People thought it must be so hard when I didn’t have a biscuit with a cup of tea but it’s okay when you get used to it. Now I have an occasional treat but that’s okay, my blood glucose levels haven’t increased since my diagnosis.

The other thing I did was to reduce portion sizes – I’m a big fan of potatoes and it’s still harder to have a smaller portion of potato than to cut sugar out of my diet. I also had smaller serves of rice and pasta. I was already eating a lot of veges but I do eat more salad and fish now. I’ve never been a big meat eater. I’m not a smoker, I don’t drink, but I’ve been overweight all my life. I lost 20kgs in the first two years. Since then I’ve put 10kgs back on but I’m comfortable with my weight now.

There is a lot of fear about diabetes, a lot of people think that your life as you know it is over. But it’s not. It’s important to find a local support group where you can go to talk to people who are in the same position, who can help take away that fear… Exercise-wise, I started going twice a week to the gym and walking 30 minutes every day. The gym was good for cardio and strength and they told me it would be good for blood sugar. I did yoga with Madhu O’Brien, who taught a special class for people with diabetes. I really enjoyed it and I’m still doing yoga in the mornings when I find the time.

Gabriele Abeltshauser lost 20kg after cutting out sugar and doesn’t need medication to control her diabetes.

I feel pretty good now. The only thing that has changed is that feeling in the back of my mind, if I don’t feel so good, is it the diabetes, should I go and check my blood sugar? There is a lot of fear about diabetes, a lot of people think that your life as you know it is over. But it’s not. It’s important to find a local support group where you can go to talk to people who are in the same position, who can help take away that fear and tell you the tricks of the trade. It’s good to talk to someone who understands what it’s like to live with diabetes. Katie Doyle celebrates her dia-versary – see page 20 >>>

Diabetes NZ has a range of free information leaflets which you can order, or download online. They cover a variety of topics including simple tips for healthy eating and getting more physical activity into your daily routine. See www.diabetes.org.nz/resources_and_publications/printable_pamphlets

Winter 2015 | DIABETES

DIAB E TES A B ROA D

VOLUNTEERING WO RLDWI DE

Helping out in Africa, Israel and India Clinical nurse specialist Dan Howarth worked in Africa for the International Diabetes Federation before volunteering in Palestine and India. Diagnosed with type 1 diabetes at the age of 10, Dan Howarth’s future career as a diabetes nurse specialist was set in motion. Inspired by the care he received from the hospitalbased diabetes team in his hometown of Warrington, UK, he resolved to help people when he grew up. Dan studied nursing in the UK and after working as an inpatient diabetes specialist nurse, he moved to Auckland, where he was part of the team that developed a now nationally regarded young adult diabetes specialist clinic. Three years later he took up a role as a global education co-ordinator for the International Diabetes Federation, providing education and overseeing diabetes education programmes across the world. One of the main projects he was involved

in was the Diabetes Africa Foot Initiative (DAFI), which sought to raise awareness of diabetes foot complications and train health professionals in sub-Saharan Africa. Dan also organised for 10 diabetes centres across Africa to come together for a week’s formal training in Johannesburg. He said: “I always wanted to help people growing up. I had such a memorable diabetes nurse when I was a kid and will never forget the care I got or the people involved and I wanted to replicate that.” As part of his holiday leave he contacted an eye hospital in Jerusalem to see if they wanted a volunteer and they asked him to create a diabetes course and deliver it to their doctors and nurses. The week-long course was really well received and Dan received great feedback. During the week Dan went to some of the hospital outreach sites in Gaza and the West Bank. Dan, 33, is currently a Clinical Nurse Specialist for Waitemata District Health Board. He also has a

Dan (centre) volunteered to help children with diabetes in India. private practice, which is funding his volunteering overseas. Through networking at the IDF, Dan volunteered for its Life For A Child programme. He attended a busy diabetes centre in Belgaum, India. Here the charity provides glucose monitoring to 200 children with diabetes. Dan’s role was to see how the charity could help provide further education to potential diabetes educators within the region. He said: “Imagine not being able to access enough insulin, or any at all. The idea is overwhelming. Yet many Indian children can’t access this basic treatment for multiple reasons. Our worldwide diabetes community deserves better and it’s my privilege to help.” “My parents are the cornerstone to my achievements, without their support I would have fallen at the first hurdle. If I can support people with diabetes and their parents and family – then it’s solely because my family showed me how to.” For more information, and how you can support the IDF programme, Life For a Child, visit www.idf.org/ lifeforachild.

Dan (in blue) with some of the doctors and nurses he helped train in Jerusalem.

DIABETES | Winter 2015

H ELPI NG PATI ENTS H ELP TH EM S ELVES

TREATMENT

Free diabetes clinic success A primary care diabetes clinic in Palmerston North is proving to be successful, with results showing participants had improved blood glucose levels and lower blood pressure just six months after starting.

In establishing a free clinic for people with poorly controlled type 2 diabetes, Dr Paul Tervit wanted to break down three barriers he believed were stopping patients manage their condition effectively – time, money and information. It was also hoped the clinic would help reduce the number of patients with diabetes who needed to use the services at Palmerston North Hospital The free clinic is based at The Palms, the largest community health centre in Palmerston North with 17,500 patients on their books, including about 580 with diabetes. After a year in operation, the clinic has seen some good results, with HbA1c tests showing the attending patients’ average blood glucose levels have dropped significantly. Dr Tervit said: “We started treating those who were on the most severe end of the scale, as far as average blood sugar levels and barriers to care are concerned. It has gone so well that we no longer have many patients on the severe end of the spectrum to treat. We are now looking to those who are a level down in terms of severity, and are working to help them with their diabetes management.” Beginning last March, Dr Tervit

From left to right: Dr Paul Tervit; Health Care Assistant Bianca Ravelich; Practice Nurse Rita Maggon. established a team of health professionals who were passionate about diabetes care, to run a clinic every Wednesday morning. This clinic helps patients have more ownership over their condition by giving them easy to understand information about their diabetes. There are two major benefits: patients have a better rapport with the staff because they are in regular contact, and they have someone to call if they need support. The second major benefit is that their treatment can be examined and quickly changed if needed. The model seems to be working. At the beginning of the clinic the average blood glucose level (HbA1c) for the group was 100mmol/mol, much higher than it should be. The average level is now down to 85mmol/ mol, with blood pressure

levels also showing a good improvement. “It has been a great opportunity to set up this clinic in a primary care environment. Our patients come here to see their family GP, so it has a relaxed and comfortable atmosphere, and they are surrounded by all the same people they normally see. Being able to work with a great team of nurses and care assistants has made this clinic such a success, and we look forward to helping these patients further improve their quality of life,” added Dr Tervit. The new approach is the result of changes in the way MidCentral District Health Board funds diabetes care. Craig Johnston, MidCentral DHB’s Acting General Manager Funding and Planning, said the great results were proof the new approach is working.

Winter 2015 | DIABETES

C ARE A N D PRE VE NTI O N

TYPE 2 DI A BETES EDUCATI O N

DESMOND drives better diabetes care An international evidence-based education programme that empowers people with type 2 diabetes to manage their own health has arrived in New Zealand. Caroline Wood reports.

The training is said to be unique and it has been proven to work – in the UK, Australia and most recently New Zealand. The first DESMOND training day was delivered in Dunedin at the end of last year to great acclaim. It is hoped the programme can be rolled out across the country in the future. DESMOND is a collection of rigorously tested and structured education programmes for people with type 2 diabetes – with an emphasis on helping people better manage their own diabetes by helping them find the answers they need to help themselves.

“I attended the first DESMOND session in the country and it was fantastic,” says Noeline Wedlock, office manager at Diabetes NZ Otago branch. “I was very impressed with every aspect of the session. The information was comprehensive and delivered in such a way that allowed everyone to get involved, with an emphasis on personal responsibility. It is a positive and practical programme for anyone and everyone. “I think those who have a better understanding of their bodies and how diabetes affects them are in a much better position to manage their diabetes. It would be very beneficial if it could be rolled out across the country.”

DESMOND, which stands for Diabetes Education and Self Management for Ongoing and Newly Diagnosed, was conceived in the UK and developed over four years through strong evidence-based research and tested by a large randomised controlled trial throughout this whole development period.

1: The WellSouth DESMOND Educator Team, after successfully completing their training, October 2014 2: Preparing for one of the many ‘hands on’ group activities on the day. 3: Participants on the first New Zealand DESMOND day getting to grips with a physical activity session.

DIABETES | Winter 2015

The first course, the Newly Diagnosed Programme, was piloted across 17 Health Care Trusts in England. Following this extensive pilot, the largest global study into education provided at diagnosis of Type 2 diabetes was undertaken, with the results being published in the British Medical Journal, February 2008 (Davies et al 2008). DESMOND in the UK is now widely available across England, Scotland, Wales, and Ireland. Further courses have been developed: a prediabetes course for people, a safer Ramadan module and one for people with learning disabilities and diabetes.

TYPE 2 DI A BETES EDUCATI O N

Bringing the programme to New Zealand has been the culmination of much hard work by nurses and dietitians at WellSouth Primary Health Network, which committed in 2014 to bringing DESMOND to Otago and Southland. Diabetes nurse Marryllyn Donaldson, from WellSouth, was one of the first seven people in the country to become a fully qualified trainer and she helped provide the first course for Kiwis in Dunedin last October. She said: “I love the way the DESMOND day is all about the participants. It means ‘sitting on your hands’ a lot of the time, as the temptation is to rattle off reams of information, whereas DESMOND is all about the participants finding the answers themselves. They do the talking, while we listen.” “We find many people are doing better than they thought, which encourages them to make their individual goals at the end of the course. They comment that small changes can make a big difference to their diabetes management.” “It has been very satisfying to bring such an evidencebased, hugely researched, structured education programme to New Zealand. The long-term aim is for our team to progress to becoming national trainers and assessors, mirroring our Aussie colleagues in helping to deliver the DESMOND experience across all of New Zealand.”

A TYPICAL DESMOND TRAINING DAY The aim of the day is to support the participant to become an expert in their diabetes. The training is delivered by two highly trained DESMOND educators, who are health care professionals working in the community, often diabetes specialist nurses and dietitians. Participants are not ‘taught’ in a formal way, but instead are supported to discover and work out knowledge. This informs the goals and plans they make for themselves about self-managing their diabetes. Content includes: • thoughts and feelings of the participants around diabetes • understanding diabetes and glucose: what happens in the body • understanding the risk factors and complications associated with diabetes • understanding more about monitoring and medication • how to take control – food choices and physical activity • planning for the future.

CARE AND P RE V ENTION

FEEDBACK Fourteen DESMOND programmes have been run to date in New Zealand – seven in Southland and seven in Otago. The course is free and patients can sign up themselves without having to go through their doctor or nurse. Feedback from the programme has been extremely positive, with comments such as:

“Very informative relaxed session. I am motivated to change my lifestyle and thinking”

“With having diabetes for over 15 years I can say that I understand things better at the end of the training. Gained more knowledge about ways of reducing blood sugar levels”

“Today was a real enlightenment for me. For the first time I can understand much about the disease and what I can do to help myself. I am very grateful to have had this opportunity.”

EVALUATION RESULTS Evaluation results six months post programme in Australia have shown: • a significant decrease in systolic blood pressure • a significant decrease in ‘diabetes distress’ • a trend toward reduction in cholesterol and HbA1c • a significant increase in physical activity.

NZ’s most popular insulin pump1

Funded for eligible patients P 0508 634 103 W www.nzmsdiabetes.co.nz 1. IMS Health Data, Oct 2012 - March 2015.

Winter 2015 | DIABETES

THE KATI E DOYLE COLUMN

CELEBRATING MY DIA-VERSARY Over the last few years, I’ve developed a tradition of doing a fun and exciting thing each year to celebrate my ‘diaversary’. This is the day marking the anniversary of my type 1 diagnosis, which falls on the 17th of March. I usually end up doing something really dramatic each year when my diaversary rolls around. From my perspective, an exciting and fun activity that commemorates a diagnosis of something challenging (and not always 100 percent fun) makes the situation a little bit better! Past diaversaries have involved celebrating St. Patrick’s Day in Dublin, Ireland and heliskiing in the French Alps.

However, I hesitated about the cost, and my sensible inclinations haunted me for a while. When it came down to it, though, throwing myself off a bridge over the Kawarau Gorge near Queenstown seemed like the ideal follow-up to last year’s heliskiing trip, so I talked myself into it. When I jumped, my exceptionally long scream was one of joy – because my host family was generous enough to do all the worrying for me as I prepared for my bungy jump. I just really wanted to do it! I only got nervous when I had to walk the plank out into nothing with my ankles Velcro-ed together. Then the guy said, “Okay, I’m holding on to you, which means you can let go of the bridge now.” Oops. And then I jumped! If you told me I was going to do this when diabetes felt like it was seriously kicking me in the guts while I was down, I wouldn’t have listened. There are still times when I feel incredibly, indescribably,

tired – when the weight of the word ‘chronic’, as in chronic disease, feels so heavy. To quote the three-yearold I looked after when he had a memorable tantrum in the car: “I. DO. NOT. WANT. TO. LIVE. LIKE. THIS. ANY. MORE.” Then, all of a sudden, I blink and here I am tied to this bridge by a piece of elastic, looking out over the bluest water I’ve ever seen, with these lovely people who care about me watching me on the sidelines, and I get this rush of adrenaline and all the work that goes into living with diabetes is worth it. *Katie Doyle is an American living in New Zealand and blogging about diabetes, travelling and her unique take on the world. A version of this article was previously published on the American Association of Diabetes Educators’ website. Visit whereintheworldiskatiedoyle. tumblr.com to check out Katie’s bungy jump video and keep up with her adventures.

PHOTOS AJ HACKETT

PHOTO ANNA NEAL

This year’s St. Patrick’s Day diaversary challenge had been on my New Zealand bucket list for a while. Since I’ve already checked off skydiving, snorkelling, and visiting Milford Sound and Stewart Island, I was starting to get anxious that I might not have time to… drum roll, please… bungy jump. When I hinted that I wanted to jump, the family I lived with immediately said “We

want to watch you bungy jump!” So it was settled.

Diaversary dive: Katie prepares to bungy jump at Kawarau Gorge near Queenstown.

DIABETES | Winter 2015

H E ALTH P ROMOTION

GET YOUR FREE FLU IMMUNISATION Influenza or ‘the flu’ isn’t just a bad cold, it’s a serious disease that can put people in bed for a week or more. It can strike all ages, including the young, fit and healthy. Catching the flu can lead to complications like pneumonia, organ failure, a hospital stay, or even death. People with ongoing medical conditions like diabetes, whatever their age, are at especially high risk from influenza complications. The influenza virus can be anywhere. It could be coming from a colleague’s cough or sneeze, or waiting in the kitchen when you make your morning cuppa. It may be hiding on the bus or your friends or whānau may be carrying it. Make sure you meet it on your terms. There’s no need for you, or those close to you, to suffer the misery of flu this year. An annual vaccination is the best protection from the flu virus.

You are entitled to a free flu vaccination if you have diabetes. For advice about influenza immunisation visit www.fightflu.co.nz or call 0800 IMMUNE. The influenza vaccine is a prescription medicine with benefits and possible risks.

can be anywhere

Anyone can catch flu – even the young, fit and healthy. •

Influenza isn’t just a bad cold – it can be serious and can kill.

•

A human sneeze can contain millions of individual influenza viruses.

•

Influenza virus can remain in the air for some time, so it can be very difficult to avoid.

•

More than 200,000 New Zealanders contract influenza each year. Of these, it’s estimated that approximately 400 people will die either directly or indirectly as a result of influenza.

•

Over a million Kiwis get the annual influenza immunisation.

•

You cannot get influenza from the vaccine.

•

Influenza immunization is FREE for people of any age with diabetes until 31 July 2015.

National Influenza Specialist Group

Winter 2015 | DIABETES

FAM I LI ES

TEACHER AID E FUND ING

with diabetes Jacqui van Blerk explains how to apply for teacher aide funding and work with your child’s school to keep them safe. When you’re struggling to come to grips with your child’s type 1 diabetes diagnosis, it becomes clear pretty quickly that the ‘new normal’ carries a few more complexities than the old one did. The immediate concern is stabilising their erratic blood sugar levels and learning how to administer blood glucose checks and insulin doses. Every meal and snack becomes a minefield of doubts – Did she eat the crusts? Did I eyeball that quarter unit correction correctly? How long will the carbs take to digest?

DIABETES | Winter 2015

Sometimes it’s easier to focus on these more immediate concerns than face the bigger question – How are we going to return to a semi-normal routine? And what about school? For some of us, when diagnosis involves a preschooler, we have a little more time to explore options before they head off to primary school. For many, a week of medical treatment and diabetes education is all that stands between the old routine and the new. After that, life becomes a bit more complicated and school is one of those hurdles that needs to be overcome. There are no hard and fast rules in the education sector governing the standards of care for children with diabetes (and nothing that provides

for the care of preschoolers). The onus falls on the parents to work with the childcare facility or school to draft a workable care plan that is specific to their child’s requirements. The most immediate concern is making sure that the child receives attention for hypoglycaemic incidents (hypos) and that insulin can be administered for meals and blood glucose checks are carried out. This becomes more critical when dealing with children who are too young to accurately interpret their blood glucose readings or who are hypo unaware. By establishing a good relationship with the school staff, it becomes easier to discuss care options and strategies, including the possibility of assigning a teacher aide to the

TEACH ER A I DE FUNDI NG

“What parents may not realise is that they can initiate the teacher aide application process themselves.” child to provide more immediate and individual care. The Ministry of Education makes teacher aide funding available through their School High Health Needs (SHHN) programme – but the process can take months to finalise. What parents may not realise is they can initiate the SHHN (teacher aide) application process themselves. The application form is available from the Ministry of Education’s website and consists of the caregiver’s description of the child’s specific healthcare situation and requirements and a medical specialist’s confirmation of your child’s health needs. It’s important to ensure that all the relevant details are listed in the initial application. This includes the likelihood and severity of hypos, frequency of bolusing (by injection or pump), as well as the age and ability of the child to assume responsibility for testing and bolusing. The school is responsible for submitting the completed form to the Ministry of Education, which reviews the application and subsequently either declines or approves the request in principle. If the initial application has been successful, the Ministry will request a meeting with the school and caregiver to review the specific requirements and set the number of funded hours per week. At this point it pays to prepare as much information as possible to include in the draft care plan! Funded hours are calculated on estimates of time required to perform various tasks, like taking a blood glucose reading, and extrapolating that out over the number of tests required

per day and then per week. If the testing process takes five minutes and needs to be done four times a day, the requirement would be 100 minutes per week, or roughly one and three-quarter hours of teacher aide funding. Additional time may be required if the test results need to be discussed with the caregiver for the calculation of insulin dosages. For small children, supervision may be required to ensure that all food that has been bolused for, has been eaten! The care plan should also take into account any additional supervision for sporting activities. Try to establish the minimum window of teacher aide coverage required; if breakfasts and lunches always trigger high blood sugars, then potentially the teacher aide would only be required from 10am, and not after 2pm. Discussing the normal daily routines will help provide the Ministry representatives and school staff with the necessary insight into your child’s healthcare needs. Once the care plan has been discussed, the Ministry will arrive at a final total of funded hours. At this point the school may decide to provide coverage for additional hours –this funding comes from the school budget and if you’re lucky enough to receive it, I strongly recommend taking an active role in the PTA or volunteering for their fundraising activities! They are not obliged to provide anything over and above the Ministry’s allocation, so any contribution from them is incredibly generous. The final piece of the puzzle is the recruitment of a suitable teacher

FAM I LI E S A ND CH ILD REN

aide. The school may already have teacher aides on their staff, and use the funding to provide increased hours, or they may need to advertise for applicants. If you’re aware of any friends, family or acquaintances who meet the general employment criteria, it can be very helpful to provide their details to the school to expedite the recruitment process. The teacher aide funding is reviewed on an annual basis and you can expect it to decrease as the child becomes more confident and competent at managing their diabetes tasks themselves. Unless there are additional compounding health issues, very few children will receive teacher aide funding once they are at intermediate or secondary school level.

Northland Primary School in Wellington has about 340 students, including two young children under eight with diabetes. It has two teacher aides supporting the children in their classes every day at school. Principal Jeremy Edwards said it was important to work closely with their parents to ensure their safety at school. The Board of Trustees has decided to fund additional teacher aide support at a cost of $8,000 a year. Principal Jeremy Edwards said: “The teacher aide funding provided doesn’t cover every hour of the school day, nor the per hour rate paid to the teacher aides. We have taken the decision to top up the funding out of the school’s operations budget. One of our teacher aides is very experienced with diabetes as she has an older child with the condition. We feel it’s important there is someone on the premises who knows what do to if either of the children has a hypo or another diabetes-related issue and requires medical assistance.”

Winter 2015 | DIABETES

FO O D

S U GA R FACTS

Sugar and diabetes: What’s the story? Diabetes New Zealand dietitian Margaret Thorsen answers some common questions about sugar.

Back in the bad old days people with diabetes were told to avoid all food with added sugar. This position was relaxed, to a degree, in recent times due to a greater understanding of the impact of different types and amounts of carbohydrate on blood sugar control. With sugar now making a regular ‘bad guy’ appearance in the media, does this mean all sugar needs to avoided once again? In short the answer is no – but the recommended amount of sugar in your daily diet will depend on the type of diabetes you have, your lifestyle and whether you want to lose weight.

What happens when I eat sugar? Our bodies use a form of sugar called glucose to fuel our muscles and brain. Sugar in our food (from broken-down carbohydrates or added ‘free’ sugar) is absorbed into the bloodstream as glucose. The pancreas produces insulin, which acts like a key allowing glucose to enter the muscles or cells of

the body so it can be stored or used as energy. When the body produces enough insulin, and uses it effectively, the level of glucose in the blood stays within the ideal range between 4–8 mmol/L. In someone with type 1 diabetes, the pancreas stops producing insulin altogether and they will need regular insulin injections to replace the lost insulin in their body. They must balance their insulin dose to the amount of carbohydrate in their meals to maintain their blood glucose levels within the ideal range. When someone develops type 2 diabetes, their body is still producing insulin but it may not be enough or isn’t working effectively. As a result blood glucose levels rise beyond the ideal range. Some form of medication (if needed), regular physical activity and careful food choices – particularly about the amount of carbohydrate consumed – are the key ways of keeping blood glucose levels down.

How much sugar can I have? The most recent World Health Organisation (WHO) sugar guidelines continue to recommend limiting free (added) sugar to less than 10 percent of total energy intake. For added health benefits it suggests lowering free sugar intake to less than five percent of total energy intake – the equivalent of just six teaspoons of added sugar per day for a normal adult and three teaspoons for children. Free sugar is the sugar added to food and drink by the manufacturer, cook or consumer. It doesn’t include intrinsic, or naturally occurring, sugar like lactose in milk or fructose found in fresh fruit. Naturally occurring sugars and added sugars are combined together to give the ‘sugar’ content of a food on a nutrition information panel. It would be a dramatic change for many people to lower their free sugar intake to these levels because of the abundance of added sugar in today’s food supply. But these are

ASK THE DIETITIAN — do you have any questions about nutrition, diet and diabetes? Send them to editor@diabetes.org.nz or write to The Editor, Diabetes magazine, Diabetes New Zealand, PO Box 12441, Wellington 6144.

DIABETES | Winter 2015

S UGA R FAC TS

useful guidelines to work towards for people with type 2 diabetes and prediabetes. The following page has some tips on how to reduce your sugar intake that will get you moving in the direction of the WHO guidelines. If you have type 1 diabetes, these are still useful guidelines to keep in mind for overall health. Ultimately your goal is to balance the amount of carbohydrate consumed with the right amount of insulin to meet your individual needs. You can include up to 10 percent of your total energy intake from free sugar if you are more physically active and a healthy weight. You still need to have a source of free sugar close at hand in case you experience a hypo.

Can I still eat fruit? Yes. Fruit does contain intrinsic sugar so eating a lot of fruit at any one time will increase blood sugar levels in people with diabetes. But it is also a rich source of fibre, vitamins and minerals so can be a nutritious way of adding sweetness to breakfasts, snacks or at the end of a meal. Whether you have type 1 or type 2 diabetes, aim to eat three to four serves of fruit at intervals throughout the day to get the goodness of fruit while reducing its impact on blood sugar levels.

Are some kinds of sugar better for people with diabetes? All carbohydrates raise blood glucose levels whether they are derived from starch or sugar. Starchy carbohydrate foods like bread, potatoes, rice or corn may also contain vitamins, minerals and fibre but free sugars are often called ‘empty calories’ because they don’t provide any vital nutrients. Free sugars include all honeys, fruit syrups, maple syrup, organic sugars and fruit concentrates. I advise making your carbohydrates count by making nutrient-rich sources your first choice.

FOOD

Coconut sugar and LoGiCane have a lower glycaemic index than regular sugar so they are absorbed at a slower rate into the blood system. Coconut sugar has been promoted as a source of minerals and antioxidants but large amounts of coconut sugar would have to be consumed to gain any meaningful quantity of these nutrients. The energy content of coconut sugar is the same as other sugars so this wouldn’t ultimately help your blood sugar levels or waistline. Both of these sugars are still considered free sugars so use them as sparingly as all other sources of sugar.

Is it better to use an intense sweetener than sugar? Reducing your preference for sweet foods is the best way to lower daily sugar intake. But there will be occasions when you want something sweet without the sugar content. This is when you may turn to ‘intense sweeteners’ also known as artificial sweeteners, low-calorie sweeteners, sugar substitutes or non-nutritive sweeteners. Because of their intense sweetness, only small amounts are needed to add sweetness to baking, cereals or beverages. As they are low-sugar or sugar-free they won’t affect your blood sugars in the way sugar does. All intense sweeteners available in New Zealand have been approved as safe for use by the Ministry of Primary Industry with guidelines set for acceptable daily intakes. Alcohol-based sweeteners, such as sorbitol and mannitol, can cause gut problems like bloating, flatulence and diarrhoea. Some people react to even small amounts of these sweeteners so limit your intake to a small amount until you discover how well you tolerate them. Top tips for cutting sugar from your daily diet – see overleaf.

Winter 2015 | DIABETES

FO O D

S U GA R FACTS

10 ways to reduce your sugar intake

Pro t

meat, chicken, fish, eggs…

Swap fruit juice and sugary drinks for water and sugar-free beverages.

Halve the amount of sugar you add to breakfast cereals, tea or coffee each week. Allow your taste buds time to adjust to the new flavour.

Choose foods with less than 10g/100g of sugar or the option with the least sugar content.

Check the labels for hidden sugars. Sauces, salad dressing and soups are just a few examples of foods potentially high in hidden sugars.

Make dishes from scratch whenever possible to avoid the hidden added sugars in many processed foods.

Reduce your desire to reach for high energy snacks by filling half of your plate with non-starchy vegetables such as tomatoes, cucumber, broccoli, pumpkin or mushrooms.

Take your time with main meals so your body has the chance to feel full. You are less likely to grab a sweet treat at the end.

Use fresh fruit to add sweetness to breakfast cereals, as a snack or at the end of a meal.

Reach for wholegrain crackers and hummus, fresh fruit, yoghurt or a piece of wholegrain toast if there is going to be a long gap between meals.

Use fruit purees, sugar substitutes or half the amount of sugar stated in a recipe to reduce sugar content of baked items. Keep serving sizes small even though the recipe has been altered to reduce the sugar content.

Car bo

potato, kumara, pasta, rice, taro…

ate dr hy

n ei

Other vegetables

A word to the wise Sugar is often present in special occasion foods, such as those served at parties, birthdays, Easter and Christmas. You can still have a small serving of your favourite dessert or a piece of high quality chocolate. Just make sure you take the time to sit down and enjoy every mouthful. If you make healthy eating choices most of the time it will have a bigger impact on your overall health than completely avoiding the odd treat on special occasions.

DIABETES | Winter 2015

RECI PES

FOOD

NEW

Winter warmer

LOW

CALORIE SWEETENER Measures spoon-for- spoon like sugar

Beef goulash A really hearty stew, great for winter nights. It is low fat and low sugar and you can use the leftovers for lunch or freeze them for another time. Serves 2. Prep time 15 mins, cooking time 2 hours.

INGREDIENTS 250g lean braising steak, cubed 250g new potatoes 2 tsp seasoned flour 1 tsp oil 1 onion, chopped ½ red pepper, chopped 1 clove garlic, crushed 1 tsp paprika 200g can chopped tomatoes 1 tbsp tomato puree 150ml (¼) pint beef stock METHOD Preheat the oven to 180°C / gas mark 4.

CHEF’S TIPS You could use lamb, venison or pork in this recipe instead of beef. If using a vegetarian alternative such as chickpeas or tofu then reduce the cooking time by 30 minutes.

Toss the steak in the seasoned flour. Heat the oil in a flameproof casserole dish, add the steak and fry for 2–3 minutes until browned all over. Add the remaining ingredients, bring to the boil, then cover and place in the oven and cook for 1½–2 hours until the meat is tender.

Try this deliciously satisfying and healthy winter stew.

Perfect to use in your favourite food or drink recipes. Add a delicious, sweet taste with fewer calories.

Serve with plenty of vegetables. * Reproduced by permission of our friends Diabetes UK. You can find more delicious recipes at www.diabetes.org.uk/enjoyfood.

EACH 570g SERVING CONTAINS (EXCLUDES SERVING SUGGESTION) Kcal 370; Carbs 39.6g; Protein 32.1g; Fat 8.7g; Saturates 2.8g; Sugars 12.7g; Salt 1.7g; Portions Fruit & Veg 2.3

For delicious recipes, visit

club

Winter 12032015_Equal Strip_59x242.indd 1

.co.nz

2015 | DIABETES16/04/2015 27

1:40 pm

LE T ’S G E T A CTI VE

TIPS FOR TYPE 1

Exercise vital for people with type 1 diabetes Diabetes nurse specialists Kirsty Newton and Gilli Lewis explain the ins and outs of exercising safely with type 1 diabetes – and why it’s vital to be active to reduce the risk of heart disease.

Everyone knows physical activity is good for them, whether they exercise or not. Physical activity is part of the juggle that people with type 1 diabetes have to do every day – juggling insulin doses, food and physical activity all in relation to their blood glucose level. People with type 1 diabetes have at least twice the risk of cardiovascular disease than those people without diabetes. So it is really important to incorporate physical activity into your day every day, or at least 60 minutes for three days of the week. Physical activity improves your cardiovascular health, maintains or reduces weight, increases bone health, improves your diabetes control and produces endorphins which make you feel good. The general rules for exercise are to reduce mealtime or basal insulin prior to the activity, eat extra carbohydrates, test often and don’t exercise if you are post-hypo.

DIABETES | Winter 2015

Testing Lots of things impact your diabetes control during exercise – duration, intensity, regularity, temperature, level of fitness, different types of activity and so on. Testing is your best friend! Testing before, during and after exercise will help you make good management decisions about insulin and food. It may help to write these down until you have a good handle on what happens for you during and after exercise. Test overnight if you have exercised in the afternoon or evening as glucose requirements increase 7–11 hours after exercise. That is when the body is restocking the glucose stores that you used during the activity.

Insulin management Hypos are most likely to be caused by moderate intensity and long duration exercise. Therefore it is a good idea to lower your basal and mealtime insulin before exercising, which is what the non-diabetic body does during exercise. Hypos can occur up to 48 hours following exercise due to the increase in insulin sensitivity that results from the exercise. Pre-meal insulin can be lowered by as much as 25–75 percent for planned exercise. You may also need to reduce your rapid acting insulin at the meal following exercise. The timing of the long-acting insulin is more flexible now we have access to long-acting insulins such as Lantus. If you are on Protaphane or Humulin NPH you may need to reduce the dose by 2030 percent before and after exercise to reduce your hypo risk.

Pumpers have the most flexible options and can run a temporary reduced basal rate up to -50 percent, this may need to be extended for two or more hours following exercise. However it may be necessary, or desirable, to detach your insulin pump during exercise, for example during swimming or for contact sport. This may reduce the risk of lows but may require a small bolus correction for missed insulin afterwards. Make sure you do not inject into the exercising limb, or inject into the muscle rather than fat. Using a 4mm needle will help prevent that.

Planned vs spontaneous exercise You can plan your insulin reduction and carb intake ahead of time if you know when you are going to do some physical activity. Keeping a record will help you be confident about the reductions. If the exercise is spontaneous, the best option is to have some extra carb if you have an active bolus on board (remember rapid acting insulin – Novorapid, Humalog, Apidra – has an approximate threehour duration of action). You may need to reduce your insulin at the meal following the exercise and even your night-time long acting insulin. If your blood glucose level is <5.6 mmols before exercise it is a good idea to have some extra carbohydrate. Carbs reduce your risk of hypo especially if you have active insulin on board from a recent bolus or you have not reduced your insulin dose.

TI PS FO R TYPE 1

LE T ’ S GE T ACTIVE

Avoiding post exercise lows (hypos) and highs Two things may help avoid hypoglycaemia (low blood sugar): • Consuming carb, fat or protein containing snacks straight after physical activity may be effective in preventing late-onset postexercise hypoglycaemia. • Whole milk is considered the best drink in terms of limiting the degree or duration of hyperglycaemia when used post exercise to prevent hypoglycaemia. • A 10-second maximum effort sprint at the end of moderate intensity exercise can delay hypos for up to two hours (see right).

Measure blood glucose before going to bed and decrease bedtime insulin (Lantus injections or pump insulin basal rate) by 10-20 percent after an afternoon or evening exercise session if the exercise was more intense than usual or an activity not performed regularly. Other factors during exercise can contribute to lows – extremes of temperature, terrain, wind, unplanned extension to duration or intensity.

Avoiding post exercise highs Hyperglycaemia (high blood glucose levels) can result from an excess of counter-regulatory hormones, insufficient insulin or an inability to increase glucose uptake into skeletal muscle. If you find your blood glucose level is elevated after exercise, be cautious about correcting with rapid-acting insulin. Often it is a high reading caused by adrenaline that will ebb away on its own. If you must correct, use a half correction dose to be safe. Remember stress can cause a blood glucose level to rise dramatically just before a competitive activity.

10-second sprint

Food Meals with high carbs content should be consumed shortly after exercise, taking advantage of the period of heightened insulin sensitivity to help replenish glycogen content and limit post-exercise hypoglycaemia. A mixture of aerobic and anaerobic activity (soccer, cycling, jogging and swimming) will typically require extra carbs before, possibly during, and often after the activity. Consume 1.0-1.5g of carbs per kilogram of body mass per hour of strenuous or longer duration exercise when circulating insulin levels are high (if pre-exercise insulin doses were not decreased). Drink sugar-free fluids to avoid dehydration. Hypos are more likely if alcohol is consumed after exercise.

There is evidence in the literature to suggest a 10 second maximal effort sprint after moderate-intensity exercise for young individuals with insulin-treated, complication-free type 1 diabetes will prevent hypos post exercise. This is better than just resting. The sprint mobilises the hormones that prevent hypoglycaemia.

Medical checks and exclusions Certain groups of patients should not do an activity more vigorous than walking until they have had a medical assessment. These groups include previously sedentary over-30s with type 1 diabetes, those who have had diabetes for 10 years or longer and people with any diabetes-related complications (microvascular or macrovascular). Tests may include exercise stress testing for cardiovascular disease.

People with proliferative retinopathy or nephropathy should avoid resistance-based exercises or anaerobic exercise that is more likely to result in high arterial pressure. Individuals with excessive hyperglycaemia (fasting blood glucose >15mmol/L) and elevated ketone levels should not participate in vigorous exercise until their blood glucose level control has been regained and ketones are no longer present (<0.6 mmols).

Winter 2015 | DIABETES

DIAB E TES I N H ISTO RY

THE 19 TH CE NTU RY

Laying the groundwork for the discovery of insulin In the third of our occasional series looking at the history of diabetes from ancient times to the present day, Caroline Wood looks at some milestone events from 1800-1899. Some important breakthroughs in our current understanding of diabetes can be traced back to the 19th century when scientists made big strides in the fields of physiology and biochemistry. Over this 100year period, scientists discovered the role of the liver and then the pancreas in diabetes. They also devised the first diagnostic test for diabetes. These discoveries were to lay the groundwork for the most important advance of all – the discovery of insulin in the early 20th century. One of the first milestones of the 19th century was the development of chemical tests to indicate and measure the presence of glucose in urine. Back in 1776 British

Michel Eugène Chevreul

DIABETES | Winter 2015

physiologist Matthew Dobson was the first to show the sweet-tasting substance in urine was sugar. In 1815, French chemist Michel Eugene Chevreul was the first to prove the sugar in urine of individuals with diabetes was glucose. Chevreul (1786-1889) was an interesting character who lived (and worked) to the ripe old age of 103. Chevreul was best known for his research into fatty accids and was the inventor of the kind of candle still in use today. He also studied the structure of sugar isolated from diabetic urine and concluded it was identical to ‘grape sugar’ (glucose). In 1848, German chemist Hermann Von Fehling (1812-1849) developed a quantitative test, known as Fehling’s solution, which was able to detect glucose in urine. By now diabetes was defined by the presence of glucose in the urine and doctors could diagnose the condition by testing a person’s urine. But the source of the glucose – the cause of diabetes – was still unknown.

Claude Bernard

Discovering the liver’s role During the early part of the 19th century, various theories were raised that diabetes was due to infection or originated in the liver, brain or nervous system. A major breakthrough came in the middle of the century when French researcher Claude Bernard (1813-1878) was able to show that sugar absorbed from the intestine converted to glycogen in the liver for release into blood as required. Bernard, a professor of physiology at the Sorbonne in Paris, was one of the most prominent experimental physiologists in 19th century Europe. He concluded that an excess of glycogen in the blood caused diabetes and this received wide acceptance. While researchers were looking for the cause of diabetes, doctors were further advancing the understanding of diabetes, its manifestations and complications. For example William Prout (1785-1850) was the first to describe a diabetic coma and Wilhelm Petters in 1857 showed the

Oskar Minkowski

TH E 19 TH CE NTU RY

DI AB E TE S I N H ISTORY

Different doctors had their own theories of the best treatment for their diabetes patients. In the late 1850s, French physician Priorry advised diabetes patients to eat extra large quantities of sugar as a treatment. And British doctor Arthur Scott Donkin promoted the therapeutic qualities of a ‘purely milk diet’ for diabetes in his Lancet article of 1869. In the second half of the 19th century, before insulin was discovered, diabetes treatments mostly consisted of starvation diets. The diets were often harsh and death from starvation was not unknown in patients with type 1 diabetes. In contrast these lowcalorie diets were often found to be quite good in patients with type 2 diabetes. In the 1870s a French doctor Bouchardat noticed the disappearance of glycosuria in his

presence of acetone in the urine of patients with diabetes. And in 1869 Henry Noyes described retinopathy in a person with advanced diabetes.

Advances towards the discovery of insulin Another breakthrough came in Strasbourg in 1889, when researchers Oscar Minkowski (1858-1931) and Joseph von Mering (1849-1908) observed that dogs whose pancreases were removed developed severe thirst, excessive urination and weight loss. Minkowski thought the symptoms were caused by diabetes and tested the dogs’ urine finding glucose.

diabetes patients during the rationing of food in Paris while under siege by German during the Franco-Prussian War. He formulated the idea of individualised diets for his diabetes patients. But not every patient was keen on the low-calorie diet. In the late 19th century Italian diabetes specialist Catoni isolated his patients under lock and key – so they would follow their strict diets. Canadian doctor William Osler advised his diabetic patients in The Principles and Practice of Medicine, 1892, to “eat food of easy digestion, such as veal and mutton, and abstain from all sorts of fruit and garden stuff”. Osler, a leading physician of his day, also recommended taking opium, commenting that “diabetic patients seem to have a special tolerance for this drug”, a daily lukewarm bath, avoidance of worry, and emigration to an equable climate.

19th century diabetes treatments (don’t try this at home…)

Diabetes patients in the 19th century were advised to move to a warm European climate.

Also writing in the late 19th century, Emil Schnee recommended living in a warm climate – the Riviera in winter, Zurich in summer – and muscular activity starting with billiards, then rowing and wood splitting. His diet recommendations included easily digested foods, no starch or sugar plus light Moselle wines, old Claret and good cigars ‘in moderation’.

Their work led other doctors and scientists to research the relationship between the pancreas and diabetes, which ultimately resulted in the discovery of insulin as a treatment for the disease.

might be the source of substance involved in glucose control. Later, in 1909, Belgian physician Jean de Mayer would name the presumed substance produced by the islets of Langerhans ‘insulin’.

Four years later, in 1893, French scientist Edouard Hedon (18631933) showed total removal of the pancreas was necessary for the development of diabetes. He grafted a small piece of pancreas under the skin and found no evidence of diabetes in the experimental animals. In the same year, Gustave-Edouard Laguesse (1861-1927) suggested the tiny island of pancreatic tissue described in 1869 by Paul Langerhans,

Sources “The Main Events in the History of Diabetes Mellitus” by Jacek Zajac et al from the book Principles of Diabetes Mellitis (L Poretsky, ed), 2010. Michel Eugene Chevreul: http:// jn.nutrition.org/content/72/1/3.full.pdf Understanding Diabetes: A Biochemical Perspective By R. F. Dods Prof Jim Mann’s Food: Fat, Fallacies and Facts presentation to Diabetes NZ conference 2012.

Next time: We look at the key discoveries during the first half of the 20th century.

Winter 2015 | DIABETES

RES EA RCH

INS-PBA-F BREAKTHROUG H

Study probes ‘smart’ insulin A ‘smart’ insulin that self-activates when blood sugars soar is undergoing trials in the US in the hope it could one day remove the need for constant finger prick blood tests. Scientists at the University of Utah have been testing a compound, known as Ins-PBA-F, which activates automatically when blood sugars rise. The compound is a chemically modified version of long-acting insulin. Tests on mouse models for type 1 diabetes show that one injection works for a minimum of 14 hours, during which time it can repeatedly and automatically lower blood sugar after mice are given amounts of sugar comparable to what they would consume at a mealtime. “This is an important advance in insulin therapy. Our insulin derivative appears to control blood sugar better than anything that is available to diabetes patients right now,” says co-author Dr Danny Chou, assistant professor of biochemistry at the University of Utah. Ins-PBA-F is engineered so additional molecules bind to a protein, called albumin, which circulates in the bloodstream. The smart insulin remains turned off when attached, but when blood sugar levels rise, insulin is released and serves to regulate glucose levels. The Utah team hopes to test the Ins-PBA-F compound in people with diabetes within two to five years. This could remove the need to constantly monitor blood sugar levels and give bolus insulin doses at meal times. “With this you would just inject it and it wouldn’t matter if you overshot because its activity would stop when glucose levels get too low,” added Dr Chou. While progression towards clinical trials in humans will take time, Karen Addington, chief executive of the Juvenile Diabetes Research Foundation in the UK, remains optimistic regarding smart insulin. “For many people living with type 1 diabetes, achieving good blood glucose control is a daily battle. A smart insulin would eliminate hypos, which are what many with type 1 diabetes hate most. It would enable people with type 1 diabetes to achieve near perfect glucose control, all from a single injection per day or even per week. That’s really exciting,” Addington said. Read more at www.healthcare.utah.edu or www.jdrf.org/smartinsulin

DIABETES | Winter 2015

Meet Mika Mika is an adorable Siberian Husky puppy in training to perform a very important, and life-saving role. Mika, which means ‘new moon’ or ‘gift from God’ was donated by her breeder Giselle Fletcher, of Snowolf Kennels, to the Kotuku Foundation, which trains diabetic response dogs to help people with type 1 diabetes in New Zealand. Mika is currently being foster trained by Vicki and Simon Parry in Auckland. Vicki owns Ada, who appeared on the cover of our Spring 2014 issue. Ada is New Zealand’s first DRD and a global success story – being the first husky to be trained as a diabetic response dog. Mika is actually Ada’s sister (several litters removed) and she will remain with her big sister until she is ready for the challenging training required of her soon-to-be profession. Diabetes response dogs are highly trained to alert their owner if their blood sugar levels drop dangerously low – using their gift of smell to give a gift of life. Find out more: www.kotukufoundation.org.nz. Do you have type 2 diabetes and kidney disease? The SONAR clinical research study is evaluating the safety and effectiveness of an investigational drug in people with diabetic kidney disease. You may be eligible for the study if you: • Are 18-85 years of age • Are male or a post-menopausal female • Have type 2 diabetes and kidney disease • Are currently taking medication to lower your blood pressure • Do not have a history of heart failure For more information, contact: Narrinder Shergill, Diabetes Service North Shore Hospital Shakespeare Road, Takapuna, Auckland. Phone: 09 486 8920 ext 3309 Mobile: 021 453 579 or email Narrinder.shergill@waitematadhb.govt.nz The study has been approved by the Northern B Health and Disability Ethics Committee.

If it’s to be, it’s up to me Auckland mum Jacqui van Blerk is Diabetes Youth’s new president. Here she tells us how she nearly lost her daughter Melissa to diabetes and how this led her to volunteer to lead New Zealand’s only youth-focused diabetes organisation. My daughter, Melissa, was diagnosed almost three years ago, a few months before her third birthday. She’d been feeling unwell for a few weeks, and we’d seen a number of GPs who kept reassuring us that she would ‘snap out of it’ in a day or two. We grew more and more concerned as she grew weaker, until one evening I took her in to the local A&E where they decided to send us to Starship for chest x-rays suspecting a viral pneumonia. Several hours later, after the x-rays came up clean, they finally took the blood tests and came back with a diagnosis of type 1 diabetes that left us completely stunned. We nearly lost Melissa that night as her body went into shock from diabetic ketoacidosis – I will never forget the feeling of dread as the

nurse tapped me on the shoulder and told me to call my husband to the hospital as soon as possible… But my daughter is a tiger! She fought back and rallied the following day. Her subsequent journey with diabetes is testament to her resilience and determination. As the shock of diagnosis wore off, I found myself struggling to cope with the anger and guilt of my ignorance. Talking to other families helped me to gain a better perspective on how to manage diabetes and I started hosting some events for the toddler/ preschool kids for Diabetes Youth Auckland in 2013. I was invited to join the Diabetes Youth Auckland committee early last year and my nomination to Diabetes Youth New Zealand was accepted last April. My main motivation for becoming actively involved in the local and national support groups is that I can help shape the environment my daughter will grow up in. I want to raise awareness of her condition and perhaps spare other parents the grief of a missed diagnosis. I want to ensure all children with diabetes are provided with a consistent standard of care.

Melissa van Blerk, now six, almost died before being diagnosed with diabetes at the age of three. A company I worked for provides a coin in its induction pack, with the following words: ‘If it’s to be, it’s up to me.’ I believe that if I want the world to change, then I have to be an active part of that change, or lose the right to complain about the status quo.

Jacqui van Blerk

President Diabetes Youth NZ You can contact Jacqui via email: president@diabetesyouth.org.nz

Diabetes Youth New Zealand

JOIN YOUR LOCAL SUPPORT GROUP BY VISITING

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

FIND US ON FACEBOOK AND TWITTER

www.diabetesyouth.org.nz Autumn 2015 | DIABETES

THE L AS T WORD

Record breaking Win Winsome Johnston has reached two amazing diabetes milestones in her life. Caroline Wood finds out more.

It has been a busy year for 86-year-old Winsome. She’s been interviewed on national television and was the ‘cover girl’ in the last issue of Living Life Well, Diabetes NZ Auckland branch’s magazine. Win, who lives in Auckland, recalls how she found out she had diabetes when she was six years old in 1934. She remembers thinking how she would die and crying a lot after her diagnosis. Her older sister, who also had type 1, had died at the age of 16. The former nurse and midwife featured in a newspaper article last year with her young friend Grace Redfern-Daly, 10, where they shared their very different experiences of growing up with type 1 diabetes. Back in the 1930s diabetes care was still rudimentary and Win recalled how there was no simple way to test urine and doctors had to boil it up in a little test tube over a flame. “If it turned a ghastly chocolate brown colour it would indicate something was wrong with the blood sugar levels,” she told the Western Leader. “The doctor came into the waiting room waving this test tube with brown urine and I burst into tears.” In contrast, Grace has an insulin pump, which is programmed

DIABETES | Winter 2015

PHOTO LESLEY WEBB

Winsome Johnston holds not one but two diabetes records – she is thought to be the oldest person in the world with type 1 diabetes and recently racked up a record-breaking 80 years of being on insulin. She’s been happy to share her story in the hope it will help others.

Winsome Johnston (centre) with her family. to automatically inject insulin, an invention Win would never have imagined when she was 10 years old in 1940. Knowledge about diabetes care and management has undoubtedly improved hugely since the early days of Win’s diabetes life. When she was young, doctors told her she shouldn’t think about having children. How wrong they were. Win saw that as just another challenge to overcome and she did. She is the mother of four and has eight grandchildren – and 10 great grandchildren! Win wants to pass on the message that it’s important to tell friends and family about diabetes so they can understand it and do what they can to help. She says it’s important not to be afraid of anything just because you have diabetes. “I have managed to improve my life as I’ve got older, just by aiming to do a little more each day,” she said. Family is a key part of Winsome’s

life and she is kept busy with all her grandchildren and greatgrandchildren. She also likes to keep active and social and enjoys walking with friends and family. Win believes having a good support group is an important part of living well with diabetes. She is proud of having been closely involved in coordinating two support groups for people with diabetes, one in Paraparaumu, outside Wellington, and the other in Point Chevalier, Auckland. Win reckons her record-breaking diabetes milestones are down to getting on with life and being sensible about eating, taking your insulin and exercising. After clocking up 80 years of living well with diabetes, she has been – and continues to be – a great inspiration to others around her, young and old. Her daughter Jan Grove agrees: “We are thrilled and proud of her, ” she says.

Chocolate

Reduced fat* Gluten Free

Vanilla Bean

Full Creamy Taste! No added sugar

No added colours

Contains 9 x 100ml servings per tub

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

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

“Sweet...!”

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

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

GLA 12.02.001