Diabetes Wellness Summer 2020 by Diabetes New Zealand

wellness DIABETES

SUMMER 2020 $8.00 INC. GST

DIABETES NEW ZEALAND | DIABETES.ORG.NZ

RONGOĀ MĀORI • WHITE FERNS CAPTAIN SOPHIE DEVINE • CELEBRATIONS ON A BUDGET ANCIENT GRAINS FOR HEALTH • CHOOSING ACTIVEWEAR • ADVENTURE FUNDRAISING

DIABETES

ACTION MONTH

FEELING DOWN ABOUT DIABETES? WE’RE HERE TO HELP

measures spoon-for-spoon like sugar Vanilla Slice with Passionfruit Glaze Preparation 10 minutes Cooking 5 minutes Chilling 5 hours Serves 18

Ingredients Cooking oil spray, to grease 200g cream crackers ½ cup custard powder 4 cups trim milk 1 cup Equal Spoonful 2 Tbsp vanilla extract 2 Tbsp fresh passionfruit pulp 1 Tbsp cornflour Extra 1 Tbsp Equal Spoonful

Instructions 1. Grease a 20cm square tin with cooking oil. Line base and sides with baking paper. 2. Line base of tin with cream crackers in a single layer, leaving a 1cm border around the outside.

3. Put custard powder in a medium saucepan and whisk in milk in two batches until well combined and smooth. Cook over a medium heat, stirring constantly for 5 minutes until mixture is very thick. Remove from heat and stir in Equal Spoonful and vanilla extract. 4. Pour over cream crackers. Spread to smooth surface. Top with cream crackers in a single layer, leaving a 1cm border around the outside. Refrigerate for 5 hours or overnight or until filling has set. 5. To make passionfruit icing, put passionfruit pulp, cornflour and extra Equal Spoonful in a medium bowl and stir until combined. Cut slice into 9 squares following crackers as a guide then cut each square in half to form triangles. Drizzle with passionfruit icing and serve.

Nutritional Information Average Quantity Per Serve:  Energy 364.9kJ  Protein 3.2g  Fat Total 2.7g - Saturated 2.3g  Carbohydrate 12.4g - Sugars 4.5g  Sodium 72.2mg

The Essential Ingredient Equal Spoonful has almost no calories and measures spoon-for-spoon like sugar. Perfect for your recipes, cereals and drinks. Find more delicious recipes at club

.co.nz

Contents SUMMER 2020

VOLUME 32 | NO 4

4 EDITORIAL

24 COMMUNITY: Will Pickering is hooked on fundraising

5 UPFRONT: Rotorua Marathon

6 YOUR DIABETES NZ: 2020 award winners 7 UPFRONT: New health role created

16 08

28 CARE: Diabetes and your eyes 30 NOURISH: Healthy festivities on a budget

8 NOURISH: Ancient Grains

34 COMMUNITY: Creating for good

14 YOUR DIABETES NZ: Meet your Advisory Council

36 YOUR DIABETES NZ: HOPE for diabetes prevention

16 LIFE WITH T1: Sophie Devine

38 CARE: Ageing well with diabetes

18 YOUR DIABETES NZ: Diabetes Action Month – Love Don't Judge

40 RESEARCH: Research roundup

20 CARE: Rongoā comes to the fore 22 MOVE: Picking the right clothes for exercise

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DIABETES WELLNESS | Summer 2020

Editorial

n our winter Diabetes Wellness magazine, we focused on our time at Level 4 during the pandemic and the stress this put on people, especially those with diabetes. The recent lockdown of Auckland has shown how unpredictable this virus is and the need for us to be agile in our ability to open and close our services. Fortunately, the increased use of technology and the recent investment in our digital platform has meant that at Diabetes NZ we have been able to positively respond regardless of the restrictions imposed by Covid-19. Our new online services may well become permanent adjuncts to our traditional face-toface support networks, but they will not replace them. Our organisation, along with other like organisations, has been aware that the Ministry of Health’s focus is consumed with Covid-19 and that, unfortunately, the focus on diabetes has taken a backward step. This month is Diabetes Awareness Month, so we are keen to ensure that government and the public are made aware that diabetes is also a global pandemic and that of our team of five million, a quarter of a million people in New Zealand have diabetes. We are concerned that current models of care and funding do not provide for the holistic support required by people with longterm conditions, especially when they are adversely affected by large-scale public health emergencies, as we have experienced this year. The impacts are most likely to fall disproportionately on those already at risk of poorer outcomes and can generate stress levels that have the potential to affect self-management routines and quality of life. It is therefore appropriate that our theme for this year’s Diabetes Month is “Love Don’t Judge”, which encourages all New Zealanders to be kinder and change the way we think and speak about diabetes. In particular, we all need to be aware of how diabetes affects emotional and mental health. On a positive note, we are delighted that Pharmac has announced its proposal to fund two new medicines for type 2 diabetes. These medications were part of our recent petition and submission to the government, so although the medications will be restricted to people with type 2 diabetes who are at high risk of heart and kidney complications it is a step in the right direction. You can read more about this on page 6. Also in this issue: we chat with White Ferns captain Sophie Devine about her diabetes journey, learn the ins and outs of choosing exercise clothing, and offer an array of inspiration for delicious and healthy summer meals. We also find out what exciting research into diabetes is going on here and around the world, as well as hear from members of our community who are doing incredible fundraising and advocacy work for diabetes. We wish all our readers a summer free of Covid-19 restrictions and the opportunity to mix and mingle with whānau and friends. HEATHER VERRY

Chief Executive, Diabetes NZ

DIABETES WELLNESS | Summer 2020

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

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

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

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

Upfront

A marathon fundraiser In September, a team from Diabetes NZ Rotorua Branch entered the Rotorua Marathon to raise money for Diabetes NZ on the everydayhero.com platform. Together, they raised more than $4,000. Rotorua Branch co-ordinator Karen Reed trained hard for the event and entered it to celebrate her 40th aniversary with type 1 diabetes. Asked how she felt the morning after the marathon, she replied, “Sore!” Congratulations, everyone, and thank you for this incredible effort. Karen and fellow team member Nancy Farmer wait at the starting line to begin the marathon. Inset: The duo makes it across the finish line.

EAT WELL LIVE WELL

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

DIABETES WELLNESS | Summer 2020

Your Diabetes NZ

2020 award winners In October, Diabetes NZ was thrilled to announce the winners of our annual awards.

very year, we grant a number of awards to recognise determined and hard-working people in our diabetes community.

JOHN MCLAREN YOUTH AWARDS

These awards offer a scholarship to young people living with diabetes who are aiming high in their chosen fields. We received no applications for the cultural category this year, so we have granted two awards in the academic category. Our two academic awards go to Madeleine Lord and Matt Slemint. Both their applications were outstanding. Our sports award goes to Yogya Mehra.

SIR CHARLES BURNS AWARD

This award is for people who have managed their diabetes for 50 years or more through insulin therapy. In 2020, we have five recipients: • Margaret Barber: 51 years on insulin • Gretchen Good: 50 years on insulin • Paul Gravelle: 63 years on insulin • David Myers: 51 years on insulin • Elizabeth McKnight: 54 years on insulin Congratulations!

Belle Burdon, winner of the John McLaren Sporting Youth Award in 2019

Diabetes NZ welcomes proposal to fund new type 2 medicines

n September this year, Pharmac released a proposal to fund two new medicines for type 2 diabetes: empagliflozin (Jardiance) and dulaglutide (Trulicity). The funding of both treatments would be restricted to people with type 2 diabetes who are at high risk of heart and kidney complications. Late last year, Diabetes NZ took a petition to Parliament and made a submission highlighting the need for a wider range of medicines to be made available to people living with type 2, and we drew attention to the valuable new classes of medication that

DIABETES WELLNESS | Summer 2020

are often available overseas. We submitted that “Longterm complications from poorly controlled diabetes has a high health cost due to additional medications, regular screening, hospitalisation for various medical and surgical needs, outpatient appointments, and much more. If other classes of medication were available for people with type 2 diabetes, the risk and cost of these longterm complications would be reduced.” After all our work in this area, we are very pleased that Pharmac has proposed to fund two new medicines. We have

written to Pharmac in support of this proposal because it will significantly improve the outcomes for people with diabetes at risk of heart and kidney disease. It will also address equity in prescribing to at-risk Māori and Pacific people. We have sent Pharmac a range of recommendations for ensuring that, should these medicines get the go-ahead, they reach the people who most need them. We note that, to date, Pharmac has not addressed our strong recommendations that CGM technology be funded for those living with type 1 diabetes.

NEW HEALTH ROLE Diabetes NZ is thrilled to announce the appointment of Matire Ropiha to the new position of Diabetes Community Coordinator | Hauora Kaimahi.

atire, from Rongomaiwahine, Ngāti Kahungunu, Te Atiawa, and Ngāti Haumia, brings a wealth of advocacy skills and experience to the role. However, she feels that, above all, what she offers is lived experience of type 2 diabetes. She says, “I was diagnosed with gestational diabetes in 2008, which progressed to type 2 after I gave birth to our daughter.” Diabetes has also affected members of her family. Based in Taranaki, Matire will liaise with iwi health organisations, diabetes youth, and various community groups. She will help those who are newly diagnosed to navigate health systems, as well as co-ordinate the diabetes self-management programme and provide ongoing support to people with diabetes. She also says it's important to make sure there is support for the support people. This role fills an urgent gap in current diabetes care in Taranaki, and the hope is that, in time, more such roles will be able to be created and funded in other regions. We look forward to hearing more from Matire in future issues of Diabetes Wellness.

WIN A FITBIT CHARGE 4 As part of Diabetes Action Month, we’re giving away a prize pack that includes the new Fitbit Charge 4. The Fitbit Charge 4 is made for health and fitness, and packed with new features to keep you on track. To go in the draw, put FITBIT in the subject line and email your name, phone number, and postal address to draw@diabetes.org.nz Alternatively, post your entry to: Freepost Diabetes NZ PO Box 12 441, Wellington 6144 Competition closes 31 December 2020.

Invest in your health Subscribe for just $28 a year* Diabetes Wellness magazine is the flagship publication of Diabetes New Zealand * Four issues delivered to your door – $7 per issue, including P&P. RRP is $32.00 To subscribe for this special price, visit www.diabetes.org.nz and click on “Magazine Subscription”. DIABETES WELLNESS | Summer 2020

Nourish

Are ancient grains just another food fad or something worth adding to your diet? Rose Miller investigates.

Ancient Grains I n recent years, we’ve been adding some new words to our food lexicon: spelt, einkorn, buckwheat, and a few lesspronounceable names. Just what are these “new” grains that are appearing on our supermarket shelves, and are they really any good for us? In fact, they’re not new at all. They’re what are termed “ancient grains”. This is a fairly loose grouping of grains that remained largely unchanged over the last several hundred years, according to the Whole Grains Council. “Modern” grains, such as bread wheat, corn, and rice, have changed through selective breeding and hybridisation, to achieve higher-yielding, fastergrowing crops. The advantage of adding some ancient grains to your diet is that they increase your dietary diversity and add some great new flavours and textures. WHOLE GRAINS

Most of us know that whole grains are important for maintaining health: they raise “good” HDL cholesterol levels and lower “bad” LDL cholesterol, triglycerides, and blood pressure. According to the Mayo Clinic, “Foods containing fibre can provide other health benefits as well, such as helping to maintain a healthy weight and lowering your risk of diabetes, heart disease and some types of cancer.” Importantly for people with diabetes, fibre — particularly

DIABETES WELLNESS | Summer 2020

soluble fibre — can slow the absorption of sugar and help improve blood sugar levels. ANCIENT WHEATS

Our modern bread wheat has some interesting ancestors and relatives, and you can easily find some of these at your local supermarket. Farro

With a nutty, slightly sweet flavour and a pleasant chewy texture, farro (also known as emmer) makes a flavourful alternative to other grains. It’s a staple in traditional Tuscan cooking. It can be used in risotto and soups, or added to stews and salads for an interesting texture and nutritional boost. Farro resembles brown rice and is packed with fibre, protein, vitamins, minerals, and antioxidants. Try our healthy fried rice recipe on page 10, where we replace rice with delicious nutty farro. How to cook farro • Rinse the farro with water. • Add 1 cup farro to a pot with 3 cups of water. • Boil and then reduce heat to a simmer. • Cook until the grains are tender, about 30 minutes. • For faster cooking, the farro can be pre-soaked in water overnight in the refrigerator. Drain the water, replace it with 3 cups of fresh water, and then cook for 10 minutes. • Drain the water and then use as desired.

Spelt

Another ancient species of wheat is spelt (also known as dinkel). Some people say that farro and spelt are interchangeable. They are not! Cooking with spelt whole grains (called berries) is very different. Spelt berries first need to be soaked and then cooked for about one hour in plenty of water or stock, and the resulting grain is a little firmer than farro. Think of it as similar to brown rice. Add pre-cooked grains to your morning porridge or to soups and stews. How to cook spelt berries • Soak the berries in enough water to cover them for an hour or longer (even overnight). Drain and rinse. • Add the spelt berries and water to a pot and bring to a boil. Once boiling, reduce heat, stir, and cover. • Simmer for about 50 minutes, until all water is absorbed (may be slightly longer, but check to make sure it hasn’t dried out). • Cooked spelt should be chewy and soft. Spelt flour is an interesting alternative to our standard wheat flour and can be used in exactly the same way, although spelt bread dough may take longer to rise because spelt contains slightly less gluten.

But wait… there’s more! Cooked farro

Cooked spelt

There are so many other grains we can add to our diets. You can find many ancient grains at your local supermarket, but venturing to a whole foods store will give you even more choice. GLUTEN-FREE ANCIENT GRAINS

Cooked millet GLUTEN-FREE ANCIENT GRAINS Amaranth

Amaranth was originally cultivated by the Aztecs but is now a staple in Indian cooking. Amaranth is actually a seed. It’s classified as a pseudo cereal, meaning that it’s not technically a cereal grain like wheat or oats but that it shares comparable nutrients and is used in similar ways. Amaranth is rich in protein, fibre, magnesium, and iron. It can be roasted, popped, boiled, and added to other dishes, making it a versatile pantry item. Its earthy, nutty flavour and sticky texture make it perfect for porridge. If you don’t like the mushy texture of amaranth porridge, try puffed amaranth. (See our recipes for both on page 11.) You can add it to your morning cereal, use it to top salads for some crunchy texture, or just eat it as it is with your choice of milk as your morning cereal. Millet

Millet originally hails from Africa, and it’s still a staple in the diets of about a third of the world’s population, particularly in northern China. Like amaranth, it’s a seed that is classified as a pseudo cereal. Yes, you’ll see it included in bird seed, but don’t let that put you off!

Raw a maranth When cooked, the grains are light and fluffy, and have a mild corn flavour. The small size of the grain makes them quick to cook. Millet can be cooked as a whole grain, similar to quinoa (see below), but by using extra water and cooking for longer you can also make it into a breakfast porridge. Add cooked millet to greens for a healthy salad with a wonderful texture – we provide a recipe on page 12. To cook millet • Heat 1 cup of uncooked millet in a large, dry saucepan over medium heat and toast for 4 to 5 minutes until it turns golden brown. • Stir in 2 cups of water or vegetable broth and ¼ teaspoon of salt, then bring the liquid to a boil over high heat. • Reduce the heat to low and stir in 1 teaspoon of butter, then cover the saucepan. • Simmer until the millet grains absorb most of the liquid, about 15 minutes – avoid over-stirring or lifting the lid too often. • Remove from heat and let stand, covered, for about 10 minutes until the rest of the liquid is absorbed. • Fluff the millet with a fork and adjust the seasoning to taste. Serve hot.

• Sorghum • Quinoa • Buckwheat • Wild rice • Teff • Chia • Amaranth GLUTEN-CONTAINING ANCIENT GRAINS

• Freekeh or farik • Farro or emmer • Spelt or dinkel • Einkorn • Barley HOW MUCH?

• Don’t eat whole grains alone – treat them as side dishes. Remember that grains are a carbohydrate and need to be consumed as part of a balanced diet. Use the “diabetes plate” as a guide, with a quarter of your plate being carbs, a quarter protein, and half vegetables. • Watch your portion size. Two-thirds of a cup of cooked whole grains is generally an appropriate amount at any one meal or snack. • Eat grains in the least-processed state. This is one great advantage of adding ancient grains to your diet – you are reducing your reliance on processed grains. I hope you’ll consider trying ancient grains. You might end up being as hooked on them as I am. My next step is sprouting, which makes some of the minerals such as iron and zinc in your grains even more available to be absorbed. (Maybe there’s another article waiting right there!)

DIABETES WELLNESS | Summer 2020

FARRO FRIED RICE Subbing out the usual rice for the nutty chewiness of farro is an absolute win in this summery fried “rice” dish. SERVES 4

1½ Tbsp canola oil, divided 1 medium red onion, chopped 1 medium green capsicum, chopped 1 medium zucchini, chopped approx 300g bok choy, ends trimmed, stems and leaves separated, then sliced ½ cup frozen peas 3 cloves garlic, minced 1 inch piece fresh ginger, grated 2 large eggs, beaten with a fork 3 cups cooked farro,* chilled ½ cup raw cashews 2 Tbsp low-sodium soy sauce or tamari sriracha, for serving (optional) *Cook 1½ cups dry farro according to package directions. It will give you this amount! Add ½ tbsp of the canola oil to a large nonstick frying pan or wok set on medium heat. When hot, add in the red onion and cook for about 2 to 3 minutes, until it starts to soften. Add in the capsicum, zucchini, and bok choy stems. Cook for about 5 minutes, until everything has started to soften. Add in the bok choy leaves, the frozen peas, garlic, and ginger. Continue to cook for about 2 to 3 minutes, until the veges are tender. Remove the mixture to a medium bowl. If the pan is dry, add in ½ tbsp more oil and give it a swirl. Add in the eggs and cook, stirring frequently, until scrambled. Remove to the bowl with the veges. Add the remaining ½ tbsp oil to the pan, then add the cold farro. Cook for about 3 to 4 minutes, breaking up any clumps and stirring occasionally, until heated through and toasted. Turn down the heat to medium low, then add in the vege/egg mixture, the cashews, and the soy sauce. Continue to cook for about 1 minute, stirring frequently, until everything is nice and hot. Drizzle with sriracha if you like a little heat. PER 375g SERVING: ENERGY 1740kJ (416kcal) | PROTEIN 18.6g | FAT 19.4g (SATURATED FAT 3g) | CARBOHYDRATE 36.9g (SUGARS 6.2g) | SODIUM 386mg

DIABETES WELLNESS | Summer 2020

AMARANTH PORRIDGE Serves 2 With an earthy, nutty flavor, amaranth has a texture that’s perfect for porridge. 1 cup amaranth 2½ cups reduced-fat milk, almond milk, or a combination 1 tablespoon raw honey or pure maple syrup Pinch of salt ½ –1 tsp warming spices such as cinnamon, nutmeg, cardamom, ginger (optional) In a small saucepan, combine amaranth, milk/water, salt, and spices. Bring to a boil, uncovered. Cover, reduce heat to simmer, and cook for about 25 minutes, stirring frequently until amaranth is tender and creamy. Remove from heat, sweeten to taste, and serve with desired toppings. Suggested toppings: Blueberries and low-fat yogurt Stewed apple Toasted seeds and nuts Sliced fresh fruit Tip: Want to prepare your porridge ahead of time? Make multiple servings and refrigerate for up to 3–4 days. Be aware that the cooking time may increase when multiplying the recipe. PER 375G SERVING: ALMOND MILK VERSION ENERGY 2040kJ (488kcal) | PROTEIN 13.6g | FAT 34.6g (SATURATED FAT 2.2g) | CARBOHYDRATE 28.4g (SUGARS 12.7g) | SODIUM 385mg LIGHT BLUE MILK VERSION ENERGY 1200kJ (287kcal) | PROTEIN 15.8G FAT 5.8g (SATURATED FAT 2.8g) | CARBOHYDRATE 41.9g (SUGARS 26.1g) | SODIUM 532mg

PUFFED AMARANTH It’s easier than popping corn! ½ cup amaranth seeds Preheat a high-sided pot over medium-high heat. Spread about 1 tbsp of the seeds at a time as evenly as possible on the bottom of the hot pot. Wait for the seeds to pop. This should be quite immediate. If they don’t pop right away, the pot wasn’t hot enough and the seeds won’t pop and just burn. Discard that batch and start over. (It might take a couple of tries to get the temperature right. Don’t be discouraged – once the temperature is right, it’s quick and easy!) Once the popping starts, shake the pot to ensure all seeds pop and the popped seeds don’t burn. Once the popping ceases, remove the popped amaranth and put into a sieve to shake out the unpopped seeds. Add the popped amaranth to a bowl and repeat the same process until all amaranth is popped. For every tablespoon of raw amaranth, you’ll get about 2 tablespoons of puffed amaranth. PER 50g SERVING: ENERGY 585kJ | PROTEIN 5g | FAT 2g (SATURATED FAT 0g) | CARBOHYDRATES 25g (SUGARS 1g) | SODIUM 0g

DIABETES WELLNESS | Summer 2020

MILLET AND GREENS SALAD ¼ tsp salt 2 cups sliced asparagus, about 2cm pieces, bottoms trimmed and peeled if necessary (but leave the tips whole, even though they will be more than 1cm long) ¼ cup olive oil ¼ cup red wine vinegar ¼ cup finely chopped onion 1 tsp Dijon mustard Freshly ground pepper to taste 4 cups baby rocket (arugula) or roughly chopped larger leaves ½ cup torn fresh basil leaves 2 cups cooked millet (see instructions on page 9)

DIABETES WELLNESS | Summer 2020

Bring about 2–3 cm of water to a boil in a medium saucepan over high heat, add salt, and add the asparagus. Cover and simmer for 2 minutes, then drain and rinse under cold water to stop the cooking and preserve the green colour. Whisk together the oil, vinegar, onions, mustard, pepper, and a pinch of salt in a large bowl. Add the cooled asparagus, arugula, basil, and millet. Toss everything to combine with the dressing and serve at room temperature. ENERGY 1290kJ (308kCal) | PROTEIN 14g | FAT 4g (SATURATED FAT 1.3g) | CARBOHYDRATE 52g (SUGAR 4.5g) | SODIUM 437g

Smartphone enabled glucose monitoring1

WITH YOUR PHONE1,2

With a digitally connected FreeStyle Libre system, you can now manage your glucose levels anytime, anywhere with your smartphone1,2. Download the FreeStyle LibreLink app today!

Visit FreeStyleLibre.co.nz to learn more

Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc., registered in the U.S. and other countries. Google Play and the Google Play logo are trademarks of Google LLC. 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). 1.The FreeStyle LibreLink app and the FreeStyle Libre Reader have similar but not identical features. 2. The FreeStyle LibreLink app is compatible with NFC enabled phones running Android 5.0 or higher, or with iPhone 7 or higher, running iOS 11 or higher. FreeStyle, Libre, and related brand marks are trademarks of Abbott Diabetes Care Inc. in various jurisdictions. Information contained herein is for distribution outside of the USA only. For more information call Customer Service on 0800 106 100. Mediâ&#x20AC;&#x2122;Ray New Zealand, 53-55 Paul Matthews Road, Albany, Auckland 0632 www.mediray.co.nz NZBN 9429041039915 ADC-16457 v1.0

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Your diabetes NZ

Meet your advisory council Diabetes NZ’s Advisory Council is all important. Just who are they and what do they do? We talked to Advisory Council Chair Lyndal Ludlow.

iabetes NZ’s Advisory Council is responsible for providing consumer and advocacy support for the CEO, and therefore the Board, on a range of issues affecting people with diabetes and their families. There are eight members of the Advisory Council, who all bring a wealth of lived experience to the organisation. Chair Lyndal Ludlow says, “Around the Advisory Council table are people who represent the Māori health sector, Pasifika communities, youth, clinicians, carers, and people with type 1. Everyone on the Council has a direct and immediate connection to living with diabetes.” The Advisory Council was first set up in 2012, but as the new

structure of Diabetes NZ evolves, the Council’s role is evolving too. Lyndal sees the Advisory Council’s role as ensuring that Diabetes NZ is connected and having two-way conversations with people who live with diabetes: “It’s essential that the higher-level advocacy and projects stay connected to the people that the outcomes will affect.” Advisory Council members put a lot of time into the council on behalf of their communities. There are monthly Zoom meetings, articles and submissions to read and write, and, of course, constant liaison with people who live with diabetes. “To keep the Board connected to the people they’re serving, the Advisory Council needs, in turn,

to remain connected to people living with diabetes and their daily lives. The realities of life with diabetes – for those who are diagnosed and for their support people – needs to be kept front and centre of all decisions made by the Board. "The Advisory Council also provides valuable support to the operational arm of the organisation, especially with respect to advocacy." Lyndal says, "In order to keep Diabetes NZ relevant and influential, the Advisory Council is continually looking for more ways to connect with those who are living with diabetes, and to ensure their voices are heard." If there are issues you would like to raise with the Advisory Council, please email dnzac@diabetes.org.nz.

This year we have welcomed pharmacist Dr Natalie Gauld to the Advisory Council, as well as Ativalu Lemuelu, who we introduce on the opposite page.

DIABETES WELLNESS | Summer 2020

Ativalu Lemuelu: “Diabetes is personal” Diabetes New Zealand has welcomed two wonderful new members to our Advisory Council this year. One is Ativalu Lemuelu.

hen Diabetes NZ put out a call for applicants to the Advisory Council, one of Ativalu Lemuelu’s colleagues passed the information on to him and asked if he knew anyone from a Pasifika community who might be interested in applying. Ativalu asked around for some time, before thinking: “Actually, I’m interested.” A relationship manager at the Ministry of Social Development, Ativalu applied and was selected. He says his interest in diabetes is personal: “I’ve been pre-diabetic for a number of years. And lately my doctors have been harping on at me – you need to look after yourself more … “Actually, I had a wake-up call at the same time as I had my first meeting at Diabetes NZ. That was when I had a lightbulb moment: this is the reality … Accessing the wrong foods is so quick and cheap, and there are cultural issues on top of that. ‘Don’t eat…’ This is easier said than done.” He realised that the struggles he was having were the same as those of thousands of others around the country. So, Ativalu sees his role on the Advisory Council as a way to give back to Pasifika communities at the same time as keeping himself accountable. “Type 2 diabetes is rife in my Dad’s family. Dad’s mum passed away, Dad’s got it now, and I want to use this to motivate me to be better as a diabetic and be more responsible and accountable to myself and my family. My nephews – I’m doing it for them especially... “I’m famous for getting into fads and diets. This time, I want to take the changes slowly, take my time with it, build it into a lifestyle. I’ve fallen off the wagon so many times, but this is a long-term commitment for me.” He sees one of his key roles on the Advisory Council as being a connector, and he’s excited to see what he can contribute in the way of networks and resources. “I’m really enjoying being part of the Advisory Council – and learning more about the bigger picture when it comes to diabetes.”

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

Life with T1

Sophie Devine, Captain of the White Ferns, wants young people with diabetes to see all the possibilities that are open to them in sport.

A PASSION FOR SPORT

ophie Devine remembers her own diagnosis as a 15 year old. She’d been losing some weight and was thirsty a lot, but her family put that down to all the sport she was playing. It was when she noticed her vision going wonky that she told her mum maybe something was wrong. Sophie says, “That’s what prompted us to head to the GP and within literally 20 minutes of seeing the GP, I was off to the hospital. “After I was diagnosed, my mum and I were in a state of shock, and I remember going and sitting in the car with her, and we just bawled our eyes out. It was a pretty overwhelming experience. Then, after five or so minutes, my mum said, okay, right. This is it. We know what we're dealing with. Now we move on. We get on with it. There's people a lot worse off than you, so we're going to absolutely go out there and we're gonna smash it. “And that's been the attitude right from the start. I'm really lucky with it. We got home, and my brothers and sisters were all really supportive and wanting to learn about it. Over the years, my teammates have been awesome too. I've been really fortunate with a support network.”

DIABETES WELLNESS | Summer 2020

SOLID SUPPORT

In the early days of her diagnosis, Sophie’s mother’s unfailing support from the sidelines was vital. “I think that was one of the hardest things – that there’s no manual about how you as an individual will react with your insulin and food and activity, and so on. She was always there to help me work things out.” Still, Sophie says she went through what many newly diagnosed teenagers do. “I did really struggle with it at college. I was embarrassed, and I remember going into the toilets at lunchtime because I didn't want people to see me inject. “I didn't really know anyone with diabetes, and I struggled to connect with people that didn't have it.” Today, she loves talking to young people and sharing her story. She says, “I like to hear their stories, too, and what they're struggling with or what they find helpful. “Often I’ll speak to a group of teenagers and their parents, and their parents come up to me afterwards and tell me their child is too scared to play sport anymore, and yet they’d loved sport. They wonder what to do. It saddens me to hear how common that is. So I want to try to get the message out there that actually staying active is one of the best things for diabetes.” Sophie is often asked how she

“I want to try to get the message out there that actually staying active is one of the best things for diabetes.”

My Identity

is proud to create

Sophie celebrates between overs with fellow batter Suzie Bates at the T20 World Cup in Australia.

manages lows on the playing field. “I've had a couple of bad lows. Not for a while. But it’s about communicating. “Once I was actually playing cricket for New Zealand and was going low. I came off and did a test and I was pretty low, but I didn't want to miss any of the game. So I just shoved a couple of jellybeans in and jumped back out without waiting. “And yeah, I was no good. I remember standing out in the field and being like: I see about two or three balls here, and I'm a little bit tingly … I had to go off again. That's when the physio said, ‘I think you probably need to take a little bit more time to let your sugars get back up. Let's have a sandwich …’ “From that experience, I certainly learnt that you've got to give yourself time at the start and look after yourself, because you're not going to be any help to anyone on the sidelines or if you can't focus.” Sophie has also always made sure to let the people around her know about her diabetes. “I’ve always tried to be really open if anyone has questions, particularly teammates. I'd much rather they ask than be scared or not want to upset me. It helps me as well, because if things do go a little bit wobbly, I've got a whole bunch of teammates that can say, ‘Hey, are you okay? Do you need to test? You look a bit funny …’”

LOVE FOR CRICKET

Sophie says cricket was her first love – her father and brother both played, and from an early age she adored watching their games. She got onto the pitch herself as soon as she could, and although she’s played many sports over the years it’s cricket she’s remained most passionate about. It’s also a sport that accommodates her diabetes. “With cricket, you're standing out in the field for quite a few hours … I usually leave my kit just on the sidelines with the physio. If I need to, I can come to the boundary and do a quick test or a scan, and if it's something more I can simply say to the umpire, look I just need to shoot off for a couple of hours. I get subbed off and jump back on when I'm ready.” Sophie says it means a lot to her when young people or their parents contact her to say that she’s helped them understand that it’s okay to play sport with type 1 diabetes. She’s also enjoying the fact that the White Ferns now have another player with type 1 diabetes on the team – Jess Kerr. Sophie and Jess share stories and tips and with each other and together are providing twice the inspiration to young sportspeople with type 1.

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Your Diabetes NZ

DIABETES ACTION MONTH 2020

Kei whakawā. Me aroha. Running from 1 to 30 November, Diabetes Action Month is an annual awareness campaign that aims to encourage all Kiwis to take action when it comes to diabetes. This year’s theme is Love Don’t Judge, which is all about the kindness and care needed to support everyone living with diabetes to live well. “We believe Love Don’t Judge is a relevant message for 2020, a year that has challenged all Kiwis, and we know it’s been especially tough for our diabetes community,” says Heather Verry, CEO of Diabetes NZ. Together with our branches, sponsors, supporters, and partners, we will be educating, supporting, and encouraging Kiwis to be kinder this Diabetes Action Month. From changing the way we think and speak about diabetes to being aware of how diabetes affects emotional and mental health, everyone can take action.

DIABETES WELLNESS | Summer 2020

DIABETES AND EMOTIONAL WELLBEING As part of this year’s Diabetes Action Month, we’re raising awareness about the many ways living with diabetes can affect mental and emotional health. It’s estimated people with diabetes face up to 170 diabetes-related decisions every day which can really take its toll over time. The relentless nature of managing diabetes and the stress and worry this causes can lead to emotional or mental health conditions such as diabetes burnout, diabetes distress, depression, or anxiety. • Diabetes distress is the emotional burden of living with and managing diabetes, including feeling overwhelmed, frustrated, guilty, or worried about diabetes. • Diabetes burnout is when you feel emotionally exhausted by the demands of diabetes, then try to cope by giving up on taking care of diabetes. • Depression is a mental illness where you feel sad and miserable most of the time, and your mood is persistently very low. • Anxiety is a normal response to a stressful or difficult event in your life, but when these feelings become overwhelming or interfere with everyday life you may have an anxiety disorder. A new resource on helping and supporting emotional wellbeing with diabetes will be available in November at the Diabetes NZ website.

JOIN THE KŌRERO This Diabetes Action Month, we’re starting a new conversation about the emotional burden of diabetes. You’re invited to join our Facebook Live sessions on the Diabetes NZ Facebook page, where you can ask experts your questions about diabetes distress, burnout, and how to look after your emotional and mental health.

WORLD DIABETES DAY: NURSES MAKE THE DIFFERENCE World Diabetes Day falls on Saturday 14 November, and Diabetes NZ will be celebrating the important work of diabetes nurses in Aotearoa. Nurses play an important role in the care of everyone with diabetes in New Zealand. Whether offering education and advice for someone newly diagnosed, supporting diabetes management, or treating diabetes complications, nurses are there every step of the way. “Nurses working in the diabetes field are passionate about improving the lives of people in their journey

with diabetes and helping reduce distress in any way possible,” says Liz Dutton, Diabetes NZ Service Development Manager and Registered Nurse. “If you have diabetes and are experiencing distress, please talk to your nurse. They are good listeners, and if they cannot help they may be able to refer you to someone else who can,” says Dutton. Check out the calendar of events on the Diabetes NZ website to see what’s happening in your area this World Diabetes Day.

Wear a Mr Vintage ChariTEE Mr Vintage has designed a ChariTEE for Diabetes Action Month 2020. The new Love Don’t Judge design features a heart on the sleeve, so you can show your support for Diabetes NZ by wearing your heart on your sleeve, too. A number of well-known and influential New Zealanders will be the first to wear the new ChariTees in this year’s campaign video – check it out on the Diabetes NZ Facebook page and website! This year’s awesome design will be available on hats, mugs, drink bottles, and jute bags as well as T-shirts. Check out the Mr Vintage website to order yours, with 25% of all sales going to support Diabetes NZ. www.mrvintage.co.nz

DIABETES WELLNESS | Summer 2020

Care

Dr Jonni Koia, Research Fellow at Waikato University, is blending traditional Māori methodologies with scientific molecular cell approaches, in an exciting project to find new treatments for diabetes and other metabolic disorders. Johanna Knox finds out more.

RONGOĀ COMES TO THE FORE

or centuries, Māori have made medicines – for numerous ailments – from the unique native plants of Aotearoa. This mātauranga (knowledge) has been passed down through generations. Various native trees and plants have long been known by Māori to have anti-diabetic properties – whether they help to prevent it or ease its progression or symptoms. Dr Jonni Koia (Waikato-Tainui) is working to support and verify mātauranga surrounding rongoā (healing) from a biomedical molecular scientific point of view. Alongside this, she’s developing systems to try to ensure that mātauranga passed down, and the people who hold it, are protected from exploitation. ANTI-DIABETIC RĀKAU RONGOĀ

Dr Koia is working in collaboration with a team at the University of Auckland, led by Professor Peter Shepherd, that specialises in biomedical research on diabetes and cancer. This year, with the team, she published The Potential of Anti-Diabetic Rākau Rongoā (Māori Herbal Medicine) * https://doi.org/10.3389/fphar.2020.00935

DIABETES WELLNESS | Summer 2020

to Treat Type 2 Diabetes Mellitus (T2DM) Mate Huka: A Review.* The review points out that, before European settlement, the prevalence of diabetes among Māori was low. Today, rates of type 2 among Māori are three times higher than for other New Zealanders, and the age of onset is significantly earlier. Type 2 prevalence among Māori children under the age of 15 is also increasing: “Adaptation to a western-style diet and lifestyles is thought to have contributed towards high rates of diabetes among Māori. A case study has indeed confirmed T2DM can be improved by lifestyle changes, with Māori reverting to traditional food intake and physical activity.” The research looks closely at the anti-diabetes potentials of three taonga plants: kūmarahou, karamū, and kawakawa. Dr Koia says “Preliminary evidence is already showing us rongoā like kūmarahou and kawakawa may play a role in glucose uptake within adipocyte fat cells. That is encouraging. I am yet to test the same effects in beta islet cells, intestinal gut, and skeletal muscle.

RESTORING RONGOĀ TO ITS PLACE

Dr Koia says, “The kaupapa of my research is to support the work of kairongoā (rongoā Māori practitioners) and the knowledge they hold. For many reasons, but mainly political, the availability of rongoā Māori services has been a long-term issue for many. “Rongoā Māori services ought to hold an equal place alongside western medicine in terms of funding, particularly with Te Tiriti o Waitangi obligations.” She outlines numerous reasons for this need. “The development of western medicines has often not taken into account differences between individuals, such as genetic variance. There is growing evidence that there are genetic factors unique to Māori patients that could impact on treatment strategies. Together with anecdotal reports that Māori and Pasifika respond worse to metformin, this raises the possibility of unique genetic factors regulating these responses to medications. “Given that Māori have been using rongoā for hundreds of years with good effect, it is possible there are gene variants or clusters

TE REO TIPU

Alongside her research into rākau rongoā , Dr Koia has developed Te Reo Tipu, a framework for undertaking research into biomedical and bioheritage research on taonga native plants. It’s attracting interest from other researchers – and industry – already. She says the framework safeguards mātauranga Māori and its custodians through meaningful engagement with Māori communities and by ensuring that protocols associated with kaitiakitanga, mana motuhake (self-determination), and rangatiratanga are followed. “Te Reo Tipu is intended as a guide for kaupapa Māori biomedical and molecular cell research on rongoā Māori … It’s

important that the mātauranga Māori of our taonga species is sought first-hand from Māori and not bioprospected or exploited. “What I find the most frustrating is that there are researchers who criticise or disregard the work of our kairongoā, while at the same time conducting scientific and clinical research on our rongoā in secret.” She says that, before doing research into the medicinal properties of native plants, “tauiwi (non-Māori) need to make the effort to find out who their local kaumātua are in the area and approach them about their research to seek consent. It is important tauiwi seek to actively and meaningfully engage with the Māori community at the whānau and marae level. “Being Māori myself, if it’s good enough for me to ask my kaumātua about doing this research, then it should be good enough for tauiwi to ask too.”

Kawakawa

KA ORA TE WHENAU, KA ORA TE TANGATA

Dr Koia says her current research is based around this whakataukī, which can be translated as “if you heal the land, you heal the people”. She says, “I view health and wellbeing as an intrinsic and intimate connection between the whenua and the people of the land. If the land is healthy, the people will be healthy. If the land is sick, the people will be sick. As such, I not only seek to develop traditional kaupapa Māori biomedical research projects that address human metabolic disease using traditional rongoā Māori but I also develop kaupapa Māori molecular bioheritage research that addresses native plant disease and the potential role other rongoā taonga species may have on diseased plants.”

Karamū

PHOTOS: PHIL BENDLE COLLECTION

of gene families common among Māori and Pasifika to enable them to process natural rākau rongoā more effectively than synthetic drugs like metformin. This is why I also believe rongoā Māori ought to be equally funded by our country’s health system: because it is what our people need in order to be well. “I’d like to see the work conducted by our kairongoā (rongoā practitioners) accepted in mainstream health systems. Further, I’d like to see their work valued in terms of meeting present-day health needs. I would also like to see less resistance towards the acceptance of rongoā rākau in the community. Traditional Chinese medicine is more accepted in Aotearoa than our own rongoā Māori practice. “Rongoā Māori is not an alternative therapy. It is a therapy practice that stands on its own merit, based on traditional, evidence-based knowledge systems and tikanga Māori.”

Kūmarahou

DIABETES WELLNESS | Summer 2020

Move

PICKING THE RIGHT CLOTHES FOR EXERCISE Whether you’re looking to buy some new activewear or thinking about what you have available already, fitness consultant Craig Wise has some advice.

f you’re like me, you look around any store that sells activewear and feel a bit bewildered. Can’t I just go for a run in my shorts and t-shirt? The simple answer (and I am a simple man) is “yes”. There are, of course, some “buts”. PLANNING AHEAD

While everyone has different needs for their own activities, there are some simple guidelines. Firstly, consider your chosen activity and what will be most practical to wear throughout the session. If you’re heading to a spin class, then shorts or tight leggings are more suitable than loose-fitting leggings. (People will recognise their own struggles when they see someone fighting through the pain to keep going in a spin class, but no one will ever forget the guy whose

DIABETES WELLNESS | Summer 2020

leggings got caught in the pedals.) A loose, strappy top may work well for a yoga or Pilates session, but if you plan on getting moving with a high-intensity interval workout, then look for something more formfitting and flexible that gives plenty of support. Also, be aware that some facilities may have their own clothing standards, so be sure to follow these. FABRIC TYPES

Over the years, we’ve all watched as the hallowed All Blacks jersey has changed from a baggy, cotton oversized rugby top to a body-hugging, tackle-slipping barely there t-shirt. That’s thanks to men and women in lab coats and millions of dollars. Thanks to those same lab-coat wearers, the options for us mere mortals just going for a run in an old cotton t-shirt and shorts have also changed. Now don’t get me wrong, that old cotton t-shirt has its place in the grand scheme of activewear – but only if you don’t plan on working up a massive sweat. Let’s take a closer look at fabrics. Cotton

As a natural fibre, cotton is great. It allows the body to breathe and has some natural wind-breaking

properties. However, it also absorbs sweat and soon becomes heavy. If you’re out for a light workout where you won’t be pushing your limits (think spring morning walks by the river or playing at the park with the kids), then cotton is great. But if you’re planning on stepping the activity up, then you might want to think beyond the old faithful cotton. On the plus side, research has shown that odour-causing bacteria from sweat don’t cling to cotton in the same way they cling to synthetic fibres. Bamboo

Yes, that stuff the pandas chew all day! If you’re keen to stick to a natural fibre, then bamboo is a great alternative to cotton. It’s been shown to have antibacterial properties, it’s strong, and it’s moisture wicking. (It’s what? We’ll come to that later.) Spandex (AKA Lycra)

Lycra is actually a brand name for spandex, but some excellent marketing has led many to believe that it’s something different. While, for many of us, the thought of going out in public in spandex and showing off our extra rolls can be a little intense, spandex is one of the most common and versatile materials in activewear.

Its stretchy properties and strength mean that it’s blended into just about all activewear, swimwear, and underwear. Having some spandex blended into a clothing fabric will allow the body to move comfortably. One proviso: Smells can cling to spandex fibres after a heavy-sweat session, so don’t leave spandex clothing in your gym bag. Wash it as soon as possible, but don’t throw it in the dryer. Polyester

Polyester is an inexpensive and durable material with a very low absorbency rate, so it won’t get heavy with sweat like that cotton t-shirt. Because of the way it’s manufactured, the fibres are very strong. This means it is less likely to shrink or lose its shape when washed. Nylon

By itself, nylon can be scratchy, but it’s often blended with other materials to make the most of the fact that it’s a very strong material with very low absorbency – great for those sweaty workouts. TECHNOLOGY TERMS

A couple of terms appear often on clothing tags; it’s useful to know what they mean. “Moisture wicking”

When we sweat, the moisture must go somewhere. It can either stay on the skin or be absorbed by our clothes. Natural materials such as cotton absorb the moisture and lock it into the fibres, which is why that

cotton t-shirt gets so heavy after the mid-summer run. However, materials with wicking properties pass the moisture to the outer level of the garment and allow it to evaporate. “Quick dry”

A quick-dry material does just that: it dries quickly. And while it’s an especially big sales point for hiking wear, I like quick-dry clothes for workouts because I can throw them in the machine, knowing they will dry overnight. TRY IT ON!

This is important for active wear. It’s not size you’re checking but comfort and manoeuvrability. In the changing room, don’t be afraid to walk about, bend over, and squat down. No matter how great a garment looks or what brand it is, if it doesn’t feel great to move in, then it’s no good. Be sure to try different brands and styles. Make sure that you are 100% comfortable before you part with your cash. WHAT’S UNDERNEATH IS IMPORTANT, TOO

While you’re checking out those great leggings and tops, remember: good sportswear always starts with a good base. Socks

You’d think this was easy: just grab a pair from your drawer and go. But you’d be wrong. Avoid cotton socks, because, just like that t-shirt, they’ll absorb all the moisture. As

well as being uncomfortable (and a bit smelly), this can also lead to rubbing and blisters. Instead, look for socks with a nylon or wool blend which will allow the feet to breathe and have that all important moisture-wicking effect. Underwear

Your entire body sweats during a workout, even down there. So, look for lightweight undies made from moisture-wicking materials to draw away the sweat. This will also help reduce chaffing. For breasts, a well-fitted sports bra will make all the difference. It will help minimise breast discomfort during exercise and prevent damage to the supporting ligaments. It’s worth taking the time to speak to an expert and get fitted properly for a bra. If your budget means you have to choose between good outerwear and a good-quality sports bra – go for the bra every time. A FINAL THOUGHT

No clothes shopping – whether work clothes, party clothes, or activewear – should be rushed. Take your time. If it doesn’t feel right, no matter what brand it is or what sports celebrity is wearing it, then don’t waste your money. You need to be 100% comfortable in what you buy and able to do the activity of your choice in it without restrictions. If it’s comfortable and you enjoy wearing it, then you’re more likely to put it on and get active.

DIABETES WELLNESS | Summer 2020

Community

HOOKED ON FUNDRAISING Alone and struggling to keep his spirits up on a gruelling cycle tour, Will Pickering turned to charity fundraising.

ill Pickering, a New Zealander living in London, was diagnosed with type 1 diabetes in 2017. The following year, he embarked on a 700-kilometre solo cycling tour around Hardanger Fjord in Norway. He’d always been fascinated by Norway’s landscape, plus he wanted to prove to himself that he could meet the challenges of a solo expedition. There was nothing easy about the route or the conditions, and by the sixth day, Will says, “The pounding daily elevation on the legs and the relentless rain forced me into a lonely bus stop.” That was when the idea came to him to start a fundraising page on JustGiving for Diabetes UK. He took out his phone, set up the page, and wrote: I’ve clocked up 400+ kms on the bike so far including an off-road mountain pass and Troltunga 8-hour climb. But I’m exhausted and I need your love and support to keep me going. I want to get to my goal of 700km so please give a little or a lot to get me that extra push as well as help me give back to a charity that has helped me and many others suffering from type 1 and type 2 diabetes. Then he got back onto his bike. Who’d see it or whether he’d even get a response at all, he didn’t know. Will arrived at his destination for the night – a remote log cabin near a ferry crossing – and logged on. “I was stunned to see the amount of support from friends around the world.” It was all the encouragement he needed:

DIABETES WELLNESS | Summer 2020

“Kindness and generosity is a great motivator.” He completed his journey after 12 days, raising £1,484. Will says he had always had the desire to give back, and after that experience he was hooked on adventure-challenge fundraising. THE START OF THE STORY

Will’s diabetes story began when he was working as a graphic designer in London. He’d come back to Wellington, New Zealand, for his twin brother’s wedding, and he noticed he was thirsty and needing to go to the toilet often. He thought this was odd. On his way back to London, Will stopped off in Australia to visit friends. By this point, “The thirst had become extreme. I was downing one-litre bottles of whatever liquid I could get my hands on, and yet my thirst was never fulfilled. I also began losing weight.” He went online and found that these were common symptoms of diabetes. He told his friends that’s what he thought he had, but – with little knowledge about the condition – they reassured him that he wouldn’t have it as he was healthy and fit. Will says, “I should have gone to a doctor as soon as I noticed the symptoms, but, foolishly, I waited another few days until I was back in London. There, I suffered major bouts of exhaustion and decided I had to go to hospital immediately.”

Unfortunately, Will arrived during a crisis. In an event that made global headlines – the WannaCry ransomware attack – anonymous hackers had targeted thousands of computers across 150 countries, demanding a ransom before they would restore normal functions. Britain’s National Health Service was one of the largest organisations hit, with computers, MRI scanners, storage refrigerators, and theatre equipment affected. Will says A&E was packed with people as the hospital’s services began to grind to a halt. He waited in the crowd, feeling worse and worse, and eventually passed out. “The next thing I knew, I was in the ER with fluid tubes attached to my arms.” He felt energy coming back to his body but still had no idea what was going on. “The doctors were flat out. It wasn’t until three days later that I finally had a proper diagnosis of type 1 diabetes.” There was no history of diabetes in his family, but when the doctor heard Will had an identical twin he urged Will to make contact with him to suggest he get tested as well. Will did so, and his twin brother followed up on the suggestion straight away. “Sure enough, they found evidence of the early stages of type 1. So now we are quite literally ‘blood brothers’.” Will didn’t want the diagnosis to change what he could do. “Being active has always been part of my life, and I’ve tried my hand at as many sports as I could.

Football was my main sports obsession in my teens and early 20s – I represented the Central North Island and played for a number of senior clubs.” Now, “snowboarding is probably my favourite – nothing beats carving through fresh powder on a clear winter day. My dad’s also a keen cyclist, and he inspired me to get into tour-cycling. I enjoy multiday rides with bags of gear and a tent, exploring and absorbing new countries.” Not long after Will’s diagnosis, he wanted to ride around the coastline of Hokkaido, the northernmost island of Japan, with friends. “My doctor said I couldn’t, but I was determined not to miss out. I educated myself on the illness and practised nutrition and blood sugar control, and thankfully won him over.” It was after completing this trip successfully that Will set himself the challenge of the solo ride through Norway and ended up discovering how much he loved fundraising.

FUNDRAISING FOR DIABETES NZ

This year, due to Covid, Will is home in New Zealand, staying with family in Hawke’s Bay. He was wondering what to do for his next fundraising venture when “a good mate who wanted to do the Kepler Challenge Mountain Run convinced me to enter, too.” The annual challenge takes place along Fiordland National Park’s Kepler Track – 60 kilometres of uneven terrain. Will says it’s lucky they signed up when they did. “This year’s event sold out in record time. We were both fortunate to get entries … So, no choice but to do it now!” At the time of writing, Will was in his fifth month of training. “It began slowly with cycling and shorter runs, but now it’s in full swing with a good balance of longer distance, hills, and terrain running.” That’s included the Hatuma Half Marathon, where he came 13th, and the Cole Murray Cape Kidnappers 32km trail race. “I aim to practice good nutrition and blood sugar management, ready for the main event.”

Want to fundraise? Will has advice for anyone who wants to fundraise. First, when it comes to choosing your event, “an adventure or challenge that would make you the happiest is the way to go. Set dreams. Be creative and think big.” When you start your fundraising campaign: “Make a compelling story, and people will see your passion and dedication and want to support your journey.” Will has had good experiences with fundraising websites like givealittle.co.nz. He says, “Make sure you share the link with friends and colleagues via social platforms. It’s also a good idea to contact local businesses that might relate to your challenge and may wish to sponsor you. Be proactive and willing to work with them.”

Follow Will’s progress or donate to his campaign here: givealittle.co.nz/fundraiser/willskeplerchallenge

DIABETES WELLNESS | Summer 2020

ADVERTORIAL

FINDING THE

RIGHT SOLUTION FOR YOUR FINGERTIPS

Regular blood glucose testing (or blood sugar checking) forms the foundation of successful diabetes management. However, many people are put off testing by the inconvenience and pain. In fact, 35% of people with diabetes said pain was the principal reason for not testing 1. So how can you make this less of a hurdle in your self-care? 1. Select a less painful lancing device. Naturally, one factor that can contribute to the pain is your lancing device. Accu-Chek® FastClix lancing device keeps discomfort and pain to a minimum and features: • Clixmotion® technology that minimises side-to-side motion, so there is less skin tearing2,3. • 11 customisable depth settings to help match your skin type. • Precisely manufactured, tapered, small in diameter lancets (or needles) to ensure smoother entry in to the skin3. 2. Make sure the depth setting suits the skin type. The penetration depth should be set to the shallowest possible depth for the skin type. Softer, thinner skin requires a shallower setting than thicker skin. 3. Change the lancet every time. Most people only change their lancets when they can feel they are getting blunt, however the lancet should be changed after each test3. Multiple uses results in the tip of the lancet becoming dull, which increases the feeling of pain.

4. Wash and warm hands before lancing. Cold hands have poor circulation. To improve circulation, hands should be washed in warm water, then dried. Fingers that are wet, or have traces of sugar, can produce results that are inconsistent4. 5. Lance (or prick) on the side for less sensitive fingertips. As the pad of the fingertip is more sensitive, lancing the side of the fingertip is best4. You should also change the finger you lance regularly, so fingertips have time to heal. For more information, consult your healthcare professional.

References: 1. Burge, M.S. et al. Diabetes Care 2001. (24); 1502-1503. 2. The drum-based Accu-Chek® lancing devices Accu-Chek® Multiclix and Accu-Chek® FastClix: Global value dossier. Data on file. 3. The Accu-Chek® Softclix lancing device for virtually pain-free lancing. Reference tool. Data on file. 4. Diabetes.co.uk. 2019. How to test your blood glucose [Internet]. 2019 Jan 15 (cited on 19 June). Available from: https://www.diabetes.co.uk/ blood-glucose/how-to-test-blood-glucose-levels. 5. Jendrike, N. et al. ‘Pain sensation at fingertips and palm using different blood glucose monitoring systems’, Diabs Tech meeting. (2009); 6. Kocher, S, et al., Comparison of Lancing Devices for Self-Monitoring of Blood Glucose Regarding Lancing Pain J Diabetes Sci Technol 2009; 3(5):1135-1143.

ACCU-CHEK® LANCING SYSTEMS

LESS PAIN. MORE GAIN! 6

Visit https://diabetesauckland.org.nz or your local pharmacy to purchase virtually pain free lancing 5,6

FOR PEOPLE WITH DIABETES. ALWAYS READ THE INSTRUCTIONS FOR USE. CONSULT YOUR HEALTHCARE PROFESSIONAL FOR ADVICE. Accu-Chek lancing devices are for single patient use only. The same device must not be used by multiple patients. CLIXMOTION, ACCU-CHEK and FASTCLIX are trademarks of Roche. All other trademarks are the property of their respective owners. ©2020 Roche Diabetes Care. Roche Diabetes Care Australia Pty Ltd, 24-32 Lexington Drive, Bella Vista NSW 2153 Australia. ABN 69 602 140 278. Distributed in New Zealand by USL Medical, 494 Rosebank Road, Avondale, Auckland. 0800 658 814. TAPS Approval No: NA 12393. AU-735. RDC7078. Date of preparation October 2020.

Care

Diabetes is a major cause of visual impairment in adults, so caring for your eyes is all important. The New Zealand Association of Optometrists demystifies this common complication of diabetes and offers advice.

Diabetes and your eyes

control and treatment of other medical conditions such as blood pressure and abnormal cholesterol levels. This will reduce the chances of the retinopathy progressing.

WHAT IS THE RETINA?

HOW CAN DIABETES DAMAGE THE RETINA?

he main way type 1 or type 2 diabetes can affect your sight is through damage to the retina – your eye’s light-sensitive lining. The damage is called diabetic retinopathy. The retina is the delicate layer of blood vessels and light-sensitive cells positioned at the back of your eye. It’s like the film in a camera: Images we see are formed on the retina itself and converted into electrical impulses that pass from the retina, along the optic nerve, to the brain. The central part of the retina, opposite the pupil, is called the macula. This part is the most sensitive and allows us to see fine detail. The rest of the retina sees less well-defined images, but it gives us peripheral visual awareness and movement sensation. It also helps us see at night. If the retina is damaged by diabetic retinopathy, the images formed on the retina are not detected by the light-sensitive cells and some of the electrical impulses are not transmitted to the brain, so our vision is reduced. EARLY SIGNS

The early signs of diabetic retinopathy are quite common among those living with diabetes. Often these changes are minor – that is, they don’t threaten your sight right now but they do require regular monitoring. Their presence also means that special attention should be given to blood-glucose

DIABETES WELLNESS | Summer 2020

Too much sugar in the blood causes the walls of the smallest blood vessels in the retina to weaken, resulting in balloon-like bulges called microaneurysms. There can then be bleeding from these blood vessels (retinal haemorrhages) as well as fluid leakage (retinal oedema) and leakage of fats (hard exudates). The blood, fluids, and fats leak into the retinal tissue. If this leakage occurs at the macula, it is called macula oedema and vision will be reduced. In some cases, the early signs of diabetic retinopathy progress to a more severe stage of eye disease called proliferative retinopathy. If untreated, 50% of those affected with proliferative retinopathy will suffer serious visual loss. This stage is marked by neovascularisation – the growth of very fine, delicate new blood vessels that bleed easily. This bleeding causes varying amounts of visual loss, and it may take considerable time for vision to return. Sometimes, the bleeding results in the formation of scar tissue that contracts and pulls away the retina. This is called retinal detachment. It is a serious, sight-threatening condition and must be treated promptly.

HOW CAN DIABETIC RETINOPATHY BE TREATED?

Usually, an optometrist is your first port of call for regular monitoring, but if the condition is progressing you may need to be referred to an ophthalmologist for ongoing medical care. If diabetic retinopathy threatens vision, it will require laser treatment by the ophthalmologist. The laser seals the leaking retinal blood vessels that cause damaging deposits of fat in the macula. The laser also stops neovascularisation – the growth of fragile abnormal blood vessels that may bleed and reduce sight suddenly. Laser treatment mainly works by preventing and delaying further damage to the retina. Early detection of sight-threatening retinopathy is extremely important so that laser treatment can be done at the optimal time. This type of treatment is painless and can be carried out on an outpatient basis. Surgical treatment (vitrectomy) may be required if bleeding into the eye is causing persistent cloudy vision or scarring has occurred. Surgery is also required if retinal detachment occurs. This is major eye surgery and requires a general anaesthetic. PREVENTION IS BEST

Do not wait until you notice problems with your eyes before having a retinal examination. Sometimes diabetic changes to your retina are well advanced and unable to be treated by the time you notice them, so it’s important to get your

eyes checked regularly no matter what. If you are newly diagnosed with type 2 diabetes, you should have a retinal examination when first diagnosed. If you are newly diagnosed with type 1, you should have your first examination within the first five years of diagnosis. Children living with type 1 should have their first retinal exam either five years after diagnosis or when they are 10 – whichever comes first. After your first examination, you need to have an eye examination every two years to pick up any changes that may be happening to your retina. Your eye exams need to be done by an optometrist or an ophthalmologist. They will tell you if you need to have your eyes examined more often than every two years. However, if you are concerned about your sight or if, for any reason, you have not had regularenough eye exams, remember that your optometrist can provide a comprehensive eye examination at any time. You can also ask your GP for information about diabetes care from practitioners such as optometrists, ophthalmologists, or diabetes specialists – or about diabetic screening and monitoring services available in your area. Your GP can arrange a referral to any of these. PREGNANCY

Check with an optometrist or ophthalmologist about the possibility of more frequent eye examinations if you have diabetes and are pregnant, as pregnancy poses additional risks. WHAT DOES A DIABETES EYE EXAM INVOLVE?

This is a simple procedure and usually involves drops that dilate your pupils so that the retina can be directly examined. Modern digital cameras may also be used to photograph the retina, and this

process may or may not require drops. If drops are used, they will temporarily blur your near vision and make your eyes more sensitive to light. You should bring a pair of sunglasses with you. Although some people can drive afterwards, leaving your car at home or bringing a driver with you is often a good idea. HbA1c – AN IMPORTANT TOOL IN EYE CARE

If you are new to diabetes, make sure you understand about HbA1c. Your GP or diabetes specialist should be regularly giving you a blood test to measure your HbA1c. This is your glycated haemoglobin – the amount of haemoglobin in your blood that currently has glucose attached to it. Measuring your HbA1c shows what your average blood-sugar levels have been over the past two to four months. Measuring blood-sugar levels with a pin pricker or CGM helps you manage those levels on a daily basis, but a regular HbA1c test gives you a big picture view, so you can see how your blood sugar levels have been averaging over time. If your HbA1c generally ranges between 43 and 52, the chances of developing sight-threatening eye disease are majorly reduced. If, over time, the number is greater than 64, then sooner or later sightthreatening retinal changes are likely to develop. KEY CARE POINTS

To look after your sight: • maintain healthy blood glucose levels • know what your HbA1c is and get it checked regularly • treat general medical conditions such as high blood pressure and abnormal cholesterol levels • have regular eye examinations • report any rapid changes of vision to your healthcare professional straight away.

What is the difference between an optometrist and an ophthalmologist? In New Zealand, an optometrist is an eyecare professional who has generally completed a five-year Bachelor of Optometry. They must be registered with the Optometrists and Dispensing Opticians Board and hold a current practising certificate. An ophthalmologist is a specialist doctor who is trained to treat serious diseases of the eye. They will have completed a Bachelor of Medicine and Bachelor of Surgery, and then spent several more years training and passing exams to become a specialist. They must be registered with the Medical Council of New Zealand.

The New Zealand Association of Optometrists The New Zealand Association of Optometrists is concerned with the professional and clinical aspects of optometry. The work of the NZAO includes: • promoting the importance of eye and vision care to the public • maintaining the highest clinical standards through credentialing, continuing professional development, and best practice standards • representing the eye care interests of the public to the government and the Ministry of Health. Optometrists provide the majority of primary eye health care to the public of New Zealand. The optometry scope of practice includes assessing, diagnosing, treating, and managing conditions affecting the eye and its appendages and the prescribing of medicines whose sale and supply is restricted by law to prescription by authorised prescribers. NZAO is not involved in the commercial activities of the optical industry or any connection with the business activities of its members.

DIABETES WELLNESS | Summer 2020

Nourish

HEALTHY FESTIVITIES ON A BUDGET For many of us, our post-Covid festive season will involve a staycation and a tight budget. Dietitian Helen Gibbs says that can still be fun – and healthy.

hen I lived in Scotland, I used to joke that we needed six feet of snow on Christmas Eve because the amount of food in the house was usually enough to last a week. Think about your own previous celebrations. How often have you had left-over food to eat for days? Or food that was wasted? If you need to budget tightly this year, start by thinking what is really important to you, and go from there. For example, my partner and I have decided the important things for us about Christmas Day are a chance to eat slowly over several hours and to have lots of interesting tastes. We also want to open and admire presents one at a time. Sometimes a radical departure from your normal approach can be the best option. If there are children in the mix, they may have particular expectations of how the celebration is going to be, so include them in the discussions and planning. AIM FOR ENOUGH

In my article on budgeting in the spring issue of Diabetes Wellness, I gave some guidelines for meal portions per person, per day. It’s okay to use this information to plan for a festive feast as well. If you’re worried that it’s not generous enough for a celebration, you may want to increase the

DIABETES WELLNESS | Summer 2020

amount by a quarter. With desserts, it’s also okay to scale back and consider smaller portions to be savoured and enjoyed. Many families that come together to celebrate also have plates and bowls of nibbles and sweets available during the day. Again, ask if this is necessary. If your family does want this, consider asking them to each nominate a nibble from a list of items available in your supermarket bulk bins. You could then buy less of these rather than relying on packets. This may feel foreign, particularly if you’re used to having lots available to visitors. Putting out smaller amounts then resealing packets and putting them away may be an option – so that these treats can last several days or weeks. Or you might have a rule that a bowl or plate has to be almost empty before you put out more. JOIN WITH OTHERS

Perhaps you’re on your own, or hosting a meal at your house is not an option. Around the country, there are many community groups that open their doors to welcome people to have meals on Christmas Day. If you feel too embarrassed to go just for the meal, consider volunteering to help prepare the meal, then enjoy sitting down to the fruits of your labour.

Five dishes for a light and healthy feast CHICKEN AND HAM ROULADES

NEW POTATOES WITH MINT DRESSING

CARROT, ORANGE, AND ALMOND SALAD

SERVES 4

4 chicken breasts without skin (total weight approx 800g) 200g lean, thin cut ham 100g reduced fat cream cheese 4 sundried tomatoes 4 Tbsp pesto Toothpicks

800g to 1kg new potatoes 1 tsp salt

480g grated carrot 4 spring onions, chopped extremely finely 1 large orange chopped into fine chunks 80g almond flakes toasted in the oven or a pan

Chop the sundried tomatoes into very small pieces and mix through the cream cheese. Take the chicken breast and whack it with a meat-tenderising hammer or a rolling pin until it is a consistent thickness of 1cm. Spread the cream-cheese mix on the surface of the chicken breasts. Then place a thin layer of ham across each one and spread a small amount of pesto on the ham. Carefully roll the chicken breasts up so they enclose the filling, and pin with toothpicks. Bake in a moderate oven for 20–30 minutes until the chicken runs clear when pricked. Serve hot or allow to cool and cut into slices. Variation: Replace sundried tomatoes and pesto with about 1 Tbsp cranberry sauce per person. PER SERVIING: ENERGY 1290 kJ | PROTEIN 52.5g | FAT TOTAL 8.8g (SAT FAT 3.8g) | CARBS 3.4g (SUGARS 3.2g) | SODIUM 481mg

DRESSING 1 cup low fat natural yogurt ¼ cup fresh mint leaves cut finely (use a food processor or chop on a board) 1 tsp sugar ¼ tsp salt Mix all the dressing ingredients at the start of the day, and set aside in the refrigerator until you’re just about to serve. Wash and scrub the potatoes, leaving some of the skin. Put in a pot, cover with water, and add 1 tsp salt. Bring to the boil and simmer for 10 to 15 minutes or until a fork can push into a potato. Drain water and leave in the closed pot to steam.

DRESSING ¼ cup orange juice ¼ cup oil (olive or canola) Put dressing ingredients in a jar and shake. Add everything together in a bowl and toss. Leave covered in the fridge for several hours to allow flavours to develop. PER SERVIING: ENERGY 651 kJ | PROTEIN 2.3g | FAT TOTAL 13.2g (SAT FAT 1.8g) | CARBS 5.4g (SUGARS 5.4g) | SODIUM 270mg

Mix the dressing through the potatoes. If making a cold salad, wait until the potatoes are just warm before mixing through the dressing. If you like, garnish with small diced pieces of red capsicum and more mint leaves. PER SERVIING: ENERGY 451 kJ | PROTEIN 5g | FAT TOTAL 0.7g (SAT FAT 0.4g) | CARBS 18.6g (SUGARS 3.1g) | SODIUM 32mg

DIABETES WELLNESS | Summer 2020

MINI SUMMER PUDDINGS WITH FROZEN YOGURT SERVES 4

FROZEN YOGURT: (requires a blender) 2 cups low-fat yogurt 1 cup frozen strawberries 2 Tbsp icing sugar PUDDINGS: 8â&#x20AC;&#x201C;12 slices of thin white bread 400g of mixed summer fruit (strawberries, raspberries, black or red currants, etc.) 2 Tbsp sugar Four ramekins or cups (about 150ml)

DIABETES WELLNESS | Summer 2020

TO MAKE FROZEN YOGURT Blend yogurt, strawberries, and icing sugar. Put into shallow tray and put in the freezer. TO MAKE PUDDINGS Cut out four cardboard circles to a size that will just fit inside your ramekins or bowls and cover the circles in tinfoil or gladwrap. Remove the crusts from the bread and cut into 4 or 5 thin fingers. Line each of your cups or ramekins with a single layer of bread. Put the mixed fruit and sugar in a glass bowl, and heat for 1 minute in the microwave, then stir. Continue to heat for 20 seconds at a time, stirring in between. You want the berries bleeding but not cooked.

Put fruit into the ramekins and put a layer of bread on top. Put the prepared circles into the ramekin and press them gently down onto the puddings, then find something to put on top of them to weigh them down. Keep the puddings somewhere cool and dark for at least 6 hours. To serve: Carefully turn each pudding out into a shallow bowl and serve with a scoop of your frozen yogurt. PER SERVIING: ENERGY 259 kJ | PROTEIN 4.1g | FAT TOTAL 1.3g (SAT FAT 0.8g) | CARBS 6.8g (SUGARS 6.7g) | SODIUM 60mg

CHRISTMAS MINCE PARCELS MAKES 4 SMALL PARCELS

4 filo squares 2 Tbsp melted butter 2 Tbsp canola oil FILLING: 25g sultanas 25g candied peel 1 Tbsp brown sugar 1 large green apple peeled and chopped 2 tsp mixed spice Preheat oven to 200Â°C. Put all filling ingredients in a glass bowl and cook in the microwave for 4 minutes. Stir, then cook a further 4 minutes. Allow to cool. Mix the melted butter and oil together.

Take 1 filo square and brush very lightly with the butter/oil mix and fold into four. You will want to make sure there is some of the butter-oil mix between each layer you fold and on both sides of the finished square. Put about 2 tbsp of fruit mix at the centre and then bunch up the filo like a parcel. Bake in the oven until the filo crisps. Allow to cook for a few minutes then transfer to a rack to fully cool, and store in a container until ready to eat. Tip: Filo pastry is not difficult to work with but needs to be kept cool and damp. Once you open a filo pastry packet, wrap it in a slightly damp tea towel between making each parcel. PER SERVIING: ENERGY 632 kJ | PROTEIN 1.9g | FAT TOTAL 5.1g (SAT FAT 1.8g) | CARBS 23.2g (SUGARS 14.1g) | SODIUM 118mg

100% sugar-free and fabulous! www.kiwibeverages.co.nz

Community

West Auckland designer and illustrator Janina Gaudin uses her skills to support the diabetes community here and internationally. Katie Doyle caught up with her.

CREATING FOR GOOD Katie: Thanks for talking with us, Janina. How's life? Janina: My life at the moment really revolves around creating art! Currently, I’m doing artwork for the Beta Cell Foundation, which is a US-based non-profit that funds grassroots projects developed and run by individuals living with type 1 diabetes. I think it’s important to focus on supporting individuals in living their best lives right now with diabetes. I feel incredibly lucky to be living in New Zealand during this global pandemic. When you’re living with an autoimmune disease, you always think of the worst-case scenario, but over time I’ve relaxed a lot more, and things are starting to get back to normal. Because our “team of five million” went hard for those months during lockdown, it means that I now have more freedom. If I’m not creating art, I like to hang out with family and friends, explore West Auckland beaches, and visit art galleries and craft markets.

Katie: What was your type 1 diagnosis like? Janina: Twenty-six years ago, I was diagnosed at age 13. I actually “diagnosed” myself, because at that time I happened to be reading The Babysitters Club books. The character Stacey was describing her type 1 diagnosis, and I recognised all her symptoms as my own: I was tired, thirsty, and losing a lot of weight. My mum, although she was worried, thought diabetes only

DIABETES WELLNESS | Summer 2020

Janina Gaudin

happened to older people. But sure enough, our family doctor tested my blood sugar, which was 18 mmol/L. A blood test later in the week confirmed my diagnosis. I remembered being quite proud of the fact that I’d diagnosed myself, although my mum was so shocked and upset. Today, I have a good relationship with my diabetes nurse and endocrinologist, who I see once per year and can contact any time if I have problems.

Katie: When did you first start to channel your creativity into a way to express your feelings about diabetes? Janina: I have a degree in architecture, but after seven years in Melbourne I made the hard decision to come home to New Zealand to pursue illustration. In 2016, I started an Instagram account and website to document my life with type 1

because my diabetes nurse told me there were a lot of young people with diabetes in the community that were feeling down about living with this chronic disease. I’d been there myself, and I wanted to find ways to uplift them and assure them that they’re never alone. My illustrations and comics explain “invisible” life with diabetes, poking fun at certain challenges while ultimately revealing a serious chronic condition. I get a lot of messages from people with type 1 telling me my comics are relatable and make them feel less alone. Even loved ones have written to me about realising what their family member or partner goes through on a daily basis. I’m happy to help brighten someone’s day.

Katie: How did you first get involved in the online diabetes community? Janina: It started when I saw that those living with type 1 in the United States were rationing insulin because they couldn’t afford it. I couldn’t believe it! Here in New Zealand, three months of insulin can cost five dollars. In the US, the price for one vial was around USD $300 – about $450 NZ dollars. In January 2019, I saw that a group of people from the US with type 1 went to Mexico to get insulin. That was when I knew I wanted to advocate for affordable insulin through my comics, starting with a comic about their trip. A few months later, I saw that Senator Bernie Sanders was going with another group to Canada to build awareness of the US diabetes crisis. Two amazing advocates for

#INSULIN4ALL

Janina's artwork is presented to Bernie Sanders.

affordable insulin saw my comic and asked if they could frame the artwork and give it to Bernie. Of course, I said yes. It was very surreal and also a huge turning point for me to realise that not only could I uplift people living with diabetes with my artwork but I could also use it to help raise awareness about serious issues affecting our global community.

Katie: How have you overcome some of the challenges of living with diabetes that you’ve faced? Janina: I experienced burnout a few years into living with diabetes. I remember feeling quite overwhelmed and tired of trying to manage a seemingly unpredictable condition that just wouldn’t fit into teenage life. It seemed like anything I wanted to do, my blood sugar would be impacted. I was just so tired and frustrated that I wanted to ignore it. That didn’t end up going so well for me!

To get through burnout, I had to train myself to focus on the positive impact of doing things to manage my diabetes, so, rather than focus on what each individual blood sugar reading was, my achievements were the act of testing it, creating a more positive relationship with my diabetes. I would also balance these “mental calculations” and doing other things in my life so it didn’t feel like diabetes was running my life. Eventually, I started to see patterns, and I established ways to problem solve the challenges that life with diabetes brings, which made me feel much happier and able to live life how I wanted to. My advice for others would be to take it one day at a time, be kind to yourself, and remember that your blood sugar reading isn’t a reflection of who you are as a person.

T1International is a global non-profit that started the #insulin4all campaign with other organisations in 2014. Today, #insulin4all raises awareness around the most urgent diabetes issues. “Many people living with type 1 diabetes struggle to survive because they cannot afford or access their lifesaving insulin, blood glucose strips, or basic healthcare,” Founder and Executive Director Elizabeth Pfiester says. “This is about human rights. Every single person with diabetes deserves to live a full life.” Visit www.t1international.com to learn more, get involved in the global movement, and to check out a video Janina recently created: Change Through Community.

Follow Janina on Instagram: instagram.com/missdiabetes

DIABETES WELLNESS | Summer 2020

Your Diabetes NZ

The HOPE programme is a powerful grassroots initiative from Diabetes NZ’s Auckland branch. We talked to the HOPE co-ordinator Iliana Fusitua.

HOPE for diabetes prevention

OPE (formerly Healthy Options Positive Eating) is a family-centred, culturally appropriate programme, teaching about healthy eating and fun physical activities for the whole whānau, in order to prevent and manage diabetes in communities most at risk of type 2 diabetes. The HOPE programme is changing lives across Auckland and has been since 2008. This year, HOPE coordinator Iliana Fusitua spent her first three weeks of lockdown adapting the programme so it could also be delivered online. The new online option, “HOPE@Home”, is making the programme even more accessible, especially when participants are unable or too scared to leave their homes. COMMUNITY DRIVEN

Iliana says, “HOPE is a familybased diabetes prevention programme that’s all about giving participants more knowledge.” The HOPE programme takes four months, with four weekly sessions covering a range of topics that include what diabetes is, cultural attitudes towards food, interactive cooking demonstrations, and exercise sessions. There is a family challenge and then a one-month and three-month follow-up to check on progress. “It's interactive – you don’t just sit and listen to lectures. Usually, we have a minimum of 15 participants and a maximum of 25, and we go beyond

DIABETES WELLNESS | Summer 2020

health. Some people share their personal journeys and problems. You have to look at it from a holistic point of view instead of just focusing on diabetes.” The programme relies on volunteers known as HOPE Champions who are trained to deliver the HOPE programme in their communities. “HOPE Champions are our connections to the community. These are the people who will go out to their own communities, recruit participants, and deliver the programme there. The focus is on at-risk communities – Māori, Pasifika, and South Asian – so we go out to churches, temples, community organisations, and other groups like elderly groups and exercise groups. “And because the HOPE Champions know their community well, they know how to adjust the course content to suit them – the language, the recipes, the activities.” Iliana says it’s important that the changes people are encouraged to make fit with their lifestyles and are culturally appropriate. “Sometimes, people will say, my doctor said that I have to stop eating my taro … But we can't do that to people. I say, you don't have to stop eating your taro. It's just about controlling the portion size. “Or, for example, we love our corned beef, and you'd normally just eat it straight from the can, but it has a lot of saturated fat in it. So when we go out and deliver the HOPE programme to Pasifika, one of our recipes

is corned beef, but we cook it in a healthier way. We show them how to drain the fat off and then bulk it up with a lot of veggies. You still can have your corn beef, but you have it in a much healthier way.” The courses are highly successful and always draw positive feedback, and Iliana says it’s not just about people feeling physically healthier. “We get lots of people saying they've changed their way of eating in their family – they’ve got more quality time with their family at meals or more bonding time through walking after work, or after school, or taking the kids to the playground.” Over the past two years, 89% of HOPE participants attended all four sessions, with 64% reducing their servings of sugary drinks, 62% reducing their servings of takeaways, and 90% achieving their family action plan for healthy eating. In addition, 85% achieved their family action plan for physical activity. On physical measurements, 73% recorded a weight loss and 58% recorded a waist reduction, while 45% reduced their HbA1c (blood glucose level). HOPE AT HOME

Early this year, there had been some discussion within the branch and with the HOPE Champions about the possibility of launching HOPE online, but when Covid-19 hit, it became urgent. Iliana turned the PowerPoints that were delivered face to

The NZ Sikh Women's Association is one of the groups that delivers the HOPE programme.

face into videos with voiceovers that could be put online. The programme already used Facebook, so it was just a matter of using the platform more intensively. Each HOPE@Home programme was delivered by a HOPE Champion through a closed Facebook page. “So far, we've run about 11 HOPE@Home programmes. We miss the face-to-face interaction with our participants, but a lot of Champions work full time and find it hard to find a time to run the course face to face. With the online programme, it's easier for them to do their work full time and then come home, put the resources up, and chat with people online.” WHO ARE THE HOPE CHAMPIONS?

Once every one to two years, Iliana runs a two-day training course to bring new HOPE Champions on board. The next is planned for April or May 2021. “The HOPE Champions are people that have already got strong

networks in their communities through the work that they do. Most of them do HOPE in their own time alongside their other work. Most, but not all, are actually social workers. They’re already working with families, and they understand the health needs and education needs of their community. These are people that have a passion to make changes in their community.” Iliana ensures there is a solid support network in place for the HOPE Champions, and four times a year they meet at the Auckland branch office. “We just catch up and talk about their programmes, any challenges that they faced, and what they need from us to improve future programmes. We're blessed to have them. If it wasn't for them, we wouldn't be able to do it.”

FIX D RY, CR AC K E D HEEL S, FAS T • • • •

Results within 5 days Non-greasy No Parabens, petroleum or lanolin Diabetic friendly

To find out more about having the HOPE programme delivered in your community, or to become a HOPE Champion, see www.diabetes.org.nz/hope and/or email office@diabetesauckland.org.nz. Available at selected pharmacies and supermarkets nationwide

Care

Whether you’re newly diagnosed or an old hand, living with either type of diabetes brings special considerations when you’re over 70. Dietitian Helen Gibbs explains.

Ageing well with diabetes

lder people with diabetes need to eat a healthy diet, and other aspects of nutrition may need to be considered alongside their diabetes.

A NEW DIAGNOSIS

One of the least well-known risk factors for type 2 diabetes is increasing age. Our cells simply become more resistant to insulin as we get older. This is exacerbated if we become less active because of other health conditions. Many people who find themselves newly diagnosed with type 2 in their 70s or beyond feel upset about it. Often, they’re carrying only a small amount of excess weight and have led active lives until relatively recently. They may also be anxious about the idea of diabetes complications affecting their end of life. GO EASY ON WEIGHT LOSS

While an older person with type 2 diabetes who is very overweight may benefit from some weight loss, many older people should stay the same weight. Research has shown that carrying a small amount of excess weight over the age of 70 reduces the risk of poor health, and people who are overweight are less likely to end up with fractured hips. I usually say to overweight older clients that I want them to have some padding if they fall. My target weight for them is a BMI of about 27. AVOID LOW BLOOD SUGAR

When I review an older person for diabetes, whether their diagnosis is new or long-standing, I let them know I’m concerned about hypoglycaemia. Avoiding hypos becomes more important as you age. Older adults may be more susceptible to hypos, and hypos can lead to falls. Interestingly, a study published this year in the Journal of the American Medical Association found that adults with type 1 diabetes who were over 60 years old had significantly fewer hypos when they used a CGM.* For those with type 2 who are on sulphonylurea meds (such as glipizide and gliclazide), hypos can be particularly severe, and, for some of those people, it’s actually easier to manage blood glucose on one of the long-acting insulins rather than by tablets. The recommendation for older adults with type 2 is to set a slightly higher target for good diabetes control in partnership with your diabetes team. We generally say aim for an HbA1c of 59 rather than 53. * https://jamanetwork.com/journals/jama/article-abstract/2767159

DIABETES WELLNESS | Summer 2020

Individualised advice on diet and lifestyle is important for an older adult living with diabetes.

DIABETES AND OTHER HEALTH ISSUES

Malnutrition and becoming underweight are greater health risks than diabetes for older people. If an older client with type 2 has unplanned weight loss, I usually seek a medication review, and we talk about managing diabetes medically while we encourage them to eat high-energy and high-fat foods to maintain or increase body weight. I also keep a watchful eye out for a very late onset type 1. I recently saw an 88 year old who was newly diagnosed with type 1, and this was a timely reminder. Another situation where type 2 can occur for the first time is during treatment for cancer. When looking at dietary changes, we need to ask if treatment is curative or palliative. Food is ultimately about quality of life, and I would rather people ate what they enjoyed if their time is short, rather than being stressed about making dietary change. ASK FOR HELP

If you’re an older person with diabetes, don’t be afraid to ask for help to individualise your diet changes for all your health conditions. While everyone should be given individualised advice on diet and lifestyle, this is even more important for the older adult living with diabetes. Ask your GP for a referral to a dietitian locally, or find a private practice dietitian via Dietitians NZ at dietitians.org.nz.

Type 2 diabetes is not a choice. But, finding a different treatment option is.

Do you have type 2 diabetes and high blood pressure? If you are between 22 and 70 years of age and not taking insulin for treatment of your diabetes, YOU may be eligible to participate in a new clinical trial.

The clinical trial involves an investigational procedure to help treat your diabetes without new medications. The catheter based investigational procedure will require an overnight stay. The study includes 4 follow-up visits that may take up to 6 hours per visit. If you would like to know more, please visit deliverstudy-nz.com.

This study has Ethics Committee approval.

deliverstudy-nz.com Doc No. 1746 Rev1

Research

RESEARCH ROUNDUP Here are a few of the highlights from the past 18 months of research into diabetes globally. THE IMPORTANCE OF TIME IN RANGE

A 2019 Canadian study points out that increased use of CGMs has given people with diabetes and their carers a new range of ways to measure diabetes control. One of these ways is time in range (TIR). TIR graphs on your CGM capture the proportion of time your glucose levels are within a target range. (The target range is usually 3.9 to 10.0 mmol/L). For people with diabetes who use CGMs, TIR is now a common discussion point at appointments with healthcare professionals. Evidence is emerging that TIR can predict risks of complications and that lower TIR is tied to greater risk. Standardised TIR targets are being developed. The study suggests that, for most people with type 1 or type 2 diabetes, a TIR greater than 70% is a recommended target. However, the study also makes the point that it’s still important to consider what blood glucose levels are when they are out of range. In particular, it discusses the importance of including the amount and severity of time below range (TBR) in any discussions. The study recommends a target of less than 4% of time below 3.9 mmol/L , and less than 1% of time below <3.0 mmol/L. However, there should be “less stringent targets for older or high-risk individuals and for those under 25 years of age … glycaemic targets should be individualised.” https://doi.org/10.1007/s00125-019-05027-0

RELAPSE AFTER BARIATRIC SURGERY – NO FAILURE

A 2020 study published by the American Diabetes Association followed 736 people with type 2 diabetes who underwent Roux-en-Y gastric bypass or sleeve gastrectomy. Of 736 patients, 425 (58%) experienced diabetes remission in the first year after surgery. These 425 patients were then followed for several more years to document any late relapses of diabetes. It was found that 136 (32%) patients did experience late relapse of type 2, but, despite this, they maintained significant improvements in their blood sugar control and other indicators, such as their lipid profiles. The study concluded that, while late relapse of type 2 diabetes after bariatric surgery is a real phenomenon, it should not be thought of as a failure, as the trajectory of the disease is still generally changed for the better.

•

https://care.diabetesjournals.org/ content/43/3/534.abstract

THE PSYCHOLOGY OF TECHNOLOGY

A study released by Diabetes UK in January this year reviews existing research into users’ feelings about, and behaviours with, three types of technology: insulin pumps, CGMs, and – newest of all – the automated insulin delivery systems that blend those technologies to “close the loop”. Points made by the study include: • Users of pumps and CGMs often report lower levels of diabetes distress or depression. This also holds true for automated insulin

•

delivery systems, but as they are so new that evidence is still limited. In one study of CGM users, most users reported increased feelings of safety, control, and confidence in their diabetes management, but not all. Some found CGM output intrusive, and others reported frustration because of technical failures and difficulty trusting the device. Some users, rather than finding the increased information provided by CGMs empowering, find it overwhelming. Some users of CGMs, particularly teenagers, may find the shareability of CGM data is associated with unwanted interference and attention to their diabetes. The study notes: “This reduction to being nothing more than a glycaemic control number and a signal of brokenness or disability, rather than the recognition of the person's self, can have detrimental impacts on selfidentity, personality and selfconfidence. These psychosocial hurdles are far from understood and may again exclude significant segments of people with diabetes from living the lives they want rather than the lives they are boxed into.” For some people, disliking wearing a device on their body is a barrier to use of any technologies. There are a number of reasons: it may feel restrictive, it may be associated with negative body image or there may be a sense of being stigmatised by making diabetes visible in this way. Continues on page 42

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Continued from page 40 • Research into the hopes and fears associated with the new technology of automated insulin delivery shows that potential users have similar feelings to those that were expressed in the early days of pumps and CGMs. Potential users hope the technology will lead to reduced burden, greater flexibility, and greater spontaneity, as well as improved glycaemic control, but they worry about over-reliance on the device, the ability to trust and control the device, and how visible their condition will be. • There is a need for more healthcare professionals to understand all these technologies in order to be able to help people with diabetes build the skills to use them. The review concludes that, over the past 25 years, there have been amazing advances in diabetes management technology available, and psychosocial research into users’ experiences with this technology urgently needs to keep up. https://doi.org/10.1111/dme.14234

MANAGING TYPE 1 WHILE BREASTFEEDING

A Danish study released this year has reviewed research relating to management of type 1 diabetes during breastfeeding. It points out that breastfeeding is a potentially stressful and demanding period in life for those with type 1 diabetes, with many things to think about, including “a decline in insulin requirements immediately after delivery, maintenance of an adequate diet with sufficient carbohydrate intake”, as well as frequent monitoring of blood sugar while looking after a new baby. The researchers found that the issues surrounding managing diabetes while breastfeeding are significantly under-researched: “In particular, there is a gap in our

DIABETES WELLNESS | Summer 2020

knowledge regarding glycemic patterns in the first 2-week period after delivery where hypoglycemia may be most prevalent.” The researchers recommend that, in the future, studies be carried out to further understand appropriate insulin-dose adjustment during breastfeeding and, for those using insulin pump therapy, expected insulin pump settings during breastfeeding. It specifies, “The use of newer insulin pumps with an automated system that suspends basal insulin administration when low glucose is predicted needs to be explored in future studies … There is also a need for further studies on the required amount of daily carbohydrate intake to meet the energy demand and request for weight loss while avoiding hypoglycemia and ketoacidosis during breastfeeding.”

common viral infections that are associated with triggering type 1 diabetes. The researchers looked at the recorded numbers of new type 1 diabetes patients in Germany who were between six months and 18 years, and found that the numbers were similar to what had been expected during this period without the added impact of Covid-19. They concluded: “It remains unclear whether elevated stress levels and reduced infection rates outweigh each other regarding effects on the onset of type 1 diabetes in children and adolescents or whether they have no measurable impact on incidence. However, there may be a delay between immunologic factors or infections and the onset of type 1 diabetes. It is therefore crucial to conduct longterm follow-up studies.”

https://link.springer.com/article/10.1007/ s11892-020-01315-x

https://care.diabetesjournals.org/content/ diacare/early/2020/08/21/dc20-1633.full.pdf

HAS COVID-19 IMPACTED TYPE 1 DIAGNOSES?

BASAL INSULIN FOR TYPE 2: PATIENT-LED VS PHYSICIANLED

Recently, a study by the DPV initiative, a German-Austrian diabetes research organisation, sought to find out whether Covid-19 had impacted diagnoses of type 1 diabetes in young people. Psychological stress is believed to increase the risk of type 1 diabetes. For example, there were reports of more type 1 diagnoses after catastrophes such as the 1986 Chernobyl incident and the Los Angeles earthquake in 1994. The DPV researchers theorised that the stress of the social changes brought about by Covid-19 could have increased the risk of type 1 diabetes. They also wanted to know if contracting Covid-19 could trigger type 1, the same way some other viruses are believed to. On the other hand, the researchers wondered if Covid-19 lockdowns and social distancing might have reduced new diagnoses – by reducing the incidence of the

European researchers reviewed six studies to compare the effectiveness and safety of patientled versus physician-led titration of basal insulin in patients with uncontrolled type 2 diabetes. They found that patient-led titration was associated with a statistically significant higher basal insulin dose, leading to benefits on HbA1c, despite a higher risk of hypoglycemia and a slight increase in body weight. They concluded that patient-led titration of basal insulin “was not inferior to physician-led titration in patients with uncontrolled type 2 diabetes. Therefore, diabetes self-management education and support programs on basal insulin should be widely adopted in clinical practice and patients provided with tools to self-adjust their dose when necessary.” http://dx.doi.org/10.1136/bmjdrc-2020-001477

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Diabetes Wellness Summer 2020

Articles inside

RESEARCH ROUNDUP

Ageing well with diabetes

HOPE for diabetes prevention

CREATING FOR GOOD

HEALTHY FESTIVITIES ON A BUDGET

Diabetes and your eyes

HOOKED ON FUNDRAISING

PICKING THE RIGHT CLOTHES FOR EXERCISE

RONGOĀ COMES TO THE FORE

DIABETES ACTION MONTH 2020

A passion for sport

Meet your advisory council

Ancient Grains

UPFRONT: Summer 2020

EDITORIAL: Summer 2020