Diabetes Wellness Spring 2022 by Diabetes New Zealand

wellness DIABETES

SPRING 2022 $8.00 INC. GST

DIABETES NEW ZEALAND | DIABETES.ORG.NZ

YOUTH WHO INSPIRE • APPLICATIONS OPEN FOR AWARDS • SIR JIM MANN - PATRON OF DIABETES NZ HEALTH REFORMS • CARE FOR YOUR BACK • SUGAR-FREE DRINKS • SNEAKER FRIDAY IS BACK

ATAWHAI EDWARDS

FITBIT MOVEMEANT CHALLENGE WINNER ON A MISSION

SPRING GREENS GROW & COOK THEM

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

A painless 1-second scan of the FreeStyle Libre sensor makes checking your glucose easier. » Easy to use and apply. » Sensor is small, hardly noticeable . 2

» No finger prick calibration. Ever. » Sensor is comfortable to wear for up to 14 days. » Water resistant so you can swim, shower, or exercise3.

FIND OUT MORE |

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

FreeStyleLibre.co.nz

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

POLY 14613 (NZ)

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

Contents SPRING 2022

VOLUME 34 | NO 3

4 EDITORIAL 5 UPFRONT: Our new DNZ Patron

5 UPFRONT: Diabetes NZ Awards – call for nominations

20 MOVE: Simple steps to care for your back 23 ADVOCATE: Healthier food and drinks for schools – Diabetes NZ's submission 24 NOURISH: Low GI rice

6 MOVE: Fitbit MoveMeant Challenge 2022

26 DIABETES YOUTH: John McLaren Youth Award winners

10 GROW: Easy container gardening

30 NOURISH: Four ways to eat your greens

34 YOUR DNZ: VIBE – our new Champion Sponsor 36 CARE: Meet Diabetes Community Coordinator Kylee Stok 38 RESEARCH: Partnership key to preventing type 2 diabetes

13 CARE: Hayfever and diabetes 14 CARE: What do the health reforms mean? 16 DIABETES YOUTH: Laura Snowden – forging connections as new NZ IDF representative

19 RESEARCH: Diabetes and hydration – the latest research findings

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Editorial

e’ve all learnt a lot over the last few years about the importance of human connections. As a parent, wife, and member of the wider diabetes whānau, it’s become increasingly obvious that being in touch with the right professionals, services, and support groups is vital. As Diabetes NZ’s vision to introduce Hauora Kaimahi – Diabetes Community Coordinators – becomes a reality in more areas across the motu, we look forward to helping people affected by diabetes connect to the things they need to live well. It’s imperative that our community has timely, culturally appropriate, and informed access to medicines, technologies, and support when they need it. To that end, we also hope that the new health reforms, with their community focus, will connect with Diabetes NZ’s own efforts. Access to the best tools for living well seems an obvious requirement. It’s not only about life-changing benefits for individuals and their whānau but also about cost savings for the health system. The fact that we’re still advocating for funded access to simple, affordable, life-changing CGM technology for people with diabetes is frustrating. However, we won’t stop. We’ll continue to advocate to politicians, Pharmac, health professionals, and the general public. We urge our supporters to also keep raising the issue with GPs, pharmacists, and anyone who will listen. In this issue, you’ll find more about our Hauora Kaimahi initiative, as well as an explainer about the reforms to our health system that came into effect on 1 July. We also profile some inspiring young people living with type 1, including Aotearoa’s newest International Diabetes Federation Young Leader, Laura Snowden, and the 2021 John McLaren Youth Award winners. All of them have something to say on the topic of CGMs! On another note, spring is in the air and soon pollen will be as well. In this issue, we look at how hayfever can affect diabetes. More positively, it’s also the perfect season to grow and cook your own greens. You’ll find articles on this and much more inside. LYNDAL LUDLOW

Advisory Chair, Diabetes NZ

DIABETES WELLNESS | Spring 2022

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

DIABETES NEW ZEALAND Board Chair Catherine Taylor Chief Executive Heather Verry Diabetes New Zealand National Office Level 10, 15 Murphy Street, Thorndon, Wellington 6011 Postal address PO Box 12441, Wellington 6144 Telephone 04 499 7145 Freephone 0800 342 238 Email info@diabetes.org.nz Web diabetes.org.nz Facebook facebook.com/diabetesnz Instagram instagram.com/diabetes_nz

DIABETES WELLNESS MAGAZINE Editor Johanna Knox editor@diabetes.org.nz Publisher Diabetes New Zealand Design Rose Miller, Kraftwork Print Blue Star Magazine delivery address changes Freepost Diabetes NZ, PO Box 12441, Wellington 6144 Telephone 0800 342 238 Email info@diabetes.org.nz Back issues issuu.com/diabetesnewzealand ISSN 2537-7094 (Print) ISSN 2538-0885 (Online)

ADVERTISING & SPONSORSHIP Business Development Manager Jo Chapman Email jo@diabetes.org.nz Telephone 021 852 054 Download the Diabetes Wellness media kit: http://bit.ly/2uOYJ3p

Disclaimer: Every effort is made to ensure accuracy, but Diabetes NZ accepts no liability for errors of fact or opinion. Information in this publication is not intended to replace advice by your health professional. Editorial and advertising material do not necessarily reflect the views of the Editor or Diabetes NZ. Advertising in Diabetes Wellness does not constitute endorsement of any product. Diabetes NZ holds the copyright of all editorial. No article, in whole or in part, should be reprinted without permission of the Editor.

Advocate for diabetes communities becomes Patron of Diabetes NZ

iabetes NZ is delighted to announce that Professor Sir Jim Mann (KNZM, PhD, DM, FRACP, FRSNZ) is our Patron. He steps into the role after the sad loss of his predecessor, Sir Eion Edgar. Board Chair Catherine Taylor says, ‘Sir Jim’s drive and passion to advocate for improved care and support for people with diabetes is second to none. We are very honoured he has agreed to be our patron and continue his work with Diabetes NZ.’ Jim has been a friend, supporter, and medical adviser to Diabetes NZ for many years – as well as a tireless and vocal campaigner for better diabetes policy and health care. He has worked on several

campaigns alongside Diabetes NZ. He is a world-leading researcher: his studies into nutrition, diabetes, and heart disease appear in more than 400 scientific publications and 90 book chapters. He has also only recently retired from a long clinical career. Jim is: • Director of Healthier Lives – He Oranga Hauora National Science Challenge • Past Director of the Edgar Diabetes and Obesity Research Centre (EDOR), and now co-director • A Heart Foundation board member • Part of the World Health Organisation’s nutritional guidance advisory group and

NEW ZEALAND LISTENER MAGAZINE/DAVID WHITE

Upfront

its expert advisory panel on nutrition. In 2022, he was appointed a Knight Companion for services to health. Jim says, ‘I acknowledge and am very aware of the people who have filled this role before me. I’m honoured to be following them.’ He says, ‘I’ll be doing my best to support Diabetes NZ in whatever way I can in this new role.’

DIABETES NZ AWARDS CALL FOR APPLICATIONS AND NOMINATIONS

iabetes 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. 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 2022, 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.

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 are always part of such a contribution to diabetes. THE LIFE MEMBERSHIP AWARD

The Diabetes NZ Life Membership is the organisation’s most prestigious honour. It is conferred on someone in recognition and appreciation of outstanding service for the benefit of people with diabetes. To ensure this award remains a distinguished and exceptional honour, there are a maximum of 40 Life Members at any one time. If someone you know deserves this, please nominate them.

THE SIR CHARLES BURNS MEMORIAL AWARD

Have you been on insulin for 50 years or more? Diabetes NZ presents this award to anyone who can demonstrate that they’ve managed their diabetes for a continuous period of at least 50 years through insulin therapy. THE SILVER MEDAL AWARD

This award, initiated in 2021, is for anyone who can demonstrate that they’ve managed their diabetes for a continuous period of at least 25 years through insulin therapy. HOW TO APPLY OR NOMINATE

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/awards. Entries for all awards close 5pm, Monday 12 September. DIABETES WELLNESS | Spring 2022

Move

FITBIT MOVEMEANT CHALLENGE 2022

THE GREAT SCENIC STEPS CHALLENGE During May, for two weeks, 14 well-known challengers strapped on their Fitbits and took to the streets and tracks of beautiful Aotearoa, competing to outstep each other for the diabetes cause.

Below: Heather Verry presents Atawhai with the Fitbit MoveMeant Challenge trophy at Pōhara Marae.

ur challengers kept stepping right till the last minute, taking an incredible 3,284,400 steps in total, traversing 2502 kms, and raising more than $14,700. They shared their journeys on radio, TV, and social media, while we cheered them on. Sometimes the leaderboard changed daily, and some fierce rivalries emerged. However, one competitor stormed forward to take an early lead and didn’t stop. By the close of the Challenge, Tainui Live presenter Atawhai Edwards had cracked the previous Fitbit MoveMeant Challenge record by more than 100,000 steps – nearly 40,000 steps a day.

WINNER: ATAWHAI EDWARDS (NGĀTI KOROKI-KAHUKURA)

Type 2 diabetes is a cause close to the heart of Atawhai Edwards. Experiencing the loss of loved ones to the condition and seeing their suffering and that of their whānau has lit a fire inside her. Atawhai wants to see better approaches to healthcare and interventions for Māori affected by type 2, and she’s determined to do everything she can to help combat the condition and its impact – starting with her own whānau. Diabetes NZ CEO Heather Verry presented Atawhai with the Fitbit MoveMeant Challenge trophy at the 65th Poukai at Pōhara Marae

WHAT IS THE FITBIT MOVEMEANT CHALLENGE?

Diabetes NZ and Fitbit first ran the Fitbit MoveMeant Challenge in 2015 as part of Diabetes Action Month, to drive awareness of how increased exercise, weight loss, and diet changes can help prevent type 2 diabetes and support people living with type 1 and 2. A huge success, it became a standalone event in 2018. Celebrities, public figures, and business personalities across Aotearoa are invited to compete.

DIABETES WELLNESS | Spring 2022

on 19 June. She spoke of Atawhai’s achievements: ‘Atawhai started on day one determined to win. In total, Atawhai completed over half a million steps. She walked over 20 half marathons in two weeks. ‘As well as wearing her sneakers out, she took to the airwaves on Tainui Live to kōrero about the challenge and her personal journey, and also extended the kōrero via Instagram and Facebook. ‘Since the end of the Challenge two weeks ago, we’ve already heard of people who have been inspired by her to take on their own challenge. ‘She has made all of us at Diabetes NZ immensely proud to have her as a champion for diabetes awareness. Her mahi is vital not only to the wellbeing of this community but to all of Aotearoa.’ Atawhai Edwards is profiled in the winter 2021 issue of Diabetes Wellness.

Atawhai with her partner Jason and son Ihaia.

RUNNER-UP: ANA HUTCHINS

In the winter 2022 issue of Diabetes Wellness, we talked to Ana Hutchins, who shares her personal experiences with type 1 diabetes and kidney disease through her ‘T1 Kiwi’ Facebook and Instagram. Ana’s total Fitbit MoveMeant Challenge step-count came very close to cracking the last Challenge’s record. She says doing the Challenge was an amazing experience: ‘Wearing a Fitbit gave me such great insight into my daily life, along with many realisations. It's incredible how many times we mindlessly sit down when we could be getting in a few extra steps.’ Ana works as a nurse for an endodontist. She adds, ‘I’d thought I was on my feet a lot at work, but, in fact, I spend a good chunk of my day sedentary in surgery having to mentally be in the game more so than physically.

DIABETES WELLNESS | Spring 2022

‘Being involved in a challenge against others was such a great motivator to get stepping, and I became more aware of opportunities I could take throughout my day to get my steps up. It was a lot of fun – and my kids thought it was great having me constantly up chasing them around.’ Ana says, ‘I get asked often for tips on exercise and diabetes. My only advice is, just start. Embrace the “trial and error” method, as every one of us is vastly different. ‘What works for me probably wouldn't work for you and vice versa. As long as you have your insulin on hand for those highs and glucose for those lows, just start and take note of how your sugar levels respond.’

OUR OTHER INSPIRING CHALLENGERS

Throughout the Challenge, radio and TV presenter Mike Puru and business leader Sir Ralph Norris battled it out for third and fourth place – often trading places on the leaderboard daily. But Mike made a final push and took out third place by more than 4000 steps. At the same time, Sir Ralph took the prize for most money raised by a single competitor – a whopping $7,800. Adventurer and fitness influencer Fili Tapa came fifth, while another battle we watched closely was that between music power couple Abby Lee and Vince Harder. The Harders’ involvement with Diabetes NZ began when their youngest daughter, Presley, was diagnosed with type 1. It was Vince who took out sixth place in the end, with Abby in seventh. Invercargill city councillor and Radio Southland manager Darren Ludlow, who has type 1 and a son who has type 1, came eighth.

Ana Hutchins

THANK YOU

A massive thank you to the friends and supporters of Diabetes NZ who signed up for the Challenge and raised funds as well as diabetes awareness: Hon Peeni Henare, Mike Puru, Makaia Carr, Vince Harder, Abby Lee, David Seymour, Sir Ralph Norris, Atawhai Edwards, Chenyang Zhao, Ana Hutchins, Katie Parsons, Rachel Grunwell, Darren Ludlow, and Fili Tapa. And, of course, thanks to everyone who donated!

Mike Puru

Sir Ralph Norris

DIABETES WELLNESS | Spring 2022

GET READY TO

fundraise

IN SPRING

Three fun runs are coming up that always prove to be fantastic events for the diabetes cause. Join Team Diabetes and reach out to your networks to support your efforts.

ROTORUA MARATHON Saturday, 17 September

Rally your team and sign up to the run at: rotoruamarathon.co.nz. Then, register to fundraise for Diabetes NZ as your chosen charity at: rotoruamarathon. gofundraise.co.nz.

BARFOOT & THOMPSON AUCKLAND MARATHON Sunday, 30 October

This is a big fundraiser for Diabetes NZ Youth Auckland. Every dollar raised by Team Diabetes will help young people living with diabetes in Tāmaki Makaurau. For more information and to sign up, see: aucklandmarathon2022. grassrootz.com/diabetes-newzealand.

TAURANGA CITY TO SURF Sunday, 6 November

Diabetes Tauranga want to make sure their 2022 Diabetes Family Camp is affordable for all families and, as in previous years, are fundraising by taking part in Tauranga City to Surf. Sign up to run or walk at cityto-surf2022.eventdesq.com and to fundraise at givealittle.co.nz/ event/dnz-city-to-surf-2022

CAN'T PARTICIPATE BUT WOULD LOVE TO SUPPORT SOMEONE WHO CAN? Head to www.diabetes.org.nz/sweat-for-diabetes

DIABETES WELLNESS | Spring 2022

Grow

Container gardening is a cheap, fun, and accessible way to get more nutritious fresh greens into your diet. Gardener Rowena Fry shares her knowledge.

GREENS

at your doorstep

or the current price of a lettuce and a cucumber, you can be set up to continually grow greens outside your front door or on your deck, balcony, or patio for much of the year. Your garden can be just a few steps from your door, making it easy to pinch off a few leaves to add goodness to your meals. Not only is a nearby pot of greens convenient but the flavour will always be superior to store bought as well as more nutrient dense. It’s also an excellent way to introduce children to the magic of what happens to seeds once they’ve been put into soil. MOBILITY AND WELLNESS BENEFITS

Container gardening is perfect if you don’t have a diggable outdoor space or if you have limited mobility. You can set it up at a level that works for you. For example, you could have your garden at waist level for some no-bend standing or at a lower level where you can harvest while sitting down. Pick what you need and leave the plant to keep producing for another day. Confining your garden to pots also means there’s virtually no weeding involved. The plants grow close together, so weeds don’t really have a chance. This could be a game changer to those with arthritis in their hands or wrists.

DIABETES WELLNESS | Spring 2022

Another benefit is that you get to share the goodness of fresh air and sunshine with your plants. Not only is it good for your physical health but brilliant for your mental wellbeing. You could even think of it as a gentle workout. WHAT GREENS ARE BEST TO GROW?

Known as cut and come again or perpetual greens, these are plants that behave as their name suggests. Rather than needing to be harvested as an entire head of lettuce, you can just pick what you need on the day, meaning there’s no waste and no fright of discovering a forgotten, rotting pile of greens at the bottom of the fridge! Mesclun is the umbrella term for a mix of salad greens. If you haven’t been a fan of edible leaves in the past, you might find you enjoy homegrown greens, as the younger and tender leaves are softer and tastier than their grown-up versions. If you prefer cooking your greens, then there are plenty of dual-use leaves to choose from. Kale, spinach, silverbeet, and pak choi are the mainstays. All of them can be harvested when young and tender and eaten raw, or cooked into stir fries, soups, and curries among others.

BUYING SEEDS

With spring not far away, now is the perfect time to start planning your garden. In a month, the soil will start to warm up and seeds will be easy to germinate. In an average pack of mesclun seeds, you’ll find a selection of common and lesser-known lettuces, as well as the baby leaves of vegetables such as radish and beetroot. You can buy these packs of seeds at the supermarket, at a garden centre, or online from seed companies. You can, of course, curate your own mix and add in herbs such as basil and coriander for a herby zing, and even spring onions. With prices starting at a couple of dollars and with anywhere between 200 and 700 seeds in each pack, one pack will easily last a few seasons. POTS AND POTTING MIX

First find yourself a few pots. You might already have some at home, but, if you don’t, then friends and neighbours often have some lying around – or at least an old bucket. Anything that’s 15 to 20 centimetres deep is a good size to start with. You can even create your own pots by commandeering containers that are on their way to recycling. Plastic ice cream containers with holes drilled or cut into the base will do the job nicely. And, if you like the rustic look, then old cane or plastic baskets will do nicely. As long as it holds soil and has drainage, then you can consider it a pot. The size doesn’t matter too much as salad greens have shallow roots, so you don’t necessarily need a large or deep pot, although the bigger the pot then the more plants and the greater harvest you’ll have.

DIABETES WELLNESS | Spring 2022

SOWING TIME

Once you’ve found yourself a container, fill most of it with potting mix and water well. Pour out about half a teaspoon of seeds into the palm of your hand. Take a pinch and evenly sprinkle them over the soil. Gently press the tiny seeds against the mix but don’t push them in, as they actually need light to germinate. Follow with a small sprinkling of potting mix and mist the surface using either a hose or a pump spray container. You’ll need to keep the soil evenly moist – but not waterlogged. So water in the morning and at the end of day, and, within two weeks, little green dots of new leaves will start to appear. Your first harvest could be a week or so later when the plants have produced a few leaves. These are known as ‘microgreens’, but if you wait a few more weeks you’ll find you have a better and ongoing harvest.

KEEPING THE SOIL RICH

You don’t have to use new potting mix each time you sow seeds. In fact, you can often reuse old mix, but you need to replenish the goodness. You can do this in a number of ways: by adding some well-rotted manure, mixing in some homemade compost, or using a store-bought fertiliser such as blood and bone. Supermarkets sell liquid plant food, and this can be also added when you water. My favourite excuse for a beach walk is to collect a few handfuls of seaweed and then scatter them at the bottom of my pots. The seaweed works as an excellent natural fertiliser – and it helps to hold moisture as well. SUN AND WEATHER

Keep your pots in a warm and sheltered spot but not in the shade, as they need some sun to grow. Greens are fairly tough and will put up with some wind, so if you live in a windy place you need not despair. However, they do draw the line at being frost-bitten, so keep the pots under the eaves of your home if you think a frost is coming.

KEEPING YOUR CROP GROWING

In 35 to 65 days, depending on your climate, your patience, and your appetite, you will have mature plants to harvest. Once a space becomes available, just pop a new seed in and the cycle will begin again. You should be able to grow your greens from early spring right through to after Easter. In the height of summer, you might need to water a few times a day. Otherwise, they’ll dry out and bolt, which leads to them tasting bitter and going to seed. Yes, you can collect the seed and sow in the next season. Container gardening is not only tidier than digging in a garden plot but it’s also physically kinder to your body as well as being extremely easy care. Best of all, this form of gardening is fairly quick to reward. Once you’ve fully harvested your bounty, you can start the process again, fertilise and re-seed. A packet of seeds, if kept dry and cool, will last a few years – that is, if you haven’t used them all up by growing good and nourishing kai for yourself and those close to you. For recipe ideas for your homegrown greens, see page 30.

A faster option If you want quicker results than you get from seeds, you can of course buy bunches or punnets of seedlings at the supermarket or garden centre. Just pop them in the pot but not too close to each other as they’ll have too little room to expand. Give them a few weeks to establish their root system and grow before harvesting a few leaves at a time.

DIABETES WELLNESS | Spring 2022

Care

For some of us, spring means itchy eyes, sore ears, blocked noses, postnasal drip, or sneezes.

HAYFEVER AND DIABETES

ince the Covid pandemic began, people with regular hayfever have been dealing with an extra layer of concern: Is what I’m feeling right now hayfever, or could it be more? For many people who have both diabetes and hayfever, there have always been additional things to think about. BLOOD SUGAR CHALLENGES

The symptoms of seasonal allergies can disrupt sleep – compounding the disrupted sleep those with diabetes often also deal with. Tiredness can make it harder to manage blood sugar levels, and it becomes a vicious cycle. At the same time, over-thecounter hayfever medications often provide relief but may impact blood sugar levels in connection with other side-effects. Decongestants

Some allergy medications containing decongestants can raise blood sugar, blood pressure, and heart rate. If you have diabetes, chat to your pharmacist or health care provider before taking either nasal or oral decongestants. They’ll be able to advise on which medications could be right for you. Antihistamines

These can make you drowsy, and long periods of drowsiness

are known to sometimes be associated with blood sugar highs and lows, as you’re less likely to be monitoring your blood sugar. If you’re finding this is an issue with anti-histamines, consider switching to a non-drowsy product.

•

Corticosteroids

Steroids are known to sometimes raise blood sugar levels, so if you have diabetes and are taking corticosteroids for allergies, it’s good to be aware of this. If you have concerns, talk to your healthcare provider.

• •

WHAT YOU CAN DO

It’s always good to talk your healthcare provider with any medication concerns and also to check with them before starting a new medication. But medication isn’t the only way to treat hayfever. There are other things you can do to reduce your exposure to seasonal allergens: • Keep an eye on pollen levels in the air through the Metservice weather report page for your town or city. • Exercise indoors during your peak allergy periods. • Keep windows closed when allergens are in the air. Of course, this is sometimes tricky at the moment when good

•

ventilation is an important part of reducing Covid spread. Air purifiers are a solution for homes, schools, offices, and other venues but are not currently affordable for everyone. If you need to be outside during peak allergy season, wear a mask. This is where Covid precautions also help fight hayfever! Wear wraparound sunglasses outdoors to keep pollen out of your eyes. If you can, have a shower and change clothes after being outside in hayfever season to get rid of pollen that’s settled on you. This is not an option for everyone – but you may want to consider drying clothes and sheets in the dryer rather than on the line when pollen counts are high. Note that smoking or being around secondhand smoke can make hayfever symptoms worse.

MORE INFORMATION

For more about hayfever, see www.healthnavigator.org.nz/ health-a-z/h/hay-fever. For more about hayfever and diabetes, see https://bit.ly/3aOf2az.

DIABETES WELLNESS | Spring 2022

Care

EXPLAINER: THE NEW HEALTH REFORMS Massive changes to our health system are under way. Here’s an overview.

n 2021, Health Minister Andrew Little announced that the Government was working towards an overhaul of Aotearoa New Zealand’s health system. On 1 July 2022, the new health system was launched. It came into effect through new legislation: the Pae Ora (Healthy Futures) Act 2022. THE OLD SYSTEM

Over the past two decades, New Zealand has had an increasingly complicated and inconsistent health system, where 20 district health boards (DHBs) planned and funded local services and owned public hospitals. At the same time, 30 primary health organisations (PHOs) coordinated GP services and other primary health care services – those are your first port of call. The DHB system has long been a problem for people with diabetes and other conditions, leading to what’s sometimes been called ‘the postcode lottery’. That is, the health care we receive has depended on what DHB area we live in. On top of this, there have been issues with patient/client information not being shared between DHBs, meaning that people travelling between areas haven’t always been able to access healthcare from providers who

DIABETES WELLNESS | Spring 2022

know their medical histories. It’s also recognised that the New Zealand health system has led to widespread inequity. It has under-served Māori, Pacific people, disabled people, those living on low incomes, and those living in rural areas. So how does the new system aim to address these and other issues? AIMS OF THE NEW SYSTEM

The inconsistent regional DHB system has now been replaced by one national health system. The Government says that the new system will be ‘nationally planned, regionally delivered and locally tailored’. Some of the key goals and principles that the new system is based on are that: • Centralising the system will make it more efficient, meaning more money can be spent on actual healthcare rather than administration. • Māori will have a greater role in designing health services that better meet the needs of Māori. • Health services will better reflect community needs and preferences, as well as have a focus on prevention, rather than being ‘the ambulance at the bottom of the cliff’. The aim is to improve wellness for everyone, while reducing the pressure on specialist and hospital care. • Digital technology such as video conferencing will be used more and in better ways to provide

people with better services closer to home, as well as when they are away from home. HOW THE NEW SYSTEM WORKS

The new system involves three national bodies working together to plan and deliver health services: • Te Whatu Ora – Health New Zealand • Te Aka Whai Ora – the Māori Health Authority • The Ministry of Health, which now has a new unit – the Public Health Agency. Te Whatu Ora – Health New Zealand

This new central health agency absorbs and replaces local DHBs to co-ordinate hospital and other health services nationally. Fepulea‘i Margie Apa has been appointed as Chief Executive. Te Aka Whai Ora – the Māori Health Authority

This is an entirely new entity that will work on behalf of Māori, planning and funding services, and managing Māori health policies, services, and outcomes. Riana Manuel (Ngāti Pukenga, Ngāti Maru, and Ngāti Kahungunu) has been appointed as Chief Executive. The Public Health Agency

The Public Health Agency is a new unit established within the Ministry of Health to lead and strengthen public health strategy, policy, and monitoring and to advise the Director-General and

the Minister of Health on public health matters. Dr Andrew Old has been appointed as the Public Health Agency’s Deputy Director-General. The Public Health Agency is also referred to as the PHA. It's not to be confused with the Public Health Association of NZ, also often called the PHA. IWI-MĀORI PARTNERSHIP BOARDS

Iwi-Māori partnership boards are a vital part of the health reforms. These boards represent the local voices of Māori. They were already part of the health system, but the new legislation formally recognises them for the first time. Among their jobs are to engage with whānau and hapū about local health knowledge and needs, and to communicate these to Health New Zealand and the Māori Health Authority, ensuring they are taken into account. LOCALITY NETWORKS

‘Locality networks’ are a key part of the new health system. They are local advisory networks made up of health professionals and consumers. They will help prioritise and plan health services so they meet the needs of local communities within the broader health system. Minister of Health Andrew Little has said, ‘A locality for the purposes of the reformed health system has to be a meaningful size – not so large it is impossible to coordinate services and not so small that it would mean an unwieldy number of localities which would fail to provide the cohesion we are seeking. ‘The first part of the challenge with localities is to identify areas around New Zealand to constitute each locality, and that will then be the basis of health networks and funding.’ The ‘locality approach’ has begun to be rolled out in nine areas for a

start: Ōtara/Papatoetoe, Hauraki, Eastern Bay of Plenty, Taupō/ Tūrangi, Wairoa, Whanganui, Horowhenua, Porirua, and West Coast. Andrew Little says, ‘At this stage, we anticipate there will be between 60 and 80 localities once they are all up and running by July 2024.’ WHAIKAHA – MINISTRY OF DISABLED PEOPLE

This is a brand new Ministry. It isn’t part of the health reforms that have been brought into force through the Pae Ora (Healthy Futures) Act 2022. But it is an important new part of the health landscape in Aotearoa New Zealand and, like the health reforms, was launched on 1 July this year. The new Ministry’s role is to lead and coordinate cross-government strategic policy. It will ensure that, whenever any government agency is writing policy that affects all New Zealanders, the rights and needs of disabled people are taken into account. Whaikaha will also centralise disability supports and be a single point of contact for all disabled people using Disability Support Services. The Minister for Disabled People is Poto Williams. At the time of writing, the interim Chief Executive of Whaikaha is Geraldine Woods.

The goal, however, is for the Ministry to be led by someone who is from the disabled community. WHAT WILL CHANGE AND WHEN?

At first, the healthcare services you receive will look and feel the same, although they will now have a different name. But behind the scenes, changes are being made. This massive overhaul to our health system will take time. In future issues, Diabetes Wellness will further explore what these changes mean for our communities. MORE INFORMATION

Te Whatu Ora – Health New Zealand www.tewhatuora.govt.nz Te Aka Whai Ora – the Māori Health Authority www.teakawhaiora.nz The Public Health Agency www.health.govt.nz/our-work/ public-health-agency Whaikaha – Ministry of Disabled People www.whaikaha.govt.nz The Pae Ora (Healthy Futures) Act 2022 www.legislation.govt.nz/act/ public/2022/0030/latest/versions. aspx

DIABETES WELLNESS | Spring 2022

Diabetes Youth

Laura Snowden is passionate about supporting young people who, like her, have diabetes. As our country’s newest IDF Young Leader, she has an exciting project planned.

FORGING CONNECTIONS, LIFTING OTHERS

arlier this year, we announced Laura had been chosen as Aotearoa New Zealand’s 2022–2024 representative on the Young Leaders in Diabetes Programme – run by the International Diabetes Foundation (IDF). The programme sees representatives from 65 countries come together – in person and online – to receive ‘continuous education throughout a threeyear period to empower them and help them become efficient advocates for themselves and others living with diabetes’. Over that time, each representative works on a diabetes-related project. Laura’s selection was a two-step process – she applied to Diabetes NZ to become New Zealand’s candidate for the programme

DIABETES WELLNESS | Spring 2022

then to the IDF to be accepted on to it. Since that acceptance, she’s partnered with Diabetes NZ to develop and submit her project proposal – a national young leaders programme for diabetes youth in Aotearoa. A RAPID DIAGNOSIS

Laura’s type 1 diabetes journey began when she was diagnosed at eight years old in the UK, where her family lived at the time. Her father had been diagnosed two years earlier, in his 30s. Laura says, ‘Luckily, I didn't get too sick because my mum knew the symptoms. I was drinking lots and peeing lots, and I was tired. Mum took me to the GP and said, “I think she might have diabetes – can you please test her?” I got diagnosed the same day. It all happened very fast.’

Her family moved to New Zealand when she was 17. ‘I didn’t have many friends here, and I thought, I’ll find people with diabetes because we have something in common to connect over.’ She began volunteering to help with diabetes youth camps in Auckland, and her life course changed. At 24, she’s been volunteering for seven years now, becoming a Group Leader, as well as a member of the Diabetes NZ Auckland Youth committee. She loves seeing how empowering the camps are. ‘The kids are really excited to see older people with diabetes. Some of them feel that, at school, they’re the odd kid. They say, “I'm the weird kid that gets picked on because I have to do injections.” Apparently kids

My Identity

is proud to create

aren’t always very nice about it. ‘But at camp and events, the people without diabetes are the odd ones. It’s rewarding even just to sit with them and check our blood sugars together, and then they don't see it as such a bad thing anymore. ‘There was one night on camp when I had to get up low. I walked into the dining hall where the nurses were, and they had all these snacks ready, and there were a couple of kids up with lows, too. They said, “What are you doing up?” ‘I said, “I'm low as well. We can all sit here and eat biscuits together.” So we just sat there having a chat at 3am about our lows. It was really nice.’ PUSHING THROUGH TEENAGE YEARS

Laura vividly remembers the difficulties of managing diabetes as a teenager: ‘I think, from 13 to about 17, I neglected it. I’d tell my mum, “I didn't ask for this – why should I have it? I don't want it.” ‘And my doctor in the UK was not very nice. Every time I’d see him, I’d end up crying because he’d be like, your HbA1c is so high and you're going to have all this damage and all these complications. ‘I was 13, and it would terrify me. It did educate me on what the complications could be, but giving me the harsh truth, like that, at that age, just made it worse, just made me more upset. ‘Because I cried in a lot of my appointments, the doctor referred me to a psychologist. And, in the end, it turned out that I did find seeing a psychologist helpful. ‘Probably the biggest challenge for me as a teenager was just accepting that it’s something I had to deal with. It probably took me a long time to realise that complaining about it and saying I didn't ask for it wasn’t going to make it go away.’

DIABETES AND ADHD

Laura has a recent diagnosis of ADHD, which has seen her looking back on her life through a new lens. ‘Everything makes a lot more sense, and I’m still in a process of discovering things about myself and how best to function now that I know my brain is a little bit different! ‘I started on meds not long after my diagnosis, and it’s been pretty good so far. I’ve also been trying to put strategies into place. And, as meds don’t work 24/7, I’m learning to be accepting of the diagnosis – just like my diabetes really. I’m trying to embrace the roller coaster more than battle it. ‘I’ve also learnt that there’s no harm in asking for help, which is also true of my diabetes. If I get overwhelmed and I’m struggling to get tasks done, there’s nothing wrong with me asking for an extension and explaining the situation or asking someone to help me with something I’ve hit a mental block on.’ While ADHD hasn’t impacted much on her diabetes management directly, she says she’s sometimes struggled with remembering whether she’s taken her insulin or not. Her pump solves that problem. ‘I had a pump before this, as a teenager, but I didn't like it. I felt it was bulky and a constant reminder of diabetes. But I’d grown up a little bit when I went back on it. ‘It sometimes still irritates me, and I take it off and go on injections again. But I've seen my HbA1c go down, so I don't mind it so much.’ She says another challenge is that ‘ADHD meds often have the side effect of nausea and loss of appetite. If I’m having a low, I often don’t want to eat because of the appetite suppression. It’s all a juggling act but keeps me on my toes.’

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A CAREER IN HEALTH

Laura always wanted to work in health care. After leaving school, she explored options: ‘I thought I wanted to be a doctor. So I started the pre-med year but, halfway through, I decided I wasn’t that interested in organ systems and so on, and I thought medicine’s not for me. I changed my major to pharmacology, and I enjoyed that more.’ However, pharmacology seemed to be setting her on path to a research career, which she wasn’t keen on. ‘Then I thought I'd apply for pharmacy.’ She completed her Bachelor of Pharmacy in 2021, and is now doing the intern year that all pharmacy graduates have to complete before becoming registered. Her internship is in a community pharmacy, but, after this year, she’d like to branch out. ‘There are lots of options for pharmacists. There’s hospital work and industry pharmacy. I’m interested in the pharmaceutical industry – medical devices and things. So maybe I'll end up there.’ A highlight of her pharmacy degree was a summer internship at Medsafe. ‘We were working under the Ministry of Health, at the border, based in Customs. We’d intercept packages coming in that had prescription medicines in them and send off letters. And we had to open packages and see if they had medicines in there they shouldn't have. That was interesting. And I think there are jobs out there in pharmacy that I don't even know exist yet. It’s early days.’ Other health-related careers are on her radar too. ‘Volunteering has made me interested in working with children more. But my mum says, “Don't think too much about the future yet – you need to do this year.” So I'm waiting to see where I end up.’

DIABETES WELLNESS | Spring 2022

Laura with her mum, Cheryl, and her dad, Steven.

BUILDING THE YOUTH LEADER PROGRAMME

At the end of this year, if all goes to plan, Laura will head to Lisbon, Portugal, for the IDF Youth Training Summit. Diabetes NZ will pay for her flights and offer as much support as possible. Laura says, ‘I'm excited to meet all the other young leaders and make more friends across the world that are interested in doing the same things and have similar mindsets.’ As for her project, she’ll be working hard on it over the next three years, in partnership with Diabetes NZ. Her first idea was to set up a mentor programme, where older people with diabetes would look after younger ones. But, after talking it through with Diabetes NZ, she realised a young leaders training programme here would be a necessary first step: ‘The idea is that a mentor programme could branch off from that. Those young leaders can go on to be mentors. ‘I'm excited to see what we do with this programme and to work with Diabetes NZ and meet more people around the country, because I've usually only worked with Diabetes NZ Auckland Youth.’

She hopes that, once the programme is up and running, it’ll give many others the same benefits she’s enjoyed: ‘It’ll allow our young people with diabetes to grow and develop into leaders in both the diabetes community and the wider community. It’ll build stronger connections between those young people all around the country and also between them and Diabetes NZ, so we can work together more.’ LAURA’S BRACELET

Laura was thrilled to be asked to choose this season’s MyIdentity bracelet. She says, ‘I was not expecting that at all!’ She chose an understated bracelet. ‘It’s a simple design but still elegant.’ She likes the bracelet she currently wears for the same reasons. ‘When people realise it’s a medical ID bracelet, they always say, “I just thought it was your normal bracelet.” Paramedics or emergency services will know what to look for, but it's not too inyour-face.’ IDF Young Leaders in Diabetes: www.idf.org/our-network/youngleaders/the-yld-programme.html.

Research

RESEARCH ROUNDUP: diabetes and hydration An ever-growing body of international research shows that drinking enough water can play an important part in helping to prevent and manage diabetes and related conditions.

FLUID INTAKE DURING EXERCISE FOR TYPE 1

EFFECT OF PRE-MEAL WATER INTAKE ON TYPE 2

Forty people with type 2 diabetes took part in a 2021 trial in Iran. Half of them drank a litre of water before each main meal for eight weeks, and half did not. At the end of the trial, the waterdrinking group had improved blood sugar levels and cholesterol profiles. Drinking water was also associated with lower intake of energy and fats. https://doi.org/10.1007/s40200-02000724-9

In 2018, a study showed that people with type 1 diabetes are at higher risk of dehydration than those without diabetes, when they do sports and train. This is due to a combination of fluid losses from sweat and increased urine. The study concluded that the recommended water intake for training generally is not enough for those living with diabetes. https://doi.org/10.1159/000489823

HYDRATION FOR KIDNEY AND METABOLIC HEALTH

An international review of evidence published in the European Journal of Nutrition found that excreting a generous volume of diluted urine is associated with beneficial health effects, especially for kidney and metabolic function. It was

found that drinking between 2.5 and 3.5 litres of water a day was optimal. Not only does this amount of water help dilute urine and increase its flow, but it also helps prevent kidney stones and urinary tract infections. https://doi.org/10.1007/s00394-02002296-z

HYDRATION AND CARDIOVASCULAR RISK

It’s commonly understood that not drinking enough water impairs mental and physical performance. The University of Delaware reports that studies have linked habitual low water intake with increased future risk for adverse cardiovascular events. Low hydration has been shown to impair vascular function and blood pressure regulation. https://doi.org/10.3390/nu11081866

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DIABETES

Diabetes Wellness magazine is the flagship publication of Diabetes New Zealand

Move

SIMPLE STEPS TO CARE FOR YOUR BACK Most of us know the pain of a back injury. Fitness consultant Craig Wise has some tips for keeping your back safe.

Craig Wise is a fitness trainer, massage therapist, and lifestyle coach at Craig Wise Health and Fitness in Hamilton.

DIABETES WELLNESS | Spring 2022

hen it comes to looking after your back, I’m currently something of an expert. I say this as I’ve just sat down gingerly, wincing slightly and sucking in air between my teeth. I’m a fairly active person, and I generally do the right things when it comes to looking after my body – but all of us sometimes slip up. My slip came courtesy of picking up my 10-year-old daughter to give her a hug. All was well until I put her down and felt that little tweak. A day later, and that ‘tweak’ is giving me grief as I sit down, stand up, and change gear when I’m driving.

BACK-CARE BASICS There are a few rules for helping to keep your back safe and healthy in day-to-day life: Exercise your core to strengthen abdominal and back muscles, and learn how to engage your core muscles when you’re doing activities.

Practice good ergonomics while you’re seated and think about limiting the time you spend seated – take regular breaks.

Ensure that your spine is supported when you sleep. Soft floppy pillows don’t properly support your head and neck, neither does an old saggy mattress.

Check your footwear. Poorly supporting footwear not only puts strain on your legs and the lower joints but also the spinal column, which is supporting the top half of your body.

STRONG TO THE CORE

Let’s talk some more about your ‘core’. That means the muscles in and around your torso – those that make up your mid-section and lower back, your abdomen, and your pelvic floor. As well as helping move your back, they support and stabilise it. So core strength and stability – and engaging your core to support movements – are some of the greatest factors in helping to prevent back injuries as we live our lives. We’ve all heard that you shouldn’t ‘use your back as a crane’, and, yes, you should bend your knees when lifting. This is sound advice – but it isn’t the be all and end all. With a weak core, even squatting and driving through your heels properly is not enough. Your body will still recruit your back muscles to try to stabilise it, potentially causing that ‘tweak’. Learning how to brace your midsection when you bend or lift, to get core stability, will allow you to perform daily activities safely and efficiently. The amount of bracing required depends upon the task. For example, to bend and pick up a dropped pair of socks requires less bracing than if you’re deadlifting a weight bar for a new world record! EXERCISES FOR YOUR CORE

It's important to consciously practice bracing your midsection and engaging the core region so that it becomes second nature and you do it without thinking. There are three movements that I talk to all my clients about. Practising them is easy and can be done anywhere, even while queuing at the checkout. While these exercises can’t be guaranteed to prevent back injury, they’ll help to strengthen your core muscles and teach your body to

naturally engage. When the core is strong, the body will rely less on stretching the back muscles to do the work. The punch brace

Standing with your feet flat on the ground, shoulder width apart, take a breath in and expand your rib cage. Then, tighten your midsection like you’re about to be punched in the stomach. Think about engaging all the muscles in the core area. Hold briefly and then release. Repeat the exercise 8 to 10 times. Remember that, in day-to-day life, the amount of air you need to breathe in depends on the task you’re doing: lifting a heavy weight like a bag of compost in the garden needs a deeper breath than picking up a few light groceries in a bag as you leave the supermarket. The tummy clinch

Standing with your feet shoulder width apart, squeeze your lower abdomen and hold for three to five seconds. Then release and let the muscles completely relax. Repeat 5 to 10 times. The pee pause (AKA Kegels)

Stand with your feet flat on the floor and imagine that you’re busting to go to the toilet. Squeeze your pelvic floor as if you’re trying to stop yourself going, and hold for a few seconds before releasing. Repeat this exercise 10 to 20 times. If you can’t do that many at first, start gradually and build up over time. For a long time, pelvic floor exercise was the domain of postpartum people or those starting to struggle with incontinence. But it is also an integral part of everyone’s core stability and functioning – whatever your age or gender.

MY DIABETES JOURNEY… A FRIEND IN YOUR POCKET!

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ERGONOMICS AND SITTING

Sitting has been called the disease of our time, and it’s true that inactivity is a health issue, but it’s not this alone that is contributing to back injury; it’s the length of time we’re sitting with poor posture. Poor posture is as much to blame for a sore back as lifting heavy boxes and overdoing it in the garden. Over time, having your head down staring at the phone screen or slouching with hunched shoulders will become your natural posture. Being actively aware of your posture can help keep your body in the shape it should be, and this will help keep your back safe. If you do have to sit at a desk all day, then you should have a heightadjustable chair with a well-fitting lumbar support. When you’re seated, try to keep the weight of your head directly above your neck. Your monitor should be directly in front of you, and the top of it should be no higher than your eye level. Your keyboard should be right in front of the monitor so you’re not having to twist your head or neck often.

If you’re concerned that your work space may not be right for your posture, chat to your employer. Under Worksafe guidelines, they need to minimise posture-related risk for their employees as much as is reasonably possible. OTHER TIPS FOR SEATED JOBS

Ensure that you regularly get up and move. Not so long ago, if you worked in an office and needed to speak with another person there, you’d get up and walk to them, whereas these days it often feels easier to message. Maybe it’s time to turn back the clock. If you’re working from home, find ways to take breaks from sitting. And definitely don’t try to work from the couch. As comfortable as it might be, it’s no good for your body. Phone calls are often an excuse to walk. Try walking around when you’re thinking about a problem too. Sometimes those minutes away from your desk or in motion can help you come up with all sorts

of solutions that otherwise you would have spent ages staring at the screen thinking about. BUILD BACK CARE INTO YOUR LIFE

While writing this article, I walked the room five times to take a break from sitting and, during two of those walks, I did 20 Kegels. Where could you build in some back care?

A WARNING ABOUT CRUNCHES

Crunches can sometimes do more harm than good. While they’ll help you feel the burn, they’ll do very little to actually strengthen the core ,and, done incorrectly, as many people do, they can cause neck and back injuries. Such exercises should only be done after consultation with a REPS registered exercise professional. (See www.reps. org.nz.)

Sneaker Friday is back November is Diabetes Action month in Aotearoa. At Diabetes NZ, we’re getting ready for a busy November full of events, actions, and fundraisers that the whole community can take part in. While much of this work is still in progress, we can announce that our popular Sneaker Friday will be back. The first ever Sneaker Friday took place on Friday, 19 November 2021. Through Givealittle, people were encouraged to donate $5 to Diabetes NZ to wear sneakers to work that day and to rally workmates to join you. The day was a massive success, raising over $10,000 for diabetes work, as well as raising awareness in workplaces around the country.

DIABETES WELLNESS | Spring 2022

This year we expect the event to be even bigger – 18 November is Sneaker Friday 2022. Start thinking about how you can rally a team. See https://givealittle.co.nz/event/ sneaker-friday-2022.

Advocate

DIABETES NZ PUSHES FOR HEALTHIER FOODS AND DRINKS IN ALL SCHOOLS Earlier this year, the Ministry of Education released a proposal for new regulations in schools that would promote healthy unsweetened drinks for students – and called for submissions. Diabetes NZ responded.

he Ministry’s proposal gave three options for regulation changes. The weakest was Option 3 – simply a duty on all schools to promote healthy food and nutrition. The strongest option was Option 2. It was the same as option 3 but with a further duty on all schools to supply only healthy unsweetened drinks to students. Option 1 was a middle ground. In this option, schools would have a duty to promote healthy food and nutrition but would only be required to supply healthy unsweetened drinks to students in years 1 to 8. Diabetes NZ urgently advocates for the strongest option: Option 2. However, we believe that even this option doesn’t go far enough and that the food schools provide should be healthy as well – not only the drinks. OUR SUBMISSION

In our submission, Diabetes NZ wrote: ‘Understanding the importance of eating healthy food and limiting sugar intake is pivotal to improving health outcomes in our community. ‘Education in our primary and

secondary schools/kura is often where these life-long lessons begin and schools/kura are an important setting for nutrition intervention as they have the power to influence children’s knowledge and behaviour. ‘It is therefore essential that the schools/kura reflect the positive health messages they espouse with their actions. Teaching the benefits of eating healthy food in the classroom, whilst selling unhealthy food and SSBs (sugarsweetened beverages) on school grounds confuses and undermines the message.’ We went on to say, ‘The research and evidence espousing the benefits of removing unhealthy foods and SSBs from school canteens is irrefutable from a child’s health and well-being perspective. Diabetes NZ supports the removal of SSBs in primary schools but feels the proposed changes to the legislation do not go far enough. ‘Diabetes NZ strongly encourages the Ministry of Education to consider applying the same legislative change to High Schools and adopting a healthy-food-only stance as well. ‘There is a concerning trend of children and young people developing type 2 diabetes in New Zealand and certain ethnicities are at greater risk. Māori, Pacific and Asian people are more likely to develop type 2 diabetes than other ethnicities, and often at a younger age. ‘Circumstantial factors can also increase risk such as people living in socio-economically deprived areas. These areas often have retailers near schools promoting cheap unhealthy

food which teens buy because their money goes further. ‘If the Ministry of Education legislated against unhealthy food and SSBs in schools, the risk for some of our children developing type 2 diabetes may be reduced.’ Our submission pointed to the evidence in a review commissioned by the Heart Foundation, which showed that nutrition policies and/or guidelines are effective in improving the school food environment and student’s dietary intake at school – and that to be effective these policies must relate to all food consumed on school premises and have the support of school parents and administration. ONGOING WORK

Diabetes NZ has a long history of advocating for legislation that will make our ‘food environment’ healthier. In 2018, we made a submission to the Tax Working Group urging a sugar tax on foods – an initiative that has been successful in Brazil, Chile, France, Hungary, Mexico, Taiwan, Thailand, and several countries in the Pacific. We’ll continue to lobby for these kinds of changes at every opportunity. Advocacy is always long-term work, but change is possible. We await the Ministry's decision on healthy drinks regulations in schools. See Diabetes NZ’s full submission to the Ministry of Education at https:// www.diabetes.org.nz/news-andupdate/healthy-food-and-drink-inschools-submission. DIABETES WELLNESS | Spring 2022

Nourish

When choosing carbs, think about their Glycaemic Index (GI).

HEALTHY CARB CHOICES FOR BETTER BLOOD GLUCOSE CONTROL DIABETES AND A LOW-GI DIET

The Glycaemic Index is the scientifically proven way of ranking carbohydrates like rice, bread, breakfast cereals, pasta, noodles, fruit, starchy vegetables, legumes, milk, and yoghurt according to how they affect your blood glucose (sugar) levels. A low-GI diet can provide a number of health benefits for people across all stages of life, from maintaining sustained energy to helping with specific health concerns – including all types of diabetes. Carbohydrates with a low GI (55 or less) typically cause blood glucose levels to rise slowly and fall gently over a longer time. Carbohydrates with a high GI (70 or more) are digested and absorbed more quickly, which typically causes blood glucose levels to rise and fall quicker. Eating low-GI foods helps people with diabetes to sustain more even blood glucose levels overall.

SUNRICE LOW GI RICE IS BACK!

After a spell off supermarket shelves in New Zealand, SunRice Doongara Low GI rice is now available in 1kg bags in supermarkets nationwide. SunRice Doongara rice is a long grain rice variety that is low GI – an excellent substitute for other rice varieties that have a higher glycaemic load. SunRice Low GI rice is a Diabetes NZ Choice product, meaning it has been approved by Diabetes NZ as a food that helps people with diabetes improve their glycaemic control.

Now there’s a rice that is NEW to NZ from SunRice, our Low GI Rice is a perfect choice for people with diabetes looking for a carb that is lower on the glycemic index (GI). Foods with a Low GI are more slowly digested and produce a more gradual rise in blood glucose levels. This allows for a more sustained and measured release of energy throughout the body. Choose from SunRice Low GI White Rice or Low GI Brown Rice for sustained energy. Both officially recognised and approved by Diabetes NZ, and certified by the Glycemic Index Foundation. This nutritious product tastes and cooks just like regular rice and is a healthy choice. Now you can feel good about making a smarter carb choice.

Visit sunrice.com.au, and search “Low GI” for recipes and more product information.

NEW

MOROCCAN CARROT, PUMPKIN, CHICKPEA AND RICE ONE PAN SERVES 4 GLUTEN FREE | VEGETARIAN

One pans are simple and the perfect opportunity to pack plenty of nutrition into one dish. Moroccan flavours inspired this one pan, and it's chock-a-block with low GI carbohydrates from SunRice Low GI Rice, carrots, chickpeas, and rocket to sustain your energy throughout the day. It’s delicious served hot as an easy weeknight family meal – or make and take to your next picnic or BBQ occasion with friends. 500g baby carrots, trimmed and peeled 400g pumpkin (butternut, grey, or crown will work well) 3 tbsp (60ml) extra virgin olive oil 2 tsp sweet paprika 1/4 tsp ground turmeric 1/4 tsp ground cinnamon 1/4 tsp ground ginger 1/2 cup (105g) SunRice Low GI Brown Rice 1 x 400g tin chickpeas, rinsed and drained, or 220g cooked chickpeas 1 1/2 cups (20g) rocket leaves 1/4 cup (40g) Turkish apricots, finely sliced 1/4 cup (40g) raisins or sultanas 100g cherry tomatoes, halved 1/2 cup (80g) almonds, roughly chopped 1/2 cup fresh coriander leaves, stalks finely chopped 1/2 cup fresh mint leaves 3 tbsp fresh orange juice Pinch chilli flakes (optional) Salt and pepper

Heat oven to 200°C and line a large baking tray with baking paper. Remove the skin from the pumpkin, and cut into 4cm thick wedges. Place carrots and pumpkin on the tray, and drizzle with extra virgin olive oil. In a small bowl, mix together sweet paprika, turmeric, cinnamon, and ginger. Sprinkle spice blend over the vegetables and toss to coat. Cook in oven for 30 minutes. While the vegetables are baking, cook your SunRice Low GI Brown Rice using the method recommended on the packet. Cover and set aside. Once the vegetables are baked, arrange the rocket leaves, SunRice Low GI Brown Rice, Turkish apricots, raisins, tomatoes, almonds, coriander, and mint leaves around the pan with the vegetables. (Alternatively, pop it all on a big serving platter). Drizzle with orange juice, season with salt, pepper, and a pinch of chilli flakes, and serve. TIP

If you don’t have baby carrots, cut larger carrots into batons – long, thick chunks. If the chickpeas you use are tinned in brine, you won’t need to add any salt. NUTRITION INFORMATION (PER SERVING): ENERGY 1910kJ (456kcal) | PROTEIN 10.4g | FAT 16g (SAT FAT 2.4g) | CARB 59g (SUGARS 26.7g) | SODIUM 240mg

DIABETES WELLNESS | Spring 2022

Diabetes Youth

SUCCEEDING WITH DIABETES As applications open for the 2022 John McLaren Youth Awards, we celebrate our three amazing 2021 winners and everything they continue to achieve alongside managing type 1 diabetes.

WILLIAM ROBERTSON – SPORTS AWARD

t just 16 years old, Southlander William Robertson has a string of local and national athletics successes to his name. William says, ‘I was very shy starting athletics and nervous that I wouldn’t be able to trust my body because of type 1. ‘There’s a lot you don’t know when you go to events, like can I take my bag to the track? Where do they put it? How long between getting called and actually starting a race? What if there’s a delay?’ While these questions don’t matter much to most competitors, for someone with type 1, they can be crucial. ‘I also found out, when I went to do my first big race at the 2019 Colgate South Island Games, that bad nerves feel like a very bad low. I got scared and stumbled in the starting blocks and got disqualified. That was the 200 metres. ‘Even though I was nearly crying, I realised I had to ignore that mishap and try again the next day. I went home to the motel and searched up all the rules so I knew everything I could.’ He was using a pin pricker to test his blood sugar at that time and says, ‘I also knew I had to trust that my last pin-prick test before the race was right. The next day, I won the 100 metres race and also got third in the long jump, which I didn’t expect.’

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MEETING EVERY CHALLENGE – WITH SUPPORT

Since that first big competition, he’s continued to persevere and has had some exciting wins. He came third in the 100 metres at the 2020 NZ Secondary Schools Athletics Championships – the biggest event of the athletics season for under 18s. In 2021, he won the junior 100 metres and long jump at the South Island Secondary Schools Athletics Championships and got second in triple jump. He’s broken Southland records for his year group in 100 metres, 200 metres, and triple jump and was part of an under 18 relay team that broke the Southland record in 2021. The 200 metres record was 34 years old. There are still challenges. ‘In early 2020, the Southland Secondary Schools Athletics was at the same time as school camp, so I came home from camp a day early. I was so tired. ‘The morning of the competition, I got there and felt sick, like vomiting. I realised that I forgot my insulin injection with breakfast. ‘I just wanted to go home and get in bed. But I tried to keep thinking how I’d feel later when the insulin was working. I just kept that in my mind and had lots of water. It was hard, but I started getting better right at the start of my triple jump.’

To William’s surprise, he won. ‘I learnt so much about double checking things when I’m tired but also that, when something like that happens, I can’t give up. I just have to try and fix it and think past feeling sick.’ His parents have consistently supported him, and one of them always travels with him to competitions. William says he’s also lucky with his coach. ‘He knows I’ll do my best and trusts that I’m not slacking off if I have to have breaks, or if I do a bit less some days when my blood sugars aren’t behaving.’ Now that William has a Dexcom CGM, his diabetes is a lot more manageable, allowing him to focus even harder on his sport. He can see his blood sugar levels at a glance and is alerted if he’s going high or low. ‘I think that to do well in sports is a very hard thing – but to do that with type 1 diabetes makes it more complicated. But it’s not impossible. I think it’s mind over matter – and just maths if you want it to be. ‘I want to show other young people that type 1 doesn’t mean you can’t do physically challenging things. You can be nervous at the start,and it might go a bit wrong, but if you learn and try again it will work out.’

GIVING BACK

PLANNING AND MORE PLANNING

Over time, William and his family have devised a set of strategies. ‘Mum and I have worked out that, on competition days, I need to avoid insulin for two to three hours before the event warm up. Sometimes it means I have to get up at 5.30 or 6am for a 10am event so I can get food into me. ‘Also, to do all the training, I have to estimate how hard it is on my muscles then work out with Mum and Dad how to adjust my insulin so I’m safe at night. I have quite a few broken sleeps – but it’s definitely worth it. ‘The Dexcom at least now alarms me, as I’m not great at waking to night lows.’ Of course, nothing is ever failsafe. In late 2020, his Dexcom sensor stopped working 90 minutes before a big final. He was prepared. ‘Luckily, I had a Libre there – and my manual tester.’

He quickly applied a Libre sensor, knowing it would take an hour to calibrate so it could give him his blood sugar readings. That would be just before he had to leave to line up for the race. ‘These types of glitches are annoying, but they show how much extra effort we make to get to where we do as type 1s.’ William and his parents fundraise all year round to help cover not only the costs of competing but his CGM. ‘Nearly every Sunday, I go to our local farmers market with my mum and sell homemade beeswax wraps and cheese, and I look after a local business stall so that I can combine my site with theirs, which saves us a stall fee. We also sell the beeswax wraps online sometimes.’ They took part in Dr Susan Wardell’s study into medical crowdfunding in New Zealand – profiled the autumn 2022 issue of Diabetes Wellness.

William says, ‘As a family, we try and help others. Even though I don’t need to attend junior athletics anymore, I still go once a month and help the younger kids learn how to do long jump or use sprint starting blocks. ‘I was also interviewed about diabetes on our local community radio. I was nervous about this but wanted to do it to talk about how diabetes doesn’t make us that different to other people and how we shouldn’t be limited by diabetes.’ He and his parents are committed to raising awareness of diabetes. ‘We sent a PowerPoint presentation about diabetes and its wider impacts to our local Member of Parliament, Liz Craig, who’s on the Health Committee.’ It was then forwarded to the committee in support of Diabetes NZ’s petition for the government to fund CGMs. William says, ‘It’s sad that Pharmac still aren’t providing CGMs – without them, life is a lot harder. It would be so hard to do well at athletics without my Dexcom. I’m just lucky my grandma and parents manage to pay for it, but I hate how others can’t. It’s totally unfair.’ LOOKING TO THE FUTURE

Covid has impacted on this year’s athletics season. ‘It was sporadic – lots of cancellations again – which was gutting, as I’d trained all year and only got to go to one national meeting.’ But William is nothing if not determined. At that meeting, the National Track & Field, he took third place in the under 18 men’s triple jump. He says his ultimate goal is to be selected in a New Zealand team to travel to the Australian Championships, and ‘one day I’d like to be selected to go to the Commonwealth Games or Junior Worlds.’ Watch this space.

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BROOKE MARSTERS – ACADEMIC AWARD

desire to work as a paediatric endocrinologist spurred Brooke Marsters to study medicine. She’s currently studying towards a Bachelor of Medicine and Bachelor of Surgery (MBChB). After completing school with an NCEA scholarship in biology, she enrolled in the Health Science First Year course at Otago University. From 1800 students, she was one of 200 to enter the medical degree. On top of that, Brooke took an extra year to do a BMedSc (Hons), receiving first class honours. Her research led her into a project focusing on the use of the Freestyle Libre among youth, a topic she says she was fortunate to be involved in: ‘Being a teenager is hard, and being a teenager with diabetes is even harder.’ LIVED EXPERIENCE

Brooke not only brings lived experience of diabetes to the medical profession but says that ‘as a Pacific Islander, I’m in a position to provide a perspective that is in tune with Pasifika values and is culturally appropriate.’ An initiative she helped organise was a health educator programme aimed at young Pasifika children to promote good physical and oral health for themselves and their whānau. There have been massive challenges, including financial ones. ‘Taking time out of the medical degree to do research was something I greatly enjoyed. However, this added an extra year to the six-year traditional medical degree.’ She says that, given the large amount of course and study hours her degree requires, it’s not recommended that students also take part-time work. The financial

DIABETES WELLNESS | Spring 2022

cost accommodation options that may be suitable for other students, such as backpackers.’ Communal refrigerators aren’t ideal for safely storing precious medication. Brooke also faces many expenses related to equipment needed for her medical training – for example, a stethoscope for examining patients’ heart and lungs. ‘In the past, I’ve been able to borrow a stethoscope from a peer, but this isn’t best practice given the current Covid situation and the need to have good hygiene practices.’

‘I hope with this visibility that others might be inspired to pursue any dream they have, irrespective of the additional challenges that living with diabetes may present.’ burden is a large one for many students. Brooke used the money from her McLaren Youth Award to help cover course-related costs – as well as additional accommodation and living costs for hospital placements. For these placements, Brooke has to travel to a new city, and find and pay for accommodation there, all while retaining her usual accommodation in Wellington. She says, ‘For many medical students, finding accommodation for these placements can be challenging, as we’re not financially compensated for them.’ She adds that ‘with type 1 diabetes, I have additional requirements and health-related costs. I need access to a secure fridge to store insulin and a secure place to store my diabetes supplies, reducing some lower-

A PROMISING RESEARCH CAREER

With publications in international journals, including Paediatric Diabetes, Brooke has presented her work on national and international stages. In 2019, as one of only two students (and the only undergraduate student) at the conference, she presented to the Australasian Paediatric Endocrine Group Annual Scientific Meeting. Earlier this year, she was selected to present to the New Zealand Society for the Study of Diabetes Annual Scientific Meeting in Wellington. Brooke believes that reducing the burden of diabetes not only betters an individual’s quality of life but their family’s as well. This allows them to live their life to the best of their ability and pursue any goals they set for themselves. ‘Being awarded this financial support to complete my degree will enable me to become more visible to others. I hope with this visibility that others might be inspired to pursue any dream they have, irrespective of the additional challenges that living with diabetes may present.’

SAM MCNEIL – ACADEMIC AWARD

high academic achiever during his school years, Sam was Dux of Opunake High School and was then accepted into Otago University Medical School. However, he decided to do a science degree first and is now in his third year of a bachelor of Biomedical Science, majoring in Functional Human Biology. He put his award money towards his tuition fees and is trying to keep his grades high to keep his options open at the end of his degree. ‘I can see myself researching diabetes in the future. It’s quite a misunderstood disease, in my opinion, and I’d love to contribute to the field somehow.’ He works hard to keep his own diabetes under control for the sake of his future health. ‘I’m always searching for new tricks to help make living with diabetes easier, and I’d love to share them with other people. ‘I joined a closed-loop pump study, and it’s made my life a lot easier.’ He’s passionate in his belief that this technology should be more widely available. ‘It greatly increases quality of life.’ Sam says, ‘I know what it’s like to miss out on different parts of school – sports and social events. Eventually, I want to help make other people’s lives better.’

We need your help to help them A diabetes diagnosis can be scary, overwhelming, and confusing. It’s a steep learning curve whatever kind of diabetes you have. We want Kiwis to know they are not alone. We are here to help them live well with diabetes and support their journey every step of the way. Your generous gift will improve the day-to-day lives of people living with diabetes and help us spread the prevention message far and wide. As a charity, every dollar we raise is crucial – please support our work today: Give securely at www.diabetes.org.nz or call 0800 342 238. Donate via Westpac 03 0584 0197985 09 – use your full name as reference.

The John McLaren Youth Awards are open to anyone 25 or under who lives with diabetes. For more information on applying for a 2022 award, see page 5.

Nourish

FOUR WAYS

with spring greens

There are so many ways to incorporate nutrient-packed leafy greens into your diet – smoothies, spreads, fritters, sauces, and more. These greens are versatile and easily substituted for each other in recipes. If you’re growing your own, but don’t have enough for a recipe, add store-bought greens to make up the amount. FRESH HERBY PESTO MAKES 11 SERVINGS OF 25g

Pesto is traditionally made with pine nuts, but sunflower seeds taste just as good and cost a quarter of the price. They also make it suitable for those with nut allergies. Cheese is another usual ingredient but isn’t necessary when it comes to taste. The fresh basil, garlic, and olive oil are the heroes in this recipe. If you’re running short of basil, supplement the mix with other leafy greens – like rocket, parsley, baby kale, spinach, New Zealand spinach, or even ‘weeds’ such as chickweed and pūhā from your garden.

2 cups fresh basil leaves ½ cup toasted sunflower seeds ½ cup olive oil 1–5 garlic cloves 1 tbsp lemon juice ¼ tsp salt Roughly chop your garlic. If you adore garlic, then put in a few cloves. If you aren’t so much of a fan, then just one clove will do. Slicing it then frying/roasting it first will also calm the flavour down. Process all the ingredients in a food processor or in a large jar if you have a stick blender. Spoon your pesto into a jar and store in the fridge for up to a week. If you can’t use it all in a week, spoon it into ice cube trays, freeze, then transfer the cubes into an airtight container to store in the freezer for up to six months.

TIPS

• Smoked garlic salt has a lower proportion of salt as it also contains spices and dried herbs. It also naturally adds some more flavour. • To toast raw sunflowers seeds, give them 10 minutes in a frying pan on a low to medium heat, stirring occasionally. Once they start turning a light brown and you can smell the delicious nuttiness, they’re ready. SERVING SUGGESTIONS

This pesto melts beautifully over freshly cooked pasta. A spoonful lifts a jacket potato and makes boiled new potatoes even more delectable. It also works well as a spread on wholemeal toast. Just add sliced tomatoes for the perfect breakfast or lunch.

NUTRITION PER SERVE: ENERGY 553kJ (132kcal) | PROTEIN 1.7g | FAT 13.6g (SAT FAT 1.9g) | CARBOHYDRATE 0.5g (SUGARS 0.2g) | SODIUM 70mg

DIABETES WELLNESS | Spring 2022

CREAMY GREEN SMOOTHIE SERVES 2

Sometimes the colour of a green smoothie can put people off wanting to try one, but once you take a sip of this of this recipe you’ll forget about the goodness hidden within it and just enjoy the smooth, creamy taste. 150g banana or other fruit 1/2 packed cup of chopped kale, silverbeet or spinach ¼ cup toasted rolled oats 1½ cup of low-fat milk or soy milk Put the ingredients in a blender, capsule blender, or food processor – or in a large jar if you have a stick blender. Whiz up and enjoy. DIETITIAN'S TIPS

Adding one tablespoon of LSA mix (linseed, sunflower seed, almond) improves the nutritional value of this smoothie. Soy milk has the equivalent amount of protein as cow’s milk. The protein, along with the fibre from the oats, reduces the glycaemic load of the smoothie. NUTRITION PER SERVE: ENERGY 1070kJ (255kcal) | PROTEIN 10.1g | FAT 6.4g (SAT FAT 0.7g) | CARBOHYDRATE 34.9g (SUGARS 13.3g) | SODIUM 94mg

pu t a spring in your step!

EAT WELL LIVE WELL

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

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CHICKEN AND GREENS SATAY SERVES 4

For satay lovers, this light tasty lunch is low in salt and fat but high in vitamins and flavour. 250g skinless chicken breast, sliced into 1cm strips 1 tsp turmeric 1 lemon 1 cup rice Olive oil spray 2 spring onions, finely chopped 1–2 cloves of garlic, finely chopped 1 tbsp unsalted smooth peanut butter 1/3 cup water 2 cups of roughly chopped leafy greens, packed down 1 tsp reduced-salt soy sauce 1 tsp sesame oil NUTRITION PER SERVE: ENERGY 1580kJ (377kcal) | PROTEIN 21.8g | FAT 5.6g (SAT FAT 1.1g) | CARBOHYDRATE 56.6g (SUGARS 1.7g) | SODIUM 78mg

DIABETES WELLNESS | Spring 2022

Put the sliced chicken, turmeric, and lemon juice in a bowl, mix well, and leave to sit. Start the rice cooking in a pot, according to instructions on packet. While the rice is cooking, heat the sesame oil in a pan on the stove at medium to high. Add the spring onions and garlic and stir-fry for around 2 minutes. Reduce the heat and add the water, peanut butter, and soy sauce. Using a wooden or other suitable spoon, work the peanut butter carefully into the liquid until you have a sauce. Add the leafy greens and stir over medium heat until the leaves soften. Set aside. Spray a second pan with olive oil and heat to medium-high. Put in the chicken slices and stir fry for around 4 minutes or until you’re sure the chicken is cooked through. Serve the chicken on top of the spinach satay sauce, with rice on the side. TIP

If using kale in this recipe, remove the stalks first. If using silverbeet, remove the stalks or chop them up finely before adding.

GREENS AND BEANS FRITTERS MAKES 10 FRITTERS | SERVES 4

These fritters make a delicious meal for four, or a snack for more. Serving them alongside a green salad will complete the meal. 1½ cups finely chopped leafy greens of your choice 170g canned beans, drained 3 eggs 2 finely chopped spring onions 2 cloves garlic, finely chopped 2 tbsp wholemeal flour ½ cup low fat milk ½ tsp of paprika ½ tsp of cumin seeds 1 tsp of mustard seeds Olive oil spray

SERVING SUGGESTIONS

Accompany with green salad, pesto, a low sugar chutney or salsa, or low-fat sour cream. We served ours with sour cream and kimchi.

TIP

Use any canned beans and any chopped greens. We chose cannellini beans and baby spinach.

Mash beans in a large bowl. Add greens, spring onions, garlic, flour, eggs, milk, and spices. Mix to combine. Place a heavy-based frypan on a medium heat and spray with olive oil. When oil is hot, cook a few fritters at a time for 2-3 minutes on each side or until golden brown. Drain on paper towel. NUTRITION PER SERVE: ENERGY 315kJ (75kcal) | PROTEIN 4.2g | FAT 3.4g (SAT FAT 0.8g) | CARBOHYDRATE 5.8g (SUGARS 1.5g) | SODIUM 104mg

Win SunRice Low GI rice and a Breville rice cooker SunRice Doongara Low GI rice is now available in 1kg bags in supermarkets nationwide. An excellent substitute for other rice varieties that have a higher glycaemic load, SunRice Doongara Low GI rice has the Diabetes New Zealand Choice approval. Enter the draw to win a Breville rice cooker plus four packs of SunRice Low GI rice. Put ‘Sunrice Low GI’ in the subject line, and email your name, phone number, and postal address to draw@diabetes.org.nz. Or post to: Freepost Diabetes NZ, PO Box 12-441, Wellington 6144. Competition closes 31 October 2022.

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Your DNZ

VIBE, a company bringing delicious sugar-free drinks to schools and other outlets, has entered into an exciting partnership with Diabetes NZ.

VIBE IS DIABETES NZ’S

NEWEST CHAMPION SPONSOR

eather Verry, Diabetes NZ CEO, welcomes VIBE to the organisation’s elite group of Champion Sponsors. ‘It’s a very positive move toward increasing awareness of the importance of reducing consumption of sugar in beverages. ‘Limiting sugar intake is pivotal to improving health outcomes in our community, reducing the risk of obesity, type 2 diabetes, and ultimately the long-term complications that can develop later in life.’ Stefan Crooks, Managing Director of VIBE, says, ‘We’re delighted to be working with Diabetes NZ. I have type 2 diabetes myself, so it’s important to me that

The team at VIBE

all the ingredients used have been signed off by Diabetes NZ.’ He says VIBE was born from a conversation about improving the products their existing school food supply business offered. ‘VIBE was created to provide a greattasting alternative to sugary drinks – one that allows kids to enjoy a carbonated drink full of flavour but with zero sugar.’ As VIBE is now available at schools and kura across Aotearoa, Verry says, ‘This allows for strong opportunities to educate school principals on the importance of nutrition intervention, as they have the power to influence children’s knowledge and behaviour.’ The New Zealand Health

Stefan Crooks

Survey 2018/2019 found that approximately one in nine children (aged two to 14) were obese, with an over-representation in Māori and Pacific communities. Crooks says, ‘Today’s consumers are looking for products like VIBE that support their emotional, indulgent, and physical health needs, ranging from relaxation to hydration. They want less sugar – no question. But they also don’t want to sacrifice taste.’ He says VIBE concentrates on the quality of its natural flavours, which are made from New Zealand ingredients. ‘Consumers are not only demanding functional drinks that don’t compromise on taste, they’re also looking for companies that adhere to a sustainable ethos. That’s why there’s no plastic used on VIBE products. Our clear can design and branding highlights the aluminium-can packaging and encourages recycling.’ Diabetes NZ is looking forward to extending the messaging about good nutrition in partnership with VIBE.

VIBE is available in schools and in New World, Pak’nSave, and Four Square stores. It’s also online at vibedrinks.co.nz.

DIABETES WELLNESS | Spring 2022

vibedrinks.co.nz

Care

DIABETES SERVICES THAT WORK FOR THE COMMUNITY Diabetes NZ is partnering with health organisations around the country to improve community-based services for those with type 2 diabetes. Newly created roles for hauora kaimahi – diabetes community coordinators – are the key. Meet Kylee Stok, our hauora kaimahi in the Hawke's Bay region.

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ith a strong background in community healthcare, including as a youth worker, a stop-smoking practitioner, and a health coach, Kylee Stok was the ideal person to fill the new Hawke's Bay role, which was created through a partnership between Diabetes NZ and Health Hawke's Bay. BUILDING THE ROLE FROM THE GROUND UP

Kylee started in her role in November 2021. Since then, she’s been building connections in the community, talking to people living with type 2 diabetes about what does and doesn’t work for them, networking with other healthcare workers, and completing a certificate in diabetes care through Waikato University. Although this course is aimed

mainly at clinical workers, she says she’s gained a good understanding of diabetes from it: ‘It’s been a real eye-opener.’ Kylee has also been setting up the programme she’ll run: Your Life Your Journey. Around the world, there’s a movement towards group-based diabetes self-management education programmes. Your Life Your Journey was developed by diabetes researchers specifically for people with diabetes in Aotearoa New Zealand. Kylee says, ‘It’s designed as a six-week programme, delivered one day per week, with each block being two hours long. So small chunks over a six week period. However, we’re going to see what our community needs are and what's going to work best for our clients – our whaiora.

‘So it could be a wānanga-style delivery at a local marae or a local church group. And it may be two full days or broken down over a two-week period.’ The unpredictability of the current Covid pandemic means flexibility of timing is vital. ‘We also want to reduce the barriers for working people, so it may be, for example, evening programmes.’ She says it’s important that, if people have children, they can bring them along. ‘And we need to be mobile as well as accessible.’ That means taking the programme to communities, rather than expecting them to come to it. WHAT DOES THE PROGRAMME INVOLVE?

Kylee explains, ‘The first Your Life Your Journey session is more of a meet and greet for whaiora. We also encourage their families to come along, or anyone that’s living in the same household, because they may wish to learn how to best support their loved one or even how to change their nutrition together. The programme is something they can do together.’ It’s not just about individuals. ‘We’re equipping people with skills to be a really connected whānau. Also, we need to equip our next generation and the one after that with the tools and skills of knowing how to prevent things that are preventable.’ It’s important that the course is a safe space for talking about diabetes and its effects and complications: ‘We let participants know before we start that sometimes it can be a bit of a reality hit for them. It can be quite confronting because it's, like, “Wow, now I see what's going on here and that's not good.”’ Kylee’s role includes training and supporting 12 facilitators, who take turns as guest

presenters on the programme. ‘They range from clinical pharmacists and dieticians to podiatrists and nurse specialists. They will come in and deliver their component, and I also deliver a component in the programme, which is around action planning and goal setting.’

‘I've always believed prevention is bigger than intervention and that prevention starts at grassroots level, which is with our people.’ Kylee has to set the tone for everyone, ‘making sure all cultural needs are met such as karakia and waiata’, and being there to keep everything running smoothly. ‘It’s important that whaiora are exposed to clinicians in a comfortable setting, so it's not clinical. It means they’re able to raise questions about what may be the barriers to them going in and engaging with, for example, a podiatrist and knowing that they can have a podiatrist visit funded – things like that. ‘And then, hopefully, out of that six weeks, they’ve formed a bit of a bond and a relationship with each other where they can continue to have a support group or maybe even just find a buddy that they can keep in contact with.’ Kylee’s support continues after the course as well. She’ll see people for one-to-one sessions if they’d like her to, ‘and if they decide to get together for a walking group, I can attend that as well’. Kylee sees one-to-one or whānau support as a vital part of what she can provide to anyone living with type 2 diabetes, whether they take the programme or not. She’ll meet people where they feel comfortable, try to understand their needs, and explain what’s

available for them and from who. She can help them set goals and create action plans, as well as learn techniques for dealing with the stress and anxiety that diabetes can bring. ‘I like to create that environment for whaiora to have me walk alongside them, rather than leading from the front or pushing from behind.’ She adds, ‘I'm a person that has needed support myself, and it is nice to be able to speak to someone that treats you and sees you as a real person.’ COPING WITH THE TIMES

Rolling out the programme during the pandemic has been challenging. Hurdles have included hesitance from people to attend events, new guidelines around room hire, and even delays to courier services, as Kylee had to source a range of interactive tools for explaining diabetes. She’s also growing the role just as the health system reforms begin to come into effect, although, so far, because this will happen slowly, it hasn’t impacted on her work. Kylee says that, in future, ‘I think people in roles like myself will be needed more a lot more. Especially with the crisis of clinical staff we have in our country at the moment. There’s a huge need. ‘I've always believed prevention is bigger than intervention and that prevention starts at grassroots level, which is with our people.’ 'Diabetes: Your Life Your Journey’ is a programme created by Capital & Coast DHB, Otago University, and Tū Ora Compass Health. Diabetes NZ is rolling it out across the country under an MOU with Te Whatu Ora – Health NZ Capital, Coast and Hutt Valley.

DIABETES WELLNESS | Spring 2022

Research

Partnership key to preventing type 2 diabetes A community in Tokoroa has joined forces with their local health provider and Massey University researcher Dr Riz Tupai-Firestone, to tackle type 2 diabetes. The ongoing partnership has been supported by Healthier Lives – He Oranga Hauora.

s one of 11 National Science Challenges set up to address the most pressing issues facing Aotearoa New Zealand, Healthier Lives funds research in the interrelated areas of cardiovascular disease, diabetes, obesity, and cancer.

VAEVAE ORO ORO – FAMILY CHAMPIONS

YOUTH LEADING THE WAY

Healthier Lives initially supported Pacific researcher Dr TupaiFirestone to establish the Pasifika Prediabetes Youth Empowerment Programme study (PPYEP). PPYEP developed a collaborative partnership between university and community-based researchers, and two Pacific communities (the Fono Health and Social Services in Auckland and the South Waikato Pacific Islands Community Services – SWPICS – in Tokoroa). The goal was to empower Pacific youth to become health advocacy leaders. Supported by this partnership, these young leaders designed programmes that successfully improved factors predisposing their communities to developing type 2 diabetes. FAMILY-BASED PREVENTION

The latest diabetes-related project to be funded by Healthier Lives focuses on a diabetes prevention programme in the Tokoroa Pacific community. The Oire Tokoroa Family Diabetes Lifestyle Programme has been developed through a process called co-design. This is where the community partner (SWPICS), along with the community members and Dr Tupai-Firestone’s university-based research team, collectively design a programme

DIABETES WELLNESS | Spring 2022

Dr Riz Tupai-Firestone

that they believe will work best for the Pacific families in the community. Co-design of communitycentred programmes is an approach used in many of the Healthier Lives-funded projects and enables more equitable and sustainable programmes. This latest diabetes prevention programme takes a family-based approach and includes Kai Tari food bags, which contain economical and healthy Pacificstyle food that family members prepare and share together. ‘We’re saving a lot of money with these food bags,’ says a study participant. ‘Seeing the ingredients that we get on shelves and in the recipes, I’ve noticed how cheap some are.’ The participant says that if it weren't for the Kai Tari bags, they’d never have bought ingredients such as lentils. The programme also includes a family physical activity programme, while whānau sessions facilitated by Pacific health experts (including a diabetes nurse specialist and a GP) will provide knowledge and understanding about managing or preventing type 2 diabetes.

An important component of this programme are the family champions or vaevae oro oro – which means ‘to serve, or doing things actively’. Their feedback reflects the extra benefits that this programme is having for their families: ‘A positive … my kids love to walk. So [the physical activities programme] has motivated me to get back out there and beat that track. ‘I have young kids, so they’re always on the go … They tell you stories about their day, and it’s just been nice to listen to them, just being able to spend time with my kids, listening to them. The exercise has been a real positive for our family wellbeing, and I’ve enjoyed it.’ Now that the programme has been co-designed and is under way, Dr Tupai-Firestone and her team have started collecting data to determine the success of this familybased approach. We look forward to hearing about the outcomes of this innovative and collaborative research initiative. To find out more about the Oire Tokoroa Family Diabetes Lifestyle Programme, visit healthierlives.co.nz/ research/pacific-diabetes-preventionprogramme.

A 2021 PwC report commissioned by Diabetes NZ, Healthier Lives, EDOR, and philanthropists Tony and Heather Falkenstein showed that Pacific communities are facing the highest burden of type 2 diabetes in this country.

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Our circulatory system affects the whole body, from large veins and arteries to the smallest capillaries like those in the eyes. Healthy circulation into the eyes brings nutrients and oxygen and removes waste products that can damage the eyes.

Pro-oxidants are highly reactive chemical substances in the body that can affect the health and integrity of blood vessels and nerves in the eyes and the rest of the body. They can come from cigarette smoke, pollution, sprays, highly processed foods or fried foods, alcohol, and drugs.

Elevated blood pressure can force blood into the back of the eye and can affect the eye’s delicate structures. However, lack of pressure may impact eye circulation needed for a good supply of oxygen and nutrients into the eye.

We can also produce pro-oxidant chemicals as part of our normal energy creation in the body, and unbalanced sugar levels in the blood can create excess acidity that can affect structures in the body and eye.

Lifestyle tips for supporting healthy blood pressure

Lifestyle tips for managing oxidative damage

• Magnesium is a mineral that is needed to support the relaxation of the arteries, which helps support normal blood pressure as well as eye blood vessel relaxation and blood flow. Increase magnesium-rich foods such as green leafy vegetables, nuts, seeds, legumes, fish, and whole grains.

• Make sure the normal sugar levels are balanced.

• Exercise supports healthy circulation in the body and normal blood pressure. It also helps strengthen the heart and maintain a normal weight and healthy blood sugar levels. • Omega 3 oils can help support healthy blood pressure by keeping our blood flowing freely.

Our most important advice for eye health! Some eye conditions can go unnoticed for years and can have significant impact on our sight. So, having regular eye tests over the age of 40 is recommended to maintain good eye health as we age.

• Cut back on processed foods and takeaways. • Stop smoking. • Increase foods rich in antioxidants as they protect the body from pro-oxidants. - Increase purple and red foods like berries, which are rich in anthocyanins.

- Vitamin E is found in avocado, seeds, nuts, olives.

- Most fruit is rich in vitamin C.

- Zinc is found in seeds, nuts, mushrooms, and fish.

- Orange fruit and vegetables contain carotenes that make vitamin A.

- Selenium is found in Brazil nuts, wholegrains, tuna, and sunflower seeds.

Clinicians for eye health Clinicians have two eye products designed to support eye health. VisionCare with Lutein supports macular health, central vision and eyes subjected to blue light from devices or the sun. OptiSight supports optic nerve health, peripheral vision and healthy circulation to the eye. Clinicians is available at pharmacies and health stores nationwide.

Always read the label. Use as directed. If symptoms persist see your healthcare professional. Dietary supplements are not a replacement for a balanced diet. Douglas Pharmaceuticals, Auckland. TAPS MR8320

HELPING TO MANAGE YOUR DIABETES

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

Skin Glu™ Barrier Wipes • Barrier wipe used pre-CGM application • Gives the skin extra protection and helps your CGM stick better • Pack of 40

Niltac™ Sting Free Medical Adhesive Remover Wipes • Pack 30 wipes • 100% Silicon Free • Hypo-Allergenic

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

Diabetes Care

Not Just A Patch™ • Waterproof adhesive patches for your FreeStyle Libre sensor • Designed to suit activity, sport or fashion choice • Assorted colours available • Pack of 20

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Frio Cooling Wallets • • • • •

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

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

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

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

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

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

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

Diabetes Wellness Spring 2022

Articles inside

Partnership key to preventing type 2 diabetes

Diabetes services that work for the community

VIBE IS DIABETES NZ'S NEWEST CHAMPION SPONSOR

FOUR WAYS WITH SPRING GREENS

SUCCEEDING WITH DIABETES

HEALTHY CARB CHOICES FOR BETTER BLOOD GLUCOSE CONTROL

DIABETES NZ PUSHES FOR HEALTHIER FOOD AND DRINKS IN SCHOOLS

SNEAKER FRIDAY

SIMPLE STEPS TO CARE FOR YOUR BACK

Forging connections, lifting others

Explainer: The new health reforms

Hayfever and Diabetes

GREENS AT YOUR DOORSTEP

Fitbit MoveMeant Challenge 2022

Upfront

DW Spring 2022 Editorial