Diabetes Wellness Autumn 2018 by Diabetes New Zealand

wellness

AUTUMN 2018

DIABETES

DIABETES NEW ZEALAND | DIABETES.ORG.NZ

DIABETES AND DEMENTIA • JERRY THE BEAR • KNOW YOUR TRIGGERS • MOVE FOR MENTAL HEALTH • MY T2 LIFE • AUTUMN GREENS • HOSTING A SUGAR-FREE PARTY • TARANAKI T1 KIDS

THE POWER OF POSITIVITY Sébastien Sasseville’s guide to achieving mental wellness

EATING DISORDERS & DIABETES SPECIAL REPORT

30 CELEBRATING OUR

Contents

YEAR

AUTUMN 2017

DIABETES NZ MAGAZINE

VOLUME 30 | NO 1

4 EDITORIAL

6 UPFRONT: Q&A with Jenni Anderson 7 UPFRONT: Welcome Heather 8 COVER: Inspirational speaker Sébastien Sasseville on achieving your dreams

COVER: SÉBASTIEN SASSEVILLE © GENEVIEVE SASSEVILLE

12 COMMUNITY: Northland’s mental wellness pilot 13 LIFE WITH T2: Avan’s story

20 DIABETES ACTION MONTH 2017: Memorable moments and Fitbit MoveMeant Challenge 2018

32 LIFE WITH T1: 8-year-old Akira tells his story

22 PREVENT: Diabetes and dementia

33 RESEARCH: Fracture risk in people with diabetes

26 MOVE: Exercise for mental wellbeing

34 EAT: How to pinpoint your triggers

28 FAMILY: Jerry the Bear helping Kiwi kids

36 DIG: Growing great greens

30 RECIPES: Delicious seasonal vegetarian fare

37 CARE: Better injection techniques 38 RUBY’S WORLD: Planning a sugar-free children’s birthday party

14 SPECIAL REPORT: Diabetes and eating disorders 18 INTERNATIONAL: Ruby McGill at the World Diabetes Congress 19 DIABETES YOUTH: Taranaki children going the extra mile

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DIABETES WELLNESS | Autumn 2018

Editorial

At the end of 2017 we said farewell to Steve Crew, our Chief Executive Officer of nearly three years. Steve’s services to Diabetes NZ were formally acknowledged at the AGM in October but I would like to take this opportunity to say thank you to him again and wish Steve well in his new position. Our new CEO, Heather Verry, started with us before Christmas and is quickly settling into the organisation. Heather comes to us with a wealth of knowledge and experience, and is passionate about diabetes. I am looking forward to working with her over the coming year. At Diabetes NZ’s Board level, Liz Hickey was formally farewelled in October, and we welcomed a new independent Board member, Alastair MacKenzie, who is a very experienced Invercargill-based businessman and director. Catherine Taylor was elected as Board Chair for 2018 and Pat Waite, who has chaired admirably for the last five years, will be Vice-Chair for the remainder of his term on the Board. On the Advisory Council we have welcomed back Chris Warren as Lower North Island Representative. Last year, we collected and analysed a huge amount of feedback about Destination Unity and the current structure of Diabetes NZ. In 2018, we are working on recommendations for the future structure, based on this feedback. A big thanks to Karen Reed and Catherine Taylor for pulling this together and to Janice McClelland for collecting and collating. The year 2018 is also a milestone year for Diabetes NZ’s member magazine, being its 30th anniversary. The look and feel of the magazine has changed over the years but its mission remains the same – to provide trusted information and inspiring stories about living well with diabetes. This autumn issue doesn’t disappoint, and features a number of articles about diabetes and mental health, including a special feature looking at the issue of eating disorders – and of course the regular and very popular exercise, gardening and nutrition columns, plus the healthy recipes that often become regulars in my house. I must take this opportunity to thank our regular contributors for achieving and maintaining such a high standard of work and also our fantastic editor, Caroline Wood, for ensuring a high quality magazine that we can be proud of, every time. I trust you will enjoy this autumn edition. DEB CONNOR

President, Diabetes New Zealand

DIABETES WELLNESS | Autumn 2018

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

DIABETES NEW ZEALAND Patrons Lady Beattie and Sir Eion Edgar President Deb Connor Chief executive Heather Verry 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 2537-7094 (Print) ISSN 2538-0885 (Online)

ADVERTISING & SPONSORSHIP Business Development Coordinator Jo Chapman jo@diabetes.org.nz or +64 21 852 054

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

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Upfront

Tell us about D-Day – the day you were diagnosed. I was diagnosed in Nov 2013. My doctor asked me to go for blood tests after a particularly persistent bout of thrush, but it never occured to me that diabetes could be the culprit. The nurse rang me with my results on a Monday but there wasn’t a free appointment with the GP until Thursday. She gave me probably the worst diabetes advice I’ve had to date: “Just pop online and learn a bit more about type 2 diabetes”, what an absolute minefield that was!

Q&A Diabetes NZ’s new fundraising guru Jenni Anderson shares her T2D journey.

How did you feel when you were told you had T2D? Overall my reaction was one of grieving – because I now had a chronic condition that would need attention every single day – but also a weird kind of relief as well. Since having the kids, I had always carried more weight than was healthy, and over many years of a crappy diet and sedentary office jobs, I was not looking or feeling my best. Now I felt I had an “inbuilt diet coach” who would keep me on the straight and narrow. Diabetes is a pretty good motivator for not making all the usual excuses. What’s was the first year like? It was really hard, there was just so much to learn (and lots of bad behavior to un-learn!) Getting used to finger-pricking, taking meds, and planning healthy meals multiple times a day was truly difficult for someone like me used to living on

Make a secure online donation today at diabetes.org.nz

DIABETES WELLNESS | Autumn 2018

a coffee and breakfast muffin until 2pm. I’ve never been a creature of routine but now I had to observe the daily rituals of diabetes management – never before has my phone had so many alerts programmed into it. And now four years later, what have you learned? One really useful piece of advice that I’ve picked up along the way is “Eat to your meter” – find out what works (or doesn’t) for you specifically. I’ve become quite creative at fitting movement into my lifestyle – I arrange work meetings in cafes that I know are a good 15-20 min walk away, I walk with girlfriends along a river trail near my home. I’ve even taken back the chore of lawn-mowing from my teenage son. I’ve also learned that sometimes, no matter how “good” you are, this disease just progresses and you end up needing additional help. Last year I was told I needed to have a daily insulin injection to help lower my blood sugar levels. What is your personal diabetes goal for 2018? Honestly? I want to get off this insulin! I would ideally love to go back to nothing more strenuous than a couple of pills each day. In the meantime I want to take a more active approach to my diabetes management – for me this means being a lot more consistent with my blood glucose monitoring. I’m going to invest in a continuous

Fundraising is never just the work of one or two ‘fundraisers’ but rather the combined strength, energy and passion of all who support Diabetes NZ. Jenni would love to hear from anyone interested in making a donation, becoming a fundraising champion in their area, or leaving a lasting gift to Diabetes NZ in their will. You can contact her on 04 499 7150 or jenni@ diabetes.org.nz. Your ongoing support is sincerely appreciated.

blood glucose meter, not cheap at $50 a week, but this will be a gamechanger in keeping a better eye on my highs and lows now that I am on daily insulin injections. You recently joined Diabetes NZ, what is your role? I’m the Director of Donor Relations and I’m looking forward to helping Diabetes NZ. I’ve worked as a fundraiser in the charities sector for over 12 years, and am very passionate about sharing the stories of those we have helped and having meaningful conversations with branches, members and supporters. Overall I’m excited to be joining such a vibrant diabetes community that is enthusiastic about changing things for the better around here. Why do you want to help people with diabetes? This disease is hard enough without having to go asking for every bit of help, support, equipment, or medication that you need. We should all have access to the very best medical advances in diabetes care and medication, and we need to keep building an active level of support around every Kiwi and their whānau, whether they are already living with diabetes or at risk of developing it. Why is fundraising an important part of Diabetes NZ’s work? We would not exist without the ongoing loyalty and generosity of our community. I want to let our supporters know how crucial every dollar is. Thanks to their generous support, we have been able to advocate on behalf of our community for more than 50 years. During that time we have improved access to information and resources for every New Zealander living with diabetes. But we urgently need to raise more funds so we can move forward and implement some exciting new projects planned for 2018 and 2019.

Welcome Heather Diabetes NZ’s new Chief Executive Officer Heather Verry says she is delighted to be given the opportunity to lead the country’s only national diabetes organisation and is looking forward to a busy year ahead.

eather Verry comes to Diabetes New Zealand with a strong background in not-forprofit organisations, most recently as Chief Executive of the New Zealand Police Association. Her previous roles include Chief Executive of Manfeild Park Trust, in Manawatū, and Deputy Chief Executive of New Zealand Council of Victim Support Groups. “I’m absolutely delighted to be given the opportunity to lead Diabetes New Zealand at such an important stage of its growth. I’m looking forward to meeting our many supporters and hard-working volunteers across New Zealand,” says Heather. “Diabetes is a serious issue affecting hundreds of thousands of people in New Zealand, in particular within our Māori and Pacific communities. We need to work with all our communities and key stakeholders to improve diabetes awareness, education, advocacy, and support research.” Diabetes NZ has been advocating and supporting people with diabetes and their families for more than half a century. With more than 270,000 Kiwis diagnosed and

the number steadily rising, the work of the paid staff and its branch volunteers has never been more important. “We’re thrilled to be welcoming Heather to the Diabetes NZ team. She brings considerable leadership experience, with a broad range of skills that will be a huge asset in continuing our growth and development and enabling us to achieve our goals,” says Pat Waite, Vice-Chairman of Diabetes NZ’s governing board.

DIABETES WELLNESS | Autumn 2018

Cover

Canadian endurance athlete and inspirational speaker SĂŠbastien Sasseville refuses to let type 1 diabetes stop him from achieving his dreams, as he explained to Ruby McGill during a visit to New Zealand last year.

DIABETES WELLNESS | Autumn 2018

THE POWER OF POSITIVITY W

hen Sébastien Sasseville decided to climb Mount Everest, something he’d dreamed about as a child, he broke it down into smaller steps. Doing this, he says, ensures that when you look at the next step it’s never overwhelming. Once you’ve completed the first step – for Sébastien this was signing up for climbing lessons – step two won’t feel as intimidating. Incredibly, on 25 May 2008, Sébastien became the third T1D person in the world to reach the summit of Mount Everest. He attributes this success to getting up, working hard every single day and being patient – and accepting that sometimes you have bad days and the only thing you can do to turn it around is to go to bed and wait for tomorrow.

And that’s okay. Sébastien Sasseville refuses to let type 1 diabetes stop him from achieving his dreams. In 2012, the French endurance athlete completed one of the toughest running races on Earth, the Sahara desert race, and in 2014 he spent nine months running 7,200km across Canada. Sébastien says he has learned many lessons along the way and he now shares these with the business world, travelling the globe giving inspirational talks. He believes his recipe for success is simple but not always easy. Sébastien embraces life with a positive growth mindset and believes his diabetes diagnosis was a blessing, even though, he confesses, it certainly didn’t feel like that on Day 1. His diagnosis at 22 years

old was just like everyone else’s – tough, frightening and overwhelming. His brother had been diagnosed with type 1 diabetes six years earlier and Sébastien recognised he was showing the classic symptoms. “I didn’t want to accept it was happening to me, but I drove myself to the clinic where I received the inevitable news from my doctor,” he says. “The love and support of my friends at college helped me adjust to living with diabetes. They were interested in what was happening and always there to help if needed.” But Sébastien never wanted to transfer the burden to them. He quickly learnt he had to be 100% responsible for his successes and take ownership of his diabetes. He didn’t have a choice and that

MEET SÉBASTIEN SASSEVILLE Sébastien Sasseville’s extraordinary accomplishments include summiting Mount Everest, completing the mythical Sahara race, and running across Canada. These feats of endurance were made all the more impressive by the fact that he lives with type 1 diabetes. Sébastien says he is glad he was diagnosed with diabetes and has turned his incredible experiences into lessons applicable to the business world. He presents talks called Inc.spiration on three main topics: change management, peak performance and leadership.

DIABETES WELLNESS | Autumn 2018

is what he believes is the true blessing, even going as far as saying it’s one of the best things that has happened to his life. “You are forced to adapt and find something about it that will be great. The positive choice was simple – caving in, not accepting it and being pissed off about it made no sense to me. It was pretty obvious it would lead to no good,” he says. Sébastien believed early on that if he managed his diabetes properly, all his dreams and things he wanted to do didn’t need to go away. They were still possible. During public speaking events he is often asked how to motivate people that hate “it”, whatever that may be. “It’s totally okay to hate it [diabetes] and don’t feel bad for hating it, but at some point you need to make a conscious effort to change how you feel about diabetes. Taking the first step doesn’t mean everything should be perfect the next day. You will need to allow for some imperfection. Diabetes is a process. It’s never a finished thing,” he explains. Sébastien reminds his audiences that motivation comes after action. The first step is to get out there and do whatever it is you love doing, then the motivation comes. It’s not the other way around. This was certainly the case for Sébastien. Even though he has successfully completed what has been described as one of the toughest physical challenges on Earth – the multi-stage Sahara desert race – and run across Canada, when he first started running he could only manage 250 metres before stopping.

DIABETES WELLNESS | Autumn 2018

“Nobody likes running when they start, but then you start doing it and your body feels better, your mind feels better, you get healthier, you get faster, you get thinner, you get sharper and you get that endorphine release – that’s the motivation! Before you know it you’ll notice how you feel when you don’t run and that becomes your drive. You start and then good things happen. It’s simple, but it’s not easy.”

When it comes to living with diabetes Sébastien realises the goal can change and sometimes it’s important to allow yourself not to be perfect. Sébastien wouldn’t wish type 1 diabetes on anyone but accepts that when you have it, there’s nothing you can do about it. Rather than letting diabetes restrict what he can do, he continues to challenge himself and views every obstacle or failure as an opportunity to learn and grow. It is this mindset that allows him to succeed in his endeavours whether that is summiting Mount Everest or delivering a change management presentation to business leaders. He acknowledges it can be scary to put yourself out there and try something new, especially when you’re not sure if it will work. By creating an environment where it’s safe to fail and where if you do, you will learn something, you will always succeed. This is exactly

how Sébastien embarks on any new training regime. “If I have a low I’ll be able to treat it because I won’t be by myself and I’ll learn something. Same thing if my blood sugars go high.” Sébastien is always thinking about the next big adventure and has set his sights on the 2019 Ironman World Championships. To prepare he knows he must train consistently, aiming for a little every day while paying close attention to his diabetes. This will allow him to put his diabetes on “auto pilot” during the race and provided everything is going to plan he can focus on racing, rather than his diabetes. This kind of regime can be tiring and Sébastien acknowledges there are days where he may not test as often and longs for a tiny break from his diabetes. When this happens he readjusts the way he measures success so he’s not disappointed and avoids feeling bad about diabetes or bad about himself. He tells himself “today I’m going to do the best I can. I’m going to have that piece of cake or beers with the boys. I’m going to do the best I can to manage diabetes and if I go a little too high, who cares. I’m giving myself that room today.” When it comes to living with diabetes Sébastien realises that the goal can change and sometimes it’s important to allow yourself not to be perfect. Managing diabetes is not easy, and is never ending but, as Sébastien has shown, it doesn’t have to stop us from achieving our dreams.

In October 2012 Sébastien completed the Sahara desert race in Egypt – a 250 kilometre, self supported ultramarathon over five days through the world’s largest desert.

After setting himself the goal of climbing the world’s highest mountain, Sébastien became the first Canadian with T1D to summit Mount Everest, in May 2008. He broke the task down into achievable steps – the first step being climbing lessons!

Sébastien set off from Newfoundland, in February 2014, to run across Canada, a 7,200km journey. This adventure culminated nine months later in Vancouver, on November 14, World Diabetes Day.

DIABETES WELLNESS | Autumn 2018

Community

An innovative pilot programme used theatre skills to help young people with diabetes improve their mental health.

I AM A VOICE

necdotal evidence suggests there is a shortage of mental health support for people with diabetes. So it’s great to hear that Northland District Health Board has successfully trialled a creative new way of helping people living with diabetes develop a voice in their community. Northland was one of two DHBs in the country selected to implement a pilot programme aimed at helping three groups of people: young people aged 16-20 with poorly controlled

type 1 diabetes, the whānau of people newly diagnosed with type 1 diabetes, and adults with poorly managed diabetes. A partnership called the Company of Giants was formed to deliver this programme of work. The pilot, which took place in the Whangarei community last year, involved artists, clinicians, community leaders, and people with diabetes. “The project focused on different platforms of self-expression, both as individuals and as a collective.

Through photography, writing, performance poetry, song writing, screen printing, audio work, video making and storytelling, the participants explored the experience of living with type 1 diabetes,” says Ian Hartley-Dade, Relationship and Funding Manager, Northland District Health Board. “This approach also helped educate their whānau and local diabetes centre staff about the physical and emotional experience of having type 1 diabetes.” The final sharing of the work was attended by around 60 people, including whānau and friends, and was a multi-media celebration of the work carried out across the three groups. The evening centred around the idea of ‘An expert’s guide to type 1 diabetes’ and was an opportunity for the group to share and express stories, ideas and journeys with T1D, educate their community and audience, and celebrate some of the things they had worked on together over the project. Check out the videos online and be inspired! https://www.youtube.com/ watch?v=tbIc8Z_26KY

DIABETES WELLNESS | Autumn 2018

Life with T2

Auckland father-of-four Avan Polo, 52, a development consultant, decided to take action after being diagnosed with type 2 diabetes. Six months later his GP gave him fantastic news – his blood sugar levels had returned to “normal”.

MY WAKE-UP CALL

ack in May last year, I declared I was no longer sixfoot tall or bullet proof. This might be a shock to some of you, I’ve kept this pretty quiet. I was told that I had become a diabetic – that’s right, I had let myself balloon out to a crazy 120.5kg and certainly wasn’t very active at all, and type 2 diabetes found me. Not one for feeling sorry for myself, I took this challenge head on and decided to make some positive changes to my life and the way I lived it. I printed off some advice from the Diabetes NZ website and made a plan. I started walking daily, at least 20-40 minutes, and one of my

daughters became my “support crew”, encouraging me to exercise early in the morning. I also parked further away from work and walked to and from my office too. I cut out all the bad things particularly sugar, dairy and the dreaded potato. The big one for me was to reduce my portion sizes. I signed up to the diet My Food Bag (Fresh Start Lite) and learned a lot about healthy eating. I’m eating lots of salads, more chicken and fish and less meat. Cooking has become my happy place and I’ve managed to become quite creative along the way. I went to see my diabetes nurse and doctor in January. I have lost

15kg and weigh 105kg, but still have a way to go yet. I’m looking to drop at least another 10kg by June. The end-game goal is 95kg or better. My original blood sugar reading last May was 68, which is rather high, but at my most recent check up I was informed that I am now down to 37, which puts me in everyday normal range. My blood pressure and cholesterol figures have improved and I now have more energy. I’ll have another follow-up test in six months to make sure I am on track. Happy to talk to or help anyone that needs it. You can contact me via editor@diabetes.org.nz.

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DIABETES WELLNESS | Autumn 2018

Diabetes on my mind

It’s a little known fact that young people with diabetes are more at risk of developing an eating disorder. In this special report we look at the issue and how friends and family can help. By Caroline Wood.

EATING DISORDERS & DIABETES SPECIAL REPORT

DOES MY CHILD HAVE AN EATING DISORDER?

t’s something of a hidden problem in the community but people with diabetes are two to three times more likely than the non-diabetes population to have an eating disorder. People living with type 1 diabetes are most likely to be affected, with young T1D women at most risk. While less common, people with type 2 diabetes can also develop an eating disorder, for example binge eating is more common among T2Ds. “It’s really important that people get early help,” says Dr Roger Mysliwiec, one of New Zealand’s leading experts in the field of eating disorders. Dr Mysliwiec is trying to raise awareness about eating disorders and type 1 diabetes in particular because he’s worried

that young people aren’t being offered the help they need. He is calling for more screening and early intervention as treatment is much harder the longer someone has an eating disorder. “Young people with diabetes can fall through the cracks. On the one hand they may not be getting screened at their diabetes clinic, and on the other their symptoms may not be obvious so they don’t get access to eating disorder services,” he says. “With diabetes, even if your eating disorder isn’t very severe, if it leads to elevated blood sugars then that is a concern regarding potential complications. “If it’s severe they should go and see an eating disorder service and make sure they closely collaborate with diabetes treatment.”

The most common eating disorder found in people with diabetes is EDNOS (Eating Disorder Not Otherwise Specified) where someone displays eating behaviours that have a significant impact on their psychological and physical health. Other eating disorders include diabulimia, bulimia, and anorexia, which is less common. Diabulimia, where a person reduces their insulin in order to reduce their weight, is a particular eating disorder that is only found in people with type 1 diabetes. “Omitting insulin functions as a kind of purging behaviour, getting rid of calories. By omitting, or taking less, insulin, glucose doesn’t get into the cells and therefore prevents weight gain or even leads to weight loss,” explains Dr Mysliwiec.

“Young people with diabetes can fall through the cracks. On the one hand they may not be getting screened at their diabetes clinic, and on the other their symptoms may not be obvious so they don’t get access to eating disorder services.” Dr Roger Mysliwiec

DIABETES WELLNESS | Autumn 2018

“But doing this predisposes the individual to the acute complications of high blood sugar levels and the severe long-term complications of elevated HbA1c.” Prevalence studies show that eating disorders are two to three times more common in people with diabetes, compared with the non-diabetes population. For example, one study of 12 to 19 year olds found that 10% of the patients with diabetes had an eating disorder, compared with 4% of the non-diabetic subjects. And there will be many more people who have problems with eating but their symptoms don’t meet the diagnostic criteria for eating disorders and treatment. There is thought to be a strong genetic factor predisposing some people to eating disorders. For example, a large genome-wide study showed there was an association between anorexia and diabetes, which could mean a person with this particular gene will have a genetic predisposition to developing anorexia. Dr Mysliwiec says that once someone has developed an eating disorder it’s a race against time. “I would unfortunately see most patients at the very severe end, which is the ‘bottom of the cliff’ scenario. “Once the behaviours have become so entrenched and the complications are severe, it’s so much harder to help people, it’s very challenging. The ideal is always early intervention. “By investing in screening and early support, one can prevent the very high cost to both the individual’s health and to society.”

Dr Roger Mysliwiec can be contacted at the New Zealand Eating Disorders Clinic, in Grey Lynn, Auckland.

TIME FOR ACTION

eople with diabetes often have a number of risk factors that come together, which mean they are more likely to develop an eating disorder. Hypoglycaemic (low blood sugar) episodes can lead to disinhibited eating, which over time can lead to regular over-eating of highly palatable foods and unwanted weight gain, increasing the risk for risky weight loss behaviour. The Heather Verry hormone insulin also leads to higher fat Diabetes NZ building in the body. Chief Executive Diabetes management also requires a preoccupation with weight, carbohydrate and fat intake. And the onset of diabetes often co-occurs with adolescence with its common concerns about weight and shape. It’s thought the Waikato Diabetes Service is the only district health board currently screening people with diabetes for eating disorders. When it sent out a questionnaire, more than 20% of respondents reported some kind of eating issue, according to Dr Roger Mysliwiec. Diabetes NZ’s Chief Executive Heather Verry said: “We are concerned that people with diabetes are more at risk than the general population, with one study showing that one in 10 teenagers with diabetes had an eating disorder. We want to raise awareness of this issue in the community and urge anyone who is worried about a child or friend to seek help from their GP, diabetes clinic, or the DEDA website (see overleaf). “It’s vital that people are diagnosed and treated early. We’d like to see more screening for eating disorders in diabetes clinics nationwide and more publicly funded treatment for people who need it. We echo concerns that this is a hidden problem in our community, that people, particularly young women, are falling through the cracks and suffering in silence.” Dr Mysliwiec is one of the clinical leaders on a project that aims to find the true number of young Kiwis with diabetes who are also struggling with an eating disorder. The study will include Waikato, Auckland, Waitemata, and Counties Manukau District Health Boards. It will initially involve screening diabetes patients (male and female) between 15-25 years for six months via a clinical Diabetes Eating Problem Survey. Patients will be asked to fill it in at their regular clinical visit. It’s hoped the study will provide a stronger rationale to provide funding for routine screening and provision of treatment for eating disorder behaviours in people with type 1 diabetes.

DIABETES WELLNESS | Autumn 2018

Diabetes on my mind

HERE TO HELP Recovery is possible and the not-for-profit website DEDA is a great place to start if you have an eating disorder or know someone who does.

EDA (Diabetes and Eating Disorders Awareness) was founded in 2015 by Lisa Ingle, a registered general nurse from Hamilton, who realised there was a need for online support for people with diabetes affected by an eating disorder. The website, which is run by volunteers, also offers support and information for families who may be worried about their loved one’s relationship with food. Lisa, who has had type 1 diabetes since childhood, said: “There is awareness of eating disorders and of diabetes but less awareness about the difficulties people with both conditions face. I just saw a need and decided to do it. “People with diabetes have a slightly unusual relationship with food. And a lot of people are on the spectrum. Early intervention is absolutely critical, it’s just so dangerous if you leave it to the later stages. There is hope and recovery is possible but you need to seek help.” The DEDA website has information about different kinds of eating disorders from the most common Eating Disorder Not Otherwise Specified (EDNOS) to bulimia, diabulimia (restricting insulin intake to control weight) and anorexia. Lisa runs the website voluntarily, fitting it in between her paid job as a nurse and looking after a young child. New Zealand and Australian volunteers help her support and advocate for people who make contact via the website. “We advocate for people and put them in touch with professionals so they can get the help they need, either through their diabetes team, or we may suggest they ask their GP for a referral to an eating disorder service,” she adds. DEDA volunteers understand the challenges of having diabetes and an eating disorder. Experiencing these two illnesses brings an entirely new set of challenges to recovery, and they are there to help – see www.deda.org.nz.

Experts like paediatric endocrinologist Professor Paul Hofman say they fully support what DEDA is doing to promote awareness of eating disorders among people with diabetes.

HOW DO I KNOW IF I HAVE AN EATING PROBLEM? Not sure if you have a problem with food? If you answer yes to any of the following questions, you may benefit from seeking advice from your doctor, nurse or DEDA: • Think about your body, weight, and shape a lot? • Eat large amounts of food at a time? • Reduce the amount of food you eat? • Avoid testing your blood sugar levels? • Not want to eat around other people? • Feel guilty about treating a low blood sugar? • Have strict rules about food and/or exercise? • Adjust your insulin doses because you are worried about your weight? Always talk to your doctor or nurse if you are worried about your diabetes or think you may have an eating problem. They are there to help.

All the information on the DEDA website is academically referenced and verified by experts in the field to ensure information is accurate. It includes a checklist of symptoms common in people with diabetes and an eating disorder, suggestions for concerned loved ones, and lots of tips and stories for people who are living with diabetes and an eating disorder. See www.deda.org.nz

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EATING DISORDERS & DIABETES SPECIAL REPORT

Zoe Sole, DEDA volunteer and hospital doctor

LIFE IN RECOVERY

was diagnosed with type 1 diabetes at the age of nine. As I learnt to adjust to daily insulin injections, life resumed the way it always had. However, as my representative sport level increased and academic pressures mounted, I developed an overwhelming sense of inadequacy and developed an eating disorder. For the next six years I flew under the radar, flirting with recovery while dually pushing the boundaries on food restriction and excessive exercise. My HbA1c was impeccable, I had straight A grades, and went on to represent Otago in netball. I was smart enough to manipulate my food intake to lower my insulin requirement, while maintaining good blood sugars. I never purposefully missed a single dose of insulin, but did everything in my power to lower the amount I needed. With my eating disorder, I never purposefully restricted my insulin intake but with my reduced calorie intake and excessive exercise, less insulin was required. My diabetes management was of the highest priority and I gave myself the appropriate amount of insulin to manage my diabetes accordingly throughout the duration of my eating disorder. Any hypoglycaemic episode was treated appropriately so my diabetes was always well looked after and almost in a way was a protective factor for my eating disorder. However in 2013, I found a reason to pursue recovery. I found a barbell. I came to understand that if I wanted to perform, to lift more weight, to be better, I had to fuel my body to allow it to do so. I realised my body was going to give me what I gave it. If I wasn’t going to respect my health, my body would surrender and shut down. I am now enjoying living in full recovery, work as a doctor, and am a volunteer for Diabetes and Eating Disorders Awareness (DEDA). Life with type 1 diabetes means your schedule can be very regimented. It is a disease which demands a lot and gives little in return. However, treat it well and it will place no limitation on what you want from life.

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International

More than 425 million people worldwide are living with diabetes

UNITED WE STAND The largest annual gathering of the global diabetes community took place in Abu Dhabi in December. Ruby McGill reports back on her visit to the 2017 IDF Congress.

t was epic, inspiring and humbling. More than 8,000 people attended the fiveday International Diabetes Federation World Congress, sharing their knowledge and expertise to help the 425 million people with diabetes and create a “brighter future for generations to come”. There was a mind-blowing amount of diabetes-related information on offer: 160 hours of sessions, 330 top-level speakers and 1,000 posters about the latest developments in diabetes clinical practice, management, education, prevalence and public health issues. One of the highlights for me was the opportunity to hear about new diabetes technologies, including smart insulin pens that track the time and dosage amount. Or the closed-loop insulin pumps that constantly self-adjust the insulin delivered

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to automatically keep your blood sugar levels in range. Sadly these new technologies are not available in every country and many people may never benefit from these innovations due to the cost. Some members of the diabetes community, who are sick of waiting, have created the Open Artificial Pancreas System project (#OpenAPS). This is an open and transparent effort to make a safe and effective basic Artificial Pancreas System (APS) technology widely available. This would quickly improve and save as many lives as possible, as well as reducing the emotional and financial burden of type 1 diabetes. I thought the Open APS was an incredible example of people sharing their skills and working together to overcome some of the frustrations of living with diabetes. Many speakers discussed their experience dealing with diabetes distress, complications, discrimination, eating disorders or their refusal to look after their diabetes because they were simply “over it”. They openly shared what they’d learned from these challenges and offered solutions to help others in similar situations live well with diabetes. It was refreshing to hear William Polonsky, president

and founder of the Behavioural Diabetes Institute, share some of his work studying and addressing the psychological needs of people with diabetes. His institute is the world’s first organisation dedicated to addressing this overlooked issue. It was also exciting to hear about the research and work being done to find a cure for diabetes. Scientists have been looking closely at human stem cells, k-cells in mice and gut microbiome for possible answers. Unfortunately no one has cracked it just yet but it’s thrilling to imagine that a cure for diabetes could just happen in our lifetime.

The International Diabetes Federation is an umbrella organisation of over 230 national diabetes associations, including Diabetes New Zealand, in 170 countries. The IDF has been leading the global diabetes community since 1950 and its members meet every year to share experiences and advocate for better access to diabetes services worldwide. For more information, see www.idf.org

Diabetes youth

Going the extra mile Diabetes doesn’t define these Taranaki kids, as Niamh O’Sullivan explains.

’m a great believer in the idea that when something negative happens in life, you can see the change as a burden or a challenge. For a group of children in Taranaki this “something” was type 1 diabetes and they have chosen, with their families, to see this diagnosis as a challenge. For them living with diabetes has the potential to mould them into stronger, more resilient people with an amazing spirit that cannot be crushed. These kids belong to a voluntary community support organisation called Diabetes Youth Taranaki, which offers the families an opportunity to connect with others going through the tumultuous journey of bringing up a child with type 1 diabetes. Diabetes Youth Taranaki is headed by two amazing women: Clare and Sacha, who organise fun-filled activities for the children throughout the year. During these events they can bond with each other over a shared experience of insulin pumps, pricking their fingers and counting carbohydrates. I was lucky enough to come on board with Diabetes Youth Taranaki last year and meet these inspirational kids who are full of life, smiles and humour and are the best fun to be around. To celebrate these kids and show the world just how capable they are, we decided to enter a team into the renowned Around the Mountain Relay to raise awareness for Diabetes Action Month. This was the first-ever team made up of children and adults

Diabetes Youth Taranaki was the first T1D team to take part in the Around the Mountain running race. Niamh is in the front row with pink backpack.

with type 1, alongside their biggest fans –parents, friends and partners whose lives are also affected by type 1. What began as an idea, soon escalated into a surge across Taranaki’s type 1 community. We had 25 people run or walk the 160km relay kitted out in our white and blue Diabetes Youth Taranaki t- shirts, with many more supporting or helping behind the scenes. Pharmaco and Dana Brooks at Urban Studio Properties generously supported our efforts with sponsored packs filled with hypo treatment, hydration and other goodies for the entire team. Steph McKenzie, one of our Diabetes New Zealand Type 1 Ambassadors, travelled to support our efforts to raise awareness. She was the perfect role model for the kids –

representing what type 1 “looks like” – fit, healthy and motivated to achieve her goals in life. But the support didn’t stop there – we had people with diabetes across New Zealand sending messages via videos before the race, which gave the team a boost. We ended up smashing our estimated time, increasing awareness about Diabetes Youth Taranaki and raising money to put towards next year’s activities, including the family camp. Type 1 diabetes happened to these kids, but they don’t let it define them – instead they let it strengthen them into warriors who are going to take life by storm. Niamh O’Sullivan was last year’s New Zealand Rose of Tralee winner and is a paediatric dietitian. She was diagnosed with T1D in Ireland just before her 21st birthday.

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Diabetes Action Month 2017

Thanks to everyone who helped make Diabetes Action Month 2017 a success. Olivia Deadman highlights some of the campaign’s most memorable moments.

KNOW THE DIFFERENCE

aising awareness and educating Kiwis about the different kinds of diabetes was the focus of Diabetes Action Month 2017. Building on previous years, Kiwis were also urged to understand their risk of developing diabetes and get checked if they noticed symptoms in themselves. Diabetes NZ’s Know Your Risk test was promoted online and our popular Take Control Toolkit became an app – it is now available free to help all New Zealanders better manage their diabetes and live well with it. This year there was a strong

focus on type 1 diabetes to try to help the general public understand more about type 1, and not confuse it with type 2 diabetes. The mainstream media supported the campaign by helping to share stories featuring people with type 1 diabetes. For example, 10-year-old Chelsea Old was featured on TVNZ’s Seven Sharp, talking about the challenges of having type 1 diabetes and how Jerry the Bear was helping her to learn to live with the condition. And Ruby McGill, Director of Youth for Diabetes NZ, shared her story of type 1 diabetes on The AM

Diabetes NZ's Ruby McGill with host Duncan Garner on The AM Show

Show, which aired on TV3 and RadioLive on World Diabetes Day. Ruby talked about some of the common misconceptions people have about diabetes as well as what it’s like living with type 1. Diabetes Action Month ambassador, multisport athlete Emily Wilson, who has type 1 diabetes, travelled the length of New Zealand with Jerry the Bear, stopping off to meet young people along the way at “Teddy Bear’s Picnics” around the country. Emily travelled by bike, on foot, kayak and any means possible (except a car) to help raise awareness for type 1 diabetes. The focus of last year’s Diabetes Action Month was knowing the difference between type 1 and type 2 diabetes.

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Married at First Sight’s Brett Renall, who has type 1 diabetes, and his new wife Angel hit the campaign trail during action month.

Brett Renall and his new wife Angel (from TV3’s Married at First Sight) also got right behind Diabetes Action Month. Brett has type 1 diabetes so he was keen to share his story with the nation. The newlyweds were great in supporting and helping raise awareness for the condition and the organisation. As well as educating New Zealanders about diabetes, the month-long campaign also encouraged Kiwis to get active and take control of their diabetes management and risk reduction. Each Friday throughout November, Fitbit Fridays inspired Kiwis to ‘Join the MoveMeant’ and post on social media about it. This February, New Zealanders will have another opportunity to get involved with Fitbit February (see right).

Emily Wilson travelled the country with Jerry the Bear to raise awareness of diabetes in children.

Diabetes NZ is delighted to announce the return of the Diabetes NZ Fitbit MoveMeant Challenge for 2018. This year the Diabetes NZ Fitbit MoveMeant Challenge is taking place in February and has a new format. Now with even more competitors, the challenge will run across the entire month and challengers will try to outstep the competitors in their group. The top four from each group will go forward to the “ultimate finals” week and compete for the championship. Prominent New Zealand TV, media and lifestyle personalities will be pitted against the nation’s business leaders and top sporting stars for champion title. Some key Diabetes NZ supporters will feature in the star-studded line up. Associated organisations will go head-to-head in fundraising drives in support of the challenge. The aim is to raise awareness of diabetes in New Zealand as well as encouraging a healthy and active lifestyle.

Check the Diabetes NZ website and social media to keep up to date and get involved in the Fitbit MoveMeant Challenge – see www.diabetes.org.nz

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Prevent

IT’S WHAT WE DO TODAY THAT MATTERS The number of Kiwis living with diagnosed dementia is growing fast and projected to triple from 62,000 to 170,00 over the next three decades.

he bad news is that having Based on Ralph’s latest scientific diabetes, high blood pressure, or research, Maggie has created more being obese are risk factors for than 200 recipes that help provide developing dementia (see right). the nutrients we need for optimum And a new study suggests that brain health. These healthy foods high variations in blood sugar over also assist with prevention of other time may raise risks of developing lifestyle diseases, such as diabetes Alzheimer’s disease later in life for and heart disease. older people with type 2 diabetes. “I have two great passions – The findings, published in the sharing my love of cooking delicious journal Diabetes Care, indicate that simple food and improving the those aged 60 and over may be health and nutrition of older people. especially at risk. I hope this cookbook does both The good news is but it’s not for ‘old’ people, there are things you it’s for you,” says Maggie. “To have can do today that “I have been a healthy old will help ward delighted to work with age you must act off dementia, leading Alzheimer’s one of the most researcher Professor now, whether you debilitating Ralph Martins in are 30 or 50.” diseases of our recent years and I have Maggie Beer later years. learned that if we are to Popular Australian avoid Alzheimer’s, and television cook and other lifestyle diseases, it is businesswoman Maggie what we eat today that matters. Beer has teamed up with world“My recipe for life is to have a leading Alzheimer’s researcher healthy attitude to eating – it’s all Professor Ralph Martins to raise about balance, variety and choosing awareness about dementia and the foods that give you the best chance need for people to act now. of being in good health now and “To have a healthy old age you into your future. This is not a diet must act now, whether you are book – it’s a way of life.” 30 or 50,” says Maggie in her new The proceeds from Maggie’s Recipe Recipe for Life book that combines for Life will be shared between delicious recipes with the latest the Maggie Beer Foundation and cutting-edge research on what you the Lions Alzheimer’s Research can do to ward off Alzheimer’s. Foundation.

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TOP TIPS FOR BRAIN HEALTH:

Dementia or Alzheimer’s, what’s the difference?

• • • •

Dementia is an umbrella term used to describe a group of conditions that affect how well our brains work. The most common form of dementia is Alzheimer’s disease – which around two-thirds of people with dementia have.

reduce alcohol drink more water stop smoking take up daily physical exercise • stay socially connected • and use your brain.

Dementia can affect anyone, and as people get older the chances of developing dementia increase. The symptoms each person experiences depend on the parts of the brain that are affected. However, the most common dementia symptoms include changes in memory, thinking, behaviour, personality and emotions. These changes affect a person’s ability to perform everyday tasks. Dementia is progressive, which means that for most people the changes gradually spread through the brain and lead to the symptoms getting worse. Dementia is different for everyone – what people experience, and how quickly they are affected is unique to them. What they can do, remember and understand may change from day to day. Source: Alzheimer’s NZ

One in three cases preventable One in three cases of dementia could be prevented if more people looked after their brain health throughout life, according to an international study in The Lancet. The study, which set out nine risk factors associated with dementia, was presented at the Alzheimer’s Association International Conference in London last year.

“Is it in my genes? Some people worry about inheriting a predisposition for dementia. However, even if we carry genes that increase our risk of Alzheimer’s, a quality diet and healthy lifestyle can still delay the onset of cognitive decline. So while we can’t alter our genes we can certainly change their expression to reduce our risk of Alzheimer’s.”

Nine factors that contribute to the risk of dementia Mid-life hearing loss – responsible for 9% of the risk Failing to complete secondary education – 8% Smoking – 5% Failing to seek early treatment for depression – 4% Physical inactivity – 3% Social isolation – 2% High blood pressure – 2% Obesity – 1% Type 2 diabetes – 1% These risk factors – which are described as potentially modifiable – add up to 35%. The other 65% of dementia risk is thought to be potentially non-changeable. There are estimated to be 47 million people with the condition at the moment. By 2050, 131 million people could be living with dementia globally. Source: Lancet Commission on dementia prevention, intervention and care

Prof Ralph Martins

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MORE DEMENTIA SUPPORT NEEDED

REDUCING THE RISK

“I

first became interested in Alzheimer’s research when my father-in-law, George, was diagnosed with the disease in his sixties. It was heart-breaking to watch as George transformed from an intellectual giant to someone totally dependent on care in just six short years. It made me determined to fight this devastating disease and 33 years later, I am still working towards diagnosing, preventing and effectively treating Alzheimer’s. So far, we know that the brain damage that ends up causing Alzheimer’s begins developing in the brain 10–20 years before symptoms start to show, and that having type 2 diabetes, high blood pressure, or heart disease increases our chances of getting Alzheimer’s. We also know that once symptoms set in, there is no known cure. But the good news is that we have begun to identify the factors that can reduce a person’s risk of developing Alzheimer’s and some other forms of dementia, and slow its progression. What does this mean? Statistically it means that some people at age 60 who would have

developed full-blown dementia by the age of 80 may only have mild forgetfulness at 80 if they adopt and maintain our recommended lifestyle changes, especially a healthy diet. In 2006 I became involved in the Australian Imaging, Biomarker and Lifestyle (AIBL) study of ageing. This research, along with many other population studies around the globe, is giving us valuable information about the specific nutritional and lifestyle factors associated with avoiding cognitive decline and staying healthy as we age. These include: • Regular aerobic exercise • Plenty of mental stimulation and social activity • A healthy diet featuring fresh, seasonal fruits and vegetables, fish, dairy foods and healthy fats (such as those in olive oil, nuts and seeds) and whole grains. I think we all want to live a full and productive life, feeling energetic well into our old age. This is not just wishful thinking – you have the power to give yourself the very best chance of a healthy future. – Professor Ralph Martins

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”

The number of Kiwis directly impacted by dementia is expected to triple to nearly 170,000 by 2050 and annual costs will reach nearly $5 billion unless something is done now, according to Alzheimer’s New Zealand. It is calling on the Government to implement the New Zealand Framework for Dementia Care urgently and in full. Alzheimers NZ chief executive Catherine Hall says: “Research indicates that for every dollar invested now in supporting people affected by dementia, government will reap a nearly $7 return. “As a country we can’t afford to do nothing about the dementia challenge, and we need to take steps urgently.” One of Alzheimers NZ’s key recommendations is to extend existing preventative approaches to obesity, diabetes, and cardio-vascular disease to include middle aged and older adults by including information that will reduce the risk or delay the onset of dementia. “This is an international problem, and other countries are actively focused on tackling the issue with a range of initiatives,” adds Ms Hall. “New Zealand, however, is lagging well behind and we need to act now or, as a country, we will face major personal, societal and fiscal impacts.” Check out www.alzheimers.org.nz for advice on preventing, diagnosing and treating dementia.

NOT JUST A COOKBOOK Maggie’s Recipe for Life features a host of easyto-prepare recipes bursting with flavours and colour. But it’s not just a cookbook. It also includes advice on the positive steps each of us can take to ward off dementia in later life, including how to eat for longevity and health, the best foods for a healthy brain, and how to develop habits for a longer life.

BUCKWHEAT CREPES WITH ROASTED RHUBARB AND CINNAMON YOGHURT SERVES 4

Buckwheat should perhaps be given a new name as it is not a wheat at all, nor a grain. It’s a seed of a plant related to rhubarb. It’s gluten free, high in protein and full of micronutrients, including iron, magnesium, potassium and zinc. In these crepes the nutty flavour of buckwheat is enhanced by the coconut milk, and the roasted rhubarb is so good it’s worth having as much for dessert as for breakfast. Don’t leave out the cinnamon with the yoghurt, and I do recommend that you taste before you add any honey – the acidity of natural yoghurts can vary considerably between brands and you may find you don’t need any additional sweetness.

DIETITIAN’S TIP There is added sugar in the rhubarb, and you may be able to reduce this depending on taste!

500g rhubarb, leaves and bases discarded 2 tablespoons lightly packed (40g) soft brown sugar Finely grated zest and juice of 2 oranges 2 tablespoons extra virgin olive oil CINNAMON YOGHURT

¾ cup (200g) thick natural probiotic yoghurt 1 teaspoon ground cinnamon 1 teaspoon raw honey (optional) CREPE BATTER

300ml full-cream milk, or milk of choice, plus extra if needed 2 free-range eggs 30g linseeds 2 tablespoons pepitas (pumpkin seeds) 2 tablespoons sunflower seeds 1 tablespoon sesame seeds ⅔ cup (100g) light buckwheat flour (see note) Pinch of sea salt flakes

Rinse the rhubarb stalks well, then cut into 5cm pieces. Place in a container with the sugar and orange zest and juice. Cover and refrigerate for several hours or overnight. Preheat the oven to 160˚C (fan-forced). Place the rhubarb in a single layer in a roasting tin and pour over the juice and zest. Cover with foil and bake for 20 minutes or until just cooked. Remove from the oven, uncover and set aside to cool. To make the cinnamon yoghurt, combine all the ingredients in a bowl, cover and refrigerate until needed. To make the crepe batter, whisk together the milk and eggs, then set aside. Place all the seeds in a high-powered blender or spice grinder and process until fine. Place in a bowl with the buckwheat flour. Whisk in the milk mixture and salt until well combined. The batter should be the consistency of pouring cream, so if it is a bit thick, add a little extra milk. Heat a 24cm frying pan with a little olive oil over low–medium heat. Lift the pan from the heat, then pour in a thin layer of batter and tilt the pan to evenly cover the base. Cook for 2 minutes or until light golden, then gently flip the crepe over and cook for another minute or until just golden. Makes about 8 crepes. To serve, fill the crepes with rhubarb and a big dollop of yoghurt. Fold into quarters and serve immediately. Left over batter will hold until the next morning. Note: There are dark and light varieties of buckwheat flour. The dark is made from grinding the seed with the hull and has more fibre and a stronger taste. You will need the finer texture of light (hulled) buckwheat flour for this recipe. CALORIES 1930kJ / kcal 462 | PROTEIN 19g | FAT TOTAL 22.8g (SAT FAT 5.1g) | CARBS 38.4g (SUGARS 23.6g) | SODIUM 313mg

Recipe extracted courtesy of Simon & Schuster Australia. Maggie’s Recipe for Life by Maggie Beer with Professor Ralph Martins is available from all good bookshops, RRP $45.

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Move

Fitness expert Craig Wise explains the link between exercise and mental wellness.

FEELGOOD FITNESS

hoever said “exercise is the most underutilised antidepressant” and “Warning! Exercise has been known to cause happiness!” was bang on the money. There is truth in both those sayings because being physically active is good for the mind, as well as the body. We all know about the need to keep our bodies on the go for the physical benefits but the plus side of being physically active runs much deeper. Exercise has been shown to be an effective weapon in the fight against a number of mental health issues with research showing positive consequences in cases of depression and anxiety. But it isn’t just those plagued with these conditions who can reap the benefits of being active. I have always been an active person and weight has never

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been an issue but in July last year I was contacted by a prospective client who made me think deeply about this. Her question to me was: “What do you know about being out of shape and then trying to get fit?” I pondered this for a while and made a decision to experiment on myself. As I write this article, it is the final day of four months without any physical activity other than dayto-day things like playing with my children, or doing the housework. Has this experiment changed my physical body? Yes, it has. Has this four-month period changed my mental state? Most definitely. I can honestly, hand on heart, say that over the last few months the little things, that previously I would have let slide, have stressed me, my memory – already fading with age – has been missing in action, a good night’s sleep has become a thing of the past, and

my overall mood has been darker and grumpier (as I am sure that my wife and girls will attest to). One of the greatest areas in which physical activity can play a role in improving a mental state is with self-esteem. Self-esteem is how we feel about ourselves and how we perceive our selfworth. It is a key indicator of our mental wellbeing and our ability to cope with the curve balls which life throws our way. Whereas the results of studies on depression have shown varying results across ages and the sexes, physical activity has been shown to have a positive impact on our self-worth. This relationship has been found across all ages – from children through to those with a few more years’ experience under their belts – and in both men and women. If you are having feelings of low self-esteem, anxiety or depression

SIX ACTIVITIES TO BOOST YOUR MENTAL HEALTH Walking The simplest, most accessible and most affordable exercise of all, plus you get to enjoy New Zealand’s wonderful nature. Try a walking group for a social boost.

Swimming Another low-impact, nonweight bearing option. Try to find an outdoor pool during the summer for an added sunshine and fresh air mood boost.

Cycling Try a spin class at your gym or buy a push bike (or an e-bike) and cycle to work a couple of days a week. It’s a great way to prepare mentally for work or destress after a long day.

Yoga Great for mind, body and soul and with a wealth of different kinds of yoga on offer – from gentle stretching to full-on cardio workouts – there’s a class to suit everyone.

High intensity training You don’t need to do hours of exercise to reap the mental health rewards. Try short bursts of exercise – run a short distance, do some squats or push ups, and see how it makes you feel.

Dancing Crank up the music and dance with your kids – who cares about mum or dad dancing in the privacy of your own home? Or join a class and learn salsa or ballroom dancing in the company of other beginners.

then exercise is probably one of the last things you feel like doing but even a little activity can make a difference. Physiologically we get the boost from the endorphins (the feelgood chemicals) released by our brain which enhance our sense of well-being. But this is not the only way which we gain from activity. There are a number of other ways in which physical activity can help our mental state. When we are physically active our mind is taken away from our worries so we find ourselves removed from a cycle of negative thinking patterns which feed the anxieties which we may be feeling. Emotionally we can find ourselves feeling more confident especially if we are achieving exercise goals or small challenges. Of course, the activity we are doing may also help to

get us into a better shape which gives us confidence through liking our own appearance. The social interaction which can come with physical activity can also help – just a friendly hello or smile as we take a morning or evening walk around the local area is enough to boost our mood. If the activity is something even more social, such as a team sport, then the benefits are even greater. Often with mental illness there is a feeling of lack of control, and exercise gives us an area of our lives that we can take control of and use as a stepping stone to move forward. As a coping mechanism for mental illness, exercise obviously has greater benefits than some other alternatives, such as alcohol, smoking or drug use, that all come with their inherent dangers and can often

lead to worsening symptoms. So what activities are best to help increase our mental wellness? Well, this is where the news is good – research has shown that no one exercise or activity is better than another, so you can enjoy the activity you love and get the same great benefits, just don’t overdo it. As ever moderate physical activity is better than any gruelling routine (and there are dangers to obsessive exercise too – yes, it is addictive). When you finish your activity, you should feel pleasantly tired. If you are dragging yourself on your hands and knees to the couch, you might want to pull back a little. And as I finish typing this article, I am looking forward to getting active again after a four-month hiatus – for both my physical and mental health.

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Family

Diabetes NZ’s #1 pack for children has been flying off the shelves since it was launched in November. Cassy Hay, and her daughter Zanthia, 4, from Katikati, explain how it’s been helping them learn about diabetes.

JERRY #1 FOR KIWI KIDS How has Jerry helped Zanthia learn about type 1 diabetes? Jerry gives her diabetes a bit more normality. She’s got her little friend that’s type 1 like her. We’ve been trying to get her to try injections in her bottom and she’s not keen, but we’ve recently heard her talking to Jerry about it. “Should I do it in your bum… Oh nah, next time.” Jerry is helping her process this information. What is your favourite thing about Jerry? Probably that you can give him insulin and finger pricks. It is quite “real”. Zanthia will do it herself and then question why Jerry is experiencing certain symptoms, and I will talk her through it. It’s been a lot of learning for both of us. Has Jerry helped others learn about Zanthia’s diabetes? She’s taken him to preschool a couple of times and they play the app on the iPad. She’s really good at preschool, she owns her diabetes. She lets them choose a spot for when she has to have “tummy medicine” (her insulin). Zanthia happily shared her diabetes story with everyone when she took Jerry to visit. What did receiving a #1 pack from Diabetes NZ mean for Zanthia and your family? It’s amazing. You don’t get a lot of things for free these days and this is something that’s going to help us with Zanthia’s diabetes. She was so excited about receiving it. We’re pretty lucky, Jerry is pretty special. • To find out how you can apply for a #1 pack visit https://diabetes.org.nz/youth/1-pack-launched/ Thank you to Denise L’Estrange-Corbet and WORLD for designing the #1 bags and Beyond Type 1 for sharing Jerry the Bear with New Zealand.

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PLEASE HELP A CHILD WITH DIABETES Please make a donation to give a child like Zanthia a reason to smile.

A type 1 diabetes diagnosis can be a scary and confusing time for the whole family and inevitably leads to all sorts of questions. That’s why Diabetes NZ created the #1 pack for newly diagnosed children. Each pack includes Jerry the Bear, who also has type 1 diabetes. With the help of a special app, Jerry shares how you can still play with your friends, take part in sport, and enjoy your life to the full, while learning more about managing your diabetes. Since last November, Diabetes NZ has sent packs to 63 children aged between 4-10 years. They are so popular we can’t keep up with demand. We need your help to ensure that every newly diagnosed child can receive a free #1 pack with Jerry the Bear. PLEASE MAKE A GIFT TODAY See www.diabetes.org.nz and click on the DONATE link or click here https://secure. fundraiserpro.com/donate/diabetes/ Please put Jerry in the comments section so we know where you’d like your donation to go.

Big on sweetness. Small on calories Vanilla Slice with Passionfruit Glaze Preparation 10 mins + 5 hrs chilling time | Cooking 5 mins | Serves 18 Ingredients

Method

Cooking oil spray, to grease 200g cream crackers 1/2 cup custard powder 4 cups trim milk 1 cup Equal Spoonful 2 Tbsp vanilla extract 2 Tbsp fresh passionfruit pulp 1 Tbsp cornflour Extra 1 Tbsp Equal Spoonful

1. Grease a 20cm square tin with cooking oil. Line base and sides with baking paper.

The essential ingredient Equal Spoonful has almost no calories and measures spoon-for-spoon like sugar. Perfect for your recipes, cereals and drinks.

2. Line base of tin with cream crackers in a single layer, leaving a 1cm border around the outside. 3. Put custard powder in a medium saucepan and whisk in milk in two batches until well combined and smooth. Cook over a medium heat, stirring constantly for 5 minutes until mixture is very thick. Remove from heat and stir in Equal Spoonful and vanilla extract. 4. Pour over cream crackers. Spread to smooth surface. Top with cream crackers in a single layer, leaving a 1cm border around the outside. Refrigerate for 5 hours or overnight, until filling has set. 5. To make passionfruit icing, put passionfruit pulp, cornflour and extra Equal Spoonful in a medium bowl and stir until combined. Cut slice into 9 squares following crackers as a guide then cut each square in half to form triangles. Drizzle with passionfruit icing and serve. Energy 364.9 kJ • Protein 3.2 g • Fat 2.7 g • Saturated Fat 2.3 g Carbohydrates 12.4 g • Sugars 4.5 g • Sodium 72.2 mg

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Recipes

Nature’s harvest The Vegetable contains 130 modern plant-based vegetarian recipes that celebrate the textures and DIETITIAN’S TIP flavours of nature. This could be a big This beautiful part of a meal paired hardback book with a lean serving of protein such as chicken, offers seasonal fish or even the recipes for every humble egg. occasion and is a great resource for anyone looking to change the way they eat for the better. PANZANELLA SERVES 4

Large and colourful heirloom tomatoes are the key to this dish – preferably organic ones, for that beautiful sweet flavour.

Extract from The Vegetable by Vicki Valsamis and Caroline Griffiths. Published by Smith Street Books. RRP NZ $59.99. Out now. Photographs © Chris Middleton.

4 large heirloom tomatoes, about 1kg in total, cut into 1cm thick slices 100g assorted baby tomatoes, cut in half 4 mini capsicums (bell peppers), about 180g in total, cut lengthways into quarters 8 baby cucumbers, sliced in half lengthways ½ red onion, thinly sliced 3 slices multigrain sourdough, about 200g cut into 2cm chunks and toasted 40g (¼ cup) pitted kalamata olives, sliced in half 7 caper berries, sliced in half lengthways 2 tablespoons white balsamic vinegar olive oil, for drizzling

METHOD Arrange all the salad vegetables, sourdough chunks, olives and caper berries on a platter.

BASIL EMULSION 1 garlic clove, crushed large handful of basil leaves, torn 80ml (⅓ cup) olive oil

Serve immediately.

Place the basil emulsion ingredients in a blender and pulse until you have a smooth sauce. Drizzle the basil emulsion over the salad. Sprinkle with the vinegar and a little more olive oil and season to taste.

CALORIES 1560kJ / kcal 373 | PROTEIN 8.4g | FAT TOTAL 22.1g (SAT FAT 3.3g) | CARBS 29.9g (SUGARS 10g) | SODIUM 448mg

DIABETES WELLNESS | Autumn 2018

INDIAN-STYLE TOMATO CHUTNEY MAKES ABOUT 320g (1½ CUPS)

If you prefer a slightly chunkier texture for this kasundi-style relish, instead of grating the tomatoes, blanch, peel and chop them. This chutney is great with curry and rice, as a sandwich spread, with hard cheeses, or with Zucchini, mint and cheese fritters.

ZUCCHINI, MINT & CHEESE FRITTERS SERVES 4

These fritters are delightful as a breakfast dish, lunch or light main meal. They are so moreish that you may even find yourself making them into bite-sized fritters and serving them as snacks. 3 zucchini (courgettes), about 500g in total 185g (¾ cup) crumbled fresh firm ricotta 125ml (½ cup) buttermilk DIETITIAN’S 2 large free-range eggs, separated TIP 110g (¾ cup) self-raising flour Chutneys are an 1 teaspoon baking powder overlooked way to get ½ teaspoon ground cumin great flavours with low ½ teaspoon ground turmeric energy into food – 100g (⅔ cup) crumbled feta well worth having 3 spring onions (scallions), sliced in the fridge. handful of fresh mint leaves, shredded 2 garlic cloves, crushed olive oil, for pan-frying 100g rocket (arugula), baby spinach or salad leaves Indian-style tomato chutney to serve plain yoghurt, to serve Coarsely grate the zucchini. Place in a sieve, squeeze out as much liquid as you can, then set aside. Put the ricotta, buttermilk and egg yolks in a large bowl, stirring until combined. Sift the flour, baking powder and spices over the ricotta mixture, then stir through until just combined. Stir in the zucchini, feta, spring onion, mint and garlic. Season with salt and freshly ground black pepper. Using an electric mixer on medium speed, beat the egg whites with a pinch of salt until stiff peaks form. Using a large spoon or spatula, gently fold the egg whites into the batter in two batches. Heat a large non-stick frying pan over low–medium heat. Drizzle a little olive oil into the pan. Working in batches, add 80 ml (⅓ cup) measures of the mixture to the pan and cook for 3–4 minutes on each side, or until puffed, well browned, and just cooked through.

3 teaspoons black mustard seeds 80ml (⅓ cup) apple cider vinegar 1 tablespoon cumin seeds 1 tablespoon grated fresh turmeric 1 tablespoon grated ginger 4 garlic cloves, peeled 1kg tomatoes 60ml (¼ cup) peanut oil 55g (¼ cup) rapadura or brown sugar 1 long red chilli, deseeded and finely sliced 1 teaspoon sea salt Place the mustard seeds and vinegar in a small saucepan over medium heat. Bring to the boil, then reduce the heat slightly and simmer for about 4 minutes, or until the vinegar is reduced to about 1 tablespoon. Set aside to cool. Heat a small heavy-based frying pan over medium heat. Add the cumin seeds and toast, stirring often, for 1–2 minutes, or until fragrant. Tip the seeds into a mortar, add the cooled mustard seed mixture, turmeric, ginger and garlic and pound until combined. Cut the tomatoes in half horizontally and squeeze out the seeds. Grate the tomatoes using a box grater, discarding the skin (which will be left behind as you grate) – it is best to do this on a tray or plate to catch all the juices, to add to the saucepan. Heat the peanut oil in a heavy-based saucepan over medium heat. Add the pounded spice mixture, along with the grated tomatoes and their juice, sugar, chilli and salt. Simmer, uncovered, stirring occasionally, for about 45 minutes, or until the tomato is reduced to a pulp and the mixture is quite thick.

Serve the fritters warm, with the leafy greens, chutney and yoghurt.

Transfer to an airtight container and leave to cool, then store in the fridge where it will keep for up to 4 weeks – or seal the chutney in sterilised preserving jars and store in a cool dark place for up to six months.

CALORIES 1990kJ / kcal 476 | PROTEIN 22.4g | FAT TOTAL 27.6g (SAT FAT 9.8g) | CARBS 31.1g (SUGARS 10.3g) | SODIUM 722mg

CALORIES 146kJ / kcal 35 | PROTEIN 0.6g | FAT TOTAL 2g (SAT FAT 0.4g) | CARBS 3g (SUGARS 2.4g) | SODIUM 50mg

DIABETES WELLNESS | Autumn 2018

Life with T1 Akira organised an awareness event at his school on World Diabetes Day 2017 and was interviewed by a local TV channel.

” T1D MAKES ME SPECIAL The Cotton family is adjusting to Akira’s surprise type 1 diagnosis a year ago when he was just seven. Here Akira explains in his own words how diabetes makes him feel and why he wants to raise awareness in his community.

“I

Mum Natasha says she was amazed when he wrote so thoughtfully about his diabetes. “I’m so happy how much he is owning it,” she says. Akira has a 14-yearold brother Tane, and the family lives in Port Chalmers, Dunedin.

DIABETES WELLNESS | Autumn 2018

was diagnosed with type 1 diabetes in February 2017. It really changed my life. You might be wondering what type 1 diabetes is. There’s an organ in your body behind your stomach called a pancreas that turns carbs (carbohydrates) into energy. My pancreas used to create insulin, and what insulin does is it turns glucose in your food into energy. Before I was diagnosed I felt really horrible. It was the worst thing in my life. I felt stressed, angry, sad, annoyed, and much more. That was because my pancreas started producing less insulin, it meant I got less energy. Once I was diagnosed, we started taking care of it. And now we have to give me insulin manually. Oh wait, I forgot to tell you I am eight years old,

so it’s a really big thing for me. I used to have to finger prick myself and it really stung, to get blood to read my glucose levels to tell me how much insulin I have to inject myself with. But now I have a Libre sensor [Freestyle Libre] that goes into my arm, and I just need to take the reader and put it next to my sensor and it shows me my levels. When I have dinner, lunch or breakfast, or snacks I have to have an insulin injection, I might have a lot or not much, it depends what I eat, and how many carbs I have. My mum has to calculate a lot of things. She is the one who gives me insulin. When I’m not well I need extra insulin. When I’m doing swimming or sports we have to check my levels more often.

Research

I feel much better now compared to how I was before. But it’s still hard to deal with. And it’s hard to get my levels right. When I’m too low I feel dizzy and horribly hungry and I have to eat something, I eat different foods, but it depends how low I am. When I’m too high for some reason I’m really angry, it feels horrible, I can’t control myself, and it’s because of the high. There are different diabetes. You get type 1 from bad luck. But with type 2 it’s about your health, and how you are not taking care of yourself. That’s the big difference. Some people get confused between the two and they might think that you have type 2 when you have type 1. For type 1 there is no known cure. But with type 2 you can get better from looking after yourself. I am going to have type 1 diabetes for the rest of my life. There are lots of other children and grown-ups who suffer from the same thing. So I wanted to do this not only for me but for them too. I am hosting a Diabetes Awareness Day at St Leonard’s School. I’d like everyone to wear blue for the day because the diabetes logo is a blue circle. And please bring a donation and the money will go to Diabetes Youth Otago because they help children like me do really fun activities including camps. I’d just like to say, diabetes is hard but it isn’t that bad, because it also means you’re extra special. – Akira Lennon Cotton

WATCH THEM BONES Researchers have found a new way to measure fracture risk in people with diabetes.

n often overlooked health issue for people living with diabetes is the increased risk of broken bones compared with those without the condition. Determining who is most at risk is a step closer thanks to research carried out by scientists from Australia’s Deakin University who have found a new way to measure fracturerisk specifically for people with diabetes. Lead researcher Dr Kara Holloway says those with diabetes have an increased risk of developing heart disease, stroke, kidney and vision problems. “But what’s less well understood is that they’re also more likely to suffer a broken bone than people without diabetes,” she says. Dr Holloway and her team have identified a new way of assessing the risk of fracture in people with diabetes.

It’s a new type of bone measurement called the “trabecular bone score” that is different to the routinely used bone mineral density test. “Where bone mineral density gives information about ‘how much’ bone a person has, it does not provide any detail about the structure, explains Dr Holloway. “Bone has an intricate, honeycomb-like structure and this is what trabecular bone score indirectly investigates.” Dr Holloway’s research shows that people with diabetes have poorer honeycomb-like structure compared to those without diabetes, which means that the bone is less capable of resisting fracture. “This measurement may therefore be a useful method of determining fracture risk in individuals with diabetes, which will improve management of the condition by their doctors,” she added.

”

You can see Akira’s TV interview at http://bit.ly/2D680M9

DIABETES WELLNESS | Autumn 2018

Eat

John was having trouble managing his blood glucose levels following a promotion. Dietitian Helen Gibbs helps him steer his healthy eating habits back on track.

WHEN WILLPOWER ISN’T ENOUGH

uring January many people will have tried to make dietary changes to improve their glycaemic control. Well done for those who have stuck with their New Year resolutions so far. For those of you who have lapsed there is probably a whole range of negative emotions around having “failed again” and most commonly people I see blame their lack of willpower for this relapse. Willpower is defined as the control exerted to do something or to restrain impulses. With dietary changes we are expecting ourselves to make changes and avoid the impulse to return to old behaviours. That is an extremely demanding goal and most situations of failure occur when there is a prior event to “trigger” the return to unhelpful behaviour. Identifying this trigger and working out strategies to overcome the problem will help you get back on track.

DIABETES WELLNESS | Autumn 2018

John, who has type 1 diabetes, had been working hard on managing his blood glucose since his daughter Zara was born two years ago. At one of his regular reviews we could see that his HbA1c had deteriorated. “So tell me what has happened in your life since I last saw you?” I ask. He told me about a recent promotion at work bringing more responsibility, and how busy life was with a two year old. He also told me they were expecting another baby in five months. We talk about how many exciting changes were happening in his life

and I ask him how he thinks it may have affected his lifestyle in relation to food. “I just don’t have the time to get a lunch together before leaving for work, as I did before,” he tells me. “The promotion means I start half an hour earlier, and I guess it is also getting harder to get Zara off to day care too because she, well, she is being a two year old! “With Lucy being pregnant, we are having more takeaway food too because we are both too tired to cook. It’s crazy, I want to be well for Zara, Lucy, and the new baby, but I just lack the willpower.” In these circumstances, I often use the “third chair” technique, when I ask people to put themselves in someone else’s shoes. “Tell me John, if you were asked for advice by someone else with this problem, what would you suggest?”

John came up with these ideas: Check and correct more, rather than guessing carbohydrate values and the amount of insulin needed. • Tiredness is a sign of high blood glucose. • Plan some quick meals with minimal cooking time. • Make a list of better takeaway and lunch choices, and have the carb counts worked out on a phone. • Cook enough, or eat a smaller serve of takeaways, and take the leftovers for lunch. We agreed he needed to check in and tell me how things were going in three weeks. His email, which included a scan of his •

testing, showed his numbers were improving and included the note: “After talking with Lucy, she said her mum had offered to make us a couple of freezer meals each week. That has really helped. I am taking leftovers three days and on the other two days I check and correct if I need to mid-afternoon. It is great feeling less tired in the evening, and I feel I can do more for Zara and Lucy.” I would describe John’s trigger event as situational. His circumstances had changed between his review appointments and he needed a bit of thinking space to get back on track. Because of the emotions associated with failure he found

it useful to think of the problem as “belonging to someone else” and when he had started solving the problem, he could then work with the main people in his life to further refine the plan. It is likely that John will keep running into situational changes with a young family and career changes, and although he might be able to solve some of the issues himself, he should feel that he can ask for support from his diabetes team when he is struggling. Support when someone has sufficient knowledge should evolve towards coaching for better outcomes.

SPECIAL MEMBER OFFER Access hundreds of diabetes-friendly recipes and healthy eating tips by signing up for a Healthy Food Guide digital membership for a specially discounted rate of $15 a year (saving $8.40). This offer is exclusive for all Diabetes NZ members. Just go to www.healthyfood.co.nz and enter the discount code DNZ17 when prompted.

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PERSIAN BEEF SKEWERS WITH CHOPPED TOMATO AND MINT SALAD SERVES: 4 • PREP: 5 MINS PLUS 1 HOUR MARINATING • COOKING: 20 MINS

Ingredients

Method

¼ cup low-fat natural yoghurt 2 tablespoons lemon juice ½ teaspoon turmeric ½ teaspoon sumac, plus extra to sprinkle 1 clove garlic, crushed 500g rump steak, trimmed, cut into cubes olive oil spray 8 short bamboo skewers 2 medium red capsicums, seeded, cut into 2cm pieces 4 large tomatoes, chopped 1 Lebanese cucumber, trimmed, chopped 400g can cannellini beans, rinsed, drained ½ cup mint leaves, roughly chopped freshly ground black pepper lemon wedges, to serve

Combine yoghurt, 1 tablespoon lemon juice, turmeric, sumac and garlic in a shallow glass or ceramic dish. Add beef and stir to coat. Cover and set aside to marinate in the fridge for at least 1 hour. Soak wooden skewers in cold water for 20 minutes. Drain beef of excess marinade. Thread beef and capsicum alternately on prepared skewers. Heat a chargrill pan or barbecue hotplate to a medium-high heat. Spray skewers with olive oil and grill for 5-6 minutes, turning, or until cooked to your liking. Meanwhile, combine tomatoes, cucumber, cannellini beans, mint and remaining lemon juice in a large salad bowl. Season with pepper. Sprinkle skewers with extra sumac and serve with the chopped salad. Serve with lemon wedges. DIABETES WELLNESS | Autumn 2018

SEVEN GREAT WINTER GREENS

Dig

The greens we plant and sow in autumn will continue growing through the winter and possibly into spring. Gardening expert Rachel Knight recommends her favourite winter greens.

GROWING GREAT GREENS

ating our greens is one of the best things we can do for our health. Even a small area of garden or a large container can provide a useful addition of interesting leaves to our plates. Fresher is better for taste, texture and nutrition. Every leaf is packed with fibre, vitamins and minerals. Available when we need them right outside our kitchen door. You can buy seedlings from the garden centre or a few packets of seeds so you can sow a few seeds every fortnight for a succession of crops. Depending on where you live, you’ll need to get the seeds germinated before temperatures drop low at night. If you can give your greens some protection from wind you’ll find they grow more quickly so they’ll be more tender. If it’s cold, a cloche will keep them cosy as long as it doesn’t cook them on a sunny day. What you grow depends on what you like to eat. Do you want fresh green leaves for a daily salad? Rocket, mizuna and parsley would be my pick. Parsley is also great added to stuffings, soups and savoury dishes to add colour and taste. Rocket and parsley make wonderful pesto to spread in sandwiches or use as a dip.

DIABETES WELLNESS | Autumn 2018

Perpetual spinach is the greenstemmed sister of silver beet – milder and sweeter, but still better cooked than raw, except when at the ‘baby leaf’ stage. A winter substitute for spinach., pak choi grows quickly and makes a wonderful vegetable side or a tasty Asian-style soup. As does Chinese cabbage which is versatile enough to shred into a slaw or a salad. Small kale leaves are delicious raw but larger ones work well in stews and curries. If you’re a smoothiesipper you can try adding any leafy combination to blended fruit to get a taste and colour that appeals. After you’ve picked your greens, soak them for 10 minutes in a bowl of salty water to release any dirt and bugs. Spin them in a salad spinner and store in the fridge in an airtight container or sealed plastic bag until you need them. They’ll keep for up to a week like this – better than storebought leaves as they’re fresher to start with. Getting outside for just 10 minutes a few times a week to tend our garden and harvest our crops is therapy for our body and mind. The satisfaction of eating something we’ve grown makes it taste all the sweeter – keeping us healthy inside and out.

rated salad. Rocket – spicy lobed or ser

Mizuna – spiky green or red leaves.

, -leaved or flat ion. y l r u c – at Parsley st for decor not ju

Perpetual spinach – smooth and shiny to enjoy big or small.

Pak choi – cup-shaped rosettes of sweet crisp leaves.

Chinese cabbage – compact, upright, fast-growing cabbage.

Kale – black, red or blue, curl y or frilled. Get creative with you r kale.

Care

BETTER INJECTION TECHNIQUES

F ORGANIC EDIBLE GARDEN CALENDARS If you’d like some advice about growing your own food, check out Organic Edible Garden www.organicediblegarden.co.nz. Diabetes dietitians recommend you fill half your dinner plate with vegetables every night, which can be expensive, so why not grow your own? At Organic Edible Garden you’ll find clear, well-presented videos on what and when to sow, plant and harvest, plus a garden-to-table section, and a list of local community gardens. The 2018 Organic Gardener’s Year calendar features key dates for gardening tasks, as well as moon phases. The OEG team is donating $2 from the sale of each calendar to Diabetes NZ. At the time of going to print, 568 copies had been sold which resulted in $1,136 worth of donations to help people live better with diabetes.

indings from a recent worldwide survey – the largestever on injection techniques –revealed the vast majority of people with insulin-dependent diabetes are not injecting their medication correctly. The survey, which was sponsored by medical technology company BD, involved more than 13,289 insulin-injecting people participating from 42 countries. The results were reviewed and analysed by over 180 diabetes experts from 54 countries, resulting in the “Golden Rules of Injection Technique” guide. The Golden Rules, which have been endorsed by leading diabetes experts in New Zealand, including Dr Brandon Orr-Walker and Dr Helen Snell, were developed to help people better manage their diabetes. They are: Golden Rule #1: Always inject into the healthy fatty layer under your skin avoiding the muscle. This allows your insulin to work properly. It’s also important to use a new site for every injection. Golden Rule #2: 4mm pen needles, inserted at 90 degrees, are recommended for all adults and children regardless of age, sex, ethnicity or body weight. A 4mm pen needle is short enough to pass through the skin at 90 degrees without a skinfold, and with little risk of injecting into a muscle. Golden Rule #3: Inject diabetes medication into areas on the abdomen, thighs, and buttocks. You can rotate from one body area to another but remember that the abdomen, thighs, and buttocks can absorb diabetes medication differently. A single injection site should not be used more than once every 4 weeks. Golden Rule #4: Check injection sites for lumps and bumps. Thickened skin or rubbery lumps and bumps can build up in the fatty layer under the skin at injection sites. People should not inject into these lumps and bumps – sometimes referred to as ‘lipos’ – as the medication may not adequately control blood glucose levels.

You have until the end of May to boost this figure. You can order online at http://organicediblegarden.co.nz/shop/ calendar-2018/.

Golden Rule #5: Rotate injection sites properly to retain healthy skin, reduce risk of developing lipos and ensure your insulin works as it’s supposed to. It’s recommended that people inject at least 1cm (or approximately the width of an adult finger) from their previous injection site. Ask your healthcare professional to develop a suitable injection site rotation plan.

DIABETES WELLNESS | Autumn 2018

Ruby’s world

Ruby McGill decides to organise a sugar-free birthday party for Felix. Can it be done?

SUGAR-FREE KIDS THE MENU

ur little man is one. We survived our first year as a family of four. This was definitely worth celebrating especially as his first three months of life were filled with colic, tears (mainly his) and sleepless nights. We wondered if we’d ever experience laughter and a full night’s sleep again. Luckily we did. I sent invites to our big and little friends that had been by our side throughout Felix’s first year, those who had delivered home-cooked meals, organised play dates, or visited in the evening with wine to offer their support through the tough times. As the day drew closer I thought long and hard about the menu. I’m conscious of the effect sugar has on my blood glucose levels and have tried to reduce my intake a number of times, with varying degrees of success. Even though my family and friends don’t have diabetes, I wanted to see if it was possible to celebrate this momentous milestone while cutting out the sugar. You don’t have to look far to find incredible sugarfree recipes – check out www.iquitsugar.com and www.ditchthecarbs.com for inspiration but I had to be realistic. I simply didn’t have time to create a menu for 30 adults and kids from scratch. I decided to scour the supermarket to find food that was quick to pull together, tasty and sugar free. We had a great time celebrating Felix’s first birthday. I love that we managed to host a sugar-free kids party but to be honest it didn’t really matter what was on the menu. We were surrounded by our village and after all it takes a village to raise a child. Thank you to you all.

DIABETES WELLNESS | Autumn 2018

Ready salted chippies and onion dip: It appears that most flavoured chips include sugar. What? Why? You can avoid the sugar by choosing ready-salted varieties. Some pre-made dips included sugar, others didn’t. We made our own sugar-free onion dip by combining reduced cream and onion soup mix. Easy. Popcorn Fruit platter: Watermelon, grapes, strawberries and kiwifruit (both great low-carb options), and mandarins. Vegetable platter: Tomatoes, celery (no carbs) and carrots. Weightwatchers jelly: I made individual servings in plastic cups. (No carbs). Pistachio nuts Sandwiches: Be sure to check the labels as I found a lot of bread had added sugar. We used Tip Top Oatalicious bread. I used a cookie cutter to make cool shapes. Fillings: vegemite, cheese and ham. Cheese and dips platter: I was disappointed so many crackers from the supermarket include sugar. I had to look closely at the labels to find sugar-free options. I used an assortment of cheese, Lisa’s Hummus, Mediterranean Chunky Dip Basil Pesto, Fantastic Thinner Bite Black Rice Crackers & Huntley and Palmers Rosemary and Garlic Wholegrain Crackers. Drinks: water, diet lemonade & Vitafresh sugar-free orange and mango juice. I Quit Sugar birthday cake from the IQS kids’ cookbook.

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