Diabetes Wellness Autumn 2020 by Diabetes New Zealand

wellness DIABETES

AUTUMN 2020 $8.00 INC. GST

DIABETES NEW ZEALAND | DIABETES.ORG.NZ

REVERSING TYPE 2 • AUDIO GLUCOSE METERS • YOUNG LEADER TESS JAMES • PREGNANCY EXERCISE REMEMBERING DAVE BALDERSTONE • RESOLUTIONS THAT STICK • DANCING WITH DIABETES

THE KEYS TO HEALTH Better prevention, smarter cures

IS ALL FIBRE EQUAL?

measures spoon-for-spoon like sugar Ginger Moments Preparation 15 minutes Cooking 15 minutes Serves 32

Ingredients 1 cup plain flour ½ cup self-raising flour 1 cup Equal Spoonful 1 Tbsp ground ginger ½ tsp mixed spice 80g butter, melted 1 Tbsp treacle, warmed 1 egg 1 Tbsp low fat milk 1 Tbsp finely chopped glacé ginger Cream Cheese Filling 125g light cream cheese 2 Tbsp Equal Spoonful 1 tsp ground ginger ¼ tsp grated orange rind ½ tsp vanilla essence

Instructions 1. Preheat oven to 180°C. Line 3 oven trays with baking paper. 2. Put flours, Equal Spoonful and spices into a large bowl and stir until combined. In a second large bowl combine butter, treacle, egg and milk. Add glace ginger then add to dry ingredients and mix until a firm dough forms. Roll teaspoonfuls of mixture into balls and arrange on prepared trays. Press down gently with a fork. Bake for 12-15 minutes or until golden brown. Allow to cool on a wire rack. 3. Meanwhile, to make cream cheese filling put all ingredients into a large bowl. Beat with an electric hand beater until smooth.

4. Once biscuits have cooled, sandwich biscuits together with a little filling. Serve. Nutritional Information Average Quantity Per Serve:  Energy 197.7 kJ  Protein 1.4 g  Fat total 0.9 g  Carbohydrates 8.2 g  Sugars 2.2 g  Sodium 41.1 mg The Essential Ingredient Equal Spoonful has almost no calories and measures spoon-for-spoon like sugar. Perfect for your recipes, cereals and drinks. Find more delicious recipes at club

.co.nz

Contents

AUTUMN 2020 VOLUME 32 | NO 1

20 CARE: Footcare – the crucial essentials

4 EDITORIAL

5 UPFRONT: Diabetes NZ Petition 6 UPFRONT: Fundraising 8 COVER: Reporting back from DAM 2019 10 COVER: Dr Lance O'Sullivan talks healthcare 11 RECIPE: Tim Read's grilled steak and courgettes

COVER: LANCE WILLIAMS. PHOTO © HAYLEY ROBERTS

12 RESEARCH: Reversing type 2 with the Newcastle diet

22 RESEARCH: Award-winning scientist Dr Lisa Te Morenga talks nutritional research 24 ADVOCATE: The lowdown on NZ's medications for type 2 26 COMMUNITY: Dave Balderstone: a commemoration for a much-loved mate 28 NOURISH: Using diet to fight inflammation

15 TECHNOLOGY: Blood sugar testing with visual impairment 16 YOUR DIABETES NZ: Packs for the newly diagnosed

30 COMMUNITY: Sue Pearson: three decades supporting those with diabetes

32 LIFE WITH T2: Shantelle Bliss tells her diabetes story 33 MOVE: Exercise and pregnancy 34 LIFE WITH T1: Lily Barton: realising a dancing dream 36 NOURISH: New year's resolutions and how to stick to them 38 LAST WORD: Call for participants for clinical trials

18 COMMUNITY: Tess James representing youth at IDF conference

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DIABETES WELLNESS | Autumn 2020

Editorial

iabetes New Zealand has had a busy and exciting quarter, with advocacy at the fore, as we called on the government to fund new medications and continuous glucose meters (CGMs), all of which make a significant difference in diabetes management. We were delighted that 27,958 people supported our petition, and we look forward to the opportunity to appear before the select committee later this year. Pharmac have announced that they are considering funding two medications on our list, and it is hoped they fund both rather than one or the other. The next hill to climb is to get Pharmac to fund CGMs or flash glucose meters (FGMs). This life-changing technology is readily available in other countries, so why not New Zealand? Our traditional advocacy and awareness month in November centred around the theme “It’s About Time”. This allowed us to advocate to government as well as build awareness of how important it is to get tested for diabetes and “Know your Risk”. The response to this campaign was impressive: hits on the “Are you at Risk” page on the Diabetes NZ website increased by 565%, and we had 68,000 views of our campaign video. We were grateful for an enormous amount of community support during the campaign – from local councils, Primary Health Organisations and organisations such as local Lions’ Clubs. Every two years, the International Diabetes Congress (IDF) takes place, and this year it was in Busan, South Korea. IDF gave delegates from around the world an update on their five-year strategy – much of which forms the strategic vision for Diabetes NZ: • Awareness – communications campaigns and online risk assessment tools • Advocacy – fostering, developing and supporting young leaders; influencing decision makers; improving diabetes prevention and management • Education – organising live learning events; encouraging high standards; disseminating online learning through having multiple modules available. The Congress itself largely focused on early intervention measures and the need to address diet and activity jointly; one cannot be done without the other. A consistent theme was “It is time people and governments took diabetes seriously.” New Zealand is not alone in its frustration with a general acceptance of getting type 2, and a lack of awareness around the seriousness of complications. A key role for Diabetes NZ is in the prevention space – preventing type 2 and preventing complications of both types. Education is key as it empowers people to self-manage their diabetes or pre-diabetes. Diabetes Wellness magazine is one way we strive to educate and empower, and we hope this issue is no exception. In this issue, you’ll find healthful recipes, words of wisdom from inspiring people living with type 1 and type 2, detailed information on caring for your feet when you have diabetes, advice on making lifestyle changes stick, the latest research into diabetes (and how you can participate in future research) and more. HEATHER VERRY

Chief Executive, Diabetes NZ

DIABETES WELLNESS | Autumn 2020

Diabetes New Zealand is a national charity that provides trusted leadership, information, advocacy and support to people with diabetes, their families, and those at risk. Our mission is to provide support for all New Zealanders with diabetes, or at high risk of developing type 2 diabetes, to live full and active lives. We have a network of branches across the country that offer diabetes information and support in their local communities. Join today at www.diabetes.org.nz

DIABETES NEW ZEALAND Patron Sir Eion Edgar Board Chair Catherine Taylor Chief Executive Heather Verry Diabetes New Zealand National Office Level 10, 15 Murphy Street, Thorndon, Wellington 6011 Postal address PO Box 12 441, Wellington 6144 Telephone 04 499 7145 Freephone 0800 342 238 Email admin@diabetes.org.nz Web diabetes.org.nz Facebook facebook.com/diabetesnz Twitter twitter.com/diabetes_nz

DIABETES WELLNESS MAGAZINE Editor Johanna Knox editor@diabetes.org.nz Publisher Diabetes New Zealand Design Rose Miller, Kraftwork Print Inkwise Magazine delivery address changes Freepost Diabetes NZ, PO Box 12 441, Wellington 6144 Telephone 0800 342 238 Email admin@diabetes.org.nz Back issues issuu.com/diabetesnewzealand ISSN 2537-7094 (Print) ISSN 2538-0885 (Online)

ADVERTISING & SPONSORSHIP Business Development Manager Jo Chapman jo@diabetes.org.nz or +64 21 852 054 Download the Diabetes Wellness media kit: http://bit.ly/2uOYJ3p 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 Wellness 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.

Upfront

DIABETES NZ PETITION ATTRACTS THOUSANDS OF SIGNATURES

he Diabetes NZ petition for funding of continuous glucose monitors (CGMs) and better medication for people with diabetes was delivered to Parliament in November. It was the culmination of a determined campaign that saw many people from the diabetes community speaking out in support. Type 1 diabetes advocate Ruby McGill appeared on TV3’s The Café and on RNZ’s Afternoons where she was able to talk about the need for CGM funding and encourage more people to sign the petition before the closing date. This provided an opportunity to start a conversation about diabetes in the media and the overwhelming need for more support from the government.

Natalie Hanna and Hayley McDonald, both parents of children with type 1 also appeared on TV3’s The Café, on the Parenting Panel. They shared their stories about the diagnosis of their children, the challenges involved with caring for someone with type 1 and the difference technology makes to the lives of those with the condition as well as their carers. With many voices sharing the importance of signing the petition, it closed with nearly 28,000 signatures. Our thanks go out to everyone who supported the petition. WHAT HAPPENS NEXT?

The petition will now go the Health Committee for consideration, probably in March 2020, and

The team makes a presentation on the steps of parliament before taking the petition inside.

Diabetes NZ will present a submission to go with it. It’s vital that we keep the need for these treatments to be funded in the hearts and minds of the public in the lead-up to this next stage. To stay up to date with the latest news and how you can help, keep an eye on Diabetes NZ's facebook page: facebook.com/diabetesnz.

WHILE WE WAIT

Diabetes NZ strongly supports the organisation Patient Voice Aotearoa, and their own petition to double the Pharmac budget. You can find out more about this campaign and sign it here: www.parliament.nz/en/pb/ petitions/document/PET_91080

Petition supporters, including Ruby McGill (with placard), march to Parliament.

DIABETES WELLNESS | Autumn 2020

Upfront

HAVE FUN, GET FIT AND FUNDRAISE FOR DIABETES Here are some awesome opportunities to run or walk for our cause. Three fun runs are coming up, and Diabetes NZ would love for as many people to get involved as possible.

FITBIT MOVEMEANT CHALLENGE

For two weeks in March, weâ&#x20AC;&#x2122;re inviting Diabetes NZ branches, families, friends and the wider community to join together, don Fitbits and get stepping for fun and fitness. Keep an eye on Diabetes NZ social media for how you can participate.

ENTER THE DRAW FOR A FITBIT IONIC WATCH To go in the draw, sign up to fundraise for Diabetes NZ through any of the above three events. Register your fundraising through the Everyday Hero links provided, then send email confirmation of your registration to fundraising@diabetes.org.nz. Alternatively, post a printed copy to: Freepost Diabetes NZ, PO Box 12-441, Wellington 6144. The competition closes on 31 March.

DIABETES WELLNESS | Autumn 2020

BY | MALOYD

Saturday, 2 May 2020 Diabetes NZ Rotorua Branch Manager Karen Reed is leading the way by entering a fundraising team for this iconic event, running through beautiful Rotorua landscapes. All are welcome to join Karen as she marks her 40th year living well with type 1 diabetes. SIGN UP HERE: rotoruamarathon2020. everydayhero.com/nz/ diabetes-nz-rotorua

ATE | January 16, 2020 2:34 PM

Sunday, 8 March 2020 Team Diabetes Auckland is preparing to hit the streets for New Zealand's largest fun run. Whatever your level of fitness, they would love you to join in to raise awareness and make a real difference through your fundraising efforts. SIGN UP HERE: diabetesauckland.org.nz/rtb

ROTORUA MARATHON

OB | 221488 Diabetes NZ Magazine Advert 4

PORTS OF AUCKLAND ROUND THE BAYSÂ

PUBLIC NOTICE FROM PHARMAC Did you change from the Animas Vibe to the Tandem t:slim insulin pump during 2019? Both of these insulin pumps are supplied by New Zealand Medical and Scientific (NZMS). Warranty periods on publicly funded insulin pumps last four years. While the replacement Tandem pumps provided were brand new, each pump took over the warranty period that was left on the Animas Vibe pump they replaced.

insulin pump they want from the list of funded pumps. Currently, this is either the Tandem t:slim X2 or the MiniMed 640G.

For example, if the four-year warranty on an Animas Vibe pump ended on 30 September 2020, the warranty on the replacement Tandem pump will end on 30 September 2020, even if people only received the Tandem pump in August 2019.

If people want to Tandem t:slim X2 MiniMed 640G know the length of the warranty of their insulin pump, they should check with their diabetes clinic, their pharmacist or the supplier of their insulin pump. NZMS can be contacted on nzms@nzms.co.nz.

When the warranty period ends on the replacement Tandem insulin pump, people are entitled to receive another funded insulin pump (so long as they continue to meet the funding criteria).

If you have any questions about this, please contact PHARMAC on enquiry@pharmac.govt.nz or phone 0800 66 00 50.

This means people will need to receive another prescription for an insulin pump from their diabetes clinic and get a new insulin pump dispensed from their community pharmacy. People will have the choice of

Note that PHARMAC will not be able to answer any specific questions about your clinical circumstances, whether you meet the criteria for a funded insulin pump or when the warranty of your current insulin pump may expire. You should check with your diabetes clinic for that information.

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� Private Consultation Room

� Sildenafil dispensing for Erectile Dysfunction

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PRESCRIPTIONS

*$5 oﬀ standard patient co-payment for prescription is subsidied by Countdown Pharmacy. Other charges relating to patient co-payment for specialist's, dentist's prescription, funded, partially funded and no-funded items may apply. Excludes Invercargill.

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Cover

2019 DIABETES ACTION MONTH REPORT Throughout November, we promoted a massively successful Diabetes Action Month with the theme It’s About Time.

ver four weeks, we communicated the importance of time, whether getting tested for type 2 diabetes, recognising the symptoms of type 1 or reducing the risk of long-term complications from these conditions. We also pushed the urgent need for improved government funding for all Kiwis living with diabetes. FIND THE 100,000

With a focus on finding the staggering number of people undiagnosed with type 2 diabetes, “Find the 100k” was the catch-cry for much of the campaign, with the aim of encouraging Kiwis to take action through the Diabetes NZ Know Your Risk test, or by seeing a healthcare professional. A group of well-known Kiwis helped share this important message by featuring in a moving and powerful video. It was seen by more than 100,000 people through Facebook, YouTube, the Diabetes NZ website, TV3 and NZ Herald online. We want to thank everyone who participated in the video’s creation, watched and shared it, and took action because of it. Diabetes NZ CEO Heather Verry appeared on TV3’s The Café and The AM Show, where she talked about diabetes and the need for Kiwis to go out and get tested. She also addressed the difference between type 1 and 2 diabetes, and the need for more support.

DIABETES WELLNESS | Autumn 2020

The Diabetes NZ Auckland Branch mobile van saw hundreds of people throughout the month and offered free HbA1c testing at Whānau Days, Auckland Council locations and outside Countdown Pharmacy stores. This resulted in many people being tested, and some of those being diagnosed. LOCAL EVENTS

Diabetes NZ branches all around the country put on wonderful events to raise awareness, educate and encourage diabetes testing in their area. Thank you to all of the incredible branch staff and volunteers who made these happen.

Our fabulous video participants. Top (left to right): Dr Lance O’Sullivan, Athena Angelou, Mike Puru. Middle: Simon Gault, Mt Roskill Primary School children, Bryn Hall. Bottom: Ben Mitchell & Ngahuia Piripi, Kerre McIvor, Lucy & Lee Weir. The video also featured Associate Health Minister Hon Peeni Henare and Her Royal Highness Princess Siu’ilikutapu.

Clockwise from top: Diabetes Youth Taranaki at the Around the Mountain Relay with Diabetes NZ ambassador Brett Renall and wife Angel. Diabetes Auckland with the Know Your Risk van. Wear Blue Day in Nelson: Harry from Hampden Street School and mum Heather, Judah and Vince â&#x20AC;&#x201C; Birchwood School T1 Champions, Jamison with T1 mascots Barnaby Bee and Jerry the Bear, Birchwood School kids.

DIABETES WELLNESS | Autumn 2020

Cover

LANCE O’SULLIVAN: PREVENTION AND PRECISION Kaitaia doctor, author, health advocate and 2014 New Zealander of the Year Dr Lance O’Sullivan opened Diabetes NZ’s Find the 100,000 video. He wants to get some clear messages across. PHOTO: NZ HERALD, DEAN PURCELL

ith a passionate commitment to improving health in rural and low-income communities, Dr O’Sullivan says, “I am always 100 percent behind anything that will increase people’s earlier and better management of their own health. “I want people out there to know that the power is in their hands. I believe, though, we need to make sure two audiences are hearing advocacy work around diabetes awareness: One is the population of people in this country. Two is government.” He says the biggest barrier to people with type 2 or pre-diabetes being diagnosed is access to primary healthcare. “It’s a big limiting step for people, and particularly Māori and Pasifika people. “The other thing is that people who do get to primary care aren’t always being screened as they should be, and that’s because of a sense of urgency or pressure from the Health Service. Then finally there’s education: people’s understanding around their risk

DIABETES WELLNESS | Autumn 2020

of diabetes and the potential symptoms. Education can’t be just pamphlets, can’t be adverts. That’s not working. We’ve got to do something different.” INNOVATIVE WORK

Dr O’Sullivan says that better access to primary care is urgent, and that this means reinventing what primary care looks like. He is leading two initiatives that work on just that – iMOKO and MaiHealth. These allow people who live far from doctors, and cannot afford the time or transport to reach them, to access quality healthcare through innovative use of technology. A recent announcement by Pharmac that they will consider new diabetes drugs has been welcomed in many quarters, but Lance admits it’s not something he can fully celebrate. “It’s putting more ambulances at the bottom of the cliff.” For him, the key is, “How do we get better prevention, and also understanding of selfmanagement of diabetes?” He says, “Let’s have medication

as the final step in our arsenal. I want to be talking about how we prevent this tsunami of complications of diabetes-related conditions.” In Kaitaia, he leads a genetic research program. “We’re looking at genetic variants that predict the likelihood of people having diabetes. That’s going to be phenomenal. Imagine a baby being born, and being able to do a test to say, look, at 40 years of age, if you have these characteristics, you have a 90% chance of having diabetes. And then we could say, you have then a 50% chance of an amputation of a limb within 10 years of the diagnosis. “These things are incredible in terms of the opportunity to say to people very early, “let’s turn the dial, and prevent you actually ending up with these unnecessary and preventable conditions, through management of your lifestyle, and then optimal medical management if needed.” Any medical management can be made smarter too. “I’d like to see more pharmacogenetics: being able to offer precise, targeted use of medications.” Research already shows that genetics determine how well people respond to different diabetes medications. “There’s lots of opportunity around saying, okay, can we check the genotype of people to see whether metformin is actually the best medication for their diabetes and, if not, what is? So I would like to see Pharmac investing in smarter, precision medicine.” For more information on Dr O'Sullivan's iMOKO initiative: public.imoko.com

SIMPLE, HEALTHY COOKING WITH TIM READ As part of Diabetes Action Month, Diabetes NZ Wairarapa hosted a cooking demonstration with MasterChef winner Tim Read. This is one of Tim’s recipes from the day. Recipe courtesy Tim Read © Copyright 2020 • instagram.com/tim.read • facebook.com/timreadmasterchef

TIM READ’S GRILLED STEAK WITH COURGETTES Season the steak to your desired level with salt. Heat the canola oil in the pan over high heat and add the steak. Flip the steak regularly until well caramelised and almost cooked. Add butter, thyme and half the garlic slices, and baste the steak with the butter. Remove the steak, rest on a warm plate and douse in the cooking butter. Heat a frying pan over medium heat. Dry cook the almonds until lightly golden and fragrant. Cut the courgettes into irregular pieces and fry in a good amount of olive oil (they will soak up a lot) till lightly charred. At the end, add the other half of the garlic slices. Then move the courgettes and garlic into a bowl.

SERVES 2

2 x 180g sirloin steaks at room temperature ½ teaspoon canola oil 25g butter 2 cloves of garlic, sliced thinly 1 sprig of thyme 2 courgettes Bunch of fresh mint 25g skinned almonds Good quality olive oil Flake salt Black pepper

Finely slice the mint and toss this and the almonds through the courgette. Season well with black pepper and your recommended amount of salt. DIETITIAN'S TIPS: • Many recipes do not specify the amount of salt and oil. With these, you may want to err towards less. Every ½ tsp salt gives you 1g sodium, which is nearly half of the recommended daily intake. • If you want to use less fat in this recipe, pre-steaming your courgettes in the microwave is one way to do this.

NUTRITION PER SERVE: 2970kJ (709kcal) PROTEIN: 60.7g, FAT: 45.5g, SATURATED FAT: 14.1g, CARBOHYDRATE: 8.6g, SUGAR 3.2g, SODIUM 878mg

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Research

Last autumn, we reviewed the Newcastle Study which showed type 2 diabetes could be put into remission. Now, lead researcher Professor Roy Taylor has released a book about how. This is an extract. Left: Roy Taylor, Professor of Medicine and Metabolism at Newcastle University

Life without Type 2

he heart pumps blood around the body, the lungs enable us to take in oxygen and get rid of carbon dioxide. But there is one dynamic function, absolutely key to the maintenance of a healthy body of which most people are totally unaware: what happens to food after it leaves the gut. How is the energy supply managed? All will be explained. Ask someone what type 2 diabetes is, and they are likely to tell you that the disease is something to do with too much sugar. It is true that diabetes occurs when there is excess glucose in the bloodstream, with devastating effects on the eyes, feet, heart and brain. However, research has shown that type 2 diabetes is caused by just one factor: too much fat in the liver and pancreas. In the normal functioning of the body, the pancreas produces insulin to help the liver control the supply of glucose to the rest of the body. When there is excess fat in the liver, however, it responds poorly to insulin, produces too much glucose and passes on excess fat to the pancreas. As a result, the insulin-producing cells of the pancreas cease to function properly.

DIABETES WELLNESS | Autumn 2020

It’s important to say that you don’t have to be obese or even look overweight to have type 2 diabetes. Every individual has their personal fat threshold – the point at which no more can be taken into their regular fat cells (in the fatty layer under the skin, especially around the thighs and trunk). The fat has to go somewhere, and it ends up not only inside the tummy cavity but also inside the main organs of the body. If the insulin-secreting cells in the pancreas are susceptible to fat-induced problems, this is the tipping point for diabetes. This susceptibility is just the luck of the draw depending on your genes. There is a surprisingly simple solution: one that most definitely involves weight loss, but is not really about a diet. The word “diet” is enough to put anyone off. It tends to be associated with an unpalatable change to eating and (usually) a failure to bring about desired weight change. Our original approach to these problems in Newcastle recognised that two very different phases were required: first, a step-change in weight and, then, a long-term way of living. In our very first study, we also

learned that an additional phase, a gradual managed transtion between the phases, was helpful. HOW MUCH IS TOO MUCH FAT?

As a rule of thumb, decreasing your bodyweight by about 15kg will correct the excess of fat … So if you weigh 80kg, weight loss of about 15kg to 65kg is likely to return glucose control to normal – provided you have not had type 2 diabetes for too long. The only way to know whether your diabetes has gone too far to be reversed is to lose weight and see. There are individuals with long-duration diabetes who have successfully escaped. It is worth repeating that the aim is not the usual unfocused one of becoming non-obese. “Obesity” itself is not relevant. What is important is to get yourself below your Personal Fat Threshold. And 15kg is the magic number to lose, whether you start at 160kg or 80kg. (The 15kg rule of thumb works fine for most people but may be too much if you are not a big person.) Of course, there may be other health gains to be had from losing even more weight, but this book is about returning to metabolic health, not becoming slim.

QUICK READ

Once in remission, type 2 diabetes will stay away if you keep your weight steady. The key is to find a way to live happily while eating only around three-quarters of the amount you used to eat. Build walking or another activity into everyday life. Different people suit different patterns of eating. No one size fits all. Moderate carbohydrate limitation may be simplest for some people; others are better suited to a Mediterranean (+ lowcarb) pattern of eating, and/or omitting breakfast or intermittent fasting. Recognising alcohol as liquid fat is important in calorie control. The obesity epidemic is environmental; it is not the result of a sudden onset of communal greed and sloth.

See page 14 for commentary from Diabetes NZ on using the 'Newcastle diet'

READER GIVEAWAY Diabetes NZ has five copies of Life Without Diabetes (RRP $35.00) to give away. To be in to win, email draw@diabetes.org.nz with your name, address and phone number and put NEWCASTLE in the subject line, or post to: Freepost Diabetes NZ, PO Box 12-441, Wellington 6144. The competition closes on 31 March 2020.

This is an edited extract from Life Without Diabetes by Dr. Roy Taylor. Simon & Schuster. RRP $35.00

DIABETES WELLNESS | Autumn 2020

NEWCASTLE DIETING:

THE DIABETES NZ TAKE Our dietitian Helen Gibbs gives her thoughts and tips.

n a nutshell, the Newcastle Study found that a complex set of genetic factors determine whether you’re susceptible to type 2 diabetes, including how much fat your body can store under your skin before it starts to store it around your organs as well, and then whether your pancreas and liver can function when they’re fatty. Fifteen kilograms was the “magic” weight-loss number for many people aiming to get rid of diabetes. Findings also indicate that, psychologically, the most effective way for many people to put type 2 diabetes into remission is to lose around 15kg rapidly, then maintain a stable long-term diet that holds weight permanently at that lower level. To do so, people usually need to eat around 25% less than they did previously. This long-term maintenance can be the hardest part. As with any process of losing weight, you’ll only be successful if you can address as many of the factors that result in overeating as possible. Professor Taylor talks about recruiting family and friends to share your weight-loss journey. This is an excellent idea, but it can also mean identifying unhelpful or unhealthy relationship

DIABETES WELLNESS | Autumn 2020

patterns. In some relationships, one partner may worry that the relationship will change if the other one loses weight. If you have someone who keeps encouraging you to break your new habits or who brings unwanted food into the house, you will need to address this with them. It is not enough to believe in willpower. If someone brings us foods we find tempting, we will eventually eat them. I particularly like the Newcastle Diet’s advice that you need to learn to be satisfied with threequarters of what you ate prior to your weight loss. This emphasises it is not so much about any one diet, but eating less overall. As part of your planning, getting smaller dishes for cooking and serving and really being careful to purchase less when shopping will improve your chances of staying in remission. (Leftovers will be eaten!) If you binge eat, or eat for emotional reasons, work to address this first. Sometimes learning why we eat frees us from the cycle of dieting then regaining weight, as we realise that we eat for reasons other than hunger.

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 250,000 New Zealanders with diabetes to live full and active lives.

For a confidential discussion, please contact Nicky Steel admin@diabetes.org.nz or 04 499 7145

Technology

Thames-based health coach Renee Clark had concerning symptoms and wanted to monitor her blood sugar levels. As she’s legally blind, she bought a pinpricker and a Caresens N Voice meter. The experience surprised her, as she explains.

BLOOD SUGAR TESTING

WITH A VISUAL IMPAIRMENT

sing the N Voice meter was fairly straightforward, thanks to clear training from a nurse and a couple of trial runs. The needles only fit into the pen one way; the strip has marks you can feel that distinguish right side up and which way round they slot into the machine; and the machine turns itself off and on as required. Once it’s set up with dates, times and ranges, it’s ready to go. The voice is clear, and audible beeps announce successful transfer of blood from finger to machine, and so on. But for me, that’s where the fun stopped. While my blood sugar levels turned out to be fine in the end, measuring them for several days before and after eating was a finger-torturing experience that has given me a huge respect for anyone with pre-diabetes or diabetes. I never appreciated the toll that finger-pricking could take on my precious fingers, which to me are my “eyes”, the tools I use to read

Braille. I found myself thinking: do I really want to run them along paper when they’re feeling tender and pincushion-like? They’re also the instruments I place on my violin strings and use to hold my bow. I constantly asked myself, should I use my right hand or my left to pin-prick? Which part of my finger? How many times should I prick the same finger? Then there was the time I slightly burnt the skin on one finger when testing the hot water level in my cup of coffee – not an ideal combination with pin-prick testing. Several times, my meter reported: “Error 4, the sample was either not enough or too thick.” I’d wonder: how do I know which? I couldn’t just look at the quantity of blood and go, “Oh, not much came out then, I need to try again.” Or “Hm, there’s plenty of blood, so why is it too thick?” I often got this error in the morning, so I’d wonder if I was

dehydrated. Then I’d wonder, if I drink water, how quickly will that rehydrate me, and would rehydration affect my sugar levels? For me, needing to pin-prick wasn’t permanent, but for many it is. I see now that people with diabetes must be continually calculating, analysing, guessing, experimenting, decisionmaking, hoping, doubting and questioning. I can appreciate why non-compliance and resistance to change is such a real concern for anyone facing diabetes, and I understand better what a complete shift in lifestyle and mindset is required. My small experiment has taught me so much and made me ask, how can I better support people with diabetes, including those with visual impairments, and build awareness among others, as well as respect for the qualities needed to deal with a chronic condition?

THE CARESENS N VOICE METER CareSens N Voice meters range from $35 to $50, depending on where you buy. Their test strips are funded – they’re the same strips others in the CareSens N range of meters use. This means people with diabetes who are losing their sight can transition from a regular meter to a CareSens N voice meter without changing their CareSens N test-strip prescription. Pharmaco’s Product Manager says, “It’s a niche market. We have provided more than 300,000 CareSens meters in the NZ market, and about 250 voice meters.” However, because visual impairment is a real risk of long-term diabetes, he says it’s vital to service this market. “We’ve had feedback from people that it’s a very nice and easyto-use no-coding meter.” Pharmaco has just released an audio manual for the N Voice meter. Files can be downloaded here: pharmacodiabetes.co.nz/products/blood-glucose-meters-andstrips/caresens-n-voice

DIABETES WELLNESS | Autumn 2020

Your Diabetes NZ

EMPOWERING THE NEWLY DIAGNOSED Diabetes NZ’s public advocacy work attracts the most media attention, but the practical support the organisation extends to the diabetes community is just as important. Newly-Diagnosed Packs are one example.

iabetes NZ distributes Newly-Diagnosed Packs to young people and their families who are in the first overwhelming days of dealing with a type 1 diagnosis. Worth around $110 dollars each, the packs contain a range of useful resources and are made possible by generous sponsors. Youth and Project Manager Marsha Mackie collates the packs at National Office and sends them to hospitals. More than 300 young people received these packs last year, and Diabetes NZ expects those numbers to rise in 2020. Marsha says the packs are “evolving”. The newest addition is a hypo kit. The pack also contains Diabete-ezy test wipes courtesy of MediRay (for cleaning fingers before pinprick testing), a copy of Diabetes Wellness magazine, and informative books for a range of situations. RESOURCE RESCUE

Some books in the pack are rescued treasures. The manual Caring for Diabetes in Young People and Adolescents has been a type 1 “bible” in New Zealand and

Australia since it was first published 20 years ago by the Royal Children’s Hospital, Melbourne. However, the hospital no longer produces hard copies. Marsha says, “It’s freely available online, but we find people like having a hard copy. We have the last of the printed stock in the country, and we have permission from the Royal Children’s Hospital to print it ourselves when we run out.” The clear, child-friendly book Diabetes Made Simple was a rescue, too. Healthcare company Novo Nordisk were cleaning out their New Zealand warehouse when they came across a stack of these forgotten treasures and thought Diabetes NZ would be best placed to use them. “The books were printed 10 years ago,” says Marsha, “but they’re still completely relevant.” Another popular resource in the pack is a flip-chart for teachers. Families can take these into their child’s class at school, talk with the teacher about them and leave them there. The flip charts allow busy teachers to inform themselves on how to care for a student with diabetes and to check information fast when necessary.

Left: Marsha Mackie collates a pack. Centre: The contents of a pack above, and a closer look at the new hypo kit below. Right: Ashleigh, who has type 1, heads off with her pack.

DIABETES WELLNESS | Autumn 2020

THE HYPO KIT

The new hypo kit in the packs is a handy grab-andgo container with all the things you need to treat low blood sugar in a child with type 1. Marsha says, “The Auckland branch of Diabetes NZ initiated them and suggested it would be a fantastic idea if they were rolled out nationwide. “We were able to introduce this only through partnerships with three companies. MediRay contributed the hypo-fit gels and dextro energy tablets. Frucor Suntory contributed fruit drinks, and Annie’s has provided fruit rolls.” The kit gives young people, with their families and carers, a way to start learning how to treat hypos, especially in the crucial early diagnosis stage when blood sugars are especially unstable. It’s an easy way to get into the habit of carrying treatments for lows, and it also offers the opportunity to try a range of hypo-treatment options to see what works best. WHAT NEXT?

Marsha invites suggestions from youth and families about what would be useful to add to the packs in future. One idea is a set of fun distractions for a child with type 1 or a sibling with their own unique needs. There is also a troubling emergence of type 2 diabetes in children and young people that needs to be recognised. You can contact Marsha with your thoughts at Marsham@diabetes.org.nz

We need your help to help them A diabetes diagnosis can be scary, overwhelming and confusing. It’s a steep learning curve whatever kind of diabetes you have. We want Kiwis to know they are not alone. We are here to help them live well with diabetes and support their journey every step of the way. Your generous gift will improve the day-to-day

WHAT OUR COMMUNITY SAYS “It’s definitely made it easier on diagnosis being able to give families the pack. No matter where in the country a child is diagnosed, they’ll get the same start.” Neil Owens, paediatric diabetes nurse specialist, Christchurch “At Starship Children’s Hospital in Auckland, we appreciate the supply of packs for our newly diagnosed children. The manual and equipment are invaluable.” Grace Harris, paediatric diabetes nurse specialist, Auckland “When our daughter was diagnosed with type 1, we were given the hypo kit. It was very useful to us, and we even put together some on our own that we brought to school and have as spare at home.” Karin McCoach, parent, Auckland

lives of people living with diabetes and help us to spread the prevention message far and wide. As a charity, every dollar we raise is crucial – please support our work today: Give securely at www.diabetes.org.nz or call 0800 342 238. Donate via Westpac 03 0584 0197985 09 – use your full name as reference. Send a cheque to Freepost Diabetes NZ, PO Box 12441, Wellington 6144.

Community

Aucklander Tess James is fresh back from representing New Zealand at the 5th Young Leaders in Diabetes training summit.

LEARNING TO LEAD

or Tess James, who was diagnosed with type 1 at six years old, Diabetes Auckland Youth was a vital part of her growing up. Passionate about giving back, she began volunteering for the organisation as soon as she was old enough. When her community urged her to apply for the international Young Leaders in Diabetes (YLD) programme last year, she jumped at the chance and was thrilled to be chosen as the New Zealand representative. She says, “I believed it would be an amazing opportunity to meet people from all over the world who are just as passionate about making a difference in the diabetes community.” Her year culminated in a trip to Busan, South Korea, to take part in the YLD Leadership Training Summit that ran alongside the biennial International Diabetes Federation (IDF) Congress from 2 to 6 December. There was plenty of preparation: “I had to make sure I had everything I’d need there and all the necessary paperwork to allow me to bring needles and other prohibited items. “As I was going somewhere totally unfamiliar, I needed to make sure I had enough supplies for all the worst-case scenarios: excess insulin, both my manual blood-testing meters as well as spare Libre sensors and things like juice boxes and familiar food in case of low blood sugars.” She also had to prepare a short

DIABETES WELLNESS | Autumn 2020

speech about herself and her diabetes journey, to introduce herself once she arrived. She says it was Diabetes NZ who made the journey possible. “They paid for my flights each way and helped with organising travel, as I’d never really been overseas before. Leading up to the trip, they gave lots of advice and encouragement. It was a massive help, and I wouldn't have been able to go without them.”

with one another, as well as activities about how to be a good storyteller and use our own stories to create an emotional connection and teach others about diabetes. I learnt a lot about how to make my own personal story impactful

FIRST IMPRESSIONS

Her first day began with nerves: “It was overwhelming walking into a room with about 60 others. That quickly dissipated. Conversation with them flowed so easily. It was like we all shared a hidden bond, knowing we all had diabetes and were here with the common goal to make life with diabetes easier for those all over the world.” From there on, “the schedule was pretty full on. We met at the conference centre every morning at nine and had activities and talks until five. Activities varied, from guest speakers to hearing the experiences and projects of past YLD members, to a lot of collaboration and discussion with the Young Leaders there about our own experiences or advice that was relevant to each topic. “A lot of what we learnt centred around how to be a successful advocate and make a positive difference through our individual projects. “We also did smaller group work, sharing our project ideas

“At first, the toughest part was being away from family and home, but, by the end, it was saying goodbye ..."

WHAT IS THE IDF? The International Diabetes Foundation (IDF) is an umbrella organisation for over 230 diabetes associations from around the world, including Diabetes NZ. Its mission is to promote diabetes care, prevention and a cure worldwide. Among its many initiatives is the IDF Young Leaders in Diabetes (YLD) Programme, which empowers and educates young people living with diabetes to become advocates for themselves and others with diabetes worldwide.

and how we can be the voice for others through being storytellers. “On two nights we organised group dinners, but even on the other nights we all ended up going out as a group. Almost all my time in Busan was spent with the other Young Leaders. I learnt so much from each of them about their home countries, as well as who they were as individuals. It was a privilege spending time with people so passionate about making a positive impact. Just to be surrounded by all these people achieving so much in their countries was inspiring.” EYE OPENERS

Tess says, “For the most part, after hearing other people’s experiences of diabetes care, I felt lucky to have what I have here in New Zealand: not only the actual medical care and what’s funded for us but also the opportunities we get to attend camps and other activities. These are unheard of in a lot of places. “Hearing about the difficulties many people face broke my heart. Many are losing their life to type 1 because the help’s not there, they have no access to insulin or insurance companies are either charging ridiculous amounts or refusing cover.” She says that, while many New Zealanders know about the horrific difficulties with diabetes care in America, “this is also happening all over the world, in far too many other places”. On the other hand, she learned

that diabetes services in certain areas could be something to aspire to. “There are some countries, particularly in Europe and quite a few African areas, where their care is exceptional, with pumps and CGMs all funded and vast arrays of activities. “There is definitely space for New Zealand to grow and change, and there are areas I’d love to see improvements in, but overall I think we’re fortunate with what we do receive. We aren’t having to watch friends and family lose their lives because of lack of access to care and basic essentials such as insulin and blood-testing meters. This is the daily reality for many others.” For Tess, the trip was life changing. “At first, the toughest part was being away from family and home, but, by the end, the toughest part was saying goodbye to the new family I’d made. We’re all still keeping in contact in a massive group chat. However, the realisation that it may be many years before we see each other again is difficult. I think many of us found it tough to say goodbye and wished the time in Busan was longer.” And what next for Tess? “I hope to take all that I learnt from the guest speakers and my fellow Young Leaders and use it to run a successful project that will make a positive impact. And I hope to become more involved, not only volunteering at events but in their creation and planning.”

My Identity

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Care

FEET FIRST Foot care is crucial for people living with any form of diabetes. Here’s what you need to know.

ver time, high blood sugar can cause neuropathy (nerve damage) and poor blood circulation. It also raises infection risks, as bacteria thrive on sugar. These three factors can combine to cause serious problems for your feet. Fortunately, giving them some extra care can help a lot. HOW IT WORKS

Neuropathy can cause tingling, pain and burning sensations in your feet, as well as numbness. When you can’t feel parts of your feet, you sometimes don’t notice cuts, sores and other damage. Sensations of pressure on your feet may also be reduced, causing you to walk or stand in ways that push your muscles or bones out of alignment. Any foot damage can be made more problematic by the increased risk of infection. And, to top it off, slow circulation means wounds and infections heal more slowly. This can be a perfect storm of issues. The worst-case scenario is that damage and infection increases in severity until amputation is required. A recent study found that, between 2005 and 2016, nearly 8000 New Zealanders diagnosed with diabetes needed lower limb amputations. Many amputations are considered to be preventable if problems are picked up early on. This means you and your health professionals have roles to play when it comes to checking your feet.

DIABETES WELLNESS | Autumn 2020

FOOT CARE WHEN YOU LIVE WITH DIABETES The longer you’ve had diabetes, the more important this advice is. If you have any nerve damage already, it’s vital. However, these are useful practices for everyone with diabetes: • Protect your feet. Avoid going barefoot, even at home. • Don’t wear tight socks or stockings. • Choose shoes that fit correctly, with no areas that rub. Don’t take risks wearing shoes that may cause discomfort or injure you, and get advice on your footwear from a podiatrist if possible. Ask about therapeutic shoes to reduce pressure on key parts of the foot. • Have your feet routinely checked by a GP or other medical professional at least once a year. (It’s a good idea to get a foot check even if you’re visiting for a different main reason.) • Check the temperature of baths before getting in to avoid accidentally burning your feet. Keep your feet away from direct heat like heaters, hot water bottles and electric blankets.

• After baths or showers, dry your feet well (wet skin is more fragile), but don’t scrub them dry. • Use a urea-containing lotion (such as DU'IT) to keep the skin on your feet supple. • Cut your toenails straight across. Cutting them in a curve or into the corners can encourage ingrown toenails. File sharp corners. • Check your own feet daily for issues like blisters, swelling, ingrown toenails, open cracks, calluses, corns, bruises, cuts, etc. Place a mirror on the floor to see under your feet, and ask someone for help if you can’t see all the parts of your feet clearly. • If you find an open crack or wound, immediately wash and dry the area, apply good antiseptic and cover with a sterile dressing.

CAN NEUROPATHY BE HALTED?

Good blood glucose levels can potentially prevent or reduce the progression of neuropathy.

WHAT IS A DIABETIC FOOT ULCER?

Most diabetic foot amputations result from tissue damage and runaway infection that begins with ulcers. Ulcers are areas on the body where the mucous membrane or skin is broken and not properly healing. Because of the risks to the feet associated with high blood sugar, foot ulcers are one of the most common complications of diabetes. Even though some ulcers do not hurt, every ulcer should be seen by your healthcare provider right away.

FACTORS THAT INCREASE ULCER AND AMPUTATION RISK

• • • • • •

igh HbA1c levels H Peripheral neuropathy Cigarette smoking Anomalies in foot shape Corns or callouses Peripheral arterial disease (reduced blood flood in the legs that causes calf muscle pain) • Eyesight troubles • Kidney disease (especially if on dialysis).

WHEN TO SEE A DOCTOR STRAIGHT AWAY

If you have diabetes, see a doctor straight away if you’re experiencing any of these things: • Sharp leg cramps after short bursts of activity • Unexplained pain, tingling, numbness, coldness or burning in your feet • An injury that doesn’t improve at all after 24 hours • Redness, swelling or any other change in foot shape or colour.

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Research

FROM SUGARS TO GRAINS

PUSHING FOOD INDUSTRY CHANGE

PHOTO: VICTORIA UNIVERSITY OF WELLINGTON

Nutritional scientist Dr Lisa Te Morenga (Ngāpuhi, Ngāti Whātua, Te Rarawa) is the latest recipient of the Royal Society’s Hamilton Award – for excellence in research over the course of an early career.

DIABETES WELLNESS | Autumn 2020

riven by a desire to make a difference in Māori health, Lisa Te Morenga completed a PhD nine years ago investigating the effects of diet composition on diabetes risk, then began researching the effects of sugars on bodyweight. Her reviews and studies have been influential, with one paper used by both the USDA (United States Dietary Guidelines) and the EFSA (European Food Standards Association). Lisa says, “People think sugar is the evil, toxic thing, but as nutritionists we know that dietary intake is more complex. There was this whole movement a few years ago, where people were saying sugar caused the obesity epidemic and diabetes, and fat had been unfairly maligned. And it’s more complicated.” One thing her early work showed was that, unlike claims to the contrary, there was nothing metabolically special about sugar in terms of how its calories contributed to body weight. It sounds like a simple finding, but it has enormous implications. “If you turn around now and blame sugar for everything, we’ll see a proliferation of junk foods that are high in fat and low in sugar. We won’t be better off, because the issue is junk food in general, or ‘discretionary foods’, and not eating enough healthy foods. We do eat a lot of sugar. But we also eat a lot of discretionary fat, salt, and refined carbohydrates.” For example, “If all you did was brought in a sugar tax to get people to reduce soft drink intake, I don’t think it would be effective. We need multi-factorial public health strategies.” She adds, “It’s not just about getting consumers to make healthier choices. You need the industry to buy into it too. They’ll respond to the consumers, but they can also drive what the consumers choose.” Essentially, says Lisa, “we’re all eating more than we need, and not exercising enough. If I think back to the food portions my family served when I was a teenager, they were smaller. Cakes were smaller. And supermarkets weren’t open all the time. We’ve got used to things getting bigger and bigger, and more food around us all the time. “I don’t think there’s any magical nutritional solution to our health and obesity crisis, but everyone wants one.” WORKING WITH WHO

Lisa has had a policy of saying yes to opportunities. “For early career researchers, if you’re brave and you take those, even if you’re not quite sure, they can lead you places you might never have anticipated.” As a result of her sugar research, “I was invited to World

Health Organisation (WHO) meetings to present on the work and then to actually contribute to drafting their nutritional guidelines on free and added sugars.” It was a fascinating process. “If you’ve ever seen the WHO guidelines, they’re very simple. They basically say ‘adults and children should consume less than 10% of their energy intake from free sugars.’ But it’s amazing how long it can take to construct that. “The panel debates how every word could be interpreted. Like, ‘Hmm … in countries where intakes are already below 10%, we don’t want them to think they can increase their sugar intake …’ I went to about four meetings, four days each, all around the world, where we just worked constantly, reviewing evidence, updating reviews, discussing the nuances. It was great.” FINDING THE BEST FIBRE

Lisa is now focusing on dietary fibre. “Earlier this year, we published a big systematic review looking at the effect of fibre and carbohydrate quality on health. It’s a key piece of evidence that will sit behind the carbohydrate review that WHO are working on at the moment. “It shows that high-fibre intakes are associated with lower risk of most chronic diseases. That’s useful, because people have been quite anticarbohydrates, but you don’t get fibre in anything other than carbohydrates. So carbs aren’t that bad for you, if it’s high-fibre, wholegrain stuff.”

However, the word “wholegrain” is tricky. “I’ve got PhD students who are clarifying that we need to pay attention to the structure of the grain in wholegrain foods, not just the composition.” This is to do with how processed it is. “Most food standards around the world define ‘wholegrains’ based on the ‘composition’ of the food. That is, if you call something a wholegrain it’s got to have all the constituent parts of a grain in approximately the same proportions as you’d find in the original grain. But it doesn’t matter if that’s completely powdered or if it’s the actual wholegrain with its original structure. “In the late 1980s, some researchers showed that it looked like the structure was important, but no one repeated that work and it wasn’t adopted into recommendations. Now everyone wants to healthwash their food, so there are all these foods called ‘wholegrain’ that don’t look like they’ve actually got any real whole grains in them.” This is important. For example, “It’s looking like, for people with diabetes or pre-diabetes, it’s particularly important to look for less processed wholegrains. They’re more resistant to digestion, which means they release the glucose slower. “Breadmakers are interested in this research because they’ve seen bread come under threat from the low-carb movement. They’re interested to see how they can make bread healthier. I’m interested in it from a public health point of view because bread is cheap and environmentally sustainable.”

INVEST IN YOUR HEALTH Subscribe for just $28 a year* Diabetes Wellness magazine is the flagship publication of Diabetes New Zealand

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DIABETES WELLNESS | Autumn 2020

Advocate

TYPE 2 MEDICATIONS EXPLAINED In type 2 diabetes, lifestyle change is vital to managing blood sugar levels, but medication is often also needed.

eeping blood sugar levels as close to a normal range as possible dramatically reduces the risk of developing diabetes-related complications. This applies to any form of diabetes. Complications can include nerve damage, potentially leading to lower-limb amputation, vision impairment, kidney damage and kidney failure. Those with type 1 diabetes generally manage their condition with insulin injections. For those with type 2, a range of other medications can help to lower blood glucose. However, when other type 2 medicines don’t work, insulin is used. Insulin carries a risk of hypoglycaemia (low blood sugar), which can be life threatening and has been shown to be a key cause of death in those with type 2. The range of type 2 medications that are funded in New Zealand is slim and has been described as “third world”. Because of this, it’s believed that many people with type 2 end up on insulin often don't need to. This may be set to change, with a recent announcement from Pharmac that they will consider funding more type 2 medications. So what exactly are the different type 2 medications? And how do they work?

DIABETES WELLNESS | Autumn 2020

OLDER MEDICATIONS Metformin

Metformin has been the frontline medication for patients with type 2 diabetes, pre-diabetes and gestational diabetes for many years. It comes in tablets that must be taken with food. Metformin decreases glucose production by the liver and increases the body’s use of glucose. It has been considered safe for most people for a long time, but there is mounting evidence that, for many, it is not the most effective type 2 medication. And a greater risk of hypoglycaemia are among the side effects. Metformin has been funded in New Zealand for some time, as it’s the cheapest type 2 medication available. Sulfonylureas

When metformin alone isn’t helping enough, a sulfonylurea may be added. There are three sulfonylureas available in New Zealand: glipizide, gliclazide and glibenclamide. Glipizide and gliclazide are shorter-acting and are generally preferred. Sulfonylureas are not suitable for everyone. Weight gain is a common side effect. They also carry an extra risk of hypoglycaemia. NEWER MEDICATIONS

In the last 15 years, three new classes of glucose-lowering drugs that act in more complex ways have come through clinical trials, but only one is funded in New Zealand so far.

Two of these classes of medication act on a hormone called GLP-1. GLP-1 is released from your lower small bowel in response to food. It stimulates insulin release, suppresses raised glucagon, slows your stomach emptying and gives you a feeling of being full. DPP-4 inhibitors

Dipeptidyl peptidase 4 (DPP-4) is an enzyme your body makes that stops GLP-1 working. DPP-4 inhibitors reduce this enzyme’s activity so that GLP-1 can work more effectively and for longer in your body. Pharmac began funding one of these medications, Vildagliptin, in October 2018. Benefits of Vildagliptin are that it appears to have no effect on a person’s weight and has a low risk of causing hypoglycaemia when used alone or with metformin. It’s available separately or as a combined tablet with different strengths of metformin. Vildagliptin has been widely used around the world in the last eight to 10 years, especially in Europe and Scandinavia, and so we have a lot of information on its safety within those populations. However, from a clinical perspective, Pharmac's choice of funding a DPP-4 inhibitor rather than an GLP-1 agonist or SGLT2inhibitor is not necessarily the best for our population. The DPP-4 inhibitors don't appear to have the cardiovascular outcome benefits that GLP-1 agonists and SGLT2-inhibitors do. Also, DPP-4 inhibitors are

The range of type 2 medications that are funded in New Zealand is slim and has been described as “third world”. Because of this, it’s believed that many people with type 2 who end up on insulin often don’t need to.

“weight-neutral” whereas the GLP1 agonists and SGLT2-inhibitors are associated with weight loss, so are recommended for patients where weight management is clinically indicated. GLP-1 agonists

GLP-1 agonists are injected under the skin, rather than taken as tablets. These medications mimic the actions of GLP-1 by binding to the GLP-1 receptor just as GLP-1 does, and they are broken down more slowly than GLP-1 because they are more resistant to degradation by the DPP-4 enzyme. This means they are active in the body for longer than GLP-1 hormone that has been produced by the body itself. As well as improving the body’s absorption of glucose, they may lead to a decrease in cardiovascular events, progressive renal dysfunction and other problems. There may be a mild increase in pancreatitis and gall bladder disease from their use, and some people find that nausea is a side effect. GLP-1 agonists are available in New Zealand but are expensive and not funded. Their price puts them out of reach for many people.

SGLT-2 inhibitors

Sodium-glucose co-transporter 2 (SGLT-2) inhibitors (or “flozins”) reduce the reabsorption of glucose from the kidneys and increase the amount of glucose excreted in urine. They often cause a small amount of weight loss, and a small reduction in blood pressure. Studies to date show they also reduce mortality in those with moderate to high cardiovascular risk. Some patients, particularly women, find that SGLT-2 inhibitors increase their risk of thrush and urinary tract infection. While cheaper than GLP-1 agonists, these medications are still too expensive for many and are not funded in New Zealand so far. WHY WE NEED NEW MEDICATIONS FUNDED

A key strength of these new medicines are that they are effective in lowering blood glucose without causing lifethreatening hypoglycaemia (unless combined with another medication that does cause hypoglycaemia). Some have additional benefits such as lowering blood pressure. Importantly, there is no

one-size-fits-all medication for type 2 diabetes. Patients need to be individually assessed for the medication that will be most effective for them with the least side effects. This is only possible if there is a good range of clinically tested, upto-date medications available. Currently, New Zealand lags behind much of the rest of the world in terms of funded type 2 medications. PHARMAC’S ANNOUNCEMENT

In January this year, Pharmac announced that it is seeking proposals from pharmaceutical suppliers for SGLT-2 inhibitors, GLP-1 agonists and DPP-4 inhibitors. Pharmac deputy medical director Dr Peter Murray said the agency hopes “to fund at least one of these medicines by negotiating with medicine suppliers and running a competitive pricing process”. He said, “Pharmac will consider all the proposals they receive and assess them against their Factors for Consideration.” Diabetes NZ will be watching this process with interest and will continue to push for more than one of these medications to be funded here.

DIABETES WELLNESS | Autumn 2020

Community

DAVE’S RACE

Dave Balderstone

An annual mountain biking race commemorates much-loved rider Dave Balderstone and his devastating death from type 1 diabetes.

ave Balderstone would be 30 now. His friends and family remember him as a generous, humble, hard-working young man with a passion for downhill mountain biking. Even today, his mother Claire Balderstone and his friend Matt Clarke struggle to comprehend how his death, nine years ago, could have happened. Dave was 12 when he was diagnosed with type 1. At the time, the Balderstones knew of no-one else in the family with the condition, but, almost two years later, his younger brother Phillip was diagnosed at the same age. Living with his family in Nelson, then Whakatāne, Dave’s diabetes was well managed. After he finished school, he moved to Christchurch and found a dream job at an aeronautical engineering firm. Outside of work, he focused on downhill mountain biking. The downhill club Gravity Canterbury was a centre for much of this activity, and Dave made many friends there, including Matt. Claire says, “They’d push their bikes all the way up, just to ride

DIABETES WELLNESS | Autumn 2020

down. They were massively fit – those are heavy bikes.” Dave was a skilled rider, and, in 2010, he went to Europe to race in the UCI World Cup Downhill and ISX races in Europe, although an injury cut his trip short. His family in Whakatāne kept up with all his news, and he seemed happy. What they didn’t know was that, after moving to Christchurch, Dave had begun to hide his type 1 diabetes. He’d stopped wearing his medical bracelet and didn’t keep his insulin in the fridge where his flatmates would see it. Matt says Dave had a cooler bag that he carried everywhere. No-one saw inside it. Matt now realises he carried his diabetes gear in it, which he used in private. When an incident suggested to Matt that Dave might have diabetes, he quizzed Dave, and Dave brushed it off. Matt, like Dave’s other friends, knew next to nothing about the condition then. He could see it was something Dave didn’t want to talk about and left it alone. Claire says, “All we can put it down to is that Dave felt pressure to be like everyone else. I guess he just

wanted to live a normal life. I’d ask him if he’d told his friends about his diabetes, and he’d answer, ‘Yeah, yeah.’ Little did I know that was his way of not saying no, but also not saying yes.” Dave involved himself with every part of the downhill community, and Claire recalls, “He loved digging, loved creating tracks as much as riding.” Matt says, “He always worked so hard in the background for races to happen. He did a lot of track maintenance and work with the rangers. He built tracks that people wouldn't know about. He probably had more passion than any of us. He wanted tracks that were challenging, and he loved seeing other people ride them, but he never looked for praise or gratitude.” In the Canterbury earthquakes, two of Christchurch’s most challenging downhill tracks were destroyed, so Dave started work on another. Matt says, “A few of us were friends through racing and lived in the same flat. We’d help with the track a bit, but Dave went up there and worked on it anyway.

He was a pretty independent person.” The track was named Tilted Sally. “It was close to where we lived and on one of the steepest areas of Victoria Park. It’s very tricky. You go roaring down through pine trees and jump across a road, 20 or 30 feet.” A LOSS FELT BY MANY

A SOUGHT-AFTER PRIZE

Dave’s highly difficult track Tilted Sally was renamed Flowrider – Dave’s own riding nickname. His workmates made the race trophy: a titanium turboprop from a jet engine, mounted in thousandyear-old swamp kauri. His boss donated $1,000 in prize money. Now, every year, between September and November, Gravity Canterbury runs the DH Summer Series, and Dave’s Race is its final race. This year will be the race’s 10th anniversary. Claire has attended every year but one. She says, “It’s a great honour that they do it for him.” Matt says, “He loved racing so much, and he would want people to keep racing.”

Dave’s friends still talk about him. Matt thinks that Dave “didn't want people to think he was weak or had a problem”. He adds, “I think men in general can be reserved about telling anyone about medical problems. It stems from stigma of weakness.” He wishes things had been different. “Even if Dave could’ve just told me and Sam, and asked us not to tell anyone. I understand how embarrassed he was. But it's only embarrassing for that five minutes when you tell people. People shouldn't be ashamed.” He wonders whether the longer the secrecy went on, the harder it got to tell anyone. He believes Dave’s death could have been prevented if shame around the condition wasn’t so prevalent. Likewise, Dave’s mother Claire says his death should never have happened and wants to make sure young people talk to their friends about diabetes. While it may go against much of the advice to allow young people to find their own way, she urges parents to be sure their teenagers who have left home have told people about their condition and are able to reach out when necessary. “Don’t presume anything. They can be at that vulnerable age when they don’t want to be different.”

PHOTO: SIMON WILLIAMS AUTHENTICAS.ORG

In March 2011, Dave, Matt and their friend Sam went to the Hokitika Wild Foods Festival. They ate and drank a lot, and, after they returned, Dave became sick. Matt checked on Dave that night and woke him to give him water. In the morning, he checked again and saw Dave still seemed to be sleeping. He wishes now that he’d tried to rouse him, but he did what most people would have: figured that sleep was what his hungover friend needed most. He turned out the light and pulled Dave’s door closed for him. Dave didn’t wake. His passing, with very high blood sugars, marked the beginning of a bewildering and harrowing period for everyone who cared about him. Claire had been planning a trip to Christchurch to visit Dave and believes, at that point, she would have discovered he hadn’t told anyone about his diabetes. “It was

tragically too late,” she says. At Dave's funeral, tributes flowed from family, friends, workmates and the downhill community. “He was so good at mountain biking,” says Matt. “A lot of people looked up to him, even people he didn't know.” There was a strong will to memorialise him, and his friends came up with the idea of an annual race on the track he built almost single-handedly. Dave’s Race was born.

Left: David riding with the race number he always liked to have. Centre: Rupert Chapman (one of Dave’s riding friends), Nils Heiniger (2019 trophy winner), Dave’s mother Claire Balderstone and Joseph Nation (another of Dave’s riding friends). Right: The Flowrider trophy.

DIABETES WELLNESS | Autumn 2020

Nourish

BEATING INFLAMMATION

WITH FOOD More and more research links ill health to chronic, low-grade inflammation in our bodies. The good news? Diet is a powerful way to combat this.

n anti-inflammatory diet is really a commonsense diet. Processed foods and refined carbohydrates promote inflammation, while anti-inflammatory foods include leafy greens, nuts, olive oil and a range of fruits and vegetables. Anti-inflammatory recipes and meal plans abound on the internet – it’s never been easier to find great ideas for simple, healthy meals. If you prefer cookbooks, a new offering from Australian nutritionist Chrissy Freer could fit the bill: The Anti-Inflammatory Cookbook. The simple vegetarian recipes below offer a taster of what’s inside.

CHICKPEA, LEMON AND SILVERBEET SOUP VEGAN | SERVES 4 PREPARATION TIME: 20 MINUTES COOKING TIME: 30 MINUTES

Chickpeas make this soup extremely filling and nutritious. It’s substantial enough to serve as a main meal. 1 tbsp extra virgin olive oil 1 large onion, finely chopped 1 fennel bulb, finely chopped 2 celery stalks, diced 3 garlic cloves, crushed 1 tsp finely grated lemon zest ½ tsp dried chilli flakes 4 vine-ripened tomatoes, diced 2 x 400g (14oz) cans chickpeas, drained and rinsed (see tips) 1 litre (4 cups) homemade or salt-reduced gluten-free vegetable stock 100g (3½oz) trimmed and shredded silverbeet (Swiss chard) leaves (see tips) Lemon juice, to taste Heat the olive oil in a large saucepan over medium heat. Add the onion, fennel and celery and cook, stirring, for 6–7 minutes or until softened. Add the garlic, lemon zest and chilli flakes and cook, stirring, for 1 minute or until fragrant. Add the tomatoes and cook, stirring, for 2–3 minutes.

DIABETES WELLNESS | Autumn 2020

Add the chickpeas and stock and bring to the boil. Reduce the heat to low and simmer for 15 minutes. Stir in the silverbeet and simmer for 2 minutes or until wilted. Season to taste with lemon juice and freshly ground black pepper. TIPS

You can replace the canned chickpeas with 450g (22⁄3 cups) cooked chickpeas. You’ll need about half a bunch of silverbeet for this recipe. This soup is suitable to freeze. Place it in airtight containers, cool completely, cover and freeze for up to two months. NUTRITION PER SERVE: 891kJ (213kcal) PROTEIN: 10g, FAT: 6.3g, SATURATED FAT: 0.8g, CARBOHYDRATE: 23.6g, SUGAR 5.8g, SODIUM 420mg

SPICED LENTILS AND RICE WITH SPINACH AND CARAMELISED ONIONS VEGETARIAN | SERVES 4 PREPARATION TIME: 15 MINUTES COOKING TIME: 30 MINUTES

This version of the traditional Lebanese dish called mujadara contains the winning combo of wholegrain brown rice and lentils, which together make a complete protein. It’s delicious as a vegetarian main course or served with grilled fish. 170g (¾ cup) brown lentils, rinsed 150g (¾ cup) brown rice 2 tbsp extra virgin olive oil 3 red onions, thinly sliced 2 garlic cloves, crushed 1 teaspoon ground cumin 1 teaspoon ground coriander 150g (5½oz) English spinach, coarsely chopped Lemon juice, to taste Natural yoghurt, to serve Cook the lentils and rice in a large saucepan of boiling water for 25 minutes or until just tender. Drain well. Meanwhile, heat 1 tablespoon of the oil in a large non-stick frying pan over low heat. Add the onions and cook, stirring

occasionally, for 15–20 minutes or until golden and caramelised. Heat the remaining oil in a large saucepan over medium heat. Add the garlic and spices and cook, stirring, for 1 minute or until fragrant. Add half the caramelised onion and cook for 1 minute. Add the rice and lentils and stir to heat through. Stir in the spinach and add lemon juice to taste. Serve the lentils and rice topped with the remaining caramelised onions and a dollop of yoghurt. NUTRITION PER SERVE: 1300kJ (310kcal) PROTEIN: 13.3g, FAT: 8.7g, SATURATED FAT: 1.4g, CARBOHYDRATE: 39.8g, SUGAR 8.0g, SODIUM 60mg

WIN A BOOK Diabetes NZ is giving away three copies of The Anti-Inflammatory Cookbook (RRP $39.99). To go in the draw, email your name, phone number and postal address to: draw@diabetes.co.nz with COOKBOOK in the subject line. Or post to: Freepost Diabetes NZ, PO Box 12-441, Wellington 6144. Competition closes on 31 March 2020. The Anti-Inflammatory Cookbook by Chrissy Freer, photography by Julie Renouf. Published by Murdoch Books, RRP $39.99

DIABETES WELLNESS | Autumn 2020

Community

Success secrets of a support group For three decades, Sue Pearson has put her all into supporting New Zealanders who live with diabetes – and her North Shore diabetes daytime support group is the longest continuously running support group in the country. Sue Pearson with her mum Joan Gross (95 years young). Sue feels fortunate to have a husband, daughter and mum who've always supported her while she supports others.

n 1984, Sue Pearson and her husband Murray had been travelling and were enjoying a new life in England. Then type 1 diabetes turned things upside down. “My flatmates and I were going on a diet together,” says Sue, “and I was losing weight fantastically.” At first, everyone was impressed, but, by the time she’d lost half her body weight, they were deeply concerned. One day, Sue’s eyesight went blurry, and her boss insisted she see a doctor. “The doctor looked at me and said, ‘You’ve got diabetes.’ I said, ‘How do you know?’ He said ‘I can smell your breath.’ There was that acetoney kind of smell, and I suppose doctors are astute to these things. I arrived at the hospital, and my blood sugar was 36.” She and Murray made the decision to return to New Zealand in 1989. They had a young daughter by then, and they settled on Auckland’s North Shore. Soon after, wanting something new to do, Sue “walked into Diabetes Auckland and asked, ‘Is there something I could do to help?’”

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It was the beginning of a lifetime of work that would see her serve as General Manager of Diabetes Auckland from 1993 to 1999, on the Council (now the Board) of Diabetes Auckland for 23 years, and for a time as Vice-President and Acting President of Diabetes New Zealand. She organised youth camps and wrote resources. In 1997, she attended the International Diabetes Federation Congress in Helsinki. There, she gave a speech on how diabetes management needed to be more patient centred. It caused ripples at the time: “The attitude in those days was that health professionals, particularly endocrinologists, would dictate what you had to do, rather than having a discussion with you. It was like, ‘you do this, this, and this, and if you don’t then it’s your fault.’ I felt very strongly that people needed more information and to take ownership of their own diabetes.” That was the focus of her support group work, along with providing professional speakers and therefore reliable diabetes education and discussion.

NORTH SHORE SUPPORT

Diabetes Auckland had asked Sue if she would run a support group almost as soon as she began volunteering for them. “I said, ‘well I’ve never been to a support group. I wouldn’t have a clue what to do.’ But a lovely lady called Audrey was fabulous and helped a lot. And I got a good relationship going with North Shore Hospital so they’d provide me with speakers.” Support group work became a passion for Sue. “We started with 17 people in the group, meeting at Mayfield Hall in Glenfield. Soon we didn’t fit in one room there, so speakers had to talk to half the group in one room, then go and talk to the other half in the other room.” When numbers grew further, the group moved to Takapuna War Memorial Hall. “At our busiest, we had up to 80 people attending and 163 on our phone list.” As well as regular meetings, they arranged diabetes expos, information days and social outings including mystery bus trips, walking groups and picnics. Notably, they were the first

support group in the country to provide a sharps disposal service – something Sue had pushed for. They won an award for this. These days, the group is smaller again and meets at Takapuna Library. Sue puts the decrease down to the wide availability of support on the internet. Nonetheless, for some people, nothing matches in-person contact, and an impressive array of experts continues to speak to the group: endocrinologists, eye specialists, nurses, dietitians, podiatrists, PHO representatives and more. “To inspire us all, we also have people who have had diabetes for a long time and others who are willing to share their stories. Then we have ‘sharing and caring’ sessions where people just talk about their diabetes, ask questions, share ideas and have a few laughs.” Meeting topics are set in advance, and Sue makes sure she always has plenty of information to take along, boning up beforehand so she can help answer people’s questions and, if necessary, counter any misinformation. In those cases, she tactfully directs people to a reliable website or document – often from Diabetes NZ. GROUP DYNAMICS

The North Shore group is for people with any type of diabetes, or pre-diabetes. “It’s mostly type 2s and some type 1s,” says Sue. Sometimes, supportive partners also attend. “It’s a very friendly group. They really care about each other.” Yes, she says, type 1 and type 2 diabetes are different, “but I don’t think we have to be segregated”. She believes there’s plenty that those with type 1 and type 2 can offer each other. Positivity and understanding may be one secret to her group’s long life, along with Sue’s unfailing energy.

“My philosophy has always been that we never criticise people. We’re there to share ideas. Our motto is ‘education is the key to diabetes management’, with the proviso that it must be in a language and manner that you understand. One size doesn’t fit all.” She adds, “Blame is one thing I try to protect our members from.” She believes it’s counterproductive. “I always say, if you go off track with your management, just remember tomorrow is another day. I try and encourage people, because sometimes people feel like they’re a failure.”

“Blame is one thing I try to protect our members from ... I always say, if you go off track with your management, just remember tomorrow is another day. I try and encourage people." Inclusion is also important. “For me, it takes quite a bit of work and understanding group dynamics and reading the audience to make sure that everybody’s included. For example, at a presentation, you have to be scanning the audience to check if somebody looks confused.” When this happens, Sue will offer to talk things through with them afterwards. And, at meetings, “you can often see when people come in the door whether they’re down or up, or whether they’ve got a problem. If they look like they do, I make a beeline to talk to them. I want to make it a positive session for everyone.” The people in her support group are frequently on her mind. She gets pleasure from knowing someone is feeling better after a meeting or that

she’s helped. “And sometimes I go home and worry about somebody because they’ve said something during the session … I might give them a ring later on to say ‘just acknowledging what you said’ or ‘just wondering if you’re okay’.” She reiterates that everyone’s different. “For some people, diabetes is horrendous. Some don’t even tell anyone else they’ve got it. Other people are willing and able to tell everybody and help other people. There’s such a variety of people with different needs, and as a coordinator you have to understand what their needs are.” She’s grateful to have always had wonderful volunteers helping with everything. “When I was general manager of Diabetes Auckland, we had 100 volunteers. And at one stage I had about 25 volunteers just for the support group.” She says the secret to managing a successful volunteer team is to work out what skills each person has. AN APRIL CELEBRATION

As the 30th birthday of the North Shore morning support group approaches, Sue is planning a special celebration. It so happens that they also have a member who, that same month, will celebrate 50 years of living with diabetes: Geraldine Stayte. “Diabetes Auckland are presenting her with a certificate and medal at our April party.” When it comes to support group work, Sue isn’t planning to slow down anytime soon. In fact, in recent years, she’s run a second group in the evenings. “There was definitely a need. I kept getting calls from people saying ‘I can’t come during the day’.” You might say that looking for where the needs are and meeting them is what Sue has been striving to do from day one.

DIABETES WELLNESS | Autumn 2020

Life with T2

Fighting to be fit Sports filled Shantelle Bliss’s childhood and teens. Unexpected illness changed that. This is the start of her diabetes story.

starting doing aerobics classes with my mum when I was four. I loved it – and the leg warmers! I did athletics from eight years old, as well as gym, swimming and jazz dance. When I was 12, living in Wellington, we saw my aunty do the World Triathlon Champs. I knew then that I wanted to do that too, so I entered one of the first Weet-Bix Tryathlon events in 1994. We moved to Auckland, and I was recruited into a triathlon training squad. From there, through high school, I trained five to seven days a week, one to two times a day. Sports was a way of life. At the very end of high school, I made the first qualifying race to go to the World Triathlon Champs. Then everything changed. I was struck down by glandular fever, and my world champs dream ended. For months, I could barely walk without my heart rate going through the roof. I'd already enrolled to do a Bachelor of Sport and Recreation, and, for months, I’d just go to lectures then sleep. In hindsight, I had mild depression. I carried on to do a Master of Health Science and Bachelor of Business. Things looked up, but I wasn’t an athlete anymore, just a typical uni student, studying, working part time, dating my now husband and popping in exercise here and there. I finished uni and worked as a personal trainer for a few years before my husband and I were expecting our first baby. In late

DIABETES WELLNESS | Autumn 2020

pregnancy, I grew unwell. I was induced early with pre-eclampsia, and it was a tough birth. I needed to feel better. During pregnancy, I’d thought a lot about how I’d always wanted to do the New Zealand Ironman, so, after my daughter was born, I said to myself: being a mum and overweight doesn’t mean I can’t achieve this. Within a few weeks of birth, I started training very slowly, constantly interrupted by a crying baby. When she was 11 weeks old, I sat by the Blue Lakes with my wetsuit half down and, while everyone else warmed up for training, I gave bubs a quick feed. I then quickly zipped up and jumped in to start. I felt so slow compared to how I used to be, but I was determined. I breastfed for a year while training, expressing milk before early morning swims and timing training around my daughter. At one point, I injured my foot from bouncing her on it, playing. Not a common Ironman injury! But when you’re pregnant or breastfeeding, the hormone relaxin makes your ligaments more prone to injury. When my girl was 17 months old, I completed the NZ Ironman: 3.8km swim, 180km bike (two flat tyres), and a 42.2km run/walk/wobble to the finish line in 16 hours and 14 minutes. It was physically and mentally tough, but harder battles were coming. It was during my second pregnancy that I presented positive for gestational diabetes. I got the results after the routine

glucose test. I was shocked, sad and angry, as well as worried about my baby. Unfortunately, I also felt embarrassed. I know now that nobody should feel embarrassed about this. We think now that I had later-onset gestational diabetes during my first pregnancy, too, but there was no testing for it in late pregnancy. After the initial shock of diagnosis, I worked hard to eat healthier and monitor my carbs and snacking. I tested my blood sugars and exercised in small but frequent amounts. If I tested high, I did some walking – just around the house if I couldn’t get out – or I did some squats or exercises to get me puffing a bit. I knew that helped draw sugar out of the blood to the working muscles. Before my diagnosis, my midwife had suspected I was heading into depression, but this settled with all my new activity and healthy habits. Depression would catch up with me, though, as would pre-diabetes, and a surprise diagnosis of type 1 in the family. Part two of Shantelle’s story will appear in our winter issue.

Move

EXERCISE AND PREGNANCY Our fitness consultant Craig Wise has some commonsense advice.

xercising during pregnancy keeps you fit and strong, which is especially helpful during late pregnancy and birth. It also helps with sleep, energy levels and the not-so-fun things that can come with pregnancy, such as constipation and haemorrhoids. With good cardio exercise comes greater circulatory flow – helpful in avoiding varicose veins. Pregnancy is one of life’s great miracles, and the body’s ability to carry on almost as normal is a greater miracle still. As a general rule, any activity you were doing regularly before becoming pregnant is probably fine to continue. There are a couple of provisos. Avoid activities where you’re likely to fall, such as horse-riding. And don’t participate in anything that may expose you to abdominal trauma. (Now is not the time to chase your dream of playing rugby.) Other than that, you just need to use a bit of extra caution: • Don’t exercise to the point of exhaustion. • Don’t overstretch or bounce while stretching. Your ligaments are looser during pregnancy, and injury is more likely.

• Staying hydrated is extra important. Drink plenty of water before, during and after activity, especially during warm weather and during the latter stages of pregnancy, even if this means even more loo stops. • Wear non-constrictive clothing. • Eat enough calories to support your pregnancy as well as your activity requirements. • Don’t spend too much time lying on your back (especially in the second and third trimester). • After floor exercises, get up slowly to prevent dizziness. • Be aware of changes throughout your pregnancy, physically, mentally and hormonally, and adjust your activity to suit. Listen to your body. If something doesn’t feel right when you’re exercising, stop the activity. If you haven’t been active before becoming pregnant, brisk walking is a good place to start. It’s fairly easy on your joints and can be done in short bursts throughout the day. Wear good supportive shoes and choose a relatively flat walk to begin with.

GESTATIONAL DIABETES Between four and eight percent of pregnant women develop gestational diabetes. This is when a woman with no previous diagnosis of diabetes develops high blood glucose during pregnancy. It’s generally screened for at around 20 weeks, although your healthcare professional may request it sooner, especially if you were overweight before pregnancy. Untreated, the higher blood sugar levels can “overfeed” the baby. This leads to a larger baby, which can cause delivery difficulties and has also been linked to premature birth. Along with a healthy diet, getting plenty of activity into your day is an important part of managing gestational diabetes. Even small amounts of exercise can help lower your blood sugar, so it's always worthwhile. Do be aware that very strenuous exercise can, short term, cause blood sugar to increase as the body unlocks stored energy reserves to power through the session. Unfortunately, there are no blanket rules and each person is different. Testing your blood glucose level after activity is the only sure way to check. If you find your blood sugars go up after exercise, look at adjusting either the intensity or the duration, but do keep going. Moderate exercise really helps blood sugars. Gestational diabetes usually goes away after birth, but it can reoccur in future pregnancies and you’re at a higher risk of later developing type 2 diabetes. The upside is that knowing that you have an increased risk of type 2 diabetes means you can take steps to prevent it.

For more information on gestational diabetes, see the Diabetes NZ website: diabetes.org.nz/gestational-diabetes

DIABETES WELLNESS | Autumn 2020

Life with T1

DANCING WITH DIABETES A scholarship from Diabetes NZ Nelson Youth helped Lily Barton realise a dream.

MANAGING DIABETES

elsonite Lily Barton, 12 years old, has been tap-dancing for most of her life. The dance competition circuit has taken her all around New Zealand, but her dreams are international. In 2019, Diabetes NZ Nelson Youth awarded Lily one of its scholarships, enabling her to enter her biggest competition yet and her first overseas – the Follow Your Dreams tap competition in Melbourne. EARLY DEDICATION

Lily was three when she saw someone tap-dancing on TV and knew that it was for her. She was diagnosed with type 1 diabetes at four, but her family didn’t want it to hold her back from anything she wanted to do, and she started tap classes a few months later. Now, she trains with Nicola Price and dances for Tasman Tappers. “I do classes every Wednesday after school for one and a half hours,” says Lily, “and again most Saturdays for one to three hours.” She practices at home five days a week and needs to check her blood sugar often during these times. She has an insulin pump, which she takes off or leaves on for practice “depending on my levels, how long practice is and how I’m feeling on the day”. She performs in shows, and dance exams are also a part of life, but competitions take up the most time. The circuit includes Blenheim, Christchurch, Napier,

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“Type 1 means a lot of extra thinking.” Jess makes sure they get a competition programme early so they can plan in advance when Lily will eat and rest. Westport, Greymouth and Motueka, and every competition has a range of categories. Lily usually enters solo, slow, waltz, speed, impromptu, duo and a team section. “There’s normally around 10 dancers from my dance school that do the same competitions as me,” she says. She and her mother Jess road-trip with another dancing family they’re friends with, staying at holiday parks or Airbnbs, then meeting up with the rest of the team at the competition venue.

Lily says, “When I go to competitions, I don’t wear my pump as I often have quick changes into my next costume. Some competitions I can have eight dances in a day, which means eight costume and hair changes. “Every hour, mum tries to clip me into the pump quickly to give me a correction and extra insulin if I need it. I got a Libre in September last year, and it’s made it so much easier to test myself more often and not get blood on my costumes! “Because of when the dances are on, I often need to eat at strange times, which can affect my levels. We work around these as best we can. We always have snacks in my bag, but our go-to while at comps is normally sushi or Subway. “I used to get big high blood sugars when I was nervous backstage before going on. It was hard to get back down and it affects my dancing. Now, I get high because my pump is sometimes off for too long with quick changes. “I don’t dance as well when I’m high as it’s harder to keep smiling and hard to have strong arms or do the moves properly.” Lily’s mother Jess is responsible for behind-the-scenes logistics: “Type 1 means a lot of extra thinking,” says Jess. She makes sure they get a competition programme early so they can plan in advance when Lily will eat and rest, as well as when she’ll need her pump on and off. There are curveballs: “You have to be ready to go on stage early,

Lily with her awards from Melbourne

Lily and her friend Ella Childs, performing their award-winning duo

but sometimes you take the pump off and then the competition is running late, an hour or more, and Lily’s just sitting there with it off. “I always check her blood sugar just before she goes on, and I can stay stage-side as long as necessary. I always have lollies and a bar to help with lows.” And Lily knows that, if she was ever too low to go onstage, everyone would understand. For Jess, offering unwavering emotional support is a given. “When Lily’s low or high, it affects her dancing. If she doesn’t do her best, we know why. The important

thing is to say, ‘Don’t beat yourself up.’” MAKING IT TO MELBOURNE

Lily’s new year began with the excitement of flying to Melbourne to take part in the Australia-New Zealand finals of the Follow Your Dreams competition. She was one of a team of eight from the Tasman Tappers who had been fundraising furiously to get there. The competition ran for six days, from 3 to 9 January. Lily says keeping her blood sugars within range while on stage was her biggest challenge, but she worked

hard at it. She placed in her tap, speed tap, slow tap and waltz tap solos. Her troupe performance took first place, as did her duo performance with her friend Ella Childs. Lily says, “Since dancing our duo together, Ella can tell if I'm high or low. It's so good having a supportive friend who understands I might not always be 100%.” Now that she’s danced in Australia, Lily has set her sights on America. She’s not sure how and when it will happen, but “it would be amazing”.

READER COMPETITION We have 20 full-sized DU’IT DRY FOOT & HEEL ROLL-ON BALMs (RRP $16.99) to give away to 20 lucky readers. The balm is an intensive and fast acting skin repair gel in a convenient, easy to use roll-on for dry to severely dry, cracked skin on heels, feet, knees, knuckles, elbows, anywhere! Visible effects within three days. To be in to win, email draw@diabetes.org.nz with your name and address and put DU’IT ROLL in the subject line. The competition closes on 31 March 2020.

DIABETES WELLNESS | Autumn 2020

Nourish

Dietitian Helen Gibbs says you can make resolutions at any time of year, and she has advice for making them stick.

BEYOND NEW YEAR’S RESOLUTIONS

f you’ve already broken your New Year’s resolutions, you’re not alone. The fact is, most resolutions that people make around food and lifestyle fail. Ask someone why this is the case for them, and they’re likely to say they don’t have willpower. I honestly hate the idea of willpower, because it’s so full of self-blame. We’re surrounded by things that will increase our risk of overeating and inactivity. We simply can’t be “on task” 24/7 trying to change our behaviour. Resolutions can be successful, though. What you need are plans and details behind them. Preparing in advance reduces your risk of returning to old behaviours. This involves thinking through what can be changed, and how, as well as who or what is going to support the change. If we don’t plan our health changes, we’ll almost certainly miss or forget important things. Spending time on planning makes sense.

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A CHALLENGE

You don’t need to wait till the next New Year: try making a new resolution at any time and backing it up with planning. And do start with just one thing. Another reason our resolutions can fail is that we’re trying to change too many things at once. The sheer strangeness of the new behaviours takes up too much brain space. We end up lapsing back into old habits because it’s easier. Here’s a challenge for anyone who wants to try for lifestyle improvement this year. Over the next 12 months, can you think of six to 12 small changes you could make to your eating that would make a big difference long term? By small changes, I mean things like replacing two afternoon tea biscuits with a small serve of nuts. Start with just one of those changes and, to prepare for it, think through these questions:

How important is it for me to focus on this activity right now?

On a scale of zero (not at all) to 10 (extremely important), making this change needs to be at least a 7. If you’re saying 5 or less, be honest. Is there something going on that’s more important? Something that needs to be resolved before you can work on change? For example, I have a client who is in a “holding pattern” because her Dad is in hospice care. For her, change is important but not the most important thing right now. What will successful change involve?

For example, let’s look at that idea of swapping two afternoon tea biscuits for a small serving of nuts. Ask yourself – what leads up to having the biscuits (without blaming willpower)? How do you end up having this routine? What maintains the routine? How would you change it?

Many people have a biscuit or two in the mid-afternoon to deal with the 3pm slump. These are often “workplace biscuits”. To change this habit, you’ll need to provide your own alternative snack.

“I will do without, I don’t need a snack at all.” However, going without is likely to lead to hungry impulse-eating later in the day.

What could prevent me from making change?

Once you have the plan for your change ready to go, check you feel confident that the change is doable. Again, score it. If you can’t score more than 7, then you need to look back at the goal, because it might be too large or too rigid. For many people, making change is difficult because of “black-andwhite thinking”. For example, they say they will never eat biscuits in the afternoon again, not taking into account some situations where this will not work. I always encourage people to think of change in terms of “most of the time” or “more often than now”. This is more likely to cultivate success than “never” or “always”.

It’s important to think about the routines and rituals you have or are surrounded by. In many households or workplaces, the afternoon break is part of a routine where someone brings the biscuit tin out. Making a change means you need to talk to the other participants in the routine. They don’t have to change (although it might also be good for them). But, ideally, they won’t sabotage your change in any way. Think also about your resources and your own mindset. In the case of substituting nuts for biscuits, you’ll need the money available to pay for the nuts, as well as the willingness to spend that money on them. This can be the hardest part of the picture for people who are used to always looking after others. Often it is unconscious sabotage:

Now that I’ve thought it through, is it doable?

How will I measure my progress?

Humans are notorious for not seeing our successes. Try simple things like making a note in your

diary or using an app to track progress towards your goal. This will allow you to see when your change goes from being something you have to think about to a habit. And remember, this could take up to six weeks – hence the idea of taking time over the year to make six to 12 changes, one by one. How will I celebrate this change?

Many people think of celebrations in terms of food rewards. Unlike many dietitians, I don’t rule out food rewards, but I encourage people to think of other ways of expressing this positive change. Even letting someone know you’ve made a change – and hearing that they are genuinely pleased for you – can be a bigger reward than you might expect. READY?

I’ve focused on swapping afternoon snacks as an example, but the questions above can apply to any change you’d like to make. Are you ready to give it a go?

EAT WELL LIVE WELL

Diabetes-friendly meals everyone will love Eat Well Live Well is chock-full of diabetes-friendly recipes from well-known Kiwi chefs. Each dish is quick and easy to prepare and great for the whole family. Head to www.diabetes.org.nz for your copy – $33.00 including delivery – or purchase it directly from your local Diabetes NZ branch, Whitcoulls, PaperPlus and The Warehouse. All profits go towards supporting Diabetes NZ’s work.

DIABETES WELLNESS | Autumn 2020

Last word

TYPE 2 DIABETES: CALL FOR PARTICIPANTS Every day, new medications and new technologies to improve blood sugar control and weight loss are being designed. However, before these can be approved for use in the general public, they must be extensively studied.

ptimal Clinical Trials is a private research centre in Grafton, Auckland, dedicated to conducting quality research and ensuring that study volunteers have a rewarding experience. Optimal offers patients with diabetes the opportunity to become involved in medical research trials. Volunteers who participate have found numerous benefits. As well as learning about and trying cutting-edge diabetes management options, there is

significant opportunity to learn more about their own diabetes management and to help with providing management options for society at large. For New Zealand participants it can also be a chance to receive medications that are currently used elsewhere but are not funded here. Leading the diabetes studies is Principal Investigator Dr Janet Titchener. Janet is an Americantrained family physician with a sub-specialisation in diabetes. She is board certified in advanced diabetes management, a member of the American Academy of Family Physicians and a Fellow of the Royal New Zealand College of General Practitioners. With over 10 years of clinical trial experience and numerous publications to her name, Janet is passionate about providing better treatment options for people with diabetes. All Optimal studies are approved by Medsafe and the New Zealand Ethics Committee.

Dr Janet Titchener

WHO IS OPTIMAL LOOKING FOR?

Currently, Optimal seeks patients with type 2 diabetes who are overweight and on Metformin to be considered for research opportunities. However, there are always new diabetes studies on the horizon. Please register your interest at www.optimalclinicaltrials.com/ participant-form#!/study/45 or call the friendly team on 0800 RESEARCH (0800 73 73 27).

WHAT’S IT LIKE VOLUNTEERING FOR MEDICAL TRIALS? Aucklander Kim Williams has always liked being part of research, but volunteering for clinical trials is special.

hen she saw a call for participants from Optimal Clinical Trials, she knew she wanted to do it to “feel like I was also doing some good.” Kim was diagnosed with type 2 diabetes over six years ago. Since signing up with Optimal, she’s taken part in two studies where she tested new diabetes medications.

DIABETES WELLNESS | Autumn 2020

Each was several months long, and one was international. Kim says she enjoyed the sense of being part of worldwide research. Recently, she wanted to sign up for a third trial, “but I’d changed medications and didn’t fit the criteria. I was so disappointed.” However, she says there will be more chances in future. The main relationships she has formed are with the research team there who “make you feel like royalty. They look after you every step of the way. You do also meet and chat with other volunteers. You bump into each other in passing in the waiting room.”

She says that during trials you visit the clinic regularly, often weekly, and the team talks with you and runs tests. Kim is an administrator for a small insurance broker. “I usually opt for early morning appointments, but I’m really lucky that my boss is flexible.” Her GP has also been supportive of her involvement. “All results from tests go through to her. And they check with her first about anything they need to. “I recommend volunteering. There are some really good medications if they make it out to the market.”

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Diabetes Wellness Autumn 2020

Articles inside

Beyond New Year's resolutions

FROM SUGARS TO GRAINS: PUSHING FOOD INDUSTRY CHANGE

LANCE O’SULLIVAN: PREVENTION AND PRECISION