Diabetes Wellness Summer 2021 by Diabetes New Zealand

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SUMMER 2021 $8.00 INC. GST

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CHOOSE THE RIGHT SHOE • ENJOY A HEALTHY BBQ • A WORKOUT FOR YOUR FEET THE COVID SHOT & DIABETES • CELEBRATE 100 YEARS OF INSULIN • WIN A PRIZE PACK

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Contents

SUMMER 2021 VOLUME 33 | NO 4

4 EDITORIAL 5 YOUR DNZ: 2021 award winners

6 YOUR DNZ: DAM: Step Up for Diabetes

10 COVER: Georgia Dacres is passionate about podiatry 12 TECHNOLOGY: The history of insulin therapy 14 COMMUNITY: Winsome Johnston: A long life, living well

18 TECHNOLOGY: My Diabetes Journey 20 NOURISH: BBQ magic 24 LIFE WITH T2: Tiahuia Abraham takes control 28 LIFE WITH T2: Taming the diabetes beast 32 MOVE: A workout for your feet 34 CARE: Finding the perfect shoe

37 CARE: Covid and diabetes – what's the latest? 38 CARE: Who is Peke Waihanga 39 MOVE: Step up 250k Challenge 40 LIFE WITH T2: Paul Rowland is staring down his fears 42 YOUR DNZ: Diabetes Wellness goes digital

6 20 Want to receive your own copy of Diabetes Wellness magazine? Subscribe today at www.diabetes.org.nz

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DIABETES WELLNESS | Summer 2021

Editorial

iabetes Action Month – November every year – is always exciting, but in 2021 it’s extra special. Two themes run throughout the month. The first is Step Up for Diabetes, which sees our precious (but often neglected!) feet given the attention they deserve. Events around the country, which include our inaugural Sneaker Friday, will encourage people to look after their feet – and give them up-to-date advice on the best ways to do so. As most of us know, this is especially important for everyone with diabetes. The second strand of Diabetes Action Month 2021 is celebrating 100 years of life-saving insulin. Events to mark the anniversary are taking place all around the world, and Diabetes NZ is proud to be doing our bit to organise celebrations here in Aotearoa New Zealand. In this issue, we take a deep dive into both footcare and the history of insulin. And in more good news, we’re announcing our Diabetes NZ Award winners for 2021. You can see this announcement on page 5. The Diabetes NZ annual awards ‘season’ always gives me the opportunity to admire and learn about New Zealanders who are achieving great things. The John McLaren Youth Awards recognise those young people who are pursuing excellence in their chosen field. Meanwhile, the Diabetes NZ Award and Life Membership Award give us, as an organisation, the chance to recognise achievements over an extended time. Congratulations to those we recognise this year. Success looks different for each of us. I, for instance, am watching our son, who has type 1, spread his wings as a first year university student – living away from home and navigating the adult diabetes services offered in his new home city. Others I know are delighted they can post a day-within-range photo on social media or are quietly pleased with themselves for choosing a healthy meal option today. Still others have walked up the stairs instead of taking the lift or perhaps called the Diabetes New Zealand 0800 number for advice. Every day, we, as part of the diabetes community, can find successes and opportunities. Whatever your success today, large or small, take a moment to be pleased with yourself and your whānau. Wishing you all a successful Diabetes Action Month. Wear those sneakers with pride and comfort! LYNDAL LUDLOW

Advisory Chair, Diabetes NZ

DIABETES WELLNESS | Summer 2021

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

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

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

ADVERTISING & SPONSORSHIP Business Development Manager Jo Chapman 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.

Your DNZ

Diabetes NZ is excited to announce the recipients of our annual awards – expanded this year to honour the 100th anniversary of insulin. Congratulations to everyone!

2021 Award winners LIFE MEMBER

Bill Neill has been honoured with a Diabetes NZ life membership, acknowledging his tireless and caring commitment to volunteering for Diabetes NZ Southland. DIABETES NZ AWARDS

Each year, these awards honour some of the inspiring members of our community. This year, we acknowledge Jenny Raynes, diabetes nurse educator, and Ruth Thomson, professional lead – dietetics, who are both at the Southern District Health Board, for their generous contributions of time and energy to Diabetes Youth Otago for more than 20 years. Mervyn Wilson also receives a Diabetes NZ Award for the countless selfless hours he has devoted to Diabetes NZ Otago as a volunteer, as vice president for two years, then as president for nine. JOHN MCLAREN YOUTH AWARDS

These awards celebrate the pursuit of excellence by people under 25 who live with diabetes. Each award is $1,500, helping winners work towards their dreams. This year, we have given two awards in the Academic category – to Sam McNeill of Dunedin, who is studying a Bachelor of Biomedical Science, and Brooke Marsters of Wellington, who is studying towards a Bachelor of Medicine and Bachelor of Surgery. The award in the sporting category goes to youth athletics champion William Robertson from Southland.

SIR CHARLES BURNS MEMORIAL AWARD

SILVER MEDAL AWARD

This new award is for anyone who can demonstrate that they have managed their diabetes through insulin therapy for a continuous period of at least 25 years. Our inaugural recipients are Elaine Macky, Tim Parsens, Scott Mancer, Alana McLaren, Chris Precey, Joanne Hazlette, Susan Paterson, Valerie Blennerhassett, Noel Blennerhassett, Peter MacCrae, Warwick Coles, David Allen, Jarrod Summers, David Charles Town, and Bernadette Barry.

Diabetes NZ presents this award to anyone with diabetes who can demonstrate that they have managed their diabetes through insulin therapy for a continuous period of at least 50 years. The 2021 award recipients are Russ Finnerty, Dr Rex Douglas Faulknor, Gordon Fenwick Haszard, Donald Hyland, Kenneth Roy Pentecost, Thomas James Stratton, Shelley Clyne, Elaine Macky, and Neil Stockdill.

Bill Neill, Life Member Bill Neill has been a loyal volunteer for Diabetes NZ Southland since 1995, always available to welcome and help people with diabetes who visited the branch’s centre for blood glucose checks and diabetes education. He has regularly operated the mobile caravan (loaned to Diabetes NZ Southland by the Invercargill City Council), which has enabled blood glucose testing and educational messages to be taken on the road and to events. Rain or shine, Bill has collected the caravan from the council, taken it to its destination, set it up – usually on his own – then returned it to storage. Off his own bat, he has provided heating for the caravan during the winter months.

Even when his beloved wife became ill and he was caring for her, he checked in with the branch regularly. Bill is committed to his community in all that he does and is well known locally as someone who would help anyone in need.

DIABETES WELLNESS | Summer 2021

Your DNZ

DIABETES ACTION MONTH 2021

STEP UP FOR DIABETES November is Diabetes Action Month, and our theme this year is simple and powerful. Diabetes Action Month is Diabetes New Zealand’s annual public health and awareness campaign, encouraging everyone in Aotearoa New Zealand to take action for diabetes. We’re excited to introduce this year’s theme – Step Up for Diabetes – encouraging everyone to focus on that often neglected, but so vital, part of the body: the foot. As ever, the entire month of November will be packed with community events, fun challenges, and informative discussions around the country.

diabetes

action month

DIABETES WELLNESS | Summer 2021

PUTTING YOUR BEST FOOT FORWARD

t’s widely known that those living with any type of diabetes are at an increased risk of foot problems. This is because, over time, high blood glucose can damage your nerves and blood vessels, which can cause circulation issues and loss of feeling in your feet. Earlier this year, the report The Economic and Social Cost of Type 2 Diabetes found that diabetes has reached epidemic proportions in New Zealand, with diabetes in Aotearoa forecast to rise dramatically over the next 20 years. But the report contained good news as well. It found that regular foot checks and better foot care could prevent more than 600 diabetes-related amputations every year. Heather Verry, CEO of Diabetes NZ, says, ‘This Diabetes Action Month, we will be focusing on foot health. We’re reaching out to the quarter of a million New Zealanders with diabetes and seeking to empower them with information on how to take care of their feet to avoid preventable amputations. ‘We will also be calling on all New Zealanders to Step Up to prevent type 2 diabetes from increasing by 70% to 90% over the next 20 years – as forecast in the report The Economic and Social Cost of Type 2 Diabetes – and to help those already living with all types of diabetes to live well.’

5 DAILY STEPS FOR YOUR FEET

19 NOVEMBER IS…

Here are five daily steps that everyone with diabetes can take to reduce the risk of foot problems: Get to know your feet, so you can spot any changes. Check for any redness, cracks, swelling, bruises, blisters, corns, calluses, or ingrown toenails, using a mirror on the floor if it helps. If you notice any changes in your feet, big or small, tell your podiatrist, doctor, or diabetes nurse as soon as possible so they can advise the best form of treatment quickly.

Wash, dry, and moisturise your feet. Take special care to gently dry between your toes and avoid moisturising this area to reduce the risk of fungal infections.

Wear socks and well-fitting footwear, inside and outside, to protect your feet. If you don't wear shoes indoors, have a pair of indoor-only slippers you can always put on. These should be covered slippers, not open, and have a hard sole that will keep your feet safe from anything sharp. As for shoes, broad, deep sports shoes are often a good option. And the best socks are cotton or woollen ones that are not too tight.

Be careful with heat – if you have loss of feeling, it’s easier to burn your feet and not realise. Be mindful with heaters, and always check the temperature with your elbow before you get in a hot bath or shower.

Look after your nails by cutting them straight across and not too short. Gently file any sharp edges. A podiatrist should cut your nails for you if you have numbness.

Living well with diabetes is the best way to reduce your risk of foot problems. This includes managing blood glucose levels, eating a healthy and balanced diet, and staying active. You can also help avoid foot issues by not smoking and keeping your blood pressure and cholesterol in check.

Wear sneakers to work and fundraise for diabetes. Sneaker Friday is an exciting new fundraising event for Diabetes Action Month, encouraging New Zealanders to Step Up for Diabetes by wearing sneakers to work. Taking place on Friday, 19 November, all New Zealand workplaces are invited to get involved. To take part, you or your workplace can donate $5 to Diabetes New Zealand at givealittle.co.nz/event/sneakerfriday-2021 and wear your sneakers to work on Sneaker Friday. It’s your opportunity to step up for New Zealand’s largest and fastest-growing health crisis, raising awareness of diabetes and making a real difference to the lives of hundreds of thousands of New Zealanders living with diabetes. Let your bosses and colleagues know! To learn more, visit www.diabetesactionmonth.org.nz.

For more tips on how to look after your feet, visit www.diabetesactionmonth.org.nz.

DIABETES WELLNESS | Summer 2021

Mr Vintage ChariTEE Mr Vintage has developed a new ChariTEE for Diabetes Action Month 2021. In line with the Step Up for Diabetes theme, the new design champions the tagline Big journeys start with small steps to encourage all New Zealanders to take a step in the right direction for diabetes. This year’s awesome design will be available on t-shirts, socks, and tote bags. Check out the Mr Vintage website www.mrvintage.co.nz to order yours, with 25% of all sales going to support Diabetes New Zealand.

Join the kōrero

Following on from the success of last year’s Diabetes Action Month Facebook Live sessions, we’re once again inviting the diabetes community to join us for two very special Facebook Lives to celebrate Diabetes Action Month. WEDNESDAY, 3 NOVEMBER

All about footcare

Join us to learn why footcare is important for people with all types of diabetes, how to look after your feet at home, and what to look out for. Plus ask our podiatrist any of your feet-related questions! WEDNESDAY, 17 NOVEMBER

100 Years of Insulin

We’re celebrating this year’s World Diabetes Day theme, 100 years of insulin. We’ll discuss the invention of insulin, technology developments over the past 100 years, and what developments might look like in the future. Most of all, we will be celebrating this life-saving class of drugs and what it’s like living on insulin.

Visit our Diabetes Action Month website for activities and events near you – diabetesactionmonth.org.nz PROUDLY SUPPORTED BY

DIABETES WELLNESS | Summer 2021

Your DNZ

DESIGN FOR DIABETES Twelve-year-old Sophia Shearman couldn’t believe it when she won our competition to design a sensor patch.

ophia entered the Design for Diabetes competition – a partnership between Medstyle and Diabetes New Zealand – because she loves to draw (along with acro and working out). She was diagnosed with type 1 diabetes in 2020 and has been using a FreeStyle Libre sensor, which the patch she created is perfect for covering. The design competition invited people under 16 to design a sensor patch that showed what ‘Living Brave’ means to them. It was judged by musical duo Vince and Abby Lee Harder, whose daughter has type 1 diabetes. Sophia’s design is being made into an official RockaDex Patch, produced and sold by MedStyle. All proceeds from sales of this special patch will go to Diabetes NZ to help people live well with diabetes. THROUGH A YOUNG PERSON’S EYES

Rebecca Long, who runs MedStyle, says ‘We love that the patch represents what Living Brave with diabetes means through a young person’s eyes. ‘Sophia’s use of needles and blood drops, throughout her design, show some of the difficult aspects of living daily with diabetes. However, the cheerful colours and the smiling face in the centre of her design, to me, represent how brave people with diabetes truly are. ‘We loved Sophia's enthusiasm and want to thank her for the time and effort she put into her design. Huge congratulations, Sophia!’ Sophia says, ‘I’ve had so much fun

Rebecca, her son Hunter, and Sophia's winning patch design.

designing a patch, and I’m excited to see my design come to life!’ A LABOUR OF LOVE

MedStyle is a labour of love for Rebecca. She says, ‘When my son was diagnosed with type 1 at nine, I searched high and low for products that weren't clinical and boring. He was already dealing with enough, and I wanted to add some colour to his life with stylish-yet-practical accessories for his medical equipment.’ This led her to create MedStyle. She says, ‘Being a small family business and having a child with type 1 diabetes, it’s important to us to give back to our community. When the opportunity arose to partner with Diabetes NZ to run the Design For Diabetes competition,

we were excited to be involved. ‘We worked together to create the competition, with the focus on it being fun and creative, as well as helping raise awareness for Diabetes Action Month.’ The competition was popular. ‘It was awesome to see people get involved,’ says Rebecca. ‘We were so impressed by the many talented creative people within our community, so thank you to all that entered. ‘We plan to run the competition annually and look forward to continuing our partnership with Diabetes New Zealand.’ Sophia’s Living Brave sensor patch is available – for FreeStyle Libre & Dexcom G6 – at MedStyle: www.medstyle.co.nz DIABETES WELLNESS | Summer 2021

Community

When podiatrist Georgia Dacres moved here in 2016, England’s loss was Dunedin’s gain – especially for the diabetes community.

Passionate about

PODIATRY

eorgia moved to this country to be closer to her sister who was already here and to give her son ‘a more pastoral, outdoorsy lifestyle than he could get in Britain’. A trained podiatrist, passionate about footcare, she was soon partnering with Diabetes New Zealand Otago to run a low-cost podiatry service. She says, ‘We realise that people living with diabetes often need a regular visit to the podiatrist, and one of those ways that we can help people attend is by just creating a very affordable price.’ EMPOWERING FOOTCARE WORKSHOPS

Another of Georgia’s aims has been developing footcare workshops. She first began running some in England and has continued to do so here. This Diabetes Action Month, she will, for the first time, deliver a workshop focused mainly on locals who live with diabetes and who want to take control of their own footcare on a day-to-day basis. ‘We’re trying to get more people living with diabetes rather than health professionals to come along, although there will be some health professionals.

DIABETES WELLNESS | Summer 2021

‘It’s going to be very hands on. This is anecdotal, but for most people living with diabetes, when they get that diagnosis, they find that their feet are high in their mind as a place which might possibly go wrong, and very badly. They've often heard, in the background, about gangrene and amputation, and often they're filled with an overwhelming desire to manage that end of their feet, but they don't quite know how to. ‘If I were to say to anyone in the general public, “How do you manage your teeth?” they would say, “Well, brush every day, do this, do that.” But if you ask someone living with diabetes about looking

Georgia wears her Diabetes NZ 'Small Steps' socks – raising money for diabetes. You can buy a pair at www. diabetesactionmonth.org.nz

after their feet, often there’s a blank. ‘They're not sure what to do. They don't want to give up favourite shoes. They may not be able to manage it because they physically cannot reach. And so their feet can be this thing at the end of their body which are slightly threatening, which could go awry because they don't know how to care for them. ‘So in the workshop, I’m going to introduce ways that they can test themselves and self-screen, demonstrate how to cut toenails, go through the variety of nail clipping implements and foot creams that you can get, and so on. ‘We’re trying to give people the tools they need to say, “Right, I’m living with diabetes. This can be a positive experience. I can manage it myself ”… especially when it comes to diabetic feet.’ She says there are all sorts of tips she can show people. ‘There are devices that you can use that can get in between the toes, and, if you can’t see what’s inside your shoe and if it needs cleaning out, you can use a little vacuum cleaner nozzle … things like that. There is all this very practical advice that we can share.’ There is perhaps an extra urgency to ensuring people can

look after their own feet now. ‘Covid has made it harder for people to see their podiatrists at times, so they need to know what to do.’ PODIATRY AS A CAREER

Georgia says podiatry is a hugely rewarding career. She decided on it as soon as she left school – although it was called chiropody back then. ‘I finished my high school A-levels and didn't get the grade that I wanted for med school, so my mother said to me, “Would you like to become a chiropodist?” ‘I had no idea what that was, so she said to me, “Go and find out.” I went down to the library, got out their huge book of careers, and I looked it up. ‘I always wanted to be a little bit different from everyone else, because everyone in my generation was becoming a teacher or a nurse, and, to them, podiatry was, “Oh, I really don't know how you could!” but I could see it wasn’t like that.

It was a very exciting profession.’ She was accepted into the Chelsea School of Chiropody, Paddington, London, the following year. In retrospect, she can see now that her life experience also helped shape her decision. ‘My grandmother suffered from diabetes, and she had a penchant for wearing pointy little slip-on court shoes, and eventually she lost her little toe. My father was a shoemaker and saddler, so footwear and feet were something that were in the background of my life from a very young age.’ Georgia is constantly aware of the wonders of the human foot. ‘Humans are unique in being bipedal. We are meant to walk upright. No other mammal does that, and I think that is a big part of what makes us human, apart from the fact we’ve got a ginormous brain.’ For Georgia Dacres, working with other people’s precious feet is a privilege.

CAREERS IN PODIATRY

A podiatrist's work includes diabetes care, sports medicine, and general podiatry. A 2020 study* showed a growing shortage of podiatrists in Aotearoa New Zealand. As of 2019, there were 430 podiatrists who held an Annual Practising Certificate in the country, with most employed in private practice (many selfemployed). Only 8% were employed in the public health sector. Demand for podiatry services is increasing here, but the number of podiatrists who can provide those services isn't keeping up. As many in the diabetes community know, a good podiatrist can be worth their weight in gold. There is currently just one way to become a trained podiatrist in New Zealand – through AUT’s Bachelor of Health Science (Podiatry) in Auckland. * doi.org/10.1186/s13047-020-00430-y

DIABETES WELLNESS | Summer 2021

Technology

A century of dramatic breakthroughs have led to the insulin therapy we are lucky to have access to today. Marlon Moala-Knox investigates.

efore the discovery of insulin, type 1 diabetes was almost impossible to treat. Putting patients on strict diets might lengthen their life by a few years, but dying young was still the norm, and sometimes the diets themselves killed the patients – they were eating too little to survive. This was the reality for people with type 1 up until about 100 years ago, when production of insulin for medical use started. Before it could be used as a treatment, however, we first needed to know it existed. HOT ON THE TRAIL OF INSULIN

It was about 150 years ago that Western science began to figure out what that long organ behind the stomach – the pancreas – might be for. In 1869, German medical student Paul Langerhans was studying the pancreas when he noticed that, scattered

DIABETES WELLNESS | Summer 2021

throughout it, were interesting clumps, or ‘islands’, of cells. Noone was sure what they did, but they were given the name ‘the islets of Langerhans’. Some researchers thought they might play a role in regulating digestion. So, in 1889, two German physicians, Oskar Minkowski and Joseph von Mering, surgically removed the pancreas of a healthy dog to see how it affected its digestion. What they discovered was that the dog immediately developed symptoms of diabetes. This was the first time a link was established between diabetes and the pancreas. From 1910, Sir Edward AlbertSharpey-Schafer, an English physiologist – sometimes regarded as the founder of endocrinology – began to theorise that the only thing missing from the pancreases of people with diabetes was a single hormone. He found that the islets of Langerhans made a chemical that metabolised glucose, and he named this ‘insulin’ after the Latin word for island: ‘insula’. However, attempts to extract insulin from the pancreas were unsuccessful. Enzymes from the pancreas kept destroying the insulin during the extraction process. That was, until 1921.

FIRST SUCCESSFUL INSULIN EXTRACTION

One hundred years ago, Canadian medical researcher Frederick Banting and his assistant Charles Best found a way to extract insulin by inducing atrophy (a kind of shrivelling) in a dog’s pancreas, while leaving the islets of Langerhans intact. Banting and Best then managed to keep a dog with diabetes alive for an extended period by injecting it with insulin extracted from a non-diabetic dog’s pancreas. Now that this method was proven to work, Banting and Best teamed up with their colleagues John Macleod and James Collip to develop the process further. Their goal was to extract insulin in a purer form, and in quantities large enough for practical use in diabetes treatment. INSULIN THERAPY TAKES OFF

It’s thought that the first human patient to be treated with insulin was Leonard Thomas, a 14-yearold boy with type 1 diabetes at Toronto General Hospital who was close to death. His first injection of insulin went wrong – impurities in the extract gave him an allergic reaction. However, after the researchers further refined their methods, and Thomas began

INSULIN DELIVERY

receiving daily doses of much purer insulin, he went on to make an almost full recovery. He continued taking insulin for the next 13 years until his death from pneumonia. Though complications from diabetes were likely a major factor in his death, living for over a decade after a diabetes diagnosis was a huge improvement compared to living only few weeks or months, as had been usual before insulin was discovered. Research and development of insulin treatment continued, now mostly using insulin from the pancreases of cows and pigs. Soon Eli Lilly and Company, an American pharmaceutical firm, made a deal with the Canadian researchers and began the first mass-production of insulin. In 1923, Banting and Macleod were awarded the Nobel Prize in Physiology or Medicine, and, although it’s widely attested that, in reality, these men didn’t get along with each other, they split the money with Best and Collip. Over the next few decades, diabetes treatment advanced rapidly, with innovations such as slower-acting insulin, and, eventually, the use of bacteria to produce and extract insulin identical to that of the human pancreas. This was a huge improvement. Cow and pig insulin don’t perfectly match ours and can cause complications.

The methods we use for administering insulin have changed a lot since it was first discovered. To begin with, insulin was delivered using heavy, painful syringes with large-bore needles (pictured left). The needles were reusable, but you had to sterilise them before each use by boiling them in water. In 1924, the first specialised insulin syringe was produced by the American medical technology company Becton Dickinson. And, in 1954, Becton Dickinson introduced the first disposable glass insulin syringe. Despite advances, using syringes could still often be unpleasant or painful, and getting the dosage right was difficult. People with diabetes tended to struggle psychologically with having to painfully inject themselves multiple times a day, and this often resulted in a lack of blood sugar control as people skipped injections. PENS AND PUMPS ARRIVE

Novo Nordisk launched the first insulin pen in 1985. Compared to syringes, pens are much easier to use, as well as being more discreet and cost-effective. By the 1990s, finer needles had been developed as well, greatly reducing the pain associated with injecting insulin. The first prototype of an insulin pump was developed in 1963 by Californian doctor Arnold Kadish. It was the size of a large backpack, and had to be worn like one, strapped on to the user (pictured, right). In 1973, Dr. Ernst Friedrich Pfeiffer, from Germany, developed a fully functioning insulin pump called the Biostator. It was still too large and complicated for anyone to use it daily, but it was proof that insulin pumps could work, and was a technological stepping stone towards more practical designs.

In 1976, the first wearable insulin pump small enough for practical use was developed by US inventor Dean Kamen, finally leading to the first real uses of insulin pump therapy. In 1986, MiniMed introduced the first implantable insulin pump. THE NEW MILLENNIUM

Advances in insulin therapy and its delivery are coming rapidly now. Closed loop systems or ‘artificial pancreases’ – which combine blood sugar monitoring with fully automated insulin delivery – are becoming more accessible. They remain out of the reach of many because of cost, but perhaps that will change. One thing is certain – for over a hundred years, researchers have been working innovatively and determinedly to improve the lives of those who need insulin because of diabetes. For any of us affected by diabetes, whether we have it or a loved one does, that’s cause for celebration. Marlon Moala-Knox is a Wellington writer and researcher whose younger sister lives with type 1 diabetes.

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Community

A LONG LIFE, LIVING WELL Aucklander Winsome Johnston turns 93 at the end of November. She is recognised as the oldest person in the world with type 1 diabetes. Her daughter Jan Grove describes life with her inspirational mum.

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“Mum has a positive attitude, and she always has, especially when it comes to managing her diabetes and keeping her blood sugar down”

insome Johnston, who has been living with type 1 for 87 years – since she was six – is held up by healthcare professionals around the world as an example of what’s possible. Jan Grove, her daughter, says, ‘Mum has a positive attitude, and she always has, especially when it comes to managing her diabetes and keeping her blood sugar down, which I believe was drummed into her when she was young. A strict diet has totally brought her this far in life. ‘One of her biggest fans is her diabetes nurse Rab Burton. He’s often commented on what an amazing lady she is. He tells so many of his patients about her and uses her as an example of awesome management every day. Rab’s been a wonderful help to me, as well, over the latter years, and has become a friend.’

Winsome still remembers the shock of her doctor waving the vial of urine in front of everyone in the waiting room as he announced loudly to her mother that Winsome had diabetes. Winsome’s doctor believed that, despite the treatment that had become available, Winsome might not live long. But Winsome and her family were determined. Winsome remembers her mother making low-carb ice cream, and her father going down to the port to collect her insulin shipments from England. The needle she used to inject her insulin had to be boiled in a pan to sterilise it, and her father sharpened it using a razor blade.

DEFYING MORE PREDICTIONS

As an adult, Winsome became a nurse, met Herbert Johnston (known as Bert), and married. She continued to be determined to meet any challenge. Jan says, ‘Mum and Dad were told they would never have children because of diabetes. Well, they proved them wrong. Early in their marriage, mum went on to have four beautiful babies. First born was my sister Sherryn, who left home at 17 to do an OE in England, made her home there, married, and had two children of her own. Fifteen months later, I was born – I’ve had four children of my own.

BORN AT THE DAWN OF INSULIN THERAPY

Insulin was discovered seven years before Winsome was born. It meant that, when she was diagnosed with diabetes at six, she had a decent shot at life, whereas, just a decade earlier, things would have been different. Indeed, she had an older sister who died of diabetes at 16. Of course, diabetes management was much trickier then. The only way to check blood glucose was through urine testing. Doctors didn’t always have the most thoughtful bedside manners, either.

Winsome in her early nursing days, and Winsome and Bert, just married.

DIABETES WELLNESS | Summer 2021

Left: Winsome cutting the 25th anniversary cake with Diabetes NZ Ambassador Dame Denise L'Estrange-Corbet. Middle: Winsome enjoying some outdoor time during lockdown. Right: Winsome and daughter Jan with the latest member of the family.

Then Mum had twins five years later: a boy who lives in the far north, John, and a girl, Joanne, who’s made her home in Taranaki, and who has had two daughters. None of us have diabetes. And we’ve gifted mum with 14 greatgrandchildren now too, none of whom have diabetes so far either. ‘I really do believe Mum’s proudest moment was introducing her four babies into the world.’ Diabetes didn’t feel like a big thing to Jan growing up. ‘It was a loving happy family with two totally devoted parents, not only to their four children but to each other. ‘We had no idea that Mum had diabetes! I guess it wasn’t as prevalent as it is today, and Mum and Dad never spoke of it. Mum must have had amazing control and, knowing how Dad was so devoted to her, he must have watched her closely. ‘To her four children, she was just a lovely normal mum, baking all the time, great family dinners on the table, and normally pudding after. ‘The only diabetes-related

DIABETES WELLNESS | Summer 2021

memory I have was a stainless steel tin in our fridge. It was in there all the time. It smelt of methylated spirits – awful. That was Mum’s tin and I later found out it contained her needles and syringes for injecting insulin.’ GOING FOR A WORLD RECORD

In 2018, Winsome and her family attempted to have Winsome recognised by the Guinness World Records as the world’s longest living insulin-dependent diabetic. Jan says, ‘Our attempt was rejected as we couldn’t provide proof of the dates when Mum was diagnosed. Her records only go back 10 years with the DHB.’ But Jan says, ‘We are definitely not giving up on that. At the moment, we have been working on a second attempt to get Mum’s record accepted.’ The attempt is being supported by Diabetes New Zealand. MORE CHALLENGES

Jan says, ‘Don’t be fooled, life has not always been straight sailing.

‘Several years ago, Mum had a small heart attack, then about two years ago she broke her hip. In both cases, she was so down, and I was frightened she wasn’t coming back. ‘She pulled through both of these times. Watching her in pain, as she was, was dreadful, but she was so strong and her attitude was amazing. Each morning, she was up and she would dress herself … Makeup always went on, then out she would go to do her exercises – some mornings with excruciating pain. I don’t know how she did it.’ In 2006, Winsome’s beloved husband Bert passed away. Not long before that, the pair had decided to move to Crestwood, a retirement village in Titirangi. Winsome moved there on her own anyway. Jan says, ‘Best move ever. Since Dad’s gone, Mum has made a lot of friends. Earlier on, she was very active in the village and involved in a lot of groups. She’s slowing down a lot now, but she’s far from giving up. She also still lives independently.’

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Jan's son Bryce and his two children popping in to visit great-grandmother Winsome.

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Jan says, ‘My four children just adore their Nana. They’ll call by to see her, just to check she’s okay, and have a chat and a coffee. Often two of my girls will meet her at the Crestwood Cafe, and our morning teas often turn into lunch. ‘Mum is a born star in my eyes. The journey we’ve had together over the latter years are so special to me, and, although we’re mother and daughter, I’m proud to say we’re now best friends as well. I keep a close eye on her, and, if I can’t see her on a particular day, I ring her three or four times to check in. ‘Mum now lives a lovely quiet life, and she deserves it. She’s surrounded by people who adore her, especially family. ‘She tries every day to go for a small walk, and, before lockdown, I’d pick her up and off we’d go on outings. She’s happy to sit and read a good book too.’ Winsome has often volunteered with Diabetes New Zealand Auckland to speak to people with diabetes and encourage them. ‘Mum is here for a reason,’ says Jan. ‘I believe that so strongly. She’s often said she wants people to know, especially the young ones, that life goes on, and, with good management and a positive attitude, you can live a long and healthy life with diabetes. ‘Mum’s done the hard yards, now it’s time to relax and enjoy the quiet life.’

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Technology

INTRODUCING

My Diabetes Journey A free app from Diabetes NZ – My Diabetes Journey – is set to make it easier and more convenient for people with diabetes to manage their health.

aren Reed, Diabetes NZ District Manager for Waiariki, is excited about the app’s launch this November. She supports people living with diabetes on a daily basis and says the app will give them the confidence to continue live life well, especially at times when they don’t have access to inperson support. PACKED WITH RESOURCES YOU CAN PERSONALISE

The new app replaces the Diabetes NZ Take Control Toolkit. Karen says, ‘At the time, the Toolkit was an innovative way of providing relevant reliable credible information about diabetes and its management. Five years on, it has little advantage other than providing a shortcut to a pdf file!’

My Diabetes Journey features about 60 resources from the original Take Control Toolkit. These have been updated and, through the app, are now easier to access exactly when you need them – as well as customisable to your own needs. With recipes, nutritional information and tips, inspiration to help you get moving, and resources to manage your mental health, My Diabetes Journey is also a place to keep track of daily exercise, food intake, emotional wellbeing, and any changes to your health. Karen says, ‘Personally, I – and many people I know – have huge inertia when it comes to “daily exercise”, so I’m hoping this will help in terms of not only setting goals but achieving them. ‘The interactive features of the

new app are key. Rather than simply referring to information, people with diabetes will be able to personalise and use the app to their own advantage.’ Interactive features of My Diabetes Journey include a food diary, space to record and track movement goals, and – a feature Karen is particularly looking forward to – the option to upload photos of changes to your feet or note down any topto-toe changes to discuss with your doctor or diabetes nurse. The app will also include new diabetes distress content that was developed as part of last year’s Diabetes Action Month, to support emotional wellbeing. EXCITING POTENTIAL

Karen says, ‘I’d love to see the app recognised as the go-to tool that can be used to support the behaviours we need to adopt in order to live well with diabetes. Locally, I’ll be promoting it to people with diabetes – and health care professionals, too.’ She’s already looking ahead: ‘There’s huge potential for this app, especially if, in future versions, users can communicate and share information with patient management systems.’

Diabetes New Zealand is launching My Diabetes Journey for Diabetes Action Month, to support people living with all types of diabetes to live well. The app is available as a free download for Apple and Android. 18

DIABETES WELLNESS | Summer 2021

Want to know more about Type 2 Diabetes and insulin? Medical jargon can be confusing, but Type 2 Diabetes Xplained takes away that confusion through storytelling. Follow a New Zealand patient’s journey and learn more about Type 2 Diabetes in one of four languages - English, Maori, Samoan and Tongan. Visit www.type2diabetesxplained.co.nz or scan the QR code to read and listen to an entertaining story written by doctors for patients. Sanofi New Zealand, Auckland. MAT-NZ-2100255. Date of preparation October 2021 TAPS PP8108 CREATED BY

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Nourish

You’ll appreciate a summer barbecue even more when you know it’s packed with healthful goodness. Rose Miller and Johanna Knox offer tips and recipes.

s the days get longer, more and more of us are firing up the barbecue to enjoy summer sunshine and smoky flavours with friends and family. Barbecued meals sometimes (justifiably!) get a bad rap as unhealthy. But there are plenty of delicious ways you can change this.

TIPS FOR YOUR BARBECUE • Choose lean meat, such as chicken tenderloin, or trim fat off and remove skin. • Add plenty of veges to the grill. Sliced onion, sliced capsicum, sliced eggplant, whole tomatoes, field mushrooms, whole zucchinis, and corn on the cob are all delicious. (See our grilled corn recipe opposite.) Spray them with olive oil spray before you throw them on. • Fruit can be grilled, too. Try banana, pineapple, peach, or melon. Use fruits that are firm and not too ripe. • Serve low-sugar drinks. • Serve high-fibre bread. • Look for low-salt, low-fat, and low-sugar sauces to have on the side – or make your own. (See our two sauce recipes on page 23.) • When you’re out at someone else’s barbecue, stay hydrated by drinking plenty of water and watch your portion size. Set yourself a challenge to build yourself a plate that meets, as closely as possible, the ‘Diabetes Plate’.

POTATO SALAD SERVES 4 AS A SIDE

Swapping out mayo for a yogurt dressing makes this a tangy, creamy potato salad everyone will love. Use whatever salad herbs you have at hand for extra zing.

DIETITIAN NOTE:

New potatoes are lower in carbohydrate than older potatoes. If you make a potato salad with old potatoes, there will be roughly twice the carbs.

500g new potatoes, chopped into chunks ½ cup plain low-fat yogurt 1 tbsp olive oil ½ tsp dijon or wholegrain mustard 2 tsp red wine vinegar ¼ cup spring onion, sliced thinly 1 tsp capers, chopped (optional) ¼ cup chopped fresh salad herbs such as mint, dill, parsley, chervil A pinch of salt, and a grind of pepper to season

Wash your potatoes, leaving the skin on (extra fibre!). Bring a pot of water to the boil, then add your chopped potatoes. Bring back to the boil and cook for 10 minutes, or until soft (don't let them cook too long or they will get mushy). Drain. While your potatoes are cooking, whisk together the yogurt, olive oil, mustard, vinegar, and salt and pepper. Mix with your cooked potatoes while they are still warm – this will help the potatoes absorb the flavours of the dressing. Once cooled, stir through the spring onion, capers (if using), and the fresh herbs. Variations: Add some chopped celery and/ or cucumber for some crunch!

DIABETES WELLNESS | Summer 2021

GRILLED CORN TWO WAYS

GRILLED CORN AND BLACK BEAN SALAD

SERVES 4 AS A SIDE

SERVES 6 AS A SIDE

Which way should you barbecue your corn? It depends what effect you’re after.

A tasty Mexi-inspired corn salad.

4 fresh cobs of sweetcorn Olive oil spray if needed METHOD 1: CORN GRILLED IN HUSKS This method produces very juicy, tender corn, without charring. Peel away the outer layers of husk, leaving a couple of inner layers on. Soak the corn in water for at least 15 minutes. Throw the damp corn on a medium barbecue and cook for about 15 minutes on each side. To serve, remove the husks, or let people remove their own, or fold back the husks as they eat – a useful handle! METHOD 2: CORN GRILLED WITHOUT HUSKS This will produce dryer cobs of corn with rich, smoky flavours. Spray the corn with olive oil, throw it on a medium barbecue, and cook for about 15 minutes on each side. TO SERVE Serve corn with a squeeze of lemon or lime juice – and an optional sprinkling of chilli powder or smoked paprika. It’s also delicious with a thin coating of the yoghurt and wasabi sauce on page 23.

Salad: The kernels sliced from 2 cobs of grilled corn 1 red onion finely sliced A large handful of basil leaves 250g cherry tomatoes, halved 1 x 400g can black beans, drained and well rinsed Dressing: 2 cloves garlic, crushed 1 tablespoon olive oil Juice of 1 large lemon or 2 small ones 1 tsp dried or finely chopped fresh oregano Mix all salad ingredients together. Whisk together all dressing ingredients. When ready to serve, toss salad and dressing together. PER SERVE | CALORIES: 635kJ (152kcal) | PROTEIN 6.6g | FAT 3.1g (SAT FAT 0.5g) | CARBS 19.9g (SUGAR 5.3g) | SODIUM 216mg

GRILLED CORN SLAW SERVES 4 AS A SIDE

Even more more-ish than regular coleslaw! Salad: The kernels sliced from 4 cobs of grilled corn ¾ cup grated carrot 1 cup finely chopped cabbage 1 cup finely chopped capsicum ¼ cup finely chopped spring onion Dressing: 2 cloves garlic, crushed 1 tablespoon olive oil Juice of 1 large lemon or 2 small ones A few pinches of chili powder (optional) Mix all salad ingredients together. Whisk together all dressing ingredients. When ready to serve, toss salad and dressing together. PER SERVE | CALORIES: 579kJ (140kcal) | PROTEIN 3.9g | FAT 4.5g (SAT FAT 0.6g) | CARBS 17.3g (SUGAR 6.5g) | SODIUM 30mg

DIETITIAN NOTE:

A corn cob has around 15g carbohydrate per 100g, so weigh your corn if you are calculating carbs. However, the carbohydrate in corn varies hugely depending on the variety, the freshness, and what part of the season it is, so this is an estimate. How much carbohydrate we actually absorb from corn varies widely, so if you are new to diabetes and have a blood glucose meter, check how much it raises your blood glucose.

DIABETES WELLNESS | Summer 2021

IKA MATA SERVES 4 AS A MAIN OR 8 AS A SIDE

Fish ‘cooked’ by marinating in citrus juice is a dish enjoyed in many parts of the world, especially around the Pacific and in South America. The citric acid coagulates the proteins in the fish, just as cooking does, so the flesh turns white. Use a firm fish that won't flake – for example, monkfish, ling, alfonsino, grouper, kingfish, or tuna.

500g fish, chopped into cubes ½ cup squeezed lemon or lime juice ¼ cup spring onions, finely chopped 1 cup chopped tomato or capsicum 1 whole cucumber, sliced into half circles ½ cup light coconut milk Mix the fish and lemon or lime juice together so all the fish is well coated. Leave it to sit covered in the fridge in a non-reactive bowl (ie, not aluminium, copper, or cast iron) for about three hours. Mix in the chopped vegetables and the coconut milk when ready to serve.

CHICKEN AND VEGE KEBABS SERVES 4

A flavourful yogurt marinade tenderises the chicken in these healthy colourful kebabs. Kebabs: 4 boneless skinless chicken thighs 1 large red capsicum 1 large yellow capsicum 1 small zucchini ½ red onion oil spray Marinade: ½ cup plain low-fat Greek yogurt 1 tbsp olive oil Juice of ½ lime or lemon ½ tsp chili powder ½ tsp cumin ½ tsp smoked paprika ¼ tsp black pepper ¼ tsp salt 1-2 cloves garlic, minced ¼ tsp cayenne pepper (optional) Sauce: ½ cup plain low-fat Greek yogurt Juice of ½ lime or lemon 1 tbsp olive oil ½ cup fresh chopped coriander

DIABETES WELLNESS | Summer 2021

Whisk together the marinade ingredients in a large bowl. Cut the chicken thighs into bite-size pieces, then add to the yogurt mixture and mix together to coat the chicken. Leave to marinate in the fridge for at least three hours (or overnight). When ready to cook, soak the wooden kebab skewers in water for up to 30 minutes – this stops charring or burning. Combine the sauce ingredients in a blender or food processor, if you have one, or mix by hand. Set aside until ready to serve. To make the kebabs, cut the peppers and red onion into 3cm chunks. Slice the zucchini crosswise into about 2cm rounds. Remove the chicken from the fridge and fill the skewers, alternating chicken with veges. Preheat the BBQ grill to medium heat (or the grill in your oven). Spray kebabs lightly with oil to avoid sticking. Grill the kebabs for 3–4 minutes on each side, rotating in quarter turns until fully cooked. (The chicken juices should run clear when fully cooked.) To serve, drizzle over the sauce and garnish with some fresh coriander. Serve immediately. PER SERVE | CALORIES: 1500kJ (360kcal) | PROTEIN 35.9g | FAT 18.1g (SAT FAT 4.4g) | CARBS 9.8g (SUGAR 9.1g) | SODIUM 252mg

GET

saucy! Bought sauces have lots of hidden sugars, salt, and fats. Making your own sauces and dressings means you know what's in them, and saves you money.

WASABI YOGHURT SAUCE

SMOKY BBQ SAUCE

SERVES 4

This is delicious with grilled vegetables or meats.

This sauce goes particularly well with meats.

1 cup plain low-fat yoghurt Juice of one large lemon or two small lemons 1 tsp wasabi powder 1 tsp water

2 tsp Worcestershire sauce 1 tsp cider vinegar ½ tin (200g) crushed tomatoes 1 tsp tomato paste 1 tsp smoked paprika ½ tsp brown sugar

Mix wasabi powder to a paste with water. Mix paste and all ingredients together. Serve in a bowl or jar with a spoon or in a squeezy bottle. DIETITIAN NOTE: You can use pre-

made wasabi paste instead of powder, but the powder is tastier and lower in sodium.

This summer, make a healthy choice

EAT WELL LIVE WELL

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

DIABETES WELLNESS | Summer 2021

Life with T2

TAKING CONTROL After a serious stroke in 2006, Tiahuia Abraham forced herself to slow down and reduce stress, while staying active at the same time.

arlier this year, Tiahuia Abraham took part in a diabetes selfmanagement course in New Plymouth – Your Life, Your Journey – run by Diabetes NZ in partnership with Pinnacle Midlands Health Network and Tui Ora Whānau Health and Wellbeing. It made her think back to life 20 years ago: ‘I was like a workaholic in those days. I didn't know I had diabetes or high blood pressure.’ She had a high-stress government job and was President of the Pan Pacific and South East Asia Women's Association. She’d also been deeply involved in the Māori Women’s Welfare League for many years, eventually becoming National Area Representative for MWWL, the Aotea Kaunihera President, and Aotea’s coordinator for the National Kohanga Reo while in her role as a Welfare Officer for Māori Affairs. ‘When I think about how I worked, it's no wonder I had a stroke. It was just full on.’ She says she was lucky that, when she had the stroke, her granddaughter was with her and took her straight to the doctor. The stroke led to a loss of mobility on her left side and the discovery that she had type 2 diabetes. ‘Until then, I didn’t really even know what diabetes was.’

DIABETES WELLNESS | Summer 2021

THE ROAD TO RECOVERY

Some time after the stroke, one of Tiahuia’s daughters was working at an aquatic centre, and suggested that her mum go along. Tiahuia has never looked back. ‘I knew that, for me, swimming would be the exercise to do. The girls at the pool were really good to me, and I always had somebody watching me – although there might’ve been a couple of times where I probably overdid it and had to go straight to hospital from the pool!’ Swimming helped her recover faster than she’d imagined she would. ‘I say to people who’ve had a stroke, if you can get into the pool, do. That was what helped me. ‘A lot of people couldn’t believe that I’d had a stroke and where I was at. Next thing, I could’ve gone back to work if I wanted to. My job was still there. But after getting mobile again, I started thinking about

things, and I thought, “No, I think I’ll take early retirement.”’ In practice, this meant reducing her workload, rather than stopping altogether – and she also has 25 grandchildren and 31 greatgrandchildren. ‘My moko live all over Aotearoa, but I try and have as much time with them as I can’. ‘I found it really hard to slow down, but now I’m enjoying it. If I don’t want to go somewhere, I won’t. And I’ve always been up at half past five, six in the morning, but, just recently, I went back to bed one morning and woke up, and it was eight o’clock. I thought, “That’s the first time I’ve ever done that!” First time ever. It felt awesome.’ Leaving behind the stress of certain types of work has been a relief as well. ‘Sometimes I get my computer and sit at the table and catch up on things … When I think

how the computer and all those devices were my job years ago, I think, “I can use that learning to easily connect with my moko via technology.”’ TE ARA HĪKOI

Tiahuia joined Te Ara Hīkoi. This is a swimming group in Taranaki that removes financial barriers to give people the opportunity to focus on their health through swimming, aquajogging, and walking. Te Ara Hīkoi fundraises to give its members heavily discounted access to Todd Energy Aquatic Centre in New Plymouth. That means unlimited swims, spas, and saunas – any day of the year except Christmas (the only day the aquatic centre is closed). The one commitment when you join Te Ara Hīkoi is that you must attend its monthly meetings to whakawhānaungatanga.

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For Tiahuia, it’s been a wonderful way to exercise and connect with others. She tries to meet the group and swim every day, although sometimes she takes a break during the school holidays: ‘All the kids go down in the holidays, so I think “Oh I’ll let them have the pool in the mornings, and we can start back once the holidays have finished.”’ Often, after swimming, ‘We finish with a spa, then we might go somewhere for lunch, then we meet again the next morning.’ Te Ara Hīkoi began as a group for people 65 years old and over, but, recently, seeing an increase in medical conditions in younger people, the group opened up more widely. One of the new younger members is Matire Ropiha, the Taranaki Diabetes Community Co-ordinator for Diabetes New Zealand, who has type 2 diabetes herself. Matire was delivering the Your Life, Your Journey diabetes self-management programme for Pinnacle MHN and Tui Ora WHW, and Tiahuia – along with her husband Steven, who also has type 2 diabetes – decided to enrol. YOUR LIFE, YOUR JOURNEY

The course was every Friday for six weeks, and Tiahuia says it has given her new information about how to take control of her diabetes more fully. She has a much more detailed understanding of how diabetes works, how the medicines she

takes work, and all the ways that diet affects diabetes. This knowledge gives her the power to make more decisions for herself over her health. ‘Even during the course, we really cut back, my husband and I: we’d have our porridge or Weetbix and maybe a poached egg on toast, and that’s us for the day until lunchtime. Then I’ll just have a salad sandwich or something like that, and then when it comes to teatime we look at each other and say, “Well, what are we going to have for tea?” ‘We talk about diabetes all the time now in our house, especially watching the mokos. We don’t really have any more fizzy drinks or anything like that now. We just have water, and the kids are having almond milk. We don’t have loads of butter like we used to. And we quite like celery! ‘I was with our greatgrandchildren in Auckland yesterday, and just seeing their lunches going off to school now … their mother gives them beautiful healthy lunches.’ Since completing the course, Tiahuia has been going out of her way to recommend it to other people. And the message about reducing stress is one she wants people to hear as well. ‘You’ve got to learn to slow down. Even to my 30-year-old granddaughter in Auckland, I say, “slow down”.’

HAUORA AND SELF-MANAGEMENT

Matire Ropiha, who runs the Your Life, Your Journey programme and is also a new member of Te Ara Hīkoi, says, ‘One thing about Te Ara Hīkoi that I love is that you have to self-manage. It’s up to you to go and sign up to go to the pools, and get in and out of the pools without help. It’s a big push for taking responsibility for your hauora, which I really align with. ‘That’s part of this diabetes selfmanagement programme too, and I agree with that philosophy. It’s like, “OK whānau, we need to self-manage.” That’s one of the messages I push on this programme, because, as a diabetic, it’s an important aspect of managing our diabetes.’

In loving memory of James Heeni McDonald, Chairman Te Ara Hīkoi (5 January 1957 – 15 September 2021) James was a staunch member of Te Ara Hīkoi, and you would see him at the aquatic centre most days with his routine, 'hop in the spa, go into the sauna, then swim a few lengths in the pool.' Nō reira e te whānau, kia kaha koutou. Moe mai e te whanaunga, moe mai e tō moenga roa. – Judith-Ann Tiahuia Abraham QSO

Benefits of aquajogging Aquajogging is a great way to exercise with little impact on your joints, as the water supports them. Pushing against the water strengthens muscles and joints and gives a great aerobic workout with little recovery time. During winter, aquajogging in a heated pool is a realistic workout for many.

DIABETES WELLNESS | Summer 2021

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Life with T2

TAMING THE BEAST Diabetes NZ volunteer Grace Wyatt shares her type 2 story.

burst into tears. It was February 2019, and my new doctor had just told me that I had type 2 diabetes. I’d been aware of the probability for many years but had hoped to avoid the family trap I’d inherited – and the medical predisposition I have as the result of surgery. With the help of tissues and careful handling by this new doctor, I got over myself, and we discussed the situation. I wanted to try and reverse my HbA1c, and she was reluctant to put me on medications immediately, so she readily agreed. I was sceptical about reversing the diagnosis, but, for reasons I’ll go into soon, I was more suspicious of diabetic medications. We talked about what I could do to help myself. I subsequently found out that this was something that should have been discussed, in depth, with me at least three years previously. Apparently, I had been prediabetic without knowing it. I’d been concerned about my slow weight gain for many years but could not seem to shift it, and although I was told to lose weight in 2018, I don’t remember being told I had insulin resistance, or that I had pre-diabetes, or what either of them meant. In 2019, my new doctor and I talked about how I could lose weight and continue doing exercise as, at 65, I was already walking 5–6 km a day. (I still do.) She’d read my notes and knew that I am prone to anxiety and raised stress levels. She was purposefully laid back about the situation as we have since discussed. To be fair, I also think this may have been why my previous doctor, knowing my family and medical history and my tendency to anxiety, had not been specific. However, that was the very reason I needed to have been told and supported, to avoid what I was now facing. Maybe there had been an assumption that I already knew, given my family experience, or maybe there was miscommunication on both sides. In any case, I’d already proven that I prefer to meet medical crises head-on. A RARE METFORMIN ALLERGY

My background is one of genetic predisposition for late onset type 2 diabetes, which my maternal grandmother and mother, sister, many first cousins, paternal aunties,

DIABETES WELLNESS | Summer 2021

cousins, half-brother, and halfsister also have. The spectre of this disease had been hanging over me since 2007 when my sister suffered major organ failure as a result of a 1-in10,000 severe allergic reaction to metformin. She came out of a week-long coma and a lengthy stay in hospital with her body having aged 20 years and only 3% kidney function. Over the next seven years, this only returned to 17%. She went blind, had heart failure, and lost her mobility. Her quality of life was severely impaired until she died after developing gangrene in 2014. My mother and my niece also experienced allergic reactions to metformin, though not to the same degree. When my sister died at 57 as a result of the above complications, the medical team advised that all our family and children needed our medical records red-flagged for metformin allergy. My other sister has been prediabetic for many years. Most of the maternal-side diabetics suffer obesity, varying from not too bad to morbidly obese. Most of the paternal-side sufferers also suffer degrees of obesity, but not my halfsiblings, despite their diagnoses. In 2019, I was in the lower end of the obese category at 162cm tall, 80kg, and with a BMI of 30.5. Added to all these hereditary factors, I’d had a rare kind of surgery. ADDED CHALLENGES

In 2008, I had a pancreaticoduodenectomy and cholecystectomy (Whipple’s procedure) for an ampullary tumour. It means I no longer have a duodenum or gall bladder and only have two-thirds of my pancreas. A radical operation was, then, the only solution for this tumour – and usually these operations are palliative measures. I knew the mortality rates and other statistics

for the operation were, frankly, scary, but as I said, I prefer to meet medical problems head on. I opted not to share the scariest possibilities with my family: I’d already decided that it was going to be a success, as I had too much to live for. Before the operation, I would drive to work each day, tears pouring down my face, listening to inspirational music and giving myself pep talks. “I am not going anywhere. I can do this. I want to see my grandbabies grow up. I want to see my children well into their adult lives. I will make this work.”

Before the operation, I would drive to work each day, tears pouring down my face, listening to inspirational music and giving myself pep talks. One of the things I knew was a very real possibility was that I could come out of the operation an insulin-dependent diabetic. Fortunately, that did not happen. Another probability was that I would lose weight drastically and have trouble maintaining enough weight. Some hope! After a month on a feeding tube and six months of severely restricted food intake directly after the operation, I got down to 66kg, at which point my very supportive GP and specialists hastened to halt the weight loss. Over the next 11 years, I slowly gained weight for no apparent reason until I reached 80kg at my heaviest and really struggled to keep from going higher. Having no duodenum affects how, and if, certain nutrients are absorbed by my body, so I have to take supplements. Another effect is having some of the symptoms

of both Dumping Syndrome and Short Bowel Syndrome. These occur intermittently and without warning, meaning I always need to know where to find the nearest toilet. I also get severe intestinal spasms, severe leg cramps, irritable leg syndrome, and random other areas of muscle spasm. All of these I attribute to a lack of nutrient absorption caused by not having a duodenum. I have acid reflux and control it with medication as well as being very careful what I eat and when. For example, I cannot eat a meal after 7pm. Despite all of this, as well as maintaining a very active lifestyle, walking, kayaking, swimming, travelling around the world, and hiking the Milford and Rakiura Tracks, I’d still gained weight. DIFFICULT DIET CHANGES

After my type 2 diagnosis, I knew I had to lose at least 10kg. I had a good understanding of nutrition but conflicting advice over the years had confused some of my understanding. Although I’ve always eaten a healthy diet, I didn’t know about hidden carbohydrates and this proved to be my problem. I’d never indulged in soft drinks, sweets, or pastries and had kept to low-GI foods, but I discovered even the most innocuous carbohydrate can have a big effect on my blood glucose levels. After a couple of months struggling to make a difference, I asked to be referred back to the dietitian who’d helped me after the Whipple’s procedure. Adjusting eating habits means a complete change of lifestyle, and it’s often touted (in media and by professionals) as easy to do. Not so. There is a high level of learning and change of long-established habits required. This needs to be acknowledged.

DIABETES WELLNESS | Summer 2021

For eight months, I struggled. I severely restricted my diet, getting my HbA1c down from 63 to 46 and my weight down to 68kg. Much of that time was spent feeling unwell and fatigued. I read and attended seminars about carbohydrates, LCHF (Low Carb High Fat), and Keto lifestyles and consulted with my dietitian. I needed to be able to keep my carbs low enough to stabilise my blood glucose. To do this and maintain energy, I needed to increase my fat intake, which can be problematic when you do not have a gallbladder. I also needed to make sure I was getting the right kinds of nutrients, given my inability to absorb some of them. Diving in ‘boots and all’ to any one type of diet is not an option for me. It is a very difficult balancing act, and I am determined it will not dominate my life – although the only way I can maintain control is to keep a daily food diary, which is onerous. My HbA1c has fluctuated several times, and, in October 2020, my doctor suggested I try the Libre FGM to get more information about how different foods affect my blood glucose levels. I’m lucky that I can afford the monitor. It costs $203 per month but is so worthwhile. It shows exactly what has happened since the last scan and is invaluable for helping me identify what my body does with certain foods. Along with my food diaries, I can now get a complete picture, allowing me more control. IMPROVING THE HEALTH SYSTEM

My first, and only, visit to the DHB Diabetic Clinic included a diabetic retinopathy check and a consultation with a specialist. My doctor’s first referral had been rejected and the second only accepted by her specific detailing of my medical history. While

DIABETES WELLNESS | Summer 2021

Attending my first support group meeting was nervewracking as I expected to be confronted by very sick people – my experience up to that point. I found, instead, a group of people with type 1 and type 2, all living well, albeit differently, with their conditions. What a relief. everyone congratulated me on reducing my HbA1c, I felt that my history was not taken seriously and that, because of my good result at that time, I was cast adrift and discharged. I do understand that there is a type 2 diabetes epidemic and there are many people in more dire need of medical care for their diabetes than me, but we should be putting the ambulance at the top of the cliff instead of waiting for everyone to fall to the bottom then blaming them for it. Education about early warning signs of type 2 diabetes needs to be better. People with prediabetes need to understand why it is crucial to take it seriously, and they need support to avoid developing diabetes. Funding for sensors before being put on medication would save millions of dollars on medications and treatment of complications. I don’t think I have full understanding of diabetes yet,

but I do know that, once diagnosed with diabetes, even if you can reverse it, you still have it. If you relax for a second, it will rear its head again. The best thing to aim for is to tame the beast in a sustainable way for as long as you can. I have been pro-active, but it continues to be a struggle. Early on, I contacted Diabetes NZ to find out if there were support groups. I found one in my area and also found we had a Field Officer. I promptly made an appointment to see her. She was so helpful, and her specific science background allowed her to understand the full implications of my case. She continues to be a support although now retired. And there is now a new Diabetes Community Coordinator here. Attending my first support group meeting was a bit nervewracking as I expected to be confronted by very sick people – my experience up to that point. I found, instead, a group of people with type 1 and type 2, all living well with diabetes, albeit differently. What a relief. I’ve begun to volunteer at various events, and talking to the public has made me realise the vast array of ways in which people with type 2 are treated. There doesn’t seem to be consistency in the criteria for being diagnosed with pre-diabetes or diabetes, nor any consistency in when people are put on, or taken off, medication. Most people I speak to don’t fully understand their condition or their treatment and have not had the right support through their journey. People with diabetes and medical professionals need to understand that everyone’s bodies deal with diabetes differently. It's important that we feel empowered to say to our healthcare professionals: ‘We’re in this together. I’m trusting you with my body – I can’t do this on my own.’

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

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

FIND OUT MORE |

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

FreeStyleLibre.co.nz

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

POLY 14613 (NZ)

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

Move

Tootsie TRAINING Fitness consultant Craig Wise has a workout routine for your feet.

s summer arrives, let’s take a moment to think about our feet and how we can best prepare them for the strolls, bushwalks, and day trips ahead. When we visit the gym or do a home workout, we normally concentrate on strengthening our arms, core, back, or legs. We rarely consider our feet – even though they do so much work for us. Each foot is a complex mechanical structure of 26 bones and 33 joints, along with muscles, tendons, and ligaments. Regularly exercising and stretching your feet can help ensure your feet are providing you with the best support. It can ease existing pain, prevent discomfort, and reduce the risk of injury. It can also increase their range of motion, keeping you active longer and reducing fatigue. Here are some of my favourite foot exercises. You can do them at home or even at work.

DIABETES WELLNESS | Summer 2021

THE FULL FOOT FLEXOR

This gets your whole foot moving and helps build flexibility and mobility. It’s done in three stages. The times given are just suggestions, and some movements may be harder than others. Keep working at it – they do get easier. 1. Sit up straight in a chair, with your feet flat on the floor. 2. Keeping toes on the floor, raise your heels. Stop when only the balls of the feet and toes remain on the ground. 3. Hold this position for 5 seconds before lowering your heels. 4. For the second stage, raise the heels and point your toes so that now only the tip of the big toe is touching the floor. Hold for 5 seconds before lowering. 5. For the third stage, raise your heels and scrunch your toes so that only the tips of the toes are touching the floor. Hold for 5 seconds before lowering. 6. Repeat each stage 10 times.

‘SPLAY IT AGAIN, SAM!’

Doing this toe-splay exercise can improve control over the toe muscles. You can do it on both feet at once or alternate feet. 1. Sit up straight in your chair, with your feet gently resting on the floor. 2. Spread the toes apart as far as possible without straining. Hold this position for 5 seconds. 3. Repeat 10 times. 4. Once you’ve built up your strength, you can try looping a rubber band around the toes. This will provide resistance and make the exercise more challenging.

SIMPLE STRETCH

THE PIGGY PINCH

Curling your toes builds up the flexor muscles of the toes and feet, improving overall strength, so get those piggies working. 1. Sit up straight in a chair, with your feet flat on the floor. 2. Lay a small towel on the floor with the edge by the ends of your toes. 3. Place the toes of one foot on the edge of the towel. Try to grasp the towel with your toes and pull it towards you, keeping your heel firmly on the ground. Then release. 4. Repeat this exercise five times before switching to the other foot, trying to move the towel slowly towards you. 5. To make it more challenging, try weighing down the opposite end of the towel. ABSOLUTELY MARBLOUS

For this one, you need about 10 marbles. It can increase strength in the muscles on the undersides of the feet and toes, as well as help with fine coordination skills. It also doubles as a party game. 1. Sit up straight in a chair, with your feet flat on the floor. 2. Place an empty bowl and about 10 marbles on the floor in front of your feet. 3. Using only the toes of one foot, pick up each marble and place it in the empty bowl. 4. Repeat using the other foot.

With any exercise routine, stretching is an important part of the process. 1. Sit up straight in a chair, with your feet flat on the floor. 2. Place your left foot on your right thigh. 3. Pull your toes up towards your ankle. You should get a stretching feeling along the bottom of your foot and heel. 4. Hold for 10 seconds. If you like, you can massage the arch of the foot while stretching, to help ease tension and pain. 5. Repeat this exercise 10 times for each foot. ROLL WITH IT!

Rolling a golf ball under your foot can help ease aches, pains, and discomfort, especially in the arch. 1. Sit up straight in a chair, with your feet flat on the floor. 2. Place a golf ball (or similar) on the floor by your foot. 3. Put one foot on the ball and move it around, pressing down as hard as is comfortable. The ball should be massaging the bottom of the foot. 4. Continue for 1 to 2 minutes, then repeat using the other foot. Tip: A frozen bottle of water can be a soothing alternative if no suitable balls are available – it’s also great for cooling down your feet after that summer walk.

Shoes and socks Appropriate footwear can make a world of difference to your whole body. If your feet aren’t sitting right or getting the support they need, then this misalignment is transferred up to the ankles, knees, hips, and back. Well fitted and appropriate footwear is key. For more on this, see page 34. What goes between your foot and the shoe is just as important. Well fitted socks really help. Look for socks with cushioning – this helps with impact. It’s also great if you can find some in microfibre fabrics, which are designed to wick moisture. Moisture build-up in shoes contributes to all manner of issues we want to avoid – from blisters, to fungus, to smell. Preferably look for white socks. Why? Not because it’s a sporty look (although it is), but because white socks make it easy to check for possible foot issues. If you see any staining on your socks, whether blood, yellowy liquid, or clear fluids, then you know something is wrong and can work to remedy it early. It’s not nearly so easy to see on dark or multicoloured socks. Orthotics or shoe inserts can help with some common issues like foot discomfort, lower back pain, and knee pain. Over-thecounter shoe inserts include arch supports, insoles, heel liners, and cushioning pads.

DIABETES WELLNESS | Summer 2021

Care

Good shoes keep you walking or running at your best. But how do you find that right pair for you? Diabetes Awareness Month partner ASICS is here to help.

The perfect shoe

FOR YOU

rongly fitted shoes can slow you down, causing friction, blisters, discomfort, pain, or injury. On the other hand, great-fitting shoes, of the right type, can ensure that you’re walking or running at your best – and even enjoying it! They’ll provide support where you need it, while still allowing proper movement.

STEP 1 Place the piece of paper and your heel against a wall. Using your pen, trace your foot as closely as possible. Now do it for the other foot as well. This is important as one foot is usually longer than the other.

MEASURING UP

When you’re choosing shoes to walk or run in, you’ll need a little more room inside than you might expect. Start by measuring your feet. Even if you’ve had them measured before, it pays to do it again. Feet can change over time based on things like age, pregnancy, weight, and injury.

STEP 2 With each foot outline, measure a straight line from the heel to the longest toe, to get the length of each foot in centimetres.

DIABETES WELLNESS | Summer 2021

You can visit an ASICS Running Expert store to have your foot professionally measured, or, if that’s not possible, use our guide here. Because feet swell with heat and activity, it’s better to measure your feet at the end of the day. What you need: • Paper • Pen • Tape measure or ruler.

STEP 3 Lastly, add 1 to 1.5 centimetres to the length. This will give you the correct length to match with our shoe size guide. (This extra space gives your feet room to warm up and expand during your run.)

STEP 4 Use the guide below to find your shoe size. These are US sizes, which is what we generally use in New Zealand.

TRYING SHOES ON Now you’re in the store, or maybe just looking through your existing shoes to check their fit. What do you do? • If you have one foot that is bigger than the other, base the correct fit on your biggest foot. • Factor in your socks. The thickness of your sock can play a big role in the fit of your shoes, so when trying shoes on try and wear the usual socks you’d wear for walking or running. • Does the sock-liner of the shoe match the shape of your foot? Remove the insert and stand on it to check. Be sure your toes and sides of your feet don’t extend over the sides of the sock-liner. • When trying a pair on, lace the shoes up so they are snug but not too tight. You should still be able to fit a finger under the knot. • How much space is at the end of the shoe? There should be about a centimetre or a thumb width between the front of the shoe and your longest toe. Pay attention to how you feel in the shoes. They shouldn’t be too roomy or too snug, and there should be that all important extra centimetre between your toes and the ends of the shoe. Your walking or running shoes are often a bigger size than your dress or casual shoes. Take a walk – or a run – around in any pair you’re considering buying, to make sure your foot feels right when in motion. Most speciality running stores should have a treadmill for a test run, so take the time to do this. Remember: Modern shoes for exercise shouldn’t have to be broken in. They should feel great on your first go.

LACING UP YOUR SHOES Did you know that how you lace your shoes can play an important role in your running or walking performance, and in correcting common problems like heel slippage and blisters? (It’s not a silver bullet though – if you have ongoing problems, consult a medical professional.) Here are some lacing techniques to address common issues.

‘My heel keeps slipping or moving in my shoe’ Heel blisters or excessive wear in the back of your shoes are common signs of heel slippage. A ‘heel lock’ style of lacing will prevent your heel from slipping out of the shoe and reduce excessive movement of your foot in the shoe. This helps reduce the friction that causes blisters and excess wear. HEEL-LOCK LACING

This technique ensures your laces don’t become loose and prevents your heel from slipping out of the shoe. • Lace shoes in the usual criss-cross pattern until the second-to-last eyelet. • Then thread the lace through the last eyelet so that the lace comes out on the inside of the shoe, creating a loop between the last two eyelets. • Finish by crossing your laces and inserting them through the loops that you’ve created and pull tightly securing the shoe around your foot, and then tie shoes as normal.

‘My shoes always feel like they are too tight’ If you feel like your shoes are too tight on the top of your foot, a ‘parallel’ or ‘straight bar’ style of lacing that evenly distributes the laces for better comfort may help. If a change in lacing style doesn’t alleviate the tightness, make sure that your shoes are the right fit for your foot size, width and foot type. PARALLEL LACING

• Lace the shoes in a parallel fashion, by skipping alternate eyelets for each lace and running the lace up the side of the eyelets to reduce pressure. • Tie up the shoe as usual.

DIABETES WELLNESS | Summer 2021

‘I feel pain in my toes’ If you often get black toenails and/or feel pain in your toes, try a lacing technique that lifts the toe box, giving your toes more space. TOE BOX LIFT LACING

• Begin by lacing from the eyelet at the big toe to the eyelet at the top on the opposite side – so it goes diagonally across the whole shoe. • With the other lace, ensure it’s about 10cm longer than the other lace and criss-cross it across all of the eyelets. • At the top, tie the lace as usual.

‘I have high arches’ If you have high arches, you can adjust your lacing to alleviate the pressure from middle section. • Start lacing normally with a criss-cross. • In the middle section, thread the shoelace only through the side eyelets. • Criss-cross through the final two eyelets and tie as normal.

HOW YOUR SHOES WEAR DOWN Several things affect the condition of shoes over time. Here are some things to consider: •

Typically, running or walking on the road or footpath all of the time will wear out your shoes quicker than off-road, as the surface has a stronger impact on your shoes.

•

Even shoes need rest! A shoe’s midsole material performs best if it has time to recover between runs. The optimum recovery time is 48 hours, so if you wear your shoes casually as well as for walking or running they’ll wear down quicker. We recommend buying two pairs of running shoes and using them in rotation to prolong the life of your shoes.

•

Leaving your shoes out in the rain and wind can wear them down quicker. Leaving mud and dirt on your shoes will also negatively impact their life. Hand washing and air drying them gives them the best chance for a long life.

•

We recommend changing running or walking shoes after about 800 to 1000 km.

‘I have a wide forefoot’ For a wide forefoot, try a lacing technique that gives you more space in the toe box. • Begin by threading the shoelace only through the sides. • From the midfoot onwards, start tying with a criss-cross. • Finish with a criss-cross through the final eyelets.

‘I have a narrow foot’ If you have a narrow foot, make sure your lacing style tightens the shoe. • Start by lacing the shoes normally with a criss-cross. • Next, skip an eyelet and thread the lace in a criss-cross. • At the end, lace in a usual criss-cross pattern.

‘I have wide feet overall’ • If you have generally wide feet, use a lacing technique that loosens the entire shoe and gives the foot more space. • Begin lacing in a normal criss-cross. • Then thread the shoe in a criss-cross every other eyelet. • Tie at the end as usual.

‘I have high midfoot’ For a high midfoot, ease any pain by relieving the pressure in this area. • Lace the shoe normally with a criss-cross. • Then thread the shoelace only through the sides. • After the point where bruising has occurred, start tying with the crisscross again.

DIABETES WELLNESS | Summer 2021

To find an ASICS Running Expert store, visit www.asics.com/nz/ en-nz/stockists.

Care

The latest on Covid-19, vaccines, and diabetes Liz Dutton, registered nurse, reviews some of the latest research into Covid-19 and diabetes – as well as the need for those with diabetes of any type to get double vaccinated.

e are in a fast-changing situation, but we know now that New Zealanders need to learn to live with the Delta variant of Covid-19, and sooner rather than later. The messages to get vaccinated, in order to protect yourself, your family, and your community are more important than ever. HELP GET OUR VACCINATION RATES UP

Perhaps you know someone who is still hesitant about getting vaccinated? They might be unsure what’s in the vaccine and what getting it means for them. Maybe they’ve heard some misinformation. Or maybe they’re so busy and stretched they don’t have time to get vaccinated right now. Transport may be an issue, too. You can help by sitting with them and talking their concerns through, or directing them to reliable information, such as that from Diabetes New Zealand at www.diabetes.org.nz/covid-19vaccine-diabetes. Perhaps you could offer transport to their vaccination, or to be with them as a support person while they have it. And

remember to make sure they take their hypo kit with them if they have type 1 diabetes, in the very unlikely event that the vaccination results in a hypo. We can all play a part to help get vaccination rates high, to give Covid-19 as little chance as possible. Every bit of supportive encouragement to those who are still unsure about vaccination will help. WHY IT’S VITAL FOR THOSE WITH DIABETES TO GET VACCINATED

While we don’t want to dwell on this, more and more evidence is showing that Covid-19 can be more serious for those with any type of diabetes. This doesn’t just mean the illness itself. We are beginning to hear more about so-called ‘long Covid’ or ‘post-Covid syndrome’ from overseas. One type of long Covid is what we commonly see with other viruses – causing a chronic fatigue syndrome. But there are also other forms that appear to be distinct, where cardio-vascular damage, for example, may feature. Unfortunately, it appears that having diabetes may be a risk

factor for the development of long Covid.1 MANAGING A COVID INFECTION WITH DIABETES

A recent study, relevant to all of us in New Zealand showed the new SGLT-2 inhibitors (Jardiance, Jardiamet) should be stopped if someone gets a Covid diagnosis. The reason for this is the risk of DKA in someone with normal blood glucose levels with this medication.2 DKA – diabetic ketoacidosis – is when your body releases too many ketones into your blood. These are chemicals that your body uses to metabolise fat when it can't get enough energy from carbohydrates. A SMALL SILVER LINING

A UK study found that people with diabetes during lockdown improved their diabetes management, compared to pre-lockdown. The researchers thought that factors could include a change of routine with respect to work, food, exercise, and daytime patterns, as well as a focus on diabetes management because of worries about catching Covid.3

1 doi.org/10.1016/j.dsx.2021.102235 2 doi.org/10.2337/dc21-0256 3 doi.org/10.1007/s00592-020-01614-5

DIABETES WELLNESS | Summer 2021

Care

Who is Peke Waihanga? Peke Waihanga is a specialist healthcare provider that sees over 4400 patients, many of whom need a prosthetic or orthotic device because of type 2 diabetes and vascular disease that has caused amputation.

eke Waihanga manufactures medical devices, mainly prosthetics and orthotics, for individual patients. It also offers an integrated rehabilitation, coordination of care, and peer support service. It provides these services through six city-based centres that also run regional clinics in other areas of the country. Peke Waihanga has an Artificial Limb Service, Orthotic Service, and Peer Support Service. Their specialists include clinical prosthetists, orthotists, device technicians, physiotherapists, occupational therapists, and nurses, who all work together as a team to provide a wraparound service to patients along each stage of their journey. WHAT ARE ORTHOTICS?

Most people know that prosthetics are – often – artificial limbs that replace limbs that have been lost. But what are orthotics? For those who’ve had leg amputations, a big part of what Peke Waihanga does, alongside prescribing prosthetic devices that support their patients’ mobility, is prescribe orthotic devices that look after the patient’s other leg and make sure there are no further complications.

DIABETES WELLNESS | Summer 2021

Peke Waihanga orthotist Derick Adendorff (left) with his colleague, technician Richard Bowns.

The orthotic service provides brace, splint, or other artificial external devices to support the limbs or spine, prevent or assist movement, and prevent deterioration of health and/or disability conditions. Clinical orthotists at Peke Waihanga, like Derick Adendorff in the Christchurch centre, work alongside the rest of the specialist team and with orthotic patients in prescribing, modifying, and fitting custom medical orthotic devices as well as insoles and footwear. If you are a patient that has lost a limb and is referred for orthotic care, an appointment would be made for you with a clinical orthotist like Derick. When you arrive at the centre for your appointment, Derick’s job is to assess your needs and prescribe orthotic devices that are going to protect your remaining limb and prevent any further issues. Whether it’s an entirely custommade casted device or an off-theshelf device, Derick works with you to design the right devices just for you. Derick considers your health needs, as well as your lifestyle,

hobbies, and activities, and he prescribes the devices that are going to best support you to carry out your life as you’d like to. An important part of Derick’s job, along with the rest of the team, is to continuously monitor and review your needs as time goes on. The methods that Derick uses for capturing the shape of your limb and your orthotic device can also come in handy in the future, as the record of that information can be a helpful tool for assessing whether any issues have occurred with your limb over time. The team works to ensure that any further deterioration is picked up and that any potential warning signs of complication are picked up early so that you can continue living comfortably. PEER SUPPORT

Alongside its Artificial Limb Service and Orthotic Service, Peke Waihanga has a Peer Support Service. The 81 trained peer support volunteers offer informal pre- or post-amputation support. Peke Waihanga matches you with volunteers who have ‘been there, done that’ and can relate to others in a similar situation to themselves. The service can be accessed by anyone at any time, and, especially for those who are awaiting an amputation, it can be a fantastic way – for you and your loved ones and supporters – to discover more about amputee life from someone with lived experience. If you or someone you know would like support, please fill out a referral form at www.peersupport.nz or call Peke Waihanga’s Peer Support Coordinator on 022 102 5697.

Move

250K STEPS. ONE MONTH. ONE LIFE-CHANGING CHALLENGE. This November, take 250,000 steps – that’s about 8300 steps a day – steps to get fit, steps to feel stronger, and steps that will change the lives of New Zealanders affected by diabetes.

tep up to the challenge and help Diabetes NZ raise funds to change the lives of the over one million Kiwis affected by diabetes. Almost 280,000 Kiwis have diabetes, with a further million predicted to either have pre-diabetes or be at risk. It’s a serious and lifethreatening condition that is often misunderstood, and the high number of people affected means the personal and social costs are enormous. Diabetes NZ has partnered with Fitbit to create the ‘Step up 250K Challenge’ to raise funds and promote healthy lifestyle habits that have a positive effect on the prevention and management of diabetes.

HOW TO TAKE PART

All you need to take part is a Fitbit, or the free Fitbit app on your mobile phone, or a pedometer or step tracker. There’s no minimum amount to fundraise, but we challenge you to raise $75 – and we’ve made it easier by setting up fundraising page on Givealittle.co.nz.

Our mission is to lead, champion, and advocate for change to reduce diabetes and empower those affected by the disease to lead healthy, active lives. So, take part in the 250K Challenge and step with friends, family, and whānau over the month of November to get fitter and stronger, and to raise money for Diabetes NZ.

To find out more and register for the challenge, please head to givealittle.co.nz/event/fitbit-250k-challenge-2021. @FitbitANZ #DiabetesActionMonth2021

DIABETES WELLNESS | Summer 2021

Life with T2

As a double-amputee, Paul Rowland has been dealing with a stretched and unwieldy health system, but he is, as he says, ‘a stubborn bugger’.

Staring down his fears

aul Rowland was diagnosed with type 2 diabetes at 34 years old when he went to the doctor about a cut on his leg that wouldn’t heal. He was determined to manage his diabetes, but, he says, in his late 40s, ‘I started getting cramp in my feet, especially my right foot. I didn’t know what it was. I had to give up football, and by the time I was in my 50s, knew I had a situation – but I disregarded it. I had that “she’ll be right” attitude. Because of my diabetes, I was seeing the doctor every three months, but I never mentioned the cramp until my foot got an infection. LOSS OF ONE LEG

‘I had an angiogram through the groin. It showed two of the three arteries had died and there was no oxygen supply below the ankle.’ Two of Paul’s toes turned black, and he lost feeling in them. He was on a waiting list for an amputation until one toe became fly-blown. It was a Saturday night in 2018 when he noticed. He drove straight to A&E and the very next day he was in surgery. ‘The nurses on the wards were brilliant,’ he says, but, after he left hospital, he found he

DIABETES WELLNESS | Summer 2021

had little to no support. He had slipped through the cracks in a health system that wasn’t coping. ‘Nobody called me, nobody contacted me ... I sat at home for near on three months before going in to the physio department at Tauranga Hospital.’ At last, things started happening. He began physio and travelled to Hamilton three times to be fitted with an artificial leg. Even so, it was some time before he discovered he was able to claim back his travel expenses from WINZ. A SECOND AMPUTATION

In November 2020, Paul noticed a blister on his left left big toe. He says, ‘That leg went quick.’ By Christmas, the three biggest toes on his foot had died altogether. ‘Between Christmas and New Year, I was in agony.’ His specialist was on holiday, so he wasn’t able to have his leg amputated until January. He’d had more time to prepare for losing his first leg, ‘but with the second leg I was frightened.’ After the operation, ‘I woke up, and when I realised I was alive I just cried.’ However, some things were easier. ‘The first time I had no idea what was going to happen. The second time I knew what services

‘I wear shorts. I’m not selfconscious about artificial limbs ... A few months ago I was in the supermarket and there was a toddler, a little girl who just couldn’t stop staring, so I smiled and gave her a wave and she smiled back.’

I could access ... I could advocate for myself this time around. The hospital knew who I was.’ It was just as well because he soon found he’d slipped through the cracks again. ‘I’m sitting at home and I’m thinking, I’m

supposed to go back and get signed off by the specialist, and I haven’t heard anything a week after seeing the doctor, a month after the amputation. I’m thinking – this can’t be happening again, surely! ‘So this time I rang up the thoracic department, gave them my number, and they said, “Oh I’m sorry, we’ll get someone to contact you.” A few more days went by, and I thought, this is not on. So I got on the Tauranga Hospital website and put together a polite but firm email. I sent it to thoracic, complaints, physio, and the artificial limb centres in Hamilton and Wellington. Within two hours, I’d received three phone calls and two emails. They were falling over themselves, all apologetic. LOOKING TO THE FUTURE

Paul says, ‘I’m managing recovery better this time around. I know my limitations, and I work to them. Currently, I can walk around the house for five minutes with both false legs on, then sit down.’ He says, ‘I’m a stubborn bugger.’ He’s taken up pool again, now that he can stand, and he would like to become a peer support volunteer through Peke Waihanga’s Peer Support Service, offering peer support to others who’ve had amputations. He is open about his journey. ‘I wear shorts. I’m not self-conscious about artificial limbs. The thing that makes me laugh is the toddlers … A few months ago, I was in the supermarket and there was a toddler, a little girl who just couldn’t stop staring, so I smiled and gave her a wave, and she smiled back.’ He has plenty of personal support – including good friends who will drive him anywhere if he needs it. Riding motorbikes, meanwhile, has given him joy for most of his life. ‘After the right leg came off, I couldn’t drive, of course, so a friend took me to a motorbike shop to see a hand-controlled scooter. Within four months, I was completely independent.’ After his second amputation, ‘I’m giving myself three months, and I’ll be back on it. My legs aren’t quite long enough to reach the ground on both sides, so I’ll be adding two inches to the artificial legs. ‘I’m currently 5 '9" but in a couple of months I’ll be 5 '11"!’

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.

Your DNZ

Diabetes Wellness goes digital From November, Diabetes Wellness will be more accessible than ever.

iabetes NZ has responded to the demand for digital access to up-to-date issues of our quarterly magazine, and now brings you the digital Diabetes Wellness subscription. We want to get this amazing resource to more people. The digital version is perfect for people who pick up a copy in a waiting room, then want to keep reading after they leave. It’s affordable (half the price of the hard-copy subscription), accessible any time, and saves paper! While older back issues of Diabetes Wellness have been available digitally for many years, now you will be able to subscribe to the very latest issue and receive it the minute it’s out. You can read it on a browser, or add the Issuu app to your smartphone or tablet.

WIN A PRIZE PACK

Subscribe to digital Diabetes Wellness magazine before the end of 2021, and you’ll go straight into the draw to win this fabulous prize pack containing an attractive Small Steps bag and socks, a pair of state-of‑the‑art ASICS running shoes, and a Fitbit Versa 3 – the watch with everything you need to just go.

Like what you see and want it in your pocket? Subscribe now for our new and improved digital edition and save 50% off the print subscription price DIGITAL Subscribe for $14 a year

Four issues on the Issuu platform or a single issue price of $4.80 To subscribe to our digital edition, head to issuu.com/diabetesnewzealand

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PRINT Subscribe for $28 a year

Four issues delivered – that's $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

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HELPING TO MANAGE YOUR DIABETES

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Diabetes Wellness Summer 2021

Articles inside

BBQ magic

Design for diabetes

The latest on Covid-19, vaccines, and diabetes

Who is Peke Waihanga?

YOUR DNZ: Diabetes

LIFE WITH T2: Staring down his fears

MOVE: Step up 250k Challenge

The perfect shoe for YOU

LIFE WITH T2: Taming the beast

TOOTSIE TRAINING

Introducing My Diabetes Journey

100 years of insulin

LIFE WITH T2: Taking control

Passionate about podiatry

DAM 2021

EDITORIAL

2021 Award winners