Diabetes Wellness Winter 2020 by Diabetes New Zealand

wellness DIABETES

WINTER 2020 $8.00 INC. GST

DIABETES NEW ZEALAND | DIABETES.ORG.NZ

EMILY WRITES • WHEN SHOULD YOU EXERCISE? • TYPE 1 TEENS • FIBRE RESEARCH COVID-19 COMICS • DELICIOUS BEAN BROWNIES • MY TYPE 2 JOURNEY • MOVEMEANT CHALLENGE STARS

Kia aroha te tahi ki tetahi

COVID-19 PANDEMIC STAY WELL & BE KIND

Look after one another

measures spoon-for-spoon like sugar Apple Crumble Preparation 20 minutes

Instructions

Nutritional Information

Cooking 45 minutes

1. Preheat oven to 180°C. Put the apples, vanilla and one cup of EQUAL Spoonful into a large pan, add ½ cup water, cover and cook over a medium heat for 10-15 minutes or until just soft. Spoon into a 23 x 33cm capacity oven proof dish or evenly among 10 individual small ramekins or serving dishes.

Average Quantity Per Serve:  Energy 1020kJ (240Cal)

Serves 10

Ingredients 2kg green apples, peeled, cored and cut into thick wedges 1 vanilla bean, split lengthwise or 1 tsp vanilla bean paste 2 cups EQUAL Spoonful 2 tsp cinnamon 1 cup plain flour 1 cup rolled oats 60g butter or margarine, softened Ice cream to serve, optional CHEF’S TIP: Replace half the apple with rhubarb for an apple rhubarb crumble.

2. Put the second cup of EQUAL Spoonful, cinnamon, flour and rolled oats into a bowl and mix to combine. Rub in the butter until the mixture is crumbly. 3. Scatter the crumble mixture over the top of the apple and bake for 25-30 minutes or until the topping is crisp and brown. Serve with ice cream.

 Protein 3.5g  Fat Total 6.2g - Saturated 1.1g  Carbohydrate Total 41.5g - Sugar 20.2g  Dietary Fibre 4.6g The Essential Ingredient Equal Spoonful has almost no calories and measures spoon-for-spoon like sugar. Perfect for your recipes, cereals and drinks. Find more delicious recipes at club

.co.nz

Contents WINTER 2020 VOLUME 32 | NO 2

4 EDITORIAL

5 UPFRONT: Covid-19 messages

6 UPFRONT: Obituary for Maureen Lonsdale

26 LIFE WITH T1: Emily Writes talks about her family's journey

7 UPFRONT: Seeking Diabetes NZ Advisory Council nominations

28 MOVE: Should you eat before or after exercise? Craig Wise gives us the lowdown

8 COMMUNITY: Getting through the Covid-19 crisis – we talk to ten diabetes heroes

30 LIFE WITH T2: Part two of Shantelle Bliss' story

18 MOVE: Fitbit Movemeant Challenge

32 COMMUNITY: Life, love and type 1

20 FAMILY: Type 1 teens under lockdown 22 NOURISH: Coping with lockdown food worries – you're not alone 24 MOVE: Anytime Fitness launches a remote coaching programme

34 RESEARCH: New study says fibre in your diet is key 36 LIFE WITH T1: Sarah Laing – type 1 author, illustrator and cartoonist 38 LAST WORD: A look back in time with Fred Knox

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DIABETES WELLNESS | Winter 2020

Editorial

reetings from the Diabetes NZ Advisory Council. I’m Lyndal Ludlow, and I took on the role of Advisory Council Chair in March this year. With Covid-19 reaching New Zealand soon afterwards, it’s been quite a time to be advocating for those with diabetes. To acknowledge that, this issue of Diabetes Wellness magazine is something of an historic issue: dedicated to the unprecedented times we find ourselves in. I hope that everyone will find something of value in here, whether it’s inspiration, support, information, or that most important thing: feeling part of a community. To introduce myself a little further, the diabetes community has been an important part of my life for more than a decade – ever since my son was diagnosed with type 1 at age seven, and eight months later my husband was diagnosed in his 40s! We also parent another teenager. I have met some truly wonderful people through my connection to the diabetes community and made some lifelong friends for shopping, socialising, and venting. I first became involved with Diabetes NZ through the Diabetes Youth New Zealand advocacy group and was a member of the national committee for several years, actively helping with the transition to a unified organisation. I then became involved with the Advisory Council. My warmest thanks to the previous Chair, Pete Sleeman, for his level-headed, calm approach and the significant governance experience he brought to the Advisory Council and as our representative at Board level. I am looking forward to finding ways to strengthen existing communication pathways and seeking ideas for making it easier for New Zealanders affected by diabetes to share their needs and thoughts with the Board through the Advisory Council. A skills-based board means it is really important that they are continually informed about what life with diabetes is and means for our communities. In the meantime, I wish you all well and hope you get as much as I have from this issue of the magazine. Ngā mihi nunui LYNDAL LUDLOW

Chair of Advisory Council, Diabetes NZ

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

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

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

ADVERTISING & SPONSORSHIP Business Development Manager Jo Chapman jo@diabetes.org.nz or +64 21 852 054 Download the Diabetes Wellness media kit: http://bit.ly/2uOYJ3p

DIABETES WELLNESS | Winter 2020

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

COVID-19 MESSAGE FROM DIABETES NZ

iabetes NZ extends our solidarity and best wishes to all in the diabetes community right now. Our community has a long history of strength and resilience. As individuals, too, we’re used to preparing for, and adapting to, whatever challenges life presents. But we all need support sometimes. We encourage everyone with any form of diabetes to reach out for more support if you need it – whether that’s through your local Diabetes NZ branch, your diabetes clinic, your GP, or other forums, communities, or healthcare providers. Healthcare professionals

are also reassuring everyone with long-term health conditions that hospitals and medical centres are taking great care to ensure their processes are safe. It's important that you don't delay getting any of the normal medical care you might need. Because Covid-19 is new to the world, much about it remains unknown, and researchers globally are working night and day to understand this virus better. At the time of writing, it appears that, in adults, any form of diabetes is a risk factor for people who contract Covid-19, and this appears to be related to hyperglycaemia.

At the same time, the latest research indicates that children and teenagers with type 1 are at no more risk from Covid-19 than other children. (And in general, younger people are much less at risk than adults.) Diabetes NZ is committed to ensuring the most up-to-date information reaches the diabetes community. A new page on our website is devoted to diabetesrelevant Covid-19 updates. Our Facebook page and our e-newsletter (links at the website) also provide news and support. Diabetes NZ Covid-19 page: www.diabetes.org.nz/covid-19/info

Covid-19 and the Abbott FreeStyle Libre

ediray, New Zealand supplier of the Freestyle Libre, dealt with a dramatic increase in sales in March. Mediray CEO George Bongiovanni says, “We had a free delivery offer for the month of March, so it was hard to say whether it was the Covid-19 panic buying or our promo that increased it. It’s quietened down now.” Staff have dealt with all the challenges Covid-19 has thrown at them, and orders are still reaching customers fast. “We have a great team culture throughout the organisation,” says George, “and this follows through to the process of getting product to our customers. We’re classed as an essential service, so during lockdown staff have been working from home, except our warehouse team, who’ve been working under strict Covid-19 guidelines. “It’s been tough for our Territory Managers not being able to make face-to-face contact with customers, but with all the digital tools available

contact has still continued on a daily basis.” George dispels any lingering worries people have about the Libre system’s availability. “We carry a minimum of three months stock, with monthly shipments coming in from Abbott.” Mediray has, however, placed a limit of 12 per order on Libre sensor purchases. “This is a precaution to ensure product purchased is used within the expiry date. About 90% of sensor orders are for two to six of them.” USING THE LIBRELINK IN ISOLATION

George says, “The Covid-19 pandemic has really brought the FreeStyle LibreLink app to the forefront of diabetes management.” The LibreLink app can be used instead of the Freestyle Libre Reader and has many of the same functions. As long as your smartphone has the right specs, the app can be downloaded from

the Apple or Google Play Store, so that you can use your phone to check glucose readings anytime. Each time you scan your Freestyle Libre sensor with the Freestyle LibreLink app, your glucose data is automatically uploaded to Libreview, a secure, cloud-based diabetes management system, which enables your healthcare professionals to have secure, online access to glucose insights.” This is particularly valuable during isolation, when face-toface appointments with your healthcare team aren’t possible. www.freestylelibre.co.nz

DIABETES WELLNESS | Winter 2020

Upfront

Maureen Lonsdale (1934–2020) Niamh McCormack farewells tireless diabetes advocate Maureen Lonsdale.

t is with great sadness that I write this farewell to Taranaki’s matriarch in the diabetes community, Maureen Lonsdale. Maureen became inextricably linked with the Taranaki diabetes community after her then sevenyear-old daughter was diagnosed with type 1. From then on, for more than 40 years, Maureen was a pillar in the diabetes community, providing comfort, compassion, and a no-nonsense approach to getting things done. She was a friend, colleague, even a surrogate mother and grandmother to many kids and now adults, and she will be sorely missed. Initially, Maureen worked with paediatrician Dr Leo Buchanan, voluntarily sharing her practical advice with other families because of the knowledge she had gained from supporting her own daughter. Later, this was formally recognised, and she became a Diabetes Educator. Maureen was instrumental in establishing the adult diabetes service – setting up outpost

diabetes clinics in hubs around the Taranaki region – and providing diabetes care through the Stay Well programme. She had a very special working relationship with the DHB dietitans, who treasured her friendship and close working relationship over the years. Maureen was also extremely involved in contributing to voluntary diabetes support through the Taranaki Diabetes Societies Network. Her mantra was “supporting each other and working together”, and she believed that Taranaki was unique in the way its organisations worked together to better health and quality of life for the diabetes community they all served. Many have also reached out to share their fond memories of diabetes family camps Maureen championed at Te Wera. Maureen was a life member of Diabetes NZ and was recognised for her tireless work through a Diabetes NZ Volunteer Award, a New Plymouth District Council Citizen Award, and a Taranaki Kiwibank Local Hero medal. Personally, Maureen played a unique and special role in my life. I had just moved from Ireland to live in New Zealand with type 1 diabetes, and I had no family or old friends here. Maureen started off

as a medical contact I found online, and, as fate would have it, this led to a very special relationship. She called me her “Irish lass”, brought me into her support circle, and instilled in me a passion for helping the diabetes community that I cannot shake. Her drive and determination to do so much good fired up my own dreams and plans for helping the community, and I hope to carry this on in her memory. I will treasure our dinners, friendly sparring over community issues, and cups of tea, and hold her friendship dear to my heart, as I know so many will. The Taranaki diabetes community is forever changed for the better thanks to the efforts of one humble, determined woman who strove for more for all of us who live with diabetes.

SELAH HART JOINS DIABETES NZ BOARD OF TRUSTEES Diabetes NZ is delighted to welcome Selah Hart as a trustee. Selah, the CEO of Māori public health organisation Hāpai Te Hauora, is of Ngāti Kuia, Ngāi Tahu, and Ngāti Kahungunu ki Wairarapa descent. She has worked in Māori Health for more than 12 years, beginning her journey in Blenheim as the receptionist for a Māori Health provider. After moving to Tāmaki Makaurau in 2008, she worked for Auckland and Waitematā DHBs in several roles, before moving to Hāpai Te Hauora. She is also Kia Ora Hauora Auckland Metro Coordinator. Selah brings a wealth of experience, skills, insight, and conviction to the role, and we are excited for her to join us.

DIABETES WELLNESS | Winter 2020

CALLING NOMINATIONS TO THE

DIABETES NEW ZEALAND ADVISORY COUNCIL

iabetes NZ 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. To help us carry out our mission, Diabetes NZ appoints an Advisory Council whose role is to provide advice to the Chief Executive and the Board. The Advisory Council is a source of sector knowledge, expertise, and experience and acts as a conduit to support communication with the Diabetes NZ family and all others with diabetes in New Zealand. The Advisory Council supports and informs the Chief Executive in identifying, formulating, assessing, evaluating, planning, delivering, and monitoring ideas, programmes, and initiatives of benefit to Diabetes NZ and to meet the strategic and business plans established or approved by the Board.

Members of the Advisory Council must be available to provide input and information on issues affecting discrete groups within the overall diabetes population and for consultation on any matters requested by the Chief Executive and or the Board. The Advisory Council is made up of eight members. Four members represent the following sectors of the diabetes population: • Youth • Māori • Pasifika • The New Zealand Society for the Study of Diabetes Inc (NZSSD) The remaining four members must have appropriate knowledge of diabetes-related matters. Advisory Council members are appointed for a term of three years but may serve for another two terms of three years. There are currently two vacant positions on the Advisory Council: one position for a person that represents the Pasifika sector of the diabetes population and the other for a person who must have appropriate knowledge of diabetes-related matters.

HOW TO APPLY

Applicants/nominees are requested to provide a brief CV and covering letter setting out their background and suitability for the position. They must also state clearly whether their application is for the Pasifika representative position or the general position. This must be provided to the Chief Executive of Diabetes NZ by 1 June 2020. Email applications to heather@diabetes.org.nz or send to: Heather Verry Diabetes New Zealand PO Box 12441, Thorndon Wellington 6144 All applications/nominations will be confidential to the Chief Executive and the assessment panel. The appointment will take effect from 1 July 2020. Information on the assessment process can be found in our Advisory Council Appointment policy at www.diabetes.org.nz/ current-vacancies

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

Community

OUR COVID-19 HEROES Heroism is taking many forms: from working in essential services to staying home when it’s desperately tough to do so, from community volunteering to supporting friends. We talk with 10 familiar faces from the diabetes world about Covid-19, its impacts, and their advice for getting through.

Harko Brown

Tākaro (Māori games) advocate, PE teacher Type 1 parent At the start of April, after an intense week volunteering on Taitokerau Border Control – the Far North iwi checkpoint – Harko Brown and his family made a decision. “I withdrew from active checkpoint duty to self-isolate, as our 17-year-old daughter Billie, with type 1 diabetes, is in a highrisk group.” He praises those who have continued:“Volunteers here have been working at over 15 checkpoints, in well-organised shifts. Many have been staying away from their own families for the duration of the lockdown, such is their aroha for their vulnerable communities. They work with police and medics. At checkpoints, they inform people about their obligations, escort tourists to large parks where they can sit out the lockdown, and encourage holiday-

DIABETES WELLNESS | Winter 2020

makers to turn around and go back home where they should be.” In the Far North, there are other flaxroots initiatives: “people organising food baskets for their community members in need, helping our elders with firewood, doing errands for them, and just keeping in contact with each other and offering personal support”. Billie withdrew from school two weeks before lockdown. Harko says, “There was so much misinformation floating around at the time and news reports saying Covid-19 was just a flu and nothing to panic about. But we know how even a common cold can affect diabetes.” The family has been busy since then. Harko’s wife Verbina is a teacher, while Harko is working (now by distance) with an architectural firm, designing māra hāpara – traditionally inspired Māori playgrounds. The whole family, including Billie and her older sister Yves, have been making Māori games equipment.“Kite flying has also been great, with added activities to make it challenging and exciting,” says Harko. “We go on bush walks

Lee Weir

Radio announcer, marriage celebrant Type 2

close to home, identifying different flowers, plants, and insects, and playing the Māori leaf game patarau. It's amazing what you can notice when you’re not so hurried. We also have singing sessions and social media catch-ups with whānau – we are much more connected now!” He and Billie have been writing an educational book together: SMArtefacts: Sportised Maori Artefacts for Teaching Science, Technology, Environmental Education & Mathematics, due to be published in August. HARKO’S STAY-HOME TIPS

• Make sure everyone keeps relatively active, busy, and contributing to the household. • Make up a roster of jobs and activities that are fun, and make fun challenges out of the chores. • Activities can create exercise incidentally. For example, mowing the lawn without a catcher and having kids rake up and collect the grass by the handfuls, and seeing how high they can make grass piles.

Lee Weir, who is candid about his type 2 diabetes journey, is in a lively bubble with his wife Nikita, their children Lucy (8) and Albie (5), his brother Donald, his sister Gary (real name Carol-anne), and Gary’s daughter, Aria (5). He says, “We put the kids to bed the other night and the adults had a good old-fashioned game of Monopoly. Before the game started, I said to my wife and siblings, ‘I just want you all to know that I love you very much, but I am not here to make friends, and I would like to apologise right now ahead

of time for my behaviour while I’m playing.’ The old saying goes, ‘No one is friends anymore after a game of Monopoly.’ I won the game, and the day after we played no one was talking to each other.” He says, “Going outside and getting some fresh air has helped keep me sane. Also using my brain to problem solve. It would be so easy to just whack on Netflix or to play video games all day, but I’ve been trying to come up with creative and fun activities for my children, and that’s really helped me. Whether or not the kids want to take part is a different story!” He’s also been loving cooking on his barbecue. “The time and attention that you need to dedicate when you’re cooking low ’n’ slow with charcoal or fire really helps keep me calm.”

LEE’S LOCKDOWN LESSONS

• Keep in touch with the people in your life who lift your spirits. • Don’t think of the isolation as “social distancing”. If you reverse that and think of it as an opportunity to be “distantly social”, it’s a lot easier to deal with. You can still be social, thanks to video calling. • Being distantly social is an opportunity to get creative. Have a family dinner via video conference. Get your kids to call their grandparents and other family members. • Don’t be an idiot to your kids. They’re kids. I think that for so many of us, because it’s been so long since we’ve been kids ourselves, we forget how they operate and how their inquisitive minds work. They need stimulation, they need direction, and they need to play. There are so many benefits to play-based learning, so don’t go too hard on trying to get them to do school work. • Honestly – just ride it out. Yes, it sucks, but one day we’ll look back at this as a nation and be able to appreciate the magnitude of our actions and how the simple act of staying at home saved tens of thousands of lives.

Lee and daughter Lucy

DIABETES WELLNESS | Winter 2020

Community

Jill Gillette

World bowhunting champion, hairdresser Type 1 The notorious hand-sanitiser shortage didn’t affect Jill. As a hairdresser working from home, she always has plenty of Barbacide on hand, a commercial disinfectant that hairdressers use for their tools. Other things about lockdown have been harder. As an adventurous “do-er”, Jill admits she’s found it tough to stay home. “On the first day of lockdown, I’d planned to sneak out early on Thursday morning with my boat and a few rods. One of

DIABETES WELLNESS | Winter 2020

my good friends had planned to do the same – to the same wharf and fishing spot together. Two boats, two bubbles … However, the night before, they told boaties and hunters to sit tight. My good friend was the reasoning voice: He said, if anything were to happen, do we want coast guard volunteers,or police stepping outside of their bubbles? No. So we stayed home. “I will go fishing when this is over. LOTS.” Losing human contact was difficult, too. “Because of my type 1, I self-isolated on the Sunday night before the lockdown announcement. And my partner Mike distanced himself from me immediately. When I saw him on the Monday and Tuesday, he kept his two metres away as he was still out in the public working. I was proud of him for keeping me safe, but sad that I’d lost his hugs for a month or longer. “So, I had a short bout of grieving when this all kicked into gear … grieving my normal way of life and not being able to touch or see my partner for the foreseeable future. Once I’d got my head around that, I was able to put a mental health plan into place. Grieving meant I could move on with things and get in a better headspace, although it still took a couple of days.” Jill and her daughter Jorja have been a bubble of two, while Jill’s partner Mike is at his own place in Whangamatā. Jill says, “Having patience with a 16 year old has its challenges. Thank goodness they are so connected with their phones. She feels immensely sorry for Jorja though, who has had three things she was really looking forward to cancelled: an international school trip, her birthday party, and sitting a driving test. “I had to wear her frustration at first.”

Jill and daughter Jorja

Jill knew that structure would be important to her mental health: “I have a get-up time to stick to, important with my medication, and I have a strict coffee routine. I have a small daily outside job list to tick off , and even if I don’t feel like doing a job the completion is a great feeling. Our dog gets a 20-minute run with me on the mountain bike every morning as well. Having an outside blast is very important.” Jill had been training for the World Indoor Archery Championship in the UK in February 2021. No-one knows now whether it will go ahead, but Jill is training anyway. She has a haybale set up at the end of her vege garden that she fires arrows into. “Staying bow-fit is important, and it’s also doing something therapeutic and mind clearing. When I’m doing archery, I don’t think of anything else except the steps of releasing an arrow. I’m totally immersed.” She and Jorja have also been listening to music and doing art at the kitchen table every evening. “It’s nice. And I’ve turned out a couple of paintings that have made me happy.”

WALKING SAMOANS COMMUNITY GROUP “Physical activity shouldn’t feel like punishment. Tune in and move your body in a way that brings you joy.”

Ashleigh Baker

Healthy Lifestyles Manager at Sport Wellington Ashleigh Baker, who co-ordinates Wellington’s Green Prescriptions programme, says, “Adjusting to the new normal of physical distancing and spending more time at home presents a lot of challenges for being active and well but also opportunities.” Since lockdown began, she’s been helping many clients work with those opportunities but without adding another layer of pressure to their lives. She says, “To quote Robert Collier, success is the sum of small efforts, repeated day-in and dayout. There’s a lot of messaging encouraging people to use this time to get fit, increase creativity, and pursue education. That can be overwhelming. You don’t have to change everything all at once. Just start where you are, use what you have, and do what you can.”

ASHLEIGH’S LOCKDOWN TIPS

• Set a routine: For example, schedule regular sleep and wake times, meals, downtime, and activity. However, with demands at home, this might not always be a reality. Our advice, when it comes to activity in particular, is just do your best. This might mean a long walk around the block or a quick 10-minute circuit. • Physical activity shouldn’t feel like punishment. Tune in and move your body in a way that brings you joy. For some, this might be dancing around the living room with your kids, going for a walk alone, or completing an exercise class. This also might change from day to day, and that’s okay. • Support others. Exercise with others in your bubble, or keep accountability with your wider whānau and friends with video calls, texts, and check-ins. • Our website has a Wellbeing Hub full of resources, including a physical activity directory: www.sportwellington.org.nz/ active-health-and-wellness/ wellbeing-hub

Since Covid-19 hit, the Walking Samoans have not been able to meet for group walks and have let their members know that walks will resume once the country heads into Alert Level 1. However, they are encouraging all their members to go for walks around the neighbourhood and to join in with "some of our amazing community groups who are offering online training sessions". Walking Samoans also wishes to acknowledge all essential services and workers for their amazing support and care of people, families, and communities. They remind all their walkers that help and support is available, and it's okay to ask for help. Some helpful sites: Ministry of Pacific Peoples www.mpp.govt.nz Pasifika Medical Association pacifichealth.org.nz/covid-19support

DIABETES WELLNESS | Winter 2020

Community

Laura Clarke

Type 1 parent This time last year, brothers Tama and Ngaru Moeke were preparing to compete in the Muay Thai world championships in Turkey. We profiled them in our spring 2019 issue, as Ngaru (11) has type 1 diabetes. Unfortunately, their trip didn’t go as planned. They went to Thailand first for the boys to get in some high-level training. There, Laura says, “We had three Libres malfunction. We believe it was because of the temperature or the sea water.” It was one thing after another: “The Caresens dual monitor failed as well, so we had to purchase an Accu-Chek device, which is all they had available in Phuket.” Laura had ordered more Libres to be sent over, but these were held up in customs. For Ngaru, not having a fast and accurate way to check his blood sugar meant that, “the risks of competing in a high pressure competition outweighed any positives.” As a mother, Laura made the tough call that they would not carry on to the World Championships. “The thought of him needing to go to hospital because of anything diabetes-related in a foreign country was too much.” She says, “The boys had so much fun training in Phuket but were still gutted they didn’t make it on to Turkey. This year, because of Coronavirus, their hopes have been dashed as well.” She says lockdown could be worse, though. “We’re blessed that we have our double garage set up for training for the boys. So they still do training and a

DIABETES WELLNESS | Winter 2020

Ngaru (left) and Tama

“I’m proud of my sons. Ever since Ngaru has been diagnosed, he’s had the best, amazing attitude.”

run around the block four or five times a week. We also live only a kilometre from our beach, so we go down there for a walk and to let out energy.” They’re keeping in touch with their club online, and “their papa is the boys’ full time coach, so they have everything they need.” Laura says the hardest part of lockdown has been “not being able to hug and see our family and friends. As a family, we’ve been making a lot of video calls. And we’ve told the boys to look on the bright side. While everyone is at home, you have the advantage of being at home and training. “I’m proud of my sons. Ever since Ngaru was diagnosed, he’s had the best, amazing attitude. He’s taken it in his stride.” Laura is finding ways to look

after herself as well. “I take time out in my day for me, whether that means half an hour reading a book, sitting on my deck, or going for a walk by myself. I’ve had the chance to convert part of our garden to a vege garden, which has also been a good de‑stresser that the kids help me with. “Also both boys have been playing a lot of guitar and learning a lot of new songs. “We’re saving a lot because we aren’t eating on the run, and there’s more structure around meal times. The boys have learnt more about gardening, and spending quality time together is good. Normally, we travel at least once a month for the boys’ Muay Thai. Having no pressure to be anywhere for once has actually been awesome.”

Katie Doyle Writer, adventurer Type 1

Katie, a regular writer for Diabetes Wellness, is currently in upstate New York, “just a couple of hours from the city where the Covid-19 pandemic is reaching its highest levels in the US”. She says, “I’m fortunate to be isolating here with my parents in their 150-year-old farmhouse. Normally, I live and work in Manhattan.” Deciding to leave was a tough decision. “I was wrestling with my instincts and worrying about my responsibility to my community, my friends, and my relatives who don’t have that option. I’ve also felt

Katie has been reconnecting with family dog Bruce.

guilty about remaining healthy thus far, while reminding myself to be grateful for the wellbeing of those I care about. “Living with type 1 was a big factor in my decision. My access to technology and my knowledge about diabetes management has

improved tremendously since my Kiwi working holiday five years ago. “I started my long-term journey with Dexcom after returning to the US. I’ve learned that my blood glucose levels are smoother when I exercise without insulin on board. I lean on talk therapy and engage with the diabetes community. I have a better relationship with my mental and physical health now, as I’ve grown to appreciate the many amazing things my body does for me instead of constantly criticising it. “While it can be challenging to live with a chronic condition even under normal circumstances, isolation has given me space to think about the amazing people I’ve met and incredible opportunities I’ve experienced, thanks to diabetes.”

Clare Robinson Owner, Te Atatu Toasted

Like other small food business owners, Clare Robinson has had to stay on her toes to deal with COVID-19. She’d built up a strong customer base at weekly markets all around Auckland, but when the pandemic hit that outlet for her product disappeared overnight. Luckily, she's found this has been balanced by a momentum to support local small businesses, and people are becoming more comfortable with buying online. Clare set up Te Atatu Toasted in 2012. After years working for large food manufacturers, she says, “I realised the focus for many big businesses was cutting costs, often by using cheaper ingredients that are low in nutritional value and higher in sugars and salts. “I felt that this trend by big food manufacturers to use cheaper, less nutritional ingredients was having a massive impact on our nation’s health. We have to eat far more to be nourished, and we’re eating way more sugars and salts. “Breakfast cereals are some of the worst, so I thought: what if I did it the other way around and made breakfast cereals that, firstly, contained only good ingredients – and then worked out how to make them a good price?” She has saved by selling direct to customers, including through subscriptions, selling in bulk bags, and by providing customers with a portion scoop. Unlike most large food manufacturers, she encourages customers to eat less, not more, knowing that most of us eat more than we actually need.

READER GIVEAWAY Win a bag of Te Atatu Toasted Healthy Blend Muesli. This lightly toasted muesli is 97% sugar free and full of complex carbs, seeds, and nuts. Te Atatu Toasted is giving away three 1.5kg bags to Diabetes Wellness readers. To go in the draw, email your name, phone number, and postal address to: draw@diabetes.co.nz Or post to: Freepost Diabetes NZ, PO Box 12-441, Wellington 6144 Competition closes on 31 July 2020. DIABETES WELLNESS | Winter 2020

Community

Shantelle Bliss

Personal trainer, parent Type 2 Shantelle Bliss, who is profiled on page 30, has been in lockdown with her three young children. She says, “For me, having them do exercise is like another learning topic. Thinking technically, I know it improves their gross motor skills, proprioception (awareness of body in space), cognitive function, and cardiovascular health. In the short-term, exercise burns off that pent-up energy they seem to have in abundance that otherwise might drive me round the twist. “Long term, it teaches good habits; what they do to keep fit and healthy, and feel good. Last week, I found all three kids exercising, and I asked what they were doing. They said, ‘training to get fit’. I was so proud.”

SHANTELLE’S TIPS FOR EXERCISING WITH KIDS

• Sometimes kids are jumping keen, sometimes not. Try not to push them into exercise too hard, or they’ll dig their heels in. Sneakily, get them to think it’s their idea. Worst-case scenario, bribe them with screen time! After a while, they start to know doing exercise is just a regular part of life, like brushing their teeth. • Exercise with your kids. They usually love mum or dad joining in. Also, as a parent, do your own exercise and lead by example. • Try getting your children to train you. Mine love being mini personal trainers. Have them make up the exercises and instruct you what to do. (Of course, they have to do it too!) Even get them to draw up exercise charts to decorate then fill in. • Always praise them for doing exercise, doing better, trying hard, or even just giving it a go. Reinforce how great that is for their growing body and how pleased you are for them.

• Preschoolers are small, strongwilled rockets. Give them some power and a sense of running the show, at least in part. Let them pick some exercises or even activities not generally classed as exercise – anything to move their body. Keep it fun, so they’ll want to do it again. Be bubbly, even show a silly side, so your toddler will connect better. You could do exercises while making animal sounds that your toddler picks. Do it at a time of day when you know they are most receptive, not hungry, tired, or ready for a nap. • Know that it’s ok for you not to be on form all the time, and there will be tough moments, days, or weeks. Depending on the kids’ age, talk to them and say you need a little time out, just like they do. You may find they’re sweet to you, and they’re learning about compassion and emotions too. • Kia kaha, and appreciate each small win and happy moment!

Exercise with your kids. They usually love mum or dad joining in.

DIABETES WELLNESS | Winter 2020

Niamh McCormack Dietitian, Taranaki District Health Board Type 1, coeliac, mother-to-be

Living with type 1 diabetes and coeliac disease, dietitian Niamh McCormack brings a particular empathy to her work. For a few months, she’s been looking at diet through another lens as well – pregnancy. Niamh says, “I was super active prior to pregnancy. Activity was my outlet for stress relief. Now, not only am I in lockdown but I’ve been struggling early on in my pregnancy with a lot of pelvic and lower back pain. That’s been a real knock to my mental health. “My first trimester was awesome. My blood sugars were the best they'd ever been. Then I got into second trimester, and the baby started to affect my blood sugar. “I wasn’t sleeping. My blood sugars were all over the place – so many unexplained lows. The hospital team explained it was likely hormones, and I should expect more turbulent bloods as the pregnancy continued. “I was coming in to work with bags under my eyes and dreading seeing patients. It was affecting day-to-day stuff. I wasn’t getting happiness from things I normally would.” She didn’t, at first, talk to anyone at her work about this, something she thinks other people with long-term conditions may relate to. “Asking for help is hard. You feel like you're letting people down or that people will see you differently. I put off talking to them about it for weeks.” Finally, she had to. “I walked into my manager’s office. I barely got a few words out, and I was already blubbering; I was just so angry at myself. But my manager was lovely. She’s a nurse and a mother of seven,

and she said, ‘I love that you've come in here and felt safe enough to talk to me.’ She’s been a saving grace, and I’ve learned that asking for help can be the best thing in the world.” Niamh’s manager suggested she put together a plan for working from home. “The minute I started doing that, I just went ‘exhale’. Someone was saying it was okay for it all to be a little bit crap. I just hope that other people in my situation have somebody like that who can help you through that tough time when you have to ask for help and it’s not something you’re used to doing. She made me feel strong rather than weak.” Soon after Niamh began working from home, New Zealand moved into Level 4, and everyone else at the healthy lifestyles programme she works for, Whānau Pakari, was too. “We’re not ‘essential services’, so we set up a spreadsheet of every single person on our books, over 100 people, and we were phoning them from our homes, and making up activity resources.” Niamh is in awe of all the other healthcare professionals, in both essential and non-essential services, who are also pulling out all the stops to look after people. “My midwife has been awesome.” Niamh’s bubble consists of herself and her husband Shane. They were in the middle of a kitchen renovation when the country moved to Level 4. Work on the renovation

had to stop, leaving them with little bench space – something they normally rely on to avoid Niamh’s food becoming contaminated with any gluten-containing things that Shane eats. “You’re working in such a tiny tight space, it's easy for burger buns to touch, or to accidentally put things into the wrong toaster.” Delivery shopping has also had pitfalls. “When the supermarkets are running low on things, they’re occasionally substituting stuff that’s supposed to be gluten free but isn’t, so you’ve got to be a bit extra vigilant. My nut bars got changed, and I had a really bad reaction. I hadn’t even thought to doublecheck, but I need to remember that the packers aren’t always going to be double-checking. They're so busy, bless them. It’s not their fault either.” Niamh is in regular contact with her family back in Ireland, where rules are looser. “I’m proud to be in a country that’s doing something really definite. I’d have been in a far more vulnerable place if I lived in Ireland right now.” Meanwhile, one of the many things Niamh has been advising her clients on is meal planning when your bubble contains picky eaters or people on restricted diets. She’s been telling clients that lockdown has been the perfect time to finally put together those meal plans you’ve always wanted to.

DIABETES WELLNESS | Winter 2020

Community NIAMH’S TIPS FOR MEAL PLANNING

• You could make a little spreadsheet of people’s favourite meals, what ingredients they need, and what ingredients you can substitute in and out of them, so you can pick and choose and make them quickly. • For picky eaters, I think it’s a good time to try and give things another go. Know that, if it’s not what you like, you don’t have to finish it. For picky eaters, it can take tasting something up to 15 times to like it, so give it another go and don’t give up. • It’s also good for people to try things cooked different ways, cut differently, all those sorts of things. For families dealing with picky eaters, you can even have a chart and tick off how many times they’re trying something. • It’s really hard when you’ve got multiple people in the household with lots of different tastes, but as long as everyone has at least one night that they’ve got their meal that they wanted, or some play on it, and everyone can be happy at least one of the nights, they can compromise a little bit on others. • With takeaway services opening back up, it's good to reflect on the positives that came with cooking more at home during Level 4. It allowed us to reconnect with food, teach our children new cooking skills, save money, and get fresher healthier food, served with love, on our plates.

DIABETES WELLNESS | Winter 2020

Sue Pearson

North Shore support group co-ordinator, Diabetes NZ Type 1 A collision of events led to Sue Pearson, thankfully, being able to go into lockdown with her 95-year-old mother Joan. Sue and her husband Murray had travelled down from Auckland and stopped off in Lower Hutt to visit Joan, before they were to head off on a South Island holiday. Sue says, “The day before we were about to leave, we came home from our walk to find my mother not at all well. After realising it wasn’t just heartburn, I threw her in the car, and drove like a maniac, one hand on the steering wheel and one hand on her.” Sue knew something was very wrong, because “usually she tells me off for not having both hands on the steering wheel!” After a spell in hospital, Joan was recovering well, but what all this meant was that, when New Zealand went into lockdown, Sue, who herself is vulnerable to Covid-19, was still at Joan’s. She’s thankful to be there to be able to look after her and enjoy her company. From Lower Hutt, Sue has been checking in regularly, usually by phone, with as many members of the support groups she runs as she can. She’s often spending a fair bit of the day on the phone in long conversations. “It’s been hard for many. Some people are worried they might lose their jobs. Some have family far away. Some who are living in retirement villages are restricted with their normal exercise programmes. There’s concern over food supplies, and the alternatives people are receiving are not necessarily what they expect.” Sue noticed during the flour shortage that older people and those with children missed doing baking. She says, “It put a smile on their faces when flour was available again.”

SUE'S STAY-HOME TIPS FOR PEOPLE WITH CHRONIC ILLNESSES

• Keep an eye on medication supplies to check that they’re not running low and are still in date. Make sure you've got someone to pick them up for you if you need it. Some pharmacies are doing free deliveries, which is fantastic. • Thank pharmacists for doing a great job, because it’s been horrendous for them and everyone in the health industry. • Isolation can be lonely. Make more phone calls – to people you wouldn't normally call or would only call occasionally. • Make lists and cross stuff off for a feeling of accomplishment, and also write down stuff you did do, even if it wasn’t on the list, because it feels better! • People with chronic conditions are used to being prepared, and I think we’re mentally prepared for these kinds of situations if we’ve had diabetes for a while. It’s harder for those newly diagnosed. All of us could use the Girl Guide and Boy Scout motto, “Be prepared.” • Listen to only one broadcast a day. Don’t overwhelm yourself with information. • Play music – it’s very soothing for mental health. Play happy music and have a wee dance around the room, even the oldies!

Smartphone enabled glucose monitoring1

WITH YOUR PHONE1,2

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Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc., registered in the U.S. and other countries. Google Play and the Google Play logo are trademarks of Google LLC. The FreeStyle Libre Flash Glucose Monitoring System is indicated for measuring interstitial fluid glucose levels in people (aged 4 and older) with insulin-dependent diabetes. The indication for children (age 4 - 17) is limited to those who are supervised by a caregiver who is at least 18 years of age. Always read the instructions for use. The sensor must be removed prior to Magnetic Resonance Imaging (MRI). 1.The FreeStyle LibreLink app and the FreeStyle Libre Reader have similar but not identical features. 2. The FreeStyle LibreLink app is compatible with NFC enabled phones running Android 5.0 or higher, or with iPhone 7 or higher, running iOS 11 or higher. FreeStyle, Libre, and related brand marks are trademarks of Abbott Diabetes Care Inc. in various jurisdictions. Information contained herein is for distribution outside of the USA only. For more information call Customer Service on 0800 106 100. Mediâ&#x20AC;&#x2122;Ray New Zealand, 53-55 Paul Matthews Road, Albany, Auckland 0632 www.mediray.co.nz NZBN 9429041039915 ADC-16457 v1.0

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Move

FITBIT MOVEMEANT CHALLENGE 2020 This year’s Fitbit MoveMeant Challenge goes down in history as one of the most interesting, with competitors plunged into lockdown just a few days from the finish.

ur challengers were determined to push on with their step counts, despite having to stay close to home and in their bubbles. Collectively, they achieved an incredible 3,437,701 steps – the equivalent of 2619.53km – and and raised more than $65,000 for Diabetes NZ. This year's winner is Maurice Trapp with 406,940 steps. Type 1 warrior Ruby McGill came second with 354,110 steps, while Rachel Grunwell, Beth Morris, and Jess Blair came 3rd, 4th, and 5th. We thank all the challengers who showed that exercising is a way to remain motivated and manage stress and anxiety despite what life throws at you. WINNER: MAURICE TRAPP, DIABETES NZ BOARD MEMBER

Maurice says, “It was probably after day five or six that I realised that nobody was well in front yet, so if I gave it a good go every day I could take out the win. “Ruby McGill was an outstanding competitor; I had to get up early each day in order to get 8000 or more steps in before she got started. But she got wise to this and was chasing me earlier most days!” When New Zealand went into lockdown, “I suffered a good deal of boredom in repeating the same walks and just hacked out those paces.” Old aches and injuries began to play up. “The body is a bit more ancient now … The first week it was just sore feet, a couple of blisters, and a blackened toe. After that, the knees seemed to jam up, the hamstrings got shorter every day, and I started to wonder if I was doing more steps per 000 metres than when I started – and was I therefore taking advantage of my limited flexibility?”

DIABETES WELLNESS | Winter 2020

Determination got him through: “I was clear about why I was doing this, and I had supporters who were offering to contribute funds on a formula of how many steps I managed.” He also looked to other competitors for inspiration: “Whenever I began to feel exhausted, I thought that it would be tougher for Ruby and any of the other competitors who had to manage blood sugars constantly. Ruby, especially, pushed me to the limit. It was a great race.” RUNNER UP: RUBY McGILL, TYPE 1 DIABETES MASTERY

Ruby went into the competition with precise goals: • To move with 20 different people – a person for every year she had lived with Type 1 diabetes. • To raise $5234 for Diabetes NZ – the annual cost of a Dexcom CGM, a life-changing device for people living with Type 1 diabetes and their supporters. She says, “I definitely had to get creative during lockdown. We set up an exercise circuit in the backyard, and I'd do laps around our garden. One evening, I placed the washing baskets on the other side of the lounge and walked back and forth across the room to put in the folded washing. That clocked up almost 3000 steps!

Ruby and whānau

“I must admit, I thought about giving up when the country went into lockdown. With all the information we were receiving online, I worried I was putting myself and family at risk by venturing outside of our property. I was scared. “Luckily, during a long walk, the perfect place to be with your thoughts, I realised how important it was to keep well during this time, and regular movement was a key part.” JESS AND ADAM BLAIR, NATUROPATH AND WARRIOR

Jess and Adam entered the MoveMeant Challenge together, but it was Jess who was in a position to push on and take 5th place in the competition: “For most of the challenge, Adam was in Australia, and I was here with the kids juggling life. So I really put effort into making time to walk. That’s carried on even after the challenge, which has done wonders!” Since then, the couple has tried to make the most of lockdown. Jess says, “We never have this much spare time as a family during the year, so we’re spending it together, cooking, being outside, walking, and taking the kids scootering. I make sure I have time to study and read as well.” A qualified nutritionist and naturopath, she is studying Health Promotion at AUT, specialising in Māori health – a kaupapa she and Adam are passionate about. She has recently been accepted into a masters. “I’ve considered medicine, but my age puts me off! My passion is working with chronic diseases, such as diabetes, and also education, especially since I can use my nutrition expertise.”

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.

Adam and Jess with their children Harlem (left) and Taika

Family

Teens under lockdown Type 1 diabetes can bring further pressure to normal parent-andteen tensions. What happens when you add a pandemic to the mix? Each family’s experience is different. We talked to four parents of type 1 teens.

onna’s son Alex, diagnosed at 12, uses finger pricks and injections to manage his diabetes. Donna says he has always taken responsibility for management, “but does need constant badgering … And he gets annoyed when we’re constantly reminding him to test.” She says, “He’s more irritable during lockdown, which I think has something to do with his blood sugar sitting higher due to inactivity.” She says this has actually got worse since online schoolwork began.

DIABETES WELLNESS | Winter 2020

None of it is easy, she says, and involves a mixture of understanding and discipline on her part. “We try to be understanding of how this unique situation is affecting us, but we also need to ensure he isn't getting out of hand. It’s difficult.” SPACE AND ENCOURAGEMENT

Lorna’s daughter Liv, 15, is motivated and self-reliant when it comes to homework and sorting her room. She wants to be the same with her diabetes, which she manages with a pump and CGM, but it’s harder. Lorna says, “From 11 to 13 years old, she didn’t want me to help at all, nor did she want her diabetes anymore, so that was a hugely frustrating and worrying time. “It’s almost completely handsoff for me now, except for when we have appointments or I upload her CGM to Diasends. I look at the data, and, when the diabetes nurse makes recommendations, I ask Liv to change the details on her pump. “I ask her now and then how her levels are, and she hates it. She usually just says ‘FINE!’”

“I think she feels horrible a lot due to highs and lows, and also she can’t deal with the burden sometimes. She’s had a few lows during lockdown, which make her emotional. I sometimes don’t realise she’s low, so we’ve had a couple of arguments.” Liv wants to stay fit during lockdown, “but is finding it difficult. She has social anxiety, so it's hard for her to leave the house to exercise.” Lorna has found the most helpful things are “just giving her space, but also encouraging her when I see she is doing what she needs to”. RESPONSIBILITY

Jenny’s 13- year-old son Callum is on a pump and has been determined to manage his diabetes independently since he began secondary school. “He’s completely responsible for himself at school. He’s told each of his teachers about it, and they know that he’ll ask for help if required but otherwise to just let him deal with it himself. He’s proud of arranging this without me.” Jenny says he’s also self-sufficient at home, but she does check on things in the background and helps

him with carb counting at dinner time. For the rest of the day, he does it himself. Like many teens with diabetes, he’s been less active during lockdown, which has affected his levels, but, other than that, “the one issue during lockdown is that boredom leads to snacking, and more lollies are sneaked in than usual!” CARRYING THE BURDEN

Alison says that supporting her 16-year-old daughter Ella’s diabetes management is a balancing act. ”You know you have to give them independence and even let them make their own mistakes, but with diabetes that can be scary. I know I fuss way too much. I was still doing night checks until recently with Ella’s Libre, and she told me to stop, because it was disrupting her sleep. I get it, and I’ve stopped, but I still just poke my head in if I wake up at night. “One thing’s really helped us – it was an idea we got from a psychologist at a diabetes day. She said to think of the different loads that everyone in the world has to carry as bags of rocks. Teens with diabetes have extra rocks in their bag, on top of the normal ones. So, as a parent, you can help them to carry some, to relieve the burden, but you have to let them choose which ones. Like, they might sometimes want help with a specific part of their diabetes management, or other times they might want help with something unrelated … packing a lunch, dealing with a teacher … “So now me and Ella sometimes sit down and talk about – are there any rocks she’d like me to carry for her right now? She has to decide if she does and exactly which ones, but I’m there to do it if she wants.” She says that lockdown, strangely, has made diabetes management easier for Ella. “I think she’s eating less and eating healthier stuff while she’s stuck at home!” Names have been changed to protect privacy.

BLACK BEAN BROWNIES MAKES 12 SERVINGS

Bored teens? Try these easy black bean brownies. They're made in less than 30 minutes, are gluten free, are deliciously fudgy, and made with simple ingredients. Plus they have the added fibre of black beans. Don't be put off by this radical brownie ingredient! Seriously, nobody will even notice. 1 x 400g can black beans, drained and rinsed ½ cup almond butter (or any nut butter) ¼ cup almond flour ¼ cup cocoa powder (the darker, the more chocolatey) ¼ cup maple syrup 1 Tbsp melted coconut oil 1 tsp vanilla ¼ tsp baking soda ¼ tsp baking powder ½ cup dark chocolate chips

Preheat oven to 180°C. In a food processor, blend beans, nut butter, almond flour, cocoa, maple syrup, coconut oil, vanilla, baking soda, baking powder, and salt. Scrape down sides as needed. Once creamy and smooth, take off lid and stir in chocolate chips. Do not process the chips. Pour into greased 20cm square pan and add a few more chocolate chips on top if desired. Bake for 20-22 minutes or until toothpick comes out clean. Store on counter for 24 hours or fridge for 1 week.

NUTRITON PER SERVE: ENERGY 744kJ (178kcal) | PROTEIN 5.6g | FAT 11.1g (SAT FAT 3.2g) | CARBOHYDRATE 13.5g (SUGAR: 7.5g) | SODIUM 76mg

DIABETES WELLNESS | Winter 2020

Nourish

COPING WITH FOOD WORRIES If Covid-19 has brought food stresses to the fore for you, you’re not alone. Dietitian Helen Gibbs offers advice and solidarity.

’m getting a lot of feedback that many of the stresses and tensions in households during lockdown have become focused on food. This can be worsened if someone in the household is unable to access their usual food choices. And if there is a medical reason to follow a specific diet, things can get even more anxiety provoking. If this is the situation you find yourself in, know that it’s okay to feel anxious and that other people are as well. Part of the lockdown message is “Be kind”. That includes being kind to yourself. I’ve started using the hashtag #fednotdieting on my social media feed to remind people that it’s more important to simply be fed than to follow a specific diet. Yes, if you have coeliac disease or allergies you need to remain careful, but, for those who are following a diet for other reasons, try to accept that you’re doing the best you can in changed circumstances. Many people have tried to use this lockdown as a time to improve their diet. For some lucky ones, it will have worked, but I suspect many people are disappointed in the outcome. Some may be blaming their lack of willpower. If that’s you, don’t beat yourself up. For most of us, a lockdown is hardly a supportive environment to make sustained changes.

DIABETES WELLNESS | Winter 2020

LOSS OF “NORMAL”

It wasn’t surprising how much excitement takeaways generated as we came into Level 3. For many, it wasn’t about the food. It was the feeling of normality that “having takeaways” could bring to what had been five weeks of strangeness. It’s been interesting to see some people admitting that, although the takeaways were nice, they weren’t as nice as they were expecting. This is because we lose our taste for foods high in sugar, salt, and fat. It generally happens about four to six weeks after we stop having them. If you’re in the group who didn’t enjoy them as much as expected, think about maintaining a pattern of fewer takeaways than in the past. What quick meals could replace your usual takeaways? They may be cheaper as well as healthier. ECONOMIC IMPACTS

The Ministry of Health defines food insecurity as “a limited or uncertain availability of nutritionally adequate and safe foods or limited ability to acquire personally acceptable foods that meet cultural needs in a socially acceptable way”. In New Zealand, before the lockdown, we knew that about 20% of New Zealand children lived in households that experienced food insecurity. This data had been collected in three previous annual health surveys and analysed to see the impact on the health and wellbeing. Results showed that there were definite physical health consequences to this food insecurity, as well as an impact on the psychological and emotional

wellbeing – for children as well as caregivers. Going into lockdown “hard and fast” was the right thing to do. It reduced our risk of a major outbreak of Covid-19. However, it had and will continue to have substantial economic impacts that will lead to greater food insecurity in this country. A 2017 fact sheet from the Ministry of Business, Innovation and Employment showed that 29% of New Zealanders are either running small businesses or employed by small businesses. Many small businesses are struggling to survive right now, and, although the level of economic support from government is unprecedented, many businesses will close as a result of this pandemic. These changes will push many more people into economic hardship and that affects what they can or cannot afford to eat. We can’t ignore this change, and we need to be mindful of how this will affect us and those around us. One thing is for sure, we will need to look after ourselves and each other more than ever. Diabetes Wellness would like to hear from readers about how they are being affected economically and what would be useful for us to feature in upcoming issues of the magazine. How are you going, and what would you like to see? Email: editor@diabetes.org.nz

Looking after yourself and your family Don’t try to hide food shortages from children. It’s far better to be honest with a child than not. Tell them you are doing your best, but this is the only option available. Children learn resilience from how we act. If you are stressing about your income but not acknowledging this to kids, they will pick up on the conflict and become stressed at the inconsistency.

Bring vegetables into your kids’ diets as snacks in the mid-afternoon rather than doing the evening vegetable fight. And as winter gets going, start using some soup recipes as a way to get those vegetables in.

If baking is helping your mental health, don’t feel guilty about it. Do try to keep the sugar low, the fibre high, and the portion small if you can … downscale recipes if needed. (I downscaled a favourite pudding that had four eggs in it to a one-egg option just the other night.)

Have regular habits. Set mealtimes, sleep times, and activity times. Routine helps with certainty. Good sleep, good eating, and good activity are the pillars of a healthy life.

Work with your diabetes team and general practice to stay well. Healthcare is experiencing a revolution with tele-health care. This is exciting and is likely to permanently change how we receive diabetes care (although those with diabetes will still need to get eyes and feet checked regularly).

DIABETES WELLNESS | Winter 2020

Move

Anytime Fitness’s new programme offers all the benefits of a personal trainer, without the trip to the gym. Their National Fitness and Coaching Manager Brent Mayhew explains.

Anytime Fitness revolutionises personal training with remote coaching

hen New Zealand moved into Level 4, Anytime Fitness jumped into action to support members – fast-tracking the new remote coaching programme they already had in the pipeline. Brent Mayhew says, “For those with diabetes or compromised health, this offers exciting possibilities for exercising anywhere, as well as a sense of certainty that you can continue a personalised exercise programme even in isolation. “The remote programme was already being trialled in select Anytime Fitness clubs. We’ve now rolled it out so that it’s available in every region. We have 45 clubs around the country, and over 20 have come on board already, with more expected to soon.” You simply find an Anytime Fitness club close to you, join up, then work with one of the club’s personal trainers remotely. “You literally have a personal trainer right there on your phone,” says Brent. “Your coach will support you with tailormade workouts

DIABETES WELLNESS | Winter 2020

“It’s a highly personalised service and it just happens to be remote. That’s worth its weight in gold.” that they build for you inside the Anytime Fitness app.” This app contains more than 6500 exercises, all of which show a static picture and a video. Your coach creates your programme based on where you’re at with fitness, your own unique health needs, and your circumstances, including what fitness equipment you do or don’t have at home. From there on, they offer one-toone advice, guidance, support,

and motivation. “It’s a highly personalised service, and it just happens to be remote. That’s worth its weight in gold.” The new system requires forethought and creativity from coaches, and Anytime Fitness supports them to support you, with weekly coach meetings and upskilling. Brent is already seeing a great response to the programme. “Particularly since lockdown, people are so comfortable with video calls.” Brent is excited by the possibilities and determined to meet all the challenges that Covid-19 is throwing at the fitness industry. “One way or another, we’re going to be living this for a while, I suspect, so for people with diabetes or other underlying conditions, we’re asking what is their new norm and how can we support them?” Find a gym close to you, and their staff will talk you through all the information you need: www.anytimefitness.co.nz/findgym/

Life with T1

WELCOME TO THE CLUB Emily Writes reaches out to other parents of children with type 1.

few nights ago, a mother messaged me. She was worried about her child. I’ve had so many of these latenight messages from panicked parents. My child won’t stop drinking water. They keep having accidents. They keep wetting the bed. I know what’s coming. I tell them to go to the hospital. Sometimes I hear back just hours later, other times it’s days. Welcome to the club. We’re all parents of kids with diabetes now. The type 1 tribe. The new normal. Six months ago, I was holding a needle and trying to find a spot on my child’s tiny sunken belly to push it into. His father was holding him down, as well as a nurse. He was screaming. Begging me. “Please mama! I’ll be good!” I was sobbing, and I kept thinking, Can’t we wait until he’s calmer? But we can’t. Because if he doesn’t have this life-saving medicine, if we don’t learn to give it to him, then … He kicked my hand, and the needle fell to the ground. Pain radiated; my finger felt like it had been shocked. The nurse injected him. He lay in a tiny ball crying. I sobbed, holding my finger. My husband stared up at the ceiling desperately trying to stop the tears from falling. Later, my husband and I injected ourselves in the stomach with saline. We wanted to know what it felt like. With a ring of fat on me,it still felt painful. He winced as he pushed the needle into his taut stomach. Our son had lost more than 10kg from his already tiny frame.

DIABETES WELLNESS | Winter 2020

The nurses were so kind that their gentle hugs and pats and support would always make me cry. I couldn’t work out how we could all cry so much. How were there still tears? Over the last six months, I’ve realised there are always more tears. And when I see these mothers on my screen, about to fall, head first, down, down, down, into this deep well, there’s so much I want to tell them about being a type 1 mum. NOTHING IS THE SAME

Six months on, my finger won’t quite straighten. It hurts at night, hurts after typing. It just isn’t the same. But nothing is the same. I don’t need this tangible reminder of that, but somehow it fits. Our son is different now. He is fuller, he looks more like a strong boy. But he gets tired easily. He’ll be so excited to go to an event, then will suddenly turn ashen and say, “I think I need to go home.” He can predict his falls now. His best friend is his fiercest protector. When another child said not to pick up his medical equipment because “you catch it!”, she yelled, full force: “It is NOT contagious!” She stands in front of him, like she will do anything to protect him. And sometimes when they play, he rests his head on her lap and she reads to him. She knows inherently his need for rest. His fears. His hopes. I want to tell those new to the club that it will change every day. That it’s no straight line. I want

My Identity

is proud to create

“Love is the answer for the questions we have. Love binds us and tells us it will get easier. Every second, minute, day, week, month – it’s love that keeps us going." to tell them that our family is a marching band now, falling into a beat. Starting to know exactly what to do. Hate this tune but getting to know it in our bones. We mess up but are back on track immediately. No room to dwell on mistakes, we keep in step. I want them to know that in the blink of an eye I cry and cry and cry – still. At the injustice of it all. They say it gets better, and it does and it doesn’t. Some days, it’s all second nature and you just do it like brushing your teeth. Other days, he says, “I don’t want to die”, and you’re bowled over, king hit. You’re back there in the bathroom at the hospital, face pressed against the wall, trying to breathe. Just breathe. I want to say join the clubs. Join with others. Find diabuddies! My son is so fortified by being with other children going through the same thing. Nobody knows what you’re feeling better than a type 1 mum or dad. The community is a blessing. They are mums who know how hard it is and want to share the load. We are there for each other at different times; each of us has a turn. We carry each other. We proudly watch our children grow. My husband and I have turned towards each other. Around our children. Around us have been more whānau, more friends. The team at the hospital are a lifeline; my husband adores them. He feels as if he is getting a school report every time we see them – it’s for this very reason I say I’ll watch the kids during clinic. We love our son's teacher aide so

much. She is calm and clever, and she brings out the best in him. We are enveloped by people who want the best for him. We married each other again. Clung to each other. Cried in each other’s arms. Somehow became stronger. Sometimes I’m overcome with how grateful I am to have him by my side doing this with me. Our youngest tells his brother, “I love you the most. You’re my best friend,” every day. We say “I love you” a lot. We say I love you then I love you and then I love you, I love you, I love you. We fortify ourselves against all of this with I love yous. I love you so much. And that’s what sits alongside the part of our fridge that is just for medicine. So much love. Love that gets you up in the morning. Love that’s there in the depths of night when you’re so afraid you can feel your heart beating. Love on the days when it’s all routine. Love on the days when it’s so confusing and you just don’t know why this hasn’t worked and why did his levels do this? Love is the answer for the questions we have. Love binds us and tells us it will get easier. Every second, minute, day, week, month – it’s love that keeps us going. I want to tell them so much, these new mothers. If only I could say it all. You’ll see your child anew, and they’ll astound you with their courage, their bravery, their strength. Then look at yourself – because you’re now all of these things as well.

$49 Fashionable Medical ID Jewellery A tribute, from Emily Writes and her son Eddie, to the courage and strength of all children with diabetes and their caregivers.

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Move

EXERCISE

BEFORE OR AFTER FOOD? Fitness consultant Craig Wise explores this tricky question.

xercise and food are two subjects where conflicting advice abounds. Put those two together, and it gets more confusing than ever. A big question that’s regularly thrown at me is: How should we time exercise and food with each other to get the best results? Over the years, there has been a huge amount of research backing the theory of eat first then exercise. Unfortunately, there’s just as much that says exercise first and then eat! So which should we do? Whose research should we believe? BREAKFAST TIME

Some people will tell you that they can’t consume anything before their early morning exercise (except maybe their coffee or smoothie). Another group says that they can’t function without fuelling their body first. In fact, both are acceptable answers. Nobody wants to curl up with cramps because they feel like they’re exercising with a kettle-bell in their stomach, but also nobody wants to collapse like those marathon runners at the Olympics because they don’t have enough fuel left to keep going. You can best answer the question for your particular situation by, first, looking at the goal of your activity and, second, listening to your body. Is burning fat your main goal? Research from the University of Bath,1 while only a small study, showed that moderate exercise for

DIABETES WELLNESS | Winter 2020

less than an hour, for example a brisk walk, burned more fat when it was before eating than after. These findings have since been replicated with other small groups. If you want to lose a little weight, this may be the way to go. Most people have enough fuel stored in their bodies for some moderate activity – about 45 to 60 minutes – when they wake up in the morning. But remember, activity in this “fasting” state is only really productive if you’re putting the effort in. If you’re doing less than you could because you’ll collapse if you go any harder, then you might still be better to wait till after breakfast. Whether you want to eat breakfast first and then get active, or vice versa, one of the key things to remember is that when we wake up in the morning our bodies are often dehydrated – so drinking some water is vital. LUNCHTIME AND AFTERNOON

There are people who are genuinely not morning people, and the thought of activity before or after breakfast sounds like a nightmare. If this is you, go with what your body is telling you, and do your exercise later in the day. Similar rules apply to exercise at this time as in the morning. If you’re a light lunchtime yoga enthusiast, then heading to the studio before you eat will do no harm. And as I mentioned earlier, research shows that moderate exercise before a meal is likely

to burn more fat than moderate exercise afterwards. However, if you’re planning a heavy weight session at the gym, then you need to consume some protein (for muscle growth and repair) and some carbs (for fuel) at least an hour before your workout. This will ensure that your body can keep going through the session. AFTER DINNER

Some exciting recent research on food and exercise is particularly relevant to people with any form of diabetes. Is blood sugar control your main exercise goal? A study by the University of Otago2 looked at how the timing of exercise impacts on blood sugar levels. The study showed that brief, moderate activity after a main meal is especially beneficial for bloodsugar control. The study showed that 10 minutes of brisk walking after each main meal helped to control blood sugar levels and post-meal glucose spikes more than a single 30-minute walk once a day. These results were especially noticeable when it came to the after-dinner walks, partly because dinner is often the biggest meal of the day. This research has since been adapted to look at other forms of exercise, such as resistance training. There, again, it was shown to work in a similar way, helping control the high blood sugars that happen after meals, especially the heavy evening meal.

Ten minutes of brisk walking after your main meal can help control blood sugar levels and postmeal glucose spikes more than a single 30-minute walk once a day

There are other benefits to light exercise after eating, too. For example, it moves food from the stomach to the small intestine faster. This movement releases the hormones responsible for feeling full. There may also be links with decreased levels of heartburn. However, all post-dinner activity is not equal. Research has only shown that moderate levels of activity benefit from being soon after the meal. Vigorous exercise straight afterwards can have the reverse effect because, as the blood is drawn to the muscles to fuel the movement, it is withdrawn from the stomach, leading to a longer digestive process.

IN SUMMARY

Yes, the timing of your eating can make a difference, but exactly what you should do depends on your goals: • Fasting before exercise is a good idea, so long as your workout is of low to moderate intensity and your goal is fat loss or weight maintenance. Just be aware of your body and its signs. If you start to feel light headed or that you’re losing energy rapidly, then stop the workout. If this happens often, think about eating before exercise. • If you’re up for a more vigorous workout, make sure that you get some protein and carbs in beforehand – but give your body time to digest them. Don’t do the exercise straight after eating.

• If you’re looking for blood sugar control, then exercise moderately after each main meal. This is especially helpful after dinner. Don’t leap straight up from the table and rush out of the door, but do get active within an hour. That’s because, after about an hour, your blood sugar levels begin their spike, so you want to get ahead of the game. At the end of the day, everybody is unique, and our bodies react in different ways to activity. The masses of research done have given us some guidelines, but you will need to experiment yourself to see what works best for you.

1 ‘Feeding Influences Adipose Tissue Responses To Exercise In Overweight Men’, American Journal of Physiology – Endocrinology And Metabolism, 2017. 2 ‘ Advice to walk after meals is more effective for lowering postprandial glycaemia in type 2 diabetes mellitus than advice that does not specify timing: a randomised crossover study’, Diabetologia 59, 2572 – 2578 (2016).

DIABETES WELLNESS | Winter 2020

Life with T2

Strength from struggle Shantelle Bliss was diagnosed with gestational diabetes in her second pregnancy and again in her third. And more challenges were coming. This is part two of her story.

struggled with post-birth blues after my first daughter was born. But after I had my second child, my son, the feelings became overwhelming. I finally went to the doctor, urged by my midwife. The doctor suggested antidepressants, but I was too embarrassed and worried about what others thought. I didn’t want to be the mum that needed to be medicated to deal with a new baby. Obviously, I totally misunderstood postnatal depression. But that word “depression” was foreign and scary to me, just like the word “diabetes” had been. I know now that there’s nothing to be embarrassed about, but at the time I felt pressure and shame. I refused medication and let negative talk take over. Everything compounded faster than I could handle, and I was sucked into the depression vortex. SOMETHING WRONG

Around this time of falling deeper into depression, I noticed that my toddler daughter was losing weight. I remember really noticing her hip bones. But when I asked people about it, they passed it off as a growth spurt. Shortly after, I was officially diagnosed with postnatal depression. I finally agreed to take medication and have counselling, but it was going to be a long road back to mental health.

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This was when I noticed my toddler, even slimmer, often getting tired and grumpy. It came to a head the week before her little brother was six months old. My husband took her to A&E on a Sunday night while I stayed home to settle baby. At A&E, although my husband relayed that our toddler was losing weight, the doctors diagnosed her with only an ear infection. By Tuesday night, she was worse, so the A&E doctors switched her to different antibiotics. On Wednesday, she had a prearranged playdate at home with a friend, and she fell asleep in the middle of the floor with her friend racing around. On Thursday, I sent her to creche for a short time, as a test. I asked her teachers to watch for anything unusual. After two hours, I picked her up early, and by then she was wanting water. She drank so much in the car that I decided to go to A&E straight away. On arrival, she vomited on their floor. Even though I insisted it was because she’d just drunk so much, they put this down to a stomach bug, and we were sent home a third time. By now, I was getting angry. My own GP had been booked up all week, so I googled and the word “diabetes” kept coming up. Because I’d just had gestational diabetes, I had some understanding.

“By sharing my experiences and talking openly ... I hope I can help.” Next morning, I rang the GP, and became “one of those mums”. I said I’d stay on the phone until they made an appointment available. At the appointment, I was told again that my toddler’s weight loss was from a growth spurt. I asked if she could do one of the pee tests I did when I was pregnant to check blood sugars. The doctor was reluctant, but I insisted. My toddler wouldn’t co-operate, so we went across the road to the mall for a walk. Once she was ready, I put my hand down a public toilet trying to catch her pee sample, while my six month old screamed. It wasn’t fun, but we did it.

Back at the doctor’s, I was told the vial would be sent away over the weekend for testing. Becoming “that mum” again, I said no, it could be tested now with a strip like we’d done when I was pregnant. They said no, as the vial was suctioned shut for sending to the lab. I stood there sweating, stressed, vigorously pushing my hungry, screaming baby back and forth in his pram, with my toddler half passed out beside me, and I said, “No. We’ll wait here until it’s tested.” Off the nurse went, and within minutes we were called in. They’d managed to open the vial to test, and I saw the colour on the stick. It was the darkest it could be. We were sent to Starship immediately. Later, in the hospital, they told us that, if our toddler had been left over the weekend, she might have gone into a coma. I’m so pleased, now, that, despite my depression, I was still able to be “that mum” who knows instinctively that something’s wrong with their child. At the time, though, the type 1 diagnosis was the last knock. ROCK BOTTOM

I felt heavy dark clouds around me. From then on, the slightest thing, even my cardigan being caught on a door handle, would set me off crying. I struggled to shower regularly. Sometimes, I just lay on the hall floor, my body in a “freeze” response. I remember my husband reading a story to our toddler while I sat on the bed with them, and he had to prompt me to laugh for her sake. I began to have intrusive thoughts and OCD issues about food and was referred to a psychiatrist. In my head, I wanted to take the diabetes away from my daughter, although it wasn’t rational. Then, almost ironically, I became pre-diabetic, a precursor to type 2. The year had taken a toll on me mentally and physically. I still worked hard to breastfeed the full year, but I’d put on more than 20kg and was shattered.

The turning point was not clear cut. It was a gradual process. Even with the pre-diabetes diagnosis, as it was a matter of taking one step at a time because I was so deep in depression. Each little bit of exercise or positive thought was a win, and I found they went hand in hand. It was, and still is, a journey. But I have been off antidepressants for more than a year. My HbA1c and my weight are decreasing, and I’ve walked two marathons. DRAWING NEW STRENGTH

Dealing with gestational diabetes, pre-diabetes, and type 1, as well as having type 2 in the wider family, I can see the differences and similarities. In general, there is a lack of understanding of diabetes. I think people with type 2 feel the most prejudice, but the fact that anyone with any form of diabetes can be stigmatised is unacceptable. I wish for diabetics to be united when it comes to advocacy, education, and empowerment. I try to put my experiences to use. I have a lot of empathy, respect and understanding for people with diabetes now, as well as for those with depression, anxiety, weight issues, or struggles with general health. I feel people are too judgemental of others who are struggling with health, whether physical or mental, and I want to change that. Realistically, I can’t move mountains, and I still have ups and downs myself. But by simply being vulnerable, sharing my experiences and talking openly when I see the opportunity, I hope I can help. I often draw strength from thinking about my Moppa, my grandmother, who passed away over 17 years ago. She had type 2. I can still remember, as a child, seeing her check her blood sugar. I can visualise her crinkled finger with the blood drop on it.

As a triathlete before kids, diabetes, and depression.

I was very close with her, and before she passed away I had a funny feeling and a sudden urge to ring the hospital. She had died just that minute. When I’m struggling with my daughter’s diabetes, I talk to my Moppa about it, and it makes me wish I knew more about what she went through. When my Poppa died two years ago, the family was sorting his belongings. One day, I was there and saw one of Moppa’s little diabetes notebooks headed for rubbish. She’d ruled lines in it herself, and it was clear she was dedicated to recording her sugars and notes. I rescued it so that my daughter could one day have it and share that connection with her great-grandmother. For now, I have it in my bedside drawer. I like looking at her handwriting, reading through her sugars and understanding a little more of what it was like for her. facebook.com/theblissfitbunch

DIABETES WELLNESS | Winter 2020

Community

LIFE, LOVE, & TYPE 1 Type 1 diabetes can strain relationships. Katie Doyle talks to people with type 1 about how they keep things running smoothly with loved ones. INCLUDE YOUR PARTNER

t was 17 years ago that Jolene McCue, a Wellington-based learning and development professional and independent marriage and civil union celebrant, was diagnosed with type 1. “My family and friends did their best to support me, but I remember how frightening, complicated, and overwhelming it all was,” she recalls. “I’ve found that managing healthy relationships with type 1 is a lot easier if you can be open and honest with your loved ones.” Over time, Jolene has discovered how to communicate her need for support, especially with her partner, Teish. “I’m a relatively private person,” says Jolene, “and don’t often like to ask for help. But I’ve learnt that, without taking care of myself, I’m

Jolene (right) and Teish

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not able to keep up with the other things I care deeply about: helping others, learning new skills, working hard to make a difference and build a better future, and looking out for my whānau and friends.” Jolene’s advice to other people with diabetes is to recognise the impact diabetes has on both partners, take responsibility when appropriate, and include your partner in your day-to-day routine. For partners of people with diabetes, she suggests paying attention to the ups and downs of daily life, becoming familiar with new diabetes technology and equipment, and staying aware of lifestyle changes and diet or exercise regimens. “Living with diabetes is tough and takes real strength. I’m grateful every day to have a supportive partner, knowing that she’s contributed to my increased confidence living with diabetes. I’m less anxious about overnight hypos, more able to articulate what I need to take care of my diabetes, and I’ve developed the courage to speak up about the struggles of living with type 1.”

Jill and her daughter Jorja

BE OPEN

Twenty-year-old Lance Ruehorn was diagnosed with type 1 when he was six. As a teenager, he ended up in DKA five times. “I told myself, I need to focus on the control of my diabetes and ensure that this doesn’t affect my life.” Lance’s parents divorced when he was 14, but both remained supportive and encouraged him to develop healthy habits and pursue his goals. Today, he’s passionate about playing and umpiring hockey, and he works as a Duty Manager for the Ōamaru Licensing Trust. In 2018, he won Diabetes NZ’s John McLaren Youth Award for Academia, which he says has “boosted me up to try and do more for people in my region”. After pushing through difficult times, Lance is now navigating type 1 management while dating his girlfriend Ellie. He says, “It was hard for me to approach the situation of diabetes as this was my first really serious relationship. At times, it has tested our relationship, but now we both can work out the plan of action for the day and what could happen in

Lance and Ellie

IF YOU HAVE DIABETES

•

Remember that your loved ones want to help, but sometimes their love might manifest as over-concern. Be specific about how they can support you, keep communication channels open, and share your feelings about how things are going. Cut yourself some slack when things are hard.

regard to blood sugar trends. Ellie knows how to do a site change for my pump if I’m unable to do it myself, and she knows what to do if things go wrong.” ACCEPT HELP

Hairdresser and field archery champion Jill Gillette lives in Auckland with her partner Mike and her teenage daughter Jorja. “My daughter has grown up seeing the best and the worst angles of the condition. She’s a bloodhound with hypos. If I have had a bad hypo, Jorja will push for glucose tests, and I get frustrated and feel picked on. But I know deep down that she is protecting me and wants me to be stable.” Both Jorja and Mike have helped Jill through challenging hypos. She says, “Since the Libre sensor has arrived in our lives, things are a lot smoother. Mike bought me a Libre for my 45th birthday. We both figured out pretty quick how life-changing this would be for me: it’s enabled both Mike and Jorja to pick up the scanner. “If something of note has happened, they do have a tendency to be overly concerned, but I just have

IF YOU LOVE SOMEONE WITH DIABETES

•

Stay informed and empathetic. It’s easy to assume what they need from you, but your loved ones might feel differently. Be proactive and ask about how you can help. Welcome open discussion from your loved one, and practice active listening: make yourself available for feedback, repeat what you’ve heard to confirm you understand, and demonstrate that you’re putting requests into practice.

to deal with it until they feel secure that I’m okay again.” ACKNOWLEDGE THE JOURNEY

US-based Joe Solowiejczyk, R.N., M.S.W., C.D.E., has lived with type 1 for 59 years and is the author of A Type 1 Diabetes Guide to The Universe, an e-book that explores the psychological impacts of type 1 on families and offers strategies for coping after diabetes diagnoses. He says, “Part of the burden for a lot of people is that they think they can’t acknowledge how hard it is. “The key to getting out from underneath the weight, the exhaustion, the fear, the anger, the resentment – is the ability to acknowledge that this is a pain in the arse. You want to get to a place where you can balance that … It does take energy, focus, and time away from the rest of your life.” Building a support system can help alleviate the relentlessness of type 1. Joe allows himself to have occasional “Diabetes Depression Days” dedicated to the negativity of life with type 1. He notifies his support system when he’s having one of these days and gets a lot

FOR EVERYONE

• •

Find communication and selfcare methods that work for you. Remember that you and your loved ones don’t have to have the same support crew. Sometimes, you just need to talk to someone who understands what it’s like for you.

from receiving sympathetic texts and calls from friends to lift him up and out of feeling sorry for himself. He says that the key is limiting his sulking Jo Solowiejczyk to a finite period of time, then he gets back up and starts fresh. Joe says that sensitivity to family dynamics is also important because diabetes doesn’t exist in a vacuum. His advice to clinicians and medical professionals who are dealing with newly diagnosed patients reflects this philosophy: “They need to help patients to feel safe falling apart, knowing that the falling apart is crucial to moving forward.” Katie Doyle is an American writer with type 1 diabetes who started writing with Diabetes Wellness during a working holiday in New Zealand. She loves connecting with other people with diabetes and learning new storytelling skills through her graduate programme in Integrated Media Arts.

DIABETES WELLNESS | Winter 2020

Research

EAT MORE FIBRE IF YOU HAVE DIABETES, SAY TOP NEW ZEALAND RESEARCHERS Edgar Diabetes and Obesity Research (EDOR) investigators have released the results of a study that will be globally influential and is relevant to those with type 1, type 2, and pre-diabetes.

n New Zealand, most adults consume 20g or less of fibre each day. The EDOR research team, based at the University of Otago, found that, for people with diabetes, higher fibre intakes of about 35g of fibre per day could mean a 35% reduced risk of premature death. They also confirmed that, when fibre intake was increased, those with pre-diabetes, type 1, or type 2 diabetes improved their blood glucose control, their cholesterol levels, and their inflammation levels, and lost weight. The team consisted of Dr Andrew Reynolds, Dr Ashley Akerman, and Professor Jim Mann, and their study involved a systematic review of research conducted around the world but predominantly from North America, Europe, Asia, and the Middle East. The authors noted that the greatest blood glucose improvements were seen when low-fibre consumers started eating high-fibre foods each day. The researchers were asked to do this work by a Study Group of the European Association for the Study of Diabetes. The Kiwi team’s work will now inform an update of European dietary guidelines for diabetes management.

DIABETES WELLNESS | Winter 2020

LEGUMES FOR LIFE

Dr Andrew Reynolds

Lead researcher Andrew Reynolds, a National Heart Foundation Fellow, says the study “will be highly useful in its own right, as well as provide the evidence base to support the carbohydrate recommendations of the upcoming dietary guidelines”. The researchers say that good ways to eat more fibre in your diet include eating more legumes, vegetables, and whole fruits, plus replacing refined grains with their whole grain equivalents. For example, have wholegrain cereal or toast at breakfast, a piece of whole fruit or unsalted nuts and seeds as snacks, and base lunches and dinners around vegetables, legumes, and filling whole grains. See the study here: https:// journals.plos.org/plosmedicine/ article?id=10.1371/journal. pmed.1003053

Legumes include beans, peas, chickpeas, lentils, and peanuts. Dr Andrew Reynolds says, “Like whole grains, legumes can provide a considerable amount of fibre and protein, as well as being easily available, affordable, and filling. “When shopping for legumes, choose tinned varieties with no added salt, or, if you have the time, buy dried beans and legumes, soak them before use, and then follow packet instructions for cooking times. “Commonly available legumes in New Zealand are kidney beans, chickpeas, green or brown lentils, and cannellini or butter beans. “Watch out for tinned baked beans as their sauces are often high in sugar. Always check the nutrition information panel on the side of the tin. “If you’re unsure how to cook legumes, start by adding them to what you normally cook. Half a tin or more can be added to soups, stews, pasta sauces, and curries, providing a savoury depth to your meals. Many people also like the texture they provide, as they hold shape under simmering or in the oven. “There are also dishes based on legumes you could try. Hummus is an obvious one, but there are plenty of great chickpea and kidney bean curries available in books and online that go well with brown rice.”

Nourish

SALMON & LENTIL SALAD WITH MUSTARD SAUCE SERVES 2 | PREP TIME 40 MINS | COOKING TIME 10 MINS

This recipe from Diabetes NZ volunteer John Norris appears in Eat Well Live Well 1 cup dried lentils 1 low-sodium vegetable stock cube 4 cups water 150g capsicum (green, red or yellow) 1 chilli, seeded and finely chopped (optional) 1 spring onion, trimmed and thinly sliced 2 Tbsp soy sauce 1 Tbsp white wine vinegar 1 Tbsp chopped mixed herbs 2 tsp olive oil 2 salmon fillets SAUCE ½ onion, finely diced 1 Tbsp plain flour 1 cup milk 1 Tbsp wholegrain mustard

Place the lentils in a pot with the stock cube and water, and bring to the boil. Simmer for approximately 25 minutes until the lentils are al dente.

Add the wholegrain mustard and mix well. Set aside.

Once cooked, drain and add the capsicum, chilli, and spring onion, followed by soy sauce, vinegar and herbs. Season and mix well. While the lentils are cooking, prepare the sauce and fish for cooking. In a pan, add the onion and fry off until translucent; do not brown. Add flour to the onions and mix. Stir in ¼ cup milk until the onions, flour, and milk are blended. Add the rest of the milk, stirring continuously to avoid lumps while reducing the heat.

In a pan, place the salmon, skin-side up, on a medium-high heat. Cook until golden brown on the side facing down (about four minutes) then turn skin-

side down for about three more minutes. You may like to leave it a little longer until the skin crisps up. To assemble, place the lentils on the plate first with the salmon on top, then drizzle the mustard sauce over the fish. AVERAGE QUANTITY PER 250g SERVING: ENERGY 1984kJ (474kcal) | PROTEIN 44g | FAT 16.8g (SAT FAT 4g) | CARBOHYDRATE 31.2g (SUGAR: 10.6g) | SODIUM 660mg

EAT WELL LIVE WELL

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

DIABETES WELLNESS | Winter 2020

Life with T1

Author, illustrator, and cartoonist Sarah Laing has type 1 diabetes. During Level 4, she posted regular comic strips online about her experience.

A CARTOONIST IN INTERESTING TIMES

DIABETES WELLNESS | Winter 2020

have to go to hospital that night. “I was then sent to sit in the car while the doctor talked to my mother alone. I remember crying without really knowing what I was crying about – I just knew that it was serious.” Her birthday party felt gloomy and pointless. ”I ate the cake like it was like the last supper, then went to hospital that night. I was in a room with a girl having her tonsils out, another girl in an oxygen tent with cystic fibrosis, and a boy in traction. “I quite liked being in hospital. I’d been caught early so I wasn’t very ill, unlike another girl who was rushed in unconscious while I was there. My blood sugars quickly stabilised, and I was taught how to test my urine, how to inject insulin into an orange, and how to count my carbs. “I got to ride around the ward in a wheelchair, practicing doughnuts and wheelies, and go to the hospital school and draw an owl. I remember the experience as fun, although I think it was scary too. “The biggest adjustment was once I came out of hospital and realised I’d have to deal with this for the rest of my life, even though in the 80s they promised that a cure was just around the corner.”

TYPE 1 IN THE 80S AND 90S

Sarah says, “I was diagnosed in the strict days when diabetics weren’t allowed jam or cake, and we were to have four portions for breakfast, lunch, and dinner, with snacks in between. Lots of snacks!” These were also the days of using syringes, rather than pens or pumps for insulin injection. “I didn’t use to tell teachers that I was diabetic. It was on my school info form, I’m sure, but I tried to keep it a secret as I was embarrassed about being different. “One day in science class, I accidentally dropped a syringe on the floor. A few hours later, someone came to my form class door and asked that I come to the office. I found myself in the deputy principal’s office with five other girls. The deputy principal was wearing gloves and had some tweezers. She said, Girls, something very serious has come to our attention and the consequences are going to be grave. We take drug use very seriously here. She lifted up an object with the tweezer – my insulin syringe. Who does this belong to? she asked. “Um, it’s mine, I said. I’m diabetic. “Oh! Oh dear. Did we know this? Had you told the school? “I think it’s on my enrolment form.

PHOTO: MIKE DICKISON

“I

think it gave me structure,” says Sarah of her Covid-19 cartoon series. “A sense that I was making order out of chaos. Also I wanted to remember this experience. I wanted to get it down. This is historic, monumental. We are living in interesting times.” Sarah’s comic strips often explore her life as a solo mum and a freelancer living with type 1. She was diagnosed in 1982. “I was staying at my grandparents’ house during school holidays, and I was just about to turn 9.” She noticed something was different. “Watching TV, I’d have to run to the loo during every ad break, and after washing my hands I’d drink copiously from the tap and yet I was still thirsty. “When my mother came to pick me up, my grandmother, who’d been a nurse, said she should take me to the doctor.” Sarah’s mother took her as soon as possible – on the morning of Sarah’s 9th birthday. “The doctor suggested it was probably type 1 diabetes and said I’d have to return for tests later in the day. “I had a party planned, so my mother asked him if I could eat any of the treats. He said yes, but that it was the last time, and I’d probably

“Oh. Well, in that case … come through! “I was taken to the principal’s office where she was sitting with two other people – counsellors from the local drug and alcohol centre. The deputy principal explained that I was, in fact. diabetic. There was laughter, and there were apologies. The drug counsellors looked a little deflated.” Sarah says she’s always tried to stay on top of her diabetes, but with varying degrees of success. “I think I went through a bad patch in the 90s, in my 20s, after I left home and had to feed myself. Everything went a bit skew-wiff. “That was when humalog was introduced too, but, when I was first put onto it, I wasn’t given a basal long-acting insulin so my levels were constantly rollercoastering. I returned to Actrapid, which didn’t really act rapidly at all. FINDING BALANCE

“I learnt how to keep tight control of my diabetes when I fell pregnant at 29.” Sarah was working overseas at the time. “I was taken under the

wing of a New York City diabetes nurse educator. She gave me a rigorous education and put me on a pump. From then on, I became a little OCD about it.” These days, however, Sarah has given up the pump. “Too many breakdowns, and too much feeling tethered to a device. But I still try to keep tight control with frequent injections, and I now have the wonderful but expensive Libre.” Hypos remain a challenge. In the first week of lockdown, “I was doing the family shopping in the supermarket, and I could feel my levels dropping.” She was trying her hardest to stick to hygiene rules. “I couldn’t take off my gloves or have any sugar until I’d finished shopping. Lucky for me, I don’t slip into unconsciousness very easily. I held it together as best I could until I’d packed my groceries into the boot and removed my gloves, and then I scoffed some gold bears.” Day to day, Sarah tries not to eat a lot of sugar or refined carbohydrate, but lockdown has been testing her. “It’s hard! I’m doing lots of baking with my

daughter and trying not to eat the baking as I know it will make me go high. “Cheese is my favourite treat food. I can indulge and not worry about blood sugars. I like making a little low-carb antipasto platter with olives, almonds, cheese, carrots, and hummus and fancy crackers that are also not too high carb. “But during lockdown, I guess my thing has been to go easy on myself. It’s a stressful situation and it’s easy to beat yourself up for not having perfect control. Obviously, we have to concentrate on our health and try our best to maintain good control, as that’s a way of protecting ourselves from the virus, but we also have to consider the effect that stress has on our blood sugars. “My blood sugars were really high for the first couple of days of lockdown. So I guess my focus has been on maintaining an equilibrium – trying to relax, not forcing myself to work too hard, trying to adjust to this weird new normal.” sarahelaing.com

DIABETES WELLNESS | Winter 2020

Last word

A look back in time Fred Knox, diagnosed with diabetes at 89, recalls the late 1930s, when polio was the illness we feared, and diabetes treatment was very different.

n 1937, Fred was nine. He lived in the small, thriving community of Ōtaki with his parents, grandparents, and sister. His grandmother, Jessie, had diabetes. Insulin treatment had been invented in Canada just 15 years earlier. It was quickly used around the world, including in New Zealand, with formulas and treatment protocols evolving continually. Nonetheless, diet plans remained another frontline treatment for diabetes, and Fred recalls that his grandmother Jessie may not have been on insulin. She was starting to get gangrene in her toes, a complication of long-term diabetes, where blood flow is reduced to the limbs. Fred remembers, “The treatment was putting oil on her toes, like olive oil for example, then she had to have her feet up with the radiator heater pointing at her feet from a metre or so away. She’d have to sit there like that for quite a while, and the infrared from the heater would actually penetrate some distance into the toes to warm them and encourage blood to flow. The oil was just to protect the skin from drying out.” Fred would help set the heater up for her. “She had to do this several times a day, and we had to check with our hands that the heater was far enough away not to burn her, as she had little feeling in her feet and couldn't tell. She was also

DIABETES WELLNESS | Winter 2020

on a fairly strict diet, having just enough calories to keep her going. The doctors worked out how much protein, how much carbohydrate … She’d get cravings for sweet stuff. She’d try to depart from the diet, and my mother had to give her warnings. “Friends would also come to visit her, and they’d be nattering, and they’d cover for her and get her more sugar. It annoyed my mother. She was working to keep my grandmother healthy, and they’d come and encourage her to take sugar.” It was around this time, 1937, that New Zealand was gripped by a polio epidemic. (There had been several before this, and they would keep coming until the advent of the polio vaccine.) Fred was at primary school and says that in some ways it was similar to the Covid-19 closures. “All the schools were closed for two or three months, and we went over to what amounted to a correspondence school system. Whoever was teaching you would send stuff through the mail, and you’d do the work and send it back in the same envelope. That envelope went backwards and forwards until you ran out of space for the address. But it wasn’t a shutdown as extreme as this one.” Polio was considered a childhood disease, so during epidemics places where children congregated were closed down,

Jessie Bills, living with diabetes 80 years ago

but workplaces stayed open. Adults would only go into isolation if there was a case of polio in their household. And was hygiene and handwashing emphasised in the same way it is during the Covid-19 pandemic? Fred says, not particularly: “You were told to wash your hands, regardless of whether there was an epidemic or not!”

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