Diabetes Wellness Winter 2024 by Diabetes New Zealand

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PICKLEBALL PEEPS • ROSALEA’S RECOVERY • A MASSIVE MIHI TO OUR VOLUNTEERS THE WELLFED CREW • WHAT TO GROW IN WINTER

JESS KERR WHITE FERNS ROLE MODEL

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Contents WINTER 2024 VOLUME 36 | NO 2

4 EDITORIAL

32 28

5 UPFRONT: Pharmac's commitment to CGM 6 LIFE WITH T1: White Fern bowler Jess Kerr 10 YOUR DNZ: Let's hear it for our volunteers

14 COMMUNITY: Volunteer Jeremy Collins 16 MOVE: Pickleball

COVER: JESS KERR © PHOTOSPORT

20 COMMUNITY: WELLfed education programme 24 NOURISH: Seasonal soup

36 DNZ+: DNZ's affiliated organisations

28 ADVOCATE: Karen Reed

37 GROW: Veges for the winter garden

32 LIFE WITH T2: Rosalea Grainger – still standing

38 RESEARCH: A roundup of the latest diabetes research

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Editorial

his month has been one of huge significance for people with type 1 diabetes and their whānau. The Pharmac request for feedback on their proposal to provide funding for CGMs, insulin pumps, and pump consumables for all people living with type 1 diabetes was an opportunity for everyone to have their say. I hope many of you were able to provide feedback, so everyone gets the outcome that works best for them, given we are aware of the concerns in relation to some parts of the proposal. I want to acknowledge all those different groups who have joined Diabetes NZ in lobbying and advocating for this outcome, which is long overdue. It has been a marathon, with lots of petitions, letters to politicians, and advocacy by people living with diabetes, clinicians, and many more to get where we are now. I am pleased that at last there is recognition that putting a fence at the top of the cliff (rather than an ambulance at the bottom) will be a significant benefit to people with diabetes and their families, and reduce the burden on the health system over time. Diabetes NZ is already giving thought to how we can support people with diabetes through the transition. Providers of the equipment will have a part to play, as will the medical profession. We know there are people who have already made the transition, and it would be great to establish a consumer support/mentor network to access as well. Providing support is a significant part of what we do, and we want to do it well. On a different note, Diabetes NZ has also been repositioning itself as a community-centric organisation rather than a health-focused organisation. What do we mean by that? A health-focused organisation is one that dedicates its efforts towards improving health outcomes, promoting wellness, providing health education, and addressing the healthcare needs of communities. In the past, Diabetes NZ used to simply produce pamphlets, provide a helpline, hold support group meetings, and extensively use volunteers to work alongside people with diabetes. A community-centric organisation centres its efforts on the specific needs of communities and works at a local level by directly engaging with these communities to foster empowerment, provide resources, and build resilience. Diabetes NZ has developed a model of care that reaches out into communities in collaboration or partnership with community members. For example, we have partnerships with iwi, Māori, and Pacific health providers and primary health organisations to work alongside their staff and provide support direct to people in the community tailored to the unique cultural, social, and economic contexts of their community. There is demand for what we do, and we are only limited by funding and having enough people to grow and develop this activity. What is pleasing is we know this community-centred model works and improves outcomes for those we work alongside. This model is also more responsive to the needs of the individual and their community. CATHERINE TAYLOR

Board Chair, Diabetes NZ

DIABETES WELLNESS | Winter 2024

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. Across the country, Diabetes NZ has staff and volunteers who help people live well with diabetes. Join us today at www.diabetes.org.nz

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

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

ADVERTISING & SPONSORSHIP Head of Business Development Jo Chapman Email jo@diabetes.org.nz Telephone 021 852 054 Download the Diabetes Wellness media kit: http://bit.ly/2uOYJ3p Disclaimer: Every effort is made to ensure accuracy, but Diabetes NZ accepts no liability for errors of fact or opinion. Information in this publication is not intended to replace advice by your health professional. Editorial and advertising material do not necessarily reflect the views of the Editor or Diabetes NZ. Advertising in Diabetes Wellness does not constitute endorsement of any product. Diabetes NZ holds the copyright of all editorial. No article, in whole or in part, should be reprinted without permission of the Editor.

Upfront

DIABETES NZ WELCOMES PHARMAC’S COMMITMENT TO CGM FOR ALL ‘Life saving and life changing’ is how Heather Verry is describing celebrating an early historic milestone.

he proposal is to fund continuous glucose monitors (CGMs), insulin pumps, and insulin pump consumables for all people living with type 1 diabetes. The current criteria for funded pumps have been reviewed, with new recommendations proposed for the future. The proposal does not include retaining all the current pumps as such. We have encouraged people using these pumps and CGMs to take the opportunity to provide feedback about their concerns to Pharmac as part of the consultation process. While we are keeping some celebrations in reserve for when the Pharmac board officially approves CGMs, we welcome its commitment to provide funding of these devices for people living with diabetes. The Pharmac commitment is a momentous decision and the culmination of many years of advocacy by Diabetes New Zealand. Heather Verry says, ‘CGMs are lifesaving and lifechanging for people living with diabetes. Living with diabetes is a 24-hours-a-day, 365-days-a-year challenge, and this technology helps make that a lot easier. It reduces the daily burden of frequent finger prick checks and means people have to spend less of

‘This is a smart decision that will save the health system billions in the long run’ is how Diabetes NZ Chief Executive, Heather Verry, describes the most recent announcement from Pharmac.

their time just managing diabetes. This can translate to improved mental and emotional health and a better quality of life. ‘It also significantly improves health outcomes and lowers a person’s risk of both short-term complications like hypoglycaemia (low blood glucose levels) and long-term complications, including blindness, heart and kidney disease, and limb amputation.’ Diabetes NZ has been working towards CGMs for all for many years. This announcement will of course benefit the type 1 community, but our commitment to all people with diabetes who are insulin dependent to access this

technology remains. We would like to acknowledge the tireless and powerful advocacy from the diabetes community, including people with diabetes and their families who have worked to advocate for this vital technology. Continuous glucose monitors reduce the need for finger prick checks and give more information to people with diabetes and their healthcare team about glucose trends and how much time they are spending within their target glucose range. You can see more about Diabetes New Zealand’s advocacy for CGM here: www.diabetes.org.nz/advocacy

DIABETES WELLNESS | Winter 2024

PHOTO © PHOTOSPORT

Life with T1

DIABETES WELLNESS | Winter 2024

At 26, Jess Kerr has had more than a few health challenges. She shares coming out the other side as a role model.

OVERCOMING THE DIAGNOSIS

finally got diagnosed with type 1 diabetes. Her symptoms were well hidden behind her passion to become a better runner. She had been training seriously in athletics since age 11, so her family assumed the daily running was why she was constantly thirsty. A random thing would happen during races. Not before or after, but during races, Jess would start vomiting. Her parents assumed this was due to nerves and so sent her to a sports psychologist. But, looking back, Jess believes it was caused by her high blood sugar.

These occurrences thankfully stopped once she was diagnosed. By the time she was 13, the symptoms, however, had ramped up. Each school class would be interrupted with bathroom visits, then she would have to go after each class, and at night she would be up four to five times. ‘Water, or just liquids, became like a drug. Not a want, it was a need.’ And then there was the constant hunger and tiredness. Frustrated by her symptoms, pretending she had a sore ear earned Jess a trip to the family’s

PHOTO © PHOTOSPORT

hite Fern Jess Kerr reckons that, if you’re going to get diagnosed with type 1 diabetes, then 13 is a pretty good age for it. She says, by that age, you’re not relying on your parents quite as much and are old enough to manage the condition by yourself. But if you’re a few years older, then bringing in changes to your lifestyle could be more of a challenge, being older and more set in your ways. Jess was nearing the end of her first year at college when she

White Fern bowler Jess takes another wicket.

DIABETES WELLNESS | Winter 2024

‘I always said I was probably a naturally better cricketer than runner. I just worked really hard at running, and I loved it. All my best friends did it. I trained really hard for it. Cricket, I didn’t love so much. I had the natural talent, but I didn’t love it. Now that’s completely changed. I absolutely love it, but I’m glad it happened in my own time and no-one forced me to do it.’

medical centre, where the nurse twigged what the issue was. It certainly wasn’t a sore ear. ‘She pricked my finger and said, “Cancel your entire week. You’re type 1 and you’re going to have to go into hospital.” And that was a new beginning from there.’ A SHOCK TO THE BODY

The new diagnosis, followed by suddenly having to take insulin, was a shock to the body. ‘I felt awful being in a stable blood sugar range because I was not used to it.’ Blurry vision and migraines weren’t fun, but she says the support team at the hospital was amazing. ‘I remember them saying when I had the first injection, “You’ll know how to do this yourself one day.” And I said, “How am I going to know what to give myself? How am I going to be my own doctor or nurse in a way, prescribing my own medicine?” But I clicked on to it over time.’ Jess recalls the frustrating period when she had to text her nurse or doctor, saying, ‘I’m eating this or that for breakfast,’ and they’d message back with how many units to give. I’d have

DIABETES WELLNESS | Winter 2024

to wait 10–15 minutes before eating. It was quite hard at first because I was so reliant on other people. I think that encouraged me to learn as quickly as possible so I could get back to my old life of being back at school, getting back into running, being active again, and not just being sick and at home and relying on other to help me survive.’ WILL I BE ABLE TO RUN AGAIN?

Coincidentally, Jess’s best friend at school happened to also be type 1, so she says she sort of knew what having type 1 entailed. But the little knowledge she had didn’t stop her asking her diabetes team if it would stop her running. She was relieved when they said exercise is one of the best things for you. ‘So, from that moment I was like, great. I’m going to run again! ‘My first proper long run was on Christmas day. The best gift I could’ve got was having the clearance to actually go for a long run. By March, I ran a Wellington 3K record and won a race. That was a big milestone. I overcame the diagnosis and was

able to compete again, which was really cool.’ OBSTACLE AFTER OBSTACLE

But, as if a diagnosis of type 1 wasn’t enough of a test, Jess has found herself fighting back from a number of serious health challenges: Bell’s Palsy, Endometriosis, Popliteal Artery Entrapment Syndrome (PAES), and Compartment Syndrome. Ironically, it was the Compartment Syndrome that Jess says helped steer her away from running and towards cricket. An injury at 16 started a two-year process to find out what was causing pain in her calves. She used to be able to run for an hour and half, but after the injury all she could manage was five to 10 minutes before the intense pain made her stop. Surgery wasn’t successful, so she went to Australia for Botox injections in her calves, and this is when she received the new diagnosis of Popliteal Artery Entrapment Syndrome (PAES). PAES is a rare condition where the calf muscles squeeze the popliteal artery, which runs through and behind the knee, limiting blood flow to the lower

leg when exercising. Surgery has a high success rate, but Jess says only being able to run short distances, and fast, is not a hindrance in cricket. Jess says, by this time, she knew the cause of the pain, the ‘running ship’ had sailed, and she was in the Wellington Blaze wider squad. Her sister, Melie Kerr, was also playing for them and shortly ended up playing for New Zealand, an appointment that inspired Jess to go down that route. ‘The female game of cricket was rising, and I thought, if I put my mind to it, I can one day represent New Zealand and make a career out of that.’ A QUARTER OF THE TRAVELLING SQUAD

Being a successful cricketer has made Jess not only a role model within her sport but also for diabetes, a role she says she enjoys.

MY DIABETES JOURNEY… A FRIEND IN YOUR POCKET!

‘I’ve noticed of late people who are type 1 come to talk to me. After a game, having that interaction is cool. One girl in Dunedin comes to pretty much every game that the White Ferns play there. I know her face now. At first, I met her Dad and he was saying how it’s great to see you out on TV, doing what you love, and we love that for our daughter who’s type 1.’ When Jess is playing with the Blaze, her Wellington team, she’s not the sole player with diabetes. In fact, she’s bookended by captain, Sophie Devine, and up-and-coming batter Kate Chandler, who both have type 1 as well. Jess says, with diabetes affecting a quarter of the travelling squad, if any of the three are feeling low while training the other two know exactly how they feel. ‘It’s really nice to have that support.’

PHOTO © PHOTOSPORT

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Right arm medium bowler Jess in action.

DIABETES WELLNESS | Winter 2024

Your DNZ

Diabetes NZ relies on a core group of volunteers who help keep our wheels running at family camps, in our offices, and on the ground. Starting from the top of Te Ika-te-Māui, we introduce six wonderful volunteers.

LET’S HEAR IT FOR

OUR VOLUNTEERS

Aucklander SUE PEARSON is our longest-serving volunteer, becoming passionately involved with diabetes since her diagnosis with type 1 in 1989. Now a Life Member of Diabetes NZ, Sue has an impressive resumé, having been Vice President and acting President of Diabetes NZ, as well as time spent as General Manager of the Auckland branch. She has also spent time writing resources and organising youth camps, giving a speech at the International Diabetes Federation Congress in Helsinki, and starting up a support group in Auckland’s North Shore. At its busiest, there were 80 people attending.

Sue has been the coordinator of the daytime North Shore Diabetes Support group for over 33 years and the evening groups for over 18 years. She is passionate about appropriate education for people with diabetes in a language they understand, as well as pushing education away from blame, as she believes it is counterproductive. ‘Blame is one thing I try to protect our members from. I always say, if you go off track with your management, just remember tomorrow is another day. I try and encourage, because sometimes people feel like they’re a failure.’

Sue Pearson.

JOSIAH MATTHEWS has volunteered at the last two summer camps, as well as this year’s teen camp, both in Auckland. Widely appreciated as one of the most liked, bubbly, and outgoing youth leaders, Josiah is encouraging, friendly, and fun, bringing a real spark to camp – an awesome role model for campers. ‘Kia ora, I’m 19, Māori (Ngāti Kuri), I’m in my third year of my carpentry apprenticeship, and I’ve had type 1 diabetes for nine years now. I went to my first camp when I was 10 and absolutely loved it. I didn’t feel alone anymore, and I knew I wanted to keep going back every chance I could get.

DIABETES WELLNESS | Winter 2024

Josiah Matthews with his two younger brothers.

‘Being a youth volunteer is so special to me because I get to share my experiences with the campers and the parents, and offer any help I can. Also, seeing the kids realise that they aren’t alone and watching them make new friends with diabetes is so amazing. It’s not the activities but the connections you make and knowledge you gain at the camps that’s so special. Even I learn something new every time I go to camp.’

RACHEL KITSON has volunteered at the last four family camps for Bay of Plenty/Lakes Youth. ‘I have been a type 1 since 24 August 2009, just after I turned 10. I am almost 25, and the changes I have seen since being diagnosed are mind blowing, not only in the technology but the knowledge and awareness of type 1 diabetes. ‘I volunteer closely with Bay of Plenty/Lakes Diabetes Youth to help run the youth events throughout the year. I help out with the running on the day, including things like bowling, Skyline skyrides, Adrenaline Forest, and more. I enjoy just spending time with the families, chatting to the kids and parents, and being there as support. They can see an adult who has been through what they have been through. They can chat to me, ask questions, and know I can honestly relate. ‘I also attend the annual camps, spending the weekend with families and campers. Being a youth when I was diagnosed, I found these events and camps so important – meeting other type 1s and growing within my personal journey of navigating diabetes. Now that I’m older, I love being there, meeting the youth, and spending time with them. It’s great to be able to give back as a volunteer when I benefited so much from the

support of the youth group when I was younger. ‘One thing I enjoyed most about being a kid at camp was meeting other kids. At my first camp, about seven months after being diagnosed, I met a family who are now my second family. We have grown up together and been through it with each other. The social aspect of being able to feel “normal” and not have to hide the pumps, sensors etc is just a great feeling.’ ROZ WATERS has been a longtime volunteer with Diabetes NZ Nelson Youth in Whakatū and is always ready to jump in with ideas and hands-on help. ‘My eldest daughter Danica was diagnosed shortly after she turned two and is now 20 and studying at Massey University. My youngest daughter Elaine was diagnosed shortly before her sixth birthday and is now 17 and in Year 12. ‘We moved from South Africa, 15 years ago to Greymouth and were hoping to find some other families in a similar situation but only found a lovely group of elderly type 2 ladies. My husband ended up volunteering as the treasurer and helped host a few get-togethers for families with children that have diabetes. ‘Seven years ago, we moved to Nelson and immediately joined up with the youth group here. We took the opportunity to join their family camp and some other activities during the year. It was great to meet up with parents who were going through the same experiences we were, and there was always somebody with some good words of advice. ‘When they needed new members to join the committee, I volunteered, believing that we need to give back to our community in gratitude for what we have received. ‘I help with our quiz nights at

Roz Waters.

the local Sprig and Fern, help with raffle ticket selling when we do raffles, and get things ready for camp. I am also available to have a coffee and a chat with other mothers of newly diagnosed children and anything that might need doing. Our group of volunteers has grown closer as our children grow up, and we have been able to lean on each other when we needed it. It definitely has been a win-win situation volunteering for Diabetes NZ Nelson Youth.’ KACEY GRITT is a youth mentor from Ōtautahi. ‘Hi guys! I’ve been living with diabetes since I was 17, 10 years ago, so I understand the challenges and experiences that come with it. Over the last three years, my partner Connor and I have been volunteering as youth mentors with Diabetes NZ. My favourite thing about volunteering is getting to do cool activities with other youth with diabetes and getting to know them. Through this, we have the privilege of engaging with kids and teens in Canterbury who are navigating life with diabetes. ‘Our main role involves attending fun activity groups where we get to bond, share experiences, and

Rachel Kitson.

DIABETES WELLNESS | Winter 2024

Kacey Gritt (far right) and her partner, fellow T1, and volunteer, Connor Allnutt. To the left is Victoria Wynn Thomas, Youth and Type 1 Coordinator, Canterbury.

support each other on our diabetes journeys. One highlight was attending the diabetes camp this year, where I had the opportunity to meet and connect with inspiring kids and teens facing similar challenges. If you’re a kid or teen with diabetes and live locally in Christchurch – come hang out!’ BRENDAN WARD, an Ōtepoti Dunedin local, has been a volunteer and camp photographer at our summer camps over many years. ‘Diagnosed at 10 with type 1 diabetes, I guess I’ve volunteered for Diabetes NZ in a few different ways, at eight camps. The first, back in 2004, we went to Naseby in Central Otago, mountain biked the Rail Trail in Central Otago, and around the forest in Naseby.

‘I assist with the running of the camp, including some of the outdoor activities, but also help out around meal and snack times, ensuring the kids are managing their diabetes the best they can. I help out the medical professionals with middle-of-the-night blood glucose tests for the kids. It can make for a tired start to the next day, but I think it’s an important job that I’m more than happy to help out with. ‘I get to have a lot of fun at the camps, taking part in some of the activities. It’s like being a kid again at times. I’ve also been able to learn a bit from the camps about how I can best look after my own diabetes. ‘As I’m one of those people who can’t survive without at

least average coffee, it’s become a tradition that I bring my Nespresso coffee machine and enough pods for the adults at the camp to have coffee at hand. I think it’d be rude if I only brought coffee for myself! ‘I do photography as a hobby, and I bring some of my photography gear to the camp in order to capture the action of the camp. The photos are later made available to the kids and their parents. Some have been used to apply for funding grants for the camps, some shared with DNZ for use in media, and a number have featured in our magazine, including on the cover. ‘The camps are awesome. I’ve seen kids grow a huge amount of confidence and competence in those years. It’s amazing to see!’

‘I go through my own challenges at these camps. It’s quite funny when an insulin pump or CGM alert goes off at the camp, and medical professionals, other adults, and kids are looking around to see who’s needing to check alerts, only to find it’s me!’

CREDIT: MARATHON PHOTOS.COM

ROSE FOWLER from Auckland found out she had diabetes in 2020. ‘Looking for a support group, I was lucky my sister-in-law and her friend had been running a group in Helensville. I live in Auckland but still went along. They were very welcoming and had speakers who were very helpful, and that’s why I have devoted my time and support to them. I help with the duties and fundraising. It is so important to have support groups in the community to help others who might not have support and to understand you’re not alone.’

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My Identity

A TRIBUTE TO OUR VOLUNTEERS

is proud to nominate

Mihi Verb: to greet, pay tribute, acknowledge, thank.

n this issue of Diabetes Wellness, we meet a selection of our marvellous volunteers, but we assure you this is merely the tip of the goodwill iceberg. There are many more wonderful helpers working tirelessly behind the scenes here at Diabetes NZ. Some people give their time each and every week, whether it is helping to run a support group or assisting in one of our regional offices. Others generously donate their time once a year at a fundraising event, such as the Auckland marathon, or at a youth camp. In this Winter issue, we pay tribute to all our treasured volunteers around the motu and present a medical ID bracelet dedicated to them: Mihi.

Hayley McDonald’s medical jewellery business, My Identity, came on board with Diabetes NZ five years ago. Since then, we have named a bracelet in honour of an awesome individual and advertised the resulting medical jewellery in every issue of Diabetes Wellness. Each exceptional individual we have featured has often undertaken a major change in their lifestyle and has risen to the challenge of living with diabetes. Over the years, My Identity has donated all the profits from these designs to Diabetes NZ. So far, this has amounted to over $12,000. And so to all our wonderful Diabetes NZ volunteers: Ngā mihi – many thanks.

If you think you would like to volunteer your time or skills, email info@diabetes.org.nz with a cover letter including details on where you are and what you are interested to help with.

$109 each Fashionable Medical ID Jewellery

Mihi: Acknowledging the massive contribution of our volunteers. Shop now for a beautiful piece of jewellery and support our community LIMITED NUMBER AVAILABLE. PRICE INCLUDES ENGRAVING AND FREIGHT.

DIABETES WELLNESS | Winter 2024

Community

A LIGHT BULB MOMENT Jeremy Collins got so much out of going to camps when he was a lad that this year he chose to give back by volunteering. He shares some of his time at camp as a big kid.

Jeremy was apprehensive about what it would be like to travel with diabetes but didn’t let it hold him back from spending three months in Europe. Above: Jeremy and his partner Charlotte, lakefront in St Moritz, Switzerland.

DIABETES WELLNESS | Winter 2024

eremy remembers his first diabetes youth camp like it was yesterday. It was the first night, just after dinner, and he was sitting at a table, surrounded by other kids with type 1 diabetes. Someone started handing out bananas, high-calcium yoghurts, and nine-year-old Jeremy was shocked. Since his recent diagnosis, he was used to eating a strict diet as he and his family all thought there were foods that you just could and couldn't eat. ‘I think I said to the instructor, “Am I fine to eat this?” because I was so used to having quite a strict diet. It was a light bulb moment for me. I remember going home after that camp and saying to Mum, “Guess what I had at camp?!!”’ Jeremy says this interaction created quite a switch in terms of how he thought about diabetes. During the camp, he found out he could eat all sorts of food, just as long as they were all in

moderation. Suddenly, highcalcium yoghurts were in, and the Collins whānau started adding them to their weekly shop. For Jeremy, the camps were an opportunity to learn that he could live life like anybody else without having to stop and restrict himself, whether it be food-wise, or activities. Coming from a sporty and competitive whānau, Jeremy was particularly drawn to the physical challenges that the camps offered. He remembers a group who came to film some of the activities. At one point, he was doing the famous milk crate challenge, where he was hoisted up on a rope and stacked as many milk crates as he could until the tower collapsed. He was super happy that he set a record that year, and the occasion was captured on tape as well. ‘It was quite a special experience that year because I thought, I’m not letting it hold me back. It was great.'

CONNECTIONS

Jeremy has volunteered at two youth camps this year and is keen to continue at more. In April, he returned to the Hūnua camp for a day, which ended up serving as a reunion of sorts. ‘I saw Anne, a nurse, there who helped me when I was a kid through to my teens, so it was special to reconnect with her about a decade later. And one of the doctors was someone I went to school with, so it was great to chat to him about diabetes and share a few tips and tricks.’

Jeremy and his dad, who came along as a helper, about to leave home for the Chosen Valley Christian Camp in Ararimu.

As well as doing the more usual jobs, such as serving meals, Jeremy found himself helping on the adventure course on one of the scariest and most exhilarating challenges on offer – the high swing – about five metres up in the air. After seeing all the rangatahi do it first, Jeremy realised he had to follow suit or lose face in front of a bunch of teens. ‘I ended up joining in. Although well out of my comfort zone, I felt supported with everyone shouting words of encouragement.’ This connection with others in the same boat was, and still is, what Jeremy believes makes camps so

‘About one to two weeks before diagnosis, Dad took us to choose a puppy, which was a surprise to us, and I remember being so thirsty that I kept asking the owner for a glass of water. The day I came out of hospital after being diagnosed, we picked up the puppy, so it was special to me as I thought of her as a support dog in a way.’

important for kids. ‘I was sitting outside, and one of the teens came up to me and started talking about diabetes. Before I knew it, there were about five to six guys sitting around having a chat with me about their experience with diabetes. I thought this was nice as we were able to bond over the same thing. When you’re at a school, you can feel alone and not fitting in, but when you’re surrounded by people who are also living with diabetes it can make you feel at ease.’ Will we see the 26-year-old ‘big kid’ Jeremy back at camp again? ‘Without a doubt,’ he says. ‘I’ve spoken to the camp staff and told them I want to continue being involved with future camps. They gave me some ideas about upcoming camps and how they’re always looking for people to help out. ‘Overall, it was a great experience and it felt very rewarding to be able to volunteer. Everyone seemed so positive and happy, and it was great to see everyone giving things a go. I think everyone came away from that thinking that diabetes won’t hold us back from doing the things that we enjoy.’

‘It was really rewarding seeing the kids. It brought back a lot of memories for myself. It was quite special to see them enjoying themselves, laughing, all testing together, getting on.’

DIABETES WELLNESS | Winter 2024

Move

Badminton and table tennis have had a baby, and its name is Pickleball.

IN A DIFFERENT KIND OF PICKLE

Ashley Gage sits among the top 10 female players in the country. PHOTO: FOXALL PHOTOGRAPHY

DIABETES WELLNESS | Winter 2024

ickleball is widely agreed to be the fastest-growing sport in the world. Hailing from the US, where it has been swiftly growing in popularity since the mid-1960s, it landed in Aotearoa New Zealand only nine years ago. The game looks a bit like tennis and can be played indoors or outdoors, but the key differences are that the bats are smaller, the balls are plastic, and the courts are far smaller – think a badminton-sized court. With two pickleball courts able to fit in one single tennis court, there is a lot less running around – perfect for older people and those who have had to give up other racquet sports for health reasons. Pickleball is perhaps the perfect game for almost anyone, regardless of age, size, or fitness level. RACQUET MAN

Father of two teens with type 1 diabetes, Paul Abbott is also in the same camp, diagnosed 28 years ago. The Wellingtonian hasn’t been playing pickleball for long but says he has loved every minute of it. ‘It’s so much fun. I’m addicted to it. I’ve only been playing a year. I’ve played all the racquet sports in my past lives, most recently table tennis, but I haven’t picked up a table tennis bat since I first started playing pickleball. All my energies are going into it.’ In his first year, Paul played and won in two tournaments, and he won the B grade doubles with his partner at the Battle of the Paddle in Hawke’s Bay last year. Paul says he definitely feels some advantages from his table tennis and tennis background. ‘Anyone who has played a racquet sport will pick it up easily, but you don’t have to have that history. There are people there who have never played any racquet sports, and they’re great at pickleball.’

Paul Abbott and his partner Graham Halliday. CREDIT: FOXALL PHOTOGRAPHY

Sixty years young, Paul explains that pickleball is also a game where age isn’t a barrier. In fact, it can often be a bonus. ‘You can be over 60 and still be a really competitive player.’ There’s not as much running as tennis, instead more of a focus on hand–eye coordination at the net. ‘You’ll see some players with knee braces, who are not as agile as they once were, but they are still very effective pickleball players.’ Most rec centres have pickleball as an option now. The set-up is easy, requiring only a badmintonsized court and a portable net, which is lower than a tennis net. The whole set-up comes in a bag, making it a very portable sport. Paul plays up to three times a week and crosses Wellington in order to play at Ākau Tangi Sports Centre in Kilbirnie. ‘It’s a bit of a drive, but it shows how much I love to play.’ He enjoys the social side of the sport as well, an experience echoed by each of the ‘picklers’ we spoke to.

ASH, TOP 10

Ashley Gage (Ngāpuhi, Ngāti Kahungunu) entered the sport after a couple of decades of playing premier-level netball. Too many injuries had her seeking a new sport that would still challenge her but that would be far gentler on the joints. Her surgeon had warned that if she had one more injury to her ankles then she would have to have plates put in and that this would put an end to any running. Along she went to the local courts, having no idea what pickleball was but knowing it was a bit like padder tennis. In her first taste of the game, Ash played a 73 year old and so naturally assumed she would have it easy. ‘He absolutely annihilated me! I have never been so pulverised in a sporting situation. But what I could appreciate from that was the skill he had. He had very low mobility. He didn’t have the power of a 40 year old. But he was able to annihilate a 30 year old. That taught me that there is a lot of skill

DIABETES WELLNESS | Winter 2024

in this game and that mobility is a perk but not a necessity.’ Four and a half years later, Ash now sits among the top 10 female players in the country. ASH, DNS

As well as being the Chair of South Auckland Pickleball, running a club responsible for two sites in Auckland, Ash is also a Diabetes Nurse Specialist. She says her patients might notice her moving just a bit slower than normal on a Monday morning, and flashing the occasional grimace, so they ask her what’s up. Happy to share what has caused the apparent soreness, she will tell them about a tournament she played in the weekend, which she then uses as a great way to rave about the game and encourage others to give it a go. ‘I tell them where they can play. I say, “If you come to any of my sites I will not approach you as a patient. Nobody will ever know that you have diabetes unless you say it. You’re more than welcome to talk to me about it, but I will never approach you.” I lay that down straight off.’ She estimates she’s encouraged about 15 patients into pickleball. Working within Counties Manukau, Ash’s patient base is largely Māori and Pasifika, ethnicities that have seen a more positive rise within the pickleball world. When Ash first started playing, she noticed she and her partner were among a very small population. ‘When I first started playing, there were only five Māori playing in the country. No Pacific Islanders. Just five of us Māoris. And me and my partner were two of them!’ Back then, she says there were only about 1000 players nationwide. Now there are close

DIABETES WELLNESS | Winter 2024

Ash and her team at Whitiora Diabetes Service. Although they've not all played yet, they have plans to 'pickle' in the near future as a team bonding session.

to 9000, with a huge contingency of Māori and Tongan players. The latter are often supported by the Mormon church. ‘It’s very refreshing to see when we know the prevalence of diabetes in those communities.’ Each Easter weekend, the Annual Tongan Tournament draws the Tongan pickleball community to South Auckland for a weekend of competition. This tournament also proves that the game isn’t just for adults, with divisions for kids as young as four. DIFFERENCES IN AGE?

‘Realistically, when you’re playing in the top ranks of the game, mobility definitely does help. Equally, if you’re heading towards winning tournaments or being in the top 10, you definitely need mobility because of how fast that ball can travel. You’ve got to be able to move. But if you’re among the seniors, mobility isn’t really necessary. But the strategy of the game changes. They’re very good at things like

placement of the ball, reading the game, reading what you’re doing, and countering you before you’ve even hit the ball. They play with a lot of intelligence, a lot of smarts to them. We call them our Masters grade for a reason. Because they’re just that good.’ KEITH, PADDER TENNIS PRO

Keith Kenderdine, retired accountant and long-time Tawa Lions Club member, was attending a community coordinators’ meeting where someone reported to the group about a wonderful new racquet sport they were playing and suggested everyone come and give it a go. That was two years ago, and Keith hasn’t stopped since, playing every Wednesday morning for two hours and Friday for an hour and a half. ‘Supposedly, it was invented by the US in 1965. But, in 1955 I played a game called padder tennis.’ The two games look similar, but padder tennis is a separate game in its own right. Originating 80 years earlier than pickleball, it uses a tennis ball, requires a slightly larger court,

and employs different scoring. The modern bats now have holes, and the game is promoted more to children than adults. Keith jokes that it’s the morning tea that the club members all share on Wednesdays that pulls him back each week. But the enjoyment of the game is a strong factor as well, not to mention the company of his fellow players. ‘The big attraction is the companionship. I’m a widower, so anything to get out and mix with other people is a good thing, even if it means I’ve got to beat them at pickleball. But they don’t see it quite the same light for some reason,’ he quips. The exercise that pickleball offers is constant but mild, depending on the level you play at, of course. Games only last 10 minutes, but in that time you are constantly moving in the quick

but gentle sport. ‘The game is as energetic as you want it to be’, Keith says. Keith started playing when he was 78 and quickly realised his mind was fitter than his body and that he needed to take it gently. ‘The first game I played I sprained my ankle. I realised I’m not as fit as when I was 20. Now I let the impossible shots go through to the back wall and forget about it. That’s my philosophy.’ Now 80 years young, Keith says he’s not the oldest player in his club. Another spritely gentleman, three years his senior, always walks from his home to the courts, a distance of three or four kilometres.

WHY PICKLE? ‘Welcome to the addiction!’ was the reaction from Ash, the nurse specialist, when our Diabetes Wellness writer mentioned she was keen to try pickleball. As Paula Duffy, Wellington Pickleball committee member, puts it: ‘Addiction occurs quite quickly for a number of reasons. A, the exercise, B, it’s very social, C, the diversity. It’s really a community, a feel-good sport. Everyone wants the same things. It is competitive, but it doesn’t get nasty. ‘There are clubs throughout New Zealand. We all work together, we all talk together. We volunteer at each other’s tournaments. We share knowledge. I’m going over to Australia for a tournament, going to get some learning from there. The Aussies have been amazing, helping us to grow the sport in New Zealand. They’re a few years ahead of us, but they’re not holding it into themselves. It’s a sharing sport. I think everyone feels that when they come in to play. ‘I love seeing sons playing with their fathers. You’ve got husbands and wives, grandparents and grandchildren playing together. It’s phenomenal. ‘We’ve created sister clubs with Queenstown, Hawke’s Bay, and Levin. When their members come and play here, they play member rates. A nice thing to do, to welcome other players.’

WHERE TO PICKLE? With memberships starting as low as $40 a year, and an entrance fee of around $5, there are 56+ clubs spread all around Aotearoa New Zealand, from Kerikeri to Gore. The entrance fee covers the use of a paddle until you’re ready to purchase your own. Keith Kenderdine in between games with fellow picklers, Terry and Gaylene Hughes.

Check out www.pnza.org.nz/whereto-play to find a club near you.

DIABETES WELLNESS | Winter 2024

Community

There’s a magical piece of land in the middle of Cannons Creek, north of Wellington. On it grows vegetables, cooking skills, and self-confidence.

‘AN INCREDIBLY TRUSTED ENVIRONMENT’

DIABETES WELLNESS | Winter 2024

f you were to visualise a timeline for WELLfed, there would be a batch of banana and chocolate chip muffins down one end and a successful business, modelling self-reliance, down the other. Eight years ago, WELLfed CEO Kim Murray was volunteering at a fruit and vege co-op. She had brought along some freshly baked muffins to share and was quickly asked by another volunteer if she could show her how to make them. Not long after, Kim rolled up to the person’s home ready for a session of baking. Luckily, she had brought along the ingredients and tools needed because the family had little equipment and few ingredients. Spurred on by her new muffinbaking skills, this person continued to bake muffins, taking them to church where, reportedly, everyone said they were amazing. Fellow church-goers started asking their fellow to teach them how to make the muffins. This experience is what spurred WELLfed’s co-founders, Kim Murray and Rebecca Morahan,

to initiate a project where locals could learn cooking skills, all based around seasonal fresh fruit and vegetables. The first classes started eight years ago within a local kura and have since moved into the former Cannons Creek Bowling Club. What was once the bar and social area has now been converted into a kitchen that can host 12 learners at a time, using electric frypans and domestic appliances that are accessible to most learners. HEALTHY GUIDELINES

All the recipes taught through WELLfed are checked by their dietitian to make sure they adhere to healthy guidelines. The team also keeps the meals seasonal and under $15 – an ambitious but achievable task when it comes to feeding a whānau of six. Pumpkin soup, fish pie, dumplings, focaccia bread, and apple Danish pastries are just an example of the roughly 100 or so recipes WELLfed has created over the eight years they have been operating. One part of their teaching

demonstrates how making your own takeaway-style meals can be far cheaper and healthier than buying it readymade. For example, a takeaway of sushi and coleslaw might cost around $20 from a shop, but creating your own can bring the cost right down. The same goes for dessert foods. As well as being delicious, this kind of kai is often needed to take to church, and buying a readymade cake can be expensive. Kim shares, ‘Our lemon cake works out at $4.80 to make a whole cake, versus buying it from a shop for $5 a slice.’ ‘THE FOOD THAT IS GROWN OUT THERE IS USED IN HERE’

The former bowling green has been renovated and now grows a huge array of seasonal fruit and vegetables, all of which end up on learners’ chopping boards. But before the produce even gets to the kitchen, it has served as a valuable example to learners of how a vegetable is raised from seed, planted in the garden beds, and tended while it grows until it’s ready to be harvested.

WELLfed is an awardwinning adult education programme, based around kai, cooking skills, and more.

DIABETES WELLNESS | Winter 2024

WELLfed refers to the students who come through their doors as ‘learners’. WELLfed is about learning practical life skills in a way that suits each individual. They support each learner and believe in the potential inside everyone. ‘This is an incredibly trusted environment,’ says Kim Murray. ‘Our learners come and feel very safe and don’t feel judged. That speaks volumes about how the staff have created this lovely welcoming environment. This is why the learners then want to become tutors and stay on. They stay nurtured, and they want to stay part of the WELLfed family.’ www.wellfed.kiwi

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A WELLfed course is a weekly class for 16 weeks. WELLfed learners are adults, often parents, who are seeking some help to learn how to prepare and cook nutritionally balanced, budgetfriendly kai for their whānau. While a parent is busy in the kitchen, tamariki are cared for by volunteers and often venture into the māra kai (food garden). This is where they learn about what you can compost, as well as what you can eat raw. ‘Kids don’t necessarily know that a carrot grows in the garden,’ says Kim. ‘They just see them in the supermarket. They don’t see it with the green fluffy top on.’

WORD OF MOUTH

The WELLfed programme is so popular that there’s currently a six-month waiting list. Word of mouth appears to be the best advertiser, with 80% of referrals coming from previous learners, who have experienced first-hand how effective the kaupapa of the organisation is. The staff have created a safe, welcoming environment where learners don’t feel judged. Many are then keen to give back, and WELLfed has found that this experience is where the best tutors come from.

DIABETES PROGRAMME

WELLfed’s website features a number of ‘Learners Stories’, shared by locals who have had some part of their lives turned around through their time with WELLfed. One learner with type 2 diabetes says she first heard about WELLfed from her husband, who had visited. Weighing more than the average, she struggled to get off the couch, finding she had to sleep there too. Both her mental and physical health were strained from not leaving the home, she had lost a lot of confidence. Six months after joining WELLfed, she had lost over 100kg and found parttime work after a break of 26 years. As part of a Re-imagining Diabetes Programme for the Porirua community, WELLfed has just announced that they are working with Te Wāhi Tiaki Tātou and a range of other community health providers to make a diabetes cooking programme available to the community. The programme has been designed for people living in Porirua who have a diagnosis of pre-diabetes or type 2 diabetes and will include both education and cooking components. With an estimaged 16,400 people currently living with either pre-diabetes or type 2 diabetes in the Wellington/Porirua/Kāpiti region, there is a definite need for the programme. More worrying is the fact that this number has increased by 20% over the past 10 years – approximately twice the rate of the population increase. The rate type 2 diabetes occurs at is inequitable across Aotearoa New Zealand with both ethnicity and level of deprivation being major factors. The population of Porirua has a notably higher proportion of Māori (22%) and Pacific (25%) people, as well as higher levels of deprivation, than other areas of the Capital and Coast health district. The team is excited to be bringing a collaborative, tailored diabetes cooking programme to the Porirua community.

Make a difference today

A diabetes diagnosis can be scary, overwhelming, and confusing. It’s a steep learning curve whatever kind of diabetes you have. Your donation will help someone just starting their diabetes journey and ensure they can access the resources, support and advice they need to live well. Your donation will remind them they are not alone.

Donate today at www.diabetes.org.nz/donate or call 0800 342 238. Thank you.

Nourish

SEASONAL SOUP As we head into takurua/winter, we start to feel the evening temperatures starting their shady descent into single figures. Here are three lovely soups that are both warming and nutritious, all with something in common. They’re seasonal and made with the cheapest vegetables on offer. RED LENTIL SOUP SERVES 2

The red lentil is one of the most inexpensive ingredients ever. They mush up beautifully, merely adding texture to the soup rather than a lentil-y flavour. Once it’s had some time with a stick blender, you wouldn’t ever know it had a lentil in it.

100g red lentils, rinsed 1 small onion, chopped 1 carrot, chopped 1 clove garlic, crushed ½ tsp fresh ginger, finely chopped 600ml low-salt vegetable stock (2¼ cups) 2 tbsp light crème fraîche 1 tbsp fresh parsley, chopped freshly ground black pepper

Place the lentils, onion, carrot, garlic, and stock into a pan. Bring to the boil and simmer for 20 minutes until the lentils are tender. Either use a stick blender or transfer to a blender/food processor, adding the parsley and mixing until smooth. Season and serve with a chunk of bread.

Lentils are protein-rich and can be used in plantbased recipes to boost the dish's nutritional value while also adding texture and fibre.

DIABETES WELLNESS | Winter 2024

SPINACH AND RICE SOUP SERVES 2

With spinach, silverbeet, or a selection of greens, this lovely green and nutty soup will keep you going for hours. 1 tsp olive oil 1 small onion, chopped 1 clove garlic, crushed 1 carrot, finely chopped 100g brown rice 150g bag fresh spinach (or 100g of frozen) 900ml (3¾ cups) low-salt vegetable stock 2 tbsp single cream freshly ground black pepper

Bring to the boil and simmer gently for 35 minutes until the rice is tender. In the last 5 minutes, stir in the spinach. Either use a stick blender or transfer to a blender/food processor with the cream and plenty of black pepper, blitz until smooth then return to the pan to reheat. Season and serve with a chunk of bread. TIPS

Heat the oil in a medium frying pan.

Spice it up with 1 tsp curry paste or powder, or a pinch of chilli flakes.

Add the onion, garlic, and carrot and fry for 3–4 minutes until beginning to soften.

You can make it vegan by substituting the cream for a plant milk. We used homemade oat milk.

HOMEMADE STOCK A good stock carries a soup. You can buy stock in liquid, concentrate, or powdered form. These ‘ready mades’ sometimes have herbs and spices added and always have added salt, but you can control the amount of salt in your stock if make your own. Next time you cook a meat dish with bones in it, such as chicken, lamb, or pork chops, or spare ribs, put the bones into a saucepan, add veges (see suggestions below), cover with water, put a lid on it, and leave to simmer for a couple of hours. You can also ask your butcher for fresh stock bones. Brown up your fresh bones in the stock pot before adding the other ingredients. You don’t eat meat? Then make a point to squirrel away whatever vegetable odds and ends you produce every day in a ziplock bag in the freezer. Onion, carrot, garlic, potato tops, bottoms, and skins, celery leaves, and herb stalks are great too, but avoid Brussels sprouts, cabbage, broccoli, or cauliflower because they will add a bitter taste to your stock. With veges that have been frozen, you only need to simmer for one hour. Simply strain at the end and refrigerate for up to four days.

DIABETES WELLNESS | Winter 2024

If you are cooking for a vegetarian or vegan, but you’re craving a meaty taste, then use a plantbased stock cube, such as Massel, that is vegan but has chicken, beef, and vege-style flavours.

CAULIFLOWER AND LEEK SOUP SERVES 6

Commonly paired with potato, this time the leek gets to hang out with the cauliflower for a soupy date. A hearty warming soup that’s quick and cheap to make, topped with spicy toasted cauliflower – you could just about call them croutons. 2 tsp olive oil + 1 tsp to oil baking sheet 1 cauliflower 1 heaped tsp turmeric 1 large onion, chopped 2 leeks, sliced 1 tsp ground cumin 2 cloves garlic, crushed good pinch white pepper 1 low-salt vegetable stock cube in 600ml water 1 x 400g can butterbeans, drained 300ml skimmed milk Black pepper to taste

Preheat the oven 180°C/gas mark 4 and lightly oil a baking sheet. Break a quarter of the cauliflower into very small florets, rinse in cold water, shake off any excess and add to a bowl. Sprinkle with the turmeric and mix well. Place on the baking sheet and roast for 10–15 minutes until the edges are starting to char, then set aside. Meanwhile, add 2 tsp oil to a pan and add the onion.

Add the cumin, garlic, pepper, and stock and bring to the boil. Turn down the heat, cover, and simmer gently for 8–10 minutes until the cauliflower is cooked. Add the butter beans and blend gradually, adding the milk until smooth. Bring up to heat then divide between six bowls and top with the roast cauliflower and a good grind of black pepper. TIPS

Cook for 3–4 minutes until softened but not browned.

You could try other beans, such as cannellini or borlotti, for this soup.

Add the leeks and the rest of the cauliflower and cook a further 3–4 minutes, stirring regularly.

Try adding 1–2 tsp curry paste or powder to the soup along with the garlic and cumin.

DIABETES WELLNESS | Winter 2024

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DIABETES WELLNESS | Winter 2024

PHOTOS: MINNI TURNER

NO AVERAGE DAY AT WORK

We continue our journey around Aotearoa, meeting each region’s Community Services Coordinator. In this issue, we meet Rotorua local Karen Reed.

riginally from the UK, Karen landed her first job in the John Radcliffe hospital, working in a research lab for Oxford University. It was here where the newly minted medical biochemistry graduate says she ‘met a chap from Papakura’. Also known as Peter, the chap and she had much in common: type 1 diabetes, and also the study of the condition. At the time, Peter was working towards his PhD. His research was part of the early work done in discovering genes associated with type 1 diabetes. After marrying and having a couple of children, Karen and Peter moved to New Zealand, where she continued her work as a freelance medical and scientific writer and editor. The bonus of living on the other side of the world meant she could take work on in what was the UK afternoon and have it completed, in time for their new day. But too much time stuck at home, working, prompted Karen to get out to find herself a local diabetes support group. She says she was always involved in groups back in the UK, having had years of experience with Diabetes UK, volunteering both at local branches and on several children’s camps as a youth leader. As she moved around the country for both study and then work, ‘If I couldn’t find a support group, then I’d set one up myself.’ She soon discovered a group in Rotorua, attended a meeting, and was approached the following month while at the branch’s AGM to see if she’d be interested in the position of Vice President. A year

later, Karen took on the role of President which she held for over 10 years. The experience of running local diabetes support groups is how Karen became involved in local service delivery as a consumer, an experience that has led on to working in voluntary, contract, and finally full-time employment within Diabetes NZ.

‘Originally, I had mistakenly thought that I was supposed to find happiness and fulfilment in spite of having diabetes. Not so! All I needed to do was to acknowledge that I had diabetes and to accept life with diabetes. Diabetes is a part of me, and it has shaped my life in many ways. I am all that type 1 diabetes is and I really wouldn’t be me if I didn’t have diabetes.’ SUPPORT GROUPS ARE ALL A BIT DIFFERENT

Karen says there is no average day at work. Running support groups takes up a significant portion of her time. In addition to Rotorua, she has also been running support groups and workshops for the last five years in Kawerau,

Whakatāne, and Taupō, and is looking to set one up in Tokoroa later this year. ‘They’re all a bit different. My main one is in Rotorua on Thursday mornings. We have a cuppa and cheese and crackers, and have a focused discussion on various diabetes related topics. We might watch a video, or I’ll do a mini presentation, or we’ll have a quiz of some kind. There’s lots of chat, lots of laughter. Some people come every week, and others just drop in from time to time or if there’s something special going on.’ YOUTH

As well as her support group mahi, Karen has done a lot of work for Diabetes NZ Youth. She is responsible for writing their camping guidelines, work she was recognised for in 2009 when she was presented with a Diabetes Youth New Zealand award. A woman with many pots on the stove, Karen also has another national role as the Diabetes NZ representative on the Clinical Networks for Children and Youth People with Diabetes, run by the Paediatric Society of New Zealand (Te Kāhui Mātai Arotamariki o Aotearoa). Karen has always remained close to her work with youth, citing the youth camps she went to in the UK as ‘being the making of her’. These were longer than the camps we have here in Aotearoa, held over either a week or a fortnight, and where contact with parents is not allowed, other than by writing DIABETES WELLNESS | Winter 2024

With a passion for the support groups she’s set up, Karen is pushing to grow them further. ‘I think it’s good when you’ve got some little knots of community support.’

Karen was diagnosed with type 1 diabetes when she was 10. In an odd turn of events, she had been brought to hospital, suddenly, in the middle of a school day without knowing why, and it was there and then that she found out her parents had been testing her urine on the sly. They were always on the lookout for diabetes as Karen’s father had been diagnosed when he was 15 years old. Living in a ‘dormer bungalow’ (also known as a one-and-a-half storey home) in the UK, a potty was kept under her bed so that she didn’t run the risk of falling down the stairs in the middle of the night. So it hadn’t been difficult for her parents to collect a few drops of urine to test without her knowing. ‘For a long time, it was hard to get my head around the fact that I had gone into hospital seemingly fit and well, and come out of hospital with a lifelong condition that would require daily injections and a prescription diet for the rest of my life... At the tender age of 10, I had always perceived hospitals to be somewhere that you went to get better...’ It was this diagnosis that lured Karen into the world of biochemistry. At 10 years old, she was fascinated by the heat generated in the test tubes she used when testing her urine and when watching the different colour changes that the tests would elicit. ‘Soon I was adding all sorts to my samples, eager to find out what would change a negative to a one percent or a two percent. What you put in the test tube before adding the reagent tablet could be anything! And hence I became a biochemist. Diabetes had started to shape my interests.’

DIABETES WELLNESS | Winter 2024

letters. Inevitably, strong bonds were formed at these camps between the volunteers, the campers, and the medical staff. ‘Everyone learned so much from each other, and precious memories were formed. At one camp we had three kids join us from Ukraine who had been badly affected by the Chernobyl nuclear disaster. I took them under my wing and later corresponded with their families.’ REGIONAL NETWORKS

Towards the end of 2021, Karen started out as admin and coordinator, setting up the Regional Diabetes Networks under Sue Tutty, who was the then Clinical Lead for Diabetes at Te Whatu Ora. The networks were set up in anticipation of the health system changes, which would see DHBs replaced by a more regional setup. Diabetes NZ was able to secure the contract to administer and coordinate these networks. Their role is to provide a way for Districts

(formerly DHBs) and Local Diabetes Teams to collaborate and share across a region. Ultimately, it is hoped that these Regional Networks will feed into a National Diabetes Network that is being commissioned by Te Whatu Ora. ZOOMING ALL OVER THE PLACE

When Karen is not busy on Zoom meetings ‘all over the place', she is travelling to meetings around the district. ‘I’m kind of stretched all over. This week, I have a Northern Regional Diabetes Network meeting. The next day is our weekly morning tea support group in Rotorua, which is very popular. On Saturday, I’m going to Reporoa for the third of six education workshops that I’m doing with the Ngāti Tahu-Ngāti Whaoa Rūnanga Trust.’ With a passion for the support groups she’s set up, Karen is pushing to grow them further. ‘I

think it’s good when you’ve got some little knots of community support.’ For example, she is reclassifying a ‘support’ group as a ‘community’ group, with the aim that it will pull in new people who might not necessarily need support but are wanting to offer it to others. ‘I’m experimenting in Eastern Bay of Plenty and Taupō with the name change to see if we can draw more people in.’ As for future hopes within her work, she says she is always looking for ways to support diabetes clinicians. ‘I would love for Diabetes NZ to have some kind of a tangible way where we can support the health professionals – working between them and the people on the ground.’ She says there are a lot of things Diabetes NZ could do to help, such as carb-counting courses. Before people start on a pump, they need to go through a formal course to learn to count carbs down to the nearest

gramme. ‘That’s something Diabetes NZ could help facilitate on the ground so that the health professionals aren’t spending so much time doing that and can spend a bit more time doing their more clinical stuff.’

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Life with T2

Rosalea Grainger has had a challenging year, living through and recovering from an amputation. She shares her experience of coming out the other side with new skills.

DIABETES WELLNESS | Winter 2024

I’M STILL STANDING G

oing through an amputation is not what anyone wants. It is only ever used in order to save the body from spreading infection. Rosalea’s experience all started at the beginning of last year when she noticed a part of her big toenail sticking out, so she clipped it. She must have unwittingly snipped the skin because before long she discovered an infection brewing under the nail. Antibiotics were prescribed, and she had twice-weekly appointments to get her wound dressed, as well as appointments with a podiatrist. But she and her team could see the toe wasn’t healing as it should so she started going into her local hospital, Kenepuru, for further checks twice a week. Rosalea estimates her medical team trialled between eight and 10 different antibiotics over the next six months, one after another, in the hope that one would deal with the infection. This is all while she was working full time and on her feet all day as a door greeter at Mitre 10, Porirua. A TRIP TO ED

A month later, Rosalea found herself at the emergency department. Her body was retaining water, which presented itself in a number of ways. Her legs became extremely swollen and blistered, and were constantly weeping. Known as oedema, excess water indicates worsening heart failure due to fluid build-up around the heart.

Two weeks later, she was discharged, monitored from home, and visiting a podiatrist in the hospital to continue getting her toe dressed. A district nurse also came a few times a week, taking photos to send back to the vascular team at Wellington Hospital. Unfortunately, they discovered that the infection had progressed on to gangrene, and she was advised to be brought back immediately. ‘I saw the message to ring them. It wasn’t until I got home after five that I checked my phone. I thought, I’ll ring them first thing in morning, but a few minutes later I saw the district nurse coming down the drive. I was in the middle of cooking dinner and everything was left on the stove, but she said, “You’re going in to hospital to have your toe taken off. I’m ringing an ambulance now.” I packed a nighty and two pairs of knickers.’ After the surgery, the wound looked like it was healing well. Rosalea wore a special boot that had packing around the wound, and the doctors seemed satisfied with how it was healing. She didn’t know this at the time, but this was the start of a five-month stint in hospital. Barely half a week had gone by when she was faced with bad news that her neighbouring toe had picked up the infection and would have to come off as well. ‘They came back the next day and said, no, it’s not working. It had died overnight.’

The doctors had discovered that the veins around the toe were calcified and that there was no blood flow to the foot. The only option was to amputate further to a point where the blood was flowing. A week and a half later, Rosalea was back in surgery, having a transtibial amputation.

BELOW THE KNEE (BKA) TRANSTIBIAL

Rosalea stayed in the surgical ward for two months. She then spent a further three months in Kenepuru for rehab, re-learning, and practising how to move herself around a typical living area. She was a quick learner, working with her physiotherapist to strengthen both legs, as well as her core. The occupational therapist also gave

Gangrene usually affects your extremities and can occur as the result of an injury, an infection, or an underlying condition – such as diabetes – that affects your circulation. It develops when the supply of blood to an area of your body is interrupted. Tissue that has been damaged by gangrene cannot be saved. If left untreated, it can lead to amputation, organ failure, and even death. But only 15%–20% of patients will need an amputation if treatment is started early.

DIABETES WELLNESS | Winter 2024

‘I made a big pot of soup the other night, so I’m still cooking. Since I’ve been home I’ve made South Island cheese rolls, cream corn cheese rolls, a quiche. What used to take me half an hour probably takes me an hour and a half, so it takes me a lot longer. And that fills in my day.’

chair, go to the bathroom, back in the chair, and back to bed.’ Rosalea laughs when remembering the struggles she first encountered. ‘The most frustrating part of the hospital was not being able to pull up my own knickers! And boy, did it frustrate me, until I figured out a new way. I didn’t have the strength in the other leg to hold myself.’ She had to learn a whole new way of transferring her body weight from one place to another, all while keeping balance. THE JOURNEY TO RETURN HOME

Amputees Federation of New Zealand organises visits to amputees in hospital and in their homes, offering practical and emotional support and companionship. Rosalea has also received phone calls from three volunteers from around the country who have been through the experience themselves, offering support. www.amputee.co.nz

her training in transitioning from a wheelchair to a bed, to a toilet, to another chair, to a shower, and back and forth from an electric wheelchair. She was expected to be able to do 50 consecutive ‘lie-down and stand-ups’ before being okayed to go home. ‘It was good. Before I came out of the hospital, I was doing everything myself. I always showered myself in the hospital. And I always transferred from the bed onto the chair by myself. A lot of the time I had the nurses there in case I needed help, which I did a few times. Once they were certain that I could do it myself, I’d get up in the middle of the night and get out of bed, into the

DIABETES WELLNESS | Winter 2024

Before Rosalea was discharged, she and her occupational therapist, physio, and social worker visited her home together, making sure everything was suitable for her altered mobility. The housing trust she rents from, Te Āhuru Mōwai, built a ramp to her front door and also has plans to turn her bathroom into a more accessible ‘wet room’. Rosalea was given further training in how to transfer from the wheelchair to the shower and back again. She wasn’t going to be discharged until everyone was 100% confident she was safe in her home. A personal medical alarm was also organised, and care agency Nurse Maude was set up as her provider for all nursing and homecare services. Two of the carers already knew Rosalea, even before they had met her. All her years being the first face customers saw when

they walked in the door at Mitre 10 made Rosalea highly recognisable by most people she came across, both in the hospital and out of it. One of the carers reckons I’m a celebrity! ‘Nurse Maude is so good. Really helpful, and nothing is too much for them. They come in four times a week to help shower me. Then two nights a week to get my washing in and do any food prep I want. Then every second Wednesday someone comes in to do housework. ‘I have a chair over the bath, so they have the shower on and bucket it over me. But, you know what, it works, I get washed. They do my hair. They are so good!’ PREPARING FOR A NEW LEG

As soon as the final scab fell off, Rosalea was issued a ‘stump shrinker’: a small stocking designed to encourage the swelling to reduce and shape the limb ready for a prosthesis (artificial limb) to

be fitted. A stump continues to change in size as it heals, and over time a patient may need a smaller stump shrinker. Starting from an hour a day, Rosalea is increasing how long she wears it by one hour a day until she can comfortably wear it from the time she gets up until she goes to bed. Once that goal is reached, she will be sent in a taxi to Wellington hospital and fitted for a prosthetic by Peke Waihanga – Wellington Artificial Limb Centre. Rosalea is excited about learning how to walk with her new prosthetic but has kept her mind free of expectation. ‘I haven’t asked how long it will take to get used to it because everybody’s different. I might get on, and it might be easy for me. Or I might get on, and it might be hard. But I’ll keep pushing and I’ll get there.’ This determination is what’s kept Rosalea’s spirits off the floor during

OUR ADVICE

High blood glucose levels can damage your blood vessels and the nerves to your feet. This can cause poor blood flow and loss of feeling (neuropathy) in your feet. This means that your foot will be numb in places, so you don’t notice when you have hurt your foot. It can lead to sores that are hard to heal and may lead to amputation. The good news is that many of these foot problems can be avoided by daily foot care. Follow these steps to help prevent foot problems. • Wash your feet every day. • Dry your feet and don’t forget between your toes. If your skin is dry, apply a moisturising cream daily but not between the toes. This can increase chances of tinea (athlete’s foot). • Be careful with heaters and hot water bottles – if you have numbness, it could cause you to burn your feet and not realise.

• Check your feet daily. Use a mirror or ask someone to help. Look for changes to your skin. Cover any cuts or blisters and change the plaster each day. If it does not start healing or gets red, sore, or smells, see a doctor straight away. • Cut toenails straight across and do not make them too short. File sharp edges. Nails are easier to cut after being washed. Looking after your feet every day helps keep them healthy. Good foot care, managing your blood glucose and cholesterol levels, eating healthily, keeping active, and stopping smoking can all help stop foot problems and leg amputations. Visit your podiatrist regularly and have your feet checked by your doctor or nurse at your next visit, even if you are visiting for a different reason.

the whole ordeal, knowing she needs to retain her sense of humour to make it through. ‘I’ve had a lot of ups and downs. But most of the time I’ve been smiling. I did go through a stage when I was crying, but I’m very determined and I think a lot of that is what’s got me through.’ With that stubbornness, Rosalea says she has plans to return to work, not in her flash new electric wheelchair but on foot, ‘once I get my new prosthetic and I learn to walk again. I’m only going to work on the Saturday and Sunday, which are the busiest times.’ Rosalea knows in which aisle every tool, adhesive, and fitting is in the large hardware store. ‘I tell people where to go. I know where everything is. And I’ve met so many people in the hospital who know me. I might go back for six months or a year. See how it goes.’

ADVICE FROM AMPUTEES FEDERATION OF NEW ZEALAND

• Never walk barefoot. Carpeted and even bare floors at home may conceal hazards like needles or bits of glass that can produce injuries that go unnoticed until a limbthreatening abscess starts to form. • Examine your foot carefully every day for evidence of injury or redness indicating areas of excess pressure or friction. If your eyesight has been affected by diabetes, have a family member or friend do this for you. • See an orthotist and obtain properly fitted shoes, which should be custom moulded if you have any prominent foot bones or a history of foot ulcers. • Shake out your shoes each day before putting them on to dislodge any objects, such as pebbles, before they can produce an ulcer.

DIABETES WELLNESS | Winter 2024

Your DNZ

DNZ+ You might’ve heard us mention a number of diabetes organisations that we work alongside. Here’s an overview so you can tell your DNZRF from your NZSSD and from your Clinical Networks, and how they all come together with DNZ to make things happen.

NEW ZEALAND SOCIETY FOR THE STUDY OF DIABETES (NZSSD)

NZSSD is the leading diabetes clinical network in Aotearoa New Zealand, as well as being the national advisory body on diabetes clinical and scientific matters. The NZSSD membership comprise disciplines involved in diabetes integrated care and services across the lifespan. This includes diabetes specialist physicians, nurse practitioners, specialist diabetes nurses, podiatrists, dietitians, ophthalmologists, general physicians, primary health care clinicians, community health workers, and allied industries. NZSSD collaborates with Diabetes NZ for consumer perspectives. Just as we have an ex officio role on the NZSSD Board, they too are on the Diabetes NZ Advisory Group. nzssd.org.nz

DIABETES WELLNESS | Winter 2024

NATIONAL CLINICAL NETWORK FOR CHILDREN AND YOUNG PEOPLE WITH DIABETES (NZCYCN) DIABETES NEW ZEALAND RESEARCH FOUNDATION (DNZRF)

DNZRF funds vital New Zealand research that will improve the lives of Kiwis living with diabetes. The Research Foundation is the primary funder of diabetes research in New Zealand due to combining research funds held by Diabetes NZ and the former NZDF (New Zealand Diabetes Foundation). This allows the Foundation to have sufficient funds to establish and grow an investment portfolio. The Trustees of the Foundation represent both Diabetes NZ and NZSSD with an independent Trustee. The research focus is sufficiently wide to allow research grants to be made for both medical and non-medical research and other such socio-health. Recent grants have included summer studentships up to $20,000 and the recently-announced Diabetes Fellowship of $150,000. All bequests for diabetes research are held by the Foundation. dnzrf.org.nz

This was one of the first networks of the New Zealand Child and Youth Clinical Network (NZCYCN) programme, developed in partnership with the Paediatric Society of New Zealand – Te Kāhui Mātai Arotamariki o Aotearoa. This programme is funded by Manatū Hauora Ministry of Health. The aim of the network is to improve the care of youth with diabetes, and their whānau, through linical networking, audit, and research. This network was approved by the Ministry of Health and established in 2012 to provide clinical leadership and oversight. This was to ensure that there is a planned and consistent approach to the provision of diabetes services for tamariki and rangatahi across the country. The Network’s Clinical Reference Group is a multidisciplinary team of experts that includes medical specialists, paediatricians, GPs, specialist nurses, dietitians, psychologists, and consumer representatives, which is where Diabetes NZ sits. This group of experts works in a variety of settings and locations around the motu. One of Diabetes NZ’s positions is participating in the development of resources for youth, such as camp guidelines. https://starship.org.nz/healthprofessionals/clinical-network-forchildren-and-young-people-withdiabetes/

Grow

Preparing for winter garden delights It is possible to enjoy tasty fresh vegetables and herbs in winter, but you will need to start work now – in the autumn – to enjoy a cold weather harvest, as gardening expert Rachel Knight explains. I enjoy my winter edible garden even more than my summer one. Things take life at a more leisurely pace in the cooler months. There’s plenty of rain, and fewer weeds, and you’ll have more flexibility about when to harvest crops. Many vegetables will continue growing all year round if you don’t get a frost. Some crops will taste much sweeter if you do get a freeze. It’s the perfect time to grow things that readily go to seed when things heat up. On a sunny day, we can often find a sheltered spot from which to soak up the sights, sounds, and smells that a garden sanctuary offers. Successful winter gardens begin in autumn to give crops a good start while there’s still enough warmth in the soil and before the days draw in. Some won’t be ready until early spring, but you’ll be even more delighted to see them on your plate then. Try some or all of these cool weather varieties (see panel) for some tasty, fresh additions to your meals. Depending on where you live, some or all of these will thrive in winter. Some protection will help move things along if it’s really cold. A tunnel house, cold frame, or cloche will raise temperatures, particularly on sunny days, and might be what you need to give seedlings a headstart. It’s a real treat to be able to appreciate the special taste of fresh winter vegetables in a stew, salad, or soup.

Pak choi

CROPS THAT LOVE THE COLD Leeks – succulent and flavoursome at any size.

Spring onions – multi-purpose onions in a bunch.

Rocket – the nutty, decorative leaf that every salad-lover can grow.

Fennel – liquorice bulb to serve raw thinly sliced or roasted chunky.

Pak Choi – fast-growing, crispy, cup-shaped greens.

Parsley – flat leaved or curly. So much more than a garnish.

Silverbeet – prolific and reliable backyard staple.

Coriander – if you love it ,you’ll use it with everything!

Red kale – a delicate, frilly appearance hides a delicious robust green.

Celery – picked a stick at a time will mean your plants will last longer.

Cos lettuce – the must-have upright leaf for a Caesar salad.

Mizuna – spiky, spicy leaf that doesn’t mind the cold.

Cavalo Nero – black kale from Italy with distinctively dark, crinkly leaves.

Cabbage – steamed, coleslaw, or sauerkraut. Great greens (and reds) to keep you healthy.

Beetroot – earthy and sweet the red beets can’t be beat.

Parsnips – a slow grower, but the pale, slender roots are worth the wait.

Carrots – round and orangey or purple and pointy, they’ll taste carrotier than anything you buy.

Chicory – bitter salad green beloved of the French.

Turnips – don’t turn up your nose at a turnip. Try roasting golf ballsized ones you’ve just dug. Radishes – take your pick from red, round, and crunchy or white, long, and pointy.

Garlic

Broccoli – green brains that give you brains. Cauliflower – white brains longing for cheesy sprinkles. Garlic – planted mid-year for a summer harvest.

Red kale

Cauliflower

DIABETES WELLNESS | Winter 2024

Research

RESEARCH ROUNDUP We bring you some of the latest local and international research news impacting on diabetes care. NON-ALCOHOLIC FATTY LIVER DISEASE IN DIABETES: NAFLD

The term ‘non-alcoholic fatty liver disease’ is used in the absence of significant amounts of alcohol or other secondary causes of fat build up around the liver. Driven by insulin resistance, whether lean or obese, steatohepatitis (the advanced form of NAFLD) develops in at least half of all people with type 2 diabetes. There is a significant risk factor for future cirrhosis (severe scarring), even for individuals without obesity. The risk of developing steatohepatitis increases the more severe the insulin resistance is, such as in obesity and type 2 diabetes. Steatohepatitis is believed to be the link for the significant increase in the rate of hepatocellular carcinoma (the most common type of primary liver cancer) observed in people with diabetes. The magnitude of the epidemic of non-alcoholic fatty liver disease (NAFLD) affecting people with type 2 diabetes is just now beginning to be fully appreciated, although it has been brewing for decades, propelled by the twin epidemics of obesity and type 2 diabetes. NAFLD is the most common chronic liver disease in people with type 2 diabetes and may be considered a relatively new complication, although it was described in people with diabetes more than four decades ago. Recent studies suggest that, in the United States, more than 70% of people with type 2 diabetes have hepatic steatosis, a proportion that climbs to 90% in those with a BMI of more than 35 kg/m2. Source: diabetesjournals.org/spectrum/ article/37/1/5/154188

DIABETES WELLNESS | Winter 2024

EXPERIMENTAL TYPE 1 DIABETES DRUG SHELTERS PANCREAS CELLS FROM IMMUNE SYSTEM ATTACK

Scientists at Johns Hopkins Medicine report that an experimental monoclonal antibody drug called mAb43 appears to prevent and reverse the onset of clinical type 1 diabetes in mice and, in some cases, to lengthen the animals’ lifespan. The drug is unique, according to the researchers, because it targets insulin-making beta cells in the pancreas directly and is designed to shield those cells from attacks by the body’s own immune system cells. The drug’s specificity for such cells may enable long-term use in humans with few side effects, say the researchers. Monoclonal antibodies are made by cloning, or making identical replicas of, an animal (including human) cell line. Source: www.sciencedaily.com/ releases/2024/04/240429133540.htm

WAKING UP TO THE IMPORTANCE OF SLEEP IN TYPE 2 DIABETES MANAGEMENT

The American Diabetes Association/ European Association for the Study of Diabetes (ADA/EASD) reports the importance of sleep as a key lifestyle component in the management of type 2 diabetes, presented using three key constructs: quantity, quality, and timing (ie, chronotype). Their findings highlight some of the key evidence justifying the inclusion of sleep in the latest consensus guidelines by examining the associations of quantity, quality, and timing of sleep with measures of glycemia, cardiovascular disease risk, and mortality. They also considered potential mechanisms implicated in the association between sleep and type 2 diabetes and provide practical

advice for health care professionals about initiating conversations pertaining to sleep in clinical care. In particular, they emphasise the importance of measuring sleep in a free-living environment and provide a summary of the different methodologies and targets. Although the latest ADA/ EASD consensus report highlights sleep as a central component in the management of type 2 diabetes, placing it, for the first time, on a level playing field with other lifestyle behaviours (eg, physical activity and diet), the evidence base for improving sleep (beyond sleep disorders) in those living with type 2 diabetes is limited. This review should act as a timely reminder to incorporate sleep into clinical consultations, ongoing diabetes education, and future interventions. Source: https://diabetesjournals.org/care/ article/47/3/331/154247

AN ELECTRIFYING DISCOVERY MAY HELP DOCTORS DELIVER MORE EFFECTIVE GENE THERAPIES

In an effort to improve delivery of costly medical treatments, a team of researchers in electrical engineering at the University of Wisconsin-Madison has developed a stimulating method that could make the human body more receptive to certain gene therapies. The researchers exposed liver cells to short electric pulses – and those gentle zaps caused the liver cells to take in more than 40 times the amount of gene therapy material compared to cells that were not exposed to pulsed electric fields. The method could help reduce the dosage needed for these treatments, making them much safer and more affordable. The research appears April 30 in the journal PLOS ONE. Source: https://www.sciencedaily.com/ releases/2024/04/240430214503.htm

HELPING TO MANAGE YOUR DIABETES

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Dextro Energy Glucose Tablets • 24 sticks per carton (12 tablets per stick) • Available in four flavours Orange, Blackcurrent, Lemon, Tropical • All with added Vitamin C

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Learn more

0800 500 226 dexcom@nzms.co.nz dexcom.com Always read the label and follow the directions for use. Read the warnings available on dexcom.com/downloadsandguides before purchasing. Consult your healthcare professional to see which product is right for you. §Compared with a previous Dexcom G6 generation. ‡Results obtained with Dexcom G7 study, which shares the similar features and usability. ¶Event Entry only available on smartphone app. †Smart devices sold separately. For a list of compatible smart devices, please visit dexcom.com/ compatibility. # Connectivity availability may vary per country. References: 1 G7 Launch Survey Conducted in the UK n=100. 2 Beck RW, et al. JAMA. 2017;317(4):371-378. 3 Beck RW et al. Ann Intern Med. 2017;167(6):365-374. 4 Lind M, et al. Diabetes Care. 2021;44(1):141-149. 5. Garg SK, et al. Diabetes Technol Ther. 2022;24(6):373-380. 6. Dexcom ONE+ User Guide 2023. 7. Dexcom G6 User Guide. Dexcom, Dexcom Clarity, Dexcom Follow, Dexcom G6, Dexcom G7, Dexcom ONE+, and any related logos and design marks are either registered trademarks or trademarks of Dexcom, Inc. in the United States and/or other countries. © 2024 Dexcom, Inc. All rights reserved. New Zealand Medical & Scientific Limited (NZMS) is a Dexcom company. 2A Fisher Crescent, Mount Wellington, Auckland 1060. MAT-3129 Rev001 April 2024