Diabetes Wellness Autumn 2022 by Diabetes New Zealand

wellness DIABETES

AUTUMN 2022 $8.00 INC. GST

DIABETES NEW ZEALAND | DIABETES.ORG.NZ

OUR RESILIENT GLOBAL COMMUNITY • PLUS-SIZE SPORTSWEAR • FOOD FORAGING FOR HEALTH DIABETES YOUTH LEADERS • TRULICITY ARRIVES IN NZ • DIABETES ACTION MONTH

SUMMER CAMPS SUPPORTING OUR TAMARIKI

SPOTLIGHT ON KIDNEY HEALTH

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A painless 1-second scan of the FreeStyle Libre sensor makes checking your glucose easier. » Easy to use and apply. » Sensor is small, hardly noticeable2. » No finger prick calibration. Ever. » Sensor is comfortable to wear for up to 14 days. » Water resistant so you can swim, shower, or exercise3.

FIND OUT MORE |

» Mobile capability. Get real-time glucose readings on your smartphone4. » Share glucose readings on the go. Wirelessly share reports with healthcare professionals and anyone you like.

FreeStyleLibre.co.nz

Why prick, when you can scan?* The FreeStyle Libre Flash Glucose Monitoring System is indicated for measuring interstitial fluid glucose levels in people (aged 4 and older) with insulin-dependent diabetes. The indication for children (age 4 - 17) is limited to those who are supervised by a caregiver who is at least 18 years of age. Always read the instructions for use. The sensor must be removed prior to Magnetic Resonance Imaging (MRI). *Scanning the sensor to obtain glucose values does not require lancets. A finger prick test using a blood glucose meter is required during times of rapidly changing glucose levels when interstitial fluid glucose levels may not accurately reflect blood glucose levels or if hypoglycaemia or impending hypoglycaemia is reported by the System or when symptoms do not match the System readings. | 1. Leelarathna L, Wilmot EG. Diabet Med 2018; 35(4): 472–82. | 2. In a study conducted by Abbott Diabetes Care, 91% of patients surveyed (n=123) agree that the sensor was easy to wear due to its small size | 3. Sensor is water-resistant in up to 1 metre (3 feet) of water. Do not immerse longer than 30 minutes | 4. The FreeStyle LibreLink app is compatible with NFC-enabled smartphones running Android OS 8.0 or later and with iPhone 7 and later running iOS 13.6 and later.

POLY 14613 (NZ)

FreeStyle, Libre, and related brand marks are marks of Abbott. Information contained herein is for distribution outside of the USA only. For more information call Customer Service on 0800 106 100. Medi’Ray New Zealand, 53-55 Paul Matthews Road, Albany, Auckland 0632 www.mediray.co.nz NZBN 9429041039915 ADC-42166 v1.0

Contents AUTUMN 2022 VOLUME 34 | NO 1

4 EDITORIAL 5 YOUR DNZ: Diabetes NZ news

COVER: JAYLEN-BLAZE AT OTAGO SUMMER CAMP © BRENDAN WARD

6 UPFRONT: Diabetes Youth – unstoppable!

28 DIABETES YOUTH: Laura Snowden: Aotearoa's new international rep

8 YOUR DNZ: Diabetes Action Month – Step up for diabetes

29 NOURISH: Finding wild fresh food in your neighbourhood

12 COMMUNITY: Ringing in 2022: global stories

32 IN MEMORIAM: Wiki Mulholland

17 CARE: World Kidney Day: Kidney health for all

33 IN MEMORIAM: John Revel Kelly

34 COMMUNITY: Professor Sir Jim Mann: A fighter for the diabetes community 36 CARE: New medication for type 2 diabetes 38 LAST WORD: Golf's longest day

18 CARE: Champions for kidney health 21 DIABETES YOUTH: Live Brave Mana Ora launch

22 LIFE WITH T2: Faapito's labour of love 26 MOVE: Beach walking for your health

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DIABETES WELLNESS | Autumn 2022

Editorial

s Covid-19 continues to make its impact felt in this country and worldwide, Diabetes NZ is still here for your needs. We are continuing to deliver our services, while also putting all-important measures in place to protect our staff and volunteers. An exciting development that we’d like to update you on is our Diabetes Community Co-ordinators initiative. A year of activity and work in building these partnerships has seen us increase our community reach in Taranaki, Hawke’s Bay, Waikato, and Te Tai Tokerau (Northland), with plans to grow this to other regions as funding allows. In this issue, we warmly welcome our new Community Co-ordinators. At the same time, Diabetes NZ chief executive Heather Verry has been working on the Ministry of Health’s Diabetes Action Plan (DAP) as part of its expert group. The DAP has been influenced by the 2021 report The Economic and Social Cost of Type 2 Diabetes, which our organisation commissioned in partnership with other health-related agencies. The DAP is, sadly, an overdue strategy to combat the rise of diabetes and its impacts in Aotearoa, and we are very pleased that the current government has seen the need to focus on a coordinated approach. Diabetes NZ is also providing secretariat support and project management to develop diabetes teams throughout New Zealand as part of the health reforms being rolled out. Fighting for continuous glucose monitors to be available and affordable to those who need them continues to be a high priority for Diabetes NZ. Our current social media campaign is being well supported by the diabetes community and will hopefully influence Pharmac to allocate the necessary funding. This magazine is all about celebrating our strength and compassion. There is a feature on how people living with diabetes around the globe and in Aotearoa have shown resilience during the Covid-19 pandemic. We also profile a number of locals who are going the extra mile for the diabetes community. Lastly, we congratulate Professor Sir Jim Mann on his recent knighthood. He has been a major advocate for people with diabetes for decades and supported The Economic and Social Cost of Type 2 Diabetes study as part of the Expert Advisory Group. As he himself says, his knighthood is a recognition that diabetes is an important issue that none of us can ignore. As the Covid-19 pandemic continues, we urge all our readers and members to be cautious and aware and to take all practicable steps to keep themselves safe. We will get through this. CATHERINE TAYLOR

Board Chair, Diabetes NZ

DIABETES WELLNESS | Autumn 2022

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 us today at www.diabetes.org.nz

DIABETES NEW ZEALAND 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 12441, Wellington 6144 Telephone 04 499 7145 Freephone 0800 342 238 Email info@diabetes.org.nz Web diabetes.org.nz Facebook facebook.com/diabetesnz Instagram instagram.com/diabetes_nz

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

ADVERTISING & SPONSORSHIP Business Development Manager Jo Chapman Email jo@diabetes.org.nz Telephone 021 852 054 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

The campaign for access to continuous glucose monitors Diabetes NZ continues to campaign for continuous glucose monitors (CGMs) to be funded for all. This year, we are building on the momentum started in our 2019 petition to Parliament and continued in our submission to the Health Committee hearing. Having exhausted the ‘official’ channels, we’re developing an ongoing strategy to raise visibility and support across New Zealand.

Diabetes Community Coordinators | Hauora Kaimahi already making a difference In 2020, Diabetes NZ partnered with Pinnacle Midlands Health Network to create a new Diabetes Community Coordinator role in Taranaki. Matire Ropiha-Stewart, with a passion for helping empower those with diabetes in her community, stepped into the role and has taken it from strength to strength. With the worth of the initiative proven, two more Diabetes Community Coordinator | Hauora Kaimahi roles and a Manawaroa Kaiārahi have been created.

In March 2022, we launch a new social media campaign – #NoMoreFingerpricks – that people living with diabetes all around the country will be able to join in with, to raise awareness of the lifechanging difference CGMs can make to those with type 1 diabetes. Get involved! Save your test strips and follow us on social media to join the push for #CGMForAll www.facebook.com/diabetesnz instagram.com/diabetes_nz

Diabetes NZ welcomes: • Lee Page-Dean in Waikato (in partnership with Pinnacle Midlands Health Network) • Kylee Stok in Hawke’s Bay (in partnership with Health Hawkes Bay), and • Tahi Tait, Manawaroa Kaiārahi, in Northland (in partnership with Heart Foundation, Arthritis New Zealand, and Mahitahi Hauora). In subsequent issues of Diabetes Wellness, we’ll be introducing each of our Hauora Kaimahi to readers and talking about the exciting work they’re doing in their communities.

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DIABETES

Diabetes Wellness magazine is the flagship publication of Diabetes New Zealand

Upfront

DIABETES YOUTH UNSTOPPABLE! Over the past two years, Diabetes NZ branches around the country have grappled determinedly with the impacts of Covid-19 on our summer youth camps. On top of all the usual hard work of organising, extra work has gone into precautions, new solutions to issues have been found, and a few tough calls have had to be made. Our camps carry on thanks to the countless voluntary hours many people put in for our diabetes youth.

DIABETES WELLNESS | Autumn 2022

DIABETES OTAGO SUMMER CAMP 18–21 JANUARY

At the Otago summer camp (for 8 to 12 year olds), new Covid protocols were built in. Any parents or siblings visiting the camp had to be fully vaccinated, and they had to QR code sign in when entering camp. For an extra layer of safety and security, the Southern DHB diabetes team, who partner with Diabetes NZ Otago to run the camps, had to make the hard decision to only invite kids from Otago instead of opening the camp up to other health board areas. SHOWING APPRECIATION

Diabetes NZ Otago is grateful to Jenny Rayns (diabetes nurse specialist) and Ruth Thomson (Professional Lead, Dietetics), who have been involved with their youth camps for over 20 years. When the pair received Diabetes NZ Awards in 2021, they were also gifted a photo album from camps over the years and a book containing memories and words of thanks from parents and children. Dr Ben Wheeler and Sharon Sandilands (diabetes nurse specialist) were also acknowledged for their contributions to the summer and winter camps.

DIABETES YOUTH WAIKATO SUMMER CAMP 26–28 JANUARY

Covid-19 presented challenges for the Waikato camp, but the organisers were determined to overcome them. For a start, they had to urgently find a new venue that would operate with vaccine passes, ensuring all staff at the venue were vaccinated. All campers over 12 also had to be vaccinated, and staff, volunteers, and teenage mentors had to return a negative Covid test before camp. Lots of outside activities were planned, and the campers even enjoyed outdoor dining. And when it came to drop-off and pick-up, the organisers requested that only one caregiver attend, to reduce crowding at these points. Organiser Joanna McClintock says that, when news came that Aotearoa was going into Red, just the night before camp, ‘we were so pleased we’d taken extra steps to keep all safe and that camp could go ahead with lots of fun’. Visit Diabetes NZ's youth page. It's packed with information for young people living with diabetes and their families, plus resources for healthcare professionals, schools, and childcare centres. www.diabetes.org.nz/diabetes-youth

DIABETES WELLNESS | Autumn 2022

Your DNZ

Big journeys start with small steps Iti takahanga nui haerenga Focus on foot health diabetes

action month November 2021 saw people across Aotearoa putting their best foot forward to support the quarter of a million New Zealanders living with diabetes. The theme for Diabetes Action Month 2021 was Step Up for Diabetes. Together with our sponsors, supporters, and partners, Diabetes NZ focused on encouraging New Zealanders with diabetes, and their whānau, to focus on the vital foundations of our body: our feet. People living with diabetes have an increased risk of serious foot problems that, with some extra love and care, can be prevented. We also had cause for celebration in November, as the world marked a significant milestone – 100 years of insulin therapy. For many in our diabetes community, this treatment is life-saving. Diabetes NZ is grateful to everyone who helped make Diabetes Action Month 2021 a hugely successful campaign, raising awareness and funds to help our diabetes whānau live well.

DIABETES WELLNESS | Autumn 2022

Last year, The Economic and Social Cost of Type 2 Diabetes report found that type 2 diabetes has reached epidemic proportions in New Zealand, with diabetes forecast to rise dramatically over the next 20 years. The report also contained promising news, finding that a preventative approach to footcare could prevent over 600 diabetes-related amputations in Aotearoa every year. Our chief executive Heather Verry says these statistics were the driving force behind a campaign focused on foot health. ‘There has never been a more important time to Step Up for Diabetes. For people with diabetes, steps as simple as regular foot checks and wearing the right shoes can have huge results, with the potential to save lives and limbs.’ The campaign aimed to empower our diabetes community to look after their feet through education. It was great to see Diabetes Action Month – and information about the importance of foot health – featured on 1 News, The AM Show, RNZ, and Newstalk ZB. We also ran an interactive Facebook Live session with two expert podiatrists and produced a health literacy video taking people with diabetes on a journey to better understand how to look after their feet. If you missed these, head to the Diabetes NZ Facebook page to see them. www.facebook.com/diabetesnz

Local events COVID-19 alert levels unfortunately meant in-person events couldn’t go ahead in Waikato and Auckland. Instead, people in these regions took part in Diabetes Action Month virtually – joining in with Sneaker Friday from home and wearing blue for diabetes on 14 November. Meanwhile, other Diabetes NZ branches around the country held wonderful community events. Highlights included: • The Otago branch hosted workshops throughout the month, including a podiatry education evening for the public and GP nurses, a blind low-vision workshop, and an education workshop with Deaf Aotearoa. • Diabetes NZ Nelson held a youth and teen event for those from Nelson, Tasman, and Marlborough. Teens played laser tag, and other families went to Natureland Zoo. • Tauranga, Eastern Bay of Plenty, Rotorua, and Taupō banded together to host a youth and teen picnic for families, followed by luging for the teens at Rotorua Skyline and the 3D Trick Art Gallery for younger kids and families. • Diabetes NZ Eastern Bay of Plenty, Tauranga, Rotorua, and Taupō held diabetes technology webinars every Thursday in November. • Do Blue Days were held at schools and community centres around the country.

Awards

Diabetes NZ branches hosted events in November to honour those in their local communities. 1. Otago Awards night: From left – Ruth Thompson, Sharon Sandilands, Ben Wheeler, and Jenny Rayns. 2. Mervyn Wilson – DNZ Award for services to diabetes. 3. Neill Stockdill – Sir Charles Burns Award for being on insulin for over 60 years, pictured with his wife Dawne. 4. William Robertson – John McLaren Youth Award, pictured with Diabetes NZ chief executive Heather Verry, and June Wright, Southland Field Officer. 5. Tauranga Awards, from left, with years on insulin in brackets: Donald Hyland (51), Gordon Fenwick Haszard (53), Warwick Coles (42), David Allan (42), Noel Blennerhassett (26), Valerie Blennerhassett (33), Peter Macrae (46), Brian Pointon, Renée Ross, Lena Fendley, pictured with Diabetes NZ volunteers Brian Pointon and Renee Ross, and Tauranga Branch Coordinator Lena Fendley.

DIABETES WELLNESS | Autumn 2022

100 YEARS OF INSULIN This year marked 100 years since the discovery of insulin, which was celebrated across the globe on 14 November – World Diabetes Day. New Zealand is proud to be home to the world’s longest living person with type 1 diabetes on insulin, 93-year-old Winsome Johnson.

Back, from left – Hon Peeni Henare, Russ Finnerty (Sir Charles Burns winner), Jarod Summers, Scott Mancer (Silver Medal winner), Dr Rex Faulknor (Sir Charles Burns winner). Front, from left – Eva Shackel (received a certificate & Fitbit for fundraising for DNZ), Diabetes NZ chief executive Heather Verry, Bernadette Barry (Silver Medal winner), David Town (Silver Medal winner), Brooke Marsters (John McLaren Youth Award winner for excellence in academia).

Diabetes NZ hosted a special event for to mark this milestone, with Hon Peeni Henare, Associate Minister for Health with responsibility for diabetes, in attendance. The Wellington celebration included an awards ceremony for a select group of Kiwis whose lives have been made possible by insulin therapy. Two attendees received the prestigious Sir Charles Burns Award to mark living on insulin for 50 years or more, and four recipients earned Silver Medal awards to honour 25 years on this life-saving medication. It was also great to see many of you tune into our World Diabetes Day Facebook Live session. We were honoured to be joined by special guests, including Kiwi pop duo Vince and Abby Harder, who shared their journey, having a two-year-old daughter with type 1 diabetes who owes her life to insulin.

NGĀ MIHI A huge thank you to everyone who stepped up this Diabetes Action Month. Whether you tuned in to Facebook Live, shared the foot health video, attended an event, purchased Mr Vintage merchandise, or donated to Sneaker Friday, we couldn’t have done it without you. We are so pleased to announce that the first ever Sneaker Friday event – along with the Do Blue Days and the Fitbit Step Up 250k Challenge – raised more than $23,000 to help fight New Zealand’s largest and fastest growing health crisis. Lockdown conditions didn’t stop Kiwis from stepping up for diabetes by wearing their sneakers at their home office, school, supermarket, or local park on 19 November. The AM Show’s Amanda Gillies joined in by wearing her glittery sneakers on set. Thanks to the generosity and support of Kiwis who donated to take part in Sneaker Friday, Diabetes NZ can continue to make a real difference to the lives of millions of New Zealanders living with diabetes. We’re looking forward to Sneaker Friday in 2022.

DIABETES WELLNESS | Autumn 2022

For those who felt empowered to take steps to better care for your feet or encourage a loved one with diabetes to do so, we commend you. Ngā mihi nui. PROUDLY SUPPORTED BY

A D V E R T I S I N G F E AT U R E

Kidney health with diabetes By Jane Cronin - Clinicians Naturopath

When living with diabetes, managing kidney wellness should be a high priority. There is a strong connection between diabetes and kidney disease, as latest New Zealand statistics show 48% of new kidney patients have diabetes.

What is it about diabetes that affects the kidneys? High levels of sugar in the blood can affect our blood vessels. In the kidneys there are many small blood vessels that can get blocked, narrowed or damaged; especially when you consider the kidneys filter 1000mL of blood per minute. High blood pressure can also increase this force, adding another risk factor to kidney damage. Diabetes can also affect the bladder nerves, which let us know when the bladder is full. Delayed urination can add pressure affecting the kidneys. Also, there is an increased propensity to bladder infections which, if unmanaged, can spread to the kidneys.

How can we tell if our kidneys are being affected? Unfortunately, symptoms of kidney impairment do not occur until a very late stage. Some of the early signs of kidney damage include loss of appetite, weight loss, headaches, fatigue, nausea and itching. However, by this stage it’s possible to lose up to 90% of kidney function, which cannot be restored. This makes having regular kidney tests important. Tests include a blood pressure, blood tests for eGFR (kidney filtering rate) and urine tests checking for albumin protein, which indicates the kidneys are not filtering correctly. Early detection through testing is essential for maintaining kidney health.

What can we do to take care of our kidneys? Many risk factors for heart disease are the same as those for developing kidney issues. For example, high blood pressure, being overweight, lack of exercise, smoking, alcohol and poor diet. Also a family history of kidney disease or previous kidney issues increase risk. Dietary adjustments could include reducing junk or processed foods as they can be high in sodium, which affects blood pressure and kidneys. They are often high in refined sugars too. Regular water is important to avoid dehydration, which is bad for the kidneys, and limit dehydrating substances like alcohol and caffeine. Also, the Ministry of Health suggest caution with pain medications such as non-steroidal anti-inflammatories like ibuprofen or diclofenac.

What other nutritional care can we take for our kidneys? When people have been diagnosed with compromised kidney function, they will be given some guidelines of what they should be eating to try and maintain the best possible kidney health. This may mean certain food groups can be limited, which could affect vitamin and mineral balance. Also, at a later stage those on dialysis may also find certain nutrients are affected by the processes, especially water-soluble vitamins. However, there needs to be a degree of caution when looking at supplementing with vitamins and minerals, when kidney function is not optimal. General multivitamin complexes contain a range of vitamins and minerals, some of which may not be suitable for those who need additional care for their kidneys. Make sure you speak with a health care practitioner before taking supplements that are for general use and not specifically designed to support those with renal issues.

Clinicians Renal Vit Renal Vit is a multivitamin and mineral supplement, specifically designed for people where renal function is not optimal. It includes all the nutrients needed to support daily wellness and excludes nutrients that are harmful to those with chronic kidney disease. It is funded by Pharmac for Grade 5 Chronic Kidney Disease, but is available for purchase from pharmacies for all other stages or general impaired kidney function.

Always read the label. Use as directed. If symptoms persist, see your healthcare professional. Dietary Supplements are not a replacement for a balanced diet. Douglas Pharmaceuticals, Auckland TAPS MR6432

Community

Katie Doyle talks with people in the diabetes community from around the world and finds out what we’ve overcome globally as we look ahead to 2022.

RINGING IN

2022 Global stories of reflection, resilience, and resolution 12

DIABETES WELLNESS | Autumn 2022

The past two years, dominated by Covid-19, have been challenging for people living with diabetes. We’ve navigated heightened heath fears along with economic uncertainty, travel restrictions, isolation, and more. A new year brings an opportunity to revitalise ourselves to build up our mental and physical stamina to take on whatever complex or joyous adventures life presents next.

EBENEZER SILVA TYPE 2 DIABETES SWEDEN

Ebenezer Silva (Ebbe to his friends) is a family counsellor in Västerås, Sweden. He was devastated when he learned he had type 2 diabetes and immediately started researching more about it. He took up cycling as a strategy for managing his blood sugar levels as well as his mental health. Later, he founded XL Biking, an inclusive online cycling community that wants an end to fatshaming in the cycling world. ‘I realised diabetes was manageable and that I was about to start living a “possible life” as opposed to my “impossible life” as an overworked, overweight, and sedentary person,’ Ebbe says. Along with his wife and daughter, Ebbe has worked to stay educated about the virus while observing how Sweden and the rest of the world is dealing with it. ‘Sweden's approach is, to us, the “minimal” requirement,’ he says. ‘We have found a sum of different approaches beneficial so far, including getting vaccinated and wearing a mask, and none of us has got the virus yet.’ He adds that ‘staying active in the winter when we have so few hours of sunlight here in Sweden is fundamental to physical and mental health. Last year, I had the chance to cross a frozen lake by bike and visited a little island there. I love doing winter cycling!’ This winter, Ebbe is looking forward to inspiring other people with type 2 to join the XL Biking community and enjoy the many benefits he experiences on his journey towards thriving with diabetes. ‘What initially sounded like a death sentence is now key for me living a better life.’ www.instagram.com/xlbiking

DIABETES WELLNESS | Autumn 2022

PEI YAN HENG TYPE 2 DIABETES SINGAPORE

School teachers everywhere have had their everyday routines disrupted. Pei Yan Heng is a teacher in Singapore who has been living with type 2 diabetes for 25 years. She has adjusted to cycles of change over the last two years – switching back and forth between in-person lessons and long stretches of home-based learning. Singapore has taken a cautious stance throughout the pandemic. Pei Yan has become more comfortable with the country’s periodic reassessment of regulations, and she feels confident in how health officials have managed public health risks. Almost 90% of the population is now considered fully vaccinated, and public places are now filling up again. Pei Yan says, ‘With the school holidays in place, many of the malls and places are crowded with people – everyone wearing masks. ‘It feels much like normal, but the worry of testing positive for Covid-19 or getting a health risk warning from exposure to a positive case still lingers.’ Another recent change is to the country’s travel policy: ‘What makes many people happy now is the opening of the “vaccinated travel lane” with some countries, so that they can go on a holiday. A few of my friends are now travelling in Germany, France, and Switzerland, but I decided to not travel at the moment.' As activities resume at home in Singapore, she has more outlets for socialising and relieving stress when she’s not teaching. In addition, she received an insulin pump upgrade to a Medtronic 780G system in late December, and she’s enjoying incorporating her smartphone into her diabetes management. It’s part of her focus on staying healthy and hopeful. ‘I’m doing my aikido training regularly for now, and I would love to go back to the sea and scuba dive once more passenger slots open up on leisure dive trips.’

DIABETES WELLNESS | Autumn 2022

HARSHITA SEAL TYPE 1 DIABETES CANADA

Students have shown remarkable resilience during the pandemic. Harshita Seal is a PhD candidate in Experimental Psychology at the University of Ottawa in Ontario, Canada. She’s had type 1 diabetes for more than 15 years, since she was eight years old, and she’s observed the pandemic’s impact on her blood-sugar levels. ‘I was used to going to school and understanding my sugars based on the time of day, but that changed when the pandemic hit,’ Harshita says. ‘It became very unpredictable.’ She has worked through what was, for her, a major obstacle – asking for and accepting help from her community: ‘Sometimes my blood sugars will take me out for a few hours, and it becomes really hard to stay on top of my assignments or cook a meal. I don’t always want to ask for extensions from my professors because it makes me feel like I don’t have a good handle on things, but I’ve learned that it’s okay and necessary to ask for what I need.’ On top of the everyday stress of managing her diabetes while studying, the pressures of isolation and restrictions piled up during lockdown. Harshita felt suffocated when her parents, friends, and boyfriend worried excessively about her coming down with Covid-19. However, establishing agency over her daily routine and empowering herself to make decisions helped her build up her self-esteem. ‘It was nice to feel the love from my family and friends, but I felt, in a sense, I was losing my independence,’ she says. ‘Despite this, I tried to do things for myself like going out for breakfast every morning and sitting at the park by my house. I learned a lot about myself because there was so much time for self-discovery.’ Harshita is bringing her new perspectives into the months ahead. ‘I’m looking forward to working on my thesis and learning my way around my research lab at school. My New Year’s resolutions are to continue to improve my routine so I’m on top of all my things and to find something that I can do just for my enjoyment. I’d really like to find a class or a hobby that fulfills me.’

JESSICA PEKMEZOVIC MODY-2 DIABETES PARENT USA NATÁN PEREIRA GUTIÉRREZ TYPE 1 DIABETES BOLIVIA

Communities around the world have applauded the herculean response of essential workers. Natán Pereira Gutiérrez is a 29-year-old doctor doing an endocrinology residency at a hospital in Santa Cruz de la Sierra, Bolivia. He has encountered a slew of negative moments but also some unexpected positives. He says, ‘The pandemic has delayed patient consultations, leaving many people unable to go to their appointments for nearly two years. On the other hand, there are people that have been achieving stable control of their diabetes. Personally, exercising at home has been an excellent way for me to improve insulin sensitivity.’ The closure of land borders around land-locked Bolivia made it impossible for some people to travel elsewhere to get their insulin, Natán says. That made making efficient use of existing insulin even more crucial than it was already. Natán has type 1 diabetes, and he grew up in a community where he had access to analogue insulin, but his next-door neighbor couldn’t even afford to buy test strips. This experience informed his decision to go into medicine. He wanted to promote change in healthcare from inside the system. ‘I realised that our health system is missing policies to help people thrive with diabetes. From the position I’m in right now, I think I can help solve these real problems – from our lack of resources to buy insulin, to the lack of diabetes education and information available.’ Natán is optimistic that things will improve in the new year. ‘Health is the most important priority. For me, stable blood glucose values are hard to maintain with the lack of good rest, prolonged fasts, and stress that come with being a doctor, but day by day I keep trying to improve. My continued motivation is having a supportive family who understands my effort and sacrifice.’

‘I honestly never gave much thought to diabetes before,’ says Jessica Pekmezovic. ‘Now I’m acutely aware that, especially when a child is diagnosed, it really is a full family effort.’ Jessica’s family was introduced to the diabetes community when her then four-year-old son, Augusten, fell ill in November 2020. Jessica lives in New York City, and she says that, at that time, ‘the streets of Manhattan were truly like a ghost town. NYC was hit hard by Covid-19.’ When Augusten started wheezing and having trouble breathing, Jessica took him to the hospital, thinking he might have the virus. Doctors ruled it out, but Augusten’s blood sugar levels were very high, leading to an initial diagnosis of type 1 diabetes. A few months later, test results revealed he had the genetic mutation that causes MODY-2 diabetes, a rare form of diabetes that is different from either type 1 or type 2. (MODY stands for 'maturity onset diabetes in the young'.) ‘Actually, we’re very thankful to Covid-19 for indirectly getting our son a proper diagnosis as quickly as we did!’ Jessica says. ‘The doctors told us most children aren’t diagnosed with MODY until much later, so this random ER visit was critical.’ Diet plays a big role in how well people with MODY can synthesise glucose, so Jessica completely changed her family’s relationship with food by committing to making home-cooked vegetarian meals from scratch, with spices and whole grains. She started an Instagram account, @mody2meals, to connect with other people who understand what she’s going through and inspire others to create simple, healthy dishes. ‘Living in New York for over 15 years meant that we ordered in and ate out a lot, so this was a wildly new way to approach eating for me,’ Jessica admits. ‘We stopped buying packaged and processed items, and everything is completely homemade these days.’ Now that Broadway is open again, Jessica is embracing New York life again by attending shows like Moulin Rouge – when she isn’t cooking. ‘What we eat truly makes a huge difference in how we feel, with or without a diabetes diagnosis.’ www.instagram.com/mody2meals

DIABETES WELLNESS | Autumn 2022

TIANA TONGI RODNEY ALEX SSEWANYANA TYPE 1 DIABETES UGANDA

In 2019, Rodney Alex Ssewanyana, an accountant in Kampala, Uganda, wrote a blog post for the Africa Diabetes Alliance (ADA) website. In it, he reflected on his loved ones’ encouragement following his type 1 diagnosis in 2017 – after his brother, Lawrence, had already been diagnosed. Beyond his immediate family, Rodney feels lucky to have built an extended network of fellow diabuddies and advocates, especially under the pressure of recent times. ‘During lockdown, I got enough time to learn how my body reacts to insulin, exercise, sleep, stress, mental health, and diet,’ says Rodney. ‘On another note, with the pandemic came job insecurity, followed by pay cuts. A lot of businesses have still not returned to full capacity. This has directly affected my earnings and ability to sustain my living, which I need in order to maintain a proper diet and purchase diabetic supplies.’ But Rodney says, ‘With the help of my diabetes community, I was able to maintain stable mental health regardless of the hardships.’ One of the ways Rodney dealt with these uncertainties was by getting his first dose of the AstraZeneca Covid-19 vaccine in June 2021. ‘The government procured doses first for disadvantaged groups of people,’ Rodney says, ‘people with preexisting conditions, teachers, police, etcetera.’ With the world slowly opening back up, Rodney looks forward to loosening restrictions that will allow him to get back to work and grant him more free time for his outdoor activities like swimming, along with indoor hobbies like creative and graphic design. He can’t wait to welcome more new people into his circle – a bonus of volunteering with the Africa Diabetes Alliance. This diabetes organisation offers peer support, social meetups, diabetes education, and advocacy in Uganda and beyond. Rodney hopes that other people find the community he found when he was first diagnosed, because sometimes that makes all the difference. africadiabetesalliance.blogspot.com

DIABETES WELLNESS | Autumn 2022

TYPE 2 DIABETES AOTEAROA NEW ZEALAND

‘Pregnancy and diabetes were a whole new ball game!’ says Tiana Tongi. Here in Aotearoa, Tiana spent most of 2021 juggling type 2 diabetes, pregnancy, and birth, all set against the background of the pandemic. As if that weren't enough to keep her busy, she also celebrated her one-year anniversary with her husband and opened a wall-decor art business while working as a full-time photographer in Hamilton. Despite feeling defeated at the outset of her type 2 diagnosis in 2019, 27-year-old Tiana has balanced medication, insulin, and carb counting while also managing other chronic conditions. Pregnancy brought new challenges: countless trips to the antenatal clinic, clinicians inexperienced with diabetes, and hospitalisation due to pre-eclampsia. ‘It was hard adjusting to the new insulin ratios each week,’ Tiana says. ‘And when I was in the hospital, some midwives didn’t know how to treat diabetes so I just had to manage as best as I could.’ During the birth, her partner and relatives were banned from the delivery room due to Covid restrictions, and she suffered a low-blood sugar event during labour that led to an emergency Caesarean. Tiana overcame all these obstacles and gave birth to a happy, growing baby girl – Soña. She says being a new parent is exhausting, but she’s taking things one step at a time. By reaching out to her community to help her when she needs it, asking for advice to get through tough moments, and delighting in each smile from baby Soña, Tiana is moving forward each day. Now that many Covid restrictions have been lifted in New Zealand, she’s hoping her photography business will pick up again as she looks toward her family’s future. ‘More than anything, I just want to be healthy and have a healthy baby and family. Our New Year’s resolution is to save for a house and grow our businesses as we continue to work towards financial independence.’ Here’s to maintaining our relationships, our selfcare routines, and our health in 2022.

Care

WORLD KIDNEY DAY 2022 KIDNEY HEALTH FOR ALL 10 March is World Kidney Day – a global campaign to raise awareness about kidney health. ‘Kidney health for all’ is this year’s theme.

idney disease is a real concern for those with diabetes. Diabetes NZ is amplifying the messages of World Kidney Day and of two organisations doing vital work in this area: the Kidney Society and Kidney Health NZ. Our kidneys are amazing. Shaped like two very large beans, one on either side of the spine, these organs work hard to keep our bodies healthy and functioning. For a start, they’re a filter, removing wastes and extra fluid from the body. They filter nearly 200 litres of blood every day to make a litre or two of urine. They send signals to your body to regulate its blood pressure – telling it when pressure needs to be increased or decreased. They also release a hormone (erythropoietin) that tells your body to make those all-important red blood cells that carry oxygen around your body and give you energy. As well as all that, your kidneys help balance the acid

WHAT TO ASK YOUR GP OR HEALTH CARE PROVIDER

levels in your body, activate vitamin D, and balance minerals in your body that you need for healthy bones. CARING FOR KIDNEYS WHEN WE HAVE DIABETES

The most important things to remember are: • Keeping your blood glucose, blood pressure, and blood lipids (fats) in a healthy range will reduce the risk of developing kidney problems. Levels of these in your blood should be tested at least annually. • The screening test for early kidney disease is done on your urine and is called the microalbuminuria test. It tests for levels of albumin in your urine. If there’s a high amount, it means your kidneys are leaking albumin – a sign they’re beginning to be damaged. You should also have this test at least annually. • If kidney problems are picked up early, there are treatments available that will delay their progress.

Currently, a once-yearly diabetes review is free for all people in New Zealand with diabetes. This involves the tests that check your blood sugar levels, your blood pressure, and your blood lipids. It also includes the microalbuminuria urine test to check kidney function. Ask for your GP to make sure you’re told when your review is due each year. One easy way to remember when to get it done is to have it scheduled for the month of your birthday. If you’ve had diabetes for a very long time, you may need reviews more often than once a year. Ask your GP or health care provider about how often you should have them if you’re not sure. For more information on diabetic kidney disease, see www.diabetes. org.nz/complication-kidney.

World Kidney Day is celebrated each year on the second Thursday of March. Events often take place throughout the whole month. World Kidney Day www.worldkidneyday.org Kidney Health NZ www.kidney.health.nz Kidney Society www.kidneysociety.co.nz

DIABETES WELLNESS | Autumn 2022

Community

Meet Tracey Drinkwater from the Kidney Society and Michael Campbell from Kidney Health NZ. They share why they’re so committed to fighting for kidney health in their communities.

Champions for kidney health TRACEY DRINKWATER, AUCKLAND DISTRICT KIDNEY SOCIETY

or a small organisation, the Auckland District Kidney Society makes a big impact. Tracey Drinkwater runs their wellness programme – the only one of its kind in Australasia. Tracey says, ‘This is an amazing job. You can make such a difference in people's lives.’ The organisation is just over 30 years old. ‘It was started by our CEO who just retired – Nora van Der Schrieck. Her husband had chronic end-stage kidney disease for 25 years and was on dialysis. She realised there was a lack of support for people.’ The Auckland-based group has extended its reach as much as it's able to with their current funding. ‘We support people from Gisborne to the top of the North Island. We're a very small team, especially at the moment, as we’re down a couple of staff. ‘There's myself, who does the wellness programme, and there’s Brian Murphy, who is our health educator. He's an ex-renal nurse. And then we normally have a social worker that does the emotional support. We work alongside nine district health boards. ‘We have over 3000 clients registered with us, and a large majority do get referred when they’re what we call “pre-dialysis”, or when they have around 20% kidney function left. They get referred to us at that stage for extra support

DIABETES WELLNESS | Autumn 2022

because we run educational workshops in the community for people prior to dialysis, or prior to transplant, to give them the information and education they need to make a decision on their treatment options. ‘We even get clients that come to us at 25% kidney function, though, and with the right information and a bit of empowerment, they can sometimes stay incredibly stable and avoid dialysis – depending on their age obviously. ‘One of the clients was saying to me that he wishes that he'd had our service at the beginning because he doesn't feel he would have actually got to the dialysis stage. ‘Like all health conditions, there’s not enough education prior. It's not until you have a condition that you suddenly have to do a crash course.’ BESPOKE PROGRAMMES

Tracey emphasises that ‘we don't just have a generic programme. Every client has an individual programme tailored to their needs, their treatments, their goals. ‘The whole idea is to educate the client so they can manage the condition themselves. It’s about making sure that the programme is giving them the tools to be able to look after their own health. And we’re able to sit down with the entire family.’ They’re not under any time constraints like GPs are. ‘We’re like medical interpreters.’ Tracey and her colleagues will take all the time needed to go through information that a client has been given and

The small, friendly team at the Kidney Society: (left to right) Maria, Jenny, Gina, Brian, Tracey, and John.

make it more accessible. Tracey says it’s common for clients to come out of GP appointments not understanding what they’ve been told. ‘I call it “medical mind blank”. You've got all these questions in your head, and then you hop into the office, and you're in front of the specialists, and they're talking, and everything's just overwhelming, and then you leave and you gasp and think, “I didn't ask this, I didn't ask that.”’ A lot of her clients have told her that when they were first diagnosed there was too much written information. ‘They felt quite overwhelmed by being given all these brochures. They said visual aids and conversations are what has actually given them better health literacy.’ Tracey is a huge fan of the videos that Kidney Health NZ has put on its website, in a range of languages, and she encourages everyone to look at them.

‘If I got the funding magic wand, every GP office would have a bigscreen TV where it would just be on one big rotation of fun, interesting, informative videos on diabetes, heart disease, and so on, that's explaining and teaching. I hate to think of the millions of dollars we all spend every year on flyers and pamphlets and brochures and glossy stuff … You wonder how many of those end up in the trash?’ The Auckland District Kidney Society also manages three dialysis houses for people who want or need to do their own dialysis treatment outside of the hospital system. Tracey says, ‘Research has shown that people who do their own treatment have much better health outcomes. With the hospital system, you can only do, say, four to five hours treatment, three times a week, and that's the bare minimum someone needs to have any kind of health benefits. With home dialysis

or private treatment, doing your own treatment, you can do up to eight hours. You can do it every day. You can do it four times a week. Whatever your body needs, you can do it, and you can do it to fit in around your job, your family, your events. So on a psychological and emotional level as well, you've got a lot more control. ‘There are always people that are going to need the hospital-based dialysis system, but home is best.’ A PERSONAL TRAINING BACKGROUND

Tracey got into personal training after suffering postnatal depression. ‘My partner got me a 12-week personal training programme, and I couldn't believe how much better I felt.’ She was inspired to become a personal trainer herself. ‘I started off working with corporate groups, and I was doing some work in one of the

gyms, and a client said to me that they had Parkinson's and diabetes, and they’d recently had a stroke. All the other trainers were like, “No, that's too hard.” And I was like, “Ooh, least he's not going to ask me how to get a six pack and a tight bum.”’ She enjoyed the challenge of working with this client. ‘I had no real knowledge of health conditions, so I had to go back and keep doing more and more courses, and, like anyone, I find it’s the clients that teach you the most. ‘From there, I started working with Green Prescription, including doing cardiac rehab working with groups of people who have diabetes. It’s exciting. It's never boring.’ And the satisfaction is huge. ‘I've got clients who’ve had chronic kidney conditions for nearly 40 years, and they live a great life. It's different and it's not easy, but they do, they live a really good life.’

DO YOU HAVE DIABETIC MACULAR OEDEMA OR RETINAL VEIN OCCLUSION?

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Christchurch 8013

Marie Taylor Phone: 03 355 6397 Email: marie@southerneye.co.nz

MICHAEL CAMPBELL, KIDNEY HEALTH NZ

idney Health New Zealand (KHNZ) general manager Michael Campbell believes the government needs to step up and do more for those with kidney disease. Last year, KHNZ commissioned and released a major report into New Zealand’s transplant numbers. Michael says the findings were a shock. The report showed that 3700 Kiwis received dialysis treatment in 2020, each at an average cost of $115,000 per annum. That demand is forecast to rise dramatically in the next 10 years. Kidney transplants are actually a better option for many patients who are currently looking at dialysis. A transplant can give a better quality of life and also cost a lot less. Michael says, ‘A transplant can mean that person gets to have a family, to see their grandkids, to go to graduations, all those sorts of things.’ ENCOURAGING KIDNEY DONORS

Over 460 New Zealanders are currently waiting for kidney transplants, but Michael says it’s estimated up to 1000 would benefit from the procedure. New Zealand’s three renal transplant units carried out only 221 kidney transplants in 2019. Those rates are well below those

DIABETES WELLNESS | Autumn 2022

of many other countries. ‘Those countries have successfully increased transplant donation rates through funding of promotion and education initiatives. The goal should be easily achievable,’ says Michael. He and his team are pushing for the government to implement the National Deceased Organ Donation Strategy that it signed off in 2017 and to overturn what he calls ‘decades of underinvestment, treatment inequity, and fragmented service delivery’. Michael says, ‘Another way of looking at the figures is that, if a thousand people walked into various hospitals throughout New Zealand, and said “I'll give a kidney”, then we've solved the problem. But, in the interim, we’re doing about a fifth of what we should be doing, and we know that the government can increase it.’ Infrastructure is needed to get the operations happening, but the number of donors also needs to increase. There are live donors, but also, Michael says, ‘We don’t know how many we might be losing in ICUs because there isn’t the resource to say to family members, “Here's an opportunity, in really tragic circumstances, to help other people.” And we know that, if it’s done well, a lot of people will say yes.’ When it comes to live transplants, the information to encourage donors is not getting out there. ‘The data says that, if you do a live transplant, the donor will have no different health outcomes than anybody in the general population.’ Michael says that there are simple strategies that can be implemented to encourage and enable more people to be donors. He and his team recognise, also, that kidney donors need support after the operation, and they’ve set up a closed Facebook group. ‘You

have to be a donor in order to get into the group – there's about 110 people in it at the moment.’ It’s a group where they can discuss everything from the mental and emotional side of kidney donation, to the kinds of clinical follow up they should be getting, to staying fit and healthy in the same way everyone should. In fact, this is just one of a number of support groups that KHNZ has been setting up for those with various forms of kidney disease and the people around them. Testing for kidney disease is another thing that Michael says needs to increase, and KHNZ takes its testing programme on the road and to events whenever it can. INSIDE UNDERSTANDING

Michael is a strong advocate for people who are on dialysis to be employed in conditions that meet their health needs. Whenever possible, KHNZ employs people from within the kidney community. Michael’s own story is that his son was born with kidney disease and was able to be operated on as a small child. He’s now 22, and his kidneys are fine. When the opportunity came up for Michael to take on the general manager position at KHNZ, it was his existing knowledge of the vital importance of kidney health, along with his background in education, that persuaded him to take it on. ‘I’d run other educational organisations, but this … I thought this is very valuable work and it's important work that needs to be done.’

MULTI-LANGUAGE VIDEOS ABOUT KIDNEY HEALTH

Kidney Health NZ has made a series of accessible videos – in Māori, English, Samoan, Tongan, Tuvaluan, and Mandarin. To find them go to www. kidney.health.nz. Click on ‘For Patients’ for a drop-down menu.

Diabetes Youth

LIVE BRAVE MANA ORA

Colouring and creative writing competition Diabetes NZ is proud to present our rebranded youth programme: Live Brave Mana Ora. COLOURING-IN COMPETITION

t Diabetes NZ, we recognise every day that children and youth with diabetes, and their families, are incredible – overcoming odds every day. The words ‘Live Brave’ and ‘Mana Ora’ celebrate their resilience and encourage them to live with courage. Live Brave Mana Ora will be used for all our youth activities and events. As part of this new brand, we have developed a character who will be part of our logo and who we hope our tamariki and rangatahi will embrace as their own. Nights are often the hardest for our youth and their families, so we’ve chosen a ruru, who is also awake at night. Like owls around the world, the ruru represents wisdom, prudence, guardianship, awareness, and protection – all traits that we want our youth with diabetes to feel when they think of our ruru.

Open to everyone 15 and under You will have seen, tucked into this issue, a colouring-in picture of a camping scene. We would love to see what you do with this! Get colouring and send us your entry. There are four age categories: 0–5 years, 6–9 years, 10–12 years, and 13–15 years. We have four amazing prizes, one for the winner in each category: • A Fitbit Ace 3 and a Fitbit Inspire 2, donated by our champion sponsor Fitbit NZ • Two Instax Mini 11 instant cameras, donated by MediRay. See the entry details at the end of this article. WRITING COMPETITION

Open to everyone aged 16–24 We’d love to read your creative stories about our ruru: • Give them a personality, and tell us their life story – do they have goals and dreams? What challenges do they overcome? • Do they have a family? Who are their friends? • Have they travelled to far-off lands? The winner of this competition will receive a mystery prize pack and have their story published in the winter edition of Diabetes Wellness. See the entry details at the end of this article. E-NEWSLETTER

We’re also taking this opportunity to launch our brand-new quarterly youth e-newsletter. It will be full of content specifically designed for young people with diabetes, as well

as updates on what’s been going on and what’s coming up in our regions. Our newsletter doesn’t have a name – we’re leaving that to you. Get your thinking caps on, and send your suggestions to youth@ diabetes.org.nz. We’ll run a poll to decide the winner, so keep an eye on Facebook and Instagram. ONLINE SUPPORT FOR TAMARIKI AND RANGATAHI LIVING WITH DIABETES

We’re on Facebook. Follow us at facebook.com/livebravemanaora. Sign up for the Live Brave Mana Ora e-newsletter at www.diabetes.org. nz/livebravemanaora HOW TO SUBMIT YOUR COMPETITION ENTRIES

Entries close Friday, 1 April, and winners will be announced on social media and in the winter issue of Diabetes Wellness. Email your entry to youth@diabetes.org.nz or post to: Marsha Mackie Diabetes NZ Level 10, 15 Murphy Street, Wellington 6011

DIABETES WELLNESS | Autumn 2022

Life with T2

LABOUR OF LOVE Self*ish is a new activewear brand that aims to remove barriers to exercising for larger people. We talk to Faapito Jonson-Faapito, owner of Self*ish, about the difference he hopes the brand can make.

aapito Jonson-Faapito says, ‘I know how difficult it is for an obese person to even get the motivation to start workouts. You get all the negative comments about what you should do and what you can't do, and it can be a downer.’ Faapito runs Self*ish with his wife and sister-in-law. Their flagship product is a rash top in large sizing. ‘It's not necessarily just for wearing in water. It's for any type of exercise activity because it's very light and breathable.’ The product is the result of his own experiences. MAKING CHANGE

‘When I got diagnosed with diabetes,’ says Faapito, ‘I really didn't take it too seriously. Then the diabetes rolled on to kidney failure. That's basically when I took my view off myself and focused on the people who’d miss me if I was gone, and the people who needed me. ‘It switched my mindset to make it about them and not about me. When it was about me, I made a lot of excuses not to do the things I needed to, to stay well. But after seeing the tears in my wife's eyes, my children, and also my parents, I realised I had to make a change. Doing swimming was one of those things, and I wanted to do walking in water, because that's what was best for my joints.’

DIABETES WELLNESS | Autumn 2022

My Identity

is proud to create

The pool he attended stopped letting people wear tee shirts in the water – they would only accept rash tops. ‘So my wife bought me a rash top from the warehouse. It lasted all of about four months. ‘One day, I came out of the pool and people were all looking at me. I was thinking, “What?” I only realised in the shower that the rash top had ripped all the way, from neck to navel. ‘I thought, “Okay, I’ll just get a replacement.” Unfortunately, no one sold a size that fitted.’ He finally found one, but it was $170. He decided he would try to get one made for him at a more affordable price – and one that he could guarantee the quality of. He spoke to Tracey Drinkwater from the Kidney Society about it. ‘I told her my frustrations and that I was going to go and source my own rash shirt. She mentioned that I wasn't the only person in that boat, and then she said, “You know, it'd be great if you could work out how to supply other people with it.” ‘I thought, “You know, that's absolutely right.”’

What Faapito had noticed at the pool reinforced the idea. ‘There were a lot of other large people there, like myself. Some were in the pool, but a lot of them were on the sidelines. They were either watching their children swim or waiting for a partner. It dawned on me that maybe they weren’t in here because they couldn’t get the garments to be in here. ‘I just wanted to be able to remove that hurdle for those people who’d made the decision to put the effort in to do something.’ From the start, Self*ish was a business that runs on a strong set of ethics, and Faapito puts this down to his parents’ influence.

$99

NEVER FORGETTING HIS UPBRINGING

Looking back on his childhood, Faapito says, ‘Our beginnings were humble, just like many other lowincome families. Dad was the only one working, and he used to walk to work, 12 to 15 km there and back, because we had no car. And when it came to any overtime he'd take it on.

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DIABETES WELLNESS | Autumn 2022

‘Every now and then, he'd be lucky enough to get a ride back home from someone, or someone arranged to give him a lift, but most days he'd be walking to work until we were able to actually get a car. And nine times out of ten that car was a push start. It had everything wrong with it – barely stuck together with tape! We did what we could with what we had. ‘Mum was pretty much the person that had to organise all the finances so that we'd even have anything to eat. She endured a lot of stress back in those days. A lot of the time, Mum would go without eating just so that we could eat. And any time we needed things for school, she would put aside other essential things just to get that done. ‘My Mum really struggled with the idea of letting us down. Anything she could do for us, she did. And she was a very strongwilled lady. ‘ CELEBRATING TOLOPO FALANAIPUPU FAAPITO

Faapito’s mother, Tolopo Falanaipupu Faapito, had been a champion cricketer when she was younger. It’s Tolopo that Faapito has named this issue’s special edition MyID bracelet after. He says, ‘She's got a few records still and a trophy at home for 308 runs not out. That's an indication of my Mum’s prowess and determination. She also was the main person involved with bringing a lot of our relatives from Samoa. So, even juggling our low income, she had the ability to bring over a few of my other cousins, who we raised and put through school. ‘She was all about service. Mum's dad was a minister, and she comes from a long line of ministers. She was all about service and very strong in the faith, with God.’ Tolopo became ill when Faapito was 15. ‘She had a stroke and lived

DIABETES WELLNESS | Autumn 2022

'It’s about being able to exercise in comfort, and being able to feel dignified in doing what you need to do.’

for 30 more years. She survived three major strokes and many, many smaller strokes, up until last year. I know a lot of people would say this about their mum, but she was probably the strongest woman I’ve known. ‘And, when it came to her illness, I don't think there would be many people who would've had the mental fortitude to handle that for so many years.’ Faapito’s father, Lesa Amataga Faapito, and siblings all helped look after her. ‘We’d had her at home ever since she was first sick. We’d always been told by our medical professionals that she should be in care, but we wanted to take care of Mum ourselves, and we strongly believe that’s the reason she was with us so long. ‘In the last two years, Mum was taken to hospital a few times for various things, and we were told – probably about four or five times – that there was nothing that could be done for her. A lot of the time, doctors asked us to turn off the machines. ‘But we were with Mum every day and we could tell, even though she couldn't speak, whether she was okay or whether something wasn't going right for her. ‘Every time that happened, she would try and fight back, and then we knew she wasn't ready to go. So we would go through the whole

medical politics of all that, and, at the end of the day, they just let us take her home every single time. ‘I think Mum’s final wish towards the end was to pass on at home, with us. Unfortunately, with the last episode, Mum had obviously been battling for 30-plus years, and I think she was just finally tired and ready to go. ‘She’s the biggest hero and inspiration to us, along with my Dad. He never faltered ever, after Mum became sick.’ ETHICS OF THE BUSINESS

Faapito saw his parents embody the ethics of service and of never quitting. ‘It’s basically you give the shirt off your back to help a fellow man. That's what my parents instilled into us, and that's what we try to live by.’ It’s easy to see how his upbringing has influenced Self*ish – a venture that he runs with his wife and sister-in-law. ‘We weren’t so interested in the money side of the business. Money is great, and it does help, don't get me wrong, but this seemed like the opportunity to help somebody else out if they were in my situation. ‘We wanted to provide a solution for large people wanting to get into the pool and exercise.’ They have repeatedly gone the extra mile for customers. ‘It was really crucial for us to explain to

our manufacturers who the shirts were going be for and why it was important to use the size chart that we had sent them, as opposed to the size chart that they were using. It did make the product more expensive to make because it was more fabric, but that was fine. ‘So our sizing isn’t based off standard sizing. It's based off US big size. For example, our 3XL is larger than a standard 3XL.’ They initially approached three potential manufacturers in China. ‘After viewing the garment samples and trying them on myself, we decided on one. Then we trialled it for about two weeks of me going swimming every day, just to see if there was any shrinkage or anything like that. ‘We were happy with it, so we finalised the label for washing the garment and decided on a first order of 500 shirts in total. That was 125 shirts in each size, so that, as time went on, we could fathom which sizes would sell faster.’ They have customers from all

around Aotearoa and sell on Trade Me as well as their own website, providing their reliably-sized garments. Faapito notes that it can be deceiving buying plus size clothes in most shops. ‘They don't actually say where the sizing is from. For example, one of our customers had bought a 6XL from a store, a rare size anyway, and when she tried it on it didn't fit. She sent us a message and asked us whether our 6XLs would fit her. I told her to use our size chart and choose her sizing off that. ‘After looking at the chart, she thought she was probably a 3XL, but she wasn't sure whether that would be correct.’ Faapito suggested she come and see them. ‘I gave her our address and she came on a Sunday. I said, “You can try the 3XL, and if it doesn’t fit, you’re welcome to swap it for something else larger.” She took one look – she didn't even try it on. She just looked at it and went, “No, that's fine. 3XL is perfect.”’

LOOKING AHEAD

Faapito says, ‘We’ve had awesome feedback from all our customers so far. They’re very happy with the sizing, and they're also happy with the quality of the garments. We’re stoked. ‘We’d love to bring in one or two other colours as an option later on, but at this stage we’re just wanting to get out as many shirts as possible for people to start getting into action.’ They may also branch out into other garments in future. ‘Basically, anything that I come across as an obese person, that is a hurdle or a barrier in terms of clothing is somewhere that we want to put our efforts. It’s about being able to exercise in comfort and being able to feel dignified in doing what you need to do.’ Visit Self*ish at: www.Selfishstorenz.com

This summer, make a healthy choice

EAT WELL LIVE WELL

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 your 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 2022

Move

Sand and sea

BEACH WALKS FOR HEALTH On warm days, taking a walk along the beach can sound like exactly what we need and for good reason. Beach walks are good for both our mental and physical health.

DIABETES WELLNESS | Autumn 2022

hile many people go to beaches to lie down and relax, or for swimming and other water sports, any safe beach also makes for a great walk. If you live in Aotearoa, chances are there’s one nearby, and taking advantage of that can help us take care of ourselves. MENTAL HEALTH

In these challenging times, looking after our mental health is more important than ever, and finding ways to reduce stress and anxiety is a boon for our blood sugar levels, as well as our general physical health. Many people already have a sense that spending time by the water is good for mental wellness, and there’s a small but expanding body of scientific research into this. A study conducted in 2020 found that office workers who went on a 20-minute walk by the beach reported significantly better wellbeing and mood after the walk, compared to those who took a walk of the same length in an urban environment.1 It’s also been demonstrated by various studies that, although noise in general is associated with increased stress, the sounds produced by bodies of water, such as ocean waves or the flow of a river, have a calming effect on us – even more so than peaceful silence.2

PHYSICAL HEALTH

The physical benefits of walking are well known, but walking on the beach has some extra advantages that might not be immediately obvious. Because sand is soft and our feet sink into it with each step, walking on sand takes more effort. It burns more calories, as well as strengthening the muscles and tendons in our feet and legs. On the flipside, the softness also makes the walk gentler on our joints and reduces injury risk. In other words, walking on sand means increased resistance but decreased impact, so we get more gain for less pain. A Belgian study has shown that walking on sand takes between 1.6 and 2.5 times more work than walking on a hard surface at the same speed. It also uses between 2.1 and 2.7 times more energy.3 The researchers found that running on sand is more difficult, too, and uses up more energy than running on a hard surface. However, the difference isn’t nearly as much as it is for walking. Running on sand takes only about 1.15 times more work than running on a hard surface and uses 1.6 times more energy. Walking on sand can also improve balance and coordination.

EASING INTO IT

If you’re not in the habit of going on walks, it’s best to do a few walks on harder surfaces in order to train your muscles before taking on the extra challenge of walking on soft sand. That could mean footpaths, but it could also mean on harder sand. The sand nearest the water is generally harder because it’s densely packed. Even for those who do walk regularly, a few minutes on a solid surface to stretch and warm up is a good idea before heading out onto soft sand. In general, getting used to beach walks is best done over several shorter distance journeys, rather than going straight into a longer trek on your first time. STAY SAFE AND COMFORTABLE

As nice as it can be to spend time in the sun, it’s important to look after ourselves when we go beach walking. Choosing a time of day when the sun isn’t too harsh can help protect our skin and eyes from UV radiation, as well as reduce the risks of dehydration. Early mornings and evenings are good – generally before 10am or after 4pm – but for specific advice on the safest times to be in the sun in your town or region, check the SunSmart website at www.sunsmart.org.nz/resources/ sun-protection-alert.

Even outside of high-UV times, it can be good to protect yourself with sunblock, a hat, and sunglasses (preferably wraparound, with a high UV rating). Hydration also remains vital. The combination of warm weather and physical activity causes us to lose water faster than we otherwise would, so make sure you bring enough drinking water along. Try to notice when you’re getting thirsty and be sure to drink water when you do. Dehydration can often be caused by forgetting to listen to the thirst signals our body is giving us. Protecting our feet is important on a beach walk, especially for people with diabetes. Always wear a good pair of shoes, both for the support they provide and to avoid any sort of injury from sharp rocks, glass, or other objects that may be lying in the sand. One more thing to check before you go is the weather forecast and the tides. You don’t want to be caught on a beach walk if the weather turns bad. And, especially if you’ll be walking close to the water, make sure you know whether the tide is coming in or going out.

THERE AND BACK AGAIN

If there’s a breeze, it’s a good idea to walk into the wind for the first half of your walk, so that when you’re tireder, and you turn around to go back, the wind will be behind you. Another aspect of walking on the beach that may not be obvious until you’re doing it is the slope involved. You’ll often find that you end up with one foot higher than the other as you traverse along the shore. This can be tiring and strenuous if it continues on for too long, but it can be mitigated by changing direction. Rather than spending the first half of your time walking one way before turning around and spending the second half walking back, the best strategy can be to try doing a quarter of your walk in one direction, then half your walk in the other direction, going past where you started, then returning there over the final quarter. You can also vary the direction you start in from day to day. Have fun! 1 https://doi.org/10.1016/j.envres.2020.109812 2 https://doi.org/10.1016/j.envres.2020.110169 3 https://doi.org/10.1242/jeb.201.13.2071

DIABETES WELLNESS | Autumn 2022

Diabetes Youth

MEET AOTEAROA’S NEW INTERNATIONAL DIABETES YOUTH REPRESENTATIVE Diabetes NZ is thrilled to announce that Laura Snowden is Aotearoa New Zealand’s 2022–24 representative on the IDF Young Leaders in Diabetes Programme.

fter graduating from Pharmacy Studies at Auckland University last year, 24-year-old Laura Snowden, who has type 1 diabetes, is looking forward to new challenges. With an exciting full-time job as an Intern Pharmacist for Life Pharmacy, as well as her three-year role on the Young Leaders in Diabetes (YLD) Programme, she knows life will be full – but she’s used to that. She says, ‘Throughout study, I’ve spent any free time volunteering, so I’m very open to using my time off for working on the programme.’ A KEEN VOLUNTEER

Laura began volunteering with Diabetes Youth Auckland five years ago – taking on a youth leader role at Auckland’s 2017 summer camp. It was a way of giving back. She spent her childhood in England, where she had enjoyed diabetes programmes and activities since she was eight. She says they were crucial to her own diabetes management and the way she viewed her diagnosis. ‘I was thrilled to meet other children with the same condition, which made the diabetes feel more normal and really supported me to accept the diagnosis.’

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After helping with the 2017 camp, she became a regular volunteer at numerous fundraising and other events for young people with diabetes. At camps, she progressed to become a Group Leader, where she says, ‘I was responsible for a group of 10 children with type 1, leading them through their activities and being a role model and support to them with their diabetes management.’ WHAT IS LEADERSHIP?

Laura was able to develop her leadership skills though participating in the Diabetes Auckland Live Brave Youth Leadership programme. ‘This also involved being part of the Diabetes Youth Auckland Committee, where I’ve been able to help with planning upcoming events and be a voice for young people with diabetes.’ She says, ‘To me, leadership is more than having authority and recognition. It’s about working with people, in a team for them, to develop them to reach their potential. It’s so important to give

others the tools and skills to thrive. Being a leader involves motivating others, showing passion and drive, sharing knowledge, communicating effectively, and being open minded.’ She also took on voluntary leadership roles at university, as a class rep, a UniGuide, and a member of the executive team for a number of clubs. She won a Leadership in Pharmacy Studies Prize in 2020. Laura is excited that she’s going to be bringing everything she’s learnt to the YLD programme. A key part of her role will involve developing and implementing a diabetes-related project alonside Diabetes NZ. ‘I hope to work closely with Diabetes NZ to determine what is important to our community and what is a priority to enhance the lives of those living with diabetes.’ She’s grateful to Diabetes NZ for supporting her nomination to the programme and passionate about the difference the programme is making around the world. What is the the IDF Young Leaders in Diabetes Programme? The International Diabetes Federation initiated the Young Leaders in Diabetes Programme in 2011 ‘to create a voice for young people with diabetes worldwide’. The programme provides youth representatives selected from 65 countries with continuous education throughout a three-year period to empower them and help them become efficient advocates for themselves and others living with diabetes. For more information, see www.idf.org

Nourish

OUT GATHERING Finding fresh, wild food in your neighbourhood Foraging can contribute to your health and wellness, according to Johanna Knox in this edited extract from her book The Forager’s Treasury.

here are so many reasons to gather wild-growing foods – and you may not have to go far. You’ll find edibles in local parks or perhaps in your own backyard (or that of a friend). Wild plants are fresh and full of nutrients. They’re free. They come without packaging. And the exercise and time spent with nature is amazing for health and wellbeing. There are a few important things to remember when you forage: • Make sure you’re absolutely sure you know what you’re gathering and that you’ve identified it correctly. • Harvest from places where the plants are growing lushly and you know it’s not polluted. Don’t harvest near roads, where plants will be covered in exhaust. • Introduce new foods to your diet gradually and one at a time. Listen to your body and stop if anything makes you feel unwell. Here are just a few of the wild plants that grow commonly in Aotearoa these days.

Pūhā | Sow thistles Pūhā plants, or sow thistles, start growing as a rosette of leaves, then send up a strong central stalk with smaller branches coming off it. They tend to grow flowers in small bunches, and they thrive in moist, fertile places with a little shade. Sonchus kirkii is the only pūhā native to Aotearoa, but the others naturalised here very soon after Europeans introduced them. Sonchus kirkii probably grew much more widely before the introduced species took over, but today it’s hard to find compared with the other pūhā. Even within species, the plants can look quite different from one another, with their form depending on their age, their genes, and the growing conditions. In ideal conditions, pūhā grows huge and lush — I’ve met a few plants that were taller than me. However, those that are forced to lead a harder life often have small, sparse leaves with a purplish tinge. USING THEM

Pūhā is a vital part of Māori cuisine. Every above-ground part, including the buds and flowers, can be eaten raw or cooked in a very similar way to dandelions. You can also substitute pūhā for spinach in any recipe. Like spinach, it loses a lot of volume when cooked, so allow for this. The young leaves and stalks are quite bitter. As the plant grows older, the stems fill with more bitter, oozing latex, but the leaves often seem to lose some bitterness. If you’re using older stalks, bruise or crush them as you rinse them to let the latex wash away before cooking them.

WIN A BOOK

Diabetes NZ have three copies of The Forager’s Treasury to give away to Diabetes Wellness readers. To enter the draw, put Book Giveaway in the subject line and email your name, phone number, and postal address to draw@diabetes.org.nz. Or post to: Freepost Diabetes NZ, PO Box 12-441, Wellington 6144. Competition closes Friday, 1 April.

DIABETES WELLNESS | Autumn 2022

Nasturtium Nasturtium (Tropaeolum majus) plants are native to the Americas, from Mexico southwards, and are especially prevalent in the Andes, where they grow up and down mountainsides. Nowadays, they grow in many countries. The leaves, flowers, flowerbuds, and seedpods are all edible and have a delicious mustardy taste. Nasturtium is easy to identify. Its distinctive round green leaves have a radiating star pattern of veins on the upperside and are attached to the stem at the centre of the underside. The trumpetshaped flowers generally have five petals, and most are a vivid orange, although there are also red and yellow varieties. USING IT

All parts of the nasturtium plant are edible – bar the roots. You can cook nasturtium leaves in any dish where you’d use leafy greens, and they have a lovely texture cooked. To preserve their mustardy flavour in its entirety, use them raw in salads and sandwiches. The smallest, tenderest leaves can be used whole. Once they’re larger, slice them into ribbons, or chop them finely. Nasturtium flowers, with their extra-delicate mustard flavour, are bright additions to salads and sandwiches.

Onion weed Onion weed (Allium triquetrum) is a native of Europe and Britain and was brought over by Europeans as a culinary herb. Today, it grows rampantly throughout the country, announcing its presence from a distance with clouds of onion smell. USING THEM

You can eat all parts of onionweed – flowers, leaves, even the underground bulbs. You can use the leaves just like spring onions. The young, tender leaves are best. Chop the stringy larger stems very finely if you’re using them. Onion weed flowers are a decorative addition to any salad or meal, with an oniony taste that’s more delicate than the rest of the plant. Chopped finely, onion weed leaves and flowers can be mixed into a low-fat buttersubstitute or olive oil. This is delicious daubed over vegetables or fish cooked in tin foil. In winter, if you know of a patch of onion weed that’s died back, you can dig up the small bulbs from the soil and pickle them. It’s best to soak them in water first and rub off the papery skins.

Fennel Fennel (Foeniculum vulgare) grows prolifically in waste places, along roadsides, in weedy gardens, and anywhere else it gets a seed-hold. It can grow up to two metres tall. With its crisp, strongly aromatic green stalks, feathery leaves, and bright yellow flowers sending out clouds of aniseedy scent, it’s hard to miss. The fennel roots or bulbs you buy in stores are really the fleshy bases of the stalks from Florence fennel, a variety specially bred for this purpose. In the wild, fennel is much more stalky and leafy. USING IT

Fennel was introduced to this country by Europeans, probably as both a culinary and a medicinal herb. Wild fennel has edible stems, leaves, flowers, and seeds, and the pollen is considered a delicacy. Grainy and yellow, it’s highly flavourful and can be used any time you’d use the finely chopped leaves, bearing in mind that it has a stronger taste. Use the pollen or very finely chopped fronds in sauces or marinades for meat, vegetables, or tofu. If you like, add a little orange zest. Fennel and orange are a classic combination. You can roast, grill, or barbecue wild fennel stalks with other vegetables to serve hot – or to add to a cold roasted vegetable salad. Choose the younger, lighter-coloured, more tender stalks, chop them to appropriate lengths, and cook them for about 10 minutes. You may want to strip away the outer layer of a stalk if it’s a bit stringy. HOW TO GATHER FENNEL POLLEN

Fennel pollen can be gathered in summer by shaking the flowers into a plastic or paper bag. The easiest method is to cut the flowers off the plant first, then place them upside down in the bag with stems sticking out, grip the stems and bag in your fist, and shake. Store the pollen in an airtight bag or container. Keep it in the fridge if you want it to hold its aniseediness for as long as possible.

DIABETES WELLNESS | Autumn 2022

Dandelions New Zealand has two dandelions – tohetaka, the native dandelion (Taraxacum magellanicum), and tawao, the introduced dandelion (Taraxacum officinale), which is now much more common. Dandelion leaves are highly edible, but they can also be bitter, like a bolted lettuce (which they’re related to). The bitterness comes from the milky sap, known as latex. Nutritional experts often say we need more bitter in the modern diet. It’s a taste we’re not used to anymore, as our diets have shifted towards sweet and salty tastes, but bitters are vital aids to digestion. Bitter tastes trigger a set of responses in the body that stimulate and enhance the digestive process, and help the body absorb nutrients. For the best effect, some people recommend you should eat something bitter about 15 minutes before the rest of the meal. You can minimise the bitterness of these plants to reveal their subtle underlying flavours by crushing the leaves and stems under running water as you rinse them, releasing some of the latex.

Alternatively, boil the leaves to release bitterness. If you have ulcers or a reflux condition, avoid eating too many bitters, or at least check with a medical professional first. SPOTTING THEM

Dandelions are notoriously tricky to identify at first, because of the many lookalikes that also grow wild. Dandelions, both the native and introduced species, are distinguishable by their smooth, usually highly toothed leaves, in combination with hollow, smooth, unbranching flower stems. USING THEM

Māori have long used dandelion (first tohetaka and later tawao) – medicinally and as a vegetable Dandelions are extremely nutritious and often described as a wild superfood. You can eat every part of the plant. Dandelion leaves are most tender to eat in spring before the flower comes up. They can be cooked quickly or eaten raw as a bitter salad green. The leaves can be at their most bitter in autumn and winter. They’re still perfectly edible, but you’ll probably want to collect lots of them and boil in water to reduce the bitterness. When selecting dandelion leaves, choose the youngest leaves (the central ones in the rosette) and snip them off with scissors. The new flowers and even the flower buds of dandelions are

edible throughout the year and are most abundant in summer. (Don’t use old dandelion flowers – you’ll get a mouthful of fluff.) To use the flowers as a vegetable, boil, steam, or sauté them. You can also pull the flowers apart and sprinkle the yellow parts into or onto whatever dish you are making. When it comes to the flower buds, you can harvest them in two ways. If you look at the base of a plant that’s flowering or getting ready to, you’ll often find one or two new buds right in the centre of its rosette of leaves – getting ready to rise up on their stalks. These are the ones to pluck. The plumpest, tastiest buds come from the biggest dandelions, which are often the plants in the longest, lushest grass. To eat the flower buds, boil them, steam them, or sauté them for just a few seconds. You can also pickle them. Alternatively, harvest buds after they’ve grown a bit larger and begun to sprout up on their stalks. Cut them so that several centimetres of stalk remain, and steam or boil them, stem and all. Serve them like any other cooked green vegetable, with seasoning or a sauce, or cool them quickly in cold water to serve in a salad. When harvesting buds, be careful not to confuse them with the spent flowers that have closed and are getting ready to turn into dandelion clocks – once again they’re full of fluff.

Edited extract from The Forager’s Treasury: The essential guide to finding and using wild plants in Aotearoa by Johanna Knox. RRP $45.00. Published by Allen & Unwin NZ. Out now.

DIABETES WELLNESS | Autumn 2022

In memoriam

Wiki Mulholland

30 November 1977 – 26 November 2021

arly Friday morning, I got the call that our dear friend was no longer in pain. Driving to her tangi, I took the time to remember Wiki Mulholland. Ko te Wikister Auē! first burst into my life while we were studying at Victoria University of Wellington, in 1996. Her leadership skills and oratory prowess, which had been perfected during her time at Hastings Girls High School and the NZ Youth Parliament, soon saw her voted as Tumuaki of Ngāi Tauira – the Māori Students Association. She also became an executive member of Te Mana Ākonga (the National Māori Tertiary Students’ Association), fighting for the rights of Māori students. I enjoyed her quick-wittedness, great singing voice, and intelligence. Wiki advocated for Indigenous populations, created youth spaces, and strengthened local communities, and this is only the tip of so much she achieved in her time with us. In May 2018, Wiki was diagnosed with metastatic breast cancer – it had spread to her bones and lungs. She quickly learned firsthand the inequity of our health system: the quality of treatment given and received is determined

DIABETES WELLNESS | Autumn 2022

PHOTO: WARWICK SMITH / STUFF

A crusader for health equity and for reforming the country’s health funding agency, Pharmac, Wiki Mulholland is remembered by her friend Matire Ropiha-Stewart. by those with money and those without. An incredibly private person, Wiki took a brave step into the spotlight to show Aotearoa what cancer looks like and how much it costs to have a day with loved ones. Wiki and her whānau lobbied the government to provide funding for more cancer drugs and also to overhaul Pharmac, Aotearoa’s drug buying agency, more generally. Ibrance, one of the cancer drugs they fought for, is now available. But access is still restricted by money. In an interview, Wiki described thinking, ‘It’s over.’ But her husband Malcolm’s words, ‘No-one gets left behind,’ pushed her to continue the fight for equity access to quality treatment and medication. Her whānau had cashed in almost everything, to the verge of being left penniless. Last year, Wiki organised a ‘girls’ retreat’ in Raumati, north of Wellington. In obvious pain, she told me – it’s these moments that count. Arriving at Wiki’s whānau home, I watched one ope (group of people) leaving after saying their farewells to her. The next ope was entering her home. Another ope waited at

her gate. All were following the Covid traffic light system tangi rules so everyone could say goodbye safely. Old Ngāi Tauira friends arrived – we embraced. Remembering our friend, one of her famous phrases was recalled: when saying goodbye to each other, Wiki taught us to say, ‘Goodbye and don’t get stolen!’ E te tuahine, ka hoki ki tō tātou kāinga tūturu. Matire Ropiha-Stewart is the Diabetes Community Co-Ordinator | Hauora Kaimahi in Taranaki. Patient Voice Aotearoa Together with her husband Malcolm, Wiki spearheaded the formation of Patient Voice Aotearoa (PVA), which has supported Diabetes NZ in our campaign to have new diabetes medications and technologies funded. PVA is a unified collective of patients, caregivers, whānau, advocates, and charitable organisations who are fighting for better access to treatment, care, and support for all patients – irrespective of socioeconomic status. For more information, see www.patientvoice.org.nz

John Revel Kelly 1939 – 2021

Sue Pearson and Maureen Hartmann pay tribute to one of Diabetes NZ Auckland Branch's most dedicated volunteers.

ohn Kelly was shy and quiet (except when the cricket was on), hardworking, and an honest man. A retired accountant who had type 1 diabetes, he was generous with his time. He worked as a volunteer from 9am to 3pm most weekdays, and sometimes in the weekend, for almost 15 years. John didn’t seem to understand what a holiday was, unless it was a statutory one – enforced on him because our doors were shut. He didn’t have a job description; he just seemed to be available to do whatever was needed. He would clean out cupboards, set up the education room, do calculations, drive the van, deliver magazines, collect mail, collate and staple documents, help with administration, sell raffle tickets, pack Dia-Log, and deliver it. He was also Treasurer of the Three Kings Support Group. John was a member of the 50-year medal club. He was the first recipient of the John Nesfield Award in 2001 in recognition of all his voluntary work for Diabetes Auckland, and, in 2010, he was awarded the Diabetes NZ Award in recognition of his long service to the diabetes community. He retired from Diabetes Auckland in June 2010 after 15 years as an invaluable member of the family. John was a huge asset to our organisation and will be greatly missed. Rest in peace, John, knowing that you have made a huge difference to the lives of so many people with diabetes.

met John at the Three Kings diabetes support group when he was treasurer. Down the track, when I became coordinator, John continued as treasurer until around 10 years ago when he retired from that role. He remained involved, and he was a real treasure. Everyone liked John. He had a caring nature and a quiet, unassuming manner, but he was also upfront and honest. He'd say it nice and quietly, but his ‘yes’ was ‘yes’, and his ‘no’ was ‘no’. You knew exactly where you were at with him. He was also a welldressed gentleman – he had class! After he needed to go into a rest home, he didn’t have family around him, so I took on the role of his welfare guardian. My family and I got to know John closely from that time onwards. He loved gardening and walking. He got on well with my 96-year-old mother-in-law, and I regarded him as an older brother. This year would be 59 years of John being insulin dependent. He didn't blow his own trumpet; he just gave of himself. He gave of his time. Not everyone does that. I felt very privileged to be part of John’s life.

Sue Pearson

Maureen Hartmann

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Community

A world-leading researcher, a dedicated Otago doctor, and a tireless advocate for diabetes awareness and prevention, Professor Jim Mann was surprised to receive a knighthood in the most recent New Year’s Honours.

im Mann, who would prefer not to be routinely called ‘Sir’, never suspected this knighthood was coming. ‘I've nominated a number of people for honours myself, and I know how much work goes into a nomination.’ He’s humbled that people who knew his work went to so much trouble behind the scenes. He says, ‘The other really important point is that, when you’re given an honour, it’s not just an acknowledgement of you, it's an acknowledgement of people who have a shared vision. ‘Both the Governor-General and the Prime Minister, who wrote to me, made that point. Yes, it's an acknowledgement of what you've done but also of what everybody else who has worked with you has done and of the kind of work you're trying to do. So one's hope is that it helps to acknowledge the importance of diabetes.’

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PHOTO: NEW ZEALAND LISTENER MAGAZINE/DAVID WHITE

PROFESSOR SIR JIM MANN A FIGHTER FOR THE DIABETES COMMUNITY

REALISATIONS ABOUT DIABETES

As a young man, Jim trained in England as an endocrinologist, and, when he worked in South Africa, he discovered an interest in nutrition. This naturally led to more work in diabetes. And although he had other research and clinical interests, diabetes was, increasingly, at the forefront for him. His social conscience also drove this interest: ‘There was the realisation that this was a really important disease that was profoundly affecting people's lives – and profoundly affecting society because it was so common, and it wasn't receiving adequate attention. ‘It particularly struck me, when I first came to New Zealand, nearly 35 years ago now, that diabetes was largely being ignored here. I was involved in a health research

council committee, which was trying to draw attention to the importance of diabetes and pointing out that, if we didn't do something about type 2 diabetes, it was going to reach epidemic proportions. ‘It's also a tremendously important cause of inequity in health. The Healthier Lives — He Oranga Hauora National Science Challenge, of which I'm now director, is all about achieving equity. Not so much reducing inequity, because that isn't good enough. We want to work for equity.’ After many, often frustrating, years of working – along with others – to get diabetes recognised as a major issue, Jim is hopeful that real progress is finally being made, particularly through the Diabetes Action Plan, which Diabetes NZ is involved with.

‘It's been a rocky road, but there's never been a national plan of action for diabetes quite as ambitious as the one currently being developed. In the long term, a plan like that has the potential to do a huge amount for type 2 diabetes prevention, as well as achieving improved management for those with type 1 and type 2. I just hope we can continue along the present path for long enough to get it embedded into the system before a different government changes the priorities.' SUPPORTING TYPE 1 YOUTH

Jim has always been interested in type 1 diabetes, as well as type 2. ‘Professor Graham Mortimer and I started the first adolescent diabetes clinic in Dunedin, and before that I started the second adolescent clinic in the UK, all those years ago. And type 1 is increasing too. It's just that the numbers are not quite as dramatic as they are for type 2.’ He continues to advocate for type 1 awareness, and, at the moment, some plans he has are at the ‘watch this space’ stage. A CLINICIAN AT HEART

Throughout all of his work as a researcher and advisor, Jim has continued to practise as a physician with a special interest in diabetes. ‘I trained as a doctor because I wanted to do medicine and not, initially, research. I primarily consider myself to be a clinician. I like people, and I like people contact.’

However, last year, Jim made the tough decision to give up his practising certificate. ‘The time comes when you can't go on doing everything. I've given up clinical work, not because I didn't want to go on doing it but because I just didn’t have the time.’ He’ll continue to work as a researcher, a facilitator of other people’s research, an advocate, and, he says, ‘a troublemaker’. He notes that, in the past, ‘I think my number was blocked on a number of political cellphones.’ With his advocacy hat on, he says that, as well as the crucial Diabetes Action Plan, New Zealand needs nutritional policy. ‘In New Zealand, nutrition policy is, I won't say nonexistent, but very much down the health agenda. I've argued for a very long time that New Zealand needs a national food strategy, because you can't have a nutrition strategy without a food strategy. ‘Food is one of the most important determinants of our health and one of the main determinants of our economy. It’s unbelievable we don't have a national food strategy. It's as important as having a Covid strategy. So, in terms of advocacy and politicking and so on, I continue to do that – through public speaking, writing, and through annoying politicians and people in the Ministry of Health whenever I can.’ He says, ‘My father worked as a GP until his mid-80s, so I've got quite a few years to go still.’

SOME OF JIM’S ROLES

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Past medical adviser to Diabetes NZ, with continuing strong involvement Director of Healthier Lives — He Oranga Hauora National Science Challenge First director of the Edgar National Centre for Diabetes and Obesity Research and now co-director Heart Foundation board member Groundbreaking researcher, with research into nutrition, diabetes, and heart disease published in almost 400 scientific publications and 90 book chapters Part of the World Health Organisation’s nutritional guidance advisory group and its expert advisory panel on nutrition

Care

Trulicity – the new, convenient type 2 diabetes medication The medication Dulagutide is now available in New Zealand under the brand name Trulicity. What does this mean, and are you eligible for it?

iz Dutton, from Diabetes NZ’s National Office, says, ‘Trulicity is essentially the new diabetes medication for people with type 2. It’s a once-a-week injectable, and it has better outcomes than the other new medication Jardiance (also sold combined with Metformin as Jardiamet). That includes more weight loss.’ HOW DOES TRULICITY WORK?

Trulicity, made by pharmaceutical company Eli Lilly, helps control your blood sugar levels. It’s also used to reduce the risk of major cardiovascular events, such as heart attacks or strokes in people who have heart disease or other cardiovascular risk factors. Trulicity limits how much sugar gets into your blood from your liver. It also helps slow down how quickly food leaves your stomach and helps your pancreas release insulin in response to your blood after you eat. ONCE-A-WEEK INJECTIONS

One of the most important features of Trulicity is its convenience. All you need to do is take an injection once a week. You can take it at any time of day, with or without food, and it works 24/7. Each pen contains one pre-measured dose that will last a full week. Trulicity comes in disposable pens that allow you to administer it to yourself by clicking a button.

DIABETES WELLNESS | Autumn 2022

You inject it under the skin of your stomach, thigh, or upper arm, but the pen design means you don’t have to see or manage the needle. Do not inject it into skin that is sore, bruised, red, hard, scarred, or that has stretch marks or psoriasis plaques, as it will not work. Trulicity is designed to be used together with the diet and exercise that your healthcare provider recommends. WHO IS ELIGIBLE FOR TRULICITY?

People who are at high risk of heart and kidney complications from type 2 diabetes now have funded access to either Jardiance/ Jardiamet (empagliflozin) or Trulicity (dulaglutide). You need to meet certain criteria to access these medications. (This is called a Pharmac Special Authority.) You are not able to have funded access to both these medications at the same time. If you stop treatment with Jardiance, you can start on Trulicity – and vice versa. (But you’ll need a new Special Authority to switch.) GPs, nurse practitioners and pharmacist prescribers can apply for a Special Authority for these medicines for you. To meet the Special Authority criteria, you must have already received an initial approval for

an SGLT-2 inhibitor (that is, empagliflozin – Jardiance or Jardiamet), or you must have type 2 diabetes, as well as meeting one or more of these criteria: • You are Māori or any Pacific ethnicity. • You have pre-existing cardiovascular disease or risk equivalent. • You have an absolute five-year cardiovascular disease risk of 15% or greater according to a validated cardiovascular risk assessment calculator. • You have a high lifetime cardiovascular risk due to being diagnosed with type 2 diabetes during childhood or as a young adult. • You have kidney disease and a target HbA1c (of 53 mmol/mol or less) has not been achieved despite the regular use of at least one blood-glucose lowering agent (e.g. metformin, vildagliptin, or insulin) for at least three months. IF YOU’RE ON OTHER MEDICATIONS

You can take Trulicity with insulin, Metformin, Gliclazide, or Glipizide, but you may have to reduce your dose of these. Note that you should not take Trulicity with Vildagliptin. You would need to stop Vildagliptin when starting Trulicity.

WHAT TO EXPECT FROM YOUR HEALTHCARE PROVIDER

Important questions to talk through with your doctor are: • Do you have other medical conditions, including problems with your pancreas, kidneys, liver, or stomach, or a history of diabetic retinopathy (vision problems related to diabetes)? • Do you take other diabetes medicines, such as insulin or sulfonylureas (Glipizide or Gliclazide) or Vildagliptin? • Do you take any other prescription medicines or over-the-counter drugs, vitamins, or herbs? Your healthcare provider should show you how to use Trulicity before you use it for the first time. Use Trulicity exactly as your doctor says. Never share your Trulicity pen, syringe, or needles with another person. If you take too much Trulicity, call your healthcare provider or seek medical advice promptly. SIDE EFFECTS TO DISCUSS

The most common side effects of Trulicity include nausea, diarrhoea, vomiting, abdominal pain, and decreased appetite, indigestion, and fatigue. Nausea is quite a common side effect with dulaglutide. It is worst in the two to three days following the injection and gets better with time, so it’s worth persisting. Here are some tips to ease the nausea: • eat smaller meals and more slowly • avoid eating two hours before bed • avoid fried or fatty foods and alcohol.

Other side effects can include inflamed pancreas (pancreatitis), allergic reactions, changes in vision, and – if you are taking Glipizide, Gliclazide, or insulin with it – low blood sugar (hypoglycaemia). Talk through these possibilities with your doctor. If you notice any of these issues, tell your health provider straight away. Tumours in the thyroid, including thyroid cancer, are a rare side effect of Trulicity. Watch for possible symptoms, such as a lump or swelling in the neck, trouble swallowing, hoarseness, or shortness of breath. If you have a symptom, tell your doctor.

MY DIABETES JOURNEY… A FRIEND IN YOUR POCKET!

WHO SHOULD NOT USE TRULICITY

Do not use Trulicity if: • you are under 18, or pregnant, or breastfeeding • you have severe gastrointestinal disease including gastroparesis • you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) • you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) • you are allergic to dulaglutide or other ingredients in Trulicity. HOW LONG WILL TRULICITY BE SUBSIDISED FOR?

Trulicity received Medsafe approval in New Zealand in August 2021 and became available from 1 September 2021. It will be subsidised as a treatment for type 2 diabetes until at least 30 June 2024. This date could be extended by mutual consent between Pharmac and Eli Lilly until 30 June 2025 and/or 30 June 2026.

We know that managing diabetes is a journey and we all need a little extra support sometimes. With helpful tips, information and inspiration, the new My Diabetes Journey app truly is like a friend in your pocket! It’s totally free, download it today. • Food diary • Space to record and track movement goals and emotional wellbeing • Diabetes resources • Recipes • Nutrition tips DOWNLOAD IT TODAY

Community

FUNDRAISING FOR DIABETES

DAWN TILL DUSK Ali Hooshyari and Nick Forrester are two of our latest fundraising heroes.

ast year, Ali Hooshyari and Nick Forrester raised money for prostate cancer through the Cancer Society’s Longest Day golf challenge. The idea is to test your skill and endurance by completing four rounds of golf – 72 holes – in a single day. Naturally, the challenge takes place in the middle of summer when the most daylight hours are available. Nick has type 1 diabetes, so the event was an extra challenge. This year, instead of resting on their laurels, Ali and Nick decided to turn their golfing efforts to a cause that was closer to home. They decided to fundraise for Diabetes NZ – and to up the ante. On New Year’s Day, Ali and Nick were up at the crack of dawn, ready to play not four, but five rounds – 90 holes – on foot. They would be carrying their bags for over 50km and, at the same time, giving their supporters an inside look at the challenges of living with diabetes. They set up a Givealittle page with a $2,000 fundraising goal, and by the end of the challenge they had surpassed that, raising $3,166. Thank you, Nick and Ali – this is a massive achievement! Nick talks about his type 1 journey at the Diabetes NZ website: www.diabetes.org.nz/your-stories/nickforrester-and-ali-hoosh

Have you come across the new closed Facebook group for New Zealand Type 1 Teens and Young Adults? It’s a safe place to discuss your issues and share your experiences with others. Find it at facebook.com/groups/t1youngadultandteennz.

DIABETES WELLNESS | Autumn 2022

ZERO

FINGERSTICKS* OR SCANNING

WHAT DIFFERENCE CAN

20 MINUTES MAKE? Try Dexcom G6 for $189.75* Scan and use code SUMMER

A 20-minute warning can help people with type 1 diabetes and impaired awareness of hypoglycaemia avoid dangerous lows. In that time, you can take appropriate action or explain to someone what is happening to make sure you are safe. The Dexcom G6 Continuous Glucose Monitoring (CGM) System has an Urgent Low Soon alert which can give you a 20-minute warning of impending hypoglycaemia† and its use has been associated with a significant reduction in hypoglycaemia.1,2 Find out more at dexcom.com/en-NZ Smart devices sold separately.‡ *Offer is for new customers only until 31 st March 2022. For One Month Trial Terms and Conditions please visit https://nzmsdiabetes.co.nz/products/dexcom-g6-trial/ *If your glucose alerts and readings from Dexcom G6 do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions. †3.1 mmol/l or below. ‡To view a list of compatible smart devices, visit dexcom.com/compatibility. 1 Puhr S et al. Diabetes Technol Ther 2019;21:155-8 2 Puhr S et al. J Diabetes Sci Technol. 2020;14(1):83-86. Epub 2019 Apr 3. Dexcom, Dexcom G6, Dexcom Follow, Dexcom Share, and Dexcom CLARITY are registered trademarks of Dexcom, Inc. in the U.S. and may be in other countries. © 2020 Dexcom International Ltd. All rights reserved. Dexcom International Ltd and its affiliated European entities. This product is covered by U.S. patent. www.Dexcom.com | +1.858.200.0200 | Dexcom, Inc. 6340 Sequence Drive San Diego, CA 92121 USA | MDSS GmbH Schiffgraben 41 30175 Hannover, Germany. LBL020815 Rev001.

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For more information on Dexcom G6, please contact us on 0800 500 226 or at diabetes@nzms.co.nz nzmsdiabetes.co.nz

HELPING TO MANAGE YOUR DIABETES

FreeStyle Optium Blood Glucose and Blood Ketones Testing FreeStyle Libre Flash Glucose Monitoring System The FreeStyle Libre Flash Glucose Monitoring System is a glucose monitoring device indicated for detecting trends and tracking pattern in persons aged 4 and older with insulin dependent diabetes Diabetes Care mellitus, without the use of lancets.

Silesse™ Sting Free Skin Barrier Spray

Niltac™ Sting Free Medical Adhesive Remover Wipes

• 50ml • Quick drying silicon film • Protects skin from damaging effect of adhesives

• Pack 30 wipes • 100% Silicon Free • Hypo-Allergenic

• FreeStyle Optium Neo Meter Kit • FreeStyle Optium Blood Glucose Test Strips 100’s • FreeStyle Optium Blood Ketones Diabetes Care Test Strips 10’s

Glucology® Sensor Patches Glucology® Sensor Patches are a blend of latex-free Cotton and Spandex which provides unique elastic qualities to ensure flexibility, durability, and maximal comfort. Compatible with Libre Sensor.

Frio Cooling Wallets • • • • •

Keeps Insulin cool and safe Refrigeration not required Simply activate with cold water Reusable, light and compact Available in five sizes and six colours

Hypo-Fit Glucose Gel • Two flavours – Orange and Tropical • 18gram sachets, 13.4grams Carbohydrates HYPO-FIT • Gluten-Free D I R E C T- E N E R G Y

MedActive Carry Cases Diabete-Ezy Accessories • • • • •

Ezy-Fit Carry Case (Blue, Pink & Green) Multi-Fit Carry Cases (Black & Red) Test Wipes Starter Pack Test Wipes Refills Diabete-ezy™ Comfy Pump Belts

A selection of convenient carry cases for medical supplies. • Easy Bag Single • Easy Bag Classic • iCool Weekender • iCool Prestige • iCool MediCube transforming lives

medactiv

Dextro Energy Glucose Tablets • 24 sticks per carton (12 tablets per stick) • Available in four flavours Orange, Blackcurrent, Lemon, Tropical • All with added Vitamin C

Order Online: www.mediray.co.nz Freephone: 0800 106 100 Address for Correspondence: PO Box 303205, North Harbour, Auckland, New Zealand