Diabetes Wellness Spring 2021 by Diabetes New Zealand

wellness DIABETES

SPRING 2021 $8.00 INC. GST

DIABETES NEW ZEALAND | DIABETES.ORG.NZ

SIR EION EDGAR REMEMBERED • GETTING FIT IN THE GARDEN • SUPER SILVERBEET LIFE-CHANGING MEDICATIONS • MEALS FOR ONE • WHAT IS DIABETIC NEUROPATHY? • YOUNG ACHIEVERS

MUSIC FOR A CAUSE VINCE HARDER & ABBY LEE HARDER

100 YEARS OF INSULIN

COMING SOON

Contents SPRING 2021 VOLUME 33 | NO 3

4 EDITORIAL

5 UPFRONT: Fieldays 2021 6 YOUR DNZ: Tribute to Sir Eion Edgar

8 COVER: Vince Harder and Abby Lee Harder on their passion project

22 NOURISH: Cooking for one 25 COMMUNITY: Murray Dear's two decades of dedication to diabetes

26 CARE: Pharmac launches new campaign

12 YOUR DNZ: We mark 100 years of insulin 13 YOUR DNZ: Diabetes NZ awards: call for applications

28 DIABETES YOUTH: Our 2020 John McLaren Award winners 32 RESEARCH: A recent roundup 34 CARE: Diabetic neuropathy – what you need to know

14 MOVE: Enjoy a garden workout 16 NOURISH: Growing and cooking silverbeet

36 YOUR DNZ: Making our voices heard

18 LIFE WITH T2: Eugene Moreau tells his tale

38 LAST WORD: Fundraise for diabetes & part-subsidies for glutenfree foods

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DIABETES WELLNESS | Spring 2021

Editorial

ince our last magazine, significant changes to the health system have been announced by the government in response to the Health and Disability System Review. A new national organisation, provisionally called Health New Zealand, will run all public hospitals. It will also be responsible for commissioning primary and community health services and will be spread across four regional bases. A Māori Health Authority to advise the government and Health NZ on giving effect to tino rangatiratanga in health is being established, as well as a new Public Health Agency that will lead public health strategy, policy, analysis, and monitoring. These changes have influenced the direction of Diabetes NZ’s strategies developed for our recent 2021 Strategic Plan. They have been aligned with the Review's recommendations in recognition that population-health functions need to be strengthened, with a shift to a health and wellbeing focus. We will advocate for NGOs to become more involved and influence the new models of care. Our focus will be on making sure that diabetes is a government health priority and that a national diabetes action plan is developed. Another piece of advocacy was the opportunity to finally – after a year’s delay because of Covid-19 – present the petition we took to Parliament in November 2019 to the Health Committee. The petition asked the House of Representatives to urge Pharmac to fund continuous glucose monitors. Medications were also part of the petition, but these have been recently funded. Our submission was well received, with an acknowledgement of the burden of this condition on individuals and their whānau. The additional cost to the Pharmac budget is incidental compared with how life changing this technology is. We will continue to push for this funding. Unfortunately, this quarter was a particularly sad time for Diabetes NZ, with the death of our patron Sir Eion Edgar, who was an active and generous supporter of Diabetes NZ for 10 years. He leaves many legacies, but the most recent one is The Economic and Social Costs of Diabetes report. He instigated the four-way partnership that produced it, between Diabetes NZ, the Edgar National Centre for Diabetes and Obesity, He Oranga Hauora – Healthier Lives Challenge, and Tony and Heather Falkenstein. Along with our usual recipes, healthcare and lifestyle features, and inspirational profiles, in this issue of Diabetes Wellness, we reflect more on his achievements and his generosity. Sir Eion was an unflagging advocate for better awareness and funding for diabetes care, particularly in those communities hardest hit by this very serious condition. Diabetes NZ is determined to continue this advocacy through our awareness campaigns and support services so his legacy will not be forgotten. HEATHER VERRY

Chief Executive, Diabetes NZ

DIABETES WELLNESS | Spring 2021

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

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

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

ADVERTISING & SPONSORSHIP Business Development Manager Jo Chapman jo@diabetes.org.nz or +64 21 852 054 Download the Diabetes Wellness media kit: http://bit.ly/2uOYJ3p Disclaimer: Every effort is made to ensure accuracy, but Diabetes NZ accepts no liability for errors of fact or opinion. Information in this publication is not intended to replace advice by your health professional. Editorial and advertising material do not necessarily reflect the views of the Editor or Diabetes NZ. Advertising in Diabetes Wellness does not constitute endorsement of any product. Diabetes NZ holds the copyright of all editorial. No article, in whole or in part, should be reprinted without permission of the Editor.

Upfront

This year, Diabetes NZ was once again part of Fieldays – the biggest agricultural trade show in the Southern Hemisphere.

Health in the heartland

n 2021, Fieldays had a massive Health and Wellbeing Hub, which was opened by Kiingi Tūheitia and featured 33 different organisations. Three of our branches worked together to co-ordinate Diabetes NZ’s stand in the Hub. Diabetes NZ staff included Karen Reed (Rotorua), Lena Fendley (Tauranga), and Jo Chapman (Head Office). Our wonderful volunteers were from Waikato Branch: Murray Dear, Phil Letford, Tim Atkinson, Clare Mataira, Robyn Van Wijk, Rob Martinsen, and Grace Wyatt. In total, 133,000 people visited Fieldays this year, and more than 42,000 visited the Health and Wellbeing Hub. At its busiest, more than 1,700 people per hour came through the doors. We had a video playing to educate punters about foot care, and gave away 1450 DU’IT foot creams to about 1300 people. We met and chatted with many more.

Our stand’s position – near the Waikato DHB diabetes team, Kidney and Diabetes Nutrition, and Kidney Health NZ – enabled us to make cross-referrals. Volunteer Grace Wyatt says, ‘I thoroughly enjoyed the interaction with the public and other stand holders. The screen display stopped many people in their tracks, and I was surprised that many people with type 2 diabetes didn’t know why looking after their feet was so important. Having the DU’IT foot cream samples to give away helped drive home the message. ‘The fizzy drink and sugar display drew everyone’s attention, especially younger people, many of whom admitted to drinking multiple bottles or cans daily. When told how many teaspoons of sugar can be consumed across all food groups in one day and how many they were consuming in one can or bottle, most were shocked.’

FIELDAYS TV

Chief Executive Heather Verry appeared on Fieldays TV, talking about diabetes and health in rural regions. You can see her panel interview at www.fieldaysonline. co.nz/fieldays-tv/video-ondemand-2021 – look for the video ‘Taking the Pulse of Rural Health’. THANK YOU TO OUR SPONSORS

Above: Clare Mataira and Jo Chapman from Diabetes NZ chat to Associate Minister of Health Hon Dr Ayesha Verrall. Right: Kiingi Tūheitia opens the Health and Wellbeing Hub.

DIABETES WELLNESS | Spring 2021

Your DNZ

Diabetes NZ mourns the loss of Sir Eion Edgar. A leader, advocate, and philanthropist, he had been the patron of our organisation since 2011.

SIR EION EDGAR 30 January 1945–14 June 2021

ir Eion Edgar did not have diabetes himself and didn’t have any close family members with the condition. Nonetheless, it was a cause that captured his heart. On becoming patron of Diabetes NZ he said, ‘My frustration is that other conditions, such as cancer and heart attacks, get good funding. But because diabetes mainly affects lower socio-economic groups, we don’t get that kind of support. That’s why we need to raise its profile.’ Sir Eion’s interest in diabetes began in 1999, when he was the first person asked to join a new Diabetes Business Group set up by Paul Bowe, then VicePresident of Diabetes NZ. This interest led Sir Eion and his wife Jan, Lady Edgar, to fund the first University of Otago Leading Thinkers initiative – a Chair in Diabetic Medicine awarded to Professor Jim Mann. As a result, the Edgar National Centre for Diabetes and Obesity Research (EDOR) was formed. It was later strengthened by the creation of a second Leading Thinkers Chair in Early Childhood Obesity, held by Professor Rachael Taylor, the current Director of EDOR. As well as his philanthropic support, Sir Eion played an active role in the life of the Centre. He was chair of the EDOR advisory board, which met several times a year. He also attended and gave the opening

DIABETES WELLNESS | Spring 2021

addresses at many of the large public events organised by the Centre. ‘Sir Eion was incredibly proud of the Centre’s achievements,’ says Professor Taylor. Founding EDOR Director, Professor Jim Mann says the Centre remains committed to excellence in research and honouring the legacy of a man who saw a need and didn’t hesitate to help. ‘We remain indebted to Sir Eion’s drive and enthusiasm to support and fund health research. He was committed to doing what he could to improve the lives of his fellow New Zealanders,’ says Professor Mann. ‘He was a truly inspiring person.’ WORK WITH DIABETES NZ

Sir Eion was an active and generous supporter of Diabetes NZ. In 2018, he raised $74,000 for diabetes in the Fitbit MoveMeant Challenge. Thanks to the many and various shoulders he tapped, the countless phone calls he made, and the emails he sent, he took the grand total raised by all the competitors to more than $81,000. In a huge effort, Sir Eion also racked up 150,438 steps, wearing out one pair of trainers and spending late nights trekking the streets to squeeze in the extra steps and reach his goal. He competed in the MoveMeant Challenge twice more after that, working with Diabetes NZ to raise more than $263,000 in the three years he competed. In 2020, his formidable networks, his many friendships, and the respect he had earned in the many groups and organisations he was involved with played a large part in the success of the Challengers Dinner, which raised nearly half a million dollars for Diabetes NZ. Chief Executive of Diabetes NZ Heather Verry says, ‘We are all so

grateful for his work for the cause of diabetes in New Zealand. The funds he raised will go towards continuing to provide a high level of support for our community. He was an unflagging advocate for better awareness and funding for diabetes care, particularly in those communities hardest hit by this very serious condition.’ Sir Eion himself said, ‘I am passionate about trying to raise the profile of diabetes or “the silent assassin”, as I call it. I think we have to work hard as an organisation to raise the profile of diabetes, so more people are prepared to talk about it and to give to us if they decide they want to help a worthy project.’ Catherine Taylor, Diabetes NZ Board Chair, says, ‘Every time I was with Sir Eion, his enthusiasm for supporting people with diabetes and his constant striving to do more to support the work of Diabetes NZ was infectious. This energy extended to everyone who came into contact with him as he helped our organisation grow and develop. To have been able to work alongside such a person was an immense privilege. We have lost a true friend and supporter.'

A LIFE WELL LIVED

Sir Eion was named New Zealand’s Visionary Leader at the Top 200 Companies awards in 2007, knighted in 2009, received the Senior New Zealander of the Year award in 2010, and was made a Distinguished Fellow by the Institute of Directors in April this year. He was a Trustee of the Halberg Trust and the Skeggs Foundation, as well as Patron of ShelterBox New Zealand and the Wakatipu Trails Trust. He held directorships of several New Zealand companies and was chair of The Central Lakes Trust, the Queenstown Resort College, and the Winter Games Charitable Trust. In addition to funding EDOR, the Edgar family also gave $1 million each to the Edgar Sports Centre in Dunedin and the Edgar Olympic Foundation. Sir Eion’s legacy is visible in The Economic and Social Cost of Type 2 Diabetes report, released earlier this year by Diabetes NZ, the Edgar National Centre for Diabetes and Obesity Research, He Oranga Hauora – Healthier Lives, and Tony and Heather Falkenstein. Sir Eion passed away surrounded by family at his home in Queenstown, after being diagnosed with pancreatic cancer in December.

From left: Dr Cherie Stayner, Professor Jim Mann, Professor Rachael Taylor, Sir Eion Edgar, and Associate Professor Kirsten Coppell.

DIABETES WELLNESS | Spring 2021

Cover

DIABETES WELLNESS | Spring 2021

Vince Harder and Abby Lee Harder’s new song – ‘Overwhelmed’ – is their most personal yet, and its video, produced in partnership with Diabetes NZ, is a heartfelt plea for continuous glucose monitors to be funded.

Passion PROJECT V

ince and Abby vividly remember their daughter Presley’s diagnosis with type 1 diabetes last year. Presley, who was 17 months old, had a high fever and vomiting, but none of the doctors the couple took her to considered it might be diabetes. Abby says, ‘They just thought she had a gastro bug. We even got a urine test done, and they noticed high glucose in the urine, but said it could be a side effect of the bug. We kept getting sent home and told to monitor her, and her symptoms just kept getting worse. ‘By around day four, Vince was saying, “Take her back to the doctor. You’ve got to take her back.”’ Both parents had a strong gut feeling things weren’t right. Vince says, ‘On that last day, she didn’t have a fever anymore, but she was still vomiting, and she had really different, sweet-smelling breath. I was like, you’ve got to take her.’ Abby recalls, ‘Our son Jaxon was due to start kindy the next day, so Vince stayed home with him, and I took Presley to A & E, and from there it was an ambulance to Waitākere hospital.

‘It was actually a paramedic in the ambulance who asked me to do a blood glucose test. We have no family history of type 1, so when they told me that her blood sugar level was 30, I didn't know what that meant.’

‘CGMs were life changing for us, so we'll do what we can.' ABBY By this time, Presley was in severe DKA (diabetic ketoacidosis). She was soon moved to Starship Children’s Hospital, where she spent two nights on a drip in the Paediatric Intensive Care Unit. New Zealand was at Level 2. Because of the level’s restrictions, ‘only one of us could be in with her at a time. Vince and I would transition in the hallways.’ Presley began to perk up on her second day, but the Harders stayed at Starship for another five days, learning about life with type 1. MAKING MUSIC TOGETHER

Their new life as type 1 parents inspired Vince and Abby to write a song about parents and children.

The duo had only recently started working closely together on joint musical projects. Vince says, ‘Pretty much since we started dating we’ve shared our music with each other. Then, when we were living in Australia, I used to do a lot of covers with different musicians and friends online, and Abby and I started doing that together as well. We grew a bit of a fan base together, but we still didn’t really write our own songs together.’ It wasn’t until New Zealand went into lockdown last year that this changed. ‘We thought, oh well, we’ve got no one else to write with now!’ says Abby. ‘Maybe now’s the time we should actually start a project together. Lockdown gave us the space and time to do that, because usually it’s easy with your spouse to just get caught up in the day-to-day stuff.’ Vince and Abby have released two of their own songs together so far. ‘Overwhelmed’ will be their third. It was friends, hearing the song and loving it, who suggested the Harders should partner with a charity to release it. Vince and DIABETES WELLNESS | Spring 2021

Keep an eye out ‘Overwhelmed’ will be available on all major music platforms on 13 August. Keep an eye on the Diabetes NZ Facebook page for the music video plus interviews with the Harders and other type 1 families. Download the track to support Diabetes NZ.

Abby knew straight away that Diabetes NZ was the organisation they wanted to do this with. ‘We’re really lucky that Diabetes NZ came on board,’ says Abby. OVERWHELMED – THE VIDEO

When it came to creating the video for ‘Overwhelmed’, the Harders wanted to use it to raise awareness about type 1 diabetes generally, as well as about how life changing continuous glucose monitors can be for those living with type 1 and their families, and how unfair it is that many can’t afford them. ‘CGMs were life changing for us,’ says Abby. ‘So we’ll do what we can. We’ll write songs and see what happens.’ She remembers, ‘The Starship nurses were amazing when Presley got diagnosed. They knew that, because she was so

DIABETES WELLNESS | Spring 2021

‘You hope for your own kids that their diabetes won’t hold them back from doing anything they want.' VINCE young, a CGM was going to be a lot easier for us. They got us started on a Libre when she was in hospital. ‘Presley’s not able to tell us how she’s feeling, so it just means you can have some peace of mind when going to sleep. Otherwise, you’re up every two hours checking. ‘So for us, it was like, if there’s some way we can help other families get these funded, that would be amazing … and then it grew into this whole thing of

creating awareness of diabetes as a whole.’ Diabetes NZ helped the Harders find two children with type 1 who were happy to feature in the video and be shown using their CGMs: Eden Iona from Auckland and Jaylen-Blaze Daane from Invercargill. While, for Vince and Abby, making the video began as something they wanted to do to give to the diabetes community, they found they got back a huge amount as well. Simply working with Eden and Jaylen-Blaze and seeing the way the two children embraced life, despite the challenges of type 1, gave them powerful encouragement. ‘It’s really cool,’ says Vince. ‘Because you hope for your own kids that their diabetes won’t hold them back from doing anything they want.’

VIDEO STARS: EDEN & JAYLEN-BLAZE JAYLEN-BLAZE DAANE, 11 Jaylen-Blaze’s mum Toni describes him as ‘unstoppable’. With a passion for performing arts, he’s currently juggling his school production, kapa haka, jazz band practice, saxophone lessons, choir, ukulele club, plus his own band – The Geeks. ‘He’s pretty much in anything he can sign up to,’ says Toni. It’s with The Geeks that Jaylen‑Blaze appears in the ‘Overwhelmed’ video. DIAGNOSED AS A TODDLER

Jaylen-Blaze was diagnosed at two and a half. Toni says it means diabetes is all he’s known. Currently, he’s using a Dexcom CGM, through a clinical trial he’s part of. The Dexcom allows him to do whatever he wants, with Toni still able to monitor his blood glucose levels from a distance, as it sends information to her phone. She wishes they’d had the Dexcom several months ago when JaylenBlaze’s pump site failed one night and he went into DKA. ‘If we’d had the Dexcom then, I would have got the alert that he was going high and we could have saved the hospital stay.’ ON SET

During the video shoot for ‘Overwhelmed’, Jaylen-Blaze had to act as if he was going low. In fact, soon after that, he did have a genuine low – which Toni puts down to the adrenaline of the filming experience. The whole band was excited about the experience. ‘We’re thinking about getting the band together and having a reveal party when the video comes out,’ says Toni. ‘It’ll be cool if they come round and we can all watch it together.’

Jaylen-Blaze Daane

EDEN IONA, 11 Eden Iona is sports mad, with a special passion for netball and waka ama. In the ‘Overwhelmed’ video she’s shown training with her netball team, Papatoetoe Rangers PR11. ‘All of us were excited,’ she says. SAFETY WITH A CGM

Like Jaylen-Blaze, Eden uses a Dexcom CGM. ‘It’s much better than trying to do finger pricks every day,’ she says, ‘and it also shows on my watch, which is much easier than trying to get my phone out of my bag.’ During sports games, the CGM is especially useful. Running off the court to do finger pricks can be a big obstacle to play. Eden’s parents are just as glad, if not more, that she’s able to use the Dexcom. It sends messages to them as well, so they can keep an eye on how her blood sugar is tracking throughout the day. ‘It’s peace of mind. She’s just started at a new school in the city,’ says Eden’s mother Tasi, ‘so it’s quite a lot further away.’

Eden (right) with her dad Sila, mum Tasi, and her little sisters Mercy and Ariya.

SPEAKING OUT FOR DIABETES

Sports isn’t Eden’s only passion – she loves public speaking. She featured in the Autumn 2021 issue of Diabetes Wellness, after capturing everyone’s heart as a speaker at Diabetes NZ's Challengers Dinner gala fundraiser in December. Remembering the first time she spoke to an audience about type 1 diabetes, she says, ‘I felt happy I was putting my voice out there. I saw how people responded, and how shocked they were at how serious it could be. That really touched me, and I understood that I made a little bit of difference.’ Tasi is a proud mum: ‘I could not do what she does – standing in front of all those people. But her dad is a natural orator, and my dad is natural, so I think that’s where she got it from. ‘She gets a lot of encouragement from us when she’s speaking, and she knows that when she’s up there she’s not only presenting herself but the family, and that gives her the confidence as well.’

DIABETES WELLNESS | Spring 2021

Your DNZ

YEARS of INSULIN

his year marks the 100th anniversary of insulin’s discovery by Sir Frederick Banting, Charles Best, John Macleod, and James Collip at the University of Toronto, Canada. Since then, insulin has saved millions of lives around the world. What’s more, 14 November marks the birthday of Sir Frederick Banting and is also World Diabetes Day. Globally, this day will celebrate the lifesaving discovery of insulin. Diabetes NZ is honouring this history. Branches around the country will acknowledge the day in various forms by hosting functions or activities. Keep your eyes on our website for local information closer to the time. We also encourage those who have managed their diabetes with insulin therapy consistently for 50 years or more to apply for the Sir Charles Burns Memorial Award. And for those whose diabetes has been managed on insulin for 25 years or more, we are offering a new Silver Medal.

DIABETES WELLNESS | Spring 2021

THE SIR CHARLES BURNS MEMORIAL AWARD

Have you been on insulin for 50 years or more? If so, you are eligible for the Sir Charles Burns Memorial Award. Diabetes NZ presents this award to anyone with diabetes who can demonstrate that they have managed their diabetes for a continuous period of at least 50 years through insulin therapy. Sir Charles Burns (1898–1985) had a distinguished medical career and was knighted following a period as Vice President of the Royal Australasian College of Physicians from 1956 to 1958. He grew up in Blenheim and trained at the University of Otago Medical School.

THE SILVER MEDAL AWARD

This new award is for anyone who can demonstrate that they have managed their diabetes for a continuous period of at least 25 years through insulin therapy. SEE OPPOSITE FOR MORE DETAILS

Charles Best and Sir Frederick Banting, c. 1924.

Diabetes NZ is celebrating inspiring members of our community. Applications are now open for these important awards. Please apply if you’re interested, or encourage others to do so.

DIABETES NZ AWARDS CALL FOR APPLICATIONS THE JOHN MCLAREN YOUTH AWARDS

Our youth awards celebrate the pursuit of excellence by youth with diabetes. They recognise the determination and resilience of young people as they strive to achieve their goals in their chosen field, despite the challenges their condition brings. In 2021, one award of $1,500 will be made in each of three fields: sporting, academic, and cultural. Anyone who is 25 or under and lives with diabetes is eligible to apply. Meet two of our 2020 winners, Matt Slemint and Madeleine Lord, on page 28!

THE DIABETES NZ AWARD

Diabetes NZ Awards may be granted to individuals who have, directly or indirectly, made a significant difference to the diabetes cause in New Zealand. The award recognises exceptional achievement and is made in the knowledge that personal sacrifices must always be part of such a contribution to diabetes. THE LIFE MEMBERSHIP AWARD

The Award of a Diabetes New Zealand Life Membership is the most prestigious honour awarded by the organisation. A Life Membership is conferred on someone in recognition and appreciation of outstanding service by that person for the benefit of people with diabetes.

To ensure this award remains a distinguished and exceptional honour, a maximum number of 40 Life Members is permitted at any one time. If you know someone who you believe deserves a Life Membership, please nominate them. HOW TO APPLY FOR AN AWARD OR NOMINATE A LIFE MEMBER

Application forms for all awards are available on Diabetes NZ's website and from your local Diabetes NZ branch. Go to www.diabetes.org.nz/ diabetes-nz-awards. Entries for all awards close 5pm, Monday 13 September.

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DIABETES WELLNESS | Spring 2021

Move

ENJOY A GARDEN

WORKOUT Getting into the garden this spring can be as good as going to the gym. Fitness consultant Craig Wise has the details.

ecently, I was part of a conversation about gyms and the convenience of 24-hour gym access, when one person in the group asked, ‘How did we ever exercise before all this access and a gym on nearly every corner?’ The answer is simple – we did stuff. And by ‘stuff’, I mean we mowed our own lawns, cleaned our own homes, washed our own cars, and more. These days, our lives are filled with convenience. What if we took a step back and started doing stuff again? The garden, for example, can be a great place to stay active and get fit. With the warmer weather and longer days coming, getting out there isn’t so much of a chore as it was, and the health benefits are more than a bonus.

DIABETES WELLNESS | Spring 2021

YOUR GARDEN GYM

Here are some garden activities that are also great exercise. Mowing

Just about every garden has some lawn, and pushing the mower is a great workout. A petrol mower, which is the standard these days, will give a leg workout. But you get extra points if you go old school and use a push mower – this will add some upper body action to your garden workout. Raking

Using the rake is an integral part of garden maintenance, whether it’s collecting dead leaves or grass clippings. The rake helps the top layer of the garden to breathe and clears away debris to give it the sunlight it needs. Raking is a bit like using a rowing machine at the gym. It will give your upper body a good

workout, especially your shoulder and back muscles. The leg muscles will also get some action when you pick up your pile of raked leaves or grass. Digging

Another activity that can give you a good all-over workout is digging the garden and turning the soil. The act of turning the soil before planting is great for aerating the soil – and also perfect for working the shoulders, chest, and back. Weeding

Any gardener knows just how quickly those evil weeds rear their heads and spoil all our good work, so pulling out weeds is a neverending exercise routine. It’s a good shoulder workout and can be excellent for hand dexterity and strength. If you’re doing a lot of getting up and down, the legs will also get a workout.

THINGS TO THINK ABOUT

When gardening, just as with gym exercise, take care not to damage your body. • If you spend time on your knees in the garden, use a cushion, keep your back straight, and don’t sit on your heels. Be sure to stand up and stretch every 10 to 15 minutes. • For digging, use a long-handled, lightweight spade and don’t overload it. Bend at the knee and step forward as you raise and lower each spadeful of soil. • Bend at the knees when picking things up. • And for your mind: make time to stop and smell the flowers. GROW AND CONNECT

If you live with young people, try making gardening a family activity. Ever since our girls were young, we have made a big thing of growing fruit and vegetables at home. With busy lives, it can be time consuming, but it’s great family bonding time, as well as a time to educate and broaden our girls’ minds. Being connected to what they eat and the process of growing it gives them a greater appreciation of fresh food than they would have by just grabbing it off the shelf in the supermarket (and it can help the food bill, too). WHAT IF YOU DON’T HAVE A GARDEN?

Perhaps you have a friend or family member who would welcome some help or collaboration in their garden. Why not ask them? Gardening with someone else can be a lot of fun. There are also many community gardens all around the country that allow for varying levels of involvement and commitment. An internet search will bring up the names of those near you and the contact details for enquiries.

GROWING MENTAL HEALTH AS WELL AS PLANTS Gardening has a positive effect on not only your physical but your mental health: • Allowing your creative side to bloom in the garden can leave you with a sense of pride and achievement at a job well done. • Sometimes the scents from plants and soil can stimulate or trigger long forgotten memories, which in turn may relieve stresses related to our everyday modern lives. • It’s well documented now in scientific studies that soil contains anti-depressant microbes. No wonder gardening can make us feel so good. It’s a full workout, it can help you connect to nature and to other people, and if you’re growing and eating your own fruit or vegetables, you can use that to help build an even healthier lifestyle. Gardening ticks all the boxes.

COUNTING CALORIES BURNED Just half an hour of weeding can burn plenty of calories, and some of those heavier duty activities like hedge trimming and weed-eating can burn even more. This year, the Harvard Medical School published the number of calories burned, per 30 minutes, by doing various activities, depending on bodyweight. Here are some of the outdoor activities. Bodyweight 57kg Activity

70kg

84kg

Calories burned per 30 minutes

Planting bulbs and small plants

240

298

356

Raking leaves

240

298

356

Mowing the lawn (powered)

270

334

400

Mowing the lawn (hand mower)

330

410

488

Weeding

278

344

410

Chopping and/or splitting wood

360

446

532

Carrying and stacking wood

300

372

444

Digging

300

372

444

Planting trees

270

334

400

More info: www.health.harvard.edu/diet-and-weight-loss/calories-burned-in-30-minutes-of-leisureand-routine-activities

DIABETES WELLNESS | Spring 2021

Nourish

YOU CAN’T BEAT BEET! Want to start vege gardening this year? Consider silverbeet (AKA chard or Swiss chard). It’s easy to grow, packed with nutrition, versatile in recipes, and looks lush and beautiful.

PLANT YOUR SEEDLINGS

FIRST PICK YOUR SPOT

WATER, WATCH, AND HARVEST

Silverbeet likes some full sun, so choose a spot that gets some good full sun for at least part of the day. It shouldn’t be too windy, either. PREPARE YOUR SOIL

Silverbeet can grow in a range of soils, but it does like one that is fertile and holds moisture well. Dig your soil to loosen it, and dig in some compost or fertiliser.

It’s cheap to grow silverbeet from small seedlings. Plant the seedlings about 25 to 30 centimetres apart. Dig your holes, place the plants in the centre, and gently heap soil back in, then press down around their base. Plant in the mornings or late in the day, as hot sun can damage seedlings. Water them well as soon as you’ve planted them.

Water your silverbeet regularly. Once your silverbeet has grown, you can harvest it perpetually: pick a few outer leaves at a time, rather than the whole bunch. This will encourage new leaf growth and keep your silverbeet plants healthy. Plant another crop in Autumn to have silverbeet all year round.

A NUTRITIONAL POWERHOUSE

Research in New Zealand from 2007 showed that silverbeet has a similar nutritional profile to spinach. It’s especially rich in vitamins A and C, and, unusually for a leafy green, it contains a good quantity of vitamin E. Also, 100g of raw silverbeet contains more than 10% of your recommended daily intake of copper iron, magnesium, and potassium, and more than 20% of your recommended daily intake of folate, manganese, and potassium. It’s rich in a range of phenolic compounds, which have varying roles in your body. If you want to make the most of this, grow and eat different coloured beets – which will give you more variety in the nutrients provided. More info www.freshvegetables.co.nz/assets/ Members-pdfs/Spinach-silver-beetegg-plant-Report-1928.pdf.

TIPS

Try different cultivars, such as rainbow chard, for a colourful plate. Chard grows successfully in a good-sized container – just remember to add drainage and water often.

DIABETES WELLNESS | Spring 2021

SILVERBEET PARCELS

Pre-heat oven to 180°C.

SERVES 4

To make filling Remove spines from silverbeet leaves. Finely chop the spines. Gently heat the olive oil in a wide pan with a lid. Add the chopped kūmara, onion, and silverbeet spines, and cook on a slow heat, with the lid on, until kūmara is soft. Open and stir occasionally. Add the tomato paste and herb or spice mix, and stir well till heated through.

8 large silverbeet leaves (or 12 slightly smaller) 1 tsp olive oil 3 tbsp low-salt tomato paste 1 tsp salt-free herb or spice mix (choose a favourite) ¼ cup breadcrumbs 225g kūmara, peeled, and chopped into 1cm cubes (this is about 1 medium-large kūmara) 1 large onion, or 2 small onions, peeled and finely chopped or grated

To make rolls Cut each silverbeet leaf vertically down the centre. Bring some water to boil in a large pot. Dunk each silverbeet leaf piece in for about 10 seconds to soften, then remove and drain. Have a wide oven pan ready. When the silverbeet leaves have cooled, add about 1 tablespoon of the filling to each, and roll up in a parcel. Place parcels in the oven pan. Once all rolls are made, add some boiled water to the remaining filling mix so that it becomes just runny enough to be pourable. Pour it over the rolls. Sprinkle the bread crumbs over the top. Cover and bake for 25–30 minutes or until done. NUTRITION PER SERVE: ENERGY 667kJ (159kcal) | PROTEIN 6.9g | FAT 2.1g (SAT FAT 0.3g) | CARBOHYDRATE 23.6g (SUGAR 10.5g) | SODIUM 413mg

DIABETES WELLNESS | Spring 2021

Life with T2

Business and life coach Eugene Moreau has struggled through dark times and made it out. The wisdom and conviction he shares with his clients comes from personal experience.

LIVING TO TELL THE TALE

ype 2 diabetes runs in Eugene’s family. As far as he is aware, he is the first Moreau male to have lived past 60 in at least four generations: ‘My father died at 59. His father died in his early 50s. My dad’s brother died in his 50s. My great-grandfather died in his 40s and, before that, my great-grandfather … As far back as I can find out, I am the first, which incentivises me. I’m 62 this year.’ Eugene and his wife Chereen have a goal: ‘85 and alive.’ TYPE 2 DIAGNOSIS

Eugene is from the American South. ‘My dad was Louisiana French. So I grew up on red beans and rice, corn bread, fried chicken, dumplings – Southern food.’ His parents moved to New Zealand as missionaries when he was a child. ‘Although we lived in New Zealand, my mother would still cook all this food. So I grew up with that southern American taste, and then, of course, I fell in love with boil-up over here and fried bread. Those are really cool foods, just not always good for your body.’

DIABETES WELLNESS | Spring 2021

My Identity

is proud to create

Eugene’s father, who had been diagnosed with type 2 diabetes, passed away when Eugene was 31. Sixteen years later, Eugene found out that he also had type 2. ‘In 2006, I noticed that I was losing weight. I had an incurable thirst and I just wasn’t well. I felt my body was packing up. I had athlete’s foot in between my toes and other little things I never had before. So I went and saw my doctor in Auckland, and he sent me for a blood test. ‘The next day he called me and said, “Get in here now. You’re a walking heart attack. Your blood sugars are ridiculous.” ‘When I saw him, he said, “Do you know what diabetes means?” ‘I said, “No. What does it mean? What does it mean to be diabetic?” ‘So he tried to explain it to me, and I just felt myself spiralling. I didn’t consider myself to be an ignorant man. I considered myself to be a fairly well-travelled and knowledgeable guy, but it just did my head in, and I thought about all the things that I love to eat. I thought, “I can’t have that now.” ‘And as soon as you start telling yourself, “Oh, I can’t do that,” there’s something that kicks in. It says, “Yeah, you can.”… It’s like telling someone, “Don’t think of the colour red.” As soon as you tell someone not to think of the colour red, they start thinking of the colour red.’ Eugene took his prescribed medications, but couldn’t bring himself to change the way he ate, and he beat himself up about this. ‘My journey from 2006 was really up and down, and I think possibly a lot of people with diabetes will have a similar experience. I got to an overwhelmed place.’ THE ‘BLACK DOG SEASON’

By 2010, Eugene was suffering from severe depression. He calls it his ‘black dog season’, and one thing led to another. ‘Everything in my life imploded – financially, I lost everything – the whole nine yards … I was up over 90kg, and I’m not a tall man.’ In 2013, he had a heart attack. He was still struggling with depression and anxiety, and comfort eating, especially sweet things, had become a big part of his life. But he knew he had to do something for his family. ‘There’s a 19-year gap between me and my wife Chereen. She’s younger. And so that’s had a big impact. Chereen said, “Look, I need you to be around.” And then our daughter Shayna – she’d just turned 25 – and she said, “I need you to be around, so get in control of this.”’ In 2014, Eugene qualified for a study that was being run out of Auckland Hospital to trial a new time-release medication that included an appetite suppressant. He was on it for six months. “I noticed that my blood sugars came down and my weight began to change, and that was the beginning of my change.” After the trial was over, he felt better and found he was understanding more about how to bring his blood sugars

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down, as well as feeling more motivated to do it. ‘For the first time, I thought, “I can get in control of this.”’ BACK TO BALANCE

Eugene increased his physical activity, while acknowledging that he was never going to be a marathon runner or a gym bunny, and he concentrated on getting control over what he ate and how much. He took it slowly, trying to reduce his HbA1c over several months. He didn’t rule out treats altogether. For example, when he sits down at home to watch a movie, he still makes himself a full bowl of popcorn to eat. It’s just that now the bowl is much smaller, and the dusting of salt and butter lighter. He says that, because he still eats a whole bowl, it feels like he’s doing the same thing. ‘Enjoy the life you’re living, but don’t be stupid,’ he says. He adds, ‘Medication will work, but you must have mental discipline to stay the course. You’ve got to learn to say “no”. I will get my blood sugar levels down because I work at it, and the medication is just my backstop. ‘I remember one time I took off on a business trip, and I forgot to take my meds with me. I thought, oh well, we’re going to see what happens for the next two days! It was interesting. My blood sugar levels when I came back were not astronomical. Because I’d been conscious to really watch what I ate. No pavlova, no ice cream! … And I think, as diabetics, we just need to understand that there are boundaries we don’t want to cross. ‘If someone said, “What’s the one thing you’d say to someone who just found out they’re diabetic?” I’d say, “You’ve got to learn the discipline of the boundary. And if you do break it, don’t break it repeatedly. Because your body will tell you, your sleep patterns will tell you.”’

DIABETES WELLNESS | Spring 2021

We older people need to look after our health for our families and for ourselves, because our stories need to be told. NEW DRUGS

Eugene has been on various drug combinations over the years – metformin and different insulins for diabetes, as well as medications for lowering blood pressure and cholesterol. Some combinations have worked better than others, and, after a period where he was having too many hypos (episodes of low blood sugar), it was time for another regimen change. Diabetes NZ, with other advocates, had been pushing to get

a wider range of type 2 medications funded in New Zealand, as the range available here was meagre compared with other countries. One new drug being advocated for was Empagliflozin, which lowers both blood sugar and blood pressure by helping your kidneys get rid of glucose, salt, and fluid when you pee. Eugene’s nurse and doctor managed to get him onto a threemonth free Empagliflozin trial, and early this year, part way through

the trial, the news came through that Pharmac would at last be funding this new drug for many New Zealanders with type 2. For Eugene, his new medication regimen, now including Empagliflozin, has been life changing. The routine is simpler than ever before, with fewer different meds to take. He says he also feels much better knowing that Empagliflozin is doing more than lowering his blood sugars. It also helps his kidneys work better and lowers his chances of heart attack or stroke. A NEW LEGACY

After losing everything financially, and suffering the health crisis that culminated in his heart attack, Eugene rebuilt both his health and his consultancy career. Then, in 2020 Covid-19 hit, and a lucrative contract in Australia came to an end. He decided to turn this to his advantage and, with a business partner, start a new venture. ‘I realised that I was tired of building everyone else’s business. Now, my endgame over the next five years is to build a business that looks after my wife and my family because, as a result of being diabetic, and as a result of having a heart attack, I’m basically uninsurable. It would cost me way too much money to be insured … it would be unsustainable. So that means I’ve got to create another legacy. ‘I’m a motivational teacher, on the road a lot. I love being in front of an audience, I love communicating, and I love helping people build healthy vibrant relationships. That’s what we’re building our business around – Partner4Growth. ‘I’m a certified Master Coach, and I work with communication and relationships, for professional people who need

to establish loyal, profitable relationships with their clients and for individuals who need to build healthy relationships. I’ve been public speaking since I was 14 and earning my living doing it since I was 19, so I run a presentation skills programme.’ The ups and downs of his own life have certainly impacted his coaching style. Eugene says, ‘I think there’s an authenticity that comes to you when you’ve gone through what I call “trauma curves”. Diabetes, heart attacks, depression, bankruptcy… These are all trauma curves.

I would say to myself, ‘I am a healthy man. Therefore, today, I will be strong with what I eat.’ ‘When you’ve had these trauma curves all in a 10-year period, there’s a certain level of authenticity that comes into your interactions. So if I’m meeting with someone who’s overweight, or struggling to get fit, perhaps putting on the pretence of having a fulfilled life but at the same time struggling with their mental and emotional health, I can recognise those signs. ‘I can see them and I say, okay, I don’t call them out, I don’t embarrass them, but I actually come alongside them and say, let me tell you a bit about my story … And let me tell you how I overcame that.’ Eugene recommends incremental changes and taking each day as it comes, saying ‘For today, I can make this change. Just today. And then doing the same the next day and the next … Over

time, you create a new mindset.’ Another thing he suggests to people is what he calls an ‘I am … therefore …’ challenge. He tells people, ‘Every morning, I want you to look at yourself in the mirror and affirm yourself – and then confirm that. For example, “I am a great dad. Therefore, today my children are going to feel loved.” Or I would say to myself, “I am a healthy man. Therefore, today, I will be strong with what I eat.” Affirmation then confirmation. And if you start talking to yourself and actually voicing those words, it gives them life.’ REFLECTION

Eugene thinks a lot about the way type 2 diabetes is taking away the chance for people to connect with their older family members who have so much hard-won knowledge. He feels sad when he thinks of the adult relationship he missed out on having with his own father. His dad was there for him as a child and as a young man, but he says, ‘I was 31 years old when my dad died of a heart attack, and I realised that I missed out on the greatest part of the relationship with him – that adult relationship where there’s real wisdom and experience talked about.’ The way Eugene sees it, we all talk about being here for our children when they’re young – but middle-aged people benefit from relationships with their elders as well. ‘I think our families need the wisdom that only age and experience can deliver. When I go, there’s going to be a vacuum of that knowledge and experience, and that happens with every family. So we older people need to look after our health for our families and for ourselves, because our stories need to be told.’

DIABETES WELLNESS | Spring 2021

Nourish

Cooking healthily for just yourself can be a challenge. Here are some quick, super-healthy dinner recipes that don’t break the bank and still feel like real meals.

Meals for one BROWN RICE AND TUNA SALAD This tasty versatile recipe is inspired by the Blokes Can Cook programme – see page 25. ½ packet microwave brown rice, cooked (use the other half for the Tofu Curry on page 23) ¼ cup frozen peas, thawed ¼ cup carrot, grated 100g cherry tomatoes, halved 95g tin of tuna in springwater, drained ½ lemon Olive oil spray Add all ingredients together in a bowl (except the lemon). Squeeze in the lemon, stir, spray with olive oil, stir some more, and serve. If the rice has been cooked recently, this will be a warm salad, but you may prefer to chill it. Variation

Stir in a teaspoon of finely grated onion or a chopped spring onion for a more intense flavour. NUTRITION PER SERVE: ENERGY 1590kJ (380kcal) | PROTEIN 23.5g | FAT 5.5g (SAT FAT 1.3g) | CARBOHYDRATE 53g (SUGAR 7.2g) | SODIUM 94mg

STOCKING YOUR PANTRY

A trick to cooking for one is making sure you buy ingredients that last a long time (like tinned beans, tinned tuna, and frozen peas) or that come ready divided into single portions – like some brands of microwaveable rice. You can also be clever about meal planning: buy foods that can be divided up when they are fresh or just opened and used for two or three nights in a row.

DIABETES WELLNESS | Spring 2021

TOFU CURRY This delicious vegetarian curry makes the most of tofu as a low-fat substitution for paneer. ½ packet microwave brown rice, cooked (use the other half for the tuna salad on page 22) Olive oil spray 1 zucchini, chopped into rounds approx 5mm thick 1 small onion 100g cherry tomatoes ½ cup baby spinach gently packed down 150g tofu ½ teaspoon curry powder ¼ cup trim milk

ROAST CHICKEN ON KŪMARA MASH You don’t have to cook a whole chicken – a single breast is a delicious just-for-one roast. Olive oil spray 1 medium kūmara ½ cup baby spinach gently packed down 1 chicken breast (around 180g) 100g cherry tomatoes, halved 1 small onion, chopped roughly ½ tsp smoked paprika 1 tbsp trim milk

Spray a saucepan with olive oil spray. Add the onion and zucchini, cover the pan with the lid, and cook on a low heat for 5 minutes. Add the tomato. Cook, covered, at low for another 5 minutes. Add the spinach and tofu. Cook, covered, at low for another 5 minutes. Add the curry powder and cook for a minute, stirring. Add the trim milk and cook, stirring till bubbling. Spoon onto rice to serve. NUTRITION PER SERVE: ENERGY 2050kJ (490kcal) | PROTEIN 28.4g | FAT 11.7g (SAT FAT 1.8g) | CARBOHYDRATE 59.4g (SUGAR 15.6g) | SODIUM 128mg

Preheat oven to 180°C. Place kūmara in the oven, and let cook for 15 minutes. Spray a wide roasting pan with olive oil. Coat the bottom of the pan with the baby spinach. Place chicken breast on top, and arrange cherry tomatoes and onion around it. Spinkle smoked paprika across everything, and then spray olive oil over that. Put the pan in the oven, and cook beside the kūmara for another 25–30 minutes. Take everything out of the oven, and let the chicken and veges rest. Wear an oven glove or use a clean tea towel to protect your hands from the heat, while you halve the kūmara, then scoop out the flesh and mash it with trim milk. Serve chicken and veges over the top of mash or alongside it. NUTRITION PER SERVE: ENERGY 2080kJ (495kcal) | PROTEIN 58g | FAT 5.1g (SAT FAT 1.4g) | CARBOHYDRATE 46.9g (SUGAR 24.8g) | SODIUM 152mg

DIABETES WELLNESS | Spring 2021

HAM AND WHITE BEAN SOUP A low-fat, low-salt version of a classic. Olive oil spray 1 small onion, finely chopped 50g lean deli ham chopped up ¼ cup frozen peas thawed 2 tsp flour 1 cup trim milk ½ cup baby spinach, chopped roughly and gently packed down 100g rinsed and well-drained cannellini beans – salt free (approx. half a can)

Since chicken breasts often come in twos, why not do a second roast the next night?

Spray a saucepan with olive oil spray. Add the onion, cover the pan with the lid, and cook the onion on a low heat for 10 minutes. Add the peas and the chopped ham, and stir for another minute. Add the flour, and stir until everything in the pan is coated – about one minute. Add the milk, and stir until the thickened mix is simmering. Add the beans and the spinach, and stir until simmering again. Pour into a bowl and serve.

Preheat oven to 180°C. Spray a wide roasting pan with the olive oil. Place chicken breast in pan, and arrange chopped potato and onion around it Sprinkle mixed herbs across all. Arange lemon rounds over and between the chicken and veges. Spray olive oil across everything. Cook for 25–30 minutes. When the chicken and veges are nearly done, boil or microwave the peas for two minutes, or until they’re how you like them and drain. Serve either with or without the cooked lemon.

Variation Serve with a slice of high fibre bread. NUTRITION PER SERVE: ENERGY 2330kJ (557kcal) | PROTEIN 39g | FAT 15.5g (SAT FAT 5.6g) | CARBOHYDRATE 55.3g (SUGAR 25.9g) | SODIUM 935mg

ROAST LEMON CHICKEN AND POTATOES

DIABETES WELLNESS | Spring 2021

Olive oil spray 1 chicken breast (about 180g) 1 large washed red potato, chopped into pieces no thicker than 1cm 1 lemon, sliced into rounds 1 small onion, chopped roughly ½ tsp mixed herbs ¾ cup frozen peas

NUTRITION PER SERVE: ENERGY 2710kJ (648kcal) | PROTEIN 59.8g | FAT 12g (SAT FAT 2.8g) | CARBOHYDRATE 59.6g (SUGAR 16.7g) | SODIUM 114mg

Community

TWO DECADES OF DEDICATION TO DIABETES As Diabetes NZ Waikato branch goes through exciting changes, we honour Murray Dear as he steps back from the branch co-ordination role but not from his commitment to the community.

urray was diagnosed with diabetes in 1986 while undergoing a routine medical. He says, ‘I'd actually lost a bit of weight, which I was happy about! My blood pressure and everything was good, but my GP said, “On the way out, give the nurse a urine specimen. We'll just check it.” ‘So I did, and the nurse came back a few minutes later and said, “You’re not going anywhere.” ‘They were uncertain if it was type 1 or type 2. I was on oral meds for a year or two, but they weren't working.’ Murray was diagnosed with late onset type 1 and switched to insulin. A FATEFUL MEETING

‘My blood glucose control wasn't wonderful,’ Murray remembers, ‘and it was my wife Lynn who spotted that the local diabetes society was having a meeting. She told me in no uncertain terms that I was going to it.’ It was 1996. Murray went along and, next thing, was roped into the committee. He laughs as he remembers. ‘I asked, “does that

involve much?” And they lied and said, “No”!’ He became passionate about this voluntary work and, in 1998, accepted the position of Waikato Diabetes Society president. ‘A few years later, I got shoulder tapped: would I be interested in standing for national vice president at the AGM? ‘I said, “What does the national vice-president do? And they lied – again – and said, “Oh, not very much at all!” ‘So I was national vice president for two years, then national president for three years.’ By then, the Waikato Diabetes Society had become a branch of Diabetes NZ. ‘I came back to the branch as Chair.’ Over his more than 20 years of involvement, Murray has also been a regional representative on the Advisory Council, and in 2008, he was made a life member of Diabetes NZ. “BLOKES CAN COOK”

One of Murray’s pet projects over the past two years has been Blokes Can Cook, a nutrition and wellness programme for older men, in which Diabetes NZ partners with Age Concern. The course runs for four mornings, with Diabetes NZ Waikato Branch presenting one full session. Other organisations that present include the Heart Foundation. ‘It's usually me and sometimes another volunteer. We prepare very simple meals that men can have a go at.’ The programme has personal resonance for Murray. ‘It's aimed at men who had wives

Murray (left) at the farewell dinner thrown for him by Diabetes NZ Waikato Branch.

or partners who cooked for them until their circumstances changed – their partners have passed away, or they’re now cooking for wives and partners who are no longer able to cook. ‘This is what happened with me. My wife has muscular dystrophy and can no longer safely cook. So this is my project to help other blokes who are in the same situation.’ At Blokes Can Cook, Murray also presents on types of carbohydrate and goes through Diabetes NZ's healthy eating resources. ‘It's a good programme. We're talking with men in their 60s plus. They’re getting into that age group when they are at higher risk of diabetes. So if we can teach them how to cook healthy food rather than buying takeaways, so much the better.’ Diabetes NZ is indebted to the time and energy that Murray so willingly invested into our organisation at both national and regional levels.

DIABETES WELLNESS | Spring 2021

Care

Pharmac launches pioneering campaign A new campaign from Te Pātaka Whaioranga – Pharmac will raise awareness and encourage Māori and Pacific people with high-risk type 2 diabetes to access equity-funded medicines through their GP.

our well-known and respected Māori and Pacific personalities who either live with type 2 diabetes or have whānau members who have it will head the three-month campaign. Kaumātua Phil Merritt, rugby league star Adam Blair, entrepreneur Makaia Carr, and playwright and filmmaker Aroha Awarau will all encourage whānau to visit their GP to see if this medicine is right for them. Trevor Simpson, Chief Advisor Māori for Pharmac, says they have used a broad range of whānau to connect with multiple demographics to ensure the campaign reaches as many people affected by type 2 diabetes as possible. ‘We have been listening, and people with diabetes, their whānau, and health professionals have told us that there is a need for these medicines (Empagliflozin and Dulaglutide) to be funded to help manage the growing health problem of type 2 diabetes in Aotearoa,’ says Simpson. A PHARMAC FIRST

This campaign is a first for Pharmac, not only in its specific reaching out to Māori and Pacific peoples, and its use of different marketing channels, but also in the way it indirectly addresses equity of access through policy. The theme of the campaign is ‘You Are a Priority’.

DIABETES WELLNESS | Spring 2021

Pharmac’s new central values: Whakarongo Listen Tūhono Connect Wānanga Learn together Māia Courage Kaitiakitanga Preserve, protect and shelter our future

Phil Merritt Makaia Carr

With mortality rates for Māori with type 2 diabetes seven times higher than non-Māori, and the prediction that one in four Pacific people will have the disease in 20 years – this equity funding is there to make sure there is fairness in the health system. ‘There are no hoops to jump through. We’re making it easier for people to get their medication,’ says Simpson. The list price for these medicines ranges from $60 to $115 a pack, but because they are now funded people

will only pay $5 for their prescription. Through this campaign, Pharmac hopes to increase awareness of these diabetes medicines and to develop a clearer understanding of how to further connect with Māori and Pacific communities about future medicines as they continue to address equity issues. The campaign starts in early August and runs until October. It will appear on Māori TV, national newspapers, posters, digital ads, Zui panels and Facebook.

CHOOSE EASY A simple and easy solution to monitor glucose1† †In people with insulin-requiring diabetes.

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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.

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Diabetes Youth

INSPIRED TO CARE

OUR 2020 JOHN MCLAREN AWARD WINNERS Matt Slemint

Studying nursing at Otago Polytechnic In 2020, Diabetes NZ broke with tradition and awarded two John McLaren Awards in the Academic category. Both winners, Madeleine Lord and Matt Slemint, were outstanding – and both had set their sights on studying to become healthcare professionals.

DIABETES WELLNESS | Spring 2021

att has been playing guitar for 10 years. He says, ‘There are just a few things I hold very dearly because I did them before I was diagnosed with type 1. That’s why I love playing the guitar so much – I started before I was diagnosed. It’s like a remembrance back to before.’ He was diagnosed six years ago, at 12. ‘A lot of the time before then I don’t quite remember, but what I do remember is playing guitar and going skiing. So I love skiing as well. They’re my two things that take me back.’ Living in Ōamaru, he was lucky to be able to go on the youth skiing camps that the Otago branch of Diabetes NZ organises each year. But guitar was all year round. ‘Guitar, for me, has become an outlet. When things turn to custard, I turn to the guitar. It’s got me through a lot of stuff. I just hop on my guitar and let it out. It really helps.’ He thought briefly about pursuing a career in music. ‘I wish I could

sing. If I could, I’d throw everything else down the drain and be off busking. But unfortunately, I can’t quite sing!’ DECIDING ON NURSING

‘From a young age, I’ve always been interested in health,’ says Matt. He jumped from one career idea to another. ‘I had a fascination with animals, and I thought I might end up being a vet one day, then I got a dog and realised I’m too much of a sook to ... you know.’ He considered emergency medicine and med school, before settling on nursing as a pathway. He’d realised how much he appreciated the nurses involved in his own diabetes care. ‘They put in so much work and they care

deeply.’ He admits that sometimes he’s felt specialists don’t take his own knowledge about his body seriously. ‘Then you talk to the nurses, and they’re the ones that actually listen, sometimes. ‘Also, I think the hardest part of diabetes is the mental side of it. The anxiety around it flares up really fast, and nurses understand.’ It was no hardship at school to study the subjects he needed to get into nursing school – chemistry and biology. ‘I always loved my sciences, and that was fuelled by the teachers I had. I went to Waitaki Boys, and their science department is second to none. The teachers are phenomenal. Science isn’t for everyone, but I had a soft spot for it and the teachers were great.’ His final year at school – 2020 – was tough for him, and not only because of Covid-19. ‘You get to your last year, and you realise you’re just over it. You’ve worked stupidly hard the whole time throughout school, and you’re at the end. You feel like you’ve finally done it all, you get your prefectureship and all your awards at the end of year 12, and then you get into year 13, and you’re like – I just want to leave. You just want to get out there and get into the real world.’ NURSING SCHOOL LIFE

Moving to Dunedin has been the fresh start Matt was desperate for: ‘New people, new friends, new everything. I’ve met some really amazing people – doing midwifery, occupational therapy, architecture, engineering.’ He lives in a hall of residence. ‘What’s good about it is you meet tons of people. The hall I’m in, there are a couple of options. You can have the traditional dorm style, with the long hallway and the rooms at the side, and then there’s the apartments. Each one’s like a little four-bedroom complex with a

lounge. It’s kind of like a flat.’ Matt chose the apartment option. ‘I thought, well, the best way to meet people is to force yourself to, by living with them. And I’m very, very lucky with who I got put with. They’re really cool people.’ His nursing degree is three years long, and, at the moment, he’s still unsure what area of nursing he’d like to move into. ‘The lecturers say everyone arrives wanting to do ED or Paediatrics. I really want to try theatre or mental health maybe.’ DIABETES MANAGEMENT AWAY FROM HOME

Thinking about how you’ll organise your meals when you move away from home is a bigger deal for young people with diabetes than for their non-diabetic peers. Matt says, ‘To make it easier for myself as I settled in, I bought the catering package the hall offers.’

‘Moving away from home and not having your mum looking after you or there to talk to, it forces me to really think about what I’m doing.’ He had to weigh up the pros and cons first though. He knew if he cooked for himself he’d be able to control what he was eating and would always know how many carbs he was consuming. But he was worried that, if he got too busy, he wouldn’t cook, ‘and then I’d start eating crap.’ Buying the catering package means a little less control, but he always knows there is decent food waiting for him. ‘I have to try and figure out the carbs for all the different meals that I get. There’s a lot of chicken and rice, which is

amazing. But there’s also lots of pasta which is always hard for me. I get delayed highs with pasta. But I think you can’t keep avoiding it. It’s good to force yourself to figure it out.’ He’s surprised himself by how easily he’s taken fuller responsibility for his own diabetes management. ‘Moving away from home and not having your mum looking after you or there to talk to, it forces me to really think about what I’m doing. ‘I thought I’d struggle a lot with getting in good routines and being healthy, but I’ve found all that pretty good. I think I’ve grown up enough to understand that I’ve got to take ownership of this now, as I always have tried to. I know you’ve got to look after yourself.’ The diabetes clinic he goes to now is close to the hall he lives in. ‘I don’t play clinic by ear. I prep beforehand, unload my pump, check all my levels, and come up with an idea of what I’d like to change before going in. It’s just taking agency. ‘I’m in a transition clinic. They do that for the students because, moving away from home, that’s quite big. They don’t want to chuck you straight into adult care. Going into a transition clinic, you get a bit more support.’ That said, ‘The nurse and the doctor thought I was quite on to it and they wanted to put me into the adult clinic straight away. I was like, hold on! We’re not doing that yet! At the end of the day, I’m still a student, still young. And I’m going to go and do the things everyone else does.’ Matt enjoys participating in clinical trials, and, as well as finding them fascinating, it’s enabled him to access various new diabetes technologies. Currently, he’s using a Dexcom CGM. He says, ‘Going back to finger-picking ... almost anything’s better than that once you’ve been on a sensor.’

DIABETES WELLNESS | Spring 2021

This is despite the fact that he has difficulties with sensors shutting off sooner than they should and has to think hard about where he puts them. ‘I have a problem trying to gain weight. With the sensor, if there’s not enough fat where it’s placed, then the filament goes in and sort of bends on the muscle, and it doesn’t last as long. Most of them will cut off before eight days. This one that’s on at the moment, I think’s it’s on its ninth day, so I’m pretty rapt with that. I’ve had a few where they’ve only lasted two days.’ He finds his blood sugar control is better when he’s using a sensor, and he’s noticed that it’s easier for him to keep his levels steady than for other students with type 1 who aren’t using CGMs. RECEIVING THE JOHN MCLAREN AWARD

Matt remembers, ‘I was really struggling last year. Things had got on top of me. And when I got this award, it was awesome.’ He says, ‘Obviously I applied for it because of the financial support – that's no secret.’ He also thought it would be a validation of his academic achievements. But as soon as he heard he’d received it, he realised it meant a lot more to him than that. It was a concrete acknowledgment of the extra challenges he faces as a young person striving to live with diabetes, and of his perseverance. ‘You can be as smart, talented, and gifted as you like, but all of that means nothing when your mental health is suffering. I like to think I’ve achieved well academically, and some believe I have a talent with my guitar, but I’ve had dark times, and I know all these so called “important things” go out the window. Nothing’s more important than being positive, happy, and proud. ‘When I got the award, I was like, oh hell, this is actually pretty bloody cool. I was rapt.’

DIABETES WELLNESS | Spring 2021

Madeleine Lord

Studying Health Science at University of Otago

adeleine has shifted all the way from Auckland to Otago to study this year. ‘My parents both went away for uni, so they were really supportive of me doing that, too.’ She’s loving her first year. ‘Studying health science means that, at the end of this year, I can decide which path I want to go on to.’ One of the options – for those who get the very highest grades – is med school. Madeleine says, ‘If I got offered a place, I definitely wouldn’t turn it down. That’s the goal. But if not, I’ll probably end up doing a biomedical science degree and maybe applying for medical school again at the end of that. A lot of people do it postgrad, and the entry requirement isn’t quite as high.’ She says that, in a way, it can be better to do med school that way, as you have more life experience when you go into it. COMING THROUGH COVID

Madeleine attended Carmel College in Auckland’s Milford. She loved it. ‘I did sciences all the way through to year 13. But I also did drama and English on the side.’ She was made an academic prefect in 2020 – an interesting year for it, thanks to Covid-19. The prefects started innovating. ‘The whole leadership team and prefect team did a lot of things to help all the students to keep going throughout lockdown. Me and the other academic prefects, we compiled a list of lots of our best study techniques for staying motivated while you’re at home.

‘We did a website where we compiled links and study resources that we ourselves had found useful over the years. And then, when we weren’t in lockdown, we organised tutoring programmes and things like that.’ As for her own school work, ‘Covid was a change in lifestyle. At first, I found it quite nice to take a step back and have more of a simple life with not so much going on all the time. But it quickly grew a bit old.’ On the positive side, ‘There was a lot more self-directed learning. I found it good working to my own schedule, but I know a lot of girls struggled with that because it was so different.’

LIVING WITH TYPE 1

Madeleine was diagnosed with type 1 diabetes in 2010, when she was six. ‘I can’t remember that much from beforehand, which I’m quite grateful for.’ She thinks her diabetes influenced her interest in health and medicine. ‘Just being in hospitals a bit more than the average child and seeing a bit more of that side of things made me interested. Also, I was always interested in the science behind diabetes. I’ve always liked the science side of things.’ When it comes to work and socialising, settling into university hasn’t been too hard for Madeleine, but ‘the diabetes side has definitely been harder. It’s the first time I’ve fully been away from my parents, and, in the halls of residence, carb counting is really hard. The food is delicious, but it can be quite fatty and high carb, and there’s the odd meal where I just have to accept it’s going to be tricky to manage my levels.’

Amazingly, she found that in her dorm she was only three doors away from another student with type 1. ‘We talk to each other about things and complain about random lows and highs. It’s nice to have someone to talk to here.’ Like Matt, Madeleine is currently using a Dexcom CGM. When she’s between CGMs, she finds the patchy information that the finger-prick tests offer her to be frustrating. For example, ‘When I wake up, I want to know what happened with my levels overnight.’ She considered using the Otago Student Health Service for her diabetes appointments, which would have allowed her to stay with the same DHB she had growing up. ‘They have some diabetes nurse specialists at Student Health, but I ended up deciding to transfer completely from Waitematā DHB to Southern DHB. It means I have an endocrinologist as well.’ She says Southern DHB seems to offer a really good service, ‘and the wait times here are a lot shorter.’

THE JOHN MCLAREN AWARD

Madeleine applied for the John McLaren Award mostly to help cover her accommodation fees. ‘I was so happy when I got the award – I immediately texted my whole family group chat. Everyone was celebrating. It was really nice.’

Who will be the 2021 John McLaren Award winners? Diabetes NZ congratulates all our 2020 John McLaren Youth Award winners: Matt Slemint, Madeleine Lord, and Yogya Mehra who received the Award in the Sports category. If you or a young person you know has diabetes and is pursuing academic, cultural, or sporting excellence, we encourage you/them to apply. For more information, see page 12.

EAT WELL LIVE WELL

Healthy food for all weathers! 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 | Spring 2021

Research

Research ROUNDUP We bring you some of the latest local and international research news impacting on diabetes care. Pre-diabetes prevalence and associated factors in New Zealand school children Pre-diabetes and type 2 diabetes are increasing in children, and early identification of pre-diabetes is vital to stopping it progressing to type 2. This New Zealand study collected data from a subset of the 685 children who took part in the Children's Bone Study (a cross-sectional study of children aged 8 to 11 years in Auckland). HbAlc was measured, as was weight, height, waist circumference, and body-fat percentage. Information on ethnicity and physical activity was collected through questionnaires. The study found that pre-diabetes was present in 71 children – 16% of the total group. It was most prevalent in South Asian children, followed by Pacific children and then Māori children. It was also associated with high body-fat percentages and low physical activity. The researchers say, ‘The prevalence of prediabetes in children of South Asian and Pacific Island ethnicities suggests the need for appropriate and timely identification and intervention to halt the progression to T2DM.’ Endocrinologist Professor Jeremy Krebs comments that the figures shown in this study ‘mirror the difference between ethnicities seen in adults and, once again, illustrate the inequities in health in New Zealand.’*

* Diabetes & Obesity Research Review, Issue 144, 2021.

DIABETES WELLNESS | Spring 2021

Cardiovascular and Renal Disease Burden in Type 1 Compared With Type 2 Diabetes: A Two-Country Nationwide Observational Study Type 1 diabetes and type 2 diabetes both increase the risks of cardiovascular and renal (kidney) disease. A Scandinavian study, based in Norway and Sweden, set out to compare the difference between those with type 1 and type 2. They followed 59,331 patients with type 1 and 484,241 patients with type 2 – aged 18 to 84 years old – over a mean period of 2.6 years. The study found that adult patients with type 1 had an overall greater risk of cardiorenal disease than those with type 2. They also found a greater risk of all-cause death among those with type 1 at middle to older ages and a greater risk of stroke at younger ages. The study found that the total burden and risks were greater among patients with type 1 diabetes compared with those with type 2. Professor Jeremy Krebs comments, ‘It is a poignant reminder that we still need to aggressively manage cardiac risk factors in people with type 1 diabetes.’* doi.org/10.2337/dc20-2839

Iwi (tribal) data collection at a primary health care organisation in Aotearoa A survey of National Hauora Coalition general practice clinics set out to understand whether iwi data was being routinely collected at a primary healthcare organisation level, how it is being collected, and what the results are. The study found that nine of the 33 clinics studied (27%) sought iwi name(s) with a specific question on their enrolment form, and that the National Hauora Collective had iwi data for only 13% of its Māori enrolments. The researchers say, ‘Indigenous peoples’ rights include the right to self-determine one’s identity. For Māori, this includes self-assignment of ethnicity, and traditional identities such as Iwi (tribe). ‘…This is the first study to describe the quantity and quality of Iwi data collection in NZ primary care. Standard procedures for collecting, recording and using Iwi data are being developed by the National Hauora Collective PHO. These could inform national protocols to optimise the quality of Iwi data.’ doi.org/10.1071/HC20037

Efficacy of telemedicine for persons with type 1 diabetes during Covid-19 lockdown In March 2020, the Italian government began a Covid-19 lockdown. Outpatient visits were limited and ‘telemedicine’ – using remote technology for virtual appointments with healthcare professionals – was encouraged. The researchers analysed data from continuous or flash glucose monitoring systems shared through different cloud systems during the lockdown by patients with type 1 diabetes. It compared data four weeks before and four weeks after a remote visit to a healthcare professional. The study found that, during the four weeks following the virtual visit, there was an improvement of glycemic control. It concluded, ‘A structured telephonic visit appears to be an effective way to replace or integrate routine visits in particular conditions … The Covid-19 emergency made this type of remote control necessary but once the emergency was over, this type of approach could be offered as an alternative or integration to the usual visit. ‘… The strategy changes imposed by the Covid-19 emergency could open new avenues in the treatment of sick patients.’

Telehealth in type 1 diabetes A US review commented that ‘The role of telehealth in the care of people with type 1 diabetes (T1D) has expanded dramatically during the coronavirus pandemic, and is expected to remain a major care delivery modality going forward.’ The researchers found that ‘Telemedicine for routine T1D care has shown equivalence to standard in-person care, with respect to glycemic control, while also increasing access, convenience, and satisfaction. Telehealth use promotes increased engagement of adolescents with T1D.’ Furthermore, ‘Telehealth platforms have successfully been used in the care of microvascular complications and to support mental health related to diabetes … As this care modality scales, it has the potential to increase access to high-quality diabetes care for many people with T1D. doi: 10.1097/MED.0000000000000600

A gift of a lifetime Every day, an average of 40 New Zealanders are diagnosed with diabetes. A gift in your will is a powerful legacy to ensure your desire to help and support people with diabetes lives on. No matter how big or small, your bequest will make a world of difference in helping Diabetes New Zealand to support the 250,000 New Zealanders with diabetes to live full and active lives.

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

Care

DIABETIC NEUROPATHY WHAT YOU NEED TO KNOW One of the most common complications of diabetes – both type 1 and type 2 – is neuropathy, which simply means nerve damage.

our nerves are the fibres in your body that send messages, electrically and chemically, between your body and your brain, so that your body knows what to do. Over long periods of time, high blood sugars can damage various nerve fibres in the body in different ways. We still don’t know the exact hows and whys of this, but research is ongoing, and there are clear recommendations and treatment options. There are three types of nerves that can be damaged: • ‘Sensory neuropathy’ is damage to nerves that detect touch or temperature. • ‘Motor neuropathy’ is damage to nerves that help with muscle movement. • ‘Autonomic neuropathy’ is damage to nerves that control the body’s involuntary actions, including digestion, breathing, and heart rate, among others. SENSORY NEUROPATHY

A person with sensory neuropathy may experience numbness, pain, tingling, or loss of feeling, often in the arms, legs, hands, and feet. The symptoms usually come on slowly and gradually – you may hardly notice them. Occasionally, however, there is sudden pain.

DIABETES WELLNESS | Spring 2021

For many reasons, feet are particularly vulnerable to neuropathy. Once neuropathy in legs and feet becomes advanced, the need for amputation is a real risk. This is why it’s so important for people with diabetes to get regular foot checks. For more about caring for your feet, see www.diabetes.org. nz/blog/steps-to-healthy-feet. MOTOR NEUROPATHY

A feeling of unusual muscle weakness is often the main symptom of damage to motor nerves. Proximal neuropathy is one of the more common motor neuropathies. It affects hips, buttocks, and thighs. It weakens the legs, and can make it difficult to walk or to stand up from a sitting position. Another symptom is sudden pain in your hip, buttock, or thigh. Proximal neuropathy is seen most often in older people. With careful blood sugar management and good care, including medication and physiotherapy, proximal neuropathy can improve over months or years, although it may never go away altogether. AUTONOMIC NEUROPATHY

This involves damage to nerves in one or more organ systems, such as the cardiovascular system, the gastrointestinal system, the reproductive system, or the urinary system. Autonomic neuropathy is one of the least recognised complications of diabetes. There are many possible symptoms, and autonomic neuropathy can often be missed and diagnosed as something else. Anyone with diabetes, especially

if they have also been diagnosed with sensory or motor neuropathy, should also keep an eye out for or be checked for symptoms of possible autonomic neuropathy. Signs and symptoms of autonomic neuropathies can include: • resting tachycardia (a rapid heartbeat even when relaxed) • ongoing hypoglycaemia unawareness • postural hypotension (sudden blood pressure drops when moving from lying to sitting or sitting to standing) • gustatory sweating (excessive sweating when eating, or even sometimes when thinking about eating) • sexual dysfunction (such as erectile dysfunction or vaginal dryness) • neurogenic bladder (a lack of bladder control because of a nerve problem) • gastroparesis (where food stays in the stomach longer than it should) • other gastro-intestinal issues, such as diarrhoea • difficulty swallowing food. FOCAL NEUROPATHY

Diabetic neuropathy often affects a wide range of nerves at once, but focal neuropathy is when there is damage to just one nerve or a small group of them. It usually, but not always, affects the torso, leg, or head, particularly the eyes. Symptoms can include double vision or other difficulties focusing, aching behind the eye, paralysis, or pain in the lower back or other places.

HOW IS NEUROPATHY DIAGNOSED?

People with diabetes, particularly those who have lived with it for many years, should be screened for neuropathy at least once a year by their GP or other healthcare professional. Diagnosis may be based on the symptoms you describe and a physical exam. You may also need your blood pressure, heart rate, strength, reflexes, and/or sensitivity tested. Referral to a specialist will likely involve further tests. If you have diabetes, it’s most likely that this will be the cause of neuropathy. However, there are other possible causes, such as infections, toxins, injuries, vitamin B12 deficiency, and other autoimmune conditions. Long-term hypothyroidism (underactive thyroid), for example, can cause neuropathy.

HOW TO PREVENT AND TREAT NEUROPATHY

Keeping blood sugars as regulated as possible is all-important when it comes to protecting your nerves. Aim for HbA1c levels of <55 mmol/mol (but don’t beat yourself up if you don’t achieve this!) High cholesterol and high blood pressure are also known to make neuropathy worse and are important things to stabilise. If you are diagnosed with neuropathy, focusing on diet and exercise and also looking at possible different medication regimens will be important. Lowering your overall blood sugar levels can help slow the progress of neuropathy and sometimes even reduce or reverse symptoms. There are also a number of medicines that can help relieve neuropathy pain. Other important things to do for neuropathy are: • make sure you get enough sleep • build time for rest into your life • talk with family, friends, a counsellor, or your healthcare professional if you are feeling down about it.

DIABETIC NEUROPATHY: COMMON SYMPTOMS Loss of sensation

Numbness and tingling in hands and feet

Muscle weakness

Dizziness when standing up Erectile dysfunction or vaginal dryness

Inability to sense low blood sugar

THE EXTRA BENEFITS OF EXERCISE

Exercise has many benefits for those suffering from neuropathy. It lowers blood sugar levels and helps with weight loss, but there’s also good evidence that regular exercise can help reduce neuropathic pain as well as increase sensation in parts of the body that are numb and strengthen areas that are weakened. The best routine includes a mix of strength and stability exercises (for example, tai-chi) and aerobic exercise (such as walking briskly).

WHAT IS NEUROPATHY AND AM I AT RISK?

1 Over long periods of time, high blood sugars can damage various nerves in the body in different ways. 2 'Sensory neuropathy' can cause numbness, pain, and/or tingling, often in the arms, legs, hands, and feet. 3 'Motor neuropathy' can make muscles feel unusually weak. Hips, buttocks, and legs are often affected. 4 ‘Autonomic neuropathy’ is damage to nerves that control the body’s involuntary actions, e.g. digestion, breathing, and heart rate. It can be tricky to diagnose. Symptoms may include digestive problems, sudden blood pressure drops, rapid heartbeat, sexual dysfunction, hypoglycaemia unawareness, and others. 5 You should be screened for neuropathy at least once a year. Check your feet daily. 6 Aiming to keep blood glucose levels within a normal range is the best prevention and treatment for neuropathy. There is also increasing evidence that exercise helps control neuropathy in multiple ways. DIABETES WELLNESS | Spring 2021

Your Diabetes NZ

MAKING OUR VOICES HEARD On 30 June, Diabetes NZ gave an oral presentation to the Health Committee, urging the government to fund continuous glucose monitors (CGMs) for those with type 1 diabetes.

Above: Our wonderful team of advocates for CGMs and FGMs at the Health Committee hearing on 30 June, 2021.

early 30,000 people signed Diabetes NZ’s 2020 petition, which asked for important new medications to be funded for type 2 diabetes and for CGMs to be funded for people living with type 1. Covid-19 delayed our associated presentation to the government’s Health Committee, and while we were waiting to present, the government listened to some of the pleas being made and announced that new type 2 medications would be funded by Pharmac. We were deeply grateful for this result. However, we still have a lot of work to do to get CGMs funded for those who need them. We firmly focused our presentation on this, and we left feeling heard. PRESENTING THE STARK FACTS

Diabetes NZ Chief Executive Heather Verry presented first, followed by Associate Professor Dr Ben Wheeler, type 1 warrior Ruby McGill, and eight-year-old Eddie

DIABETES WELLNESS | Spring 2021

Writes – all strong advocates for the type 1 community. Heather opened by describing the enormous inequity that needs to be resolved: only 30% of people who would benefit from CGMs are able to afford them. She pointed out the especially significant impact this has on children with diabetes and on their whānau. She asked the Health Committee to recommend to Pharmac that funding should be provided for both CGMs and FGMs (flash glucose monitors) for all people with type 1 diabetes without exception, to enable them to lead as normal life as possible. This would also significantly reduce the risk of long-term complications from diabetes and the personal as well as social costs of regular hospitalisation. Associate Professor Ben Wheeler, a paediatric endocrinologist, followed up with medical evidence, talking about his work with CGMs on their own, as well as paired with insulin pumps to form an ‘artificial pancreas’ system.

Movingly, he said, ‘We’ve done a lot of research on continuous glucose monitoring systems and those [artificial pancreas] systems, and they are the only systems I’ve researched where people cry when you take them off them at the end of the research. They are completely life changing. It’s not a “nice to have”, CGM monitoring. It’s an essential part of our fight against diabetes, particularly type 1 diabetes, which affects over 20,000 people in New Zealand.’ Next, Ruby demonstrated the finger prick process that everyone with type 1 has to go through many times a day when they don’t have access to a CGM or FGM. She asked the committee to imagine what this would be like. She also explained the confusing lack of information that finger-prick testing gives you about what your body is doing in comparison to the information that someone with diabetes or their caregivers get from CGM technology. In response to a query from the panel, Ruby explained that one

of the biggest benefits of CGMs was simply the ability to sleep. As Ben had also said, the fear of going low over night, causing unconsciousness or even death, is something that isn’t often talked about. However, it is something people with type 1 and their families who care for them live with constantly – that is, unless they have the peace of mind offered by CGM technology. Emily Writes’ son Eddie presented last, impressively explaining the massive impact that being able to use a CGM has had on his own life. WHY ARE WE LAGGING BEHIND?

CGMs became funded in Australia after the death of a young child. New Zealand is now the only Western country in the world that doesn’t fund CGMs or FGMs. We told the panel that, in Australia, the latest data suggests that children and adolescents using funded CGMs are 2.5 times more likely to reach healthy blood

glucose targets. For those meeting targets, this could mean a 10- to 20fold reduction in complications risk. It shouldn't be a luxury to live well with type 1 diabetes in NZ. As Heather said, ‘In 2021, the ambulance at the bottom of the cliff mentality is not acceptable.’ We've seen how proactive the government has been to protect Kiwis from Covid-19 and the potential long-term health complications. What about people living with type 1 diabetes?

STAY UP TO DATE WITH THE CAMPAIGN FOR FUNDED CGMS

See our presentation at www.diabetes.org.nz/petition-hearing See Emily Writes’ description of the presentation at emilywrites.substack. com/p/eddie-shares-his-story-withpoliticians. For updates on the response to the presentation, keep an eye on our Facebook page at www.facebook. com/diabetesnz

DIABETES WELLNESS | Spring 2021

Last word

Fundraise for diabetes youth Team Diabetes is at it again – this time fundraising for the Live Brave Mana Ora Auckland programmes and camps. The team will take part in the ASB Auckland Marathon, on Sunday 31 October, 2021. This colourful, iconic running event is turning 30 years old and promises to be a a huge celebration. Whether you want to join Team Diabetes yourself or encourage others you know to do so, find out more at www.diabetes.org.nz/aklmarathon.

PHOTO: AUCKLAND MARATHON

PHARMAC PART-SUBSIDIES FOR GLUTEN-FREE FOODS

n our Winter issue, we ran an article about autoimmune illnesses that people with type 1 diabetes may also be diagnosed with. A reader responded with an enquiry about the part-subsidy offered to people with coeliac disease, which may enable them to buy subsidised gluten-free foods. To receive this part-subsidy, you need to obtain a Special Authority Number from a GP, dietitian, or specialist, and to be eligible for that, you need to have been diagnosed with coeliac disease by biopsy. However, because of the current regionally divided health system, the usefulness of the subsidy differs depending on where you live.

DIABETES WELLNESS | Spring 2021

SOUTH ISLAND AND THE HUTT VALLEY

If you live in the South Island, or in the North Island’s Hutt Valley, the news is good. You may be eligible for a prescription through the excellent Hospital to Home (H2H) programme. To find out more, and for application forms, go to www.crombie-price. co.nz/hospital-prescriptions.html.

NORTH ISLAND

For those living in North Island areas other than the Hutt Valley, the partsubsidy may be less useful. By the time you pay a prescription charge from your GP, plus a pharmacy dispensing charge, the subsidy itself may not be worth it. However, if you are interested, we suggest you talk with your pharmacist or healthcare professional to find out more.

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Diabetes Wellness Spring 2021

Articles inside

Last Word

Inspired to care

Living to tell the tale

Enjoy a Garden Workout

Health in the heartland

PASSION PROJECT

Pharmac launches new campaign

Making our voices heard

RESEARCH ROUNDUP

Diabetic neuropathy – what you need to know

YOU CAN'T BEAT BEET!

MEALS FOR ONE

Murray Dear: Two decades of dedication to diabetes

EDITORIAL

100 years of insulin

UPFRONT: Fieldays 2021

Tribute to Sir Eion Edgar

Call for applications