Diabetes Wellness Autumn 2017 by Diabetes New Zealand

wellness

AUTUMN 2017

DIABETES

DIABETES NEW ZEALAND | DIABETES.ORG.NZ

BEYOND T1 • TEEN CAMPS • DIABETES X APP • JAMIE OLIVER’S SUPERFOODS • HAPPY FEET • DIABETES DOGS • WHAT’S FOR LUNCH? • FITNESS 1,2,3

FAMILY TIME: THE HIGHS AND LOWS OF GIVING BIRTH WITH T1 DIABETES

FOOT & HEEL BALM

Suitable for diabetics. Bio-organics Glycemix Foot & Heel Balm hydrates and smoothes the cracked skin of heels, providing immediate relief with results within 24 hours. Always read the label. Use only as directed. If symptoms persist, consult your healthcare professional. Sanofi Consumer Healthcare, Auckland.

Bio-organics Glycemix™ Neuropad® Diabetic Foot Test Patch Easy to use 10 minute self test for early detection of diabetic foot syndrome. 2 patches – one for each foot. Always read the label. Use only as directed. This device may not be suitable for every person with diabetes, seek the advice of your healthcare professional. Use of Neuropad does not replace the need for patient vigilance for the early signs of diabetic foot neuropathy and regular consultation with their healthcare professional. A normal result does not preclude diabetic foot syndrome or foot neuropathy. Common signs of diabetic foot neuropathy include numbness, reduced pain, ability to sense temperature range, tingling or burning sensation, sharp pains or cramps, increased touch sensitivity, muscle weakness, loss of reflexes, loss of balance, ulcers or foot deformity. Consult your doctor if you experience any of these signs even in the event of a normal test result. Sanofi Consumer Healthcare, Auckland 0800 445 365. TAPS PP9144.

ONLY IN UNICHEM AND LIFE PHARMACIES

CHCANZ.BORG.17.01.0070

Contents AUTUMN 2017

COVER IMAGE: RUBY AND HAYDEN MCGILL WITH DAUGHTER OLIVE AND BABY FELIX. PHOTO © TESSA CALOGARAS

VOLUME 29 | NO 1

4 Editorial

19 MEAL MAKEOVER: Helen Gibbs gives mince the makeover treatment

6 Upfront 8 COVER: Baby time with Ruby McGill

20 DIABETES AWARENESS MONTH: Take Control Toolkit and the Diabetes NZ Fitbit Movemeant Challenge

10 ADVOCATE: Pita Pit teams up with Diabetes NZ 12 KNOW: Beyond Type 1 – a new global community

14 ASK AN EXPERT: Inspirational words from Dr Tom Mulholland 16 CARE: Metformin and vitamin B12 17 WALK2WORKDAY: NZ’s national day to celebrate walking 18 COMMUNITY: Diabetes nurses go on a rural road trip to the Far North

22 LIFE: Lenise Onekawa takes control 23 CARE: A guide to your first eye test 24 FAMILIES: Carla Adlington has fun on a diabetes teen camp 25 FAMILIES: Hamish Beadle joins Team Novo Nordisk 26 KNOW: Type 2 Diabetes Xplained – a new app based on the real story of two New Zealanders

28 LIFE: Brenda Ferguson introduces Pip, the first diabetes assistance dog to work in a public hospital 30 EAT: Helen Gibbs spells out some healthy lunch options 32 RESEARCH: Reasearchers are seeking out participants for a new gestational diabetes study 33 FEET: Suzanne Moorhouse and her foot-check message 34 RECIPES: Superfood ideas from Jamie Oliver’s latest cookbook 36 MOVE: Get fit to help control your diabetes. Craig Wise tells you how 38 REFLECT: Ruth Jeffrey takes on Mt Kilimanjaro to celebrate turning 50

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DIABETES WELLNESS | Autumn 2017

Editorial

Welcome to 2017. I hope the year so far is being kind to you. This promises to be another year of positive change for Diabetes New Zealand. In 2017 we formally welcomed diabetes youth from across New Zealand into the organisation in the form of a new Youth Advisory Committee that will sit within the Advisory Council. We also have new roles and personnel at National Office and around the Advisory Council and Board tables. The Advisory Council has a substantial amount of work planned for the coming year including a review of the organisation and Destination Unity, and a stocktake of services across New Zealand for people with diabetes. Both of these will require input from our membership. We will invite members, initially by email and via branches, to consider participating in the teams who will lead these pieces of work. If you are interested in taking an active role in either of these, and have not received any information, please contact your branch, National Office, or me directly to express your interest. Your Advisory Council includes the regional representatives nominated by your branches in addition to myself, the Vice President, and two other members elected by you. As your representatives we appreciate hearing from you and trust that issues and opportunities that need to be discussed at a national level are brought to our attention. While we may not always be able to resolve issues or take advantage of opportunities, we cannot consider what we donâ&#x20AC;&#x2122;t know. So if you wish to raise anything, please contact your regional representatives in the first instance, or any other members of the Advisory Council. I do ask that you bear in mind that, like yourselves, we are volunteers. We all have many demands on our time, including day jobs and family commitments, but we have a passion for our diabetes work so will endeavour to respond in a timely manner. I hope you are enjoying the new-look magazine as much as I am. Happy reading! DEB CONNOR

President, Diabetes New Zealand

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.

DIABETES NEW ZEALAND Patrons Lady Beattie and Sir Eion Edgar President Deb Connor Chief executive Steve Crew Diabetes New Zealand Inc. National Office Level 7, 15 Murphy Street Thorndon, Wellington 6144 Postal address PO Box 12 441, Wellington 6144 Telephone 04 499 7145 Freephone 0800 342 238 Fax 04 499 7146 Email admin@diabetes.org.nz Web diabetes.org.nz Facebook facebook.com/diabetesnz Twitter twitter.com/diabetes_nz

DIABETES WELLNESS MAGAZINE Editor Caroline Wood editor@diabetes.org.nz Publisher Diabetes New Zealand Production & distribution Rose Miller, Kraftwork Magazine delivery address changes Freepost Diabetes NZ, PO Box 12 441, Wellington 6144 Telephone 0800 342 238 Email admin@diabetes.org.nz Back issues issuu.com/diabetesnewzealand ISSN 1176-4406

ADVERTISING & SPONSORSHIP Advertising John Emmanuel john@affinityads.com or 09 473 9947 Business development manager Sue Brewster sue@diabetes.org.nz or 09 810 7047

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.

DIABETES WELLNESS | Autumn 2017

NEW. THE METER THAT TALKS!

Living with diabetes can be tough. It can be even more challenging trying to test your glucose with low vision. With its talking function, the CareSens N Voice makes testing a little bit easier so you can be sure of your test results.

CARESENS N VOICE HAS: • No Coding required and uses funded CareSens N test strips. • Post meal flagging • Calculates test averages from the last 1, 7, 14, 30 & 90 days • Wide operating temperature range (5-50oC) • Strip ejection button • Data port to download results to SmartLog software.

Uses funded CareSens N Test strips

For more information visit www.caresens.co.nz. To buy your CareSens N Voice call:

0800 GLUCOSE (0800 45 82 67) or enquire at your nearest pharmacy. Always read the label. Follow the manufacturer’s instructions, and the advice provided by your healthcare professional. Pharmaco (NZ) Ltd, Auckland. 1116CS02. TAPS DA 1617FA.

Upfront

DON’T SKIMP INSULIN TO LOSE WEIGHT A project has been launched that aims to find the true number of young Kiwis with type 1 diabetes who are also struggling with eating disorders.

He said: “Being diagnosed with diabetes requires a much more restrictive diet, which can also cause a lot of self-consciousness at a very vulnerable time.”

The study will include Waikato, Auckland, Waitemata, and Counties Manukau District Health Boards. It initially involves screening patients aged between 15-25 years for six months via the clinical Diabetes Eating Problem Survey.

Diabetes UK estimates 40 percent of young women with type 1 diabetes withhold insulin to lose weight. This practice, known as diabulimia, is not a clinical diagnosis but exists alongside eating disorders such as anorexia and bulimia.

A small study within the Waikato youth and young adult diabetes team in 2015 found one in four patients aged 11-14 showed signs of disordered eating. Roger Mysliwiec, from the New Zealand Eating Disorders clinic, is a clinical leader on the study.

Action on sugary drinks The New Zealand Dental Association has launched a consensus statement on sugary drinks endorsed by key health organisations, including Diabetes NZ. It wants to see an icon added to the label on drinks indicating the amount of sugar in each drink in teaspoons. The proposal would see a fullstrength 600ml bottle of fizzy drink state “contains 16 teaspoons of sugar”. Spokesperson Dr Rob Beaglehole said: “This is about informing the public about the negative health impacts of sugary drinks, and advocating for a comprehensive approach to reduce sugary drink consumption.”

Other measures include introducing water-only policies in schools, council facilities and events and a sugary drinks tax. The statement also urges the government to adopt World Health Organisation guidelines on sugar. It recommends adults and children reduce their daily intake of free sugars to less than 10 percent of their total energy intake. A further reduction to below five percent, or roughly 25 grams (6 teaspoons) per day, will provide additional health benefits. The Consensus Statement was also endorsed by many other organisations, including: Activity and Nutrition Aotearoa (ANA), Association of Salaried Medical

“This is the sad thing, we were seeing them after they had been hospitalised – when a lot of the damage had already been done. These people should be identified early,” added Dr Mysliwiec. Source: stuff.co.nz

16 The Dental Association wants all drink labels to carry an icon to indicate how many teaspoons of sugar the drink contains. Specialists, Cancer Society of New Zealand, Hapai Te Hauora, NZ Dental & Oral Health Therapists Association, NZ Society of Hospital and Community Dentistry, Te Ao Marama, The Heart Foundation, The Public Health Association. For more information see healthysmiles.org.nz.

Exciting plans are being drawn up for Diabetes Action Month 2017, more details in the next issue! In the meantime you can read the highlights of last year’s campaign on p20/21.

DIABETES WELLNESS | Autumn 2017

NEW YOUTH DIRECTOR Diabetes NZ has appointed a Director of Youth to advocate for young people with type 1 diabetes nationwide. Wellington-based diabetes advocate and blogger Ruby McGill will take up the post in March. Up to 20,000 New Zealanders have type 1 diabetes and Diabetes NZ believes it’s vital to recognise the specific needs of people with T1, many of whom are diagnosed as children. Steve Crew, Chief Executive of Diabetes NZ, said: “About 2,000 Kiwi children and young people have type 1 diabetes. Their experience with the health system starts at a young age and involves their family, and other carers, in school and social settings. “They need intensive support from a health care team that includes members with specialist expertise who can provide psychological support. Parents also need support as they adjust to having a child with a chronic disease. “Diabetes New Zealand is well placed to lead in this space. This is why we are employing a Director of Youth whose job will be to advocate for young people across the whole country. “I’m sure Ruby will do an excellent job and I’m delighted to welcome her to the Diabetes NZ whānau. We look forward to working together to help young people with diabetes be the best they can be.” Ruby is featured in our cover story, see overleaf. p

Kiwi scientists discover missing T2 link New Zealand researchers have uncovered a new mechanism that controls the release of insulin in the body, providing hope for those with a genetic susceptibility to type 2 diabetes. The findings show for the first time that a protein known as betacatenin is crucial for controlling the release of insulin from the pancreas to maintain stable blood sugar levels. “This discovery potentially opens up a whole new drug discovery field to understand how we could manipulate beta-catenin levels to control the release of insulin,” says University of Auckland lead researcher Professor Peter Shepherd. Researchers focused on a variant in a gene called TCF7L2, which is the biggest contributing factor to whether people are genetically susceptible to getting type 2 diabetes or not. “TCF7L2 binds directly to the beta-catenin protein. We wanted to understand how the gene variants in TCF7L2 affect the regulation of glucose metabolism in the body,” says Professor Shepherd. “We found that beta-catenin levels not only change in response to rising and falling nutrient levels, but that they also regulate how much insulin is ready for secretion and ensure that we have the right amount of insulin at the right time. It’s like the volume control mechanism on your phone or TV.” The University of Auckland team’s findings were published in The Journal of Biological Chemistry, in December.

MEDTRONIC AND FITBIT LINK UP Medical device maker Medtronic has teamed up with Fitbit to integrate physical activity data with blood glucose levels into one streamlined application. People living with type 2 diabetes who use Medtronic’s iPro2 continuous glucose monitoring system and its companion app, iPro2 myLog, will now be able to have their Fitbit data automatically synced to the app. This will allow users to easily see the connection between their exercise and glucose levels. Understanding how exercise affects glucose is a critical element to proper diabetes management but many people have been manually tracking and recording their physical activity or working with several apps at once.

DIABETES WELLNESS | Autumn 2017

Cover

BABY TIME Ruby McGill advocates for people living with type 1 diabetes. Here she compares the experience of giving birth to two children.

All images by Tessa Calogaras

DIABETES WELLNESS | Autumn 2017

felt the public health system had let me down when Miss Five [daughter Olive] arrived into the world. It all seemed to go horribly wrong. When my blood sugars dropped drastically during labour, it was obvious the hospital staff in the room knew little about diabetes. My husband had to take charge and pull me back from hypoglycaemia. Testing my blood sugars and feeding me, all while convincing the staff it would take longer than 30 seconds for glucose to have an effect. I woke hours later in a theatre recovery room, alone. I’d needed an emergency caesarean under general anaesthetic. I was joined

by a nurse and asked her the terrifying question “Do I have a baby?” I did! What a relief. Hayden and I slowly adjusted to life with a baby, adamant we were never going through that again. But as time went by and memories faded we found ourselves preparing for the arrival of baby No 2. I was going to do everything I could to ensure this delivery was different. I called in the expertise of a private obstetrician, began using an insulin pump, imported a Freestyle Libre to test my blood sugars and agreed to a scheduled caesarean. At 38 weeks I was admitted to hospital for steroid injections

T1 and PREGNANT? RUBY’S TOP TIPS It has taken me more than 17 years to feel confident managing my diabetes, which certainly helped during this pregnancy and the delivery of Baby No 2. But what if you don’t have 17 years to master diabetes? What if you only have nine months to get everything sorted? Here are a few things that really made a difference: • Using an insulin pump during pregnancy meant I could easily adjust my basal rates, carb ratios, insulin sensitivity factor and see the insulin I had on board with the click of a few buttons. • A Freestyle Libre allowed me to see my blood sugar level with a painless one second scan of a small sensor in my arm, automatically measuring

and continuously storing the readings, day and night. It made frequent testing while in hospital and while feeding or settling our little man a breeze! • I discussed my “diabetes delivery plan” with the endocrinologist and diabetes team. You will have spent the last nine months working together, preparing for the arrival of your baby. Make sure you are kept in the loop and everyone understands what to do if your blood sugar levels go astray during the delivery. • Remember, it takes a village to raise a child, so if you’re not able to be the diabetes expert during the delivery (it’s highly likely you’ll be somewhat preoccupied), assign the role to someone you trust such as your partner, a parent or friend.

You can follow Ruby’s journey to master diabetes at www.masteringdiabetesnz.com

to speed up the baby’s lung development because he was scheduled to arrive early. This is common for diabetic mums. As expected, the steroids increased my blood glucose levels. I monitored them closely and increased my insulin dose to bring them down. I had to explain to the midwives that I had enough insulin on board to bring my blood sugars back within range so there was no need to panic. It seemed that once again the team on the ward were not diabetes experts! My blood sugars settled down but after the final steroid injection they increased again and I developed ketones in my

blood. I still had 12 hours until my caesarean… The midwife on duty had no idea what to do. Then it hit me, of course she didn’t, she’s an expert in pregnancy and giving birth. It was unrealistic to expect her to be a diabetes expert too. At that point it was up to me. I tried to recall everything I’d learnt about ketones. I injected additional insulin and rehydrated via a drip. Slowly, my blood sugars returned to normal and the ketones disappeared. Panic over! I had avoided diabetic ketoacidosis (DKA). Everything was going to be okay. Thanks to the help of the Hutt Hospital

Remember, it takes a village to raise a child, so if you’re not able to be the diabetes expert during the delivery (it’s highly likely you’ll be somewhat preoccupied) assign the role to someone you trust such as your partner, a parent or friend.

Ruby, daughter Olive, baby Felix and husband Hayden

diabetes team during my pregnancy, and the use of an insulin pump, I had become the diabetes expert I so desperately wanted during the delivery of Miss Five. A sense of calm came over me. The ward was quiet, my blood sugars were under control and in a few hours we would meet our new family member. On 30 September at 10.52am Felix Mckechnie McGill arrived safely and calmly into this world, weighing 8lb 3oz. As we went to press Ruby was named Diabetes NZ’s new Director of Youth, find out more in our next issue!

DIABETES WELLNESS | Autumn 2017

Advocate

From left: Former Silver Fern netballer Leana de Bruin serves up healthy options at Pita Pit Hamilton; rugby player Jordan Taufua at Pita Pit Christchurch; and Louisa Wall MP at Pita Pit Lambton Quay.

Pita Pit launches diabetes-friendly menu Diabetes NZ has teamed up with Pita Pit to promote healthy eating choices, as Sue Brewster explains.

ita Pit New Zealand has become the first quickservice food chain in New Zealand to join forces with Diabetes NZ and offer a diabetesfriendly range of salads and wraps. The ‘Diabetes NZ Choice’ symbol is being promoted in every Pita Pit store nationwide. It means anyone with diabetes or prediabetes can easily identify the products more suited to them. The choices are also perfect for any Pita Pit customer who wants to follow a healthy, nutritious diet. “We had been looking for a partner in the food sector for a while but it was very important to us to wait until we found the right partner. With Pita Pit, it became clear very quickly that we had a lot in common in our messaging around food,” says Steve Crew, Chief Executive of Diabetes NZ.

DIABETES WELLNESS | Autumn 2017

“Pita Pit’s range of fresh vegetables, grilled proteins and salad options are in keeping with our healthy plate promotion and Pita Pit can provide choices suited not only for people with diabetes but also for those wanting to make healthier food selections.” Some of New Zealand’s wellknown sports stars and politicians helped celebrate the new Diabetes NZ Choice Pita Pit range on the last day of Diabetes Action Month. They served up lunch on 30 November at stores around the country. Black Sticks player Gemma Flynn, NZ Triathlete Andrea Hewitt, Labour MP Louisa Wall, rugby player Jordan Taufua and former Silver Fern Leana de Bruin all jumped at the chance to get behind the counter, promote the new menu, and ask customers to ‘round up’ their purchase total to the nearest dollar with Pita Pit

The Diabetes NZ Choice range of Pita Pit products has been designed as a guide to give people with diabetes a ‘choice’ across a range of products. The range has been developed in line with dietary advice for people with diabetes in the New Zealand context.

matching the public donation as a fundraising opportunity for Diabetes NZ. “We are thrilled to be in a position to help educate Kiwis about diabetes by dishing up information around the importance of making good food choices,” says Duane Dalton, Director of Pita Pit in New Zealand. “We serve up healthy food, not health food, and our menu includes plenty of fresh vegetables, grilled proteins and salad options. We hope the Diabetes NZ Choice range in-store will make it even easier for people to make the best food choice for them.” Customers can also use the Pita Pit Nutrition Calculator, a sophisticated online tool that helps people easily identify nutritional values across any combinations of Pita Pit products.

Food and nutrition is an important part of living well. Thatâ&#x20AC;&#x2122;s why Pita Pit is proud to provide a range of choices suited for people with diabetes and for those wanting to make healthier food selections. Our Diabetes NZ Choice range is packed full of fresh vegetables, grilled proteins and salad options. And to make it even easier for you to make the best food choices weâ&#x20AC;&#x2122;ve developed an online Nutrition Calculator so you can work out the nutritional breakdown of your favourite Pita Pit meal. OFFICIAL NUTRITIONAL PARTNER

Know

BEYOND

TYPE 1 Kiwis with type 1 diabetes are flocking to a new global online community offering positive messages of support and encouragement, as Jill Brinsdon explains.

Founder Nick Jonas sums it up like this: Beyond Type 1 is the place we can go to crash and get lifted up again.

In 2017, there are plans for New Zealand to become the first country to have its own geographical breakout across the website and app.

wo years ago a small group of talented Americans got together to look at supporting people with type one diabetes in an entirely different way. Singer songwriter Nick Jonas (the Jonas brother with T1), Sam Talbot, a star in the US culinary world (also T1), Sarah Lucas, a firebrand who had already raised over $10 million for type 1 charities and Juliet de Baubigny, a business leader specialising in human capital and not for profit, set out to bridge the gap between diagnosis and cure with inspiration, celebration and action. From a single Instagram post, Beyond Type 1 has mushroomed into six dynamic digital channels, eight grant-aided projects, 27 new diabetes initiatives, and hundreds of events and fundraisers. Everything is unashamedly contemporary, inclusive and disruptive. Every day, new content

puts an inspiring human face on type 1 diabetes, clears up misunderstandings that surround it and works towards eradicating the stigma that comes from living with a chronic disease. You can find all of this at www.beyondtype1.org, which already has more than 500,000 followers across its channels since being launched in February 2015. A council of medical professionals checks the diabetesrelated advice before it is posted. There are also inspiring personal stories of people with diabetes from around the world, including New Zealand. Beyond Type 1 already boasts over 1,000 active Kiwis and I sit on the Global Council. My job is to help draw attention to the amazing assets now available to New Zealanders with type 1. Why join in? If you spend some time on the website, you’ll quickly appreciate what a breath of fresh

ABOUT THE NEW APP Beyond Type 1’s recently released app brought together over 10,000 members

from 180 different countries within six weeks of its launch – proving there’s a real call for a new kind of community. You can share stories, ask questions in real time, participate in polls, troubleshoot and be a part of a collective that offers daily inspiration and support. Download the app via www.beyondtype1.org

DIABETES WELLNESS | Autumn 2017

JILL AND CODY’S STORY

Founders Nick, Juliet, Sarah and Sam

air and information Beyond Type 1 is. The most common feedback across all the channels is: “I know now that I am far from alone”. In 2017, there are plans for New Zealand to become the first country to have its own geographical breakout across the website and app. So Kiwis will be the first to enjoy the best of both worlds – we’ll still be part of the global conversation while at the same time we’ll have our own support system and be able to connect with, learn from, and be inspired by people in our own backyard. To get involved, all you have to do is choose one (or all) of the channels and sign up. For example, you can download the app, follow Beyond Type 1 on Facebook, sign up for news via the website, become an ambassador, connect with others, listen in and even tell your story. If you have type 1, you definitely have experience to share!

CONNECT TODAY www.beyondtype1.org

The week before Cody was diagnosed I had declared my life as officially full. ‘No vacancies!’ I said to a friend, probably over a glass of wine. I was a solo mum in Auckland with two rambunctious sons, aged four and 10. I had a new business, a new relationship, a dog and a big home to maintain. There was nothing more I could fit into my life. And then Cody turned 5, started school, got sick and was diagnosed. Thirteen years later, certain memories from that hospital room can still bring me to tears. A wee boy kicking and screaming as he was held down for another jab, then changing tack and sweetly saying to the nurse that he felt completely fine now and was soon going home with his mamma and dad. His father’s liquid eyes, my own terror. Have I got used to it? Not really, if I’m honest. I’ve heard type 1 described as a ‘frenemy’, and for me it’s true. I soon developed a mantra with Cody: you are the boss of your diabetes or it is the boss of you. That’s true, too, but you can’t just sit it down once a year and let it know who’s in charge. Every three to four hours, every meal, everything out of the ordinary, there’s my boy negotiating once again with the terrorist called type 1. But, here’s the thing, the personal strength, tenacity and passion Cody has had to call on every day to stay in charge of his body are transforming him into a remarkable young 18-year-old man. He’s already endured burnout fury, crisis and discrimination. He’s handled it, and I have no doubt the life he

Cody and mum Jill (below) are Beyond Type 1 supporters

will create for himself is going to be successful, and significant, because of all he’s already been through. His journey has changed me, too. I had my own grief to deal with, losing the right to a healthy child. I’m softer in the heart, but harder in the head. I’ve become politicised. #diabetes on a picture of a cake isn’t funny and spotting a cookbook called Reverse Diabetes, like I did recently, makes me crazy. Beyond Type 1 suits Cody and me. I’ve been parenting him to live beyond T1 for 13 years already and now we’ve joined a global community who are doing that too – passionately, pragmatically, with creativity and commitment. Jill Brinsdon is an Aucklandbased media commentator, brand strategist and mum-of-two. She sits on the Global Council of Beyond Type 1.

A version of this story was first published on www.beyondtype1.org

DIABETES WELLNESS | Autumn 2017

Ask an expert

An hour with…

DR TOM MULHOLLAND Know your numbers, look after your pipes, disengage the grumpy unit, and other gems from Dr Tom Mulholland, emergency doctor, adventurer and motivational speaker.

Dr Tom reckons he saves more lives by encouraging people to take control of their own health than he does in the course of his work as an emergency department doctor.

DIABETES WELLNESS | Autumn 2017

r Tom is a man on a mission. Specifically he wants to be the ambulance at the top of the cliff, helping people to help themselves by preventing illness, rather than treating people once they’ve got sick, when it’s often too late to help them. With 30 years of experience treating people in hospital emergency rooms, Dr Tom Mulholland gave a no-holds barred talk at the Diabetes NZ conference late last year, when he explained his down-to-earth attitude towards being healthy. He started by asking how many of us wanted to live until 100 years old? Quite a few hands went up in the audience. It’s perfectly possible, he told us, but only if we work at being healthy and looking after ourselves. My mantra is “health is safety”, he said. Dr Tom played a game where we answered questions about our health – did we know our numbers (cholesterol, blood pressure etc), had we ever smoked? Did we text and drive? Have unprotected sex? We had to sit down if we couldn’t answer a question, until we were down to the “healthiest” person in the room. The person most likely of the group to live to 100 years old. He tells us it’s perfectly possible to live for a century, but reminds us that even at 100 years old, we still want to be “continent, cognitive, ambulant and living the dream”. The sad fact is that there are communities in New Zealand where the average life expectancy is just 65 years old. Where people are needlessly dying because they are not looking after themselves, not treating cholesterol, high blood pressure, not getting important medical tests, and not controlling their diabetes. There is “a bigger tsunami of diabetes than you think coming,” he says. And Dr Tom should know because in 2014, he decided to do something about it, literally! “The reality is we don’t save many people’s lives [in the emergency department] because it’s often too late. My passion is helping people. That’s why I thought a few years

ago ‘Why don’t I become an ambulance at the top of a cliff?’” He went out and bought an old ambulance, kitted it out with medical equipment, and pledged to spend five years travelling to remote rural communities offering medical care and tests for things like blood pressure and diabetes. The motto of the Dr Tom on a Mission initiative was to make a difference, have some fun along the way – and not to annoy anyone... “I funded it myself for the first six months. I had to get out there and do it. We went up to the Far North to start up with and then along the East Coast.” Since then he has been all over the country from Tolaga Bay to Invercargill. And he now receives some government funding to help him do it. Dr Tom tells us how he did blood tests during his visits and the results were sobering. Of 550 blood sugar tests, 28% showed prediabetes and Dr Tom found 24 people with undiagnosed type 2 diabetes, some with stratospheric HbA1c levels. Dr Tom doesn’t mince words with his patients. Take the story of “Fats”, ex-Mongrel Mob member, high HbA1c, hates doctors, won’t get help for his diabetes. “I told him that if you leave it at that, you’re going to have your legs cut off. He told me that his dad had his legs cut off and Fats was the one who dressed his stumps as a child. “You feel like giving up, but I tried another tack. I asked him: ‘How many kids do you have?’ Eleven kids, he tells me. ‘And which kid will dress your stump?’ I asked him.” This approach made Fats sit up and listen and accept some help from Dr Tom. You can find out what happened next by watching the video on www.facebook.com/ drtomonamission/.

He believes that health and longevity are in our own hands. He suggests setting a target age that you want to live to and working backwards. How many kids’ birthdays do you want to celebrate, how many rugby World Cups do you want to watch? How many oceans do you want to sail on? Whatever rocks your boat, or is your passion, how long do you want to do it for? Dr Tom reckons he saves more lives doing his talks and driving his ambulance than he does in the course of his work as an emergency doctor. It’s essential for every person to “know their numbers” – what is your blood pressure, cholesterol, HbA1c? Blood tests are essential, ask your doctor for them, he says. Stress is another big issue for Dr Tom. It elevates the hormone cortisol and can cause heart attacks. De-stress where you can and get treatment for high blood pressure. That’s very important, he tells us before recounting a story that didn’t end well for a man who was “too busy” to order a repeat prescription of blood pressure meds. Which leads us on

to another gem of advice to “look after our pipes” – too much salt and fat will clog up our blood vessels and lead to problems. Dr Tom also tells us about his brush with depression and how he got out of a big black hole he was in some years ago. He has written books about reducing stress and using healthy thinking to stay positive. He tells us we need to “disengage the grumpy unit”. Everyone needs to rest, eat well, and don’t be afraid to see a professional if that doesn’t work and you are still feeling down. He finishes with a crucial piece of advice: “It’s not your diabetes that will kill you, it’s your attitude towards it that will.” I think most of us would agree with that. For more information, check out Dr Tom’s Facebook page or to go www.drtomonamission.com Dr Tom Mulholland is an Emergency Department Physician at Auckland Hospital, a lecturer in Psychological Medicine at Auckland clinical school, teaching medical students, and founder of the Healthy Thinking Institute.

DIABETES WELLNESS | Autumn 2017

Care

TAKING METFORMIN? CHECK YOUR B12 STATUS A recent study shows it’s worth checking your vitamin B12 level if you are taking the diabetes medication metformin.

octors believe there are many benefits of taking metformin if you have type 2 diabetes but one possible negative effect is that it may impact on your B12 levels, causing deficiency in this important vitamin. B12 is needed for the healthy function of the brain and nervous system and for energy production but recent research from the global Diabetes Prevention Programme has shown that long-term metformin use may lead to B12 deficiency. Similar results were found in a local Wellington study. Diabetes specialist Prof Jeremy Krebs commented: “Metformin can reduce the absorption of vitamin B12. We have published data from Wellington demonstrating relatively high rates of low or borderline vitamin B12 in those with type 2 diabetes who are on metformin. This paper reports similar data from participants of the Diabetes Prevention Programme. “Although it is uncommon to be associated with anaemia or neuropathy, metformin does increase the risk of these. These data support the call to monitor vitamin B12 status in those on metformin.” You can ask your GP for a blood test to check your vitamin B12 level. Intramuscular injections are an option if you are severely deficient but sublingual B12 (under the tongue spray or drops) is just as good for maximum absorption. “We have also published a study showing that sublingual vitamin B12 is as good as intramuscular injections to replace vitamin B12 in those on metformin, and may be more acceptable to those who need it”, Prof Krebs added. Reference:J Clin Endocrinol Metab 2016; 101(4): 1754–61

Am I at risk? • You are over the age of 60 – as you get older you are less likely to absorb B12 at optimum levels. • You are vegetarian or vegan – B12 doesn’t occur naturally in plant-based foods. Some of the best food sources are meat, eggs, milk and cheese. • You take regular PPI (proton pump inhibitor) medication – such as omeprazole – it impedes B12 absorption. • You suffer from a digestive issue – people with irritable bowel and coeliac disease are less able to absorb B12 – or have undergone weight loss surgery. • You have low energy levels – you need B12 to make red blood cells, which transport oxygen throughout your body. • You have raised homocysteine levels – studies show that insufficient B12 can elevate homocysteine, which in turn increases the risk of heart disease, stroke and pregnancy complications. Source: betteryou.com

Vitamin B12 Vitamin B12 plays an important role in the functioning of the brain and nervous system, and in the formation of the red blood cells. It is required for energy production in every cell in the body, and in the synthesis of DNA. If left untreated, vitamin B12 deficiency can lead to anaemia, as well as nerve and brain damage which may manifest in symptoms such as brain fog, memory problems, fatigue, depression, muscle fatigue and tingling in the extremities.

If you think you’re at risk, ask your GP for a blood test to check your vitamin B12 level.

DIABETES WELLNESS | Autumn 2017

Walk2Work Day

MAKE WALKING PART OF EVERY JOURNEY If you walk to work one day this year make it Wednesday 8 March because that is New Zealand’s national day for walking.

ou can walk almost anywhere, at any time, in any weather for free. It’s great for our health and the health of our planet. Walk2Work Day is New Zealand’s national day to celebrate walking. Living Streets Aotearoa started this annual day in 2009 to promote walking, its health benefits, and its priority position in the sustainable transport hierarchy. Diabetes NZ is supporting Walk2Work Day 2017 and is encouraging its members to get out and be more active, even if it’s just for an extra 10-15 minutes a day. Chief Executive Steve Crew walks as much as he can every day and encourages his staff to walk at lunchtime. He said: “Walking is a wonderful activity, I’ve seen firsthand the benefits it can bring. Since I’ve been making an effort to walk more, I feel more healthy and I’ve lost weight.” Even a small amount of extra walking a day will see your

body (and wallet) benefiting. For example, if you walk 1,000 metres (about 1,300 steps or 12 minutes) you will: • Gain energy, tone your legs, bottom and tummy, use up 74 calories (for a 70kg person), lift your mood, improve balance and coordination. • Save $3.62 of health benefits, save $0.72 cents of car costs, and avoid 0.2kgs of carbon emissions. • Reduce disease risk and improve heart health. • Be able to socialise with friends and community on the way. Taking the bus or train is good for you too. Research reported in the British Medical Journal showed that people using public transport had lower body mass indices than those that travel by private transport. To find a Walk2Work Day event near you, see www.livingstreets. org.nz or check out Living Streets Aotearoa’s Facebook page or your local council’s website.

WHY WALK?

The health benefits of walking are commonly known these days but walking to work also saves money, is good for the environment and results in a more productive workforce. WANT TO HELP?

Living Streets Aotearoa www.livingstreets.org.nz has developed the Walk2Work Toolkit for businesses and organisations who want to encourage their staff to be more active.

HOW MUCH WALKING?

Ideally aim for 30 minutes a day – or 10,000 steps if you’re using a pedometer.

Walk2Work Day is on Wednesday 8 March 2017. Walk or catch a bus or train to your daily activity and see a host of health benefits.

DIABETES WELLNESS | Autumn 2017

Community

Diabetes nurses Floss Subritzky and Marama Brown (pictured left) travelled through rural Northland treating patients with T2 diabetes

RURAL ROAD TRIP What do you do if your patients don’t come to their GP surgery for their annual diabetes check ups? You go to them, says diabetes nurse Marama Brown.

urses in the Far North hit the road during Diabetes Action Month visiting a string of small rural centres in the Kaitaia region where they held two-hour health clinics for people with type 2 diabetes. Two teams of two nurses visited small settlements where medical services aren’t normally available. They used a variety of tactics to make themselves as visible as possible, including wearing giant Diabetes Action Month blue glasses fashioned out of foam swimming noodles, holding clinics outdoors where possible and giving away $20 fruit and vege vouchers. Organiser Marama Brown, from Far North primary care health provider Te Hiku Hauora, said the initiative was very popular among patients who turned out to see a nurse and get help for their (often uncontrolled) diabetes. Letters were sent out to all patients who hadn’t been seen for a year or

DIABETES WELLNESS | Autumn 2017

more saying nurses would be in their communities at a certain time and day. Patients were offered a range of holistic health checks – a diabetes WOF – including cholesterol, blood pressure, HbA1c and feet checks. As well as treating diabetes patients, the nurses also offered free health checks, including diabetes tests, for anyone who wanted one. The number of people attending the clinics depended on location, with 15 people attending in one community, but just two or three people turning up in other places. Marama and the team also offered evening clinics in Kaitaia during the week from 5-7pm for those unable to get to the daytime sessions. Marama said: “The aim was to connect with patients who had diagnosed diabetes but hadn’t seen a health professional in a year or longer. We dressed up, used the glasses, put ourselves out there, it was a great way to start the conversation with people. “I was happy because this is a hard-to-reach group and connecting with even just one or two people was a success in our eyes.” In another plus, the nurses’ road trip has revealed an unmet need in the local community, says Marama. So, from 2017, Te Hiku Hauora

will offer mobile health clinics throughout the year. Health professionals will travel to remote rural areas to offer a range of services, including diabetes care. Claire Paget-Hay, of Diabetes New Zealand’s Northland branch, who attended one of Marama’s sessions, said: “This is a fantastic initiative and involves a lot of work on their part. “It is exciting to see an organisation such as Te Hiku Hauora really reaching out to the rural community to connect with people who are living with diabetes.” TE HIKU HAUORA

Established in 1995 as a charitable trust, Te Hiku Hauora is the largest provider of primary health care services in the Te Hiku (Far North) region. It has approximately 800 people with diabetes on its books, out of a total patient register of 12,000. Te Hiku Hauora has a multidisciplinary approach to health care incorporating: general practitioners and dentists, health promotion, mobile nursing services and home support, all a part of its aim to provide a onestop-shop for health care, with a particular focus on Māori.

Meal makeover

MARVELLOUS MINCE Dietitian Helen Gibbs suggests easy ways to make our favourite mince-based dishes healthier while cutting the cost of the weekly family shop. Beef or lamb mince in tomato sauce is the basis of many Kiwisâ&#x20AC;&#x2122; favourite family meals such as spaghetti Bolognese, lasagne and chilli con carne. While full of protein and iron, the problem often lies with there being too large a serving of meat and not enough vegetables in mince-based meals. My mince makeover uses red lentils to replace some of the mince, reducing the fat and increasing the fibre.

MINCE MAKEOVER 4 tsp oil 200g mince 60g red lentils 400g tinned tomatoes 1 medium onion, chopped finely 2-3 carrots, grated 80g spinach, shredded finely Add spices, herbs or other flavourings to taste

I like to add onions, carrots and spinach to the tomato sauce. If you have a particularly fussy audience for your mince and tomatoes, you can cook the tomato sauce and vegetables recipe (see right) and blend until smooth. Then add the cooked mince and lentils and your little ones wonâ&#x20AC;&#x2122;t realise they are eating lots of lovely veges and lentils in their mince sauce.

SERVES 4

Cook onion in a pot with 4 tsp of oil until soft. Add mince and brown. Add red lentils, tomatoes and the remaining vegetables. Add approximately 125ml water and simmer for around 20 minutes. If you have fussy eaters, cook onion with 2tsp oil, add tomato, spinach and carrot and cook for 5 minutes then blend. Brown mince with 2tsp oil then add red lentils, add blended tomato mix and cook for approximately 20 minutes, adding up to 125 ml water to the pot when cooking for lentils to soften. Use the mince for spaghetti Bolognese, lasagne, chilli con carne or any recipe that calls for mince and tomato. You can also easily double the recipe and put half in the freezer for later use in whatever recipe you like to use mince for.

When you serve, you can add extra fibre by having wholewheat pasta or brown rice and extra vegetables you know your family will eat, such as broccoli, peas or green beans.

MEAL MAKEOVER CALCULATOR BEFORE

AFTER

Mince and tomato sauce per serve kJ(kcal)

945 (226)

749 (179)

Fat (g)

6.4

5.0

Carbohydrate (g)

2.9

15.7

Fibre (g)

1.2

5.5

Do you have a favourite family recipe you would like to know how to make over? Email editor@diabetes.org.nz.

DIABETES WELLNESS | Autumn 2017

Diabetes Action Month

Branch members and staff turned out in blue to celebrate World Diabetes Day last November.

A hugely successful Diabetes Action Month saw thousands engage with our messaging on multiple platforms, as Sue Brewster explains.

Thousands join the MoveMeant

hings really ramped up for our second annual Diabetes Action Month last November with the hugely successful launch of our Take Control Toolkit, Fitbit MoveMeant Challengers clocking up nearly three million steps, and Pita Pit unveiling a new Diabetes NZ Choice range (see p1o). The Take Control Toolkit was the primary focus for our 2016 Action Month. Exclusively developed by Diabetes NZ, the toolkit contains online support tools and information to help people learn how to control their diabetes through healthy living, eating and physical activity. This in turn significantly reduces the risk of them developing health complications. As leading diabetes expert Dr Rinki Murphy explains in one of three videos developed for the Toolkit: The long-term implications of

DIABETES WELLNESS | Autumn 2017

poorly controlled diabetes affect the organs that are most sensitive to small blood vessel damage, for example the eyes (that can lead to vision loss). In the case of the kidneys it can lead to kidney failure, and in the case of damage to blood vessels supplying the feet, this can affect the nerves and cause numbness, injury, ulceration and infections that are hard to treat and sometimes result in amputations. How do we know there is a need for information and support to help people better manage their diabetes? Last year Diabetes New Zealand conducted a nationwide survey that revealed some worrying trends. For example, less than half of those living with diabetes feel they are in control of their condition. And a third said it had a negative effect on their mental wellbeing. We wanted to make sure the resources we developed for the Take Control Toolkit were effective. So we

The Take Control Toolkit is an enduring resource created as part of Diabetes Action Month. It is available for any existing or new member of Diabetes NZ. For any enquiries about the Take Control Toolkit, please email sue@diabetes.org.nz

asked 12 people living with prediabetes or diabetes to use the Toolkit over a 12-week period. The results speak for themselves. In the majority of cases their HbA1c levels decreased, two of the group reduced their HbA1c to prediabetes levels, a number lost weight, their fitness increased and nearly all of them have changed their diets (see our story overleaf). One of our 12 Take Control Toolkit users reduced their dangerously high HbA1c reading. Another lost 13kgs and one of our seniors, aged 70+, who could only manage seven press-ups at the beginning increased to over 30 by the final week. Are the changes sustainable? All of our Take Control Toolkit users say they want to carry on living their new healthy lifestyles. As one said: “I want to continue because I want to see my grandchildren. We haven’t got any yet but one day we will, we are happy that we have made changes.”

Step it up! The Diabetes NZ Fitbit MoveMeant Challenge returned for a second year to show New Zealand how important it is to keep moving and not be sedentary. In 2016, participants knocked the ball out of the park with an astonishing 2,832,417 total steps taken. A number of our challengers have the blisters to prove just how far they stepped up during Diabetes Action Month. The final week saw Louisa Wall MP, Black Sticks player Gemma Flynn, TV presenter Sam Wallace, triathlete Andrea Hewitt, former Silver Fern Leana de Bruin and defending champion Andrew Barnes (Founder of Perpetual Guardian) undertake a massive combined total of 957,800 steps.

Challenge winner, Andrea Hewitt

And the winner? Our 2016 champion stepper was Andrea Hewitt who managed 242,265 steps in one week. Mere mortals are recommended to reach 10,000 steps a day for good health and Andrea managed more than 30,000 a day! Congratulations to Andrea and a huge thank you to all 17 of our 2016 challengers for their involvement, particularly for the very important social media messaging and awareness they helped provide. For example, Health Minister Jonathan Coleman tweeted that he was taking part in the challenge as did other MPs. Nickson Clark used Instagram to update on his Diabetes Action Month movemeants, as did Leana de Bruin and Gemma Flynn.

Others like Sam Wallace posted on Facebook. And last issue’s cover story Malakai Fekitoa also posted about the new-look Diabetes Wellness magazine.   We are already planning for our 2017 Diabetes Action Month as we continue in our mission to support all people affected by diabetes to live well!

DIABETES WELLNESS | Autumn 2017

Life

Lenise Onekawa was one of the first to use Diabetes NZ’s Take Control Toolkit. Check out the difference it has made!

LENISE

BEFORE AND AFTER

TAKES CONTROL

Meet Lenise Onekawa (49)

• Lives in Auckland • Has 3 adult kids • Diagnosed 20 years ago • Father and mother also have T2 diabetes

“I have really enjoyed making small changes in my life, making the change to drinking more water, making the change to eating more vegetables, moving away from those high-sugar snacks from the bakery. “We are eating more fruit, we have planted our own garden. I am really proud of what we have been doing.” Lenise was one of the first people to use the Take Control Toolkit. Before starting, Lenise’s HbA1c was 54. After 12 weeks of managing her condition, using the Take Control Toolkit, it went down 11 points to 43. For the first time in the two decades since she was diagnosed, Lenise has managed to lower her blood glucose levels and achieve better day-to-day management. She has also lost 4cm from around her waist, where the visceral fat is stored. You can read more about Lenise’s story in a New Zealand Herald article published at the start of Diabetes Action Month http://bit.ly/2gvrD0f

TAKE CONTROL TOOLKIT

DIABETES WELLNESS | Autumn 2017

START YOUR WELLNESS JOURNEY The Take Control Toolkit is available online for Diabetes NZ members. It includes more than 60 online materials in downloadable print or video formats. You can access advice and information across three categories – Food & Nutrition, Physical Activity, and Health & Wellbeing – from anywhere in the country. A pilot group of people with type 1, type 2 and prediabetes used the tool for 12 weeks. They found they were eating more nutritious foods, being more active and were more aware of the choices they need to make to better manage their T2 diabetes. Members can access the toolkit via a secure email link, which should have been emailed to you. If you need help, email admin@diabetes.org.nz. Not a member yet? Go to www.diabetes.org.nz and click on click on “Membership” to find out about our membership options.

Care

Eye test time Here’s a guide to what to expect when you go for your first retinopathy screening test.

f you have just been diagnosed with type 2 diabetes, your GP should organise a retinopathy screening test (RST) for you. This appointment should happen within 90 days and is an important part of your diabetes care.

Why should I get tested?

People with all kinds of diabetes are at risk of developing diabetic eye disease (also known as diabetic retinopathy). This is one of the most common causes of sight loss in adults, but with early diagnosis and treatment, damage can be reduced or avoided.

What will happen in the test?

The person checking your eyes may ask if they can put drops in your eyes to temporarily make your pupils larger. You can choose whether you will have the drops put in or not as they may sting. Sometimes it is necessary in order to get an accurate picture. Photographs will be taken of the back of your eyes. The camera does not touch your eyes. A letter will be sent to you and your GP within three weeks to let you know your results and when to have another check. This is not a full eye check for glasses or other eye problems. It is just a check for diabetic eye

What do I need to think about on the day?

Allow about 30 minutes for your eye check appointment. Bring all the glasses and contact lenses you wear along with contact lens solution. You could also take along sunglasses because your eyes may feel sensitive after the eye drops. Plan how you can get home safely after your appointment because your sight might be impaired by the eye drops for a short while after your appointment.

You should have a retinopathy check at least every two to three years if your diabetes is very well controlled. This advice applies to people with type 1 and type 2 diabetes. Your optometrist or ophthalmologist will tell you if you need to have your eyes checked more often.

What is diabetic eye disease?

Diabetic retinopathy occurs when diabetes affects small blood vessels, damaging the part of the eye called the retina. Diabetes can cause the blood vessels in your retina to leak or become blocked and can affect your sight. Often, these changes are not sight- threatening, but they need to be checked regularly. Their presence means special attention should be given to your blood glucose control and treatment of other medical conditions, such as high blood pressure and cholesterol levels.

disease. You should continue to visit your optometrist regularly for a full eye examination.

REDUCING THE RISK • • • • •

Control your blood glucose as effectively as possible See your doctor regularly to check that your blood pressure is not raised Attend your diabetic eye screening appointments Get professional health advice if you have any problems with your sight Take your medication as prescribed.

The information in this article is taken from the Minstry of Health’s national guidelines for retinal screening for people with diabetes (2016).

DIABETES WELLNESS | Autumn 2017

Families

TEEN CAMPS L What happens when you take a busload of teenagers away on diabetes camp? A lot of laughs and learning, as Carla Adlington explains.

“When you go on diabetes camp, you’re no better or worse off than those around you, and that creates a really special bond no matter whatever age you are!”

ast September I headed down to Castle Rock Adventures in the Waikato with a full bus of teenagers and volunteer leaders ready for a fun weekend with a bunch of young people with diabetes. Being a new camp location, none of us were sure what to expect and it started out as a very quiet drive down from Auckland but by the trip home it was a lot louder! At the end of the weekend, all of us had pushed our height and mud boundaries, learned something new about diabetes, and made quite a few new friends in the process. After an evening getting to know each other with icebreaker games, home-cooked meals, and trivia quizzes we were ready for some adventure the following morning. We headed outside for a day filled with activities. We knew it was going to be an adventure when the walk to our first activity involved crossing paddocks, navigating streams, and being covered in mud within the first five minutes! It was a great warm-up for finding our way around the mountain to clip all of the orienteering tickets. There were plenty of campers and leaders alike who were climbing to

new heights (literally), not to mention dropping down from them as we were going rock climbing and abseiling. Balancing rain, mud, activity, snacks, paper bag lunches, testing blood sugars, and calculating insulin dosages was a lesson in multi-tasking for everyone! The beauty of being around other people with diabetes is there’s no judgement, questioning or comment from anyone around you. Everyone helps each other out, no questions asked whether it’s getting sugar to treat a low or cheering on a peer to climb that little bit higher to reach the top. We finished off the day with a dip in the pool, BBQ dinner, and an anonymous open forum Q&A session. The leaders and medical staff sat on a panel ready to face any questions thrown at us and we covered it all! There wasn’t a single person in the room who didn’t learn something new about diabetes management (adults included). For the last day we headed into the rain to go mountain biking, play disc golf, and shoot arrows at archery. Despite the weather, everyone was enthusiastic to get outside and make the most of it. After nine years of attending diabetes camp as a camper, I’ve spent even more years as a staff member and leader. While camp usually involves a bunch of fun activities, and a whole lot of learning about diabetes management, the equally important outcome is that we always get to build relationships with others in the same situation. When you go on diabetes camp, you’re no better or worse off than those around you, and that creates a really special bond no matter whatever age you are! Carla Adlington, 30, has had diabetes for 26 years. She is volunteer camp manager for Diabetes Youth NZ. To find out more, see www.diabetesyouth.org.nz.

DIABETES WELLNESS | Autumn 2017

Families

SPINNING WHEELS Former John McLaren Youth Award winner Hamish Beadle joins Team Novo Nordisk professional cycling development team.

amish Beadle began biking at a young age. “My dad and my brother rode,” he says, “so I just picked it up as well.” He began competing at the age of nine and immediately dreamed of being a professional. Since then, Hamish has gone on to receive several accolades, including a 2015 New Zealand National Championship for team sprint. The 18-year-old recently signed a contract with a professional development bike team with a difference. Team Novo Nordisk is a Georgia, US-based cycling team, featuring riders with type 1 diabetes, supported by experts, including a dietitian and medical staff. Hamish, who has had type 1 diabetes since he was three years old, was the winner of a Diabetes Youth John McLaren award in 2014.

WHAT ARE THE JOHN MCLAREN AWARDS?

The annual awards recognise young people who are excelling in their chosen field despite the challenges of living with diabetes. “My biggest accomplishment is being able to live an active lifestyle with good diabetes management,” says Hamish. Hamish is already training and riding with Team Novo Nordisk. “It is an amazing opportunity and it means I will be living in America and I will be travelling pretty much all around the world,” he told his local paper in Southland. Hamish heard about Team Novo Nordisk through former Southland cyclist Steph McKenzie, who also has diabetes and rides for the women’s team (we featured Steph’s story in our Spring 2011 issue). She contacted the team and told the teenager to email them so he

John McLaren bequeathed a sum of money from his estate to be used by young New Zealanders with diabetes. The annual awards are organised by Diabetes Youth NZ and recognise the pursuit of excellence across cultural, academic and sporting fields. See www.diabetesyouth.org.nz for more details.

did hoping he might get “some kit or something”. Instead, he was offered the chance to travel to the US and trial for the team. Hamish has joined the development team of 19 riders who will compete mainly in the United States, but also in Europe.

DIABETES WELLNESS | Autumn 2017

Know

If you struggle to put into words what type 2 diabetes is about, there’s a new app that could make life easier. By Olivia Deadman

MODERN TECHNOLOGY MEETS MODERN MEDICINE

ype 2 Diabetes Xplained has been developed just for Kiwis, to give those with type 2 diabetes a practical tool to help better understand the condition. Embracing modern technology, with simple storytelling techniques and world-class design, the app is designed to be an upbeat and interactive way of digesting complex information, using the example of real-life journeys of two Kiwis with type 2 diabetes. Behind the new Type 2 Diabetes Xplained app is Kiwi doctor Kim Chilman-Blair. After studying at the University of Otago, Chilman-Blair began her medical career at Starship Children’s Hospital. While working as a junior doctor, she realised how challenging it can be for patients and their

DIABETES WELLNESS | Autumn 2017

families to understand medical conditions, so she set on a path to help people in a new and different way. “As a doctor I know first hand how confusing it can be for someone when they’re diagnosed with a new condition. Storytelling is a centuries-old way of sharing information and a great way to cut through medical jargon and complicated terminology, which is the approach we have taken with Type 2 Diabetes Xplained,” says Dr Chilman-Blair. “Sharing real-life stories and experiences of others with type 2 diabetes is a powerful way to engage not only those who have the condition, but their support networks.” Medicine X, with support from healthcare company Sanofi, created Type 2 Diabetes Xplained

Kiwi doctor Kim Chilman-Blair: “Storytelling is a centuries-old way of sharing information and a great way to cut through medical jargon.” to help Kiwis understand and manage the condition. The app is designed to reach as many people as possible, and is free for all New Zealanders to view online in English or in te reo Māori at type2diabetesxplained.co.nz, or for download at the App Store or Google Play.

APP BASED ON REAL KIWIS TYPE 2 DIABETES XPLAINED follows the journey of Hare from the day he is diagnosed with type 2 diabetes. We see him learning about diabetes and how to manage it. The app shows Hare getting to know about the ins and outs of blood glucose, insulin and how to keep on top of his diabetes. He starts making lifestyle changes but struggles to keep going, until he meets Lisa who inspires Hare to take control. Lisa shares the story of her struggles with diabetes and by doing so helps Hare to avoid making the mistakes she made before she got her condition under control.

MEET THE REAL HARE

MEET THE REAL LISA

Hare LeLievre was diagnosed with type 2 diabetes in 2007, and although he has experienced some complications from the condition, he now says he has it under control. Hare says he wanted to be a part of Type 2 Diabetes Xplained as a way to give back to those around him who have supported him along his path. In particular, Hare says he wants to help fellow Māori break down barriers that stop them taking control of type 2 diabetes, a condition that affects so many New Zealanders.

Lisa McDonald found out she had diabetes more than 20 years ago. But she carried on living as she always had without taking control of her condition, only to suffer the consequences many years later. She has suffered the loss of sight in one eye and is legally blind in the other. She has had part of her foot amputated, and Lisa’s uncontrolled diabetes has caused irreversible damage to her body. More recently, Lisa has worked hard to get her life back. She lost nearly 30kg and learned to manage her diabetes. Now she wants to help others do the same, by sharing her story in the new Type 2 Diabetes Xplained.

VISIT WWW.TYPE2DIABETESXPLAINED.CO.NZ OR DOWNLOAD YOUR FREE APP

Want to know more about

Type 2 Diabetes? Medical jargon can be confusing, but Type 2 Diabetes Xplained takes away that confusion through storytelling. Follow a New Zealand patient’s journey and learn more about Type 2 Diabetes in an engaging, informative and entertaining story. It is written by doctors for patients. Be sure to download your copy today.

CREATED BY

KINDLY SPONSORED BY

champion sponsor of

SCAN ME TO DOWNLOAD

Life

Pip is the first diabetes assistance dog to work in a public hospital, as Dunedin nurse Brenda Ferguson explains.

Pip & Brenda

“

have had type 1 diabetes since a very young age and have had to rely on others to come to my rescue during a hypo – low blood sugar. It drops so rapidly that I’m past the point of self-help. I don’t get warning signs or symptoms so I’m not able to treat myself at all, leaving it for others to sort out. I find this incredibly annoying and terribly frustrating having to burden others all the time. Waking up to find St John’s staff attending to me following a hypo was scary. I’ve often lost minutes, or even hours, of the day. Over the years I have sustained many injuries from collapsing after having a hypo, including cuts, bruising, swelling, black eyes and fractures. I’m a constant worry to all. A few months ago Pip, my diabetic alert assistance dog, came to live with me in Dunedin. He is a two-year old black Labrador, who has been specially trained to help people with diabetes. He can tell (through his sense of smell) when my blood sugars are going low. He is trained to alert me so I can do something about it. Pip has been specially trained to work in a hospital setting and is the first assistance dog in a public hospital in New Zealand. Because Pip has a specific job, visitors and staff are encouraged not to play or talk to him. He does not accompany me near patients, and stays resting in the corridor. I’m very grateful to Dunedin Hospital for supporting me to have an assistance dog. Recently they agreed to allow Pip to stay

DIABETES WELLNESS | Autumn 2017

permanently after a three-month trial. I received a letter saying they would like him to become a permanent member of the team. Pip has been trained to fetch me the phone, bring me my blood glucose testing kit, open the fridge and give me my sweetened cordial. He’s one talented dog. It’s a shame he can’t start my washing machine or vacuum cleaner! I’m so glad Pip can continue coming to work with me. In the first week alone he alerted me three times that my blood sugars were going low. Having Pip means I can take back control of my life. With an assistance dog at my side, I am alerted to my rapidly dropping blood sugar levels early on. I can grab my jellybeans, or glucose powder, and treat myself instead of having to be a burden to others. It’s definitely a huge step forward – being able to take back control of my life. I’m also able to lessen the stress for my family and friends so they can also get on living their own lives without the constant worry that I’m ok. I’ve tried many different ways of stabilising my blood sugars over the years but all have failed. I work at a busy hospital and I want to become a role model for others to show them no matter how grim things can get there is always a light at the end of the tunnel. I’m very grateful to Professor Jim Mann, my diabetes educator Cate Wilson, and the Human Rights Commission for their help in getting me Pip.

”

Brenda has set up a Givealittle page to raise the $20,000 she needs to contribute towards the $48,000 cost of buying Pip. See www.givealittle.co.nz and search for “Brenda Ferguson”

“I want to become a role model for others to show them no matter how grim things can get there is always a light at the end of the tunnel.”

DO YOU HAVE TYPE

DIABETES

that is not controlled with your current management plan? Consider learning about a clinical research study. Southern Clinical Trials â&#x20AC;&#x201C; Waitemata Ltd | 29 Birkenhead Ave Birkenhead Auckland 0800 4TRIAL (0800 48 74 25) | www.sctrials.co.nz/sctwaitemata

Order our free Diabetes NZ information pamphlets Go to www.diabetes.org.nz, download the order form and email it to pamphlets@diabetes.org.nz or call us on 0800 342 238

ALSO AVAILABLE FREE TO HEALTH PROFESSIONALS

DIABETES WELLNESS | Autumn 2017

Eat

WHAT’S FOR LUNCH? Have you just been diagosed with diabetes? Or want to make your diet more healthy? Nutrition expert Helen Gibbs offers some nutritious lunch options.

n the summer issue of Diabetes Wellness I suggested some ways to make dinner more healthy, especially if you have type 2 diabetes. Lunch is another important meal but, because it is often eaten on the run, it poses its own set of challenges for making good choices in your diabetes journey. THE “EAT MORE TO EAT LESS” PARADOX

Many people with diabetes will say to me they miss lunch, or they just have something small, but then on the next breath complain about overeating when they get home from work and after dinner. Over-eating, which is often blamed on a lack of willpower, may well be a result of hunger, due to a low intake earlier in the day. If you struggle with late afternoon or evening hunger, it is worth experimenting with making your lunch more substantial. Or you could eat a nourishing, protein-rich afternoon snack, such as yogurt, cheese and crackers or a small serve of nuts.

DIABETES WELLNESS | Autumn 2017

SALAD IS OK BUT DON’T FORGET TO INCLUDE FILL-MEUP FOODS

People trying to manage their weight often report eating salad for lunch, then find by 3pm they are hungry enough to buy something from the work snack box. When questioned further, it turns out their salad lunch didn’t include enough carbs or lean protein to fill them up. If you are planning a salad lunch, follow the same rules as you would for a dinner – have the palm of protein food and the fist of starchy carbohydrate food. Your starchy food does not need to be limited to bread – try rice, pasta, cous-cous, quinoa, bulgur or even the humble potato instead. See right for my healthy potato salad recipe. Sometimes it is difficult to move away from traditional protein options, such as cold ham or cheese in your salads, but there are a wide range of other options you can try: • Cook up extra chicken at dinner and add to your lunch • Chickpeas, lentils or mixed beans can make an excellent base for a salad • Hummus or baked falafel balls are healthy vegetarian choices • Remember you can have one egg per day, even if you have diabetes.

BUYING LUNCH

Making good choices when you buy lunch in a cafe or restaurant can be a bit of a challenge. If you stick with the following principles, you won’t go far wrong: Eat less overall Consider asking for an entree size or children’s portion. Don’t be tempted by supersizing or large options. Eat less fat, particularly saturated fat Avoid extra cheese, creamy dressings or high fat meats such as salami. Ask for “without mayo and spread” if your lunch is being made from scratch. Eat more vegetables Load up on salads or vegetablebased soups. Ask that dressings are “on the side” so you can control the amount. Eat higher fibre and wholegrain carbohydrate foods Select wholegrain bread, brown rice or wholemeal pasta if this is an option.

Make your own lunch – Helen’s healthy potato salad recipe SERVES 2

It is important to eat slowly and enjoy your food, because it takes time for your brain to register your stomach is full. Eating lunch while working at your desk is a recipe for indigestion and it increases your risk of overeating.

2 fist-sized servings of new potatoes cooked in their skins and allowed to cool slightly 1 spring onion finely chopped 1 serve of another vegetable (eg peas, red peppers, broccoli, or asparagus, cut into small pieces, as appropriate) 1 tbsp of reduced fat mayonnaise 2–3 tbsp of low-fat natural yoghurt. Pepper and herbs to taste Mix the mayo and yoghurt. Add pepper and herbs to flavour. Chop the still-warm potato into 2cm cubes, add the potato to the vegetables and then add the dressing. Mix well and leave to cool in the refrigerator. Portion into your salad when making your lunch. NUTRITIONAL INFORMATION PER PORTION KJ(KCAL) 798 (191) | FAT 2g | CARBOHYDRATE 37g | FIBRE 2g

DIABETES WELLNESS | Autumn 2017

Research

Are you pregnant and living in Auckland? Researchers need your help for an important gestational diabetes study.

PREGNANCY STUDY

regnancy-related diabetes is affecting more and more New Zealand women and a major Auckland study is underway to find out the best way of diagnosing the condition, which carries serious health risks for mum and baby. The call is out for 9,000 pregnant women to sign up to the GEMS study, run by researchers at the Liggins Institute. More than 900 women have already taken part but many more are needed. Most participants just have to fill in a questionnaire when they join the study, towards the end of pregnancy, and twice after the birth. If you’re pregnant, haven’t had gestational diabetes before, and plan to have your baby at Auckland City Hospital, Birthcare, Middlemore Hospital or Counties Manukau Birthing Units (Botany, Papakura, Pukekohe), the GEMS study is open for you to join. Gestational diabetes is high blood sugar that starts in pregnancy. It can cause problems for mothers and babies in the short and longterm. Babies born to mothers with gestational diabetes may be larger than normal, suffer birth injuries, breathing problems, jaundice and low blood sugar. They are

also at increased risk of growing up overweight or obese, and of developing diabetes in adulthood. Long-term health risks to mothers include a raised risk of developing type 2 diabetes and heart disease. Around one in 12 pregnant women in New Zealand is diagnosed with gestational diabetes , and the incidence is rising. The Ministry of Health currently recommends all pregnant women are tested for it. “If blood tests show a pregnant woman’s blood sugar level is above a certain threshold, she is diagnosed with gestational diabetes. New Zealand uses one blood glucose threshold, but there have been calls internationally to use a lower one that some countries now use,” says GEMS study lead Professor Caroline Crowther, of the Liggins Institute, based at the University of Auckland. “What this study will do for the first time is carefully compare our current threshold in New Zealand to the lower international threshold, so we can see which is better for reducing the short and longer term problems for the mother with gestational diabetes and her baby.”

To find out more, email the study coordinator Debbie Samuel on gems@auckland.ac.nz or text 022-407-8258.

DIABETES WELLNESS | Autumn 2017

Amrita Naidu’s midwife encouraged her to join the study when the Papatoetoe local was 24 weeks pregnant. “I was motivated to take part because I have a family history of diabetes,” she says. “I almost knew beforehand that I would have diabetes in pregnancy. It wasn’t intrusive at all. If someone asked me if they should take part, I would say ‘definitely’. You find out things about yourself and your diet.” Amrita was given guidance on diet and exercise changes to manage the condition. She gave birth to a healthy boy, Aarav, last August.

Amrita Naidu is urging pregnant Auckland mums to volunteer for the GEMS study.

Feet

USE THEM OR LOSE THEM Suzanne Moorhouse is on a mission to make sure GPs and nurses remember to check their diabetes patients’ feet regularly.

t’s vital that everyone with diabetes gets their feet checked by their healthcare team at least once a year. Trouble is sometimes GPs and nurses forget to do this vital check. In fact studies show that only 50 percent of patients are getting their feet looked at by a health professional trained to spot diabetes-related foot problems. Why does it matter? It’s important that those with diabetes regularly check their feet as nerve damage and reduced circulation, caused by diabetes, can mean having reduced awareness of pain (neuropathy) and slower healing. Untreated foot problems can lead to serious disability and even amputation.

Suzanne, who is a clinical diabetes nurse at Midlands Health Network, in Hamilton, came up with the idea of a competition to come up with a fun way to help medical professionals to remember to check their patients’ feet. The three winning entries are printed here (see right). HAPPY FEET 1 Check your feet daily for sores and cuts 2 Ask for an annual foot check 3 You are entitled to see a specialist podiatrist if you need help with your feet

FOOT CARE RIGHTS The government says people with diabetes, regardless of wherever they live in New Zealand, “should be assessed for the risk of foot ulceration and, if required, receive regular review. Those with active foot problems should be referred to and treated by a multidisciplinary foot care team within recommended timeframes.” Ministry of Health Diabetes Guidelines 2014.

LONE RANGER

…to the theme from the Lone Ranger

Check their feet Check their feet Check their feet feet feet Check their feet Check their feet Check their feet feet feet Check their feet Check their feet Check their feet feet feet Diabetics –Check their FEET!!

Helen Cant, a pharmacist working at Tokoroa medical centre, scoops a feet-focused prize pack courtesy of Waikato Podiatry Clinic containing a pair of Asics shoes, socks and a podiatry kit.

MADE 4 WALKING These feet are made for walking and that’s just what they do but only if they’re checked in your annual diabetes review Rawiri Blundell, Māori Health manager, Pinnacle Midlands Health network. He wins a morning tea courtesy of Suzanne!

CHECK TODAY Check my feet As we meet So I can say All is ok Heather Mitchell is a health care assistant at Te Awamutu Medical Centre, south of Hamilton. She wins a grocery voucher courtesy of New World.

FOR MORE INFORMATION ABOUT HOW TO CARE FOR YOUR FEET, SEE DIABETES NEW ZEALAND’S PAMPHLET ON DIABETES.ORG.NZ OR ORDER FROM US ON 0800 342 238.

DIABETES WELLNESS | Autumn 2017

Recipes

JAMIE’S SUPERFOODS Freshen up your family favourites and expand your recipe repertoire with new nutritious, tasty meals courtesy of British celebrity chef and restaurateur Jamie Oliver. Every recipe is tried and tested, has clear and easy to understand nutritional information on the page, including the number of veg and fruit portions in each dish. It includes valuable advice on everything from cooking with kids and tackling fussy eaters, to good gut health, the importance of fibre, budgeting and, of course, getting the good stuff into your family’s diet. If you’re looking for fresh ideas and an easy way to make healthy eating a part of everyday family life, Jamie’s Super Food Family Classics is the book for you. Here we feature two delicious recipes from the book, courtesy of Jamie Oliver.

Super Food Family Classics by Jamie Oliver (RRP $60) is published by Penguin Random House

CHICKEN LOLLIPOP DIPPERS PEA & MINT COUSCOUS, CHARRED ASPARAGUS SERVES 2 • 24 MINUTES

250g fine asparagus 120g fresh or frozen peas 120g wholewheat couscous 1 lemon 20g flaked almonds 2 x 120g skinless chicken breasts olive oil 2 heaped teaspoons sun-dried tomato paste 2 tablespoons natural yoghurt ½ a bunch of fresh mint (15g) Trim six wooden skewers so they’ll fit inside a large non-stick frying pan, then soak in cold water. Trim the woody ends off the asparagus, then char in the dry pan on a medium heat, turning occasionally. Meanwhile, place the peas and couscous in a bowl. Finely grate over the lemon zest, then just cover with boiling kettle water. Pop a plate on top and leave to fluff up.

As well as being nice and high in fibre, humble wholewheat couscous is high in the mineral copper, which our metabolic systems need in order to function efficiently.

DIABETES WELLNESS | Autumn 2017

Once done, remove the asparagus to the plate, crumble the almonds into the pan to toast until lightly golden, then remove. Use the base of a pan to flatten the thicker side of the chicken breasts slightly, then use three wooden skewers

to pierce each chicken breast at regular intervals. Sprinkle both breasts with a pinch of sea salt and black pepper and rub with 1 teaspoon of oil. Place the chicken breasts in the pan for 10 minutes, or until golden and cooked through, but still juicy, turning every couple of minutes, and returning the asparagus to the pan for the last minute to warm through. Meanwhile, mix the sun-dried tomato paste with the yoghurt and half the lemon juice until smooth. Fluff up the couscous, squeeze over the remaining lemon juice, then pick, finely chop and stir in the mint leaves. Taste and season to perfection. Slice between the skewers to create chicken lollipops ready to dunk in the sun-dried tomato yoghurt and coat in the crunchy almonds, then serve up with the couscous and asparagus. CALORIES 535kcal | FAT 15.7g | SAT FAT 2.7g | PROTEIN 46.2g | CARBS 53.8g | SUGAR 8.2g | SALT 0.9g | FIBRE 7.9g 2 PORTIONS VEG & FRUIT

MANGO TERIYAKI SALMON BROWN RICE & CHILLI CUCUMBER PICKLE

I’ve used mighty mango here instead of sugar to create that wonderful sweetness we associate with teriyaki sauce, plus it gives us a nice hit of vitamin C, helping us to think properly. SERVES 4 • 50 MINUTES

300g brown rice groundnut oil 1 ripe mango 4 cloves of garlic 4cm piece of ginger 3 limes 2 tablespoons low-salt soy sauce ½ a cucumber 1 fresh red chilli 4 tablespoons white wine vinegar 4 x 120g salmon fillets, skin on, scaled, pin-boned 1 bunch of spring onions 250g broccoli ½ a bunch of fresh mint (15g) 2 teaspoons sesame seeds 4 tablespoons natural yoghurt

Cook the rice in a large pan of boiling salted water according to the packet instructions, then drain. Rub a roasting tray (25cm x 30cm) with 1 teaspoon of groundnut oil, then add the rice in an even layer. Meanwhile, wash the mango, cut the cheeks off the stone, peel, and put the flesh into a blender, reserving the skin. Squeeze the stone over the blender to get the juice out of that remaining flesh. Peel and add the garlic and ginger, finely grate in the zest of 2 limes and squeeze in their juice. Add the soy sauce and 1 teaspoon of groundnut oil, then blitz until supersmooth. Pour into a large bowl.

To make a quick pickle, finely slice the mango skin and place in a shallow bowl. Halve the cucumber lengthways and scrape out the watery core, then finely slice with the chilli and add to the bowl. Toss with the vinegar and a good pinch of sea salt to draw out excess moisture (you’ll drain the liquor off, so don’t worry about the amount of salt). Preheat the grill to high. Slice the skin off the salmon and reserve (or get your fishmonger to do this for you). Toss the fillets in the sauce, then lay them on the rice. Trim the spring onions and chop

at an angle into 2cm chunks, cut the broccoli into bite-sized florets, slicing the stalk, toss it all through the remaining sauce really well, then arrange around the salmon. Lay the salmon skins loosely on top, and place the tray under the grill for 12 to 15 minutes, or until everything is just cooked through and nicely charred – keep an eye on it! Drain the pickle, pick and finely slice the mint leaves, toast the sesame seeds, toss together, and serve on the side. Finish each portion with a dollop of yoghurt and serve with lime wedges, for squeezing over.

Move

FIGHTING FIT It’s as easy as 1,2,3

ome of you may have used the simple fitness tests we talked about in the summer issue (p34). But what do you do if you’re not happy with the results? You can improve your fitness in many ways: employ a personal trainer, become a gym junkie, head to the pool, or exercise from home. The key is to incorporate a mix of three kinds of exercise into your week for maximum health benefits.

1. PUMP IT LIKE ARNIE

Getting fitter will help control your diabetes as well as reduce the risks of complications, as Craig Wise explains.

There is only one way to increase your strength and that is to lift some stuff and give your muscles a workout. This doesn’t mean you need to recreate the Olympic weightlifting competition in your home. And no you won’t end up looking like Arnold Schwarzenegger in his prime! Nor do you need to cheat like some “athletes” and use steroids or testosterone injections. Just remember any object (eg a can of beans) that provides resistance when you move it is lifting weights. Government recommendations now state that we should include resistance exercise in our weekly activity plans. Check out my TV commercial workout on p32 of our Winter 2016 issue www.issuu.com/diabetesnewzealand for some easy ways to improve your strength at home. Increased strength can help many aspects of our lives such as carrying that heavy bag of groceries or picking up the grandchildren.

You don’t need to join a gym to stay fit. Try doing some couch exercises – pump iron with cans of beans for weights!

DIABETES WELLNESS | Autumn 2017

2. GET MORE HUFFY PUFFY

Increasing our cardiovascular strength has lots of benefits. It’s also a major weapon in the fight against heart disease. Increases in cardiovascular fitness improve blood flow which means we are better mobilising and utilising the sugars in our blood. So how do we do it? One of the phrases my personal training clients hear me say all the time is “Move, move more, move differently”. What do I mean by this? Well, to increase cardiovascular strength first you have to “move” and be active. Find time in the day for those walks, and I mean the kind of walking that gets you breathing a little heavier. Remember if you don’t have 30 minutes in your day to go and be active then spread this time throughout the day – 10 minutes here and 10 minutes there. “Move more” means simply that – if you are doing 20 minutes of huffy-puffy activity in your day, then find another five minutes or even another 10 minutes. “Move differently” – this is the key, this is where the real magic begins. I ask my clients to find something which makes them huffy puffy in a different way. Maybe you have been walking but you have always enjoyed dancing. Check out what’s going on in your area and join the dancing club, or maybe join a local social sports team. On the subject of dancing, you can get your huffy puffy going by dancing at home. You can even move your feet while doing the housework (brooms make great dance partners and they don’t tread on your toes!). Imagine how great it will feel to jog up steps without running out of breath and being able to keep up with the kids at the park.

3. BE MORE BENDY

When I first qualified as a fitness professional, the local gym where I worked had a 73-year-old female client who could contort her body into all sorts of weird and wonderful positions from doing the splits to putting her feet behind her head. I asked her one day how she did it and with a smile she said “I’m 73 years old and I have been practising this for 73 years.” Flexibility is so important because it decreases injury risk and improves our sporting ability. It does this by allowing the joints in our body to move unhindered through their full range of motion. This allows our muscles to work to their full potential. It also promotes blood flow into the muscles so we can endure that huffy-puffy exercise for longer (it flushes away the toxins exercise creates in our muscles). You can increase flexibility by joining a local yoga group or you can do it yourself at home. A very basic stretch routine performed three or four times a week can greatly improve flexibility. Before you start always make sure you warm up your muscles (never stretch cold muscles). The warm up can be as simple as a brisk walk around the room a few times or jogging on the spot for a minute. Stretch the big muscles groups in the arms and legs until you just feel that little pull and then stop. Stretching is so good for our bodies and I can never express my belief in its great power to keep our muscles moving. I once ran a half marathon and didn’t stretch afterwards – and then could barely walk for the next two days. By 1. lifting things, 2. getting a little more huffy puffy ,and 3. getting your stretch going you will find that noticeable improvements come quite quickly – and you will start feeling fitter (and healthier) all over.

Got a question for Craig? He’s happy to send you through fitness ideas, hints and tips. Email Craig at info@getfitandhealthy.co.nz. Alternatively check out his website for more exercise tips at www.getfitandhealthy.co.nz. DIABETES WELLNESS | Autumn 2017

Reflect

CLIMBING AFRICA’S HIGHEST MOUNTAIN Ruth Jeffery ticked off another physical challenge when she climbed Mt Kilimanjaro, in Tanzania.

he stars are out, but it’s dark and very cold. I take another slow step upward. Ahead of me I can see an endless array of headlamps moving slowly up the mountain. I suck in vain from my CamelBac mouthpiece – but the water in the tubing has frozen. I whistle a short tune and smile. I’m at 5,000m above sea level, it’s 2am and I have been 50 years old for two hours. I feel great! It’s summit day on Mt Kilimanjaro and we are heading to 5,900m. We started at midnight, aiming to hit the crater rim for dawn and summit an hour later. My travel companions are all suffering to varying degrees from the effects of altitude, including nausea, headache, vomiting and breathlessness. I alone am symptom free and actually enjoying the climb. Mt Kilimanjaro was on my ‘bucket list’ and after an indepth conversation with my partner John (“I think we should

DIABETES WELLNESS | Autumn 2017

climb Mt Kilimanjaro for my 50th birthday”–“OK”) and some extensive research we booked a trip. I looked for the least popular route over the longest possible time to allow for altitude acclimatisation, settling on the eight-day Lemosho route, with a max of six people in the party. The tour package included porters to carry our gear, pitch our tents and cook our food and guides to get us there safely. Another friend came with us from New Zealand, and we were joined by two other women in Tanzania who were both great fun. Training for altitude isn’t really possible in New Zealand (Kilimanjaro being over one and a half times the height of Mt Cook), so we settled on lots of tramping and day walks up as many hills as possible (easy in Dunedin!). World Nomads provided the best solution for insurance for hiking with diabetes to altitude. We debated whether or not to take Diamox to reduce the effects of altitude, but the possible side effects with diabetes convinced me not to and John also decided to go drug free, but to carry some in case (interestingly everyone

else we met used Diamox). Further research confirmed that all glucose meters are unreliable over 10,000 feet, and the reliability of insulin pumps is not guaranteed either. Oh well. I decided the convenience of the Freestyle Libre continuous glucose monitoring system would be worth the expense (and inconvenience of sourcing it through friends in the UK). It proved to be the best decision, making control if not easy, then at least hassle free. We reached the summit at 8am, after seven stunning days of trekking through rainforest, moorland and then into alpine desert. On the summit my companions managed to smile and sing me happy birthday. In turn I tried to whistle a tune – but sadly at 19,340 feet I couldn’t manage it. But what a way to celebrate turning 50! Ruth Jeffery, 50, is a lawyer currently studying for a PhD at Otago University. She has previously written about running the Kepler Challenge and sailing from Alaska to Scotland. Ruth has had type 1 diabetes since 1992.

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1. Dexcom G5 Mobile Continuous Glucose Monitoring System, User’s Guide, 2015. 2. Pettus J, Price DA, Edelman SV. How Patients with Type 1 Diabetes Translate Continuous Glucose Monitoring Data into Diabetes Management Decisions. Endocr Pract. 2015;21(6):613-620. *If your glucose alerts and readings do not match your symptoms or expectations, you should obtain a fingerprick. A minimum of two fingerpricks a day are required for calibration. † Based on testing 10 time per day. ^To view a list of compatible devices, visit www.dexcom.com/ compatibility. Dexcom G5® Mobile is not currently indicated for children under 2 years of age. Not compatible with Animas® Vibe® insulin pump. Always read the manufacturer’s instructions and use strictly as directed. ©2017 Dexcom Inc. All rights reserved. NZG5JAN17V1 TAPS MR5114