Diabetes Wellness Winter 2022 by Diabetes New Zealand

wellness DIABETES

WINTER 2022 $8.00 INC. GST

DIABETES NEW ZEALAND | DIABETES.ORG.NZ

CYCLING FOR DIABETES • INSPIRATIONAL ANA HUTCHINS • NEUROPATHY EXERCISES • SUPER HEALTHY BREAKFASTS • RESEARCH ROUNDUP • WINTER FITNESS • DIABETES & COFFEE

LAYLA SAE

TACKLING DIABETES WITH GRIT

CGMS FOR ALL OUR CAMPAIGN

The Fitbit MoveMeant Challenge is back for 2022 and we’re challenging 16 of NZ’s most familiar faces to outstep each other and raise funds for Diabetes NZ. From the 16 - 29 May, we’re inviting you to join in and take action to prevent and improve management of diabetes. Head to givealittle.co.nz and search “fitbit” to find out more!

20% OFF

Fitbit range for readers of Diabetes Wellness Redeem the discount at fitbit.com/global/nz/store/dnz/welcome Use access code: diabetesnz20

Contents WINTER 2022 VOLUME 34 | NO 2

4 EDITORIAL

5 UPFRONT: Taking on the world

6 COMMUNITY: Fundraising champs

24 COMMUNITY: Jack and Vincent's greatest race

7 YOUR DNZ: The Great Scenic Steps Challenge

26 RESEARCH: Roundup of the latest research

8 ADVOCATE: CGMs for all – our campaign

28 MOVE: Winter exercise 30 COMMUNITY: What are they doing now?

COVER: LAYLA SAE © HAGEN HOPKINS/GETTY IMAGES

10 NOURISH: Best breakfasts

32 ADVOCATE: Healthy drinks in schools

14 LIFE WITH T1: Layla Sae – Type 1 and true grit

33 DIABETES YOUTH: Live Brave Mana Ora competition results 35 CARE: Covid catch-up 36 ADVOCATE: Medical crowdfunding 38 NOURISH: Coffee, tea, and diabetes

18 CARE: Self massage for numb feet 20 LIFE WITH KIDNEY DISEASE: Ana Hutchins' twin journey

23 CARE: Insulin pen prescriptions

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DIABETES WELLNESS | Winter 2022

Editorial

he last quarter has been an interesting and extremely busy one for Diabetes NZ, despite the challenges of Omicron impacting on our community engagement. Local offices have continued to deliver much needed support services, but our community prevention work has been severely restricted. The delay in diabetes diagnoses, due to pressure on the health system from Covid-19, will inevitably have long-term implications, because of the potential increase in complications. It’s no wonder that our campaign in March – which called on people with diabetes, and their allies nationwide, to flood social media with images and posts illustrating the burden of diabetes and the need for technology to be funded – was such an overwhelming success. Diabetes NZ has advocated for continuous glucose monitors (CGMs) to be funded for more than four years, and this campaign was on the back of a petition to the Health Committee. More than 50,000 people agreed with our position that ‘it’s about time government took the needs of the diabetes community seriously and enabled Pharmac to fund this life-changing technology’. Diabetes NZ has also been part of the Ministry of Health’s Expert Advisory Group to develop a national Diabetes Action Plan. This plan sets out the priority actions for improving diabetes care in Aotearoa New Zealand over the next five years. It addresses the need for early identification and better management of prediabetes, type 1, type 2, and gestational diabetes. The focus areas and key actions outlined in the action plan align with the key system shifts for the new health system: reinforcing Te Tiriti o Waitangi principles, supporting people to stay well in communities, equitable access to high-quality emergency and specialist care, strengthening digital services and technology, and ensuring we have a well-resourced workforce. The report is currently undergoing stakeholder feedback. The key actions in the Plan support the service direction Diabetes NZ has taken through its partnerships with Primary Health Organisations (PHOs). Our Diabetes Community Coordinators are well placed to address the inequities that are persistent across the diabetes care pathway, especially for Māori and Pacific people. In this issue of Diabetes Wellness, we look back on the progress made during our CGM campaign and take a closer look at one of our PHO partnerships. We celebrate some of our many amazing community members – their personal achievements and their determined efforts for diabetes – and bring you all our usual healthy living features. We’re sure you’ll find plenty that informs and inspires.

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

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

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

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

HEATHER VERRY

Chief Executive, Diabetes NZ

DIABETES WELLNESS | Winter 2022

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

Taking on the world Some Diabetes Wellness readers will have been following the fortunes of now 13-year-old Ngaru Moeke, who, along with his big brother Tama, has a passion for Muaythai kickboxing.

garu also has type 1 diabetes, but it didn't stop him taking out a title at the New Zealand Muaythai Federation Nationals, in April. Many athletes, sportspeople, and perfomers with type 1 find that one of their challenges is high or unpredictable blood sugar – caused by adrenaline – just before or while performing. Ngaru is no exception. Ngaru's mother Laura Clarke says that, at the 2022 championships, 'He managed his blood glucose spiking, and he fought two other teens, both older than him.' He still came away as the NZ Muaythai kickboxing champ aged 16 and under for his weight division. Excitingly, his win means he’ll be competing in the world championships in Kuala Lumpur, Malaysia, this August. Congratulations Ngaru!

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Community

We’re inspired by, and so grateful to, the intrepid adventurers who’ve been pushing themselves hard to raise money for Diabetes NZ’s work.

FUNDRAISING CHAMPIONS THE YOLO TEAM

In early 2021, Dale Smith, Blair Wolfgram, Jeremy Priddy, and Kim Hughes banded together as the You Only Live Once (YOLO) team to enter the GodZone Adventure – a multi-day, non-stop expeditionstyle adventure race that’s known as one of the toughest in the world. The annual race spans trekking, kayaking, and mountain biking, and each year’s route contains multiple options and is kept secret from teams until the day before the race. YOLO team-member Dale’s niece Payton has type 1 diabetes, so the team decided that, as well as testing their own resilience, determination, and strength, they would fundraise for Diabetes NZ on their journey – especially to

DIABETES WELLNESS | Winter 2022

assist with all the Newly Diagnosed resources we gift families. YOLO trained hard, and before they’d even started the race they’d raised over $15,000 on their Givealittle page. Then disaster struck. Suddenly and unexpectedly, Covid-19 restrictions meant the team couldn't take part in the event. They were devastated. However, they didn’t give up on the dream, and, this year, they entered again and completed the race. By the end, they had raised an incredible $17,417. The team and route are pictured below. Last year Diabetes NZ distributed 360 Newly Diagnosed packs at a cost of $160 per pack, plus 103 Jerry-thebear packs costing $130 per pack to children with type 1 diabetes.

CHRISTIAN REYNOLDS

Christian was diagnosed with type 1 diabetes in 2010 at the age of 33. His father also had type 1. At the start of 2022, Christian set himself the mission to ride from Cape Rēinga to Bluff in under 25 days. He was keen to combine it with fundraising and decided that Diabetes NZ was the obvious choice. This determined solo rider raised $3,335 for Diabetes NZ. Thank you to all the wonderful members of our community whose fundraising efforts are helping us make a difference to diabetes in NZ. Thank you also to all their generous donors and supporters. You can read about another amazing fundraising duo on page 24.

Your DNZ

THE GREAT SCENIC STEPS CHALLENGE The Fitbit MoveMeant Challenge is back! This May, we’re challenging you to get out and explore Aotearoa New Zealand with your Fitbits for the Great Scenic Steps Challenge – and step up to raise funds for Diabetes NZ.

he Fitbit MoveMeant Challenge is back by popular demand, and we’re encouraging Kiwis to step up to the challenge once again. From 16 to 29 May, we invite you to join some familiar Kiwi faces in getting out and moving – to take action to prevent diabetes, as well as improve its

management. You get to explore beautiful Aotearoa while raising money and awareness for a great cause. We’re excited about some of the high-profile friends and supporters of Diabetes NZ who’ve signed up already. Meet just one of them – Ana Hutchins – on page 20. You can join the Fitbit MoveMeant Challenge yourself and set up your own fundraiser where you can track and share your progress. You can also show your support for one or more of our participants by donating to their individual fundraising pages. Now’s the time! Start rallying your families, friends, and work colleagues and preparing for the two-week challenge. To find out more, go to https://givealittle.co.nz/event/ movemeant-challenge-2022.

20% off selected Fitbits for members! To help you get set up for the challenge, Fitbit is offering 20% off selected devices for members of Diabetes NZ. Redeem the discount at fitbit.com/global/nz/store/dnz/ welcome Use access code: diabetesnz20

DIABETES WELLNESS | Winter 2022

Advocate

CGMS FOR ALL THE CAMPAIGN SO FAR As Diabetes NZ prepares to keep pushing for funded access to continuous glucose monitors (CGMs), we take a look at how far we’ve come.

iabetes NZ represents and champions the needs of all people with, or at risk of, diabetes. For the past three years, raising awareness about lifechanging CGMs and lobbying government to fund them for everyone in Aotearoa who needs them has been one of our most important activities. When it comes to advocacy, you need to play the long game – results almost never come quickly. However, we will not stop.

DIABETES WELLNESS | Winter 2022

NOV 2019

JUNE 2021

AUG 2021

Diabetes NZ presents a petition to Parliament, asking for funding for better technology and medications for diabetes – including CGMs.

A follow on from the petition, Diabetes NZ argues our case for CGMs in front of Parliament’s Health Committee.

The Health Committee presents its report to Parliament on the petition.

Te Pataka Whaioranga – Pharmac responds to our case a week later.

Read the reports and watch the hearing at: www.diabetes.org. nz/petition-toparliament-2019

#WEWILLNOTSTOP AUG 2021

FEB 2022

15 MAR 2022

WINTER 2022

In partnership with Diabetes NZ, Vince Harder and Abby Lee Harder release their song and video ‘Overwhelmed’ – a heartfelt plea for CGMs to be funded.

Diabetes NZ begins gathering support and building momentum for our #CGMforAll social media campaign.

The #CGMforAll social media campaign is a massive success! All day long, people whose lives are affected by diabetes flood social media with their stories – and their pleas for CGMs to be funded.

We await Pharmac's review announcement and this year's Budget.

Proceeds from listens and downloads of the song go to Diabetes NZ. See the video at: www.vinceharder. com/overwhelmed

Next steps: raising awareness with policy-makers.

Find out more about the campaign and read people’s stories at: www.diabetes.org. nz/cgm-for-allcampaign-2022

England, Wales, and Australia already fund CGMs for all people with type 1. Will New Zealand? #WEWILLNOTSTOP until life-saving CGMs are funded in Aotearoa.

DISCOVER MORE You can find out about all Diabetes NZ’s advocacy campaigns here: www.diabetes.org.nz/ advocacy

DIABETES WELLNESS | Winter 2022

Nourish

Best Breakfasts Our traditional breakfasts – cereals, toast, muffins, pancakes – are heavy on the refined carbs and sugars, exactly the things we know we should be avoiding. Rose Miller looks into what we should be eating.

reakfast is a meal we often skip when we’re in a hurry. And for some, it’s not a time when they are particularly hungry. Come mid-morning, it’s easy to succumb to a takeaway muffin and or some other carbladen snack and to over-eat at lunch and dinner. Having a healthy, balanced breakfast is an important tool in controlling blood sugar levels throughout the entire day. It seems the old adage does ring true, especially for people with diabetes – breakfast really is the most important meal of the day. In a study,1 researchers found that skipping breakfast increased blood sugar levels after both lunch and dinner. When type 2 participants skipped breakfast, lunchtime blood sugar levels were 37% higher than on the day they ate breakfast and 27% higher at dinner time. This even happened when sugars and starches for lunch and dinner were reduced. So what should we be eating for breakfast? Just because breakfast is important doesn’t mean it has to be elaborate. It can be as simple as a piece of avocado on wholegrain toast, a chunk of cheese and a handful of nuts, or a hardboiled egg and a piece of fruit. With some forward planning, you can make your breakfasts a tasty and healthy start to the day.

TIPS FOR BUILDING A HEALTHY BREAKFAST

Limit or avoid refined grains and sugars. Many of us have been brought up on traditional packaged cereal for breakfast, but most are high in added sugar. Even supposedly ‘healthy’ muesli from the supermarket can have lots of added sugars and fats. Cereals can have their place as a convenient breakfast food, so learn to read the food labels to pick the healthiest choice. For a How to Read Food Labels fact sheet, head to the ‘My Diabetes Journey App’ tab on the Diabetes NZ website and click on Food and Nutrition. Choose packaged cereals with high fibre, low sugar, and low fat, and keep an eye on the sodium levels. Better still, make your own! It’s not only healthier but much cheaper. (And you’re reducing packaging, too!) Watch your carbs. Keep an eye on your carb count – don’t forget that milk, yogurt, and fruit all contain carbs. They’re great additions to your breakfast, but limit how much you have. Choose the right oils. Fats can help you stay fuller for longer, but avoid saturated fats that can contribute to heart disease. If frying, use small amounts of olive oil or canola oil and add nuts, seeds, and avocado for healthy unsaturated fats. Oily fish such as mackerel, salmon, tuna, and sardines are good sources of healthy Omega 3 oils.

Keep your protein lean. Avoid traditional breakfast protein choices such as sausages, and bacon that are high in saturated fats. Try nut butters, beans, cottage cheese, fish, eggs, low-fat yogurt, chia seeds, or tofu. Fibre is your friend. Foods with fibre help you feel fuller longer, along with many other health benefits. Fibre from whole foods is your best source, so keep to whole grains where you can and include fruits and veges. Watch your caffeine intake. Caffeine can affect your blood sugar levels, causing lower or higher fluctuations. Be mindful of how much caffeine you consume. See page 38 to find out more. TIMING YOUR FIRST MEAL

When is the best time to eat breakfast? It appears that timing is important – a different study found that eating breakfast within 90 minutes of waking up is ideal.2 Researcher Marriam Ali said ‘We found people who started eating earlier in the day had lower blood sugar levels and less insulin resistance, regardless of whether they restricted their food intake to less than 10 hours a day or their food intake was spread over more than 13 hours daily.’ Aim to eat your breakfast before 8.30am, spreading your meals out evenly throughout the day.

1 Daniela Jakubowicz, Julio Wainstein. Fasting Until Noon Triggers Increased Postprandial Hyperglycemia and Impaired Insulin Response After Lunch and Dinner in Individuals With Type 2 Diabetes: A Randomized Clinical Trial. July 2015. Diabetes Care 38(10). DOI: 10.2337/dc15-0761 2 Endocrine Society. Eating before 8:30 a.m. could reduce risk factors for type 2 diabetes. March 17, 2021. https://bit.ly/3JQsDti

DIABETES WELLNESS | Winter 2022

Breakfast smoothies

Put it on toast!

Not all smoothies are created equal. Most store-bought smoothies are high in sugar. Making your own is easy! Here are two recipes for a quick on-the-go breakfast.

Toast for breakfast is quick and easy, and with the right toppings can provide you with everything you need for a balanced brekky. Choose wholegrain bread. Ditch the butter or margarine, or choose a spread with the healthy heart tick. Try these tasty pairings…

TOFU BLUEBERRY SMOOTHIE

Smashed avocado and egg

SERVES 2

1 x 300g pack of silken tofu 2 cups frozen bluerries 1 cup low-fat milk (or calciumfortified plant-based milk) I cup of ice (or water)

Sardines and sauerkraut

SERVES 2

2 tbsp nut butter ½ cup low fat yogurt 1 cup low-fat milk (or calciumfortified plant-based milk) ½ avocado 2 cups fresh baby spinach About 10 ice cubes, or 1 cup water

VEGE BREAKFAST WRAP

Grab a wholewheat wrap, add a scrambled egg, pack in a load of veges, then wrap and eat! Use leftover veges such as chopped cooked broccoli, kumara, or pumpkin. Add in some fresh crunch with sprouts, capsicum, or cucumber. Throw in some nuts and seeds, and add some flavour with a dash of chipotle sauce or a sprinkle of chopped herbs. Experiment to find your favourite flavour combo. Remember, a variety of colours means more nutrients! Love eggs for breakfast? Make it a vege scramble by sauteeing onion, red peppers, and mushrooms till soft. Then add some chard or spinach and cook until wilted. Now add your eggs and turn occasionally till the egg is cooked. Serve with a slice of wholegrain toast. SALAD? FOR BREAKFAST?

GREEN SMOOTHIE

Place all ingredients in a blender and blitz till smooth.

Throw away your traditional idea of breakfast and embrace veges as part of your first meal of the day. There's no better time to start getting your 5+ a day! Here are some simple ideas to pump your breakfast full of veges.

VEGE SCRAMBLE

Veges for brekky?

Cottage cheese and cucu mber … or nut butter and crunchy sprouts, scrambled eggs and wilted greens, peanut butter and sliced banana, hummus and sauteed mushrooms.

You’d usually think of salads for lunch or dinner, but salads for breakfast make a lot of sense. Protein plus the fibre from your veges will really set you up for the day. Try: • roasted pumpkin chunks, apple slices, avocado, red onion, walnuts, and a poached egg • quinoa, baby kale, fried tempeh strips, grated fresh beetroot and a drizzle of olive oil • cherry tomatoes, green capsicum, olives, feta, cos lettuce, tuna chunks and a third of a cup of brown rice.

DIABETES WELLNESS | Winter 2022

HOMEMADE TOASTED MUESLI Store-bought muesli is often high in sugars and fats. I find this homemade version tastier and cheaper. MAKES ABOUT 8 CUPS (16 HALF-CUP SERVES)

4 cups rolled oats ¾ cup desiccated coconut (or coconut threads) ¾ cup sunflower seeds or pumpkin seeds ¾ cup mixed raw nuts of your choice (roughly chopped) 1 tsp cinnamon ½ cup sultanas ½ cup dried apricots, chopped Cooking oil spray Mix together the oats, coconut, seeds, nuts, and cinnamon. Spoon the mixture into a large shallow roasting pan. Spray with a little cooking oil. Bake at 150°C for about 25 minutes or until golden and toasted. Stir occasionally to ensure even cooking. Remove from oven and allow to cool completely. Stir through sultanas and chopped dried apricots (or other dried fruit). Store in a large airtight container. PER SERVE | CALORIES: 983kJ (235cal) | PROTEIN 6.5g | FAT 13.2g (SAT FAT 2.4g) | CARBS 20.1g (SUGAR 3.8g) | SODIUM 6mg

MINI FRITTATAS Make these in the weekend for a quick and easy weekday breakfast. You could make these with any seasonal vegetables. Try artichokes and asparagus in the spring, tomatoes and eggplant in the summer, or fennel and roasted peppers in the autumn. MAKES 12

1 tbsp olive oil 1 small red onion, diced ½ cup diced capsicum ½ cup diced courgette 1 cup steamed, diced brocolli 4 eggs 1/4 cup grated parmesan 1 tbsp fresh herbs, chopped (optional) Non-stick spray Preheat oven to 180°C. Spray muffin tins with non-stick spray. Add 1 tbsp olive oil to a pan on medium heat. Add onions. Sautee until soft. Add courgettes and capsicum. Cook till soft, stirring occasionally, about 5–8 minutes. Take off heat and leave to cool for about 10 minutes. Whisk eggs in a medium-sized bowl. Add parmesan. Add in the sauteed vegetables and combine. Divide between 12 muffin tins – the mixture should fill about halfway. Cook for around 10 minutes. The egg should set and the top become slightly golden. PER SERVE | CALORIES: 238kJ (57cal) | PROTEIN 3.9g | FAT 3.7g (SAT FAT 1.2g) | CARBS 1.3g (SUGAR 1.3g) | SODIUM 57mg

DIABETES WELLNESS | Winter 2022

OVERNIGHT CHOCOLATE CHIA PUDDING A pudding that you can eat for breakfast? Yes please! Chia seeds are low in calories, and high in fibre and plant-based protein. Almost all the carbs in chia seeds come from fibre, which your body digests differently from sugar and starches. This means that chia seeds will provide a steady supply of energy without blood sugar spikes. SERVES 4

1/4 cup cocoa powder 3 tbsp sugar-free maple syrup ½ tsp ground cinnamon (optional) 1 pinch sea salt ½ tsp vanilla extract 1½ cups unsweetened almond milk ½ cup chia seeds To serve: Top with 1/4 cup low fat yogurt and ½ cup frozen berries. To a small mixing bowl add cocoa powder (sift first to reduce clumps), maple syrup, ground cinnamon, salt, and vanilla. Whisk to combine. Then add the milk a little at a time – whisk until a paste forms. Add the remaining almond milk and whisk until smooth. Add chia seeds and whisk once more to combine. Cover and refrigerate overnight. Serve chilled and top with yogurt and frozen berries. Leftovers will keep in the fridge for 4–5 days, covered, though best when fresh. PER SERVE | CALORIES: 1410kJ (337cal) | PROTEIN 13.6g | FAT 17.5g (SAT FAT 2.1g) | CARBS 12.3g (SUGAR 9.2g) | SODIUM 203mg

Weekend brunch

SHAKSHUKA

KEDGEREE

Shakshuka is a Middle Eastern dish, featuring poached eggs in a hearty, spiced tomato sauce. Spices can vary, but we like the combination of garlic, cumin, and smoked paprika. If you don't like it hot, omit the chili flakes.

Use long grain brown rice that has been cooked and cooled, or you can use pre-cooked microwave brown rice instead.

SERVES 6

1kg mature potatoes well washed and cut into 1cm cubes 2 tbsp olive oil 1 medium onion, diced 1 red capsicum, seeded and diced 4 garlic cloves, finely chopped 2 tsp smoked paprika 1 tsp cumin ¼ tsp chili flakes (optional) 1 can whole peeled tomatoes 120g bag of baby spinach leaves 6 large eggs 1 tsp salt Pepper to taste 1 small bunch fresh parsley, chopped (optional) Cook chopped potato in a microwave proof dish in microwave for 10 minutes on high. Heat olive oil in a large sauté pan on medium heat. Add the chopped capsicum and onion, and cook for 5 minutes or until the onion becomes translucent. Add garlic and spices, and cook another minute. Pour the can of tomatoes and juice into the pan, and break down the tomatoes using a large spoon. Add spinach leaves, pushing down into your tomato mixture. Season with salt and pepper, and bring the sauce to a simmer. Stir in the partially cooked potato. Use your large spoon to make small wells in the sauce and crack the eggs into each well. Cover the pan and cook for 5-8 minutes, or until the eggs are done to your liking. Garnish with chopped parsley. PER SERVE | CALORIES: 1220kJ (291cal) | PROTEIN 14.7g | FAT 12.3g (SAT FAT 3.2g) | CARBS 25.2g (SUGAR 9.1g) | SODIUM 343mg

SERVES 4

400 grams smoked fish, cooked and flaked (warehou or hoki work well, as does tinned mackerel) 2 tsp olive oil 1 tsp mustard seeds (optional) 1 tsp ground turmeric 2 tsp curry powder, mild or hot to your taste 2 cm fresh ginger, peeled and finely grated 1 clove of garlic, crushed 6 spring onions, chopped 8 cherry tomatoes, halved 1 red chilli (optional), finely chopped 50 grams frozen peas 1 cup wholegrain rice or basmati, cooked and cooled (follow cooking instructions on rice packaging) 2 tbsp fresh coriander leaves, chopped 4 eggs, hardboiled and halved ¼ tsp freshly ground black pepper On a medium heat, heat the oil in a large non-stick frying pan. Add the mustard seeds, stirring and cooking until spluttering. Add the turmeric and curry powder, stir well, then add the spring onions, cooking until softened. If using fresh chili, add at this point. Add the ginger and garlic, cooking until fragrant. Add the cherry tomatoes, and fry over medium heat for 2 minutes, stirring. Tip the pre-cooked rice or microwave rice into the frying pan, and stir to incorporate the spices and onions. Add fish and combine. Add peas, chopped coriander, freshly ground black pepper and mix well. Continue to heat on medium-low until the fish, rice, and peas are heated through. Serve topped with halved eggs and a few sprigs of coriander. PER SERVE | CALORIES: 1460kJ (349cal) | PROTEIN 41.2g | FAT 9.4g (SAT FAT 2.4g) | CARBS 21.1g (SUGAR 3.4g) | SODIUM 312mg

DIABETES WELLNESS | Winter 2022

Life with T1

TYPE 1 AND TRUE GRIT Team sports have always been central for rising rugby star Layla Sae. Her type 1 diabetes is something she manages on the side – her ‘normal’.

DIABETES WELLNESS | Winter 2022

hen we spoke to Layla for this article, at her home in the Manawatū, she had an hour to spare between her job and her training, and she was about to head off, the next day, to the Black Ferns camp. The Kiwi Sāmoan 21-year-old isn’t counting on selection for the team this time – ‘I’m one of the newer players’ – but her goal is to wear that black jersey. Last year, during the provincial season, the Black Ferns posted a video on their Facebook page of Layla playing for the Manawatū Cyclones, with the comment ‘Layla Sae – remember the name’. Layla is unfailingly modest about her achievements but admits that was exciting.

‘I like to try a bit of everything, and if I’m good at it I just give it my all.’

EARLY YEARS

Layla was diagnosed with type 1 just after her fourth birthday. She says, ‘I guess the silver lining is that I don’t remember what it was like not to have it. It's basically my normal.’ Sports were another normal in her household. ‘My mum and dad were always doing something active. Mum played netball, and Dad was always watching rugby or playing it.’ Layla showed talent and determination early – winning cross-country races and triathlons at primary school. Club soccer was the first team sport she threw herself into. ‘Mum made sure my numbers were good before I played and that my blood sugar wasn’t going to be too high or too low. She made sure I always had sugar on me, just in case. There are times when you get sick of diabetes, but having the support of my family, and especially my mum, just makes it that much easier.’ Layla’s mother, Tracy Black, already knew a lot about type

1 when Layla was diagnosed, as her oldest and best friend, Melanie Cooper, who is also Layla’s godmother, has the condition. For Layla, having an adult in her life with type 1 who she was close to made a difference. ‘Sometimes when we were together, or I’d stay at her house, we’d do our numbers together – and she would understand.’ TRYING EVERYTHING

After soccer, Layla turned her attention to other sports. ‘I like to try a bit of everything, and if I’m good at it I just give it my all.’ Her ability to throw herself wholeheartedly into seemingly any sport has seen her play at the highest levels, often internationally. Basketball took her to Australia. She was selected to play in the Under-19 Z-Air Māori Volleyball team, which travelled to Manila, Philippines, to compete in the Rebisco volleyball competition. And, in 2019, she was in South Africa for the Under-21 Indoor Netball World Cup, where her team

picked up the gold medal for six a side and the silver for seven a side. ‘My favourite sport’s probably volleyball,’ she says, ‘because I did that from Year 8 to last year. That’s the one I know the most about and I feel the best at, but rugby is taking off more in New Zealand, so I thought I’d give my all to that and see where that takes me. ‘There’s a little bit more support for it, and there are more girls that can play rugby at a higher level. So that helps.’ As a contact sport, rugby is slightly different to the others. ‘I've got a pump. You can't wear the pump during the game. With other sports, I could just tuck it away. I think that's the only difference. Other than that, it’s pretty simple. Just do your numbers before, at half time, and afterwards, and correct it from there. ‘Because I've been playing sports for so long, that's just normal for me now. The testing and correcting – it's my routine since I was little.’ It’s such an unobtrusive part of her playing that sometimes team

DIABETES WELLNESS | Winter 2022

FAMILY SUPPORT

Layla’s mother Tracy still does her best to come to national games where Layla’s playing, and, when it comes to international tournaments, Tracy is always ready to help with any extra admin, including getting letters from doctors to make sure Layla can take her needles and pump overseas. ‘Other family members know the basics. Sometimes they’ll ask, have you tested today, all that, but they don’t know every little detail. They’re really supportive, too, though, and do what they can …

‘In normal daily life, you might say to someone, “I’ve got your back.” But on the field or court, you actually show that.’

mates haven’t even realised she has diabetes: ‘Girls that I've been playing with for, like, two years … I do my finger prick test, and they say, “oh my gosh. What's that?” ‘I say, “I've got diabetes.” ‘They say, “No way. I didn't know you had diabetes!” ‘I don’t really tell people; they just find out. But they don't treat me any different. They know I've got it under control.’

DIABETES WELLNESS | Winter 2022

offer me lollies if I need it!’ Layla uses Mentos now for hypos. ‘I have Mentos all the time. I got sick of eating jellybeans. I was, like, please no more jelly beans! But I like Mentos because of the different flavours and the little packets. Those are good to carry round.’ A PASSION FOR FASHION

As well as sports, Layla loves clothes. She says modestly, ‘I don't really know how to sew that well, though.’ Still, when the opportunity came up to enter the 2018 Wearabull Arts Awards in Bulls, after the local Pasifika Fusions Wearable Art competition, she thought, ‘I want to make something but what's another way I can do it?’ After some research, she came up with an ingenious idea for a white plastic-bag ball gown. She was still at school then – St Peter’s College. ‘I got everyone to donate plastic bags. I put it in the school newsletter – if anyone

TEAM SPIRIT

What is it that draws Layla so strongly to team sports? She says, ‘I think it's the connection you have with the players on the field or on the court. ‘In normal daily life, you might say to someone, “I’ve got your back.” But on the field or court, you actually show that. ‘Especially on the rugby field – you make a tackle for your friend that's next to you, or you run the ball hard, so you can give it off. You put those words into action. The connection with your teammates is something that’s really cool. Really special.’

PUSHING THROUGH ANYTHING

In September last year, Layla broke her ankle playing rugby but was determined to try and recover for the 2022 Super Rugby season. She kept training, cast and all, and this year was selected for the Hurricanes Poua squad to play in the firstever women’s Super Rugby Aupiki competition. Covid-19 affected the season – with every team dealing with cases and contacts who needed to isolate. One match even had to be cancelled. Typically philosophical, Layla says, ‘It was a little bit annoying, but it is what it is.’ It’s the same attitude she brings to diabetes: ‘I think I’m pretty relaxed with my diabetes. My mum would probably say sometimes too relaxed! But I just think of it as whatever happens happens, and you have to deal with that and change things when you can.’ What’s next for Layla Sae? ‘I definitely want to wear the black jersey. That's the main goal for me.’

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

has any spare plastic bags, can I please have them?’ To the pride of her school art department and Pasifika group, Layla’s gown placed second. ‘I do like wearable arts,’ she says, ‘but I just haven’t had time to get back into it. But I’d like to do more. Sport is the main thing that I do.’

MY DIABETES JOURNEY… A FRIEND IN YOUR POCKET!

Care

SELF MASSAGE

for numb feet

Peripheral neuropathy – loss of feeling in hands and feet – is a complication of diabetes and kidney disease. Tracey Drinkwater from the Auckland Kidney Society suggests self massage with a foot roller.

racey says, ‘Neuropathy and nerve damage in the feet are debilitating. They restrict people exercising; it restricts their independence.’ Tracey runs the Kidney Society’s Wellness Programme, which supports people with end-stage kidney conditions to improve fitness, strength, mobility, and general wellness. One of the many things she does as part of this is help clients who have neuropathy to find affordable, accessible ways to try to bring back a little feeling in their feet. She makes a simple piece of equipment for them – a foot roller. ‘It’s a piece of PVC pipe, about 30cm long and about 4cm wide. We have a little garden tie tied through it. And when clients are sitting down, they just give their feet a massage.’ She says it’s especially good for clients with low mobility: ‘It's a

COMPETITION – WIN A FITBIT SENSE The Fitbit Sense allows you to manage stress with an innovative EDA sensor and put heart health first with an ECG app. Fitbit are giving away two of these advanced health smartwatches – which retail at $469.95 – to Diabetes NZ members. To find out more about the Sense see www.fitbit.com/global/nz/products/ smartwatches/sense. To enter the draw to win, put Fitbit Sense in the subject line and email your name, phone number and postal address to draw@diabetes.org.nz. Or post to: Freepost Diabetes NZ, PO Box 12-441, Wellington 6144. Competition closes 1 June 2022.

DIABETES WELLNESS | Winter 2022

nice passive way to do a bit more leg movement as well, but it massages the feet and increases the circulation. You can do both feet. It's very easy. With the garden tie, it’s like a dog on a lead, so, if it rolls away, you can pull it back. ‘That’s also useful for people with vision impairment, which can be another big issue.’ She says, ‘It feels nice on your feet whether you have a little bit of, or a lot of, neuropathy. For those with a lot of feeling loss, they may not feel it very much when they first start doing it, but, if they do it regularly, they quite often find that within a few weeks they start getting a little bit of sensation. ‘I had a client whose kidney transplant had stopped working earlier this year, and she’d become quite unwell. She’d lost all sensation in her feet and, within two months, using the foot roll, as well doing a series of exercises,

A gift of a lifetime she got sensation back in her feet. And now she's doing driveway walks. Her goal is to get back on the transplant list for another transplant.’ Tracey sends the rollers out to clients as part of a larger wellness pack, but she says anyone can make these foot rollers at home – or improvise. ‘During level 4 lockdown last year and the year before, I couldn't send the packs out, so I was getting people to use things like fly spray cans, rolling pins, all different things, until we could actually get these sent out. ‘Just remember to ensure that whatever you use is smooth and there are no sharp edges that may cause damage to the skin on your feet. ‘As I explain to clients, exercise is your body's way of increasing circulation to the area you're moving.’

THE KIDNEY SOCIETY WELLNESS & EXERCISE YOUTUBE CHANNEL

The Kidney Society has a long-term goal of creating an accessible online video series full of renal-friendly exercises. Tracey says, ‘Covid put a hold on our project, but the good news is we’re finally heading to the recording studio in early May and hope to have it up and running by the end of June.’ Keep an eye on Diabetes NZ social media or the Kidney Society website for more info: www.kidneysociety.co.nz

Every day, an average of 40 New Zealanders are diagnosed with diabetes. A gift in your will is a powerful legacy to ensure your desire to help and support people with diabetes lives on. No matter how big or small, your bequest will make a world of difference in helping Diabetes New Zealand to support the 250,000 New Zealanders with diabetes to live full and active lives.

For a confidential discussion, please contact Nicky Steel info@diabetes.org.nz or 04 499 7145

Life with kidney disease

In writing about her twin journeys – with type 1 diabetes and kidney disease – Ana Hutchins inspires and encourages others, and releases some of the burden for herself.

ANA HUTCHINS OPENING UP TO HELP AND HEAL

na looks back to when she first decided to start sharing her story: ‘It all started when I was on maternity leave with my first child. I wasn’t used to the slower days – I needed a project. I have a love for words, and people were always captivated by my diagnosis story, so I thought, why not use this time to write a book about it? ‘That process was overwhelming, so I turned it into a blog. Writing shorter snippets of my story was more enjoyable. ‘That led me to Instagram, where I stumbled across the type 1 diabetes community. I knew right away that I’d found the perfect platform to share my story. Everyone in that community is so inviting. I love the interaction, and we all learn so much from

DIABETES WELLNESS | Winter 2022

each other. It’s such a positive space, where I’ve gained confidence in myself as a diabetic, a woman, and a mother, as well as the confidence to be able to openly and honestly share more and more of my life while navigating type 1. I’ve also made lifelong friends along the way – the biggest reward of it all.’ Ana believes it’s vital for there to be people publicly sharing their diabetes stories: ‘It’s important to acknowledge the heaviness, so no-one ever has to feel like they’re alone. I like to be the voice that others can resonate with. Type 1 diabetes is an invisible illness. We look absolutely fine on the outside, but inside is another story completely. ‘I hope to resonate with youth and teens the most. It’s such a tough gig navigating those tender

years, going through puberty, trying to discover yourself and fit in with your peers, and, at the same time, trying to juggle everything type 1 throws at us. ‘I also always acknowledge the parents and caregivers of children who have type 1. When your child goes through anything in life, a parent feels it twice as much. Parents carry that burden for us so we don’t have to, and, at times, it can feel like a thankless job. I just want everyone dealing with type 1, whether it’s themselves or a loved one, to feel seen and heard. I hope that my posts can lessen some of the heaviness, even if it’s just in that moment.’ Ana says the greatest highlights of her writing journey are often the messages she receives from parents, thanking her for sharing

My Identity

is proud to create

her story and showing their type 1 children that normal lives are possible. ‘It’s a humbling feeling knowing I’m providing value to so many. I believe this is my purpose in life. To share what I’m going through to help others.’ MEMORIES OF DIAGNOSIS

Ana was 11 when she was diagnosed with type 1: ‘Looking back, I had the classic symptoms: weight loss and excessive thirst. I fell ill and was misdiagnosed with tonsillitis. I deteriorated rapidly and started falling in and out of consciousness. After that, I was taken straight into ED. ‘From then, I can only recall snippets. I remember hearing the word “diabetes”, and I knew what that was, thanks to Stacy from The Babysitters Club books. I was continuing to fall in and out of consciousness, and when I woke again I was in our hospital’s ICU surrounded by all of my family. ‘I was so sick that my veins had all sunk. I was begging for a drink. so the doctors bribed me with a piece of ice if they could try new places on my body to get a line in.’ ‘When I woke again, I was in the ICU at Starship Children’s hospital. I’d been put on a child flight and flown there for urgent specialised care. I spent seven days in hospital learning everything there was to know about how to manage my new diagnosis.

‘There was no fancy technology back then, which meant no real flexibility in the management. I was told to always eat 60g of carbs for breakfast, lunch, and dinner, and 15g carbs for snacks in between so that I could have the same amount of insulin each time. Mind blowing when I think back now. ‘My mum would have to prick my finger every few hours overnight, and she’d pray that I was in range so she wouldn’t have to wake me with jellybeans and toast. Apparently, I wasn’t the nicest person to wake up overnight. (Sorry, Mum!). ‘One day before I left hospital, they purposely let my blood sugar go low so I’d know the feeling and how to treat it. I was nervous and wasn’t sure what to expect and then it happened, and the feeling was so familiar to me… I’d been low countless times before but never told anyone because I was unaware what it was. I’d just have this overwhelming feeling of needing to eat everything in sight and thought I must have just been super hungry. I told the doctor right away, and they said I would have had diabetes long before diagnosed, which came as a shock.’ PREGNANCY AND KIDNEY DISEASE

In her early 20s, Ana travelled for six years. ‘Those were the days where I hated my diabetes the most. I was experiencing the

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wonders of the world, living my best life, all the while putting my diabetes on the back burner and causing major damage to my body.’ When she returned to New Zealand, she found herself dealing with two major life changes at once. ‘I fell pregnant, and that’s when I was told of my kidney disease. ‘I had an extremely tough pregnancy, as my body was not in the best condition and I was in denial about my kidney disease.’ Ana was told her baby might not make it. ‘It was really awful, but I trusted my body and felt, in my soul, it was meant to be. I delivered at 33 weeks, and, although early, he was absolutely perfect. I believe he was sent to me to change my life around for the better. ‘From that moment on is when I really started taking care of myself, my diabetes management and taking a proactive approach to my new-found kidney diagnosis. I not only had myself to live for now, but a little boy who needed a mum. A healthy mum. ‘Unfortunately, during my pregnancy with baby number two, my kidneys lost further function. I delivered early again – at 32 weeks – to another beautiful baby boy. ‘During the months right after delivery, I was monitored extremely closely. My kidneys never gained back any more function like I’d hoped they would once they were relieved from the stress of pregnancy.’ Ana now feels she is caught in a kind of limbo with her kidney disease, waiting to see what happens next. She says, ‘There’s nothing that can be done until we can determine a pattern … which way my kidneys will go and at what rate. It’s the waiting that I struggle with the most.’ She says her biggest fear is dialysis. ‘I’d prefer to skip that part altogether and go straight to a transplant with a live donor, but,

DIABETES WELLNESS | Winter 2022

unfortunately, things don’t work like that.’ If and when that happens, ‘I’ll also have an option to get a double pancreas/kidney transplant, which would mean no more type 1 diabetes! Sounds like a dream, right? In all honesty, I’m unsure how I feel about it. ‘Diabetes is all I know, and the thought of a double transplant frightens me. I would need some serious therapy to get my head around not being diabetic anymore. I get anxiety already just thinking about going to sleep without knowing what my blood sugars are doing. ‘For now, I’m trying to take each day as it comes and enjoy every moment before the heavy stuff starts.’ DEALING WITH EVERYTHING AT ONCE

As a hands-on parent who has both kidney disease and type 1 diabetes, Ana has a lot to deal with. Support has been crucial. ‘I was given advice from my boss when I had my first baby – “Go where the need is most”. My work is unbelievably understanding when it comes to my health and my family needs, which I will forever be grateful for.’ As well as external support, she has built her inner resources. ‘I’ve had to learn different ways to cope that work for me during those hard times. I believe opening up more with how I’m feeling, and being vulnerable with everyone around me, certainly helps lessen the mental heaviness of it all.’ ‘I went through a really rough patch mentally last year trying to cope with the burden of it all and show up for everyone else when I could barely show up for myself. Plus the country was in lockdown, which definitely didn’t do my mental health any favours. ‘It all got too much, and I found myself pushing everyone around me away. I thought I had to go through

that hard patch on my own because I felt misunderstood. But the truth was, I wasn’t actually talking in the first place to give anyone the chance to understand me. It felt like I was in this vicious cycle with myself. I’d never experienced anything like that before, so I was struggling to identify it. ‘I’ve found that writing everything down helps with the mental load of it all. Getting it all down on paper and out of my head makes a big difference. ‘I always feel a little lighter once I write. The bonus is that hopefully others in my situation find it and they feel less alone too. Our minds can take us to some pretty dark places at times, and it can be lonely. ‘I now make sure I take time for myself. I’m in love with mornings, and I always wake well before my family just to be able to sit in the calm with just myself and a coffee. ‘I also like to work out and run. In fact, I solve many of my problems while running! I’m consciously teaching myself to live in the moment and soak up all the magic that this life has to offer me.’ WHAT NEXT?

Above all, Ana wants to encourage young people to take control of their diabetes: ‘I would love to create a safe space where I could mentor our youth to help guide them and build self-confidence around dealing with type 1 mentally. This is in the hopes that they never have the “it would never happen to me” mentality, and that they’re proactive in their management to avoid the long-term complications. ‘I used to hide my diabetes. I was embarrassed. I didn’t want to be different. If I’d had a “me” to look up to when I was that age, I believe I’d be telling a completely different story today.’ Ana shares her stories here: www.facebook.com/typeonekiwi www.instagram.com/t1.kiwi

CARE

Are you getting the 200 insulin pen needles you’re entitled to? It recently came to our attention that some people on insulin therapy have been having trouble accessing their full three-monthly supply of 200 insulin pen needles. Diabetes NZ member Barrie Hart set out to understand why.

harmac recently increased the number of subsidised insulin pen needles that those on insulin therapy can access every three months – from 100 to 200 per three-month period. Many had been struggling to make a single box of 100 needles last the whole three

months. They'd either had to change needles less frequently than is ideal or fund more needles themselves. The change to an allocation of two boxes of 100 every three months was welcome. However, there has been a degree of confusion around dispensing, and some people, such as Barrie Hart, were struggling to access both boxes. Barrie says, ‘The chemist required a separate script for the second box, but this began to result in the script being cancelled for whatever reason.’ Barrie made contact with Pharmac directly and found out what the issue was. The subsidised boxes of needles are available only for patients who are using insulin. Therefore, in order for needles to be dispensed,

they must be prescribed on a document that also states the patient is using insulin. That means either: • both boxes of needles must be prescribed on the same prescription as the insulin, or • a prescription that is for needles only must be annotated by either the health professional who prescribes them or the pharmacist who receives the prescription. (A pharmacist who knows that the client is on insulin therapy should be able to do this.) Pharmac suggests that anyone who is having trouble accessing both boxes of needles they’re entitled to should talk to their health professional or pharmacist about this. Thank you, Barrie, for sharing this.

NOURISH YOUR FAMILY THIS WINTER

EAT WELL LIVE WELL

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

DIABETES WELLNESS | Winter 2022

Community

DIABETES WELLNESS | Winter 2022

On 2 April, Hamilton 17-year-olds Jack Murray-Griffiths and Vincent Gordon set off on a month-long journey, cycling the length of the country to fundraise for Diabetes NZ.

JACK AND VINCENT’S GREATEST RACE (SO FAR!)

ack has type 1 diabetes – he was diagnosed just before his seventh birthday. He and his best mate Vincent are no strangers to long cycle trips, but this challenge – from Cape Rēinga to the Bluff – was beyond anything they had done before. It would be a challenge for anyone, they note – with or without type 1! Once they decided to do it, though, there was no stopping them. Jack says, ‘We’re pretty much always on our bikes – or planning the next great attempt. After we did a trip cycling from Hamilton to Wellington, we knew we could do something bigger. With that thought in mind, we decided: why not do it in support of an organisation that has helped me so much?’ Jack had a Dexcom G6 CGM to help him manage his blood glucose on the trip, and he used it with his pump. Making plans to stay safe was vital for everyone, so Jack and Vincent wore trackers so their parents could see where they were at any given time. Meanwhile, Vincent has always been well versed in what to do if Jack has a hypo.

OVERWHELMING SUPPORT

Along the way, the friends say they’ve met a lot of wonderful supporters. ‘Northland people are super friendly!’ says Jack. ‘And thank you to all the people who gave us free accommodation, like Dave from Dave’s Diving in Kaikōura and Lisa from Waterfront Hotels in Blenheim, who provided five-star accommodation and beautiful meals. Neither of them had ever met us, but they, and others, went out of their way to care.’ Five-star accommodation was rare, of course. Most of the time the duo couch-surfed with friends or camped. Jack’s auntie, Sarah Wells, volunteered to publicise their campaign – running their Givealittle, their Instagram, and a Facebook page with all their updates. Through social media, love and encouragement poured in for the duo. Sarah was also always there to speedily field questions from media as well as supporters. She says, ‘Living in Whangārei meant that I wasn’t actively involved in Jack’s life, day to day. So when Jack mentioned this plan to me, I was all over it. It's been great for Jack and me to bond through this.

‘It’s actually made me really proud and excited for Jack’s future, because, if this is what he can achieve at 17, imagine what he’s going to do with the rest of his life.’ RESULT!

From the start, Jack and Vincent set a cracking pace. By their ninth day, they were at National Park. They realised then that they could avoid hanging around doing nothing for two days in Wellington if they pulled out all the stops to get to the capital in time for an 8.45am ferry to Picton on day 10. That’s exactly what they did – starting at 7am and riding for 19 hours. They made it to Wellington at 2am, caught the ferry little more than six hours later, and arrived in Picton three days ahead of schedule. After catching up on some sleep there, there was no stopping them. They continued to push themselves beyond their original schedule and reached Bluff a full seven days earlier than they’d planned. That wasn’t the only way they exceeded expectations. Their fundraising target had been $10,000. In the end, they raised an amazing $11,510 for Diabetes NZ, given by 230 generous donors. What an incredible effort.

DIABETES WELLNESS | Winter 2022

Research

RESEARCH ROUND-UP GLOBAL PREVALENCE OF DIABETES

The International Diabetes Federation (IDF) regularly publishes the IDF Diabetes Atlas, containing updates on the global diabetes situation. The 10th edition provides global, regional, and country-level estimates of diabetes prevalence and health expenditures for 2021 and projections for 2045. Reviewing and analysing multiple sources, the IDF found that more than half a billion people aged 20 to 79 are living with diabetes worldwide – that means that over 10.5% of the world’s adult population now has this condition. That figure is projected to rise to 12.2% (783.2 million) in 2045. The IDF found that, globally, diabetes prevalence was similar in men and women and was highest in those aged 75–79 years. It was estimated to be higher in urban (12.1%) than rural (8.3%) areas and in high-income countries (11.1%) compared to low-income countries (5.5%). The report says the greatest relative increase in the prevalence of diabetes between 2021 and 2045 is expected to be in middle-income countries. Global diabetes-related health expenditures were estimated at US$966 billion in 2021 and are projected to reach US$1054 billion by 2045. Find the full report at https://idf.org/e-library/epidemiology-research/ diabetes-atlas.html

DIABETES WELLNESS | Winter 2022

THE IMPACT OF DAILY STEPS ON DIABETES

A Swedish study has assessed associations between total steps per day and diabetes onset in older women. The researchers followed 4838 women with an average age of 78 and who did not already have physician-diagnosed diabetes for up to 6.9 years. It also tracked their daily steps. Of those women, 395 developed diabetes. The researchers found that, on average, participants took 3729 steps per day. They found that more steps per day were associated with a lower risk of diabetes developing. They also found that higher-intensity steps seemed to lower the risk more than lightintensity steps. The researchers conclude, ‘This evidence supports that regular stepping is an important risk factor for type 2 diabetes prevention in older adults.’ For the full article, see doi.org/10.2337/dc21-1202

We bring you some of the most recent research into type 1, type 2, and gestational diabetes.

BARIATRIC SURGERY AND CANCER INCIDENCE IN THOSE WITH DIABETES

A further Swedish study notes that bariatric surgery has been shown to reduce cancer risk in patients with obesity, but the effect of bariatric surgery on cancer risk in patients with both obesity and diabetes is less studied. Therefore, they examined the long-term incidence of cancer after bariatric surgery in a cohort who also had diabetes. They say their results ‘suggest that bariatric surgery prevents cancer in patients with obesity and diabetes and that durable diabetes remission is associated with reduced cancer risk.’ For the full article, see https://doi.org/10.2337/dc21-1335

DIABETES AND THE MILITARY INVASION OF UKRAINE

An article published in Diabetes Care, in late February 2022, highlights the impact of global conflict on diabetes. The authors report, ‘In some southeastern cities, such as Mariupol, people have been facing critical shortages of food, water, and life-saving medicines, which were aggravated by the blockade of humanitarian convoys trying to reach the region with supplies … ‘In the middle of this social and humanitarian crisis, patients who have chronic diseases perceive health resources deteriorating

at an unprecedented rate, raising concerns about their sustainability. For people living with a disease as prevalent as diabetes, the scarce access to essential health resources is even more worrisome. ‘According to the International Diabetes Federation Atlas, there were about 2,325,000 inhabitants with type 2 diabetes in Ukraine in 2021, representing a prevalence of 7·1%. For type 1 diabetes, around 6700 children and adolescents had the diagnosis in the past year.’ The authors say that different domains of diabetes care are potentially affected: ‘First, some infrastructures such as deliveries and pharmacy services have been disrupted, resulting in shortages and rationing of insulin and supplies for blood glucose control.’ The report also states that, ‘The military conflict brought the need to reallocate resources to support victims of the war, overloading the health system, and making it difficult to predict the availability of care, if care became necessary.’ As well as this, ‘the disruption of food distribution is potentially serious for these patients, who are at risk of hypoglycaemia without proper meals’. And lastly, ‘the effect on these individuals’ mental health is immeasurable.’

The authors say, ‘This is a moment of solidarity and empathy with the people of Ukraine, especially for those living with diabetes. While we wait for negotiations and diplomacy, we need strategies to help these patients in a timely fashion.’ There has been help and support: ‘Groups led by peers with diabetes from neighbouring countries have been mobilising online to get donations of insulin and supplies for the Ukrainian population, but the uncertainty of how long this confrontation will last makes it difficult to estimate whether these efforts will be enough.’ The authors say, ‘Robust strategies need to be developed so that, in similar situations in the future, there is a clear and effective action plan to support patients with diabetes.’ They add, ‘It is hard to believe that, just after celebrating the 200th anniversary of the discovery of insulin, we find ourselves in a situation in which insulin is scarce in Ukraine, for political reasons. We hope that, at least in this battle, diabetes treatment will win.’

GESTATIONAL DIABETES AND RISK OF TYPE 2

A United States study assessed pregnancy histories in 50,884 people and found that a history of one or more pregnancies with gestational diabetes predicted elevated age-specific risk of type 2 diabetes six to 15 years after an affected pregnancy. They also found that risk increased steeply with each additional affected pregnancy. In those who had gestational diabetes, the risk of type 2 diabetes remained elevated for more than 35 years. However, with each passing decade, the risk did lower, with an estimated 24% reduction per decade. The researchers conclude that people with a history of gestational diabetes mellitus should be screened regularly for type 2 diabetes, even late in life. For the full article, see https://doi.org/10.2337/dc21-1430

For the full article, see doi.org/10.1016/S0140-6736(22)00480-9

DIABETES WELLNESS | Winter 2022

Move

MOVING THROUGH WINTER Chilly temperatures, shorter days … Staying active through the winter months can feel tough. Here are some tips.

xercising in winter is good for your mind as well as your body. And if you have seasonal depression or find the shorter, greyer days affect your mood in any way, know that even just a little bit of exercise can help with that – indoors or out. Outdoor exercise will give you the extra mood-enhancing benefit of some sunlight (even if it’s filtered through clouds!). But if heading to the pool or a gym is more appealing – go with that.

DIABETES WELLNESS | Winter 2022

STAYING SAFE IN THE WEATHER

Walking or running during winter can sometimes end up being more enjoyable than doing it in the blazing heat of summer, so make the most of that. Just take a few extra precautions: • Check the forecast before you go. We all know that Aotearoa's weather is notoriously unpredictable. You don’t want to go out in an icy wind, be caught in a downpour or without the right gear, or end up on a dangerous, icy surface. • Do think about drastically shortening or even skipping your outdoor exercise in extreme weather. • If you’re out in wintry weather, let someone know your exercise route and your expected return time, just in case something does go wrong.

• Watch out for signs that it might be too cold to be out – if you’re shivering or your teeth are chattering, you’re too cold! Call it a day and go get warmed up. LAYER UP

Exercise warms you up, but when sweat evaporates from your body, it cools you down again, and – when the air is cold – you can easily get chilled. The secret to dressing for outdoor winter exercise is in the layers. If you layer up, you can take off some clothes as you sweat, and put them back on as soon as your body temperature feels back to normal. (Don’t wait till you’re actually cold.) This is an ideal basic set of layers: Layer 1 Something made of synthetic material, such as polypropylene, that draws sweat away from your

body (not cotton, which soaks up your sweat and stays damp). Layer 2 Something insulating, such as fleece or wool. Layer 3 Something waterproof but breathable. Experiment though. Everyone’s body temperature systems are different, so go on shorter walks or runs to start with, and see what works for you. The intensity of your exercise and whether you stop and start a lot or not will also affect how many layers you need. You may well need more than three. HEAD, HANDS, AND FEET

Remember your extremities: • A hat is important in the cold or, at the very least, a headband to stop your ears getting too cold. • Breathing in cold air can be painful, so consider a scarf around your mouth and nose or a mask. • Gloves or mittens for your hands are essential in winter – or both. Hands respond well to layers too. A thin pair of gloves made from synthetic fabric with heavier insulating gloves or mittens over the top can be perfect. • Choose footwear with extra good grip in the damp winter months. • Wear thick thermal socks if cold feet are likely to be an issue – and make sure your shoes are big enough to accommodate thick socks.

OTHER IMPORTANT SAFETY POINTS

• If you plan to walk or run before the sunrise or after sunset – especially anywhere near a road – it’s vital to wear reflective clothing. If you don’t have any, a Google or TradeMe search will give you some options. You could also add reflective tape to clothes you already have. Again, when it comes to doing that, Google is your friend. • If you’re walking or running in the dark or the damp, work out your route beforehand, and choose ground that isn’t too uneven and doesn't have unexpected steps or drops. Also make sure you don’t take a route where the ground gets slippery. • If you’re exercising outside in the middle of the day, remember that, especially if you’re fair skinned, you can still get sunburned before or after summer. Consider wearing a good sunblock on exposed parts of your skin. • Hydrate! Carry a water bottle when you exercise just as you would in summer, and be mindful of staying hydrated even when you’re not in the throes of exercise. Sometimes winter makes it harder to notice when we’re getting dehydrated. • Warm up before you go out. The best warm up is movement that’s similar to the kind of movement you’ll be doing while you’re out, but lower intensity.

MOTIVATION TIPS

If the best time for you to exercise is in the morning or evening, but you find the cold and dark of winter are offputting, one psychological trick is to first concentrate on just getting dressed in your exercise gear. Once you’re actually wearing it, it’ll feel that much easier to get outside and go. Another tip is to find a winter exercise buddy or even form a small winter exercise group, so you can help motivate each other. INDOOR EXERCISE

If the warmth of indoors sounds more enticing than the outdoors, or if the weather is too bad to go out, think about a local pool or gym. You could also find a home exercise routine. There are plenty of live online classes or YouTube videos to explore. The motivation tips above are useful for indoor exercise too. Find buddies and/or just focus on showing up for a start, and the rest will follow.

Take care with health conditions If you have asthma, a heart condition, or Raynaud's disease, be sure to stay safe. Check with your healthcare professional about what extra precautions you should take when exercising in winter.

DIABETES WELLNESS | Winter 2022

Community

We catch up with three past interviewees who live with type 1, and ask how life – and CGM technology – is going.

What are they doing now? Nova Moala-Knox

Lily Barton In autumn 2020, Diabetes Wellness readers met young dancer Lily Barton. At 12 years old, she’d just been awarded a Diabetes NZ Nelson Youth scholarship to help her go to Melbourne to compete in the Follow Your Dreams tap competition. Now 15, Lily is still following her dance dreams. She’s juggling dance exams, shows, and competitions around the country (the next is in June, in Blenheim), along with the demands of high school. She still uses a Freestyle Libre to manage her type 1, which her mother Jess says she couldn’t be without. She’s added a MiaoMiao smart reader to it. The MiaoMiao sits on top of the Libre, effectively turning it from a flash glucose monitor (FGM) into a continuous glucose monitor (CGM), sending updates to connected phones every five minutes.

DIABETES WELLNESS | Winter 2022

In 2019, Diabetes Wellness interviewed Nova Moala-Knox, then a 16-year-old aspiring actor. Nova was doing her best to manage the type 1 diagnosis she’d received at 13 and to get through high school. She says she never felt she was academic, but she jumped at every chance she got to involve herself in theatre and film – dreaming, all the while, of one day going to Toi Whakaari: NZ Drama School. At the end of 2020, Nova auditioned for the prestigious school, and was floored to get in on her first try. Now, in 2022, she’s in her second year of a Bachelor of Performing Arts there. She says her first year was tough: ‘Control of my diabetes got harder because of the intensity of the course and the fact that you can’t take much time off class without missing out on important stuff and getting behind. ‘The tutors said that my health was the main priority, but it’s easier said than done. I spent a lot of time with my blood sugar higher than it should have been. It made it hard to stay present in class. ‘This year, I’ve made a pact with myself to make my health a priority, but it’s still hard because the course hasn’t got any less intense. ‘One thing I know I need to do is make sure I step out of class to test and correct as soon as I can

feel myself going high or low. It’s psychologically hard, because I’m still scared the teachers might think I’m slacking off, even though they’re really understanding. ‘I’ve also realised that getting enough sleep is key. High blood sugar through the night or waking up low is exhausting, which affects my performance at Toi. ‘One practical thing I try to do now is eating dinner earlier in the evening, so I have time to make sure my blood sugar is correct before I go to bed. My whole family has to help with that, as everyone in the household tends to have late dinners.' Nova and her family are also looking at whether they can afford to trial a Dexcom or even just add a MiaoMiao to the Libre she uses a lot of the time. The ability to get automatic alerts whenever she's going high or low would make a world of difference. Nova says, ‘I’m hopeful if I can manage my diabetes through the intensity of Toi Whakaari, I can do it anywhere!'

‘Around Christmas, I took up a historical longbow – a learning curve for sure. I’m competing on a national level with it and managed a gold at the National Bow Hunter Tournament. I was so grateful to another archer out on the field with me. Part way through the second day, my bow snapped. Stick bows do that occasionally! But this fellow archer lent me his, and we shot the rest of the competition together with one bow.’

Jill Gillette Diabetes Wellness last caught up with world champion bowhunter Jill Gillette during the first Covid lockdown, when she shared how she and her family were getting through. Looking back, Jill says pre-Covid times feel like a different world. ‘How unworried we all were, back when we could get out and play our sport, travel, and socialise afterwards with friends, without Covid hanging over our shoulders.’ Nonetheless, Covid restrictions haven’t stopped Jill moving into one of her busiest periods ever. ‘I’m making hay while the sun shines,’ she says. But also, ‘As much as I hate to admit it, the type 1 diabetes means I have to be extra vigilant all the time.’ Jill has recently become President of the NZ Field Archery Association – a full-on volunteer role. The association is making a bid to hold a World Bow Hunters Championship in NZ in 2025. ‘There are loads of meetings ahead – prior to even getting an international proposal together.’ She’s also chairing a woman’s division of the International Field Archery Association, looking into ways to increase the numbers of women taking up archery. On top of this, she’s helped set up an indoor archery facility in Pukekohe, started coaching more, and taken up a new bow style.

TRIALLING DEXCOM

Jill says, ‘My 18 year old has moved down to Dunedin for uni, which often leaves me in the house alone at night now. So we decided I’d trial the Dexcom CGM. It’s so damn expensive, but it’s a game changer for my blood sugars. Being able to set alarms that warn me – with plenty of time to halt a blood sugar fall or rise – is keeping me on a fairly even keel. ‘Having the security of going to bed knowing my phone will wake me up if I drop during the night, before it’s actually an issue, is just a good thing. Being able to add my partner’s phone as a second alarm is an extra layer of safety.’ Jill has also taken up beekeeping. ‘For Christmas, my daughter Jorja decided to get me a beekeeping

course. I thought that was a pretty cool gift! Although she said to me a month later, “Bloody hell, Mum, you were only supposed to do the course, not come home with bees!” ‘It’s fun, it’s absolutely fascinating, but it is scary. I’m so worried I’ll get something wrong, or the bees will die suddenly. In saying that, I’ve studied lots, read lots, done a disease elimination course, and feel I’ve got this! ‘Last week, I was out there inspecting the hive, and my phone alarmed that my blood sugar was heading lower than 4.5. ‘At the time, I was holding a full frame of honey, partially covered in bees. The fact that I could have just taken a bite out of the frame and righted myself did cross my mind. But I couldn’t! The bees had spent all that time out gathering it, and it wasn’t their fault I was heading low. ‘I ended up popping inside and ate a few spoons out of the jar in the cupboard.’ Jill is posting about her beekeeping adventures on Instagram: www.instagram.com/ macherie.bees. She says, ‘Every time I go into the hive, I find something absolutely amazing to share. The other day, it was a bee hatching. How beautiful to witness.’

Archery for everyone: Franklin County Archers on the line.

DIABETES WELLNESS | Winter 2022

Advocate

HEALTHY DRINKS IN SCHOOLS – HAVE YOUR SAY Diabetes NZ is excited and hopeful to see the Government responding to calls to allow only healthy drinks in schools. You can have your say on a new proposal from the Ministry of Education.

hether you’re a parent, student, organisation, principal, teacher, or any other interested person, the Ministry of Education invites you to have your say on a proposal for new regulations in schools. If accepted, this proposal would see these regulations come into force at the end of this year. WHAT DOES THE PROPOSAL SAY?

The proposal gives three options for regulation changes: • Option 1: a duty for all schools and kura to promote healthy food and nutrition, and a duty on all schools with students in years 1–8 to only supply healthy drinks to year 1–8 students. • Option 2: The same as option 1, but with an additional duty on all schools (primary and secondary) to only provide healthy drinks. • Option 3: a duty on all schools to promote healthy food and nutrition with no additional duties on school boards regarding the provision of healthy drinks.

DIABETES WELLNESS | Winter 2022

‘Healthy drinks’ are defined as: • plain, unflavoured water; • reduced or low-fat milk; and • unsweetened reduced or lowfat plant based milks (e.g. soy, rice, almond, oat) with added calcium and vitamin B12. TO FIND OUT MORE AND MAKE A SUBMISSION

You have until 2 June 2022 to make a submission. Submissions will inform advice to the Minister of Education on final policy proposals that would be submitted to Cabinet. The full proposal is available at: https://consultation.education. govt.nz/te-puna-kaupapaherepolicy-governance-legislationand-accountability/ promotion-and-provision-healthydrinks-in-schools

Diabetes Youth

LIVE BRAVE MANA ORA

COMPETITION Diabetes NZ was thrilled with the entries we received for our colouring competition celebrating the launch of our rebranded youth programme: Live Brave Mana Ora.

he entries we received were bright and colourful, and we loved the creativity shown by many who added their own detail to the original design – a lot of care had obviously been taken over them. It was a pleasure to receive so many beautiful pictures, which we now have hanging on our office wall. We also received several comments from grateful parents whose children loved the activity. It came in handy for a few who had also been unwell.

0–5 YEARS OLD

Winner: Anaya Sharma, aged 2.5 Honourable mentions: Caylee Zhao and Grayson Hunter

6–9 YEARS OLD

Winner: Ash Leung, aged 8 Honourable mentions: Ashi Sharma and Lilah Rako

10–12 YEARS OLD

Winner: Charlotte Zhao, aged 10 Honourable mentions: Larissa Currie and Jesse Storey

DIABETES WELLNESS | Winter 2022

Care

Covid-19 catch-up As Covid-19 continues to make its impact felt, here are some important ways to keep yourself, loved ones, and your community safe. HAVE YOU HAD A FLU JAB?

It’s important to protect against flu this winter with Covid around too. While Covid and flu are separate viruses, having them both circulating this year is predicted to put extra stress on our hospitals and health systems. Also, no-one wants to catch Covid and flu at the same time. Flu vaccinations are free for: • anyone over six months old with diabetes, asthma, a heart condition, or other long-term medical conditions • anyone pregnant • Māori and Pasifika people aged 55 and over • children aged four or younger who’ve been in hospital with respiratory illness such as asthma • anyone aged 65 and over. If you’re eligible for a free flu shot, contact your GP or healthcare provider to book. Some pharmacies are also doing flu shots for people 13 and over. Ideally, get your flu shot before the end of May to be covered before the worst of the flu season hits. Get your Covid booster shot too

Your third Covid shot, AKA your booster shot, gives you the best protection against the Omicron variant of Covid-19 – the main variant circulating right now. If you haven’t had your Covid booster yet, you can get it at the same time as your flu shot. (Just check beforehand that the place

you’re getting your flu shot from does Covid boosters as well.) If you’re not eligible for a free flu shot

You may want to consider paying for one, if you are able, to help keep yourself and those around you safe. It costs between $25 and $45 depending on where you go. Some employers provide free flu shots for their employees. When not to get a flu or Covid shot

If you’re feeling unwell, delay your flu and/or Covid shot till you feel recovered. CAN COVID-19 TRIGGER DIABETES?

More and more research is showing that Covid-19 is triggering diabetes in some people – this includes both type 1 and type 2. Researchers are working to discover why this is, and there are many unknowns. But we know the Covid-19 pandemic may result in more people with type 1 and type 2 diabetes in our communities. How to help

One useful thing we can all do is help raise awareness of the warning signs of diabetes to make sure those who develop the condition are diagnosed quickly. For both types of diabetes, symptoms include frequent urination, increased thirst, feeling tired and hungry, vision problems, and yeast infections. There may also be slow wound healing. Talk to whānau, family, friends, and workmates about the symptoms and raise awareness if you get the chance. If an organisation you belong to has a newsletter, maybe see whether they’d put in a small piece about the warning signs of diabetes.

Children and teenagers

For children and teenagers, picking up diabetes early is crucial. The poster on the opposite page was developed to raise awareness of the signs of type 1 diabetes. Consider cutting it out or copying it and putting it on a kindy, school, club, community, or workplace noticeboard. There is more information about both types of diabetes at www.diabetes.org.nz. PROTECTING AGAINST LONG COVID

While there isn’t a globally accepted definition of long Covid yet, this is coming, and it’s clear that a portion of people will have lingering clusters of symptoms after a Covid infection (sometimes with a delay after initial recovery). Long Covid varies in its severity and the length of time it lasts. Ongoing fatigue is one of the most common symptoms of long Covid. Research is showing that Covid vaccinations can prevent or reduce the symptoms of long Covid – possibly even if you get the vaccination after you have actually had Covid. The message is clear: make sure you are up to date with all your Covid shots. You can find out more about long Covid at www. healthnavigator.org.nz/health-az/c/covid-19-long-covid Diabetes and Covid-19 For more about diabetes and Covid-19, go to www.diabetes.org.nz/covid19

DIABETES WELLNESS | Winter 2022

Advocate

In 2020, Author, lecturer, and researcher Dr Susan Wardell began a project investigating medical crowdfunding in Aotearoa. She became deeply affected by the stories of young people with diabetes who needed CGMs.

SPOTLIGHT ON

MEDICAL CROWDFUNDING

usan is a senior lecturer in social anthropology at Otago University, with numerous books, articles, and research papers to her name. Some of her main research interests lie in medical, psychological, and moral anthropology. In 2020, Susan was awarded a Marsden Fast-Start grant for her project Medical Crowdfunding in New Zealand: Illness, Giving, and Moral Emotion. For the project, she set out to analyse a range of medical crowdfunding campaign pages, as well as interviewing campaigners and donors. Part way into the work, she began coming across families who were crowdfunding for CGMs for their children with diabetes. She says, ‘I was shocked and heartsore to realise the situation that people with diabetes or who have kids with diabetes are in without these being funded in Aotearoa New Zealand. (They are funded in many other countries.) I decided to direct a portion of my research towards this topic.’ In this research, Susan has been grappling with the many thorny issues around crowdfunding campaigns for medical treatments and technology that should be government funded.

DIABETES WELLNESS | Winter 2022

MOVED TO ADVOCATE

As Susan talked to families of children with type 1, her research interest in the topic grew into a determination to help advocate for CGM funding in this country. At the start of 2022, she wrote an article for The Spinoff about the topic, in the hopes of raising awareness generally about the need for CGMs. The families she’d interviewed for her research were glad to have their stories shared more widely. When it comes to research and advocacy, Susan has also begun exploring the impact of visual art alongside words. In the Spinoff article, she incorporated some of her own illustrations of families with diabetes.

She says, ‘I wanted to convey the real, intimate, human experience of the CGM. With this in mind, I prepared artwork based on real photographs of some of my participants, but done in a way that kept them anonymous. I was honoured that all the participants chose to use their real names in the end.’ You can see some of her beautiful artwork on this page and opposite. She says, ‘I wholeheartedly support Diabetes NZ’s campaign for CGMs to be funded in Aotearoa,’ and she wants to add her voice to the campaign in any way she can.

MEDICAL CROWDFUNDING IN NEW ZEALAND – SOME KEY POINTS Susan Wardell presents a tailored summary of her research findings for readers of Diabetes Wellness.

ogether with my Research Assistant, Laura Starling, I undertook case studies of five New Zealand families who had kids with type 1, aged between two and 15. We ran multiple interviews with the parents and the children. I also analysed 15 Givealittle campaigns and a variety of news articles and social media pages. FINDINGS

Firstly, findings affirmed the benefit of CGMs to individuals and families in terms of not only health outcomes but quality of life. This included better control of blood sugar levels (and so access to a wider range of activities), reduced stress, easier calculations around food and insulin, and peace of mind when sharing care responsibilities with other adults (including at school or childcare). There was also less pain for children from finger-pricking, and there were fewer interruptions to other activities to do this, as well

as better sleep overnight. This was life-changing for many families. Secondly, the analysis highlighted some of the realities New Zealanders are living with, trying to cover the costs of CGM equipment – including expensive sensors that need replacing every 10 days – in the absence of Pharmac funding. The families we engaged with were using a variety of informal fundraising strategies, many reliant on social media. These included Givealittle pages, raffles run via Facebook, and a market business run during weekends and online. Some families had positive experiences with this. They experienced huge amounts of care from both friends and strangers, and formed genuine connections, through the process of fundraising. However, many also faced awkwardness and embarrassment about publicly asking for help, uncertainty and stress while

waiting to see the outcome that their child’s health depended on, and worry over wondering if they could keep this sort of thing up, since the need was ongoing and lifelong. In the end, not everyone was successful, with some making well over $10,000, and others only $400 in a similar time period. The current situation creates significant inequalities in who ultimately gets access to CGMs. This is because these sorts of fundraising strategies depend on someone in the family having the time and skills to put into ‘marketing’ their story online. Outcomes are additionally at the mercy of audiences (mostly their existing social networks), including whether they have money to give and whether they deem the request ‘worthy’ – something that can be clouded by misinformation and stigma around type 1 diabetes. Even the families who were successful at crowdfunding felt that New Zealand people shouldn’t have to rely on these unpredictable and laborious strategies to get access to such an important health tool. Overall, the research affirmed that the push for government funding for CGMs is essential, for health equity in Aotearoa, and a more liveable life for type 1 families. Susan’s Spinoff article: https://thespinoff.co.nz/ society/18-01-2022/meetaotearoas-cyborg-kids

DIABETES WELLNESS | Winter 2022

Nourish

Research over the past two decades indicates that caffeinated drinks impact on diabetes in varied ways.

Coffee, tea, and diabetes

his research is ongoing, but, increasingly, it’s emerging that those living with type 2 diabetes may need to be moderate when it comes to consuming coffee or other caffeinated drinks. As far back as 1967, there was evidence this was the case. That year, a small study of men with ‘maturity-onset diabetes’ reported that just two cups of instant coffee a day impaired glucose tolerance.1 In 2004, a laboratory-based study at Duke University in the US gave caffeine tablets to a small cohort of people with type 2, while another cohort of those with type 2 had placebos that didn’t contain caffeine. Those who took the caffeine tablets showed a greater increase in blood sugar levels after meals than those who didn’t.2 1 2 3 4 5

A further Duke University study in 2008 also used caffeine tablets for one group and placebos for another. This study was not lab based but had participants with type 2 diabetes measure their blood glucose with CGMs as they went about their lives. Those who’d taken the caffeine tablets had higher average blood glucose levels throughout the day, as well as higher spikes after meals.3 A number of other studies over the years also indicate that coffee and/or other caffeine consumption reduces insulin sensitivity. Conversely, some evidence has been accumulated over the years that ongoing coffee consumption may have a small protective effect when it comes to preventing type 2 diabetes developing in those who don’t have it. However, there is a danger in any one-size-fits-all recommendation.

It’s known that, genetically, some people metabolise coffee faster than others. A 2018 clinical trial tested the effect of coffee drinking on people’s baseline blood glucose levels, as well as post-meal glucose levels, and found that the results were very different depending on whether people had a slowcaffeine-metabolising genotype or a fast-caffeine-metabolising genotype.4 CAFFEINE AND TYPE 1

A few studies have shown that caffeine may increase hypo awareness in those with type 1 diabetes – for example, one UK study in 2000.5 However, as good sleep is important in managing diabetes, a result like this needs to be offset against any detrimental effect coffee may have a person’s sleep.

Effect of coffee on glucose tolerance and circulating insulin in men with maturity-onset diabetes, Lancet 1:527–529 https://doi.org/10.2337/diacare.27.8.2047 doi.org/10.2337/dc07-1112 doi.org/10.1017/s0007114518000260 doi.org/10.2337/diacare.23.4.455

DIABETES WELLNESS | Winter 2022

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FIND OUT MORE |

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FreeStyleLibre.co.nz

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

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