Diabetes Winter 2016 by Diabetes New Zealand

Diabetes Winter 2016

Living well with diabetes

MEET

Billie Brown

ASPIRING AUTHOR AND YOUNGEST COMPETITOR AT THE RECENT WORLD INDIGENOUS GAMES

DIABETES ISN'T FOR ME

Radio DJ Nickson Clark shares his amazing story

BLOOD SUGAR MOVIE Type 1 diabetes through the eyes of a toddler

TRAVEL TIPS Tips for taking off to far-flung places

TREATMENT

The benefits of patient-centred care

skincare tips + exercise at home + winter recipes

Dexcom G5 Mobile is here ®

Dexcom G5® Mobile gives you glucose readings every 5 minutes1 so you can see your highs, lows and how fast you’re getting there. Better yet, customisable alerts and alarms help you respond quickly to, or avoid potentially dangerous hypoglycaemic events2.

Alerts and Alarms help keep you safe Respond quickly to potentially dangerous hyper- or hypoglycaemic events2 with automatic alerts and alarms that let you know when your glucose levels are too high or too low.

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View your CGM results directly on your compatible smart device^ and ShareTM your glucose data with up to 5 followers, even when they’re far away.

For more information or to order contact us between 9am-5pm, Mon - Fri on 0508 634 103 W www.nzmsdiabetes.co.nz

E nzms@nzms.co.nz

1. Dexcom G5 Mobile Continuous Glucose Monitoring System, User’s Guide, 2015. 2. Pettus J, Price DA, Edelman SV. How Patients with Type 1 Diabetes Translate Continuous Glucose Monitoring Data into Diabetes Management Decisions. Endocr Pract. 2015;21(6):613-620. *If your glucose alerts and readings do not match your symptoms or expectations, you should obtain a fingerprick. A minimum of two fingerpricks a day is required for calibration. † Based on testing 10 time per day. ^To view a list of compatible devices, visit www.dexcom.com/compatibility. Dexcom G5® Mobile is not currently indicated for children under 2 years of age. Not compatible with Animas® Vibe® insulin pump. Always read the manufacturer’s instructions and use strictly as directed. ©2016 Dexcom Inc. All rights reserved. NZG5APR1602V1

Diabetes: the national magazine of Diabetes New Zealand | Vol 28 no 2 Winter 2016

COVER PHOTO: REPRESENGING AOTEAROA: BILLIE IN CULTURAL DRESS FOR THE INDIGENOUS BEAUTY PARADE. ÂŠ TINA MCGREGOR PHOTOGRAPHY

INSIDE winter 2016 Editorial

Your Diabetes NZ

14 Donations and bequests

Your support is vital

Upfront

Community

16 Andrew Fifita-Lamb:

Diabetes news

Cover story

Billie Brown: Game changer

Treatment

10 Patient-centred care in Hawke's Bay

Jandal man

Care and prevention

18 Serious about skin Branch spotlight

20 Rotorua

Technology

Families and children

12 Freestyle Libre

21 Blood Sugar movie

World Health Day

FABruary

13 Dawn4Diabetes campaign

22 DJ Nickson Clark talks diabetes

Travel

24 Hiking the Inca Trail

Food

26 Perfect pulses 28 Recipes: Winter feast Living with diabetes

30 Rachel Woodrow: Saving my life

Let's get active

32 Winter workouts:

Exercises to try at home

The Ruby McGill column

34 My new insulin pump

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

Diabetes New Zealand is a national charity trusted to provide leadership, information, advocacy and ongoing support to people with diabetes, their families, and those at risk. Our aim is to help all New Zealanders with diabetes live well and have access to high-quality services that meet their needs. We have a network of branches across the country that offer diabetes information and support in their local community.

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

E D I TO RI A L | F R OM T HE CHIEF EXE C UT IV E

Your support is vital Nga mihi nui koutou katoa. Welcome to the winter edition of Diabetes, the magazine of Diabetes New Zealand. Diabetes NZ has a lot be proud of and a lot to look forward to. Reflecting over some of our recent accomplishments, we have seen the first Diabetes Action Month where our staff and volunteers travelled across New Zealand, visited 32 sites in 15 different parts of the country, and engaged with 4,436 people. Planning for this year’s Diabetes Action Month is well under way. The campaign theme is Eyes on Diabetes. This is relevant for every person living with diabetes. As you know, diabetes can lead to complications, including blindness. During Action Month, our primary focus is to encourage all New Zealanders to take action to prevent the onset of type 2 diabetes or modify its course. This year, we also want to educate

and motivate people with type 1 or type 2 diabetes to take action to prevent diabetes-related eye disease.

These campaigns have been successful because you as members supported them and became involved.

Last year we also launched our social media plan. With the introduction of Facebook, Twitter and Instagram, we have extended our support and information to the wider diabetes community across New Zealand. We recently launched DiabetesChat. This provides online access to diabetes specialists from a range of fields who will be available to answer your questions about self-care and diabetes management. Please keep an eye out for the next one!

Over the next few months we will be launching a new drive for members. The drive will be for people wanting to be affiliated to a branch and for people who just want to support Diabetes NZ’s work. During the membership drive, we want to reach out and connect with the hundreds of thousands of New Zealanders impacted by diabetes. With 40 people a day being diagnosed with diabetes, we must provide leadership, support and information in a way that is relevant for all. This is a challenging time for Diabetes NZ.

The World Health Organisation (WHO) chose Diabetes as its focus for World Health Day 2016. As New Zealand was one of the first countries to see in World Health Day on 7 April 2016, Diabetes NZ took this opportunity to draw attention to the rise of diabetes in our communities. Many of you supported and participated in the Dawn4Diabetes campaign, see p13. This was made very successful not only by you, the members, but by the wider public, too.

I'd like to thank you all for your loyalty to Diabetes NZ. Our organisation’s most valuable attribute is all of you. I want to finish by saying winter is just around the corner and for many this time of the year is for raking leaves, stacking firewood and winter sports. But don't forget that it is also the time to get your flu shot. Hei kona mai. Steve Crew Chief Executive, Diabetes New Zealand

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

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

DIABETES | Winter 2016

JOIN DIABETES NZ TODAY! Our great value membership includes a free subscription to Diabetes magazine, regular newsletters and support from your local branch. Members also receive a 10% discount on any product at our shop: www.diabetesauckland.org.nz/shop It costs just $35 per year ($27.50 unwaged). Call 0800 342 238 or visit www.diabetes.org.nz.

IMPORTANT ANNOUNCEMENT

Diabetes Monitors Abbott Diabetes Care are proud to announce the introduction of the FreeStyle Optium Neo to the New Zealand market effective 1st September 2015. The Neo uses the existing FreeStyle Optium Blood Glucose and Ketone Test Strips.

Blood Glucose and Ketone Monitoring System

AVAILABLE AVAILABLE OTC OTC 1ST 1ST SEPTEMBER SEPTEMBER 2015. 2015. FUNDED FUNDED 1ST 1ST NOVEMBER NOVEMBER 2015. 2015. RESTRICTIONS RESTRICTIONS APPLY APPLY REF. PHARMACEUTICAL SCHEDULE. REF. PHARMACEUTICAL SCHEDULE.

Blood Glucose and Ketone Monitoring System

Currently Funded. Restrictions apply. Ref Pharmaceutical Schedule.

info@mediray.co.nz 0800 106 100 www.mediray.co.nz

U P F R O N T | DI ABET ES NEWS

Review of Diabetes NZ’s Constitution

Digital delights

Diabetes NZ’s Board and Advisory Council are undertaking a review of the Constitution with the aim of:

Diabetes NZ has hosted the first live DiabetesChat on its Facebook page, offering members and the general public the chance to ask questions about footcare issues with Wairarapa podiatrist La Donna Stancliffe-Deans.

• addressing issues of clarity that have been raised by members and branches • removing now irrelevant clauses that applied only to the transition period following unification • ensuring the Constitution remains current and appropriate for the organisational and operational environment. A Change Proposal document and redrafted Constitution will be made available to all members, branches and other stakeholders for review and feedback. It will be posted on the website from the week of 10 June 2016.

Branches, members and other stakeholders will have until 30 July 2016 to provide feedback on the draft. During that period members of the Board, Advisory Council and staff will be available to answer any questions. Following this, the feedback will be reviewed and, where appropriate, incorporated into the revised Constitution document. A summary of all feedback received will be collated and made available on the website by 30 August 2016. The final Constitution document will be available in early September 2016, and will be put to the membership for voting at the AGM in November 2016. Deb Connor, President, Diabetes NZ

**Stop press: SAVE THE DATE FOR DIABETES NZ’s AGM and SYMPOSIUM: Saturday 26 November 2016 at West Plaza Hotel, Wellington**

Adam and Sue (pictured above) enjoyed taking part in FABruary this year.

That's the reason I decided to take part in FABruary along with my partner Adam. We made pledges to give up certain foods and alcohol, and also commit to 30 minutes minimum exercise a day for the month of February. Adam also plays masters hockey and represented North Harbour at the national tournament in Nelson at the end of February. His team told me that he played the best hockey they have ever seen him play ... Go FABruary! *Sue Brewster, Diabetes NZ's Business Development Manager, and her partner Adam raised over $1,200 during FABruary. FABruary inspires change, read radio presenter Nickson Clark’s amazing story on p22.

DIABETES | Winter 2016

“Feedback has been positive for the chat from my patients and others that logged on. It was an exciting experience, something new for the diabetes community,” said La Donna. The idea was the brainchild of Diabetes NZ’s new Digital Communications Manager Rose Gawn, who is busy lining up specialists for future DiabetesChat sessions to focus on nutrition, exercise, vision and eye health. Rose was originally employed to establish Diabetes NZ’s social media profiles on Facebook and Twitter. She will continue to build on this work in her new role, while leading the redevelopment of Diabetes NZ’s website and setting up new online communication tools such as e-newsletters and blogs.

My FABruary pledge When I started working for Diabetes NZ, I was shocked by the long-term health impacts of diabetes, including heart attacks, strokes, kidney failure, blindness and limb amputations. Type 1 diabetes is an autoimmune disease that cannot be cured but many people can prevent, or delay, type 2 diabetes by losing weight, changing their food choices and doing more exercise.

Questions were received by email in advance and La Donna, who has a wealth of experience in providing podiatry care to patients with diabetes, also responded to live questions during the hour.

The aim of the online digital strategy is to use social media channels to share news, highlight awareness campaigns and continue to build diabetes networks across New Zealand and internationally. Rose has also recently introduced a monthly e-newsletter to keep people up to date with the latest national office and branch news. The first was trialled during the Dawn4Diabetes campaign (see p13). Members will automatically receive e-newsletters. If you are not a member but would like to subscribe, please go to our website www.diabetes.org.nz and follow the instructions on the home page. social media GU Fandollowjoinustheonconversation.

D IA BE T E S N E WS | U P F R O NT

Time to step up, New Zealand The World Health Organisation (WHO) has called for global action to halt the rise in diabetes and improve care for people living with the condition. The first WHO global report on diabetes shows the number of people living worldwide with diabetes has almost quadrupled since 1980 to 422 million adults. The WHO says obesity and being overweight is one of the key factors driving this dramatic rise. Steve Crew, Chief Executive of Diabetes NZ, commented: “This report makes very disheartening reading. Data from hundreds of countries shows that diabetes is rising fast across the world, with potentially devastating health impacts on people and economies, especially in developing nations. “We need action and leadership to help New Zealand adults reduce their weight and type 2 diabetes risk.” New Zealand is the third heaviest country in the world, with the WHO’s report card showing that one in three adults is obese and 66 per cent are overweight. One in four adults has prediabetes and an estimated 300,000 Kiwis have diagnosed diabetes. The number of people living with diabetes is predicted to rise sharply in the future. “This report shows it’s even more important than ever that Diabetes NZ leads the sector and represents all the people living with diabetes in New Zealand,” added Steve. The WHO’s global report card for New Zealand showed nine percent of the population has diabetes and that a worryingly high percentage of Kiwis are overweight and inactive – a known risk factor for type 2 diabetes.

Male

Female Total

Kiwis with diabetes

10%

Overweight

70% 62% 66%

Obesity

29% 32% 31%

Physical inactivity

37%

44%

41%

Source: Global Report on Diabetes, see www.who.int/diabetes/global-report/en/

John McLaren Awards 2016 The John McLaren Youth Awards recognise the pursuit of excellence by young people with diabetes across cultural, academic or sporting fields. Winners, who must be 25 or under, receive a cash prize to help them achieve their goals. Entries open on 1 June and close 31 July. For more details, see www.diabetesyouth.org.nz.

2016 Auckland Marathon Diabetes NZ Auckland Branch is taking part in this year’s Auckland Marathon and we want you to join Team Diabetes! There are nearly 100,000 people living with diabetes in Auckland, with many more affected by prediabetes. Diabetes NZ Auckland Branch provides services and support to those most in need, engaging with communities across the city to raise awareness of diabetes. Last year, we raised over $26,000 thanks to the hard work and effort of Team Diabetes and this year we want to raise even more, with more people getting involved. The 2016 Auckland Marathon will take place on October 30th and places are now open. Be quick though as they go fast and we don’t want you to miss out. Head to our website at www.diabetesauckland.org.nz to find out how you can join Team Diabetes and help support our work throughout Auckland.

Flu reminder If you have diabetes, you are three times more likely to be hospitalised from influenza and its complications than other people. It may also interfere with your blood glucose levels. This is why everyone who has diabetes is entitled to a free flu vaccination in New Zealand. If you haven’t had one, contact your doctor and make sure you mention you have diabetes so you don’t have to pay for it. If you are struck down with flu-like symptoms this winter, be sure to continue taking your diabetes tablets and/or insulin. Don’t stop taking them even if you can’t eat. Test your blood glucose every four hours, and keep track of the results. Drink extra sugar free beverages, and try to eat as you normally would. If you are concerned, contact your GP or diabetes team.

Eyes on Diabetes: We'd like to talk to people who have been affected by diabetes-related eye issues. Please contact editor@diabetes.org.nz if you have a story to tell.

Winter 2016 | DIABETES

COV E R STO RY | BILLIE BROWN

GAME CHANGER Billie Brown, 12, represented New Zealand at the first World Indigenous Games in Brazil last year. She was the youngest of 2,000 participants and is writing a book about her experiences. She hopes to inspire other young people with diabetes to achieve their dreams, as she explains in her own words. I BECAME A MEMBER of the unique and special type 1 diabetes whānau when I was six years old. I cried the first couple of times I needed injections in my puku when I became hospitalised after my initial diagnosis. But by day three I was running around the ward calling the other children to my bedside to watch me getting medicated. It became a fun thing and I loved having my parents and family so close all the time.

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sting + sugar addiction T2 drug trial + easy compo

DIABETES | Winter 2016

Billie Brown playing kı¯-o-rahi on the cover of our Autumn 2014 issue. Left: Making friends with the locals in Palmas, Brazil during the Indigenous Games. Right: Billie and her dad Harko Brown.

PHOTOS © TINA MCGREGOR PHOTOGRAPHY

Basically not much has changed in my life since then, except testing and medicating several times a day. My dad used to get up twice every night for the first few years to make sure my [blood sugar] levels were kept stable. And immediately

BILLIE BR OWN | COV E R STO RY

after I left hospital he threw in his teaching job to take up work in my primary school classes and follow me through from years two to six. I was in good hands! It was cool having Dad around, he created exciting events in school for myself and my classmates with kites, Māori games and other activities at camps and during lunchtimes. I started high school in year seven and have managed to keep up good numbers independently and be involved in a lot of sports and academic opportunities. For fun my big sister, Yves, and I came up with the Māori word ngaretahu, an abbreviation of Māori words about diabetes, which translates to type 1 diabetes. I think a distinctive name for type 1 diabetes might be useful so that the ongoing confusion with type-2 diabetes for some people will cease. I love sports and keeping active. I also like eating veges that dad grows such as cucumbers, tomatoes, lettuce, strawberries, peas and corn. Dad says I should do what I can to help other ngaretahu children, their parents and people generally become more informed and understanding about type 1 diabetes. Last year, in October, I was selected to represent Aotearoa/ New Zealand in the First World Indigenous Games in Palmas, Brazil. It is the indigenous equivalent of the Olympic Games, except in addition to sports it features traditional dances and environmental discussions. It was amazing and we met so many interesting native peoples who were spectacularly dressed. The local Palmas children who lived near our accommodation liked to congregate around us and were super friendly too and I made many friends. We shared accommodation with the indigenous peoples from Mexico, the Philippines, Guinea, Ethiopia and other First Nations tribes from Canada and the US.

I think sports diversity is a good way to build up your physicality and life skills and to help in the ongoing ngaretahu pathway that we all tread, including our parents and extended whānau. Forty people were selected from our country. This opportunity came about because I have been involved in many Ngā Taonga Tākaro (traditional Māori games) initiatives – such as tautoko [support] of the first New Zealand secondary schools tīhae (‘rippa’) kī-o-rahi champs in faraway Uawa. Kī-o-rahi is a traditional ball game played with a small round flax ball called a kī on a circular field. I’ve also attended job inductions for some of our older Kī-o-rahi Akotanga Iho (KAI) club members in Auckland; played against France and Musqueam (Canada) for our New Zealand junior kī-o-rahi reps; helped build the carved kī-o-rahi field at Waitangi, as well as been involved in hosting various overseas groups at our marae; performing kapa haka and volunteering in events like the Manu Aute Kite Festival and Auckland International Cultural Festival. I also keep fit with many other activities like athletics, netball, swimming, indoor basketball, ballet and tennis. At 12 years of age I was the youngest rep out of the 2,000 international

athletes from indigenous tribes in 23 countries including Brazil, Peru, Russia and Finland. I competed in the 100m sprint race making the semis in the open age event, and taronarona (tug’o’war), where we made the Open Women’s quarter finals. We also performed kapa haka daily, taught visitors how to play Māori games like kū, ruru-nei, poi toa, o to rongo, and mahi ringaringa. I was shocked and proud to be selected by our team to represent Ngā Puhi [Billie’s iwi] in the Indigenous Beauty Parade at the games. Each of us could display our cultural uniforms and some quick, basic dance movements like the wiri and pūkana. I am presently writing a book about my experiences, it is titled Ngaretahu: Good Times in Sport. I hope it enthuses my peers to keep active and to try new and exciting physical experiences like Ngā Taonga Takaro, our 300 traditional Māori games, and indigenous games from around the world. I think sports diversity is a good way to build up your physicality and life skills and to help in the ongoing ngaretahu pathway that we all tread, including our parents and extended whānau. I have had lots of much-appreciated help from my family, community, iwi and health specialists to be able to experience the many exciting educational/sports opportunities in my life – and to have support with ngaretahu. It is through essays like this and my ongoing involvement with ngaretahu initiatives that I hope to give back. I am even thinking of an occupational pathway to help people with ngaretahu. Best of health to our ngaretahu whānau, especially those recently diagnosed. Ngā mihi mahana ki a koutou. Nā Billie Brown, Kerikeri. *At the time of writing Billie learned she had been chosen to take part in the World Junior X Kī-o-rahi games in France this September. Winter 2016 | DIABETES

T REATMEN T | PAT IENT-CENTRED CA R E

TAKING CONTROL A Hawke’s Bay doctor is winning accolades for her results-driven diabetes care. Crystal Beavis explains. “I feel like I can live my life now,” says Andrew Dickson. Andrew, who was diagnosed with diabetes when he was 10 years old and is now in his 30s, says he never felt in control of his diabetes until after he attended the GPSI Diabetes clinic run by Dr Janet Titchener in Havelock North. Since then, the man dubbed a “ticking time bomb” by his other doctors has dropped his HbA1c from 105 to 45 mmol/mol and no longer lives in fear of losing his eyesight. Andrew, 33, who is a teacher from Hastings, feels so strongly about the service he received from Dr

Titchener that he posted a video on Facebook about it two years ago – and he’s not the only one. Other patients have also posted videos to say their experience attending the General Practitioner with Special Interest (GPSI) Diabetes clinic has not only taught them to understand their condition, but has put them in charge of their diabetes and made them “feel normal again”. Silver Fern Farms meat works supervisor Henry Ruwhiu, 57, from Waipukurau, says he found out he had type 2 diabetes about five years ago after a medical check-up at work. He says he didn’t really understand his condition despite going to his doctor nearly every month for a check-up to make sure he was “doing things properly.” But all that changed after he started

attending the GPSI service and getting the information he needed to control his own condition. And it’s motivated him. “Now I can do it all myself – I might go to the doctor once or twice a year. I’ve pushed my life in a different direction. Exercise is one of the things I do – I enjoy – actually.” Five GP practices in Hawke’s Bay have also endorsed GPSI Diabetes by stepping in to fund it when Hawke’s Bay District Health Board decided two years ago not to renew public funding for the service that has been running in the region since 2006. A local businessman, Andy Lowe from the Lowe Corporation, inspired by employees who used the service, also came forward to contract Dr Titchener to teach her methods to other GPs, nurses and pharmacists in Hawke’s Bay, and

Far left: Teacher Andrew Dickson is a huge supporter of Dr Titchener’s methods. Left: Henry Ruwhiu learned how to control his diabetes after attending education sessions at the GPSI Diabetes clinic in Hawke’s Bay.

DIABETES | Winter 2016

PAT IE N T- C E N T R E D C A R E | T R E ATM E NT

to provide community education sessions for employees of large corporations such as Apollo Apples Ltd, Silver Fern Farms and Higgins Group Holdings Ltd. Meanwhile, word-of-mouth endorsements have seen patients outside the DHB – from Christchurch to Whangarei – seeking Dr Titchener out privately, leading to the formation of a private practice that Dr Titchener now runs out of rooms in both Hawke’s Bay and Auckland. What’s the attraction? A review of her practice published in the Journal of Primary Health Care about 18 months ago shows her methods achieve outstanding results, regardless of patient ethnicity. In type 2 patients, the average reduction in HbA1c levels has been 20 mmol/mol (18 mmol/ mol for NZ Europeans and 22 mmol/mol for Māori) – levels that are still maintained even two years after discharge from her service. Among type 1 patients, the average reduction in HbA1c for NZ Europeans has been 17 mmol/ mol. Māori with Type 1 diabetes achieved even better results, but small numbers prevented proper statistical analysis. See the panel on the right for how she helps patients take control of their own condition. Dr Titchener trained in the United States as a primary care physician specialising in diabetes before returning home to New Zealand in 2005. She says New Zealand medical education does not yet provide for formal primary care specialist training in diabetes, although there is a growing demand to treat patients in a primary care setting. She hopes that the work she is doing to share her knowledge with other family doctors and nurses will serve to improve primary care management of diabetes.

PATIENT-CENTRED CARE Dr Titchener says the reason for her off-the-chart results is patient-centred care – an approach that empowers people to self-manage their own condition. In four to five appointments she teaches patients about the physiological changes caused by diabetes – that it is a disease affecting the blood vessels, what this means in terms of their long-term health, and what all the treatment options are. Once fully informed, the patient then chooses what they would like to do to manage their diabetes. They are not “told” what to do. “When patients have the same understanding and information as their doctors, not surprisingly they make all the right management choices. If a patient is not doing well, my role is to discover what knowledge they are missing that is preventing them from making appropriate choices,” she says. This contrasts with the traditional approach in which the doctor prescribes a course of action and seeks patient “compliance”, even exhorting the patient to “get your blood sugar down”. Dr Titchener says, “I tell every patient the HbA1c provides much more important information than their average blood sugar. It actually tells them their risk of having a heart attack or stroke within the next year. I explain how the test measures the sugar coating their red blood cells, and how this correlates with sugar ‘sticking’ to the inside of their blood vessels, damaging them so that blood can’t be delivered to many parts of the body leading

Locals rallied together to support Dr Titchener to continue her diabetes clinic when the local DHB stopped funding it.

to dementia, heart disease and kidney disease.” She says a common reaction of many patients has been to say “Why hasn’t anyone ever told me this before?” Many adult type 1 patients who were diagnosed as children have never learned about their condition because at diagnosis doctors taught their parents, she says. What’s more, Dr Titchener helps patients on their own terms – whether that means enabliing parents to teach their child to start taking over their own diabetes care, spending time on the telephone with patients discussing blood sugars, or providing a 24hour on-call service for patients needing urgent advice. “Every contact that I have with a patient is an opportunity to expand their understanding, to empower them to self-manage,” she says.

*You can contact GPSI Diabetes on 0800 477 434 or email gpsidiabetes@gmail.com.

About the author: Crystal Beavis is former President and a Life Member of Diabetes Youth NZ.

Winter 2016 | DIABETES

T E C HN O LO GY | THE A B B OTT F REESTYLE LIBRE

MY TECHNOLOGY

ADDICTION The Freestyle Libre is causing a buzz even though it’s not yet released in New Zealand. Diabetes Youth President Jacqui van Blerk finds out what the fuss is all about. I remember the shock of my daughter’s diagnosis with crystal clarity. Her tiny body had lost a tenth of its weight in a fortnight and the miniscule amounts of insulin we were injecting caused her blood sugar levels to fluctuate wildly. I wished at the time that we had a little window into what was going on inside her, to take some of the guessing and constant finger pricks out of the equation. A year later we heard about the Dexcom G4 system and leapt at the opportunity to finally have more insight into how her body responded to food and insulin. Two years and many dollars later, the second Dexcom transmitter gave its ominous low battery warning and I gingerly raised the topic of its replacement with my husband…

After much discussion, we decided that although we really loved the trend data the Dexcom system provided, it was just too expensive for us to run on an ongoing basis. For a while I moped around like a teenager whose iPhone has been confiscated, until I heard about the glucose monitoring system that Abbott had just released into the UK market. An amazingly generous friend let me piggyback on her customer account to purchase a reader and the first month of sensors, at less than half the cost of a new Dexcom transmitter, and we anxiously awaited our You Shop parcel’s arrival in the mail. From the outset the Freestyle Libre experience was a game-changer. The system consists of a small white disc that is positioned on the upper arm and holds a sensor just under the skin. We found the application of the sensor to be easy and relatively painless. A ‘reader’ is scanned over the sensor to give a blood glucose reading. The sensor has a one-hour countdown and does not require calibration, although we’ve found that the first 24 hours of data may be a bit higher or lower than a fingerprick reading. We do still take fingerprick readings when dealing with stubborn lows or unexplained highs, as the sensor lags a little on sharply rising levels. Melissa van Blerk demonstrates her new Freestyle Libre that uses a sensor rather than finger pricks to give blood sugar readings. Mum Jacqui reckons the technology is a game changer.

DIABETES | Winter 2016

The Libre sensor records interstitial glucose levels at 1-minute increments for the past 15 minutes, and then archives readings older than 15 minutes at quarter of an hour intervals up to the past eight hours. The data is retrieved by scanning the sensor with the Libre reader using similar technology to PayWave payments. It can then be uploaded to the Abbott software or Diasend using a standard USB cable. The reader has an arrow on the screen indicating rising or dropping levels. The Freestyle Libre does not transmit the data in real time like the Dexcom, so may not be the best solution for people relying on an alarm system, but its cost (currently £57 plus shipping for a sensor that provides two weeks of calibration-free blood glucose readings) and ease of use, make it perfect for those wanting visibility on trends so they can adjust diet or insulin regimes. The screen display makes it possible to do those pesky 3am checks without fumbling for strips and torches and the reader is extremely easy to use – even on long-haul car trips! As an added bonus, the reader serves as an optium blood glucose and ketone glucose monitor. Abbott is due to release the Freestyle for the Australian market mid to late June. There is no date set for the New Zealand launch.

WOR LD HE A LT H DAY | YOU R D IA BE TE S NZ

Winning shots: The team at Te Awakairangi Health Network got together their favourite diabetes resources for their photo (left), while the Nelson Bays Primary Health team channelled their inner superheros, inspired by the WHO posters created for World Health Day.

Dawn4Diabetes Our new Digital Communications Manager Rose Gawn was delighted by the positive reaction to the Dawn4Diabetes social media campaign. What an amazing day we had! Our heads are still spinning after trying to keep up with all the wonderful photos that came to us from all over New Zealand. The focus of this year’s World Health Day was diabetes and, to help celebrate, we launched a social media campaign to raise awareness about the rise of diabetes in our communities. As New Zealand is one of the first countries in the world to see in the day, we called it Dawn4Diabetes. We asked businesses, clubs and community groups to gather together at a local landmark on the morning of April 7, take a photo, and post it to social media using the hashtag #dawn4diabetes. We were bowled over by the response. Photos poured in from all over the country from Diabetes NZ branches, public health

organisations, district health boards, diabetes researchers, gyms, walking groups, international cricket players, MPs, families and so many more people. They all wanted to share their support for people impacted by diabetes. There were so many fabulous and creative images, it was very hard to award our prizes – two FitBit Charge HRs. The first winning image came from the team at Nelson Bays Primary Health, who caught our eye with their fantastic shot of diabetes “superheroes” standing at the top of a steep walking track in the centre of Nelson. Team member Bee Williamson said: “We took part in the Dawn4Diabetes event because we felt inspired by the WHO’s superhero poster messages. It was a great opportunity for staff at Nelson Bays Primary Health to ‘walk the talk’ and show that we do practise what we preach. “Many early morning joggers, and dog walkers were quite shocked to see a team of Superheroes out and about at that time of day. To top it off we also had a workplace healthy morning tea and got staff involved in a diabetes quiz.”

Te Awakairangi Health Network, in Lower Hutt, Wellington, scooped the second Fitbit prize. They managed to squeeze a huge array of their favourite diabetes tools and messages into a photo, along with 15 staff, exercise equipment and someone getting their blood pressure tested. “Diabetes is one of the biggest health issues in the Hutt Valley,” says Chris Polaczuk, who sent in the photo. “Everyone in the photo from our team plays a role in improving health outcomes for people with diabetes. For our Dawn4Diabetes photo, everyone brought their favourite diabetes tool, or resource, that they use every week in their role. “Our outreach nurse Trish brought her trusty blood pressure cuff and even her own patient, which shows how passionate she is about good blood pressure control and monitoring. Our healthy families coaches brought scales and even an exercise bike for the photo shoot!” Well done to our two winners and thank you to everyone else who took part. Much love and thanks to you and your families from the team here at Diabetes NZ. Winter 2016 | DIABETES

YOU R DI A B ETES NZ | BEQU ESTS

Leaving a legacy Making a bequest is one way you can leave a lasting legacy that will help the next generation of Kiwis living with diabetes. By Sue Brewster. How do you define the value of leaving a gift in your will that will continue to benefit others for so many more years to come? Pericles, the revered and influential Greek statesman, summed it up beautifully with his wise words: “What you leave behind is not what is engraved in stone monuments, but what is woven into the lives of others.” This statement speaks volumes of why people choose to leave a bequest in their will. A bequest becomes a living legacy, helping others in need and assisting communities they care deeply about. At Diabetes New Zealand, we have been the extremely fortunate beneficiary of bequests in the past and these have enabled us

to provide the ongoing support required to help people with diabetes live full and active lives. Last year we responded to over 5,500 requests for support, answered over 3,000 Freephone helpline calls, published four high quality magazines, and distributed 260,000 information packs – much of which was made possible by the forward-thinking people who wanted to ensure what they valued in life lived on. No matter how big or small, a gift in your will is an enduring expression of your personal wishes and a powerful way to make a difference in the lives of New Zealanders with diabetes beyond your lifetime. You can choose to bequeath a specific amount or leave an item or a percentage of your estate. You can choose to leave a bequest that is an unconditional gift or you can identify how you would like your gift used. The choices are all yours and leaving a bequest doesn’t mean you have to create an entirely new will.

Over the years, generous benefactors have left Diabetes NZ bequests of cash, a part share of the family home, and money to set up a diabetes research fund. Chief Executive Steve Crew said: “After you’ve provided for your loved ones, there is no greater gift than a legacy that will support New Zealanders living with diabetes and help them deal with the challenge of having a condition that will never go away and will always demand their attention every single day of their lives. “Hopefully one day there will be a cure but until then Diabetes New Zealand is the only national charity supporting Kiwis who live with diabetes – whether it’s type 1, type 2, gestational or prediabetes. Like many not-for-profit charitable organisations, we have limited opportunities for funds and your support through bequests is vital for our work.”

A gift of a lifetime Every day, an average of 40 New Zealanders are diagnosed with diabetes. A gift in your will is a powerful legacy to ensure your desire to help and support people with diabetes lives on.

No matter how big or small, your bequest will make a world of difference in helping Diabetes New Zealand to support the 257,000 New Zealanders with diabetes to live full and active lives. For a confidential discussion, please contact Sue Brewster sue@diabetes.org.nz 027 569 7777

DIABETES | Winter 2016

EVERY LITTLE BIT COUNTS Your bequest may be a private matter that you would prefer not to discuss, but if you would like to learn more about leaving a gift in your will and how this will help to make a difference, please contact Sue Brewster at Diabetes NZ. Write to Sue at Freepost Diabetes New Zealand, PO Box 12-441, Thorndon, Wellington 6144, or email sue@diabetes.org.nz, or phone Sue on 027 569 7777

HOW DO I LEAVE A BEQUEST? If you have already an existing will, a codicil is the only requirement needed to formalise your bequest. Here is an example of a codicil to an existing will. “I give and bequeath the sum of $

(or)

% of my estate, (or) the residue of my estate, (or) a

description of property or assets free of all charges to Diabetes New Zealand Incorporated (PO Box 12-441, Thorndon, Wellington 6144) to be used where most needed. The official receipt of the Chief Executive, or registered officer of Diabetes New Zealand Incorporated, will be sufficient acknowledgement of having received this gift.” Signature of testator and solicitors and witness of each: Signed: Signed:

(YOUR SIGNATURE)

(YOUR LAWYER’S SIGNATURE)

Witness:

(SIGNATURE OF WITNESS)

(THE WITNESS OF LAWYER’S SIGNATURE)

Date:

(DATE SIGNED)

Diabetes NZ recommends you work with your legal adviser if you want to add a bequest to your will.

Winter 2016 | DIABETES

CO MMU N I TY | DREAM BIG

Jandal man

PHOTO © RAYMOND SAGAPOLUTELE

Ultra marathon runner Andrew Fifita-Lamb wants his Pacific Island community to be aware of the devastating impact of untreated diabetes. By Caroline Wood.

Main image: Andrew Fifita-Lamb (left) in his trademark jandals. He doesn't have diabetes but his parents and six of his siblings have or did have diabetes. Top and middle: Completing a run around Tonga's main island Tongatapu in 2014. Bottom: Andrew's mum has insulin-dependent type 2 diabetes. His dad (right) and two of his brothers passed away from diabetes-related health conditions.

Andrew Fifita-Lamb’s extreme running challenges are not for the faint-hearted. His attitude towards life has been described as “inspirational” and “determined” and he is clearly both of those things. But what some people don’t know about Andrew is that he has a demon called “Diabetes” on his back. It’s what prompted him to take up

DIABETES | Winter 2016

running four years ago at the age of 46 and is a strong motivator for the extreme physical challenges he has set himself since. Andrew doesn’t have diabetes or prediabetes but his family history puts him in the highrisk category for developing it. He explains how his family is “riddled with it”. His mum, dad

and six siblings have, or did have, type 2 diabetes and devastatingly, three family members have died of diabetes-related conditions in the past four years. The 50-year-old Auckland social worker’s passion is ultra marathons – runs of 42+ kilometres, which can see him running for 14-30 hours without a break. He is famous for

D R E A M BIG | COM M U NI TY

doing these mega-runs in homemade jandals – he wants to make the point that to enjoy running you don’t need any fancy running gear. Andrew works for Auckland District Health Board as a needs assessor and service coordinator for over-65s. He is sharing his story with Diabetes because he wants to raise awareness – especially among New Zealand’s Pacific Island community. The father-of-six explains: “Being a Pacific Islander (I am a Tongan) I know that diabetes is a huge problem for us both here and back in the islands. I would like to be able to contribute, however little that may be, to the great work that Diabetes NZ is doing.

“It makes me sad because it’s so close to me and my family. I know we are more prone to have diabetes and because I live here in South Auckland I see a lot of Pacific Islanders carrying excess weight (including some of my own children) and that saddens me. I know the consequences.” Andrew came to New Zealand from Tonga in 1981. He comes from a large family of 12 siblings. His mum, who still lives in Tonga, was diagnosed in 1984 and is now on insulin. She is very careful and looks after herself with a healthy diet and she exercises regularly. “But my father was a very stubborn man and he thought he knew better than the doctor about diabetes,” says Andrew.” “He had diabetes for a while before he was diagnosed. He had his big toe amputated and then another below the knee amputation leaving him in a wheelchair. He passed away two years ago of renal failure and heart problems, but a large part of it was his diabetes.

“Two of my oldest brothers also passed away. One of them, my eldest brother was obese, he lived in Hawaii, had heart problems and was also diabetic. He was 54 years old when he died last September. “I had another brother who also died. He lived in New Zealand but was visiting Tonga to play rugby and he broke his leg. He didn’t go to see the doctor and developed septicaemia by the time the doctor saw him. They were going to give him a drug to treat it but found out he was diabetic. His blood sugar levels were so high they couldn’t give him the medication/ injection. He knew he had diabetes but denied it, he said I’m okay I don’t need to see a doctor.” He has two other siblings who are also living with diabetes, both in New Zealand. “I wouldn’t be surprised if there are a lot of other families the same as ours,” he added. Andrew has regular tests to see if he has diabetes. His advice is to take the risk seriously and go see a doctor and get tests. And follow their advice about diet and exercise. “About the jandals, this is what worked for me. It wasn’t that I was desperate, I’ve had good running shoes but chose to make my own. The jandals worked for my running posture and I found it stops the pains in my knees and joints. “I understand the need for wearing/ using supportive, enclosed footwear and I have taken this as another challenge – to make sure that I keep diabetes away to continue running in my jandals,” says Andrew. His philosophy is simple: “To achieve your dreams, you just have to put in the hard yards, determination and commitment. Hold on to God and your dreams will come true. Mine did!”

Getting started Andrew says he used to be overweight and eat unhealthily but the turning point came in 2012 when he took on a 12week fitness challenge offered through one of the ministries of his church (Faith City Church, in Manukau). “It inspired me to get up to do some exercise. My family history with diabetes prompted me to do something to stay active and avoid being caught up in that [diabetes],” explains Andrew. “I was very fit as a teenager then I got quite overweight – I wasn’t active at all. For my first run in 2013 I weighed 112kg. I completed the 12-week Temple Ministries challenge and dropped to 87kg for my first ultra marathon run. Now I’m around 90kg.” Andrew admits he has to watch the sweet stuff in his diet. He used to eat ice cream and have sugar in his coffee, now sugary foods are for treats rather than everyday. His wife and younger children have adopted a new healthier eating pattern. But his older children are a bit harder to help. “It’s harder to persuade them to eat healthily when they are at university or work. They have access to food they shouldn’t be eating, or should eat sparingly. Like many young people, they enjoy it and disregard the future,” he says.

*Diabetes NZ doesn’t recommend running in jandals if you have diabetes because of the higher risk of damaging your feet. Supportive, enclosed running shoes will protect your feet from injuries like cuts and nerve damage. If you have diabetes be sure to visit a podiatrist for an annual check up and report any changes, like tingling or loss of feeling.

Winter 2016 | DIABETES

CA R E A N D PR E VE N TIO N | SKINCARE

SERIOUS about SKIN You are far less likely to develop skin problems if you take good care of your skin â&#x20AC;&#x201C; and have healthy blood glucose, blood pressure and blood cholesterol (lipids) levels

You are more likely to develop skin problems if you have diabetes especially during the colder winter months. Up to a third of people with diabetes will have a skin disorder caused or affected by diabetes at some time in their lives. Sometimes skin issues are the first sign that a person has diabetes. Anyone can develop a skin disorder but people with diabetes may be more prone to having skin issues, including bacterial infections, fungal infections, and itching. Skin conditions are also more likely to become infected if you have diabetes (especially if your blood glucose levels are high). Sharon, 30, from Wellington, who has type 1 diabetes, worries that her diabetes makes her more prone to having skin problems. She recently had to take a week off work after developing a boil on her leg that got infected despite taking antibiotics. "I went to the doctor and was taking antibiotics but it got worse and I ended up in hospital having an operation," she said. Luckily, most skin conditions can be prevented or easily treated if caught early.

DIABETES | Winter 2016

SKINCARE | CARE AND PREVENT I ON

Dry skin Rough, dry and scaly skin affects most people with diabetes over the age of 64. It can be found on particular parts of the body, for example, the legs, feet, hands and/or face. Or it can progress to all parts of the skin. In more serious cases the skin loses its suppleness, which can then crack and become red and inflamed. Itching is the most obvious symptom. Aside from being irritating, dry skin can be made worse if you scratch and rub it. Scratching can also lead to infection, or even ulcers. Dry skin often happens in winter because heating your house can lower the humidity (amount of moisture in the air) and dry cold winds during winter can also exacerbate the problem.

Fungal infections Fungal infections in people with diabetes are often caused by a yeast-like fungus called Candida Albicans (thrush). It can create itchy rashes of moist, red areas surrounded by tiny blisters and scales. These infections often occur in warm, moist folds of the skin, including in the mouth and groin. Other common fungal infections include athlete's foot, ringworm (a ring-shaped itchy patch), and vaginal infection that causes itching. If you think you have a yeast or fungal infection, call your doctor. You will need to have it diagnosed before you can treat it.

10-point maintenance plan for good skincare Health professionals believe people with diabetes can reduce their chances of skin problems by taking good care of their skin and managing their diabetes properly. Here are their top tips.

2 3 4

Bacterial infections Several kinds of bacterial infections occur in people with diabetes, including: • styes, which are infections of the glands of the eyelid • boils, which are infections of the hair follicles • carbuncles, which are deep infections of the skin and the tissue underneath. Infections can also occur around the nails. Infected tissues are usually hot, swollen, red, and painful. The most common cause of skin infections are the Staphylococcus bacteria. If you think you have a bacterial infection, see your doctor quickly.

Itching Localised itching is often caused by diabetes. It can be caused by a yeast infection, dry skin, or poor circulation. When poor circulation is the cause of itching, the itchiest areas may be the lower parts of the legs. You may be able to reduce itching yourself. Take care not to rub the skin hard when bathing or showering. Use mild soap with moisturiser and apply a light moisturising skin cream after bathing.

7 8 9

Keep your blood glucose levels in as healthy a range as you can. When your blood glucose levels are high you are more prone to have dry skin and you are less able to fend off harmful bacteria. This means high blood glucose levels increase your risk of infection. Keep your skin clean and dry. Use talcum powder or anti-chaffing cream in areas where skin touches skin, such as armpits and groin. Protect your skin. For example, wear gloves when using cleaners, solvents and other household detergents. Avoid very hot baths and showers. If your skin is dry don't use bubble baths. Moisturising soaps may help. Afterward, use a light moisturising skin cream, but don't put lotions between your toes as extra moisture there can encourage fungus to grow. Where possible prevent dry skin. If you scratch dry or itchy skin it can open up and infection can set in. Moisturise your skin to keep it supple and prevent chapping especially in cold or windy weather. Treat cuts right away. Wash minor cuts with soap and water. Do not use alcohol or iodine to clean skin because they are too harsh. Only use an antibiotic cream or ointment if your doctor says it's okay. Cover minor cuts with sterile gauze. During cold, dry months, keep your home more humid. Use mild shampoos and unscented soaps. Do not use feminine hygiene sprays. Take good care of your feet. Check them every day for sores and cuts. Wear broad, flat shoes that fit well. Check your shoes for foreign objects before putting them on.

10 See a doctor right away if you get a major cut, burn,

or infection. If you have nerve damage or poor circulation in your feet you should immediately see a doctor if you get any sort of cut on your feet.

**See a dermatologist (skin doctor) about skin problems if you or your GP are concerned. Winter 2016 | DIABETES

BRANCH SPOTLIGHT: ROTORUA We travel to Rotorua in the first of a new series highlighting the work of Diabetes NZ branches around the country. By Karen Reed For more than 40 years, the Diabetes NZ Rotorua branch has been the focal point for diabetes support in our town, where there are an estimated 5,000 people living with diabetes. One of our priorities this year is to increase membership, which is currently sitting at about 100. We have quite a few youth members and many older members but not so many in between. Last spring, we delivered 20,000 leaflets around Rotorua offering half-price membership. They were delivered by our friends the Tane Takitu Ake men’s health group. The leaflet drop has been successful and we have new members coming in from the areas where they’ve been delivered. We are grateful for a grant from the Rotorua Energy Charitable Trust that paid for this initiative. We offer all our new adult members a half-price membership for the first year. Newly diagnosed children get their first year’s membership free and we buy them a medical alert bracelet. The telling time is when the membership comes up for renewal!

Diabetes NZ Rotorua has an office in QE Health, which is manned by volunteers and is open 9.30am-2pm every Wednesday, Thursday and Friday. The people coming by the office for advice range from the newly diagnosed to long-timers, concerned family members and nursing students. Rotorua has a large Māori population and some concentrated areas of high socio-economic deprivation. We have a walking group for our members (Wayne’s Wednesday Walks) which meets every Wednesday morning and walks in the Redwoods in the summer or around the lakefront in the winter. The group often splits into two, so we accommodate all styles of walking – fast and slow. Support from Korowai Aroha Health Centre means that we usually have nursing staff on hand. Every Thursday morning we hold a branch morning tea between 10am and midday, which doubles as an informal diabetes support group. This is popular, and we have regulars who come every week, while others pop in when they can or when they feel like

it. St John’s has offered us the use of its Health Shuttle so those less mobile can attend. Sometimes we invite ‘guest speakers’ to join us. We’re hoping to have a nutritionist come in and run a monthly workshop. The regulars pop a gold coin in the tin – last year we went out for a meal at Christmas and still had takings left over! Charlie Windell is our youth coordinator but we need some parents to volunteer as well so we can offer more events for our younger members. Please pop in and say hello if you are in Rotorua. We are very relaxed and welcome all comers. For details of our events, see www.diabetesnzrotorua.org. nz and our Facebook page. *Want to see your branch featured here? Contact Caroline Wood editor@diabetes.org.nz

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

DIABETES | Winter 2016

B LO O D SUGAR MOVIE | FAMI LI ES AND CHIL DRE N

What better candidate to describe the condition than a little girl who says: “I don't know what diabetes is, but I know what it is like”

BLOOD SUGAR MOVIE A dad made it his mission to make a documentary about his daughter’s condition from her unique perspective. By Jacqui van Blerk. Understanding diabetes is a challenge for many adults but explaining type 1 diabetes in words that a toddler will understand is even harder. I was recently introduced to Project Blood Sugar, which is Pukekohe director Joe Hitchock’s proposed short documentary portraying type 1 diabetes from his four-year-old daughter Dahlia’s perspective. The project was dependent on crowd funding and it received overwhelming public support, raising more than the $2,000 target which allowing filming to start in late April. Blood Sugar is also partially funded by the Loading Docs initiative, with support from the New Zealand Film Commission and NZ On Air. Reflecting on her diagnosis a year ago, when she was just three years

old, her dad Joe says: “Our initial reaction was shock then fear, which later became exhaustion. There's so much to learn at diagnosis that it takes a while to sink in. “I'm still not sure Dahlia understands what diabetes means exactly, but she knows to ask a parent if she is offered sugar.” Dahlia’s resilience and humour shine through as she determines the daily classification of her finger-prick readings asking: “High, low or perfect?” Joe decided to use his experience in producing short films to create a visual resource about diabetes from a child’s viewpoint. He decided to do the project because he felt most of the current offerings were fairly technical and confusing to a small child. “Our Blood Sugar documentary explores how a four-year-old girl lives with type 1 diabetes and it’s told through her unique perspective. A child diagnosed with diabetes must go through many changes that are complicated to explain technically,

so what better candidate to describe the condition than a little girl who says: “I don't know what diabetes is, but I know what it is like”. “This is an important subject, so we're stoked to be raising awareness while also trying to capture Dahlia's awesome attitude to life.” New Zealand has one of the highest rates of paediatric diabetes in the world and numbers are estimated to be growing at 10 percent annually. The cause of this is not yet understood. Many resources have been developed to explain diabetes to teens and adults but there are few tailored specifically for a very young child. Project Blood Sugar promises to be a valuable way to explain diabetes to a young audience, as well as raising awareness of what it is like living with diabetes from a child’s perspective. The three-minute documentary is set to premiere in July. You can follow the project on Twitter @BloodSugarDoc or via Joe’s website: www.joehitchcock.com

Winter 2016 | DIABETES

FA BR UA RY | J O IN THE MOVE MENT

Hip hop DJ Nickson Clark lost a third of his body weight and his diabetes symptoms disappeared.

THIS DIABETES THING – IT ISN’T FOR ME FABruary ambassador and radio presenter Nickson Clark talks publicly about his diabetes for the first time in the hope it will inspire others. When one of Nickson Clark’s mates approached him about his FABruary concept, he didn’t think twice before signing up. The Mai FM presenter said: “It hit home for me because a lot of people from my family suffer from diabetes and I had it myself in my younger years. I wanted to support a good message especially for Polynesians

DIABETES | Winter 2016

and Māori and for my listeners at Mai FM.

prediabetes. Two months later I was diagnosed with type 2.

“I joined up to keep myself accountable and be a positive role model because I know what it’s like not to be healthy.”

“It was scary, I’d seen the effects of diabetes in my family, my cousin had type 1 and I knew all about the injections and finger pricking. Four other people in my family have type 2 diabetes.

Nickson, who is Samoan, was only 23 years old when he was diagnosed with type 2 diabetes in 2007. His diagnosis came as a shock and he found it hard to tell people about it, especially his mum. “I didn’t really know what was going on. I was tired, thirsty and going to the toilet a lot. I told myself I was just a bit unhealthy but I went to the doctor and he told me I had

“I told my dad – he’s emotionally quite strong – but my mum never knew the full extent of my diabetes. I’m an only child and I didn’t want to put mum through that stress and blame herself. It wasn’t her fault, it’s just our culture. “Food is central to family and social gatherings, if you don’t eat you are

JOIN THE MOVEMENT | FAB RUARY

Nickson’s FABruary pledges Nickson decided he still had a few things he could work on, like the sneaky packet of M&Ms after going to the gym to ‘reward himself’ for his workout. During FABruary he promised to: • eliminate unhealthy fast food and takeaways, sweets, and confectionery • eliminate bottled fruit juices, soft drinks, energy drinks and sports drinks • join a local sports club or gym, add jogging or swimming into his weekly routine, and increase outdoor activities with family, friends or colleagues

What is FABruary? Diabetes NZ was the proud partner of New Zealand’s first FABruary in 2016. The campaign aims to raise awareness about this country’s obesity epidemic and its health-related risks. FABruary, which stands for Fight Against Bulge, aims to help people make small steps towards being healthy. People are encouraged to make month-long healthy living commitments during February. The concept was first launched in Australia and was the brainchild of Nickson’s friend and ex-Warriors player Clinton Toopi. Next year Diabetes NZ will be inviting all New Zealanders to join the FABruary movement and make their own health pledges. For more information, see www.diabetes.org.nz/Fabruary for details.

being disrespectful. Island food is full of fresh fish and fruit but when families come to live in New Zealand, it is substituted for KFC and Pizza Hut.”

At his heaviest, Nickson was 120kg. Nine years later, he weighs just 75kg. His doctor told him he could stop taking his diabetes medication (metformin) in 2011.

But being diagnosed with diabetes was a turning point. Nickson started going to the gym several times a week, changed his diet and the kilos dropped off really fast.

He gets checked for symptoms every six to eight months but is still symptom free and feels great about the future.

Nickson says he enjoyed being part of FABruary – it was a great kickstart for him personally, as well as a chance to raise awareness of obesity and its health risks.

He’s run three marathons since 2007 and he encourages his whole family to exercise together, including his wife, uncle and mother-in-law. They go on walks, cycle or do boot camp.

“People can sometimes be a bit judgemental about what I’m doing. But I just tell them I want to be healthy in my old age and see my grandkids growing up.

“It’s getting more acceptable to eat healthily and exercise – more people are talking about it. I’m all about

“Ninety-five percent of them get that. If I can help one person by telling my story, I’m happy.”

“This diabetes thing wasn’t working for me. I told myself that it just wasn’t right. I needed to do something about it,” says Nickson, who is now 31. “I’ve a bit of an addictive personality, so once I’d committed it was all on.”

scare tactics. I tell people what will happen if they get diabetes and don’t do something about it.”

GPSI DIABETES

Now with rooms in Auckland and Hawkes Bay

Winter 2016 | DIABETES

T R AVE L | O F F THE B E ATE N TR ACK

How do you combine the rigours of a high altitude tramp with the extra requirements of completing the walk with diabetes? Experienced traveller Fay Murray recounts her recent trip to Peru.

HIKING THE INCA TRAIL “You can do it brave hikers!”. These were the words of encouragement from our guide, Santi, as he coaxed us up another seemingly endless, rocky staircase on the demanding Inca Trail. I had no doubts that I would complete the tramp even though my body felt like lead and my lungs were working overtime trying to overcome the effects of being at high altitude. Giving up was never an option I would consider.

Travelling and learning about other cultures is one of my great loves and my husband, Brian, and I have recently been fortunate to spend two months touring South America. One of the highlights was completing the ancient Peruvian trail of the Incas which leads to the lost city of Machu Picchu. Our group included six Kiwis and two Aussies and we were accompanied by 14 porters, two guides and a cook. Everyone was fit and had prepared well but the altitude of up to 4,200 metres above sea level proved to be a real challenge. We were amazed at how effortlessly the locals moved along the trail with much laughter and constantly chewing on coca leaves. Santi said he had walked the trail over 400 times with tourists and our group was the first not to resort to chewing the leaves to combat the altitude.

DIABETES | Winter 2016

The starting point of the trek was a short bus trip from our hotel in Cusco. On day one we walked 13km before reaching our campsite where the porters had set up our tents and prepared our evening meal. Day two covered approximately 9km climbing up the highest pass (Dead Woman’s Pass) which is at 4,200 metres, before descending down the old Inca stairs to our overnight camp.

“GOOD PLANNING IS AN INTEGRAL PART OF ANY TRIP BUT HAVING DIABETES MEANS THERE NEEDS TO BE A LOT MORE ATTENTION TO DETAIL.” Day three was a seven-hour walk passing ancient ruins of Inca civilisation. The last day was the most exciting when we rose very early for the final walk to Machu Picchu, greeting daybreak and the sun rising over the famous Sun Gate. It’s hard to find words to adequately describe the magnificence of Machu Picchu. The “Lost City” is located high above the fast flowing Urubamba River and was originally completely selfcontained with natural spring water

to drink and agricultural terraces to grow food. The ruins consist of palaces, temples and approximately 150 houses, all in a remarkable state of preservation, and are one of the wonders of the modern world. When I was first diagnosed with late-onset type I diabetes when I was 50 years old, I knew very little about the condition so I visited the library and read all the information I could find. Within days I made the decision to do everything possible to try and maintain control of the condition. I was determined not to let diabetes rule my life. Mostly I win the battle but things don’t always go to plan and I do get frustrated at times. Now, at the age of 66 years, I have come to accept that perfect readings are not always possible and I am more relaxed about the occasional hiccup. Good planning is an integral part of any trip but having diabetes means there needs to be a lot more attention to detail especially when visiting a country where the health services are not as advanced as those which we take for granted in New Zealand. Before leaving home there were appointments with my dentist, podiatrist, diabetes specialist nurse, GP and a travel doctor. I needed to make sure that I had enough supplies

OFF THE BEATEN TRACK | T RAV E L

Top left: Team photo on trail – Reaching Dead Women's Pass, the trail’s highest point at 4214 metres (Fay is third from left). Right: Fay and Brian Murray see Machu Picchu for the first time. Bottom left: Team photo with sign – starting the walk (Fay is pictured left).

for my insulin pump plus a back-up plan in the event that it malfunctioned. I had recently been supplied with a personal plan from the University of Otago Insulin Pump Action Plan Study which gave me the confidence to know I could cope in an emergency. When travelling I keep my insulin in a thermos and carry icepacks to keep it as cool as possible. By the time I had assembled extra supplies, regular medications and extra medication for unexpected problems, plus snacks and jelly beans, my backpack was bulging at the seams. I never let my backpack out of sight when travelling and I am paranoid about keeping my insulin safe and cool. Unfortunately when I returned to Cusco from the trek hotel staff had moved my supply of insulin from the safety of the refrigerator, and put it in the freezer. I do admit to freaking out when I saw the frozen vials and realising that they would need to be replaced. In a city of almost 500,000 it was impossible to obtain NovoRapid from the three main emergency pharmacies but luckily the doctor who wrote the prescription out for me was able to supply a couple of vials which lasted me until we reached Bolivia’s capital of La Paz and were able to purchase more (at great expense). Brian and I have now travelled to 53 countries. That leaves only 175 still to visit. We don’t expect to get to them all but intend to continue our adventures as long as we can. Diabetes has not prevented me from living a normal life and hopefully if I continue to eat well and keep exercising it never will.

TOP TRAVEL TIPS • • •

• •

•

Buy travel and medical insurance and specify your diabetes. Take enough medication – ideally enough for your time away plus two weeks’ worth. Ask for a letter from your doctor verifying you are required to carry all the medications you need (think customs, immigration). Make several copies. Keep the original pharmacy labels on all your meds – in the same name as your passport. See your diabetes specialist or diabetes nurse specialist to get a travel plan for insulin doses across time zones. They can also help you prepare for your trip. Learn how to say "I have diabetes" in the language of the country you'll be visiting. Keep quick-acting sugar and snacks where you can reach them easily. For example, keep glucose tablets in your pocket, purse or carry-on bag under your airplane seat. Buy and wear a diabetes medical ID bracelet. Make sure you keep your insulin cold if you are going to warm countries. Invest in a Frio or a similar portable cooling pack. If you wear a continuous glucose monitor, opt out of body scanners and request a security pat-down instead to avoid any potential issues.

For more travel tips see diabetes.org.nz

Winter 2016 | DIABETES

FOO D | P E R F EC T P UL SE S

LOVELY LENTILS

(and beans and chickpeas) Pulses should be a regular feature in everyone’s diet, especially if you have diabetes, as Teresa Cleary explains. The United Nations has declared 2016 to be the international year of “pulses” and with good reason as they are easy to grow, environmentally friendly, highly nutritious and an affordable source of healthy low-fat protein. As well as being good for the waistline and the planet, pulses, which include lentils, dried beans, chickpeas and split peas, have many benefits for people with diabetes. They have a low glycaemic index (GI) meaning that they are slowly digested and absorbed. This results in greater feelings of “satiety” (fullness and satisfaction) after a meal and help with blood glucose control.

DIABETES | Winter 2016

Pulses have a high fibre content and eating them regularly can help us achieve the recommended daily intake of dietary fibre. Much of this fibre is soluble, which is known to have a small additional effect in lowering cholesterol. Eating lentils, beans, dried peas and chickpeas regularly may reduce your intake of less nutritious, higher fat foods. This is because of the very low fat content of pulses, combined with the fact that they are highly filling. How often should everyone try to eat pulses? I suggest you aim for 4-5 servings per week, which aligns with the New Zealand Guidelines Group’s Guidelines for the Management of Type 2 Diabetes. It defines a serving as 1 cup of cooked dried beans, chickpeas, lentils or split peas (dahl). There isn’t an equivalent guideline for people with type 1 diabetes but the same benefits of pulses also apply. However if you are not used to eating pulses regularly, it is important to introduce them slowly and watch for hypoglycaemia after the meal.

Eating pulses five times a week will be a challenging target for many people. If you have not used many beans, chickpeas or lentils in the past, start slowly and gradually expand the variety of meals that include them, and the number of servings per week. One of the easiest ways to increase your intake is to use them to partly replace meat – think of the red kidney beans in chilli con carne, for example. Beans or lentils are a good way to make a small amount of meat go further, particularly mince. Another trick is to use a tub of “falafel” mix (made from chickpeas and found in the chilled section of the supermarket) and combine it with mince to make tasty meat patties. Winter soups are another great way to use pulses at this time of the year (try our lentil and roast pumpkin recipe overleaf ). In summer they are great for adding fibre and protein to salad meals. Canned beans or lentils that are ready to use are a simpler option than cooking dried beans when you are not familiar with pulses. Look out for varieties canned without added salt.

PERFECT PULSES | FOOD

NEW

POPULAR PULSES The United Nation’s Food and Agriculture Organization (FAO) has declared 2016 the International Year of Pulses, acknowledging their benefits as a nutritious food crop around the world. It says pulses are a significant source of protein, fibre, carbohydrates and dietary minerals. Like other plant-based foods, pulses contain little fat or sodium and no cholesterol. The UN has brought together a collection of global pulse recipes to highlight their versatility and encourage home cooks from around the world to use them. You can see the recipes at: www.fao.org/pulses-2016/recipes/

LOW

CALORIE SWEETENER Measures spoon-for- spoon like sugar

Quinoa and Rice with Lentil Stew Ecuador | Medium | 50 Min | 4 servings | Stew

This stew is very common in the to prepare, low cost and very coastal area of Ecuador. It is easy rich in flavour. As a main dish, it usually comes with fried fish or fried eggs.

Short Rib Stew Peru | Medium | 3 hours | 4 servings | Main Dish

~ large pot or dutch oven ~ skillet

Tools and equipment ~ 4 small baking molds

Directions cooked black beans boneless short rib corn beer If using dried cannellini beans, soak them overnight, and then boil until cooked (about 1 hour). salt and pepper cumin Pre-heat oven to 180 °C. oil Cut the shallot into slices and fry in a pan with two tablespoons of oil. red onion Add the peas and cook over low heat for about 15 minutes, adding broth gradually. yellow chili paste panca chili paste When the peas are tender, pour them into a blender and blend until they form a smooth, creamy puree. If too oregano thick, add a little water.

For the stew:

Ingredients • 1 shallot (medium size) • 200 gr of peas • 200 gr of cannellini beans • 1 clove of garlic

• 4 thin slices of prosciutto • 200 ml of vegetable broth • bread crumbs • salt, pepper, oil and rosemary

1 2 3 4 5 6

Line the edges of four molds with the slices of prosciuotto and bake them in the oven for 10 minutes until they become crisp (they will form into baskets).

7 8 9

Wash and drain the cannellini beans. Toss in pan with olive oil, garlic and rosemary taking care not to break them.

~ blender or food processor

Ingredients

• 1 cup of lentils • salt and pepper to • 1/2 red onion, diced taste • water • ½ green plantain, chopped • cilantro, chopped Marinate the beef with salt, pepper, cumin •and3corn beer for atchopped least 24 hours. tomatoes, with no • 1 ½ cups of rice skin Reserve the marinade and pan sear the meat in a large pot or dutch oven. Set aside. • ½ cup • 4 tablespoons of vegetable of quinoa oil • 1 clove of garlic In the same pot, make a dressing with red onion, yellow pepper paste, panca paste, oregano and garlic. Then add the liquid of the meat marinade, chopped cilantro and the previously seared meat.

Directions

1 2 3

~ blender

Ingredients 1 cup (250 ml) 250 gr 100 ml 5 gr 15 ml 150 gr 75 gr 25 gr 1 gr

garlic cilantro Loche pumpkin (cubed) cooked faba beans cooked rice lime glazed baby carrots

5 gr ½ bunch 25 gr 100 gr 100 gr ½ unit 2 units

~ Knife ~ Stove

~ Pan ~ Wooden spoon

Directions

For the stew:

Tools and equipment

A creamy puree of peas and sautéed beans with rosemary in a basket of prosciutto. The sweet pulses and the salty and crunchy ham provide a nice contrast of flavours and textures.

Cook until the meat is almost tender, about 2.5 hours over low heat. Add the pumpkin, and cook another 30 minutes until the meat is tender.

Blend the faba beans to a smooth puree. Mix rice and faba beans puree in a bowl, add yellow pepper paste, cumin, salt and pepper. You may choose to add a whole egg (optional).

In a skillet, sear the faba beans puree on both sides until golden brown to make a tacu tacu. Set aside.

Serve short rib stew with the faba beans tacu tacu, decorate with glazed carrots and creole onion salsa.

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

Tools and equipment

This traditional Peruvian recipe incorporates delicious ingredients such as boneless short ribs, spices, and a variety of vegetables (including Loche pumpkin!), to create a comforting and filling stew. Serve the short rib stew with faba beans tacu tacu, and you’ll impress anyone at your table!

Double Pulse Italy | Medium | 40 min | 4 servings | Starter

1 Soak the lentils in water for at least two hours before cooking. Heat the oil in the pan and 2 plantain. add the red onion. Once the onion is brown, add the Cook

3 4 5

tomato and the green until the water evaporates, stirring constantly. Sautee these ingredients for a minute or two, and then add the lentils and the water thirty minutes. Season with and let it boil for salt and pepper.

Make sure there is always

some water in the stew until

Before removing from the heat,

the lentils are soft.

add the chopped cilantro and

For the rice:

check for seasoning.

1 Heat a small amount of oil in a pan and add the clove of crushed garlic. 2 Add the rice and the quinoa, stir it in the hot oil for a minute, and then add the 3 Cook the rice at a low temperature until the water is gone and the grains are soft.water and the salt. 4 Serve the rice combined with the lentil stew in a bowl. SOURCE: Mauricio Recalde

mao.recalde@gmail.com

SOURCE: Global Pulse Confederation (http://www.pulses.org/)

Toast the bread crumbs in a pan. To serve: Place three tablespoons of puree of peas on every plate. Place the prosciutto basket in the middle and the beans inside. Garnish with toasted bread crumbs and a little oil.

Source: Riccardo Fortuna (http://metalikarus.wix.com/morethanfood-ita)

Most dried pulses need to be soaked, drained and then cooked before they are ready to be included in a dish. Use fresh water (no salt) and leave overnight. Drain and rinse. Do not skip this step as it is vital! Draining removes many of the compounds that can contribute to “wind”. Boil or simmer the beans in water (again don’t add salt), following the cooking instructions on the packet. This may take over an hour (it’s faster in a pressure cooker). Cooked beans and chickpeas should be tender and be able to be mashed against the roof of the mouth. Any kind of lentil, green or yellow split peas and black-eyed beans do not need to be soaked prior to cooking. Follow the cooking directions on the packet. Cooked beans and chickpeas can be frozen in meal-sized amounts meaning that enough for several meals can be soaked and cooked at one time. Overleaf: Try some lovely lentil, chickpea and bean recipes.

PREPARING DRIED BEANS AND CHICKPEAS

For delicious recipes, visit

club

Winter1 2016 12032015_Equal Strip_59x242.indd

.co.nz

| DIABETES 16/04/2015 27

1:40 pm

R E CI P E S | PE R F E C T P UL SE S

WINTER FEASTS Try these affordable winter warmers that combine meat, chicken or vegetables with a healthy serving of beans, chickpeas or lentils.

Roast pumpkin and lentil soup Serves 4

INGREDIENTS 2½ cups pumpkin, peeled and diced 2 Tbsp oil 1 cup dried red lentils 1 large onion, diced 2 cloves garlic, crushed 2 tsp curry powder 1 Tbsp fresh ginger, finely grated 2 Tbsp fresh coriander, chopped ½ cup reduced fat, unsweetened yoghurt

As well as tasting fabulous, adding pulses to any meat or chicken dish will help it go further and save a few dollars.

METHOD Heat oven to 225°C Coat the pumpkin in 1 Tbsp oil. Spread out the pumpkin on a roasting tray and roast in oven for approximately 25 minutes or until browned and cooked through. Heat a large saucepan with remaining oil. Sauté onion until soft. Add garlic, ginger and curry powder and sauté for 1 minute. Add lentils and 4 cups water. Simmer gently for approximately 30 minutes or until the lentils are soft. Remove from heat and add pumpkin. Puree to smooth consistency. Garnish with yoghurt and coriander.

APPROXIMATE NUTRITION PER SERVE Energy: 1017kh, Sat. fat: 0.9g, Carbs: 31g, Fibre 8.5g, Sodium: 41mg

Recipes courtesy of our friends at the Heart Foundation. They are from their fabulous Full O’ Beans recipe book. You can download a copy here: www.heartfoundation.org.nz/uploads/Full_o_Beans_web.pdf

DIABETES | Winter 2016

PERFECT PULSES | REC I P E S

Chicken and white bean casserole Serves 6

INGREDIENTS 6 skinless chicken thighs 1 Tbsp oil 1 medium carrot, diced 1 large onion, diced 1 stick celery, diced 4 cloves garlic, crushed 2 tsp Worcester sauce 1 can crushed tomatoes 1 cup water 1 tsp brown sugar 1 can butter, haricot or cannellini beans, drained and rinsed METHOD In a large casserole dish gently brown the chicken thighs with the oil. When browned remove from the casserole dish and set aside. Gently sauté the onion, carrot and celery in the casserole dish until softened and lightly browned. Add the garlic and mix through, do not allow garlic to brown. Add remaining ingredients to casserole dish and bring to the boil. Reduce heat and put the chicken back in. Cover with a lid and gently simmer for about 45 minutes. APPROXIMATE NUTRITION PER SERVE Energy: 896KJ, Sat. fat: 1.8g, Carbs: 10.6g, Sodium: 262mg

TRY TH IS NEW PRODUCT!

Slow-cooked tomato, beef and chickpea ragout Serves 4

INGREDIENTS 330g diced beef rump steak 1 Tbsp oil 2 large red onions, diced 4-8 cloves garlic, roughly chopped 2 medium carrots, diced 1 can chickpeas, drained and rinsed 2 cans crushed tomatoes ½ cup red wine 1 cup water METHOD Brown the diced beef with the oil in a large, heavy-based casserole dish or sauté pan. When well browned, remove the beef. In the same casserole dish add the onion, garlic and carrots and reduce the heat to sauté gently until lightly browned. Add all other ingredients back into the casserole dish including the beef. Bring to a gentle simmer and cook for approximately three hours or until the beef is very tender and the sauce has thickened into a rich gravy. Alternatively, for a slow cooker follow steps 1-4, then add to slow cooker and cook on low for 7-9 hours. Serve with mashed potato and steamed vegetables. APPROXIMATE NUTRITION PER SERVE (WITHOUT THE SIDE DISHES) Energy: 1294kJ, Sat. fat: 2.8g, Carbs: 22.3g, Fibre:10.4g, Sodium: 486mg

Winter 2016 | DIABETES

L IV IN G WI T H DIA B E TE S | R AC HEL'S STORY

SAVING MY LIFE A diagnosis of type 2 diabetes when she was 37 years old saw Rachel Woodrow, from Waikanae, completely changing her lifestyle. She lost a third of her bodyweight, started exercising regularly and is now symptom free. She tells her story in her own words. MY DOCTOR AND MY FAMILY

had warned me over and over again that I was too big and my lifestyle was killing me. In 2011 I went to help my sister who had gestational diabetes and was injecting herself and, of course, taking her blood sugar levels. They were quite high so we thought it would be funny to use my readings to surprise her midwife. Well, they certainly did surprise her – they were really high and it took a bit to convince the midwife they came from me.

DIABETES | Winter 2016

The midwife took me aside and told me I needed to get help. When my doctor delivered the news that I had diabetes I broke down not because I was concerned for my health but because everyone had been right and now everyone would know. I told my family and very close friends and no-one else until now. I took some action and through reducing my general food intake I dropped to 87.6kg. My highest weight had been 99kg and I’m only 5'2". Amazingly (as you often read), after dropping 10 per cent of my body weight I finally got pregnant after 13 years of trying! Of course that meant I had gestational diabetes and was under a fantastic specialist team. Now I was the one injecting insulin and Tabitha was delivered two weeks early. I wish someone had told me what it’s like for a baby born to a diabetic mum in Wellington

hospital. She was whisked away less then an hour after a very dramatic birth and given so many heel pricks her feet looked like a pin cushion. People with diabetes are given regular checkups with diabetic nurses as you know and I went to my appointments and my nurse was an extremely lovely woman, but when I tried to discuss reversing diabetes with her she would just tell me I was doing good. I believe there was an attitude of just accepting my fate. I always felt so down after these meetings and would slip into a depressed state for quite a while. This led to more eating and less movement – I was in a cycle for getting worse! I couldn't control myself or my eating, I couldn't get motivated and was starting to accept my young daughter would probably not see me live a long life without ailment.

RACHEL'S STORY | LI VI NG WI TH DI AB E T E S

Before: Rachel used to weigh 99kg and had to inject insulin daily after being diagnosed with type 2 diabetes.

While I was pregnant I got used to checking my blood sugar levels regularly and it helped me think about what I put in my mouth and started me on the idea of not eating for two hours after a meal (awesome habit to get into by the way). When I was no longer pregnant, I couldn't get enough test strips to test my bloods all day long. It’s not funded, unless you are taking insulin. This seems crazy – surely the people that should be testing their blood regularly are the pre-insulin people? I pretty much begged, borrowed and stole strips to keep testing my bloods through the day. I downloaded an app to graph the information and in March of 2015, I started really watching what was happening to my bloods. About this time, I started reading about calorie reduction and the effects on diabetes. I rang my diabetes nurse and asked if they had heard about this experiment where people dropped their calories for I think it was eight weeks and they had pretty much reversed their diabetes. She basically told me to forget that nonsense and I was doing fine, I would always have diabetes. Depression set in again but not for long. I have been wearing Fitbits (activity trackers) for years and they are very motivating, however I am not the best owner and I lost a few after putting them through the washing machine. When I started to watch my blood sugar levels, I was given another Fitbit. Movement had meaning again, the Fitbit dashboard

on my iPhone was amazing and you could easily add food and count your calories. All the tools I needed to try out my new plan for getting better. So on 18 Jan 2015, I brushed off my Aria scales, clicked on my Fitbit Flex, and started to face what needed to be done. The graphs and the green lights when I completed my daily goal were so inspiring! Plus I hated seeing the big red knife and fork when you go over your calories. This was my ideal jump start to a healthier new life. A year on and I cannot go to bed without completing my 10,000 steps a day. When I was tracking my food intake, it became apparent that my downfall was chocolate, biscuits and other sweet goodies (baddies) and the calories they took away from real food meant I was eating too much. As I was stuffing down more junk food one day (standing at the cupboard hating myself ) I realised I was addicted to these foods. More research needed. I decided that addictions take 90 days to break but the thought of never having these foods again was very scary so I made myself a deal: 90 days without sugar foods and I could have a “whoo hoo” day. That means you can eat everything you've been craving once every 90 days. Giving up sugar-filled food was so incredibly hard and I really struggled for a month, but at the end of the 90 days I had lost 7.2kg and felt much more in control! I joined Michelle Bridges’ 12-week body transformation programme in August (I had lost 13.5kg on my own).

Now I weigh 62kg and my Fitbit (now a Charge HR) is still one of my most precious possessions. I still use the Fitbit app all day/every day and I like taking part in any online Fitbit challenges. It's a great motivator. My husband’s just got a Fitbit for his birthday so he's just learning how much fun it can be.

RACHEL'S TIPS I most often stick to 1,200-1,500 calories a day and most of the food is clean and whole. No one is perfect right? I change the rules regularly – diets lose their shine so I don't “diet”. I make rules like “no eating after 8.30pm” because after 9pm my willpower has gone to bed and I used to do quite a bit of damage surfing the cupboards at night. I acknowledge and understand that losing weight is 20% exercise and 80% diet. Going for a walk is not going to undo even a small chocolate bar. I play games to make up my steps with everyday activities. For example, putting the washing basket quite a way from the line and walking back and forward to get each item. I regularly document my journey with photos and create comparison photos to remind myself how far I have come.

Winter 2016 | DIABETES

L E T ' S G ET ACTIVE | E X E R C ISING AT HOME

WINTER WORKOUTS Our fitness expert Craig Wise gets creative with simple exercises you can do without leaving the house.

The long summer days are over and perhaps you have put your early evening walks or gardening on hold until spring. But it doesn’t mean you have to go into hibernation or retreat to the comfort of your couch over the winter months. You don’t even need the gym and lots of expensive equipment to get active, a few household items and a bit of imagination can get you a long way. Plus you can do it in the comfort of your own home and watch Shortland Street while you are exercising. You can try these exercises at any time of the day – and if you like watching a bit of telly, I have created a workout just for you. Little or no equipment required!

CRAIG’S COMMERCIAL BREAK WORKOUT Before your favourite TV show starts, grab all the bits you will need for your workout, we can’t go wasting those precious moments in the commercials having to go and find stuff. Here’s what you’ll need for your basic workout. A sturdy dining chair

Some kitchen-supplied hand weights

A cou ple of 300m l water bottles or two ca ns of ba ked bean s

A yoga mat or a towel

THE WORKOUT During commercial break 1 10 Stand ups 10 Leg extensions (Repeat twice) During commercial break 2 8 Modified push ups 8 Dips (Repeat twice) During commercial break 3 10 Curls 10 Military press 10 Tricep extensions (Repeat twice)

Follow our handy “cut out and keep” exercise guide on the next page Perform the exercises at a slow steady pace, and if it begins to get easy then grab something heavier to use as hand weights, add in another set of the exercises, or keep alternating the exercises right throughout the break.

CRAIG’S TIPS Exercise at a moderate intensity. If you feel your heart rate go up, your body is benefiting. Low-intensity exercise is appropriate for beginners or people who are overweight, but moderate intensity is beneficial for health and weight loss, if you are able. Remember it is always important to select an appropriate level of physical activity for your skill and ability. If you have any injuries or concerns, then it is important to consult with your health care professional before commencing any activity.

DIABETES | Winter 2016

You don’t have to limit yourself to these exercies. Try walking lunges around the lounge while the adverts are on, perform arm circles or lie on your side and do some leg lifts or leg clams. They are a great way to get the whole family involved – you can even turn it into a game or challenge – the possibilities are endless. When you are watching a rugby game you can do squats every time there is a line out or a scrum.

Think back to when you were younger – you didn’t exercise, you played and kept fit that way. So maybe grab a skipping rope or run up and down the stairs in your house. Don’t let the winter couch time stop you from being active – remember every little bit helps. Question for Craig? Email him at info@getfitandhealthy.co.nz. Check out his new website for more exercise tips: www.getfitandhealthy.co.nz

EXERCISING AT HOME | LET'S GET AC T I V E

THE COMMERCIAL BREAK WORKOUT

REPEAT TWICE

STAND UPS x 10 Sit upright on the edge of a chair (or couch) with your feet shoulderwidth apart. Without using your arms, press into the floor with your feet, and stand up. (Tightening your butt muscles as you rise. Keep your abdominals tight and your back straight.) Then slowly lower yourself back to the seat.

LEG EXTENSIONS x 10 Sit upright on your chair with your feet flat on the floor shoulder width apart. Slowly raise your legs until they are parallel to the floor, do not lock your knees at the top and then lower then back down again.

REPEAT TWICE

MODIFIED PUSH UPS x 8 Facing a sturdy dining chair (or couch), kneel on a yoga mat or towel about 60cm away from it. Cross your ankles, and place your hands shoulder-width apart on a cushion edge. Slowly bend your arms, and lower your upper body until your chest touches the couch. Hold, then press up again. If using a dining chair, brace it against a wall.

CHAIR DIPS x 8 Sitting on the edge of a chair (or couch), place your hands on the edge on either side of you. Move your feet out so that your butt is off the chair, and your knees are bent at a 90-degree angles. Bending your elbows so they point behind you, lower yourself as far as comfortable. Hold, then slowly press up again. If using a dining chair, brace it against a wall.

THE CURL x 10

REPEAT TWICE

Sitting upright on your dining chair with your arms tucked in at your sides holding your “weights” in each hand resting on your thighs. Slowly curl the arm bringing your weights up to your shoulder and then lower back down. Keep your back straight and your shoulders back, trying to make your arm the only part of your body moving.

THE MILITARY PRESS x 10 Sitting upright on your dining chair, holding your “weights” at shoulder height slowly raise your arms above your head until they are nearly straight before lowering back down again to the starting position. Keep your back straight and your shoulders back.

TRICEP EXTENSION x 10 Sitting upright on your dining chair, holding your “weights”, put your hands behind your head with your elbows close to your ears. Straighten your arm lifting the weight up and then lowering back to the starting position. (If necessary use both hands on one “weight” to start with and then build yourself up to using each arm individually). Winter 2016 | DIABETES

T H E RUBY MCGILL COLUMN |

I’ve had type 1 diabetes for almost 17 years but at the start of 2015 it all started to unravel. Since then, I’ve been on a journey to master diabetes. Surely it’s possible…

MY NEW INSULIN PUMP

OUR WEEKS AFTER WE'D

appealed Pharmac’s decision to decline my insulin pump funding, we had a response. I had the green light – funding approved! Had Pharmac made a mistake the first time when it declined my application? How come I was suddenly within the ‘criteria’? Perhaps our letters to them had made me more than a number? Who knows? The important thing is the funding was approved and I’d been given a chance to try an alternative way of controlling my diabetes. In August 2015 I began using a pump. I felt excited, nervous, emotional and empowered. Imagine if I’d given up when Pharmac had initially said no. I spent two days at Hutt Hospital learning how to use an insulin pump. I was fortunate enough to share this experience with Neville, who also has type 1, his wife Judy, diabetes nurses Hazel and Lyn and Kevin the insulin pump rep and tutor. We explored insulin pump jargon, how to refill cartridges, change cannulas and batteries, correct high blood sugars, hypos, ketones and how

to troubleshoot when things went wrong. It was a lot to take in. During the workshop we had time to practise using and programming the pump and test the effects it was having on our blood sugars. At one stage, I tested and was 18.6mmol/L. I’d only had a sandwich and a coffee for lunch, I’d carb counted and taken insulin to cover this. What went wrong? I’d followed the rules exactly and failed. Then Neville tested his – 17.6mmol/L. What, this is normal? You mean to tell me the highs and lows I’ve been battling for 17 years aren’t a reflection of bad choices or lack of determination, but simply part of diabetes? I’m not the only one fighting hard to achieve the somewhat mystical illusion of consistent blood sugar levels between 4-8mmol/L. What an absolute revelation to discover I was not alone. We’d been warned the first few months of using a pump would be the hardest and unfortunately there’s no one-size-fits-all with diabetes. In fact there’s not even a one-size-fits-one person. There are so many variables to

consider, such as food, exercise, time of day, sickness, stress. I even find the weather affects my blood sugars and medication requirements. I survived the first few months supported by my family and friends. Together we meticulously read the back of food labels, chose sugarfree alternatives wherever possible, made time to exercise, recharge, rest, laugh and learn. They ‘lifted me up’ during the tough times and celebrated each and every success, no matter how small. It’s certainly been a massive learning curve! Here are a couple of things I’ve discovered along the way: Surround yourself with strong people Their strength is contagious! It would have been easy to give up when Pharmac said no. However my diabetes nurse, Hazel, said let’s appeal and I pulled up my socks and started planning. Together we’ll win. Don’t give up! Keep fighting This is my health. One of the most important assets I’ll ever own. If I don’t fight for it now, who else is going to?

You can follow Ruby’s journey to master diabetes at www.masteringdiabetesnz.com 34

DIABETES | Winter 2016

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

AVAILABLE IN NEW ZEALAND

Would you prefer your insulin without the needle?

InsuJet, your needle free option. InsuJet was developed for people requiring insulin treatment for their diabetes who have a needle phobia, or would prefer not to inject themselves with a needle. InsuJet is suitable for use with all types of insulin. Please discuss InsuJet with your diabetes health care professional to see if it is suitable for you.

To find out more about InsuJet, call 0800 45 82 67 or visit www.insujet.co.nz. Always read the label and use only as directed. Insujet and its consumables are not funded, a charge will apply.

Distributed by Pharmaco (NZ) Ltd Auckland 1060 TAPS: NA 8012