Diabetes Wellness Winter 2021 by Diabetes New Zealand

wellness DIABETES

WINTER 2021 $8.00 INC. GST

DIABETES NEW ZEALAND | DIABETES.ORG.NZ

GENTLE KNEE EXERCISES • HEALTHY WINTER DINNERS • BIKING AND HIKING ADVENTURES LAUGHTER FOR WELLBEING • TYPE 1 AND OTHER AUTOIMMUNE ILLNESSES • A NEW TYPE 2 MEDICATION

NEW REPORT SAYS TYPE 2 DIABETES TO INCREASE 70–90% IN 20 YEARS

SPIKE YOUR WELLNESS, NOT YOUR BLOOD SUGAR

• LOW CALORIE • GREAT SWEET TASTE

DITCH SUGAR, SWITCH TO

Contents WINTER 2021 VOLUME 33 | NO 2

38 26 CARE: Diabetes and the Covid-19 vaccine

4 EDITORIAL

5 UPFRONT: Fundraising heroes

6 UPFRONT: Major health reforms + T1 care for youth falls short 7 RESEARCH: The latest type 1 research

28 COMMUNITY: Atawhai Edwards: aiming for the stars 32 CARE: Type 1 diabetes and other autoimmune conditions

8 COVER: The Economic & Social Cost of Type 2 Diabetes report

36 TREATMENT: Empagliflozin – the new type 2 diabetes medication available 38 LAST WORD: Is laughter really the best medicine?

12 NOURISH: Healthy winter warmers 18 COMMUNITY: An adventure and a secret: fundraiser Ben Mitchell 22 MOVE: Looking after your knees with Craig Wise

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

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DIABETES WELLNESS | Winter 2021

Editorial

ia ora koutou. The launch of The Economic and Social Cost of Type 2 Diabetes report at Parliament on 15 March was a highlight for Diabetes New Zealand. The report found New Zealand has a serious and growing type 2 diabetes problem, and it predicts the number of people with type 2 diabetes will increase by 70% to 90% within the next 20 years. The prevalence of diabetes in New Zealand and the chronic downstream health complications mark diabetes as this country’s most serious long-term health challenge. We know the personal and social costs are enormous, as is the vast cost to our health system. We also know the impact the condition has not only on individuals but on whānau. There is a need to change New Zealand’s model of care for people with diabetes. We are hopeful the information presented in the report, coupled with the proposed changes to the health system as a result of recent announcements by the Minister of Health, Hon Andrew Little, will result in the development of a long-term conditions strategy that includes a comprehensive plan for the oversight and management of diabetes. Diabetes New Zealand is a small organisation. We recognise that, to achieve better health outcomes for many of those with type 2 diabetes, partnering with other health NGOs such as the Heart Foundation and Arthritis New Zealand will allow us to support a wider range of health initiatives at a local level to reduce the incidence of diabetes, gout, and cardiovascular disease. By partnering, we believe we can more effectively reduce more than one long-term condition. Delivery of services at a local level is, however, the ultimate goal. There is much for us to do. Diabetes New Zealand is just beginning to strengthen its position as a strong advocate for all people with diabetes so we can turn the tide on a health condition that is placing an increasing burden on individuals, whānau, and the health system. In this issue of Diabetes Wellness, we share more about The Economic and Social Cost of Type 2 Diabetes report and begin to explore what the government’s newly announced health reforms might mean for all of us. As the colder months approach, we bring you a feature devoted to healthy winter dinners – and part 2 of our article on caring for your knees while staying active. We answer your questions about the Covid-19 vaccination, and we also celebrate some amazing, determined individuals who are working, fundraising, and advocating for the type 1 and type 2 diabetes communities. Until next time, we wish you all the best. CATHERINE TAYLOR

Board Chair, Diabetes NZ

DIABETES WELLNESS | Winter 2021

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

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

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

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

Upfront

OUR FUNDRAISING HEROES

Young rally car driver Jordan Grant raised awareness for diabetes at the 2021 NZRC Otago Rally in April by having his rally car painted with the Diabetes NZ Youth logo.

In 2021, we're off to a great start fundraising-wise! Diabetes New Zealand extends a huge thank you to everyone who has walked, run, rode or set themselves some other challenge to raise money for diabetes – or raise all-important awareness – this year. Of course, our fundraising heroes need their support crews and their donors, so we’d like to thank all of you as well. Special hats off to the teams who had their fundraising plans derailed by the Auckland lockdown this year. This was a massive disappointment, but it was wonderful to see the way donors still showed their support by giving anyway. This year, Diabetes Wellness will continue to bring readers inspiring stories of the fundraisers who are going the extra kilometre (or 100) for diabetes. Thank you to everyone who is continuing to find amazing ways to contribute to our communities. We couldn’t do it without you.

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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 2021

Upfront

MAJOR HEALTH REFORMS: HOPE ON THE HORIZON FOR ALL TYPES OF DIABETES? On 21 April, Health Minister Andrew Little announced major changes to New Zealand’s health system.

ll 20 District Health Boards (DHBs) will be replaced by one national health body, Health New Zealand, to fund and run the health system. A new Māori health authority will be created, with power to commission health services, monitor the state of Māori health, and develop policy. The Ministry of Health will become an advisory and policy agency only. A new Public Health agency will be created within the Ministry of Health. The DHB system has, over time, created duplication, inconsistency, and unnecessary bureaucracy between regional healthcare organisations. For those with type 1 diabetes, type 2 diabetes, and pre-diabetes, this has meant major disparities in care and access to services from region to region. It’s hoped that these health system reforms will result in improved care for people with diabetes in all regions and the end to “the postcode lottery” that the diabetes community has been dealing with for so long.

Young adults with type 1 diabetes falling through the cracks Earlier this year, a new study* and subsequent media reports revealed that seven of New Zealand’s 20 district health boards don’t offer specialist care for emerging adults – those aged 15 to 25 – who live with diabetes. And, even in those DHBs that do, the services may be minimal and understaffed. This is extremely worrying. As the study says, “In New Zealand and worldwide, emerging adulthood is typically the period of worst glycaemic control in the lifespan due to the high prevalence of psychosocial stressors and increased insulin resistance of puberty and risk-taking behaviours. In addition, the glycaemic control of emerging adults with diabetes in New Zealand often deteriorates due to the loss of support from family and friends from moving regions, the failure of support from paediatric services to extend to emerging adulthood and the loss of public funding for insulin pump therapy as glycaemic targets are no longer met.” The study, by Ryan Paul and Vicki Corbett, concludes that New Zealand is falling well short of international guidelines on care for young adults with type 1.

WHAT WOULD GOOD YOUNG ADULT CARE LOOK LIKE FOR YOU? Diabetes Wellness would love to hear from young adults with type 1 about what you think a good care system would look like. What healthcare support are you receiving now, and how would you improve it? If you could design a perfect diabetes healthcare system for those who are going through what you are, what would it be? With the hope offered by the new health reforms, we at Diabetes New Zealand think it’s important to start talking now about what we would like the future of care to look like. Email us at editor@diabetes.org.nz. *‘The clinical workforce caring for emerging adults with diabetes in New Zealand is under resourced’. NZ Medical Journal. Vol 134 No 1529: 5 February 2021.

DIABETES WELLNESS | Winter 2021

Research

Two new studies reported in the Diabetes and Obesity Review raise important questions about the treatment of type 1 diabetes in this country.

The latest type 1 diabetes research LOSS OF ACCESS TO INSULIN PUMP THERAPY

For people with type 1 diabetes who meet certain criteria, insulin pump therapy has been government funded in this country since 2012. Of those people who get pump funding, some – about 4% each year – later lose access to the funding. A 2020 study has investigated this. Disturbingly, but in keeping with trends across the health system, the researchers found that loss of access was more common in certain demographics. Youth (those aged 10–29 years) were overrepresented among those who lost funding. So were nonEuropeans, in particular, Māori and Pasifika. The researchers say that compounding this is the fact that those who are non-European or more socio-economically deprived are less likely to obtain funding for insulin pumps in the first place. The study concludes that efforts to reduce these disparities are needed – including reviewing current public funding access criteria. Study: ‘Youth and non-European ethnicity are associated with increased loss of publicly funded insulin access in New Zealand people with type 1 diabetes’. DOI: 10.1111/dme.14450.

‘DOUBLE DIABETES’

As the incidence of type 2 diabetes and pre-diabetes rises around the world, a rise in type 1 is also being seen. Less commonly discussed is the fact that these conditions are also being seen together more often – a dual metabolic condition sometimes called ‘double diabetes’. A UK study to investigate possible interventions has begun. The researchers found that lifestyle changes and extra hypoglycaemic drugs may help those with type 1 diabetes in the same way that they help those with type 2. Professor Jeremy Krebs from the University of Otago comments on the study: “Many people with type 1 diabetes struggle with their weight, just as those in the rest of

the population do. Managing this is made more difficult by the need to use insulin therapy and the anabolic effects of this interacting with genetic and/or lifestyle factors … [The study] raises the question whether [hypoglycaemic drugs] should also be funded for people with type 1 diabetes in NZ. SGLT‑2 inhibitors are not without significant risk of ketoacidosis in type 1 diabetes, and the body of evidence remains small; however, the question needs to be asked.” Study: ‘The impact of pharmacological and lifestyle interventions on body weight in people with type 1 diabetes: A systematic review and metaanalysis’. DOI: 10.1111/dom.14221.

Of those people who get pump funding, some – about 4% each year – later lose access to the funding. Disturbingly, researchers found that loss of access was more common in certain demographics.

DIABETES WELLNESS | Winter 2021

Cover

On 15 March, we launched a groundbreaking report that lays out the stark reality of the type 2 diabetes epidemic in New Zealand. It also offers hope.

The Economic and Social Cost

OF TYPE 2 DIABETES Report commissioned by: • Diabetes New Zealand • The University of Otago’s Edgar Diabetes and Obesity Research Centre (EDOR) • Healthier Lives – He Oranga Hauora National Science Challenge. The report was undertaken by PwC New Zealand and funded in part by a generous donation from Tony and Heather Falkenstein.

DIABETES WELLNESS | Winter 2021

he Grand Hall at Parliament House was packed for the launch of The Economic and Social Cost of Type 2 Diabetes. Among the more than 200 people assembled, a shared sense of the importance of the event was palpable. The Hon Peeni Henare launched the report, and we heard a range of powerful speeches. Hon Aupito William Sio spoke candidly of his determination to set a healthy-living example to his community. Diabetes NZ’s own Matire Ropiha riveted the audience with her story of the impact of type 2 diabetes on her whānau. Sir Jerry Mateparae sent a strong reminder of the need for the government to honour Te Tiriti in healthcare. And Professor Jim Mann’s presentation had members of the audience gasping at the statistics, but he didn’t let anyone forget that we are talking about people not numbers.

A JOINT CALL TO ACTION

The report shows that, in Aotearoa, type 2 diabetes has reached epidemic proportions and is on a steep upward trajectory for the next 20 years. However, the report also shows that this steep curve could be flattened or even squashed with the right interventions. We’re calling on the government to act now to prevent type 2 diabetes, reduce inequities in healthcare across different communities, and improve the quality of life for everyone in New Zealand. The numbers are scary, but if the government acts now we can change that. The report shows four changes the government can make now to help turn the tide and reduce the costs of type 2 diabetes to individuals and their whānau.

• The number of New Zealanders with type 2 diabetes is expected to increase by 70% to 90% in 20 years. • The estimated annual cost of diabetes in NZ is currently $2.1 billion (0.67% GDP). This is projected to increase by 63% to $3.5 billion in 20 years. • There is a shift towards younger people developing type 2 diabetes, and this is expected to increase the personal and economic impact of type 2 diabetes significantly. • Inequities and health outcomes will worsen for Māori, Pacific, and Asian populations if no action is taken now. • Holistic and system-wide response from government, society, and individuals is needed urgently to change the projected type 2 diabetes prevalence, costs, and health outcomes. • Four interventions could each save hundreds of millions of dollars, as well as increase life expectancy and improve quality of life for a huge number of New Zealanders. URGENT ACTION NEEDED

Heather Verry, Diabetes NZ chief executive, says, “The new report shows that urgent action is needed now to curb the growing costs of diabetes to the New Zealand economy as well as the costs to individuals and their whānau, both in terms of financial impact and livelihood.” “We’ve known for a long time that type 2 diabetes is an important and worrying issue in our communities,” says Professor Jim Mann, Director of the Healthier Lives National Science Challenge, “but we now know that its impact on New Zealand can be measured as a fraction of GDP, with the $2.1b annual equivalent to 0.67% of GDP.” That's just the financial cost, before even looking at the human cost.

Tamati Shepherd-Wipiiti from PwC, one of the report’s authors, says, “Pacific, Asian, and Māori peoples are disproportionately affected by this disease, and part of the reason for undertaking this report was to address these health inequities in New Zealand.” The current and projected prevalence of type 2 diabetes is highest for Pacific peoples, with a quarter of all New Zealand’s Pacific peoples projected to be diagnosed with type 2 diabetes in 20 years’ time. A similar concerning trend for Asian and Māori people demonstrates that, if no further action is taken to address New Zealand’s type 2 diabetes problem, inequities and health outcomes will worsen for these populations. LOOKING FOR SOLUTIONS

EDOR Director Professor Rachael Taylor says, “The current approach is not working if we want to stem this growing epidemic. Type 2 diabetes is not tracked as a national health target for a start, and yet the figures are growing at an alarming rate. New Zealand needs a holistic and system-wide response from the government, society, and individuals to change the trajectory. “The report provides a strong case for reorienting policy and prioritising resources to

address type 2 diabetes towards more equitable and effective interventions.” Heather Verry agrees: “By changing from an ambulance at the bottom of the cliff approach to a fence at the top, we could be avoiding more than 600 amputations a year in people with type 2 diabetes.” Tamati Shepherd-Wipiiti says, “Prevention is key to tackling this disease, and we need effective public health prevention measures in place.” INTERVENTIONS THAT OFFER HOPE

Despite the dramatically increasing numbers of people with type 2 diabetes in Aotearoa, the report reveals some good news. The team investigated several viable and promising solutions that could reduce both human and economic costs. It found four interventions that would lead to cost benefits as well as vastly improved wellbeing for those with diabetes and their family/whānau. Jim Mann says, “Although many are aware of type 2 diabetes issues, this report revealed a surprising extent of the issue, and we were also surprised by how successful and cost-effective some of the interventions were.” PHOTO: LUKE PILKINTON-CHING

KEY FINDINGS

At the launch of The Economic and Social Cost of Type 2 Diabetes: Diabetes NZ Board Chair Catherine Taylor, Prof Jim Mann, Hon Peeni Henare, Diabetes NZ chief executive Heather Verry, Prof Rachael Taylor, Hon Aupito William Sio, and Sir Jerry Mateparae.

DIABETES WELLNESS | Winter 2021

Each of the team’s chosen interventions addresses a different part of the type 2 diabetes pathway, from preventing pre-diabetes progressing to type 2 diabetes, right through to better treatment for people who already have type 2 diabetes. THE SUITE OF FOUR INTERVENTIONS

Based on cost–benefit analyses, the report shows significant cost savings could be gained from these four interventions:

Healthy people, healthy lives intervention Lifestyle intervention to prevent development of type 2 diabetes

Foot screening and protection Better foot screening and protection to avoid amputation

Owning our futures Lifestyle intervention to achieve remission from type 2 diabetes

1. The healthy people, healthy lives intervention

This aims to prevent New Zealanders from developing type 2 diabetes by providing subsidised whānau/community-centred lifestyle change programmes. The intervention is estimated to achieve a total government benefit of $42 million and a societal benefit of $88 million. 2. The owning our futures intervention

This enables New Zealanders to reverse type 2 diabetes and simultaneously reduce other obesity-related conditions by providing subsidised, intensive whānau/community-centred lifestyle change programmes. The intervention is estimated to achieve a total government benefit of $23 million and a societal benefit of $63 million. 3. The better diabetes medications intervention

This aims to enable people to better manage their type 2 diabetes by providing access to “gold standard” subsidised medication (SGLT2 inhibitors and GLP-1 receptor agonists). For SGLT2 inhibitors, the intervention is estimated to achieve a total government benefit of $510 million and a societal benefit of $510 million.

DIABETES WELLNESS | Winter 2021

Better diabetes medications Gold standard medication to better manage type 2 diabetes

For GLP-1 receptor agonists, the intervention is estimated to achieve a total government benefit of $595 million and a societal benefit of $148 million. 4. Foot screening and protection

This aims to prevent people with type 2 diabetes from developing serious foot-related complications by providing people with access to optimal foot care services. The intervention is estimated to achieve cost-saving benefits of $36,000 to $40,000 for each diabetes-related lower limb amputation avoided. If the intervention is implemented as intended, 390 major and 211 minor amputations might be avoided each year.

INCREASING WELLBEING FOR THE FUTURE

The study is about so much more than numbers. It reveals how government investment in the prevention, treatment and care of type 2 diabetes could have a significantly positive impact on New Zealand’s economy and society. The benefits vary with each intervention but are driven primarily by reducing health costs and increasing economic value through increasing life expectancy and productivity. “As well as economic benefits, significant societal benefit can be achieved by improving peoples’ quality of life and ability to participate in society,” says Heather Verry.

To find out more about the report’s findings, see the Diabetes NZ website: www.diabetes.org.nz/news-and-update/ new-report-cost-of-diabetes-staggering-but-fixable.

Tony Falkenstein: change for the better

hen Tony Falkenstein’s friend Sir Eion Edgar told him about the possibility of a new report being commissioned into the cost of type 2 diabetes, Tony knew he wanted to contribute. “My wife, Heather, and I take on projects whereby we think we can make change for the better.” When it comes to type 2, “I see so much money being wasted at the bottom of the cliff, when we could save that money by bringing in measures to reduce sugar and fast food consumption, and save people going through this horrible disease.” As the chief executive of Just Life Group – with its flagship enterprise Just Water – Tony has been committed to driving and supporting initiatives that promote healthy living for decades. He says, “Prior to setting up my own business, I’d worked in other companies that had no soul. To me, the values underpin the spirit of a business.” He says, “As a company, we know water is a better solution than sugar-saturated drinks. In 2016, we trialled free water coolers in 5000 homes, and the results were amazing in terms of reducing soft drink consumption. Sugar is similar to smoking – it’s very difficult to give up unless highly incentivised.” He adds, “Like the wearing of seat belts, the government does have to intervene to protect its citizens.” Tony thinks a lot about ways to do this: “What we need to do is incentivise manufacturers to reduce the sugar content in their products. For example, in the UK, the government announced a levy two years before the imposition. This gave manufacturers time to reduce their sugar content to below the 8% threshold, and most of them did this. I believe the threshold could then be reduced to 4% over four years, as manufacturers change recipes and consumers adjust to less sugar. It’s not the whole answer, but it would have a dramatic effect in reducing type 2.” Tony recognises that change can take a long time – sometimes too long. Contributing to The Economic and Social Cost Of Type 2 Diabetes report was a way to take action now. He is transparent about bringing an entrepreneur’s perspective to the table. “If you want to change something, you need input from various points of view – an academic does not think like an entrepreneur, and vice versa. I really endorse the work done by Jim Mann and his team, and it needs other types of thinking as well to achieve the result that everyone desires.”

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.

Nourish

DIABETES WELLNESS | Winter 2021

Classic

winter warmers with a healthy twist

Here’s five hearty, comforting meals, packed with healthy proteins and veges, and low in fat, salt and sugar. BEEF AND MUSHROOM STROGANOFF SERVES 4

So many ways to customise this classic! We use rice as the carb here, but there are delicious alternatives – such as mashed kūmara. There are also hearty vegetarian and vegan versions. Olive oil spray 3 tsp low-fat butter substitute (you’ll use each teaspoon separately) 400g lean beef stir-fry 1 large onion, or 2 medium, thinly sliced 3–4 garlic cloves, crushed 400g sliced button mushrooms 2 Tbsp cooking wine 2 Tbsp Worcestershire sauce 1 tsp onion powder ½ cup hot water ¼ cup low-fat sour cream 1½ cups basmati rice NUTRITIONAL VALUE PER SERVING: ENERGY 1850kJ (442kcal) | PROTEIN 35g | FAT 8.5g (SATURATED FAT 3g) | CARBOHYDRATE 51.3g (SUGARS 6g) | SODIUM 162mg NUTRITIONAL VALUE PER SERVING (VEGAN VERSION): ENERGY 1760kJ (420kcal) | PROTEIN 22.7g | FAT 10.7g (SATURATED FAT 1.6g) | CARBOHYDRATE 50.4g (SUGARS 5.1g) | SODIUM 157mg

Spray a large stovetop pan with olive oil spray and fry the beef at a high temperature for 1-2 minutes, keeping it moving with a spatula, until browned.

Add the hot water gradually, stirring constantly, until the mix thickens up.

Remove the beef and set aside.

Stir in the fried beef, Worcestershire sauce, and onion powder.

Turn down the heat, give the pan another spray, and add 1 tsp of the butter substitute.

Cover, turn the temperature down, and let gently cook on a very low heat for another 20 minutes.

When melted, add in the chopped onions and cook at a low temperature until translucent.

Cook the rice according to instructions on the packet.

Add in the crushed garlic and cook for another minute. Add 1 more tsp of the butter substitute, and when melted, add in the mushrooms. Turn the heat up to medium. Stir the mix until the mushrooms are coated and just beginning to brown. Add the wine and let cook for another minute. Add the third tsp of butter substitute, and, when melted, sprinkle in the flour and stir quickly so it is evenly distributed throughout the mix. Keep stirring the mix as it cooks for another minute.

Just before serving, stir the low-fat sour cream into the stroganoff mix. Serve the sauce over the rice, with salad or steamed green veges on the side. Make it vegetarian or vegan • To make a vegetarian stroganoff, use sliced tempeh or tofu instead of beef, or just add more mushrooms. Instead of Worcestershire sauce (which contains anchovies), use 4 tsp soy sauce and 2 tsp of either cider or balsamic vinegar. • To make the meal vegan, do the above, and also use dairy-free butter substitute and a low-fat plant-based yoghurt instead of the sour cream.

DIABETES WELLNESS | Winter 2021

STUFFED CHICKEN BREAST ROAST WITH PEA PUREE SERVES 4

There are a lot of innovative stuffed chicken breast recipes, but sometimes you just want the comfort of old-fashioned sage and onion. 2 large chicken breasts 4 medium potatoes, washed or peeled 1 large kūmara Olive oil spray ½ tsp salt 1 tsp onion powder STUFFING 1 finely chopped onion 1 tsp olive oil 1 tsp low-fat butter substitute 2 slices bread, torn into small pieces ½ tsp thyme PEA PUREE 250g frozen peas 1 Tbsp low-fat sour cream 1 tsp low-fat butter substitute

To make the stuffing Heat a stovetop pan to a medium heat and add the olive oil and the butter substitute. When the oil is hot, add the finely chopped onion, stir, then turn down the heat and cook slowly until translucent. Add the torn bread and stir till it’s well coated in oils and juices. Add the thyme and stir in well. To put together the roast Preheat oven to 200°C, and have a large, roasting tray at the ready. Split each chicken breast by cutting into the thickest long side of it with a sharp knife, slicing inwards and along so the breast forms a pocket. (Don’t cut all the way through on any of the other three sides – think of it like a pita pocket.) Fill each breast with half of the stuffing mix, pushing in well, and set aside. Quarter the potatoes. Peel the kūmara and cut into four roughly equal pieces. Arrange the breasts, potatoes, and kūmara on the roasting tray and spray with olive oil. Quickly stir the salt and onion powder together and sprinkle over the top.

DIABETES WELLNESS | Winter 2021

Roast, covered, for 30 minutes, then remove the cover and cook for a further 10–15 minutes or until done. To make the pea puree Do this about 10 minutes before the roast is done. Boil the peas in a little water until cooked through and drain. Stir in the butter substitute and lowfat sour cream. Blitz with a blender until smooth. To serve Cut each chicken breast into two even pieces. Distribute the roast evenly among four people, with pea puree on the side. Tips To be sure chicken is cooked, push a skewer into the thickest part and see if juices run clear. If you don’t want pea puree, simply stir the butter substitute into the cooked peas and serve them on the side like that. To bulk up the meal, chop and roast some additional low-carb veg: carrot, zucchini, cauliflower, capsicum, and/or mushrooms. NUTRITIONAL VALUE PER SERVING: ENERGY 2110kJ (504kcal) | PROTEIN 57.4g | FAT 7.8g (SATURATED FAT 2g) | CARBOHYDRATE 45.2g (SUGARS 9.8g) | SODIUM 487mg

PUMPKIN SOUP WITH CROUTONS SERVES 4

Hot, filling – and super-economical – pumpkin soup is a winter staple Approx 1kg of pumpkin Olive oil spray 1 large onion, chopped 3–4 cloves of garlic, chopped 1 large apple, peeled and chopped 1 large carrot, peeled and chopped 4 cups hot water 1 tsp onion powder 1 tsp salt CROUTONS Four slices wholemeal bread 1 tsp chopped dried parsley or another favourite herb or spice

Chop the pumpkin up into about 12 even pieces, remove the seeds, and peel off the skin.

Spray a wide stove-top pan with olive oil, and turn up to medium heat.

Spray the bottom of a big stove-top pot with olive oil, and turn the heat to low.

When the pan is hot, add in the bread squares and cook for 5 minutes, stirring to ensure they brown but don’t burn. Add in the herbs or spice, and cook for another minute, stirring constantly.

Add in the onions and garlic, and let them cook gently, stirring now and then, until they’re beginning to brown and soften. Add another spray of olive oil. Add in the chopped pumpkin, apple, and carrot, and stir to coat in oil. Let cook on a low heat, covered, for 10 minutes, lifting the lid occasionally to stir and check nothing is burning. Add hot water, onion powder, and salt. Bring to a simmer and let cook for half an hour. Blitz with a food processer, or mash if you don’t have one. To make the croutons Chop the sliced bread into squares (1–2cm). Leave the crusts on to reduce waste, or take them off if you prefer.

To serve Scatter the croutons across the soup, or pile them up in the middle. Tips • You can boil your pumpkin pieces for 2 or 3 minutes, then let them cool to make the skin easier to peel off. • There are lots of ways to make croutons. Another energy-efficient way is to toast them in a sandwich press, then spray with oil and toss with the herbs and spices afterwards. NUTRITIONAL VALUE PER SERVING: ENERGY 1140kJ (272kcal) | PROTEIN 10.9g | FAT 3g (SATURATED FAT 0.4g) | CARBOHYDRATE 42.8g (SUGARS 25.4g) | SODIUM 670mg

DIABETES WELLNESS | Winter 2021

VEGETARIAN COTTAGE PIE SERVES 4

Cottage pie is a great dish for preparing in advance and heating just before you serve. 4 medium potatoes 1 tsp olive oil or rice bran oil 1 tsp low-fat butter substitute 2 medium onions, very finely chopped 2 carrots, grated 1 small kūmara, peeled and grated 2 zucchinis, very finely chopped 250g firm tofu, chopped into 1cm cubes 1½ Tbsp soy sauce 1 Tbsp cider vinegar or balsamic vinegar 2 Tbsp tomato paste 2 Tbsp low-fat milk 2 Tbsp low-fat sour cream 1 Tbsp low-fat butter substitute

Preheat oven to 200°C.

To put the pie together

Peel and halve the potatoes and start them boiling. When they are soft, take them off and drain them.

Mash the potato with the milk, sour cream, and remaining low-fat butter substitute.

While the potatoes boil:

Dollop small spoonfuls of mash evenly across the mix in the oven dish, and smooth gently with the back of a fork.

Heat a wide pan to a low heat, and add the oil and tsp of butter substitute and allow it to heat up. Add the onion and stir to coat in oil. Cover the pan. Let the onion cook slowly for 5 minutes, giving it a quick stir once or twice. Stir in the carrot and kūmara and let the whole mix cook slowly for 10 minutes with the lid on, giving it a quick stir every couple of minutes or so. Stir in the zucchini and let the mix cook gently for another for 5 minutes, again giving it a quick stir or two. Stir in the tofu, the tomato paste, and the cider or balsamic vinegar. Let the whole mix heat up, and simmer for 5 minutes. Transfer the mix an oven dish.

DIABETES WELLNESS | Winter 2021

Bake, covered, till piping hot – about 15 minutes if straight after putting together, or 35 minutes if you have prepared the cottage pie in advance. Make it vegan Use dairy-free butter substitute and a low-fat plant-based yoghurt instead of the sour cream. NUTRITIONAL VALUE PER SERVING: ENERGY 1230kJ (294kcal) | PROTEIN 16.1g | FAT 8.3g (SATURATED FAT 1.7g) | CARBOHYDRATE 31.8g (SUGARS 10.8g) | SODIUM 375mg

HEALTHY BOIL UP SERVES 6

This meal is a favourite from the Diabetes NZ cookbook, Eat Well Live Well. 1kg boneless brisket or 500g fat-free brisket 500ml liquid beef stock or 2 salt-reduced stock cubes 6 handfuls of watercress, pūhā, or spinach 4 palm-sized potatoes or kūmara, skin scrubbed ½ pumpkin, peeled ½ kamokamo (optional) 2 carrots, peeled

Cut any visible fat off the meat (or buy pre-trimmed meat).

Tip

Put the meat in a large pot, cover with water and add the stock. Simmer for 1 hour on a low heat.

You can add more vegetables such as parsnip, zucchini, beans, peas, onion, and broccoli to ensure that half your meal is non-starchy veg.

Add the watercress, pūhā, or spinach and let simmer for another hour.

NUTRITIONAL VALUE PER 433g SERVIING: ENERGY 1240 kJ (297 kcal) | PROTEIN 28.9g | FAT TOTAL 5.4g (SAT FAT 1.7g) | CARBS 27.6g (SUGARS 12.9g) | SODIUM 330mg

In a separate pot, boil the potatoes (or kūmara), pumpkin, kamokamo (if using), and carrots until soft – roughly 30 minutes. Serve the meat with the vegetables.

DIABETES WELLNESS | Winter 2021

Community

An adventure…

AND A SECRET Ben Mitchell spent a month cycling solo from Cape Reinga to Bluff to raise money for Diabetes NZ. He didn’t find out till he was almost finished that his wife Beverley – who lives with type 1 – had been keeping a secret that would have sent him rushing home.

Photo: Looking back up the Whanganui River.

DIABETES WELLNESS | Winter 2021

hen retirees Ben Mitchell and Beverley James moved to Wānaka, the many beautiful cycle tracks around the region enticed them to take up biking more seriously. It was Ben who became interested in the Tour of Aotearoa. He says, “It was set up some time ago by cycling fanatics the Kennett brothers. They set themselves a target of creating a route from the top of New Zealand to the bottom and taking in as many of the famous cycleways and cycle trails as they could along the way. So it zigzags its way down and through and across the country, and it's got quite a following. Over the

years, I've cycled some of the cycleways that it traverses, and it just started to worm its way into my brain as an idea.” Billed as “one of the world’s great bikepacking trips”, Tour Aotearoa attracts adventurers from around the world in pandemic-free times. “There's a huge amount of work that the Kennett brothers and other volunteers have put into creating this ride, keeping it updated and supervising it. They don't ask for any money for it, but they do encourage people to donate to a worthy charity that means something.” Once Ben resolved to do the tour, the charity he would donate to was “a no brainer”.

My Identity

is proud to create

A LATE-IN-LIFE DIAGNOSIS

Ben remembers Beverley’s type 1 diagnosis vividly. “She got a virus about 10 years ago when we were living in Christchurch and going through the earthquakes. It was a hell of a time. We were out of our home because it had been damaged by the earthquake, and I came down with whooping cough, which was going around at the time, and Beverley got this virus that she couldn't shake. It was debilitating. She finally went to the doctor, and she couldn't pin it down, so she did a number of blood tests, and then we got the call: come to the diabetes centre straightaway. “It was a real shock. The virus had triggered the type 1 diabetes. So that’s been a part of her life – and our life – for the last 10 years.” From the outset, Ben was impressed by the local support available – and grateful. “The diabetes communities in Christchurch, and now in Central Otago where we live, have been wonderful. It just seemed the right thing to do to try and contribute to that in some way and to Diabetes New Zealand with all the resources that they provide. “Everybody knows or has heard of diabetes, but we don't know much about it until it becomes part of your family or affects someone close to you. And then it's all immediate. It’s a steep learning curve, and you’re heavily dependent on people to help you come to terms with it and to help you through the change in lifestyle, the medication-related elements, and just understanding the complexity of it all when your head’s full of that shock.” PLANNING THE TRIP

Ben set up a Givealittle page for his trip and put together an email list. “It was mostly friends as well as some business contacts and associates from over the years – really those people that I’d worked

closely with, and I had a good relationship with. It was a hundredodd people I sent it out to, rather than the 2000-odd on my contact list.” He was blown away by the enthusiasm he was met with. “I sent out introductory information and a video link about what I was planning to do and the links for the Givealittle page. A lot of people said, ‘hey, that's a great idea’, even before I started. So, in response to their generosity, I thought I should try and give them a little bit more in return.” Once Ben started the trip, he began sending out updates. “Every day or two, I’d write an email on my phone. I'd stop at a cafe and write what I'd call a cycle log of what I'd been up to and what I'd seen and what had interested me, and I’d put in a few photos. So everyone was following with me along the way and sending emails in response, which was very motivating. And it was also my way of giving something back to them for their generosity, because people put in some very large sums of money.” BEVERLEY’S SECRET

Unbeknown to Ben, just over a week into his trip, Beverley had had a serious accident back in Wānaka. “She was on a reasonably technical mountain bike trail not far from our home, but it was during the week so there weren't many people around. She went over the handlebars on a steep section, and, luckily, a chap found her, about 20 minutes later they think … She'd been concussed. He went up and climbed a hill to get some phone reception and called up the cavalry, then they flew a helicopter in. We’re very grateful for his help! “She was flown to the medical center in Wānaka. Then she was put in an ambulance to the hospital at Dunston. And then she was transferred the next day by ambulance to Dunedin Hospital.

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Left: Preparing to leave Cape Reinga. Middle: Visiting the Diabetes NZ head office. From left: Liz Dutton, Nicky Katsanos, Ben Mitchell, Frances Redpath. Right: Bluff at last, after 3000km.

She ended up having to get two titanium plates put into her forearm. So, it was a hell of a deal. It really was. But she didn't tell me any of this!” Ben remembers her being “very circumspect” on her daily phonecalls to him around this time. “Had I known about it then, I absolutely would have stopped my trip. I might have left my gear and then gone back. I don't know what I would have done. But Beverley knew that I wouldn’t carry on ... Her friends helped out a lot, and they were all sworn to secrecy. I wasn't allowed to know.” Ben didn’t find out what had happened until the fourth-to-last day of his tour. Because the route passed by Wānaka, he thought he would stop off at home for a quick rest. He wasn’t expecting Beverley to be there –she had been scheduled to be away on a trip with friends. “So I came across the bridge heading to home, and there she is on the bridge taking photos of me. I said, ‘What are you doing here?’ And then she showed me the broken arm. I spent maybe a day there making sure she was okay and just being certain that I was happy to carry on to the last three or four days.” Twenty-eight days and 3000km after he started his solo tour, Ben rode into Bluff. Beverley and a

DIABETES WELLNESS | Winter 2021

friend had driven down to meet him, along with people from the local diabetes support group. “It was lovely to be welcomed on my arrival.” All in all, Ben raised $14,000 for diabetes. MEMORIES AND HIGHLIGHTS

For Ben, the trip was a mix of personal challenge, spectacular scenery, and social highlights. He often met other people who were also on the tour and stopped to chat with them or even rode with them for a while. Friends were important, too. “Not only were my friends and family generous with donations, but some met me along the way. I stayed with some – had a meal and lots of laughs with others. One ex-boss even joined me on a 40km stretch. This personal contact during the trip really buoyed me up.” Apart from two nights he spent camping under trees, Ben ended each day by staying at a small town hotel, a backpackers, or a cabin at a camping ground. His most memorable stay was at a hotel at Fox Glacier that had been impacted hard by Covid-19. “They were really suffering, because of the loss of tourism. All the way down the West Coast, numbers of tourists were right down. People had lost jobs,

and places were only open certain days and hours. So I stayed at this hotel in Fox Glacier. It was really nice, and the people were wonderful. I was the only guest there.” That, he says, was an eye opener. Another of Ben’s stops was in Wellington, where he visited Diabetes NZ’s head office. “They put on morning tea for me, and it was lovely to meet them because what they do is really important. There was clearly a passion among the people who I met, and so I'm impressed by that.” WHAT NEXT?

At the end of the trip, Ben let the friends on his email list know that this would be his last cycle log. ‘Two or three people came back and said, ‘No, no, go and find something else to do. We want to keep hearing your tales!’” Ben says he’s keen to do some overnight trips around central Otago with a sleeping bag and tent. “I look at this country with different eyes now. So I look for new opportunities … but no more grand cycle adventures.” Meanwhile, Beverley is recovering steadily from her concussion and working on regaining movement in her arm with physio. Any more new adventures, Ben says, are going to be things they do together.

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Move

LOOK AFTER THOSE KNEES! PART 2

Fitness consultant Craig Wise offers Diabetes Wellness readers some knee-friendly leg exercises.

n the Autumn issue, I discussed general knee care. One of the most important ways you can look after your knees is by keeping your leg muscles strong to support your knees – especially your quadriceps. Here are some of simplest, equipment-free exercises you can do at home to help you to strengthen your leg muscles without putting strain on your knees if they are vulnerable. There are numerous variations to these exercises, and you can make them harder by using ankle weights, but I would advise against this until you’re comfortable with completing them in their simplest form. TIPS

• •

Ideally, find time to do some of these exercises each day. Try to do three sets of your chosen exercise or exercises. At the start, it may be hard to complete three full sets of some exercises. That’s okay. Just aim to get better each time. However, if you feel any real discomfort or pain, stop immediately. You don't need to do all of these exercises together. Choose a selection covering different muscle groups. Mix and match to add variety. As with any exercise, you may feel some soreness in the muscles for a day or two afterwards. This is called Delayed Onset Muscle Soreness (DOMS), and is a natural and good thing. However, if you're getting pain during or after any exercise then consult your medical advisor.

DIABETES WELLNESS | Winter 2021

LEG LIFTS

Works: Thighs; hip flexors 1 Lie on the floor with your legs flat. 2 Bend one knee, and have the other lying flat. 3 Pull your abdominal muscle inwards. (Imagine trying to push your belly button downwards. This should bring the lower back against the floor.) 4 Slowly raise the straight leg, keeping it straight, until your upper legs are line with each other. Do not raise your straight leg higher than your bent leg. 5 Slowly lower your straight leg back to the ground. Control its descent and don’t let it just drop. 6 Repeat 10 times, then swap legs.

STANDING HAMSTRING CURLS

Works: Buttocks; hamstrings; calves 1 Stand with knees about 8cm apart. 2 Slowly bend one knee, so that you are raising your lower leg 90 degrees behind you. Keep your thighs aligned – try not to bring the bent leg forward. 3 Slowly lower this leg to the ground. 4 Repeat 10 times, then swap legs. TIPS If necessary, use the back of a chair for support. If you cannot lift your leg to 90 degrees then lift it as far as is comfortable. The more you do this the easier it gets to bend the leg.

STEP-UPS

Works: Thighs; buttocks; inner thighs; hamstrings; calves 1 Place one foot on a step. (You can use an aerobic step, or a stair, or improvise with a stable box or large book.) 2 Shift your weight onto the stepped-up foot, and bring your other leg up until your thigh is parallel to the ground. 3 Slowly lower that leg back down to the ground and place your weight back on it. 4 Repeat 10 times, then swap legs. TIPS Keep your chin up and shoulders back. Placing your hands on your hips can help to keep you square to the step.

ONE-LEGGED PARTIAL SQUATS

Works: Buttocks; thighs 1 Stand with one foot on a step, box, or stool. Have the other leg just hanging over the side. (Be careful to place your weight so you will not tip the step.) 2 Slowly lower the hanging foot towards the ground, bending the other knee. Try not to let the bent knee drift forward past the toe. Also keep the knees soft: don’t lock them when you raise back up to the start position. 3 Don’t let the hanging foot touch the ground, and keep it parallel to the floor – don’t point the toe. 4 Push back up on the stepped-up foot to return to the start position. 5 Repeat five times, then swap legs. TIP Start small. Don’t expect the get right down close to the ground when you first start.

DIABETES WELLNESS | Winter 2021

STANDING LEG EXTENSIONS

Works: Buttocks; thighs 1 Stand with your feet shoulder-width apart. Slowly raise your left leg until your thigh is parallel to the ground and the lower leg is hanging straight down towards the ground. 2 Extend the lower leg 45 degrees outwards, keeping the thigh stable and parallel to the ground. Be sure you are not leaning back as you extend your leg. 3 Lower your lower leg again, still keeping the upper part of your leg stable and parallel to the ground. 4 Repeat 10 times, then swap legs. TIP If you need to, use a chair to help maintain your balance.

WALL SQUATS

Works: Thighs 1 Stand with your back, hips, shoulders, and head flat against the wall. 2 Step both feet out about 50 to 60cms away from the wall, while keeping your back and shoulders against the wall. Keep your feet shoulder-width apart. 3 Slide your back down the wall slowly until you are in a seated position with your thighs parallel to the floor. Do not squat too low – make sure that your knees do not go out past your toes. 4 Hold for five seconds and then slide back up. 5 Repeat six to eight times.

PARTIAL SQUATS

Works: Buttocks; thighs 1 Stand facing a friend, holding your arms out in front of you. Hold hands. 2 Slowly lower yourselves into the half squat position. 3 Hold for two seconds and then rise back to the starting position. 4 Repeat 12 times. TIPS Keep your eyes fixed on your partner. Ensure that your legs stay in alignment and don’t drift in or out. Don’t let your knees go forward past your toes. This is a partial squat, so don’t go down deep.

Thanks to Xanthia and Saskia Wise for demonstrating the exercises.

DIABETES WELLNESS | Winter 2021

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Care

Diabetes and the Covid-19 vaccine As New Zealand’s vaccine programme rolls out, we answer some of the most common questions.

or adults with diabetes, and especially older adults, the risk of severe illness from Covid-19 is increased. Vaccinations are an important way to reduce your risk of contracting the virus – and to help protect your whānau, friends, and community. In New Zealand, the vaccine is free and voluntary. Diabetes NZ encourages people living with any form of diabetes to receive the vaccine when it’s available to you. Consult with your doctor about your individual circumstances. WHEN WILL PEOPLE WITH DIABETES RECEIVE THE VACCINE?

The government’s current priority for vaccination is border workers and frontline health workers, as well as people living in Counties Manukau District Health Board (DHB) district who have underlying health conditions that make them most at risk of severe illness from Covid-19. Both type 1 and type 2 diabetes are considered to be relevant underlying health conditions. That means those with diabetes within the Counties Manukau DHB district are now able to get vaccinated. Those with diabetes living in all other locations will be offered vaccines from May.

DIABETES WELLNESS | Winter 2021

WHAT VACCINE IS NEW ZEALAND USING AND HOW DOES IT WORK?

Several vaccines are being rolled out globally. The Pfizer-BioNTech Covid-19 vaccine is the vaccine currently in use in New Zealand. The Pfizer vaccine is a messenger RNA (mRNA) vaccine, meaning it doesn’t use virus cells, but contains a piece of RNA code that “teaches” the body to recognise the virus, so that it can respond straight away if you become infected. It does not alter DNA. The vaccine also contains buffers and a very small amount of sucrose to protect it during the ultra-low temperature storage it requires. IS THE PFIZER VACCINE SAFE?

The World Health Organization’s Strategic Advisory Group of Experts on Immunisation (SAGE) has deemed the Pfizer-BioNTech Covid-19 mRNA vaccine safe and effective for most people aged 16 or over. New Zealand’s own medicines safety authority MedSafe has also provisionally approved the PfizerBioNTech Covid-19 vaccine for use in New Zealand. This approval has involved a robust assessment process to ensure the vaccine meets international standards and local requirements for quality and safety. It means the company that makes the vaccine must meet certain conditions, including supplying

more data from its clinical trials around the world while the vaccine is rolled out. MedSafe has streamlined its approval processes to make sure New Zealand can access Covid-19 quickly, but these processes still have the same rigorous level of scrutiny that all other medicines undergo. The vaccine cannot give you Covid-19, and the Pfizer vaccine, which New Zealand is using, is not associated with blood clots. IS THE VACCINE SAFE FOR PEOPLE WITH DIABETES?

The Pfizer-BioNTech Covid-19 vaccine is safe for people with diabetes aged 16 years or older. The World Health Organization has found the vaccine to be safe and effective in people with various conditions that are associated with increased risk of severe disease. This includes diabetes, as well as hypertension, asthma, pulmonary, liver, and kidney disease. We recommend you discuss any concerns with your GP and/or your diabetes team. WHAT ABOUT CHILDREN WITH DIABETES?

At this stage, the Pfizer-BioNTech Covid-19 vaccine has not been approved for use in children under 16, even if they have an underlying health condition such as diabetes. This is because

clinical trials in children have not yet finished. Those under 16 may be included in future. WHAT ABOUT DURING PREGNANCY OR BREASTFEEDING?

Clinical studies have so far not investigated the vaccine in pregnancy. Trials are currently under way in the US, and it is expected the vaccine is unlikely to pose a specific risk when given to pregnant people. We will update this information as it becomes available. For now, though, the advice for pregnant people, including those with gestational diabetes, is to delay vaccination until after delivery if you are at low risk of exposure Covid-19. For pregnant people who are at high risk of exposure to Covid-19 the vaccine can be offered with informed consent. People who are trying to become pregnant do not need to avoid pregnancy after receiving the vaccine. People who are breastfeeding have also not been included in clinical trials. However, as with all vaccines on the New Zealand Immunisation Schedule, there are no safety concerns about giving the Pfizer vaccine to people who are breastfeeding. WHAT ARE THE COMMON SIDE EFFECTS OF THE VACCINE?

Like all medicines, the Pfizer vaccine may cause side effects in some people. This is the body’s normal response and shows the vaccine is working. Side effects are usually mild, don’t last long, and won’t stop you from having the second dose or going about your daily life. Common side effects include pain at the injection site, headache, feeling tired or fatigued, muscle aches, feeling generally unwell, chills, fever, joint pain, and nausea.

Serious allergic reactions can occur but are extremely rare. New Zealand vaccinators are trained to manage these. If you have an unexpected reaction to your Covid-19 vaccination, your vaccinator or health professional should report it to the Centre for Adverse Reactions Monitoring (CARM). You can also report any unexpected reactions directly by emailing CARM. We recommend you discuss any concerns with your GP or other medical professional. DOES THE VACCINE AFFECT BLOOD SUGAR IN PEOPLE WITH DIABETES?

It’s important to carefully monitor your blood glucose for 48 hours after you receive your vaccination, as it may rise because of the vaccine's effect on the immune system. You also need to stay hydrated and have a sick-day plan ready in case you feel ill. Again, discuss concerns with your GP or diabetes medical professional. HOW EFFECTIVE IS THE VACCINE?

Clinical trials have shown the Pfizer-BioNTech Covid-19 vaccine to be 95% effective. Similar results were seen across age, gender, race, ethnicity demographics and people with health conditions – including diabetes. Of those who participated in clinical trials for this vaccine, 9.4% of people had diabetes. It’s not yet known how long you will be protected from Covid-19 after receiving the vaccine. We also don’t yet know if the vaccine will stop you from passing on the virus to others, but evidence shows this may be the case. CARRY ON WITH OTHER PRECAUTIONS

Once you’ve been vaccinated, you should continue to take precautions to prevent the spread of Covid-19. Thoroughly wash and dry your

hands. Cough or sneeze into your elbow, and stay home if you feel unwell. This will help you protect you, your whānau, and others. Continue using the Covid tracer app, turn on your phone’s Bluetooth function, and you may wish to wear a face covering or mask. WHAT ABOUT NEW STRAINS OF COVID-19?

While there is currently limited data, early research has shown that the Pfizer-BionTech Covid-19 vaccine is just as effective against the UK (Kent) strain. Information about its effectiveness against other strains will become available as research continues. WHO CAN’T HAVE THE VACCINE?

There are specific populations for whom the Pfizer-BionTech Covid-19 vaccine is not recommended, because of contraindications, lack of supply, or limited data. These populations currently include people with a history of severe allergies, pregnant people, and children under 16. HOW MANY COURSES OF THE VACCINE WILL I NEED?

The vaccine is given as an injection into the muscle of the upper arm by a doctor, nurse, or pharmacist. When receiving the Pfizer-BioNTech Covid-19 vaccine, you’ll need two doses, at least three weeks apart. To ensure you have the best protection, make sure you get both doses of the vaccine. You’ll need to wait 20 minutes after your vaccination so medical staff can check you do not have a serious allergic reaction. Anyone who has a history of anaphylactic shock needs to wait 30 minutes. NEED MORE INFO?

For more information, as well as updates on the Covid-19 and diabetes, see www.diabetes.org.nz/ Covid19.

DIABETES WELLNESS | Winter 2021

Community

ATAWHAI EDWARDS Reaching for the stars

DIABETES WELLNESS | Winter 2021

When Tainui Live broadcaster Atawhai Edwards decided to take on the Great Wall of China Marathon, nothing was going to stop her – not money, not fitness, not doubters.

Left: Atawhai’s Chinese characters say “Pōhara” – it’s the name of her marae, as well as her son Ihaia’s middle name. “It means poor but it also means humility. It’s a reminder to live life with humility.”

former Kyokushin Karate world champion, Atawhai was used to aiming high physically and pushing herself to achieve distant goals. Then everything changed with the heartbreak of a broken relationship. Atawhai, who is of Tainui, Cook Island, and Pākehā descent, says, “I turned to my family, and when I turned to them there was a lot of love there and a lot of food. Both Māori and Cook Islanders, they love their food ... Big families, big feeds, big hearts. We try and help those uncontrollable situations with food because we can control food and we know it’ll make the people we love happy. I just ate and ate because my heart was broken, and it took me ages to realise I was emotionally eating. It was my mum who sat me down and told me I was still grieving.” Atawhai says that, eventually, “I got to a point in my life where I felt like – I need to do more. I was at my heaviest at 120kg. And then that opportunity came. One of my friends, Cheryl Matenga, signed up to do the Great Wall Marathon.” Cheryl was going with Albatros Adventure marathons, a company that takes tour groups to some of the most spectacular and gruelling marathons in the world. “She was telling me about it, and I was sitting there thinking, that’d be a cool opportunity …” Suddenly, the old Atawhai was back. Next thing, she was signing up as well. “I just thought – I can do this. So I signed up, but I didn’t tell anyone. I’d decided it in myself and I thought, you know what? No one’s going to sway me. I was 120kg. I’d never run a marathon before, even at my fittest. That opportunity came up, and I thought, I can do this. I always let other people’s opinions get to me. So I was like, no one’s going to know. No one’s going to shake me. I only had 12 weeks to train for it

at 120kg, and to prep and get the $6,000 I needed to go. But I just decided: I’m going to do this.” Only once her sign-up was confirmed did she tell people. “As expected, all the waves started coming in. You know, people saying you’ve never run a marathon in your life, what are you doing?” But Atawhai had prepared herself. “I knew that stuff was going to come, and I was like, I’m not going to be swayed. I had to show myself that I could do it.” THE HAKARIMATA AT MIDNIGHT

Atawhai knew a lot of people who were fundraising to go to Te Matatini, the national kapa haka competition, by walking or running up and down the Hakarimata – an hour-long walk in Ngāruawāhia. “I thought, I’m gonna up the stakes. I decided I was going to run from Hamilton to Ngāruawāhia, and then up and down the Hakarimata. And then I ended up deciding that I wanted to do it at midnight, because of the insecurities of being big. I didn’t want to run during the daytime. “So I did it at midnight and, fortunately, I had some crazy family and friends that wanted to do it with me. They came and supported me, and we ran in the middle of the night from Hamilton to Ngāruawāhia. “My cousin followed me in the car. She was playing some music, and we just ran, walked, ran, walked all the way to the Hakarimata. My son and my nephew were in the car sleeping, but as soon as we got to the Hakarimata they wanted to come up with us. “We got to the top of the Hakarimata and did karakia, looking at the stars. And in that moment, we were just lying there, tired as, looking up at the stars, and I was like, I can do this. “My family always roll their eyes

DIABETES WELLNESS | Winter 2021

at me. They’re like, oh, Atawhai has another bright idea … But I always do it. I love a challenge.” Sure enough, 12 weeks later, she had raised the money she needed and increased her fitness enough that she felt ready. THE GREAT WALL

The 42km Great Wall Marathon started in 1999 and is known as one of the world’s most challenging marathons – as well as one of its most exciting. “The history of the wall is something else,” says Atawhai. “The wairua there. It’s just ancient. I love history. It shapes us. It makes us who we are.” People had gathered from around the world for the marathon, and Atawhai was asked

to kōrero before they all began. “I got up in front of everyone, and I could feel our ancestors and their ancestors coming together. I did a kāranga and I mihi’d to all the ancestors that were there, because they were people from all over the world. You could feel the spirits, and the wairua was beautiful. “So we did a kāranga, acknowledged everyone there, did a little kōrero, and then our group did our haka. I thought – what better way to start this event? Just the marathon alone was an opportunity, but to be able to get up there and share our culture to the world. Having that opportunity was absolutely humbling.” She still feels like crying when she thinks about it.

“And because I was 120kg and a lot of people doubted me, I stood there as me. I thought I did it. I’m here. “I wore my marae T-shirt, and everywhere I went I carried my family with me. I carried my ancestors with me. I carried my son with me.” After the marathon, Atawhai and her friends explored the city, and, although they only were in China for a total of 10 days, they all felt so connected to the experience that they got tattoos together in a small tattoo shop. Atawhai’s Chinese characters say “Pōhara” It’s the name of her marae, as well as her son Ihaia’s middle name. “It means poor but it also means humility. It’s a reminder to live life with humility.” Atawhai says the whole experience was one that will stay

Atawhai with the Terracotta Army in China, after beginning her fitness journey with the Great Wall Marathon in the year of its 20th anniversary.

DIABETES WELLNESS | Winter 2021

with her forever. “Honestly, I would encourage anyone to go into a marathon with Albatros Tours – or any marathon.”

ourselves because we didn’t do it.” She also says to make sure you’re ready for negative feedback. “There’ll always be doubters. There’ll always be haters. It’s just life. But just don’t be the doubter yourself. Don’t be the hater. And get yourself ready for it.” She says, ultimately, “It all comes down to believing in yourself. Believe in yourself because by believing in yourself you believe in all those that have passed on before you. Know that they’ll never let you down. That’s what’s helped me. Because everyone around us can let us down in different ways: our family, our friends … sometimes they’re the ones who contribute to the negative – but we can control that.”

WAYS TOWARDS HEALTH

“When I got back,” says Atawhai, “everyone was so proud of me. And now some of my whānau are trying to find avenues to better their health.” She’s glad, because whānau health preys on her mind all the time. “I think of my koro who died from diabetes, or, at least, diabetes started his issues. And I think of how much I miss him. We’ve all got family members that we’ve lost to diabetes. “And I look at family members who are selflessly helping others and not looking after themselves. In a Māori or Pacific Island society, you need to look after everyone else because that’s what makes you feel good. But sometimes you exert all that energy and that love to everyone else, and then there’s no more for you.” She’s often asked for advice. “It’s been a journey. I’ve lost so much weight, and people are like, what do you do? What’s the secret? It’s not one answer. It’s a lot of answers. “In terms of eating, I pretty much eat 30% of what I used to. Before, with one meal, I’d have about five or six pieces of bread, thinking that’s normal. But it wasn’t normal and it wasn’t okay because it didn’t serve me. It didn’t serve my body. “So I started with five pieces of bread, and then I went to four, and I just slowly broke it down. And now, even with a burger, I’ll have one burger and I’ll go, I’m just going to have half. And I’ll give half to my cousin or my sister. So I started halving my food. I’d go to McDonald’s, and I’d just have half the chips. I knew I could do that – just start cutting everything in half. And now I can control what I eat, and I listen to my body.”

Atawhai's often asked for advice. “It’s been a journey. I’ve lost so much weight and people are like, what do you do? What’s the secret? It’s not one answer. It’s a lot of answers.” The way she feeds her son has changed as well. “He’s taking it on board quite easily. I’m grateful. He doesn’t complain much. It’s me that does the complaining! “One big thing that I always tell people is – you don’t have to ‘start on a Monday’. Sometimes people are on a health buzz, and, come Wednesday, they slip. Then they always say, “I’m going to jump back on the health buzz on Monday.” You know, eat the bad foods and start again on Monday. That’s probably the worst habit. “I say to people, just start again on your next kai, your next feed. “And always break your goals down, because otherwise it gets overwhelming and it’s not realistic, and then we lose the belief in

WHAT NEXT?

Atawhai has now set her sights on bodybuilding, signing up for a 16week challenge. “I have stretch marks all over. Do I care? No. And I know people will come at me with the negative comments, because that’s life. I know people are going to try and sway me. But I’ve decided. I’ve signed up. I’m doing it. “At the moment, I look at bodybuilders, and I can only imagine how much hard yakka it is … To get up on the stage half naked and just exude your hard work. And you see those people, and you think: wow, they did it. I wonder what their story is. I wonder what gave them the confidence to stand there and believe in themselves. “Matariki’s coming up, and I have some more plans in my head that I haven’t shared with anyone. I have some bright ideas coming in, and I’m so excited for them. Because once I’ve decided I’m going to do something, I do it. All I look for after that is support, not doubt.”

DIABETES WELLNESS | Winter 2021

Care

Type 1 diabetes and other autoimmune conditions For most people, type 1 diabetes will remain the single autoimmune condition that they deal with. However, about a fifth of those with type 1 will develop at least one other autoimmune condition. This overview looks at some of the most common and some of the rarest.

utoimmune illnesses – where the body mistakenly turns its own immune system against itself – can be hereditary. These illnesses may cluster together in individuals and in families. In type 1 diabetes, the body destroys its own insulin-producing cells in the pancreas. Last year, a Finnish study found that – out of 4000 people living with type 1 – 22.8% had at least one other autoimmune condition.1 The researchers recommended that people with type 1 should be regularly screened for additional autoimmune illnesses. At the moment, here in New Zealand, the system is variable from region to region, and those with type 1 are sometimes – not always – screened for coeliac disease and thyroid disease. If you live with or care for someone with type 1, it’s good to be aware of the symptoms of these and other autoimmune illnesses, so you can keep an eye out, and push for tests from your doctor if you suspect something. If your doctor knows you already have – or a family member already has – an autoimmune illness, this can help with getting tests for others. Many autoimmune conditions are similar to type 1 in their unpredictability and in the way that their progression varies from person to person. It means specialist individualised care, good information, and peer support are vital.

1 ‘ Every Fifth Individual With Type 1 Diabetes Suffers From an Additional Autoimmune Disease: A Finnish Nationwide Study’. doi.org/10.2337/dc19-2429.

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Coeliac disease In coeliac disease, the immune system sees substances in gluten as a threat and attacks them, damaging and inflaming the small intestine, and interfering with its ability to absorb nutrients from food. SYMPTOMS

Some of the most common symptoms of coeliac disease include fatigue, weakness, lethargy, anaemia from iron or folic acid deficiency, weight loss, osteoporosis, diarrhoea or chronic constipation, wind, cramping, bloating, and nausea. There is also a range of rarer symptoms that include (but are not restricted to) easy bruising of the skin, mouth and tongue swelling and ulcers, miscarriages and infertility, and skin rashes – particularly dermatitis herpetiformis. Coeliac disease affects more women than men. DIAGNOSIS

A coeliac diagnosis can take some time, especially if you have some of the less common symptoms. Research indicates that a number of people who have coeliac disease are unaware of it. Tests may include blood tests, biopsies of the small bowel, and tests for genetic markers associated with coeliac disease. If you think you might have coeliac disease, it’s very important that you don’t start a gluten-free diet before the diagnosis process, as this can affect the process and the results. TREATMENT

The only way to manage coeliac is by going strictly gluten free. Pharmac offers part-funding for some gluten-free foods, such as gluten-free flour, glutenfree pasta, and gluten-free bread mix or baking mix. This is available by prescription only. For more information and support: coeliac.org.nz

Hashimoto’s disease

Graves’ disease

This is one of the most common autoimmune illnesses. In Hashimoto’s disease, your immune system attacks your thyroid (a gland in your neck), damaging it so that it doesn’t make enough thyroid hormones. Thyroid hormones are vital to your body’s metabolism, i.e. how it breaks down and uses energy. They influence your heartbeat, your breathing, your temperature, your weight, your energy levels, and more. Hashimoto’s disease is also called Hashimoto’s thyroiditis, chronic lymphocytic thyroiditis, or autoimmune thyroiditis. It’s much more common in women than men.

In Graves’ disease, the body sends an antibody called thyrotropin receptor antibody (TRAb) to one part of the thyroid gland, which then ‘overrides’ the thyroid gland’s normal regulation system so that it becomes over-active and over-produces thyroid hormones.

SYMPTOMS

Deep, ongoing fatigue is one of the most common symptoms. Others include depression, anxiety, weight gain, hair loss, unexplained pains, and/or a general feeling of unwellness that you can’t shake. Sometimes, the thyroid gland enlarges. DIAGNOSIS

Diagnosis involves blood tests for thyroid hormone levels, as well as for antithyroid autoantibodies. TREATMENT

Hashimoto’s thyroiditis is usually treated with levothyroxine: synthetic thyroid hormones that replace those the body is no longer producing. In many cases, it’s a very simple disease to treat. It requires taking a pill each day and getting your thyroid hormone levels tested from time to time. However, people in the thyroid disease community sometimes report difficulty convincing doctors that their thyroid levels are low enough to be treated. Similar issues can also arise for those who are already diagnosed, when the disease advances and their medication needs to be increased. This is because, while there is considered a normal range for thyroid hormone levels, everyone is different, and some people will begin to feel very unwell when their levels are still at the lower end of normal. For more information and support: www.thyroidsupport.org.nz Thyroid Association of NZ Facebook page: facebook.com/groups/196992133177

SYMPTOMS

Common symptoms include anxiety and irritability, fatigue, a tremor in the hands, heat sensitivity, sweating more, frequent bowel movements, bulging eyes or a sense of pressure and pain around the eyes (known as Graves’ ophthalmology), trouble sleeping, rapid heartbeat or palpitations, and menstrual cycle changes. The thyroid gland may also become enlarged. Graves’ disease is not as common as Hashimoto’s disease. DIAGNOSIS

Blood tests to check levels of thyroid hormones are used to diagnose Graves’ disease. The tests may also show low cholesterol and low triglycerides. TREATMENTS

Beta-blockers are a temporary fix for some symptoms. Long-term treatment involves reducing the amount of thyroid hormones that the body produces. This can be done by taking antithyroid medications. Radioactive iodine therapy is also available. The goal is to kill some of the cells in the thyroid that are overactive. For more information and support: www.thyroidsupport.org.nz Thyroid Association of NZ Facebook page: facebook.com/ groups/196992133177

DIABETES WELLNESS | Winter 2021

Rheumatoid arthritis

Pernicious anaemia

Rheumatoid arthritis (RA) is the autoimmune form of arthritis (not to be confused with osteoarthritis, which is caused by joint wear and tear and is not an autoimmune condition). In RA, the immune system attacks the synovium – a membrane that lines bone joints and makes fluid to help them move. The synovium becomes inflamed and thickens, making it painful and difficult to move the joints.

In the autoimmune form of pernicious anaemia, your immune system attacks the cells in your stomach that make a protein called intrinsic factor. Your body needs intrinsic factor for it to absorb vitamin B12 from the food you eat. Because your body doesn’t have enough vitamin B12, it can’t make enough healthy red blood cells, which you need to move oxygen around your body.

SYMPTOMS

RA, like many autoimmune illnesses, affects more women than men. Symptoms include discomfort, swelling, stiffness, and a feeling of heat in the joints. More stiffness in the joints in the morning is a particular indicator. Other symptoms are fatigue, low-grade fever, and appetite loss. In adults, the pain and swelling usually (but not always) starts in the small joints of the hands and feet, and occurs symmetrically, i.e. in the same joints on both sides of the body. However, especially in children and teens, RA may first present asymmetrically and in larger joints such as knees and elbows. DIAGNOSIS

An initial diagnosis is often based on symptoms alone. Blood tests and X-rays may be used to see how fast RA is developing. Early diagnosis is important, so you can get the treatment you need to avoid damage to your joints. After an initial diagnosis, your doctor should refer you to a rheumatologist. TREATMENT

RA is particularly unpredictable. Symptoms and flares can come and go without you noticing a pattern. There are a range of medications available – from nonsteroidal anti-inflammatories such as ibuprofen and voltaren, to steroids, to “biologics”, to disease-modifying antirheumatic drugs (DMARDS). Because RA affects people so differently, your treatment will need to be individualised, and you may need to trial different treatments to find what works best for you. RA treatment is not just about medication. Perhaps counterintuitively, it’s vital for those with RA to stay active to help keep the illness under control, and to find forms of exercise that don’t strain joints during symptomatic times. An anti-inflammatory diet is often recommended, including cutting right down on sugar. Good, supportive, shockabsorbing shoes can also be important. For more information and support: www.arthritis.org.nz facebook.com/groups/RAsupportnz

DIABETES WELLNESS | Winter 2021

SYMPTOMS

Symptoms of pernicious anaemia are the same as those for any vitamin B12 deficiency: feeling tired and weak, memory problems or confusion, depression, vision problems, a sore tongue or mouth ulcers, numbness or pins and needles, or unsteadiness. Again, women are more often affected than men. DIAGNOSIS

Your doctor can order a blood test that will measure your vitamin B12 levels. If they are low, and you suspect pernicious anaemia, further blood tests can check for tell-tale antibodies. TREATMENT

Treatment involves a series of vitamin B12 injections to rebuild your body’s stores of vitamin B12. Once your stores are at a normal level, you will need to keep getting injections, but less often, to maintain the level. Vitamin B12 tablets are not usually effective for pernicious anaemia as they don’t often have enough B12 in them, and it may not be well absorbed when taken orally. For more information and support: facebook.com/ groups/450939528258418

Vitiligo In vitiligo, your melanocytes (the cells that produce melanin/ pigment in the skin) are lost or destroyed, and skin becomes lighter in patches. It may also affect hair. SYMPTOMS

Vitiligo can affect any part of the body, in a single patch, or in multiple patches of varying sizes. The face, neck, eyelids, nostrils, fingertips and toes, and body folds such as underarms are often affected. So are injury and burn sites. There are usually periods of pigment loss, followed by stability. The progression of the condition may be slow or rapid, and it varies heavily from person to person. Men and women are equally affected. DIAGNOSIS

Vitiligo can be diagnosed from the symptoms alone. TREATMENT

Vitiligo cannot be reversed, but there are ways to take care of yourself that may slow or reduce the effects. Wear protective clothes and try to avoid skin injury and sun exposure. For more information and support: vitiligosociety.org

Autoimmune gastritis In autoimmune atrophic gastritis, the immune system destroys the parietal cells in the stomach, which make stomach acid. SYMPTOMS

Sometimes, there are few or no symptoms, but some people may experience nausea, vomiting, a feeling of fullness in the upper abdomen after eating, or abdominal pains. Autoimmune gastritis can often cause anaemia and vitamin deficiencies. Anaemia symptoms include weakness, light-headedness, chest pain, heart palpitations, and ringing in the ears. Autoimmune gastritis is closely linked with autoimmune pernicious anaemia, and the two conditions may go together. DIAGNOSIS

Diagnosis involves an assessment of symptoms along with blood tests for the autoantibodies that act against stomach cells. Endoscopies may also be used. TREATMENT

Treatment usually involves effectively dealing with the nutritional deficiencies the disease causes, and may include iron infusions and vitamin B12 injections. It’s important not to try and treat these deficiencies by relying on over-the-counter vitamin supplements, which may be ineffective. For more information and support: facebook.com/ groups/450939528258418

Addison’s disease (Primary Adrenal Insufficiency) Addison’s disease, also called Primary Adrenal Insufficiency is very rare, affecting about 35 to 120 people in every one million. Addison’s disease is usually the result of an autoimmune disorder where the immune system gradually destroys the adrenal cortex (the outer layer of the adrenal glands). As a result, the adrenal glands stop making enough cortisol and aldosterone. SYMPTOMS

Common symptoms include weakness, fatigue, appetite loss, and weight loss. There may also be hair loss; nausea; low blood pressure; dizziness when standing or sitting up; darkening of the skin on the face, neck, and back of the hands; muscle and joint pain; and salt cravings. DIAGNOSIS

Diagnosis involves a hospital visit for a complex series of blood tests. In New Zealand, you need to see an endocrinologist for this. TREATMENT

Treatment of Addison’s disease involves replacing the hormones that your adrenal glands are no longer making. Getting the exact dosage and schedule right can be a fine balancing act. Your endocrinologist should work with you on this. For more information and support: adrenal-insufficiency.nz

DIABETES WELLNESS | Winter 2021

Treatment

Empagliflozin – the new type 2 diabetes medication available In February this year, empagliflozin became fully funded for people who meet certain funding criteria. Here’s what you need to know about this potentially life-saving medicine.

s campaigners for better access to medication for people with type 2, Diabetes NZ is delighted that empagliflozin is now accessible to many New Zealanders who need it. Empagliflozin is available under the brand name JARDIANCE®. It’s also available in combination with metformin (another older diabetes medication), under the brand name JARDIAMET®. If you’re already on metformin, you may be able to take JARDIAMET®, meaning you can take empagliflozin without taking any extra tablets. WHAT IS EMPAGLIFLOZIN?

Empagliflozin is a type of diabetes medicine called a sodium-glucose co-transporter 2 (SGLT2) inhibitor. Empagliflozin helps lower bloodsugar levels by blocking a protein in your kidneys called SGLT2. This stops your kidneys from putting glucose back into your bloodstream. Instead, the sugar is removed in your urine when you pee. JARDIANCE® can remove up to about 78g of sugar from your body in a day. One of the exciting things about empagliflozin is that, for some people, it also helps manage the risks associated with cardiovascular (heart and blood vessels) and kidney disease.

DIABETES WELLNESS | Winter 2021

JARDIANCE® OR JARDIAMET®?

Only your healthcare professional can advise if either of these medications is right for you. JARDIANCE® is funded for people with type 2 diabetes and established cardiovascular disease to reduce the risk of cardiovascular death. It can be used in combination with other glucose-lowering medication including insulin, when these, together with healthy food and physical activity, do not provide adequate control of blood glucose. JARDIAMET® is indicated when blood sugar is inadequately controlled with metformin or empagliflozin alone (or in combination with insulin therapy), or if you are already treated with empagliflozin and metformin as separate tablets. Both JARDIANCE® and JARDIAMET® are also indicated for people who have both type 2 diabetes and established cardiovascular and kidney disease. These people should use these medications in conjunction with other measures to reduce cardiovascular risk. WHO IS ELIGIBLE FOR FUNDED EMPAGLIFLOZIN?

Having JARDIANCE® or JARDIAMET® funded means you will pay only $5 per prescription. You may be eligible to have one of these medications funded if you have type 2 diabetes and you are at high risk of heart and kidney complications. High-risk groups include people with: • Māori or any Pacific ethnicity • pre-existing cardiovascular disease • a high five-year risk of

cardiovascular disease (15% or greater) • a high lifetime risk of cardiovascular disease from being diagnosed with type 2 diabetes during childhood or as a young adult • diabetic kidney disease. You may be eligible if your diabetes has not been well controlled by another blood-sugar-lowering drug that you have taken for at least three months. To measure this, your healthcare provider will use an HbA1c blood test. This tests your average blood sugar over the past approximately three months. You will be eligible if your test result is higher than 53 mmol/mol. If you qualify, your healthcare provider will apply for a Special Authority for you. The Special Authority number will be on your prescription, so your pharmacy knows the medicine is funded. You will only need to get this Special Authority once. IS LOW BLOOD SUGAR A RISK WITH THESE MEDICATIONS?

If you’re on another medication to treat type 2 diabetes, your risk of hypos (low blood sugar) may be increased when you take JARDIANCE® or JARDIAMET®. It’s important to know the signs of low blood sugar. Tell your healthcare provider as soon as possible if you notice sweating, dizziness, flushing or paleness, weakness, trembling, numbness, strong hunger, headache, or a fast pounding heartbeat. WHAT ABOUT OTHER SIDE EFFECTS?

Other possible side effects with empagliflozin can include weight

loss, lower blood pressure, urinary tract infections, and genital thrush. So, tell your doctor or pharmacist if you notice any of these: • genital burning, redness, pain, and discharge • passing more urine than normal • itching • excessive thirst. Genital thrush may well be avoided by regular good hygiene. Drinking plenty of water reduces your risk of urinary tract infections. Rare, serious side effects

According to Medsafe, the most serious possible side effects, although they are rare, are diabetic ketoacidosis (DKA) and necrotising fasciitis of the perineum (Fournier’s gangrene). DKA is caused by a build-up of substances called ketones in the blood. DKA symptoms include rapid weight loss, nausea, abdominal pain, excessive thirst, difficulty breathing, confusion, or unusual fatigue, a sweet smell to your breath, a sweet or metallic taste in your mouth, or a different odour to your urine or sweat. Fournier’s gangrene symptoms

include pain, redness or swelling in the genital or perineal area, fever, or malaise. If you have any of these symptoms, contact your health provider immediately. THINGS TO REMEMBER IF YOU’RE ON JARDIANCE® OR JARDIAMET®

• If you miss a dose, and it is less than 12 hours before your next dose, skip the dose you missed and just take your next dose when you’re meant to. • If you miss a dose, and it is more than 12 hours before your next dose, take your dose as soon as you remember, and then go back to taking your medicine as you would normally. • Do not ever take a double dose to make up for a dose that you missed. This may increase the chance of an unwanted side effect. If you’re not sure what to do, ask your healthcare provider or pharmacist. • Before and while taking an empagliflozin medication, make sure you tell your doctor or pharmacist if you’re taking any

other medicines, in case these may react in some way. That includes any medicines that you get without a prescription from your pharmacy, supermarket, or health food shop. • If you have a stomach bug or are unwell in any other way that means you can’t eat normally, consult your health care provider. They may recommend that you temporarily stop taking JARDIANCE® or JARDIAMET® until you can eat normally again. • The same goes for if you’re preparing for surgery or a procedure and need to fast or eat differently: consult your healthcare provider. • JARDIANCE® can be taken with or without food, while JARDIAMET®, because of the metformin it contains, needs to be taken with food. BEYOND THE MEDICATION

It’s important that empagliflozin, like other medications for type 2 diabetes, is seen as just one part of treatment. Staying active and trying to eat well are just as important.

EAT WELL LIVE WELL

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

DIABETES WELLNESS | Winter 2021

Last word

Laughter

and your health Laughing is good for our health – we know that almost instinctively. These days, scientific research is trying to understand more about this simple truth.

ay 2 was World Laughter Day, so we decided to review some of the recent research into the health benefits of a good laugh. LAUGHTER AND CARDIOVASCULAR DISEASE

A Japanese study published in 2019 investigated whether people’s daily laughter frequency was associated with mortality and cardiovascular disease. The study included 17,152 people who were over 40 and who participated in an annual health check in Yamagata Prefecture. Participants self-reported how often they laughed. Analysis revealed that, in the years that followed, all-cause mortality and cardiovascular disease incidence were significantly higher among subjects with a low frequency of laughter, even adjusting for age, gender, blood pressure, smoking, and alcohol consumption. LAUGHTER AND TYPE 2 DIABETES

A 2018 study by universities in Lebanon and Egypt reviewed research on laughter and type 2 diabetes and concluded, “Although laughter therapy is still poorly investigated, recent studies show that laughter may retard the onset of diabetic complications, enhance cardiovascular functions and rectify homeostatic abnormalities associated with T2DM … Laughter therapy is effective in delaying

DIABETES WELLNESS | Winter 2021

diabetic complications and should be used as an adjuvant therapy.” The study also outlines the different biochemical, physiological, and immunological, mechanisms by which laughter may help with wellbeing. REAL VERSUS “FAKE” LAUGHTER

Turning to local work – a 2018 study by the University of Auckland compared the effects of spontaneous laughter with forced or “simulated” laughter. The researchers reported, “Laughter leads to increased heart rate and reduced heart rate variability, which is similar to the effects of exercise.” They found that, in terms of beneficial effects, the more laughter the better. Laughter didn’t need to be spontaneous to have these beneficial effects. In fact, simulated laughter was more effective because it usually ended up producing greater amounts of laughter. LAUGHTER YOGA

“Laughter yoga” first became popular as a form of exercise in the 1960s. It includes yoga breathing techniques and laughter exercises, along with eye contact and play with other members of the group. It’s based on the idea that laughter doesn’t need to be spontaneous to be beneficial. At the same time, it’s recognised that deliberate laughter often turns into genuine laughter.

A 2020 Turkish study found that laughter yoga has a positive effect on depression, anxiety, sleep quality, quality of life, loneliness, life satisfaction, blood pressure, and pain in older adults. It identified that laughter: • activates muscles and also relaxes them • increases respiratory rate • stimulates circulation and increases oxygen saturation • decreases stress hormones (e.g. adrenaline, noradrenaline, cortisol) • increases endorphins and alleviates pain • improves mental functioning. The study concluded that laughter yoga is a cost-effective form of exercise or therapy for older adults, with no adverse effects. INTERESTED IN LAUGHTER YOGA?

There are more than 5000 laughter yoga clubs around the world, in more than 50 different countries. In New Zealand, you can find local groups and events at laughteryoga. org.nz. 1 ‘Associations of Frequency of Laughter With Risk of All-Cause Mortality and Cardiovascular Disease Incidence in a General Population: Findings From the Yamagata Study’. https://doi.org/10.2188/jea.JE20180249. 2 ‘Homeostatic effect of laughter on diabetic cardiovascular complications: The myth turned to fact’. https://doi.org/10.1016/j. diabres.2017.11.014. 3 ‘A comparison of the cardiovascular effects of simulated and spontaneous laughter’. https://doi.org/10.1016/j.ctim.2018.02.005. 4 https://doi.org/10.1016/j.ctcp.2020.101252.

Diabetes Burnout? It's time for a new approach to type 2 diabetes.

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Diabetes Wellness Winter 2021

Articles inside

Last word Laughter and your health

Type 1 diabetes and other autoimmune conditions

ATAWHAI EDWARDS: Reaching for the stars

Diabetes and the Covid-19 vaccine

LOOK AFTER THOSE KNEES! Part 2

An adventure… AND A SECRET

Classic Winter Warmers with a healthy twist

Tony Falkenstein: change for the better

The Economic and Social Cost of Type 2 Diabetes

The latest type 1 diabetes research

Editorial: Winter 2021

Upfront: Winter 2021

Empagliflozin – the new type 2 diabetes medication available