Diabetes Wellness Summer 2022 by Diabetes New Zealand

SUMMER 2022 $8.00 INC. GST

MOEKE, THE MUAY THAI CHAMP • DIABETES MATTERS • SHARING THE VIBE • TRAMPING WITH DIABETES COOL RECIPES • JERRY, MORE THAN A TEDDY • CAMPING WITH GESTATIONAL DIABETES

INTO THE BLUE

TRAMPING AND CAMPING THIS SUMMER

SUMMER HEAT OUR ADVICE

Contents SUMMER 2022 VOLUME 34 | NO 4

4 EDITORIAL

5 UPFRONT: Sneaker Friday 6 YOUR DNZ: Diabetes Action Month 9 LIFE WITH TYPE 1: Getting away from it all with Neil Beckett 13 GESTATIONAL DIABETES: Third time lucky for Leah Topp 17 COMMUNITY: Tarty Tonic a tasty fundraiser

18 DIABETES YOUTH: Ngaru Moeke gets his gold

32 YOUR DNZ: 2022 award winners

20 NOURISH: Berry berry nice!

34 ADVOCATE: Lee Page-Deane – in demand Hauora Kaimahi

24 DIABETES YOUTH: Jerry the Bear – more than a teddy

36 COMMUNITY: Super pets

26 LIFE WITH TYPE 2: Catching the vibe with Stefan Crooks 30 CARE: Tips for coping with summer heat

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Editorial

iabetes NZ continues to grow its activities and expand its reach into more local communities. Over the last year, we have increased the number of Hauora Kaimahi (Diabetes Community Coordinators) in the field, with appointments now in Taranaki, Hawkes Bay, Waikato, Tairāwhiti, and Southland. This new role connects people who have diabetes with educational and clinical support. It also works alongside primary healthcare clinicians to enable access, improve equity and provide psychosocial support. Te Whatu Ora – Health New Zealand has recognised the value of this work and increased funding to Diabetes NZ so we can continue to expand and grow. This is stunning news. A further significant decision has been made by trustees to divide a portion of the funds towards research purposes to support people with diabetes. We have joined with the former New Zealand Diabetes Foundation to create the Diabetes New Zealand Research Foundation. These funds, held by Diabetes NZ for research purposes, have been transferred to the Research Foundation and now total just over $2 million. Collaborating with the New Zealand Society for the Study of Diabetes (NZSSD), the Research Foundation will be seeking applications from university students to undertake small pieces of research relating to diabetes. This is a small step as the new Diabetes NZ Research Foundation establishes itself with a new purpose and focus. We are very excited with the opportunities this initiative offers. Planning is well under way for Diabetes Action Month, with the theme Diabetes Matters. Why has this theme been chosen? Because diabetes does matter. • People with diabetes matter and deserve to live well. • People with diabetes deserve to be treated with respect, kindness, and support. • There are big issues to be addressed around diabetes in New Zealand because it is a big problem. Diabetes Action Month provides us with an opportunity to talk about those concerns and also take action. I hope you will participate in supporting us all to turn the tide on a health condition that is placing an increasing burden on individuals, whānau, and the health system. In this issue, we celebrate the Muaythai Moekes and their recent impressive wins in Malaysia. Our Hauora Kaimahi for Waikato tells us about the wonderful work she is doing in the community. As the weather warms up, we offer advice on keeping levels level in the summer heat. In the recipe section, you will find delicious recipes all centred around fresh summer berries. And for those who want to get away from it all this summer, we hear what it’s like to go tramping and camping with diabetes. Happy holidays everyone! CATHERINE TAYLOR

Board Chair, Diabetes NZ

DIABETES WELLNESS | Summer 2022

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

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

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

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

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

Upfront

SNEAKER FRIDAY IS BACK! E SAVE THE DAT

SNEAKER FRIDAY 18 Nov!

Supporting Sneaker Friday is a fantastic way to show your support for the more than quarter of a million Kiwis living with diabetes. Join us by wearing your sneakers at work or play and donating $5 to Diabetes NZ. While you're at it, invite the team at your workplace to wear their sneakers to work on Friday, 18 November and donate $5 to Diabetes NZ. You can donate as an individual, set up a team, or donate $5 each for everyone in your whanau or at your workplace so that your whole team can get involved. Share with your workmates, friends, and whānau and ask them to support you and/or get involved themselves! We'd love you to see your photos on the day – share on social media #SneakerFriday @Diabetes_NZ Sneaker Friday is a key date in Diabetes Action Month, running throughout November. See more on pages 6 and 7.

DIABETES NZ SOCKS Iti takahanga, nui haerenga. Big journeys start with small steps. Wear our Step Up for Diabetes socks and show your support for the quarter of a million Kiwis with diabetes! Crew socks (not medical socks), super soft, made from 80% Cotton, 15% Polyester, 5% Elastane. Unisex. One size fits most. ONLY $10 at diabetes.org.nz

DIABETES WELLNESS | Summer 2022

Your DNZ

DIABETES ACTION MONTH 2022 Running throughout November, the theme for Diabetes Action Month 2022 is Diabetes Matters. 280,000 Kiwis have diabetes – a number projected to rise to between 390,000 and 430,000 by 2040.

These are numbers that matter. Not just to people living with diabetes but to everyone: the many New Zealanders at risk of diabetes, our healthcare system, and all the people who provide vital support, including friends and whānau. This Diabetes Action Month, Diabetes NZ is working to take action and raise awareness of why diabetes matters to help turn the

tide on diabetes rates in our country. Heather Verry, CEO of Diabetes New Zealand, says ‘Diabetes matters now more than ever. New Zealand’s rates of diabetes are amongst the highest in the world, with numbers set to dramatically rise. But, if we act now, it’s not too late to help our diabetes whānau live well and change the trajectory of diabetes prevalence.’

WHAT MATTERS? Prevention matters – to avoid more serious diabetes-related complications like amputations and blindness. Nutrition matters – to help manage blood glucose levels. Movement matters – to make you feel better physically and mentally. Language matters – to ensure communication with our diabetes whānau is clear and accurate, respectful, and free from judgement and bias.

DIABETES WELLNESS | Summer 2022

‘This Diabetes Action Month, it’s time to show Aotearoa New Zealand and our diabetes community that diabetes does matter, and that, together, we can help people live well so they have more time to focus on what else matters in life, like friends, family, work, and hobbies,’ says Heather Verry. There will be a number of Diabetes NZ initiatives taking

place during November, including the launch of the new Diabetes Matters podcast, Facebook Live sessions, local regional events across the country, and the return of Sneaker Friday. Diabetes NZ is also looking forward to introducing Aotearoa to some well-known #Changemakers in the fight against diabetes.

LANGUAGE MATTERS NEW DIABETES NZ PODCAST

PREVENTION MATTERS WORLD DIABETES DAY

Diabetes NZ is excited to be launching a new podcast, Diabetes Matters, this November. Hosted by Monique Bradley, the podcast will cover a range of important diabetes matters and feature some amazing guests. The podcast series kicks off with an episode on Language Matters, which will focus on the power of words and how the language we use can make our diabetes whānau feel valued, understood, and supported, or misunderstood, excluded, and stigmatised. Check out www.diabetesactionmonth. org.nz for more information.

The theme for World Diabetes Day 2022 is ‘Access to Diabetes Care: If Not Now, When?’ with a focus on access to education. This 14 November, it’s time to stand in support of the millions of people with diabetes around the world, including Aotearoa, who do not have access to diabetes care. With rates of diabetes on the rise in this country, access to proper care, education, support, medicine, and technology is vital in preventing diabetes complications and further strain on our healthcare system. Tune in to our Facebook Live event on 22 November to hear from a panel of diabetes experts about why prevention and managing your diabetes matter to live well.

MOVEMENT MATTERS SNEAKER FRIDAY

NUTRITION MATTERS BE A #CHANGEMAKER

After raising valuable funds last year, Sneaker Friday is back this Diabetes Action Month. Sneaker Friday encourages New Zealanders to put their best foot forward for diabetes by wearing sneakers to work or at play on Friday, 18 November. Why not get moving and walk or cycle to work while you’re at it? To get involved, simply donate $5 to Diabetes NZ and wear your favourite kicks to work on Sneaker Friday. It’s your opportunity to show your support for Diabetes NZ and help spread the word that Diabetes Matters. To learn more, visit www.diabetesactionmonth.org.nz.

We are thrilled to have the support of well-known Kiwis and inspiring people in our diabetes community this Diabetes Action Month. This year’s #Changemakers will be encouraging people living with diabetes to make lifestyle changes in November, because Diabetes Matters. You can also be a #Changemaker this Diabetes Action Month. November is the perfect time to make some changes in your life, big or small. A good way to start is with nutrition. We all know that healthy eating is important to managing diabetes. This November, try drinking more water, low-fat milk, or zero sugar products like VIBE instead of sweet drinks or looking for diabetes-friendly alternatives to food staples – such as the new SunRice Low GI rice.

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

NGĀ MIHI NUI

A huge thank you to all the wonderful sponsors who help make Diabetes Action Month happen. With your support, we can show New Zealand that Diabetes Matters. PROUDLY SUPPORTED BY

DIABETES WELLNESS | Summer 2022

ADVERTORIAL

It’s not rocket science, just real science. This year, we have been developing and testing ASICS Movement for Mind – a simple programme of mindful outdoor movement – and the results are in. In one of the largest, independent, randomised control trials of its kind, we discovered just how effective movement is at improving our mental wellbeing. It’s simple, fun and effective. Since our foundation, we’ve known that movement helps promote a sound mind in a sound body. Now we can reveal how and how much. Working with one of the world's leading mental health researchers, we devised an 8-week programme to put the theory to the test. Just two 30-minute sessions, twice a week, can measurably improve how we feel. Walking or running, it all works. ASICS Movement for Mind is grounded in science, but also in history. We looked at the things that make us human – controlled, unforced movement, being part of the natural world, staying aware and connected – and combined them in a simple audio series. Led by renowned experts in their fields, ASICS Movement for Mind is designed for everyone, regardless of fitness level or experience. With 16 sessions over 8 weeks, ASICS Movement for Mind is a coordinated programme of movement with a focus on being more aware of your body and mind. You can run or walk, and each session builds on the last. You'll learn how to breathe as you move, mindful physical movement, the mind-body connection, appreciating nature and music and simple mindful meditation.

For more information on how you can join the programme and start experiencing the benefits, visit https://www.asics.com/nz/en-nz/mk/asics-movement-for-mind

Life with Type 1

GETTING AWAY FROM IT ALL Bush walks can relieve stress, reduce anxiety, boost mood – and are enjoyable exercise. Tramper Neil Beckett shares his experience of tramping with type 1.

lways an avid outdoors person, Wellingtonian Neil Beckett was diagnosed with type 1 diabetes at 30. ‘We’ve got a strong family link to diabetes. There’s my father, my eldest brother, and myself. And now my daughter – all type 1.’ A keen windsurfer and mountain biker before the diagnosis, Neil made sure to keep up his physical activity. ‘As my father says, “We need to manage our diabetes. We don’t let diabetes manage us.” It shouldn’t stop me doing anything.’ Originally from the UK, Neil and his wife quickly realised the New Zealand bush was vastly different from what they were used to. They joined the Tararua Tramping Club for a year, where completing a bushcraft course was a prerequisite for membership. On the two-night

course, they learnt bush safety and survival in the outdoors. Learning to safely cross a river was certainly a new thing. ‘In the UK, you don’t come to a river and there’s no bridge.’ MANAGING FOOD

Neil favours the one-night tramp. ‘Generally, I just walk in, stay one night, walk out. ‘The barrier to doing more than one-night tramps is not the diabetes management but the foodcarrying management – what can fit in the backpack and how much weight you can carry. I could take dehydrated food, but I like to have a good feed. ‘Some trampers might run out of food on the second day. So they’ll arrive back at base, and they’re hungry. Someone with diabetes can’t take that risk. You have to

DIABETES WELLNESS | Summer 2022

ration your food better so I’ll pack meals quite separately. I even take extra food, just in case I have to stay an extra night for whatever reason. ‘It’s all about the food and the snacks. You always want to have close access to jellybeans; lollies the body absorbs quickly. Our goto is Mentos.’ TESTING AND INJECTING

‘Monitoring is the most important thing because, when I’m exercising, I’m burning up more energy than usual and so it’s easy to go low. I’d definitely test more regularly while tramping. I’d normally test two to three times a day, but when tramping I’d test six times.’ Neil uses an insulin pen and always takes spares. When he’s tramping in hot weather, he carries his pens in a cooler wallet. But by the time you reach the hut, where there’s no refrigeration, the wallet has warmed up and you don't have any way of cooling it down again.

A good tip, he says, is to wrap the insulin in a damp towel or tissues in a zip-lock bag. Extreme cold, he says, is more of a risk than heat. The useful life of the insulin is shortened if it gets hot, but if it freezes then it crystallises. This kills it, so it should be thrown away. ‘We nearly had a problem when tramping with six people and a lot of food to carry. Someone had to take frozen mince, and we took a can of beer each. We wrapped the beer in the frozen meat to keep it cool. Now, obviously, you don’t want to get the insulin close to that.’ Keeping equipment dry is also vital. It doesn’t matter if the pen gets wet, and you can swim in a Libre, but the test kits are a different story. The CareSens meter is not waterproof. Neil says this is where zip-lock bags become your best friend – to keep test kits dry and also to stop moisture from your cooler wallet or food supplies invading the contents of your backpack.

AWARENESS

‘Everyone in your party needs to be aware of your condition. So that if I say I need to stop and have something to eat, you don’t go “c’mon, we need to push on”.’ Neil advises keeping hypo treatments in your pockets. ‘It can creep up on you. You might not have the frame of mind to get the pack off and unpack everything, so you’ve got to have it handy. I’m very lucky. I feel a hypo coming – I get a bit trembly and a bit clammy.’ But Neil has a friend who’s not so good at spotting hypos. ‘He can go vacant. It just hits him.’ ‘I’ve never (touch wood) had a bad experience. I’ve been reasonably low, but I’ve known it’s there and I can deal with it.’ SHORT WALKS

It’s not all about overnight tramps. Neil fits in an eight kilometre walk around the hills of Wellington with a friend or two each weekend. As long as you understand your body and are prepared, then you can easily take diabetes management along for the walk. ‘I honestly believe there’s worse things you can have. That’s a real key thing. Getting old might stop me. Diabetes certainly won’t.’ USING A PUMP

Claire, Fay, and Neil Beckett outside Boar Inn in the Orongorongo Valley, 2016.

DIABETES WELLNESS | Summer 2022

Heading out into the bush connected to a pump is freeing for some but a test for others. Neil’s teenaged daughter Fay has found the anxiety of being away from roads a challenge but not enough to kill her enjoyment of the outdoors. Fay did a tramp in the Marlborough Sounds as part of her bronze Duke of Edinburgh Award. ‘It pretty much rained the whole time, and everything was soggy, so that was hard for her. ‘Fay wore a Libre connected to a pump. They are awesome if you can afford them. It makes a huge difference.’

Bushwalking tips

Tramping is a fun, relaxing way to experience the great outdoors with friends and family. You get to explore places in nature that roads cannot reach. You can start with a short walk in a park with trees and move up to a longer, multi-night sleepover with nature.

SHORT WALKS Typing ‘short walks’ into your browser will immediately bring up ‘short walks near me’ as an option. The Department of Conservation and your regional council will list all the walks in your region. You can choose the duration and difficulty, and whether they are wheelchair and buggy-friendly. You can even find out if dogs are allowed on a particular walk. If you would like more one-on-one guidance on the walk and to not have to carry a pack, you will also find links to commercial operators on the DOC page. www.doc.govt.nz/parks-and-recreation/ things-to-do/walking-and-tramping/

LONGER TRAMPS There are always further things to consider when you go into the New Zealand bush. Being away from close and ready help requires forethought. Neil Beckett takes a Personal Locator Beacon (PLB). These are only to be activated in situations of grave and imminent danger. Examples would be a major injury to a party member or a party that has become dangerously trapped by rising floodwaters. Once activated, your PLB transmits a distress frequency alarm signal. Within a few minutes of that PLB being activated, the signal is picked up by a satellite and sent to RCCNZ (Rescue Coordination Centre New Zealand), which then uses the data to determine the exact location of the beacon. PLBs can be purchased or readily hired at a reasonable cost. Many tramping, hunting, and fishing stores hire them out as well as Department of Conservation centres. Every tramping club should have ones for members to hire or borrow as well. The Tararua Tramping Club advises each trip to have at least two PLBs, carried by separate people, to reduce the risk of losing one of them, for example, by being swept away in a river. Neil advises, ‘Carrying an PLB in the New Zealand bush isn’t a bad thing for anyone.’ The Mountain Safety Council website has a list of places throughout the country where you can hire one. www.mountainsafety.org.nz/learn/skills/ communications/plb-hire/

DIABETES WELLNESS | Summer 2022

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GT-2000™ SX (Walking Shoe)

RUNNING VS WALKING They're both great for your health, but what are the benefits of walking compared to running? Temporarily increases your cortisol levels, which then drop over time; improving your ability to deal with daily stressors.

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Releases endorphins to reduce pain and trigger that positive feeling in your body.

Brisk walks can boost your release of endorphins too, helping you achieve that 'runner's high'.

Helps your heart by lowering blood pressure, reducing the risk of heart disease, stroke, and diabetes.

Brisk walking has been proven to provide benefits to your heart slightly more than expending the same amount of energy during running and other more vigorous acitvities.

Burns more calories than walking— potentially over twice as many, and helps to control appetite.

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Each summer, Leah Topp, her husband, and kids go camping with five other families. They’ve done this since they all first met at an antenatal class back in 2016. Leah shares her experiences of camping and tramping while having gestational diabetes.

Gestational Diabetes

THIRD TIME LUCKY

eah’s children are five and three, and she also has one on the way. ‘Third pregnancy. Third time with gestational diabetes.’ Although they’ve moved to the Bay of Plenty now, Leah’s family returns to Shakespear Regional Park in Whangaparāoa every January, where they meet up with the other families. ‘All have had second babies. Some are on their third round.’ CAMPING

Leah acknowledges the difference that being away from home can make to a routine. ‘When you’re camping, you’re in holiday-mode. You’re not aware of the time so much. Meals are all over the place, so that’s a bit of a challenge. I put alarms on my phone to remember to take my medication at night at a certain time. ‘The testing can be a bit disruptive when you’re camping. You need to have clean hands. In my kit, I keep a packet of unscented wet wipes so if I am out and about I can wipe my hands first. I’ve found in the past when I’ve given the kids

afternoon tea in the car on the way to activities and I test my blood sugars, they’re so high. Then I realise it’s because I handed them a biscuit and the residue is on my hands. So that is a challenge out in the bush, trying to make sure you’ve got the wipes.’ Leah keeps all her medication in a cool pack in an area of the tent that doesn’t get much sun. Her used needles go into a sharps container that she was given at the beginning of the pregnancy. Leah says, ‘I need to do the best I can, but I’m not going to get myself caught up in knots about it. Because, for me, stress has far more impact on my sugars than food does. My diabetes midwife is aware of it. She says, “When you get back from camping, we’ll get you back on track.”’ HIKING

During her current pregnancy, Leah squeezed in two overnight hikes before she did the initial Glucose Tolerance Two-hour test [GTT]. ‘I knew I was going to get diagnosed, being the third time.’ Knowing exactly what she was going to be in for, Leah wanted a

diabetes-free hike. Leah says they’ve worked their way down the North Island and done every tramp that is a kid-friendly distance. ‘We’ve done a lot of the western Bay of Plenty, Thames Valley, into the Coromandel, both sides of the Ruahine Ranges, and the Rangitīkei Gorge. We did three huts in there. We’ve done a bit around New Plymouth too. ‘We like to go to huts where you can book so we know we’ve definitely got a bunk for the kids. There would be nothing worse than being three hours in and then there not being bunks for the kids and then you’ve got to turn around and get them back.’ Leah’s five year old has been to 10 huts now. She acknowledges that it is going to be a new challenge doing it with three kids. ‘We have one booked for March next year. The three year old will have to walk, but she’ll be nearly four by then. That will be the first time she’ll walk the whole thing. She probably walked 75% of the way in the Pinnacles in the Coromandel.

DIABETES WELLNESS | Summer 2022

‘People will ask me, what is gestational diabetes? I say basically, I have diabetes when I have a baby in my body. And then when it’s born it goes away.’

FIRST DIAGNOSIS

When Leah found out she had gestational diabetes, she was surprised as there was no history of the condition in her family. She also happened to be training for her third marathon. She says she was confused and angry, and felt very judged. With no prior knowledge of gestational diabetes, Leah says she didn’t understand why she had it and what it meant. It was pitched to her as being caused by having a really bad diet. ‘I was told to stop eating takeaways. I said, “That’s not my problem. I eat really healthily.”’ Leah went into her first meeting with the diabetes nurse and dietitian defensive and argumentative. ‘I felt I knew my body. It was never explained to me that this is just a hormonal thing that happens when your placenta is not processing blood sugar properly. ‘I was given a generic sheet saying how many carbs a day I should have. I told them this is more carbs than what I eat currently.

DIABETES WELLNESS | Summer 2022

‘While training for her marathon, Leah had done a food log. She asked the dietitian and nurse to tell her what was wrong with what she was already eating and what she should cut out. Leah says the dietitian was unable to do that. ‘She kept telling me what the recommendation was. I said, “I understand the generic recommendation, but you’ve not taken into account my height, my weight, my levels of exercise, my ethnicity, nothing.” ‘I did end up on insulin and again I was really defensive, angry. I didn’t want to go on the medication and refused it for a very long time. It wasn’t explained to me why I needed it and what it was going to do. It was just, “Here’s a needle and shove it in your tummy.” ‘I was constantly feeling like I was failing.’ The main frustration Leah experienced during her pregnancy was the lack of communication and education from health professionals. ‘Each time my insulin was raised, I was really

upset about it because it was never explained to me that your hormones are going to go like this and then they’ll drop off at the end of the pregnancy. And you’ll probably never get your goal of a fasting blood sugar of under 5.0. And to not take that as a bad thing. To understand that the insulin is acting better than if you were having nothing.’ SECOND TIME

The second time around, Leah understood the situation better. She knew she didn’t have any precursors to type 2 diabetes. ‘My blood sugars were squeaky clean between pregnancies.’ She was calmer and so decided she could eat a wider variety of food. ‘And that baby came out an absolute whopper. It turned out I had been a little too relaxed on things. 4.7kg. The size of a three month old.’ She accepted insulin a lot earlier with the second pregnancy. ‘It is what it is. I knew what food I could eat.’

THIRD TIME

The third pregnancy was different again. Because of Covid guidelines, she said she never met any health professionals face to face. She was never referred to a dietitian, and all communication was done via emails. The third time around, and with more understanding, Leah says she took the situation more seriously. She accepted the insulin immediately. Leah found a greater variety of food made it much easier for her. ‘This time around, there are so many more products around that are low carb and low sugar. Keto is a thing now. You can buy crackers and actually have something crunchy, rather than meat and potatoes all the time.’ STRESS

Leah has found stress to be a major contributor to her blood sugar levels. ‘This time around, I have two children plus I run my own business, so I’ve suffered more stress effects.

Last week was really stressful, and my blood sugars were all over the place, yet I was eating the exact same thing every day.’ Leah lives at Waihi Beach, and her midwife lives in Tauranga. She says she even feels the effects of stress on her blood sugars from being back in city traffic and looking for a parking space. ‘But I understand that now. Whereas that wasn’t explained to me earlier in the piece.’ Sometimes there has been a trade off with the stress though. Like when Leah’s mother-in-law came to visit and cooked dinner every night. ‘I would try and explain to her, “Just meat and vege,” but there would end up being too much oil, or this or that, and my blood sugar levels would be all over the place. But you’ve got to counteract that with, I’ve actually been able to rest and someone else has been able to make me dinner. ‘Third time around, I very much subscribe to the theory that I still need to live while I’m pregnant.’

OUR ADVICE • Pregnancy causes certain types of hormones (that are made by the placenta) to be released. These hormones make it harder for insulin to do its job. • The developing baby's demands increase the mother’s need for insulin. • Unlike type 1 and type 2 diabetes, gestational diabetes is only temporary and usually disappears after pregnancy. However, a person who has had gestational diabetes has an increased risk (50%–60%) of developing type 2 diabetes in the future; therefore, they should be tested for type 2 diabetes each year. • In most cases, gestational diabetes is able to be managed by diet and exercise during the pregnancy. It usually disappears after the baby is born – once the need for high levels of insulin, during pregnancy, has gone. Please check out our page on gestational diabetes for more advice, including exercise tips, advice on healthy living, and diabetes-friendly recipes. https://www.diabetes.org.nz/gestationaldiabetes

DIABETES WELLNESS | Summer 2022

Now there’s a rice that is SunRice Low GI Rice is a perfect choice for people with diabetes looking for a carb that is lower on the glycaemic index (GI). It combines everything you love about rice with the bonus of being low GI. SunRice Low GI Rice is a Diabetes New Zealand Choice product, approved by Diabetes NZ as a food that helps people with diabetes improve glycaemic control. It is also low GI certified by the Glycemic Index Foundation. This nutritious product tastes and cooks just like regular rice, so you can feel good about making a smarter carb choice. For a healthy boost to your favourite meal, look out for SunRice Low GI White Rice and SunRice Low GI Brown Rice in supermarkets nationwide. Visit www.sunrice.com.au and search “Low GI” for recipe inspiration and more product information.

What is Low GI? The Glycemic Index (GI) ranks carbohydrates according to how they affect your blood glucose levels, and how quickly different carbohydrates are absorbed and digested by the body. Carbohydrates with a low GI (55 or less) typically cause blood glucose levels to rise slowly and fall gently over a longer time. This means you will stay fuller for longer, with energy released more slowly. Carbohydrates with a high GI (70 or more) are digested and absorbed more quickly. A low GI diet is a great way of maintaining a healthy weight through sustained energy release, as well as helping with specific health concerns including diabetes.

NEW

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Community

‘TARTY TONIC’ W

Last year, 16-year-old William Robertson was a winner of the John McLaren Youth Award. This year, he and some classmates wanted to give back to Diabetes NZ by creating a lowcarb lemonade to sell at the Southern Farmers Market in Invercargill.

e last heard from 16-yearold William in the Spring issue of Diabetes Wellness. A record breaker in athletics for the Southland region, he’s gone on to raise funds for Diabetes NZ. This year, as part of his Business Studies class, he and two classmates created a lemonade to manufacture, market, and sell. The recipe came from a family friend. William’s mother, Rachel, adapted it after he was diagnosed with type 1. With added fizz and at only 10 carbs a glass, it was a perfect drink for anyone and, of course, for summer. William and two others in the Business Studies class came up with the concept. Having some understanding of diabetes made

it more real for the students. It also educated the punters. While selling it, the students would talk about how the recipe came about and where the funds were heading. William’s role in the project was making the drink as well as creating the market display. The lemons were donated by a friend’s grandfather from his tree in Nelson and they were spray-free. They called the drink ‘Tarty Tonic’ and it went down well with the locals at the Southern Farmers Market. William is already well known at the market as he also fundraises there for his athletics trips each weekend. William says he’s been learning about corporate social responsibility and he enjoyed giving back to Diabetes NZ.

DIABETES WELLNESS | Summer 2022

Diabetes Youth

NGARU MOEKE GETS HIS GOLD In the last issue, we covered 14-year-old Ngaru Moeke’s win at the New Zealand Muaythai Federation Nationals. Ngaru has continued his winning streak at the International Federation of Muaythai Associations Youth World Championships in Kuala Lumpur, Malaysia.

aving type 1 diabetes is no barrier to success for this Taranaki rangatahi. Ngaru’s major successes have all been since he was diagnosed. That includes his latest win: taking out the gold medal for his weight and age division at the 2022 World Championships. His big brother, Tama, won the silver in his division.

DIABETES WELLNESS | Summer 2022

DIAGNOSIS

Just after his 10th birthday, Ngaru’s parents, Laura and Shan, noticed something wasn’t right. Laura says, ‘He dropped weight and was always thirsty. We couldn’t work it out.’ It was also watching Ngaru perform on stage with kapa haka that alerted his parents to how much weight he’d lost. Laura says Ngaru was always heavier than his big brother Tama – and had been since he was four years old. When he dropped below his brother’s weight and they couldn’t see a reason for it, Laura went searching for answers. ‘I chucked into Google all the symptoms he was having. Then we went to the hospital and I’m so blessed that the nurse took me seriously, because I know a lot of other people don’t get taken seriously. She said, “Ok, we’ll prick his finger.” ‘His levels were 32 and his ketones were pretty high, but he was still coherent. We were very, very blessed.’

After Ngaru spent three days in hospital, his whānau had a type 1 diagnosis to quickly learn about. ‘It’s crazy to think about those days and of how little we knew, but Ngaru just adapted to it crazily well. His main thing was, “Can I still train?” We got home, and he was downstairs that day, training.’ Within six months, he regained the weight. AN AVERAGE DAY

‘I wake up about 6.45am, do my needles, have breakfast.’ (Bacon and eggs and a shake are his favourites.) Then the brothers get in a little bit of training and then go off to school. It’s handy that kura is just two minutes’ walk away. Ngaru enjoys all subjects there, but his favourite is te reo Māori. After school, it’s a longer training session where the boys have started fitting in some strength training. After dinner, it’s often talk-time with their dad and coach, Shan. He might ask the boys their opinion on a fight that they

watched in the weekend or have a post-fight talk where they go over what they could’ve done better. Or it could be a performance talk and analysis. It’s handy that their gym is so close. So close that it takes about 10 seconds to get there. The whānau has two double garages, so the whole bottom floor of their home is now fully dedicated to Muaythai. Bad weather can never be used as an excuse to miss training. When asked what makes Muaythai the best, Ngaru’s face lights up before he finds the right words. Laura pipes up, ‘It’s their thing. Training isn’t a job. It’s not like “oh no, I gotta train.” They’re down there with big smiles on their faces. They’re happy. Then when they get a new piece of equipment it’s like Christmas.’ A few of Ngaru’s friends have given Muaythai a go, gone on to train under Shan, and even fought in the ring. Laura says a moment she’ll

never forget is when one of Ngaru’s friends gave him a Christmas card. Inside it said, ‘Thank you for introducing me to Muaythai. You saved my life.’ HOW DO MEDALLISTS RELAX?

Ngaru enjoys movies, books, and drawing. With the beach only 900 metres from their house and beautiful Taranaki Maunga a constant presence, the whānau enjoys the wealth of outdoor activities with walks, swims, and hikes. Laura says, ‘Every time we come home from being away, it’s like, wow. And then we get over it, we get used to it.’ And what’s next? The Moeke brothers are going to the Oceania Championships on the Gold Coast in October. Then, in December, they’ll be competing with the New Zealand team in Brisbane. What’s happening in five years? ‘Definitely get myself a title belt. The Youth Olympics 2026.’

INSULIN AND ATHLETES Competing at this high level with diabetes brings up an interesting issue. Insulin can be seen as a growth hormone, and because of that it was banned by the International Olympic Committee in 1998. Luckily, the ban doesn’t apply to athletes living with diabetes whose health depends on insulin. So, for each major tournament Ngaru competes in, he has to fill out a TUE (Therapeutic Use Exemption). ‘On fight day, my bloods do go high because of the adrenaline, so I try to take insulin about two hours before.’

DIABETES WELLNESS | Summer 2022

Nourish

BERRY BERRY NICE!

DIABETES WELLNESS | Summer 2022

Whether grown in your garden, bought at a roadside stall, or found in the supermarket, berries are one of the treats of summer. Strawberries are possibly the most naturally sweet berry, so an added sweetener is seldom needed. Pictured: Summer Berry Crush

BLUEBERRY CRUMBLE SLICE SERVES 6 PREP TIME: 10 MINS BAKING TIME: 15 MINS

This is thinner than your average fruit crumble and so quicker to bake. 2 cups fresh or frozen blueberries 4 tbsp water 2 tbsp cornflour 3 tbsp soft brown sugar ½ tsp ground cinnamon ¼ cup wholemeal self-raising flour (or add ½ tsp baking powder to plain wholemeal flour) ½ cup rolled oats 2 level tbsp margarine Preheat the oven to 200°C. Mix your cornflour and 2 tbsp water into a paste.

SUMMER BERRY CRUSH SERVES 4 PREP TIME: 5 MINS

Who would’ve thought cottage cheese could be used in a dessert? This can be made half an hour before rushing out the door to a potluck. 200g fresh or frozen strawberries. 200g low fat (less than 2%) cottage cheese 1 tsp SweetNZ Classic Blend (sugar-free sweetener) Six gingernuts shattered and scattered over the top just before serving Scoop the cottage cheese into a small bowl and process with a stick blender until smooth. Chop up the berries. Allow variety with some chopped and some mashed. Gently fold all the ingredients together and chill. Serve in any glassware and sprinkle with the gingernut crumbs. TIP

If using frozen berries, make sure they are defrosted. NUTRITION PER SERVE: ENERGY 599kJ (143kCal) | PROTEIN 10.4g | FAT 2.5g (SAT FAT 1.2g) | CARBOHYDRATE 18.4g (SUGARS 10.3g) | SODIUM 104mg

In a small saucepan, combine blueberries, 1 tbsp sugar, cinnamon, and water. Mix well. Bring to a boil, then reduce heat and simmer for five minutes with the lid on. Take off the heat and mix cornflour and water paste through the fruit mix. In a medium bowl, combine wholemeal self-raising flour, oats, and 2 tbsp sugar. Melt the margarine (see note below on cooking margarine) and stir through the dry ingredient mix. Spoon in the berries and smooth out to cover the base of the baking dish OR individual ramekins. Sprinkle dry mix over the blueberries. Bake for 15 minutes or until the top is golden. If you are used to cream with your crumble, use low-fat natural yogurt instead. DIETITIAN'S TIP

For best results in your baking, be sure to check that your margarine is made from a monounsaturated oil such as olive or canola and contains 70% fat. Lower fat content may result in a dry product. NUTRITION PER SERVE: ENERGY 877kJ (210kCal) | PROTEIN 3.6g | FAT 5.3g (SAT FAT 1.1g) | CARBOHYDRATE 34g (SUGARS 13.4g) | SODIUM 99mg

DIABETES WELLNESS | Summer 2022

BERRY CHIA JAM MAKES 5 SERVINGS – 2TBSP PER SERVING

This is ridiculously easy and takes just a few minutes. 135g (approx. 1 cup) fresh or defrosted frozen berries 1 tbsp chia seeds Mash the fresh or frozen berries, so they are mushy but not purée (avoid blitzing them). Add the chia seeds and mix well. Spoon the jam into a sealable container. Refrigerate for at least one hour. The seeds will plump up and absorb the liquid, creating a thick jam perfect for spreading on toast. Unlike regular jam, this contains no sugar and must be stored in the fridge. I recommend making it in small servings – enough to last no more than a week. NUTRITION PER 2 TBSP SERVE: ENERGY 84.5kJ (20kCal) | PROTEIN 0.8g | FAT 1g (SAT FAT 0.1g) | CARBOHYDRATE 1.1g (SUGARS 1g) | SODIUM 1mg

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 2022

ONLINE SALES WHOLESALE BULK

YOGHURT BERRY BARK SERVES 4 PREP TIME: 5 MINS FREEZING TIME: 3 HOURS MINIMUM

2 cups plain Greek yoghurt (no more than 2% fat) 1 tsp vanilla-flavoured essence ¼ tsp SweetNZ Classic Blend (sugar-free sweetener) 35g raspberries 35g blueberries 1 tbsp walnut pieces (approx. 7g) In a bowl, mix together yoghurt, vanilla-flavoured essence, and sweetener to taste and stir until blended. Pour the mixture onto a flat tray lined with greaseproof paper and smooth out until you have an even surface. Sprinkle berries and nuts over the top so they are evenly spaced. Freeze for a minimum of three hours. Cut into shards. TIPS:

• These treats will start to thaw as soon as they are taken out, so leave them in the freezer until they are required. • Get creative with seasonal fruit for a variety of toppings. Some other favourites are sliced strawberries with a sprinkling of chia seeds, mandarin segments, or slices of apple or stone fruit. • If you want to reduce your calories but not at the expense of flavour, SweetNZ has a range of great alternatives to sugar. Their Classic Blend measures spoon-for-spoon like sugar. Note: It’s important to use Greek yoghurt for this recipe as other natural yoghurts crystallise too much. NUTRITION PER SERVE (ONE SERVE EQUALS 150g): ENERGY 430kJ (103kcal) | PROTEIN 9g | FAT 2.1g (SAT FAT 0.4g) | CARBOHYDRATE 9.6g (SUGAR: 9.5g) | SODIUM 107mg

100% NATURAL 100% SUGAR FREE 1:1 SUGAR SUBSTITUTES Erythritol, Monk Fruit, Allulose, Xylitol, Stevia & Blended Sweeteners

www.sugarfreefood.co.nz

Diabetes Youth

JERRY

MORE THAN A TEDDY Standing a little bit under knee-high, tanned and brown, and with arms the perfect length for a cuddle, our friend Jerry the Bear has been busy teaching young children about their new diagnosis.

ore than a comforting teddy, Jerry the Bear is a learning tool that children find relatable. This cuddly character has been in Aotearoa New Zealand since 2017. That’s when the Grocery Charity Ball generously donated funds allowing Diabetes NZ to gift a Jerry to every child with type 1

Jerry the Bear. He’s a friend when you’re going through a tough time.

DIABETES WELLNESS | Summer 2022

diabetes aged 4 to 10. In that time, Diabetes NZ has given away 610 bears. Jerry the Bear’s job is to help not only the child who has diabetes but the whole whānau learn how to manage the condition. As well as being a thoroughly cuddly friend, his colourful patches work with a smartphone app designed specifically for children. In Jerry’s virtual world, children can wash and dry Jerry’s paws, test his blood sugars, and give him insulin when he needs it. They also learn how to count carbs and can see the results of choosing various foods on his blood-sugar levels.

GLOBAL BEAR

Jerry is well travelled. Before he came to Aotearoa New Zealand, he had already been to many countries. An earlier iteration of Jerry even met Barack Obama when he was President of the U.S. Designed by Sproutel in the U.S., Jerry is the result of a group of engineering students who wanted to create an interactive learning tool for young children. The originators found that kids with diabetes would make-believe that their existing soft toys had diabetes. Just as they had to prick their own finger, they might ‘prick’ their toy’s paw, pretending to test blood-sugars. Jerry’s designers found that children were mirroring their own lives by re-enacting the routines that they experienced every day with their own diabetes. And through involving Jerry in their daily lives, children can change their perception of diabetes. Children become caregivers to Jerry, suddenly elevated to the same level as their parents, thereby feeling that they have more control over the situation. The feeling of control makes them feel less alone if they can see that a cuddly bear is on the same journey as they are. Jerry the Bear has been used as a learning tool outside the home as well – in schools and early childhood education centres. This is where Jerry can educate the wider community, breaking down diabetes in a way that kids can easily understand. Because the diabetes

My Identity

is proud to create

‘Jerry the Bear has helped my little warrior through tough times. She carries him everywhere.’ – MACIE’S MUM,

LEIGH SHARLAND

YOUR HELP

activity is done through the app and isn’t built into the bear, he can be carefully spot-cleaned. He doesn’t like swims or soaks though. KIA ORA, JERRY

Jerry has been a hit with Kiwi kids since his introduction five years ago. He flies into a kid’s home in a Brave Bear Pack, which includes a drink bottle, and it’s all wrapped up in a drawstring bag. Six-year-old Macie Sharland, from Greymouth, adores her Jerry. Her mum Leigh says Jerry the Bear has been a big part of her daughter’s diabetes journey. Diagnosed at only 23 months old, Macie has found a constant friend in Jerry. He accompanies her on every hospital visit. Another six year old, Adele Morgan, from Wellington, has found comfort in her Jerry. Her mum Monnie says, ‘Jerry bear helped my little girl when she was first diagnosed. He made her feel comfortable when Jerry needed to get an injection or a blood test done. She still has tea parties with him. He is definitely a sentimental treasure she will keep forever.’

The donation from the Grocery Charity Ball has lasted a wonderful five long years. The last Jerry is about to walk his way out the door and into a child’s arms, but the funding has finally run out. Diabetes NZ needs funds to buy some more and is seeking to raise money through generous donations. There are about 3600 children and young people living with type 1 diabetes in Aotearoa New Zealand. It’s estimated that a further 400 are diagnosed every year. We would love to be able to support each of these courageous tamariki with a Brave Bear Pack, but the cost per pack is $150. Public support is crucial to help Diabetes NZ continue to gift Brave Bear Packs to tamariki aged 4–10 who are living with diabetes in Aotearoa New Zealand. We are grateful to those who have donated in the past. People who are interested in supporting this project are able to donate through the Diabetes NZ website www.diabetes.org.nz, using the donation portal. Thank you in advance for your support. Our young people and families living with diabetes thank you too. With your help, we will continue to help them and all Kiwis living with diabetes.

$79 each Fashionable Medical ID Jewellery

Jerry the Bear, the little bear with a big job to help children who have type 1 diabetes and their whānau as they learn how to manage the condition.

Shop now for a beautiful piece of jewellery and support our community LIMITED NUMBER AVAILABLE. PRICE INCLUDES ENGRAVING AND FREIGHT.

DIABETES WELLNESS | Summer 2022

Life with Type 2

In 2015, Stefan Crooks was diagnosed with type 2 diabetes. He shares how he had to make some tough calls about the rest of his life.

CATCHING THE VIBE

‘I

n 2015, I was diagnosed with diabetes. The funny thing about that is I probably knew it was coming because it was in my family. And the crazy part about life is that we ignore all those indicators of what we should be doing to protect ourselves. And yet we think we’re bulletproof.‘ Stefan had a successful career behind him. He had travelled the world running businesses for 16 years.

DIABETES WELLNESS | Summer 2022

‘I was living like a king. But a king that was going to die young! Travelling the world work-wise is not what it’s made out to be. You’re entertaining. You’re eating too much, drinking too much. You’re in time zones.’ Stefan swore at his GP. ‘I said, “F you. I’ll be back in six weeks.” I then went home and apologised to my family. I sat my wife and kids down and

said, “I’m sorry, I should’ve known this, should’ve done something about it.” At that stage I was 160kg, which is pretty crazy.’ From that moment it was time to make a change. After apologising to his family, he put his shoes on and went for a seven-kilometre walk around the hills of Titirangi. He returned red faced and puffing.

Stefan with his wife Jo and kids Harrison and Casey.

‘THIS IS WHERE IT BEGINS’

‘I’d lived with diabetes with Mum and Dad for 20-odd years prior to that, so I understood life was going to fast go from one bad day a year, to one bad day a month, to one bad day a week, to every second day. ‘I buried both of them before their time. That didn’t need to happen.’ Stefan began to make small alterations to his life. With the help of his family, he started to feed himself better and learn how to manage his highs and lows. He was on controlled doses of Metformin at the time. ‘Within six months, I was able to go down from three doses of Metformin a day to one.’ With these changes to his lifestyle, Stefan’s health steadily improved. Over the next six years,

and with 15kg lost, he returned his blood results to a target zone. ‘My GP said everyone in his practice had the graph going the other way.’ Six months along the line, and after dropping the 15kg, the GP said he was back to normal. LISTENING TO HIS BODY

The next five years confused Stefan. Over that time, he only lost a further eight kilos. ‘I wasn’t losing the weight. I wasn’t listening to my body.’ He wasn’t taking time for himself. Stefan was busy giving himself to the community. He funded and rebuilt a rugby club (Suburbs) and returned it to being one of the strongest clubs in Auckland, going from 16th to first. He invested in Feed to Read – a Rānui library community project.

Before that, the library would issue only a few books over the holidays. When they offered kids a pie and a drink to come get a book out, it increased to 240 books. ‘The irony is that I was giving while harming myself. I gave myself to the wrong part of the world. I forgot to give myself back to myself, which I’ve done now.’ During that time, Stefan also discovered a 14 x 4cm lipoma in his neck. ‘Funny enough, I didn’t noticed it until I’d lost weight. I was shaving one day and found this massive lump in my neck.’ When he had it removed, he set a goal to get to where he had been when he was 18. This was when he was playing representative rugby and weighed 118kg.

DIABETES WELLNESS | Summer 2022

‘We’re controlled, whether we like it or not, by the food marketers of the world. They are the biggest drug supplier the world has ever seen. We’ve got to give the kids an alternative to get away from what they’re consuming, which is harmful. We’re not quite there to get everyone to just drink water out of the tap. We wanted something to sit in between.’

PRESCRIBING ‘STEF’ UNITS

It took seven months to reach this next goal. ‘I created a “Stef” unit. This is where I had to give myself an hour every day. I could walk, run, or just get out of the office.’ He realised that just changing his diet was only part of the solution. Stefan’s family took a while to get used to their new husband and father.

VIBE

Vibe is part of the Westie Food Group, a business Stefan took over and rebranded in 2010. It manufactures a selection of eight natural fruit-flavoured sparkling waters. This came about after Stefan wanted to offer an alternative to the highly-sugared and carbonated drinks that are marketed and sold to children in school tuck

‘We know these drinks aren’t good for us, but telling people not to have something they already like is pointless.’ ‘My wife said. “I’ve never known you, cause you’re now smaller than when I married you 29 years ago.” She had a “new” husband.’ At the same time, their children witnessed their father’s changes, something they never believed would happen in their lives.

DIABETES WELLNESS | Summer 2022

shops and dairies. He says, ‘We know these drinks aren’t good for us, but telling people not to have something they already like is pointless.’ This is when the business started to design better choices. ‘We set about creating a drink that takes us back to childhood memories without

the sugar. A light carbonation to give you that aha moment. I wanted flavour processes to take me back to the day I had that Popsicle, or when I grabbed that grape off the vine in the back yard, or when I bit into that peach or when I had that sour raspberry. ‘When we did the testing of the flavours, which are botanic extracts, if they didn’t take me back then we had to alter it. Until it took me back on that journey, I refused to stick it in the can.’ Stefan says the flavours trick the mind. Our yearning for sweetness has nothing to do with the body needing sugar. He says it’s to do with sensations that we think we need. ‘It’s not as carbonated as other commercial fizzy drinks out there, and it’s got no sugar. We combine two sweeteners to reduce the chemical aftertaste and to provide a good RDI

(Recommended Daily Intake), which the Diabetes NZ nutritionist has signed off. Our job now is to improve it and make it better.’ Vibe is sold in 160 New World and PAK’nSAVE supermarkets as well as in 200 schools around Aotearoa New Zealand. OUR CONNECTION

This year, Stefan reached out to Diabetes NZ. ‘I’m living with type 2 diabetes, and I’ve created a drink. I want to be able to help you guys. So where do we start?’ With Stefan being an excellent advocate for diabetes and wanting to challenge the stereotype, Vibe is Diabetes NZ’s Champion Sponsor. When Diabetes NZ is out and about in the community over the next six to 12 months, we will have samples available.

PARIS MARATHON

Stefan still takes a single dose of Metformin a day. It’s more cautionary than anything, he says. He is working to eliminate it by November, which is when he has to pass a medical in order to enter the Paris Marathon next year. He’s busy training for that and keeping up with his Stef units. ‘When I get the sign off, I can start blogging about it and put videos onto my website.’ He says he’s on track to get to Paris in April. Not to break any records but just to get to the end. ‘The thing I fear most about that is having my DNA, as opposed to getting across the line in five to six hours.’ www.stefancrooks.com

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DIABETES

Diabetes Wellness magazine is the flagship publication of Diabetes New Zealand

Care

The heat and humidity of summer can sometimes play havoc with blood sugar levels. Here are some tips for getting through a hot summer.

f the recent high summer temperatures in Europe are an indicator, we might be in for a hot summer ahead. Whichever type of diabetes you have, summer heat and humidity can bring challenges. Some people with diabetes find heat has their levels sitting higher than normal. Others, expecially those with type 1 or who have type 2 and are on insulin, find lows become more common. It can also simply be harder to cool yourself down.

WHAT’S GOING ON?

There are three key factors that on their own or in combination with each other can affect those with diabetes during summer: • Dehydration can make your blood sugar levels rise, and rising blood sugar makes you urinate more often, so it becomes a vicious circle. • Some complications of diabetes, such as blood vessel and nerve damage, make it harder to sweat and cool yourself off. • High temperatures can change how your body uses insulin.

DIABETES WELLNESS | Summer 2022

STAY HYDRATED

Upping your water intake during summer is a good idea for everyone and especially those living with diabetes. Also avoiding, as much as possible, drinks that dehydrate you – such as alcohol. Be aware, too, that some diabetes medications such as Metformin and Jardiance may have a dehydrating effect. Drink plenty of water to make up for this. Waiting until we feel thirsty often means we’re already about 2% dehydrated. Milk, soft drinks, juice, and smoothies might seem like good thirst quenchers but save them for after you’ve drunk some water. Your body needs the water first. If water is boring to you, add in a splash of fruit juice or even slices of fruit to your glass. You can infuse a jug of water with herbs such as lemon balm, lemon verbena, or mint and leave in the fridge overnight. We have pages of recipes for infused water in our Autumn 2021 issue. Another drink that can be made in the fridge is Mugicha. This drink is very popular in Japan and South Korea and is simply roasted barley so has a delicious nutty flavour. Drop a teabag into a glass jug of cold water and leave in the fridge for an hour. Mugicha or barley tea can be easily found in any Asian food store, or try this simple recipe for homemade Mugicha.

HOMEMADE MUGICHA (JAPANESE ROASTED BARLEY TEA) MAKES 8 CUPS

1⁄₃ cup uncooked pearl barley 8 cups water Put the barley in a large dry frying pan and toast over medium heat for about 10 minutes, stirring the grains and shaking the pan occasionally so that they toast evenly, until the grains have turned a dark rich brown color. Remove from the heat and pour out into a bowl to cool. Bring the water to a boil in a pot, add the cooled toasted barley, and simmer over low heat for 20 minutes. Remove from the heat and let the barley continue to steep as the mugicha cools, for about 5 minutes. Strain out the barley, pour the mugicha into a jug, and chill.

KNOW THE SIGNS OF HEAT STROKE

To see how hydrated you are, look at the colour of your urine. Check out this handy chart, previously published in the 2019 Summer issue.

ARE YOU DRINKING ENOUGH WATER? Check your urine colour against this chart for an indication of your hydration levels. A TOUCH OF YELLOW

Looking good; you’re hydrated. MID YELLOW

Time for water, even if you’re not thirsty. DARK YELLOW

Getting dehydrated. If you think about it, you’re probably thirsty. HONEY COLOURED

Drink more fluids – dehydration is probably affecting your blood glucose. DARK HONEY OR BROWNISH

Have plenty to drink, and if your urine remains a similar colour for more than two weeks, speak to your GP so they can check liver and kidney function.

Heat stroke and heat exhaustion happen when your body temperature gets too high due to being exposed to too much heat. Once your temperature rises to over 40°C, you will have heat stroke. Heat stroke is an emergency and needs to be treated immediately. Signs to look for: • Feeling sick or vomiting • Severe headache • Confusion or agitation • Fast pulse • Shallow and fast breathing • Hot and flushed skin • Weak or cramping limbs • Not sweating despite being very hot • Dizziness • Seizures • Collapse or loss of consciousness

SWEAT

Sweating is vital to help cool yourself off. It’s harder if you have some nerve or blood vessel damage that affects your sweat glands. Cooling yourself off can be difficult when humidity is in the mix. The moisture in the air means any sweating isn’t such an effective way to cool yourself down as it would be on a dry day. If you suffer from nerve damage that affects your temperature control, cool your body by moving to an airconditioned space, sitting in the shade, sitting in a cool breeze, wearing lightcoloured clothes made of breathable fabric, wearing a ventilated widebrimmed hat, and using a spray bottle to spritz water on your skin. Use cool damp cloths and drink cool water.

INSULIN AND BLOOD SUGAR LEVELS

Many people with diabetes notice that the heat of summer changes how their body uses insulin, and research backs this up.1 If this is the case for you, test your blood sugar more often than usual and adjust your insulin dose, what you’re eating and drinking, and how much you’re exercising. You might find that it works best for you to make sure you exercise in cool, well ventilated places, and at cooler times of the day. Wearing lightweight, loosefitting clothes can help a lot. Always take care when outdoors to avoid sunburn, which stresses your body and can raise blood sugar levels. Use a broad-spectrum sunscreen, wear protective eye gear, and pop on a hat. If you’re in any doubt at all about how your blood sugar levels are tracking, see your health care provider for advice. It’s especially crucial for those with diabetes to take precautions to stay cool and hydrated in summer – but even those without diabetes can benefit a lot from it, so see if your friends and family will join you in trying to stafe safe and well throughout the hot summer months. 1 Managing Diabetes in the Heat: Potential Issues and Concerns. https://doi. org/10.4158/EP09344.RA

PROTECT YOUR KIT

Don't forget to protect your insulin and kit from the summer heat. Consider a car cooler that plugs into a 12-volt car adapter to keep your supplies at the right temperature. This will keep the temperature stable for some time. There are many other insulin coolers on the market, so hunt around and find something that works for you. If you are using an insulin pump, be sure to protect your pump from high temperatures. Check the tech specs for your pump to ensure you know the types of conditions your insulin pump system can withstand.

DIABETES WELLNESS | Summer 2022

MY DIABETES JOURNEY… A FRIEND IN YOUR POCKET!

Your DNZ

2022 Award Winners Every year, we grant a number of awards to recognise determined and hard-working people in our diabetes community. In September, Diabetes NZ was thrilled to announce the winners of our annual awards.

DIABETES NZ AWARDS

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

DIABETES WELLNESS | Summer 2022

Each year, these awards honour some of the inspiring members of our community. This year, we acknowledge Ruby McGill from Wellington, for her outstanding work lobbying for CGMs and her presence on social media, Jaylen-Blaze Daane, for being a relentlessly positive 12-year-old role model and educator in Invercargill, and Jo McClintock, a clinical psychologist who works with youth in Waikato. SIR CHARLES BURNS MEMORIAL AWARD

This award is for people who have managed their diabetes for 50 years or more through insulin therapy. In 2022, we have five recipients: Shelley Brown – 50 years Lois Goodin – 51 years David Town – 50 years Howard Patterson – 51 years Maxine Hall – 65 years

SILVER MEDAL AWARDS

This award is for anyone who can demonstrate that they have managed their diabetes through insulin therapy for at least 25 years. This year, we have seven recipients. Alana McLaren from Auckland – 27 years Ann Jennifer Connor from Auckland – 46 years Mark Jackson from Auckland – 25 years Geraldine Knowles from New Plymouth – 33 years Melanie Heather Cooper from Palmerston North – 30 years Natalie Kate Clement from Canterbury – 27 years Sianne Chapman from Auckland – 25 years JOHN MCLAREN YOUTH AWARD

These awards offer a scholarship to young people under 25 living with diabetes, who are aiming high in their chosen fields. Bridget submitted her application for the academic category, but the judges felt her application was actually a cultural one. Nice to see the South so well represented. Cooper Gough from Invercargill – Sport. Cooper is representing NZ at the Oceania Taekwondo Champs in Tahiti. Hannah Clark from Invercargill – Academia. Hannah will be embarking on a Bachelor of Nursing next year. Bridget Dalley from Dunedin – Cultural. Bridget has been accepted for a semester at the University of Applied Arts in Vienna, Austria, where she will be learning knitting and weaving skills.

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

POLY 14613 (NZ)

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Advocate

LEE PAGE-DEANE – IN DEMAND HAUORA KAIMAHI Lee Page-Deane is in demand. As one of a team of five Hauora Kaimahi, she is employed by Diabetes NZ, where her role has her helping people with diabetes across the Waikato region.

DIABETES WELLNESS | Summer 2022

hen Diabetes Wellness spoke with her, she had just come from a hui where she estimates they had about 100 attendees. ‘I’ll get an email saying, “You’re doing this,” so off I go.’ One day, she might be visiting a marae or hosting an expo. On another day, she could be doing one-on-one visits in the community. ‘At an expo or a hui, we present Diabetes NZ and have lots of resources to give to people. It’s always our table that is targeted. But at the last one, we had so many people, I ran out of resources, business cards. They went left, right, and centre. The need out there is so huge. ‘Sometimes I hand my card over to someone at an expo, and I might end up with their husband calling me and saying, “Hey, my wife gave me this, can you pop in and see me?”

‘Today, I met the wife of a truck driver. He’s rung me and asked if I can do a whare visit and have some kai with them. That might happen next week. ‘I’m talking to whānau all the time. I have a community nurse that sends me referrals, but anyone can self-refer.’ Lee says she has a good network and so can link people back to the right providers. She can also connect people to diabetes support groups in their region. She says it’s a matter of fitting people in, doing whatever it takes to enhance people’s lives, even if it falls outside the usual nine-to-five day. Lee sometimes jumps in in the weekends for expos and hui so she can continually get information out there and not fade into the background. ‘Diabetes doesn’t stop, you see.’

‘My job is amazing. I get to join people on their journey and show them awhi.’

CROSS POLLINATION

Lee has always worked in the health sector. She feels her past experience working in mental and community health crosspollinates well with her current role. Lee also has whānau with diabetes. Because she is down to earth, people are keen to tell her their stories, and she is trained to be a good listener, enabling a deep and meaningful kōrero with her clients. Lee can also sign, so she can communicate with members of the Deaf community and together they can have a conversation. ‘It’s about getting the engagement,’ she says. ‘If we can get people to contact us, ring, email, face to face, whatever it takes, then they can be more knowledgeable around their diabetes. Perhaps it’s technology they’re requiring or just someone to go to their appointment with. That’s what we’re all about. Linking communities and regions back to providers so they don’t fall through the gaps.’

INTO PEOPLE’S HOMES

An obvious people person, Lee says that people pick up on her energy as soon as she walks into a space. ‘That’s the buy-in. If you’re enthusiastic and passionate, they get that. They feel it as soon as you walk in by your voice and your tone.’ Lee comes across people at all stages of their diabetes journey and says they all handle the experience differently. ‘Some people are reluctant. Some are scared, fearful of the end result. They want to know what it all means for them and their health. ‘I make sure they feel comfort that I am there for them. That I am going to stay and that I am going to follow through. Through that, they feel validated. We are there to support them along their journey, and so I make that time for them.’ Lee says she understands how to support people towards making positive changes. She works on breaking the medical language down and simplifying it so people can understand better. She believes this empowers people and that the results speak for themselves. ‘People come to me and they have a convo and they go, “Ahhh, now I get it.”

Because not everyone’s a doctor or a nurse.’ She says people always want to know more about their diabetes. ‘From a clinical point of view, they might not understand their medications or why they’re taking what they’re taking.’ She encourages them to phone, and, if necessary, she will help them talk to their GP or medical centre. From that self-directed learning, she believes they feel more empowered. PROUD MOMENTS

There are many layers to Lee’s role as she works across services. ‘I do whatever it takes, really, to support people with diabetes on their journey.’ Something as straightforward as a whare visit sometimes ends up with someone needing more medical support. In Lee’s first week, she picked up that a client was having a heart attack and ensured he got to the hospital. ‘When I went back the next day, they said, “Sure enough he was having a heart attack. How did you detect that?” They told me it’s harder to detect heart attacks in people with diabetes, so “Well done!”’

Community

Cats and dogs famously have highly sensitive noses. We meet a group of pet owners living with diabetes who have learnt what persistent barking or continual nocturnal nose boops from their pets can really mean.

SUPER PETS I f you type, ‘What can dogs sense?’ into a search engine, you’ll quickly get reports of everything people say a dog can sense: pregnancy, cancer, earthquakes, and more. Dogs have been trained for millennia to help us, whether it be herding animals, fetching things, or guarding properties and people. Due to their advanced olfactory system (great sense of smell), they are also commonly employed to sniff out drugs at the border as well as track down people, whether they’re lost or not wanting to be found. Then there are the many types of assistance careers our canine friends can embark on too. The most common is helping guide those with low vision. They can also protect people with epilepsy and support people with mental health challenges.

In some countries, dogs have been trained to alert their owner, or someone close, when their owner’s blood-sugar levels have become either too high or too low. Known as diabetes service dogs or alert dogs, they’re professionals who’ve had intensive training. Dogs with qualifications, if you like. Diabetes alert dogs are trained using samples of sweat from their owners when they have had both highs and lows. The dogs are rewarded during training when they detect a major change in blood sugars. TEAM DOG

Alerting an owner to their blood-sugar level is a valued skill that some dogs can learn. But there are also reports of when people have found their animals doing it naturally.

Helen McCormack's 'heroes' Shadow and Zimba.

DIABETES WELLNESS | Summer 2022

For some, having a four-legged friend around has come with extra benefits. Eighteen months ago, Tui Penman, when sleeping in a different room than her partner, woke up in the early hours with a severe low. She managed to get herself out of bed but says she couldn’t walk properly. ‘I was dragging myself across the floor.’ When she got to the front door, she couldn’t get it open. It was cold, and she couldn’t think straight. ‘I was trying to call out to my partner, but I knew I wasn’t yelling, I was just saying his name. I couldn’t bring the energy to yell. Then I was laying on the floor thinking, “Oh my god, I’m going to die.”’ It was then that Tui’s German Shepherd, Frank, started yapping. ‘He sounded like a chihuahua! It was really high pitched, and he was whining.’

‘I think they pick up on that vulnerability when you need it the most. When I’m not feeling great, they don’t leave my side.’ – TUI PENMAN

Tui’s partner works as a fire fighter, so he was tired from work and not paying much attention to the dog. So Frank started pawing at him and continued yapping. When he woke, he says it was like Frank had told him in his sleep. He knew immediately that Tui was in trouble. ‘Frank’s a rescue. We got him when he was a year old. He came from a really bad background. He’d been abused and was really emaciated and quite aggressive. We couldn’t turn our backs on him because he’d bite.’ The young dog took to the couple’s existing German Shepherd, Titan, who is more than 20kg heavier than Frank. Tui says that Frank would follow him everywhere and quickly bonded with him. Titan hasn’t shown any talent in sensing lows, but he is aware of when his food bowl is empty. Tui says she’s always been really open with her German Shepherds. ‘When I’m doing my injections or changing my sites, I always let them have a sniff. They are quite curious, especially Frank. He’ll stand around and have a good sniff at what I’m doing. And that’s how they know.’

Both dogs get really nervous when Tui is having a low. She says they won’t let anyone near her, except their dad. This includes ambulance staff. Frank, especially, will gently but firmly nudge the medics away from Tui. ‘I think they pick up on that vulnerability when you need it the most. When I’m not feeling great, they don’t leave my side.’ ‘BITSA’

Lynda Newton, from Taihape, has a kelpie ‘bitsa’ called Valkyrie, who’s been part of the family since she was a puppy. Lynda says that before her 10-year-old daughter Emma was diagnosed, Valkyrie would not leave her alone. ‘She’s an outside dog, and every time Emma would go outside she would nudge her along and follow her, and it was really weird. We didn’t put two and two together until she was diagnosed.’ Emma still gets checked on when she goes outside but not to the same extent. Valkyrie will come and sniff her but then carry on with her life. The family also has three cats, a rabbit, and an old Labrador who is only interested in food.

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TEAM CAT

While a dog’s sense of smell is extraordinary (they boast up to 300 million olfactory receptors), cats are doing pretty well with their 50–80 million. As a comparison, we humans only have about six million. Helen McCormack lives in a retirement village outside Hamilton and has two 8kg ragdoll cats called Shadow and Zimba. Both cats are 10 years old, and Helen says that, until she started using a CGM, the cats would regularly alert her when she went low. ‘Shadow woke me by headbutting me in the face until I sat up and tested. Sure enough, it was 1.6.

DIABETES WELLNESS | Summer 2022

Then another time he was sitting on my lap when suddenly he would headbutt me. I thought he was letting me know it was time for bed and that he wanted to get warm. But he wouldn’t stop, so I did a finger prick and, sure enough, it was 1.8. ‘ Helen points out that the cats will nudge her if they want a stroke or a cuddle. But they won’t wake her at night solely for attention. It’s when they’re persistent that she knows something is up. When Shadow had to spend the night at the vet after having surgery, his brother Zimba took over duties. ‘He woke me by sitting on my head. I kept pushing him off, but he wouldn’t leave me alone.

I checked my Dexcom, and it said 4. I did a finger prick. 1.6. ‘My boys are my heroes.’ OTHER TALENTS

Cats and dogs, of course, might play havoc with those who have allergies. And not every cat and dog appears to have this talent of alerting their owners for the right reasons. Helen says her previous cats didn’t alert her. There are even reports of cats appearing to not care at all about their owners and being more focused on dinner time. But if not every pet can offer some useful insight, then at least they can offer themselves for a stroke to get the blood pressure down.

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For more information and support on Dexcom G6 CGM, please contact the NZMS Diabetes Customer Care Team on 0508 634 103 or at diabetes@nzms.co.nz nzmsdiabetes.co.nz References: 1. Beck RW, et al. JAMA 2017;317:371-8. 2. Welsh JB, et al. Diabetes Technol Ther 2019;21: 128-32. 3. Heinemann L, et al. Lancet 2018;391:1367-77. 4. Reddy M, et al. Diabet Med 2018;35: 483-90. 5. Polonsky WH, et al. Diabetes Care 2017;40:736-41. Dexcom and Dexcom G6 are registered trademarks of Dexcom, Inc. in the United States and/or other countries. NZDI_DEX_111 September 2022

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Diabetes Wellness Summer 2022

Articles inside

DW Summer 2022 Editorial