Diabetes Wellness Winter 2017 by Diabetes New Zealand

wellness

WINTER 2017

DIABETES

DIABETES NEW ZEALAND | DIABETES.ORG.NZ

DIABETES & AGE • ASK A PHARMACIST• TYPE 1.5 DIABETES • BEST BREAKFASTS • BLAME YOUR GENES SLEEP APNOEA • BUCKET LISTERS • NIGHTSCOUT PROJECT • BIKE BEYOND T1

RAISING AWARENESS OF TYPE 2 मधुमेह IN OUR INDIAN COMMUNITIES

FOOT & HEEL BALM

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

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

ONLY IN UNICHEM AND LIFE PHARMACIES

CHCANZ.BORG.17.01.0070

Contents WINTER 2017 VOLUME 29 | NO 2

4 Editorial

5 RESEARCH: $6m funding for three Kiwi-led research studies 6 Upfront

COVER: AMAR RAMAN, DAUGHTER KAYLA RAMAN, 5 .© KENT BLECHYNDEN

8 COVER: Amar Raman on awareness raising in the Indian community

12 DIAGNOSIS: LADA or slow-onset diabetes 14 ASK AN EXPERT: Helen Cant answers questions about diabetes medications 17 LIFE T2: Phil Wright ticks one off his bucket list 18 BEYOND TYPE 1: Helen Mepham cycles the US for diabetes

20 THINK: Do genes play a part in your weight? Dr Giles Yeo explains.

32 TECHNOLOGY: The Nightscout project – CGM in the cloud – could be a life-changer

22 ADVOCATE: Celebrating longevity with Winsome Johnson

34 EAT: Build yourself a healthy breakfast for the best start to your day

23 CARE: How diabetes affects older adults

36 PROFILE: Claire Robinson’s boutique muesli business takes breakfast seriously!

24 RECIPES: Two super soup recipes to warm you, body and soul 26 FAMILIES: Harry Winmill’s journey from diagnosis to triathlon

38 RUBY’S WORLD: Ruby McGill on managing basal rates with a new baby on board

28 CARE: Sleep apnoea – when snoring is no joke

30 MOVE: How to stay active as you age

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DIABETES WELLNESS | Winter 2017

Editorial

Kia ora koutou. Many people with diabetes spend very little time with a health care professional. After diagnosis, most people are left to manage their health themselves. I find this surprising because, as most of us know, uncontrolled diabetes can cause people living with it (and the wider health system) a lot of problems and stress. This often troublesome condition called diabetes can damage our hearts, our eyes, kidneys and feet, to name a few well-known complications. This is why one of Diabetes NZ’s priorities last year was to help people with type 1, prediabetes and type 2 diabetes “take control” and proactively manage their blood glucose levels. Some people have great medical support if they need it, and others don’t. In practice, most diabetes care happens far from a general practice or diabetes clinic. The daily business of managing diabetes happens in our homes, neighbourhoods, workplaces, schools and within the wider community. Fortunately, people living with all kinds of diabetes are generous in sharing tips, ideas and support on how they live well with this life-long condition. We feature their stories and advice in this magazine, on our website and via Facebook. In this issue, for example, we hear about another kind of diabetes – slow onset type 1 – and how it can often be misdiagnosed with serious consequences. And our cover story features Amar Raman and his family who are telling their story to raise awareness about diabetes in the Indian community. Many health professionals, doctors, diabetes nurses, dietitians, pharmacists and others also donate their time to advise Diabetes NZ and write expert articles about diabetes and its management. Our autumn magazine includes Dr Giles Yeo on how genes affect your risk of developing diabetes, pharmacist Helen Cant answering common questions about taking medications, dietitian Helen Gibbs on choosing the best breakfast options, and fitness expert Craig Wise on how exercise needs change as we age. Having diabetes can sometimes feel lonely but our community is full of supporters and friends who are ready and willing to come along for this journey. We may lack beta cells, have dwindling or no insulin, and feel the pinch of medical costs, but we are rich in compassion and concern for others. We share a desire to make life better for all people affected by diabetes. Go well this autumn and be assured all of us here at Diabetes NZ are along for the ride with you.

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

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

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

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

Ka kite ano. STEVE CREW

Chief Executive, Diabetes New Zealand

DIABETES WELLNESS | Winter 2017

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.

Research

HEALTHIER LIVES How can we better prevent and manage diabetes in the future? Three major Kiwi-led studies aim to shed light on these important questions, thanks to almost $6m of new research funding. STUDY 1: PREVENTING TYPE 2 DIABETES WITH PROBIOTICS AND PREBIOTICS

STUDY 2: INNOVATIVE DIABETES MANAGEMENT – DIGITAL HEALTH PROGRAMME

STUDY 3: MANA TŪ – A WHĀNAU ORA APPROACH TO LONG-TERM CONDITIONS

Professor Jeremy Krebs, University of Otago, Wellington FUNDING: $1,800,000 DURATION: 36 months SUMMARY: Prediabetes is a condition that can progress to type 2 diabetes and cause significant long-term health problems. Research demonstrates that microbes in our gut affect our health in many ways, including how our bodies process foods and sugars. We can modify our gut microbes by taking probiotic supplements, which contain live bacteria that give health benefits, and prebiotics (substances from foods which support gut microbes). This study is a blinded randomised placebo-controlled trial to see if taking a probiotic supplement with a) a standard cereal or b) a cereal enriched with a specific prebiotic called beta glucan for six months can improve glucose and fat levels in the blood of adults with prediabetes. This work will also evaluate the cost effectiveness of the interventions and how to translate the study findings into clinical practice.

Diana Sarfati, University of Otago, Wellington FUNDING: $1,600,000 DURATION: 36 months SUMMARY: Rates of diabetes and prediabetes are rapidly increasing, and are higher among Māori and Pacific people. We have developed an innovative digital health programme that supports the prevention and self-management of prediabetes and diabetes. The programme is delivered via web and mobile-based platforms. It integrates with primary care providers and uses peer support, health coaches, health tracking, and tools with engaging content to drive changes in behaviour. Initial pilot results showed that more than 70% of people with prediabetes had normal blood glucose levels after four months on the programme. We propose a group of studies to assess the clinical and cost effectiveness of this intervention in reversing prediabetes and improving selfmanagement of diabetes, compared with usual care. We will explicitly assess the impact among Māori and Pacific people.

Harwood, National Hauora Coalition FUNDING: $2,300,000 DURATION: 36 months SUMMARY: Diabetes is a longterm condition in which there are significant ethnic and social disparities in prevalence and outcomes. There is huge scope to reduce diabetes inequalities. The complex nature of the condition needs a comprehensive and sustained approach that tackles the wider determinants for causes, management and complications. We propose to test Mana Tū, which is a programme co-designed with whānau, clinicians, health service planners and whānau ora providers, to improve the impact of clinical and lifestyle interventions for whānau living with prediabetes and people with poorly controlled diabetes. Mana Tū deploys skilled and supported Kaimanaaki-whānau (KMs) in practices. The KMs work with general practice teams while being operationally supported by a central hub. The hub will coordinate broader community and social service support systems for whānau and provide training, programme design, and support within a rich data environment.

LEAD INVESTIGATOR: Associate

LEAD INVESTIGATOR: Professor

LEAD INVESTIGATOR: Dr Matire

Funding for the three studies comes from a joint partnership initiative between the Health Research Council, Ministry of Health, and the Healthier Lives National Science Challenge. For more details see www.hrc.govt.nz.

DIABETES WELLNESS | Winter 2017

Upfront

DEMYSTIFYING DIABETES New advances in understanding and treating obesity and type 2 diabetes were discussed at a free public symposium in Wellington in April, with a thought-provoking talk by UK geneticist and BBC presenter Dr Giles Yeo. Diabetes NZ co-sponsored the event, which was organised by the Maurice Wilkins Centre for Molecular Biodiscovery. It was attended by leading experts, health professionals, government and health policy officials, members of the public and media. Opening the event, Chief Executive Steve Crew called on those attending to have courageous conversations about obesity and type 2 diabetes. He said, for example, that prediabetes should actually be called “stage 1 diabetes” and recognised as the next big

epidemic of our time. He said: “We need to harness the power of social media and technology to advocate for change and for a better deal for people living with diabetes and prediabetes in this country. It’s not enough to write a letter to the Minister or sign a petition. If we always do what we have always done we will always have what we already have. “People with diabetes are being stigmatised and people don’t understand the difference between type 1 and type 2 diabetes. We need more understanding of the causes of diabetes and to stop blaming people for having it. The science happening right here in New Zealand, and around the world, can help demystify it.

Diabetes NZ CE Steve Crew with geneticist Dr GilesYeo

“Diabetes NZ wants to facilitate the transfer of scientific knowledge from diabetes and obesity experts to the community and ask for the public’s help to advocate for new drugs and better services via social media and other new technologies.” *Are your genes to blame when your jeans don’t fit? See p20.

Grocery Charity Ball raises money for diabetes The Grocery Charity Ball is one of the biggest fundraising events in New Zealand and has become one of Auckland’s premier social events since it was launched 13 years ago. Diabetes New Zealand is the very fortunate beneficiary of this year’s Grocery Charity Ball and is working hard with organisers S2N Events, and the Trustees, to make it another outstanding success and experience. In the past, the generosity of attendees has raised as much as $500,000, with the average donation being a phenomenal $250,000 for a different charity each year. Diabetes NZ knows what an amazing opportunity this is and the proceeds from the ball will

significantly contribute to our work in a variety of ways, including the introduction of newly diagnosed packs for youth. Katherine Rich, chief executive of The New Zealand Food & Grocery Council, said: “We wholeheartedly support the mission of Diabetes NZ to provide support for all New Zealanders with diabetes, or at high risk of developing diabetes, to live full and active lives.”

We are also in the process of finding items to auction and would very much appreciate any assistance you might be able to offer in this area. Please contact Jo Chapman, Business Development Coordinator, Diabetes New Zealand on 021 852 054 or jo@diabetes. org.nz if you can help us to make this one of the most memorable balls ever!

Please join Diabetes NZ at this truly unforgettable evening, which will be held on 2 September 2017 at the 5-star Langham Hotel in Auckland with Mark Sainsbury as MC. Come alone, bring a friend or book a table!

For more information on the Grocery Charity Ball, see www.grocerycharityball.org

DIABETES WELLNESS | Winter 2017

Go-getting grannies Broadcaster and journalist Jack Tame (pictured) wrote about his globetrotting T1 granny in his New Zealand Herald on Sunday column earlier this year.

“Granny was in Aleppo only a year or so before civil war kicked off in Syria. China’s Silk Road, the Galapagos Islands, Taiwan and Vietnam: you can never be sure from where Granny’s next postcard will arrive.”

The theme for this magazine is living well with diabetes as you age. We’ve got lots of inspiring stories and tips for how to be healthy while living with type 1 or type 2 diabetes from middle age right through to your senior years and beyond.

He explained how his granny is planning a couple of weeks in Myanmar just before she turns 90. “It’s a bit of a fiddly trip, not only because of her type 1 diabetes, but because Myanmar’s hardly a week on the Gold Coast,” Jack writes. “But Granny has it sussed. She’ll walk, she’ll learn, she’ll haggle at the markets, and in no time she’ll be home to plan her 90th bash. It’s inspiring for those of us 60 years younger to consider her, still engaging with the world.

Jack’s column reminds us that not everyone will aspire to adventure travel in their 90s but a successful retirement plan allows for the greatest luxury of older age – options.

For another inspiring granny, check out record-breaking Winsome’s story on p22.

HEALTHY FOOD EXPO DATE: 20-21 May, 2017 LOCATION: North Shore Events Centre, Auckland TICKETS: Early bird $10 and free for children.

Healthy Food Guide LIVE! is an exciting new healthy food expo where you’ll get inspiration and practical ideas to help you and your family get healthier. Come along to attend expert sessions led by New Zealand’s top health experts covering a wide range of topics related to your health, enjoy cooking and fitness demos, plus fun and interactive competitions on the live stage. Diabetes NZ will be there too with Art Green and the chance to win fantastic Fitbit activity trackers! Being healthy is fun at Healthy Food Guide LIVE! and it’s suitable for all ages. Don’t live in Auckland? Another Healthy Food Guide LIVE! event is being held in Christchurch in October. For more information see www.healthyfoodlive.co.nz

VOLUNTEERS NEEDED Diabetes New Zealand is seeking members to join steering groups tasked with undertaking two important reviews for the organisation. The first review will look at the availability of/access to diabetes services nationally. The second will assess where Diabetes NZ is now as an organisation following the Destination Unity process. Please register your interest with National Office before 21 May 2017 by emailing admin@diabetes. org.nz or by post to Diabetes NZ, PO Box 12441, Wellington 6144. Include your contact details, which project you are interested in, and a paragraph outlining why you are interested and what you will bring to the Steering Group. You will need access to email to be part of the group and be available to help between June and October.

SAVE THE DATE: Diabetes New Zealand’s AGM/Conference is on 28 October 2017. The theme is: “I know, do you know?”

DIABETES WELLNESS | Winter 2017

Cover

DIABETES WELLNESS | Winter 2017

Raising awareness about the risk of diabetes in the Indian community is a priority for Diabetes NZ. Luckily we have some incredible supporters, like Amar Raman and his family, who are determined to help. By Caroline Wood

MAKING A DIFFERENCE फर्क डालना

PHOTO: KENT BLECHYNDEN WWW.KENTBLECHYNDENPHOTOGRAPHY.CO.NZ

mar Raman has learned a lot about diabetes in the past five years. He doesn’t have diabetes himself but a lot of his relatives do, including his mum-in-law, uncle and several cousins. “It’s feels like it’s rife in our community, particularly among older people,” says Amar, who lives in Wellington with his wife and their two daughters. Unfortunately Amar is right, diabetes disproportionately affects Indians, with older adults at particular risk of developing type 2 diabetes. The number of Kiwis of Indian descent diagnosed with diabetes increased by 60% between 2010 and 2015 to about 16,000 people. Half of them are aged 55 and over. One of them is Amar’s mumin-law, Ba, 72, who was diagnosed with type 2 diabetes three years ago. Ba is Hindi and doesn’t speak very good English, which has made it harder for her to adapt to life with diabetes. Amar, 42, says: “My mother-inlaw found it hard, she’s eaten the same diet for 70 years, and Indian

food has lots of rice, chapatti, and sweets. She found it difficult to make changes. But she changed her lifestyle gradually, she’s eating less sugar, less fatty foods, and doing more gardening and walking. She’s got her diabetes under control now.

Amar wants to make a difference for people with diabetes and has decided to volunteer for Diabetes NZ, where he is currently working on some game-changing IT projects. “Quite a lot of my generation knows about diabetes and we are changing our diet and activity levels. But the older generation didn’t get told these things when they were my age. Like how much sugar to eat, how our Indian snack foods are full of syrup and should only be eaten as treat foods, not every day. Forty years of habit is hard to change, let alone 70 years.

Amar’s uncle, 75, was diagnosed a year ago – it was a quicker diagnosis as he had low iron and a simple blood test showed he also had type 2 diabetes. “He told me that when he was young he used to eat a lot of junk food, and beer, and he reckons it’s caught up with him. He’s stopped alcohol and snacking and eats less junk food,” says Amar. “Lack of English is a problem for some of our older generation. Also Indians don’t like talking about diabetes, some of them feel ashamed. They don’t like talking about medical stuff generally. Even close family members find it hard to speak about it. “But diabetes is rampant in the community and we need to raise awareness. It got me thinking about whether I could help make a difference, so I got in touch with Diabetes NZ and met up with Steve [Crew].” And we are grateful he did because Amar is an IT specialist with 21 years ICT and project management experience. He used to own his own company and worked for a number of

DIABETES WELLNESS | Winter 2017

Q&A WITH BA, 72, (AMAR’S MUM-IN-LAW)* Thinking back to the day you were diagnosed; how did you feel? I was very sad and mad at the same time. But I knew then I had to change things in my life, even though I was almost 70 years old. Were you surprised you had diabetes? Yes I was. I didn’t expect it as I thought I was living a healthy life. Did you know what diabetes was before you were diagnosed? I had a small understanding of what it was but I didn’t fully understand the impact on myself, and on my close family. What do you think Indian people of your generation think about diabetes? I think they are very shy to talk about it in the family and outside the community. More awareness needs to be raised in this area. Did you find it easy or difficult to find out information about type 2 diabetes? I found it difficult because I’m not very good with all the technology and the English language. What changes have you tried to make to help you manage your diabetes? Have you noticed any differences? I have made changes to my diet and I’m more active. I feel a lot better and I think with more guidance and direction I could do even better still. *Translated by Amar Raman

DIABETES WELLNESS | Winter 2017

companies and government departments in Wellington. Amar is working part time for a big company and in his spare time he has decided to volunteer for Diabetes NZ, where he is currently working on some game-changing projects. He’s building a new website that will be mobile friendly and easy for staff and volunteers to edit and update. He’s also writing a fiveyear digital roadmap, streamlining Diabetes NZ’s back office IT needs, developing cloud-based solutions, and organising the leasing of new equipment that could lead to significant savings. Chief Executive Steve Crew said: “It’s very exciting having Amar come on board. We couldn’t afford to build a new website without his help. We expect to be able to make significant savings in our IT expenditure thanks to his specialist knowledge, and the money saved can be spent on our frontline diabetes services. “I’m bowled over by the fact he’s prepared to go the extra mile for Diabetes NZ by giving us his time and expertise. We are immensely grateful and by helping us, he is potentially helping every person living with diabetes in this country.”

Amar says he wants to make a difference, after 20 years working in the corporate sector, and plans to do this by helping Diabetes NZ, and by raising awareness in his own community. “Like most charities, Diabetes NZ is operating on a shoestring, with really tight budgets. I think I can help save quite a lot of money. I told Steve I can help and I’m looking for a long-term relationship. “I’ve learned quite a bit about diabetes by reading information on the website, it’s a wonderful organisation doing an important job but some people in our community haven’t heard of Diabetes NZ. “I want to help, I plan to give a talk at the Indian temple, hand out Diabetes New Zealand’s brochures in Hindi, share this magazine article, get the word out there. It’s good to talk about it within our community, and it might help prevent diabetes in the future. “I want to talk about it with my daughters, who are five and eight years old. Hopefully it will help them make better lifestyle choices that will lower their risk of getting type 2 diabetes.” Amar is willing to volunteer his time to help other charitable organisations who need IT support. You can contact him on 021 062 0745 (location and size of organisation is not an issue).

There are lots of ways you can help Diabetes New Zealand – join, donate or volunteer. For more information, see www.diabetes.org.nz or get in touch by phone on 0800 342 238. We’d love to talk to you!

Amar Raman and his daughter Kayla, five. He hopes that by raising awareness in his community he will be helping younger Indians reduce their risk of developing diabetes in older age.

KNOW YOUR RISK Members of the Indian community have the highest risk of developing diabetes in New Zealand. Indian adults are three to four times more likely than Europeans to be diagnosed with type 2 diabetes, and the risk increases the older you are. Scientists don’t yet understand why but it’s likely to be a combination of genes and lifestyle factors. How many people with diabetes do you know? It’s an increasingly common condition. More than one in 10 Kiwi adults over 65 years has diabetes but the figure in the Indian community is much higher. Many people don’t realise they have high blood sugar levels because sometimes there are no symptoms. If you ignore your diabetes, it can lead to blindness, heart attacks, stroke, feet problems, and kidney issues. But properly managed, you can feel a million dollars! By following your doctor’s advice on taking medication, eating more healthily and doing a bit more exercise you can reduce your blood sugar to safe levels, reverse your diabetes symptoms, and have more energy.

Language can be a barrier for some people, which is why Diabetes NZ publishes its pamphlets in other languages. We have a Hindi version of Staying Well With Type 2 Diabetes, which is also available in Chinese. You can download them for free at www.diabetes.org.nz or call 0800 DIABETES.

Take action today! Talk to your doctor and ask for a diabetes test. It’s quick and easy. Knowledge is power – your health is in your hands.

ी जोिखम जान, अपन अपनी जोिखम जान, -यूज़ील2ड म, भारतीय समुदाय के सद<य मधुमेह के िवकास का सबसे Aयादा जोिखम रखते ह2। यूरोपीय वय<कC को टाइप 2 मधुमेह के साथ िनदान करने कH तुलना म, तीन से चार गुना अिधक होने कH संभावना है, और जोिखम िजतना पुराना हो, उतना बढ़ता है। वैPािनकC को अभी तक समझ म, नहR आता है, लेTकन यह जीन और जीवन शैली कारकC के संयोजन होने कH संभावना है। मधुमेह के साथ Tकतने लोग जानते ह2? यह एक तेजी से सामा-य ि<थित है 65 साल से अिधक कH उY म, 10 से अिधक Tकवी वय<कC म, मधुमेह है लेTकन भारतीय समुदाय का आंकड़ा ब]त अिधक है। ब]त से लोगC को पता ही नहR है Tक उ-ह, उ^ र_ शक` रा का <तर होता है aयCTक कभी-कभी कोई लdण नहR होते ह2। यTद आप अपनी मधुमेह कH अनदेखी करते ह2, तो यह अंधापन, Tदल के दौरे , <gोक, पैर कH सम<याएं, और गुदा` के मुhC को ज-म दे सकता है। लेTकन ठीक से jबंिधत, आप एक लाख डॉलर महसूस कर सकते ह2! दवा लेन, े अिधक <व<थ भोजन करने और थोड़ा अिधक mायाम करने के बारे म, अपने डॉaटर कH सलाह का पालन करके आप अपना र_ शक` रा सुरिdत <तर पर कम कर सकते ह2, अपनी मधुमेह के लdणC को उnटा कर सकते ह2, और अिधक ऊजा` jाp कर सकते ह2। आज कार` वाई कर, ! अपने िचTकqसक से बात कर, और मधुमेह परीdण के िलए पूछ,। यह qवsरत और आसान है Pान शि_ है - आपका <वा<tय आपके हाथC म, है

DIABETES WELLNESS | Winter 2017

Diagnosis

TYPE 1.5 DIABETES? It took three years and a heart attack before Karen Staveley was properly diagnosed with a slow-onset form of type 1 diabetes. Words and photos by Karen Reed.

LADA, or slow-onset type 1 diabetes, isn’t very common and it can often be misdiagnosed, as Karen Staveley found out.

DIABETES WELLNESS | Winter 2017

ost people have heard about type 1 and type 2 diabetes, even if they are a bit fuzzy about the differences (more of this later). But how many know someone with a third type of diabetes, called LADA, sometimes referred to as type 1.5 diabetes? Latent Autoimmune Diabetes in Adults, or LADA for short, is a slowonset form of type 1 diabetes that can be misdiagnosed as type 2 diabetes, sometimes with serious health consequences. Diabetes NZ wants to raise awareness of LADA because up to 10% of people diagnosed with type 2 diabetes may actually have this form of diabetes. The treatment pathway is very different for each condition. Karen Staveley, 52, of Rotorua, knows only too well the impact of being misdiagnosed because it almost killed her. She was diagnosed with type 2 diabetes in November 2011 after several months of being unwell with shingles. She was first prescribed metformin, however her blood glucose levels remained high (in the 20s). Karen, a supermarket checkout supervisor, was slim and underweight for her height. She had felt tired and unwell for three years, suffering unexplained and recurrent periods of thrush and urinary infections. “It was a miserable period,” she recalls. “I was continually feeling unwell. At one stage I became really sick with pneumonia. My blood sugar level was 31.” Karen decided to take part in a clinical trial being run in Rotorua. She started once-a-day long-acting insulin injections. But this didn’t make her feel any better. Then she developed another serious bladder infection and was prescribed antibiotics. Taking them, she had what was thought to be an allergic reaction – she became short of breath and had serious chest pain. After an ambulance was called, she was given antihistamine and sent home.

Four hours later, another ambulance was called – Karen had suffered a heart attack. The cardiac team at Waikato referred her to specialists at Rotorua Hospital. Eventually, with blood glucose levels still persistently in the 20s, she was diagnosed with a slowonset form of type 1 diabetes called LADA. Karen knew they had the diagnosis right this time because just one injection of a fast-acting insulin, Novorapid, made her feel so much better. “It was such a relief to be properly diagnosed, three years after my initial type 2 diagnosis. I felt alive again, it was amazing. And I still feel so much better now.” But the misdiagnosis of her diabetes as type 2 – and subsequent inadequate treatment – caused three years of suffering that Karen could have done without. “I still feel angry sometimes about the length of time it took to get the correct diagnosis. “It’s been a bit of a journey, but I’m pleased to be feeling well again and I now have my blood glucose levels under control.” Karen says it took a while to readjust her mindset from having type 2 diabetes to having type 1. Instead of concentrating on a general low-carb low-fat low-sugar kind of diet with lots of exercise, she had to start thinking about carb counting and adjusting her insulin doses to get the ratio of insulin to carbs right. “It took me a while to get the hang of things, but I feel so much better now, it’s incredible,” she adds. Karen’s specialist Dr Nic Crook confirmed her LADA diagnosis. If you think you may have LADA, talk to your GP or diabetes provider. There are blood tests available to confirm this type of diabetes.

WHAT IS SLOW-ONSET TYPE 1 DIABETES? This type of diabetes has been referred to as type 1.5 diabetes because it is a form of type 1 diabetes but shares features more commonly associated with type 2 diabetes. LADA, or Latent Autoimmune Diabetes in Adults, is diagnosed during adulthood like most cases of type 2 diabetes. However, LADA is an autoimmune disease, like type 1 diabetes, and sooner or later the insulin-producing beta cells in the pancreas will be destroyed. Eventually insulin is needed for survival, usually within a few years of type 2 diagnosis. Some features of LADA may include: • being slim, or at least not overweight • a history of autoimmune problems • no ketoacidosis at diagnosis • a positive GAD antibody test (blood test) • the patient may need insulin relatively soon after initial diagnosis – usually within 3-5 years

MISDIAGNOSIS COMMON Up to 10% of people diagnosed with type 2 diabetes may actually have LADA, according to endocrinologist Dr Rick Cutfield, of Waitemata District Health Board. The consequences of misdiagnosis could be grave – as they were for Karen – or of little impact. Metformin is the first medication usually given when someone is diagnosed with type 2 diabetes. This helps reduce insulin resistance, a key feature in the majority of cases. However people with immunemediated diabetes, like LADA or type 1 diabetes, have little or no resistance to insulin. Quite the opposite – they are sensitive to insulin so metformin doesn’t work for them. Other medications for type 2, which increase insulin production, may work for a while in people with LADA. This often means their misdiagnosis takes longer to recognise. Doctors are encouraged to consider the possibility of LADA in cases of type 2 diabetes that don’t fit usual clinical features.

WHY DOES TYPE 1 DIABETES DEVELOP EARLY IN LIFE IN SOME PEOPLE BUT LATER IN LIFE IN OTHERS? The current line of thinking is that our genes provide a risk/susceptibility to (or possibly protection from) type 1 diabetes. Whether you develop T1 depends on the interplay of our genes with environmental factors. My family history tells a story in itself. My father was 15 years old when he developed diabetes, his sister was 27, and his brother 38 when they were diagnosed. They all had type 1 diabetes. If the genetic causes in each of the siblings were similar, then the initiation and/or the length of the disease process was presumably more related to environmental factors. By the way, I was 10 years old when I was diagnosed with T1. – Karen Reed

DIABETES WELLNESS | Winter 2017

Ask an expert

Pharmacist Helen Cant answers some common questions about taking diabetes, blood pressure and cholesterol medications.

MEDICINE TIME

elen Cant’s job is to help people understand their medicines and healthcare professionals identify the best mix of medicines for each patient. Here she covers some of the most common questions people with diabetes have about their medications.

Why has my doctor prescribed me so many different tablets when some of them are for the same health issue? This is a really common question. The answer is that your body has several different controls for each system, and it’s common to have to use different medications to “reset” these controls. It’s a bit like driving the car down a hill, you do several things to keep your speed under control – first, take your foot off the accelerator, then press on the brake, and sometimes change into a lower gear, depending on what’s happening. Different people require different combinations of medicines to achieve the same health benefits, so it is really important not to share medicines, even if you have the same medical condition.

Can you give me an example?

Say a person has type 2 diabetes, the increase in their blood sugar is often partly due to their body becoming insulin resistant. Insulin’s job is to “unlock” gates in the walls of the cells to allow glucose out of the blood and into the cell where it gets burned up for energy. But in

DIABETES WELLNESS | Winter 2017

someone with insulin resistance, insulin has difficulty unlocking the gates, so glucose doesn’t get into the cells. It stays in the blood – causing blood glucose (blood sugar) to rise. Metformin is prescribed to help the insulin open the locks and let the “gates” open again. It also helps control the amount of glucose the liver puts into the blood. Taking metformin is enough for some people to control their blood sugar. But many people need another medication to help release enough insulin from their pancreas. That’s where medications like gliclazide or glipizide are used. They work by increasing the amount of insulin the pancreas releases. So then you have one medication encouraging the pancreas to release insulin (eg gliclazide) and the other helping insulin to work more effectively (metformin). Some people with type 2 diabetes can’t get enough insulin from their pancreas and will need insulin injections.

I have high blood pressure, why do I need to take more than one tablet to control it?

Blood pressure is controlled by several different nerve, hormone and enzyme controls, coming from different organs like the brain, the adrenal glands and the kidneys. The body keeps all these systems working together to maintain blood pressure. But if someone’s blood pressure is too high, it is common to have to take several different medicines that work on different systems to lower it.

My blood pressure, blood sugar and cholesterol levels have come down. Can I stop taking my medicines?

It depends, many people have to take these medications regularly for the rest of their lives. Shortterm conditions, like a cold or infection, are treated and go away, and the medication for these are only taken for a short time. Usually a person can stop taking their medication because they’ve been cured. On the other hand long-term (chronic) conditions, such as raised blood pressure, diabetes, high cholesterol and arthritis, often mean the changes in the body don’t go away. These changes can be controlled but not cured by medications. For example, a person who has had a heart attack may be prescribed a combination of long-term medications to help the heart function better. Having said that, changes in lifestyle and diet can often reduce the amount of medication that people need to take. For example, people with type 2 diabetes can often make a big difference to their blood sugar by changing their food choices and making lifestyle changes like increased exercise. Likewise, high cholesterol can also often be reduced through different food choices, and increased exercise. It is always worth discussing what the options are. Just remember that it’s common to still need

Taking medications can be quite confusing for people. If they don’t understand why they are taking the tablets, people may choose not to take them regularly or even stop them altogether.

Helen Cant says diabetes is rapidly becoming her speciality area. She really enjoys talking to people about their medications, helping them understand how they work and how to get the best from them.

some medication even though you are doing all the “right” lifestyle and diet things.

How does taking these medications help lower the risks of heart attack and stroke?

Many long-term medications are prescribed to reduce the risk of other health conditions developing. Often the person isn’t aware they have a potential problem. For example, the reason that medicines are prescribed to people to lower their cholesterol is usually to reduce the risk of having a heart attack. The cholesterol blocks arteries and stops blood getting through, causing the cells on the other side of the blockage to be starved of oxygen and die – if this happens in the heart, this is one form of heart attack. High blood pressure increases the risks of having a stroke, as among other things, the high pressure can cause leaks in the blood vessels. Having type 1 or type 2 diabetes also increases the risks of heart attack and stroke, and of damage to the kidneys, eyes and nerves.

Managing diabetes, blood pressure and cholesterol helps reduce the risk of long-term damage for many people.

I feel worse when I’m taking a medication, why’s that?

All medications have unwanted effects. The trick is to get the best mix of medicines for each person for the conditions they have right now. Often when a new medication is started, the person will feel the change in condition – for example it is common to feel a bit dizzy with the first few doses of medicines to lower blood pressure. For many people this will settle down in a few days. Another common side effect is stomach upset. This can often be reduced by taking the medication with food. Often medications can be started at a low dose and gradually increased to control the condition without causing troubling adverse effects. My advice is to ask your prescriber what the plan is for the medication, and then ask to speak to the pharmacist when you get the medicines dispensed, tell them

it is a new medication for you and ask about how best to take it, any interactions with other medicines or foods, and if there are any situations when you should see the doctor immediately. Ask for written information if that would be helpful for you.

Why do I have to take some tablets once daily and others four times a day?

It depends on what the body does with the medicine when you take it and how the tablet or capsule is designed. When you swallow a plain tablet/capsule, it dissolves in the stomach and the medication is absorbed through the walls of the stomach and intestines into the blood. Your blood carries the medication around the body passing through some other organs on the way. The first place is often the liver, which takes large molecules and processes them so the body can either use them or dispose of them. Then the kidney filters out unwanted substances and disposes of them in the urine. All of this means that

DIABETES WELLNESS | Winter 2017

Ask an expert

Pharmacists play an integral role in diabetes management in New Zealand. People with diabetes often have co-existing conditions and can end up taking multiple medications.

the amount of medication in the body is steadily reduced as more of it passes through the liver and kidneys. So, we need to take regular doses to keep enough medication in the blood to be doing the job we want it to do. The body takes a while to process some medications, so they need to be taken less often. Other medications, like paracetamol, are processed very fast. We need to take a dose every few hours (usually every six to eight hours, but sometimes as often as every four hours) to keep the pain under control. There is also a maximum dose that should not be exceeded in any 24-hour period.

Sometimes I forget to take the tablets regularly, are there any other options?

We know that taking medicines every few hours can be difficult to remember consistently unless

you are getting a prompt like pain. To help with this, many medicines are made into special tablets/ capsules that dissolve slowly over 12 or 24 hours. These will be called slow-release (SR), long-acting (LA), extended release (XR or ER), modified release (MR), extended action (XA), or something similar. Ask your prescriber if these are an option. The thing to remember about these kinds of tablets is that they must not be crushed. If you need to take half a tablet, ask your pharmacist, but as a general rule, if a tablet has a line across its middle, it is probably ok to cut there, but if it doesnâ&#x20AC;&#x2122;t, check before cutting it. Finally, if in doubt about anything at all, talk to your pharmacist. Itâ&#x20AC;&#x2122;s about getting the best mix of medicines for you at this point in time and we are there to help. Helen Cant is a pharmacist with a special interest in diabetes. She is based in a GP practice in Tokoroa.

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

ALSO AVAILABLE FREE TO HEALTH PROFESSIONALS

DIABETES WELLNESS | Winter 2017

Life T2

THE BUCKET LISTERS After his diabetes diagnosis, former top cop Phil Wright retired early from the New Zealand Police and set off with his wife Jackie on a round-the-world sailing odyssey.

uth Jeffrey’s climb up Mt Kilimanjaro (p38, Autumn 2017) was inspirational. Many people with diabetes have bucket lists. Maybe it’s being confronted with the news that our health is under threat? I was diagnosed with type 2 diabetes in 1993 at the age of 45. Seven years later my wife Jackie and I gave up stressful jobs and, one windy evening in September 2000, we set sail from Opua to scratch “Sailing around the world” off our bucket list. Our boat was a relatively old Cavalier 39 fibreglass yacht, slow but safe and stable. This trusty boat took us up the Red Sea, through the Suez Canal and over the next three years we visited Israel, Turkey, sailed through the Mediterranean to Greece, Italy and Spain. Passing into the Atlantic at Gibraltar, we crossed to the Caribbean, through the Panama Canal and back across the Pacific. We get asked “Were there any scary times?” In the piracy-prone Indian Ocean, 400 miles from Oman, we were stopped by a rough looking fishing boat. Jackie hid below while I went up on deck to

see what they wanted. Our fears turned to smiles when they held up a bunch of coconuts, which we traded for biscuits! Arriving by boat can be difficult. You sail into port with a yellow flag at the mast (certifying you don’t have plague aboard). Tie up where you can, look for the harbour master’s office, with ship’s papers and crew passports in hand. Fill out the forms and pay taxes, (some invented by poor officials). You must learn enough of the local language to ask “Where is the grocery store/diesel/the bus/ Internet café?”, “Please” and “Thank you” and “Buzz off” to the pesky peddlers! Highlights included sailing under the Sydney Harbour Bridge, visiting Jerusalem, swimming in the Dead Sea, visiting the Blue Mosque at Istanbul, and seeing Lonesome George, the last turtle of his kind, a year before he died on the Galapagos Islands. Six years later, and eight days out from Tonga, we saw the smudge of New Zealand on the horizon. We were home. During our trip, we saw how diabetes was managed around the world. In New Zealand we have the best treatment in the world – free diabetes medications, Pharmac, Ministry of Health support with yearly assessments, free blood analyses, test meters – and the help of Diabetes NZ! Insulin supplies were a problem. With the help of officials at the Ministry of Health, a friendly chemist and my GP, I could manage a year’s supply at a time. A solar panel and small fridge were

needed. My health on our return was better than when I left. Jackie and I now live in a remote bay in Tory Channel, Queen Charlotte Sound. We have no power and no roads, cutting firewood and taking the yacht to Picton for supplies keeps me active and I have my diabetes under good control. Would we do it again? You bet, in a heartbeat! Phil Wright, now 71, was Assistant Commissioner of Police when he retired aged 53 in 1998. His wife Jackie Wright, now 67, was sole-charge Librarian at GCSB, and retired at age 51.

Taking the plunge: Phil didn’t let diabetes get in the way of his round-the-world sailing adventure.

TAKE THE PLUNGE: What’s on your bucket list?

Tell us how you are living your dream life and kicking diabetes into touch, email editor@diabetes.org.nz

DIABETES WELLNESS | Winter 2017

Beyond type 1

DOING IT FOR

KIWI KIDS Teacher aide Helen Mepham, 30, is hoping to smash some T1 stereotypes when she takes part in an epic cycle across the USA.

was with family in Wanaka when I got the most exciting email I've ever received. I had been selected to be part of an international team of riders taking part in Bike Beyond – a 10-week adventure that will see us pedal from New York to San Francisco, a distance of 6800km. We are raising money for Beyond Type 1, which is organising this awesome adventure. As the only Kiwi on the team, I’m drawing attention to the work Beyond Type 1 is doing here in Aotearoa with Diabetes NZ. All the funds I raise will be assigned to projects to help our type 1 community right here in New Zealand! Beyond Type 1 is an American charitable foundation that is helping young people with T1 be the best they can be. They use social media to promote positive stories about people living with type 1 diabetes. Beyond Type 1’s goals are to educate, advocate and eventually cure this disease. Beyond Type 1 is an online community that I often visit. I love sharing and

DIABETES WELLNESS | Winter 2017

reading helpful tips. They also connect T1s of any age with others as pen pals and I love writing to mine who lives in France. After graduating, I trained to be a ski instructor and worked in Italy, Canada and Cardrona. I’ve always loved travelling and first visited New Zealand in 2011. My partner and I moved from the UK to Christchurch in 2015 and I've found the lifestyle here works wonders for my type 1, which I've had for nearly 17 years. I found that biking, hiking and pump class have given me more awareness of what and how different activities affect my blood glucose levels. I know many type 1s fear exercise because of the risk of hypos and hypers. With knowledge and confidence, an individual can go out and enjoy endless types of exercise. It may take more planning, more things to carry and having people close by who are aware of what to do if you require assistance, but you can do it.

It took me a long time to gain confidence to get on my bike by myself, but I did it. Now, a few years later, I find myself training six days a week so I can take on the average 120km a day I will need to ride during Bike Beyond. There are times type 1 gets in the way, but I won't let it stop me from achieving my dreams. I want people with type 1, especially children, to realise all the incredible things you can achieve beyond your diagnosis. While it is a physically and mentally testing condition, I've found that it has made me stronger and more determined to enjoy the great opportunities life has to offer. As I talk about Bike Beyond for the 30th night in a row, my partner says “I wish I was type 1”. He quickly takes it back, but I think this shows just what the Beyond Type 1 community is achieving – that living with diabetes shouldn’t be seen as a negative thing and positives come out of being part of a global community. Please support Helen’s fundraising at https://donate.beyondtype1.org/ helenmephambikebeyond

BIKE BEYOND Helen is joining an international team of 21 riders who hail from the US, UK, Australia, Canada and New Zealand. Collectively they have a whopping 263 years of T1 experience! As they journey across the USA from June to August 2017, they’ll be destroying stereotypes and showing the world what living beyond type 1 looks like. They’ll be stopping in all kinds of cool cities, hosting events and cutting loose, showing what it’s like to be a diabadass. And you don’t have to be a rider to join in the fun. Check out www.beyondtype1.org and get involved in the biggest global T1 community in the world! For more about the foundation, see p12 of our Autumn issue.

CONNECT TODAY www.beyondtype1.org

TEAMING UP The US-based Beyond Type 1 charitable foundation and Diabetes NZ are teaming up to support young New Zealanders to live “beyond type 1”. Chief Executive Steve Crew recently met with Beyond Type 1’s New Zealand-based Global Council member Jill Brinsdon (pictured above) to discuss how the two not-for-profits could work together. Three hero initiatives were agreed for 2017 that will culminate in this year’s Diabetes Action Month campaign, which focuses on the differences between type 1 and type 2 diabetes. The first joint Diabetes NZ/Beyond Type 1 campaign will be raising awareness of the early symptoms of T1 diabetes among GPs and families, with the aim of reducing the number of young people who have diabetic ketoacidosis (DKA) at the time of diagnosis. DKA is an acute, lifethreatening set of symptoms that mainly occurs in patients with type 1 diabetes. “Beyond Type 1 developed this initiative as an estimated 41% of individuals are in DKA at diagnosis in the US. New Zealand will be only the second country in the world to roll out the campaign, something we’re very proud of!” says Jill Brinsdon. “The second initiative involves what we expect to be a high profile ‘stunt’ involving amazing Kiwis from across Beyond Type 1’s social media channels – the biggest type 1 community in the world.” Thirdly, Diabetes NZ will work with Beyond Type 1 to completely upgrade Diabetes NZ’s newly diagnosed packs, including access to Beyond Type 1’s popular teaching aid – Jerry the Bear. Chief Executive Steve Crew said: “We are delighted to be working with Beyond Type 1. These three new initiatives will be a great addition to our work supporting New Zealand’s T1 community, especially our children and young people.” “The New Zealand Society for the Study of Diabetes is very supportive of this initiative and is working closely with us and Beyond Type 1.”

DIABETES WELLNESS | Winter 2017

Think

The role of genes in the development of diabetes is an exciting new frontier of science and could lead to treatments tailored to a person’s individual biology. By Caroline Wood.

ALL IN THE GENES

any Kiwis are overweight, we have the third highest rates of obesity in the world. But why do some obese people develop type 2 diabetes and not others? And if diabetes is a lifestyle disease, why do skinny people get T2 as well? In New Zealand, Pacific Islanders and Indians are three times more likely than Europeans to develop type 2 diabetes. Māori are also disproportionately affected. Why are these groups most at risk? Could it be a result of their genes? Our genes play a major role in determining who puts on weight, or develops a disease. Increasingly research shows that our genes can also determine how a specific individual responds to treatment, including medication. The challenge for scientists is to better understand the role that genes and biology play so we can tailor treatments to fit the individual. In future, perhaps it may be possible to even predict who is likely to become obese or develop diabetes in later life. Dr Giles Yeo is a geneticist and obesity expert from Cambridge University and a popular BBC presenter. He recently toured New Zealand raising awareness about the role of genes in obesity and diabetes.

DIABETES WELLNESS | Winter 2017

He argues that people shouldn’t be fat-shamed for being overweight – or stigmatised for having type 2 diabetes. The heritability of body weight is 70%, he says. This means our weight range, or BMI, is pretty much set by our genes. The rest (30%) is down to environmental factors, which can be changed. For comparison our height is 85% inherited and 15% influenced by the environment. “The control of body weight is not just about willpower, there’s a biological process going on behind it,” says Dr Yeo. The trouble is a lot of people, including some doctors, think that type 2 diabetes and obesity are a “lifestyle choice” and therefore 100% curable. This is not helpful, he says. Finding and eating food is one of our prime directives in life. Unfortunately it also means that everyone is an “expert”. “We eat every day, we buy food every day, we judge. How come she eats like that? I don’t do that. We judge people, how they look and how they behave. “If you eat more than you burn in calories, you put on weight. But biologically we are asking the wrong question. “We should be asking why people behave differently in the same

food environment. How come some people can resist eating chocolate and others can’t? “There’s got be a biological variation. If the problem lies in the physics, then education should work – ie eat less, move more, and you will lose weight. This is correct but it’s not working. “But if we ask the question: Why do some people eat more than others? Then we may get some useful information.” Dr Yeo explains how the world is getting heavier, it’s a global problem. The average BMI in 1984 was 22, but it is now 27. But some groups of people are heavier than others. For example, the Cook Islands have the highest rates of male obesity in the world at 60%. But in Bangladesh, which has the lowest rate of obesity, fewer than 1% of adults are obese. “People are behaving differently in the same [foodrich] environment because there is biological variation and that is something to be studied – a lot of the variation will be down to your genes,”says Dr Yeo. “I can’t blame a single gene on my BMI, which is 27 [overweight], there’s going to be lots of genes involved. There are

WHAT’S YOUR NUMBER?

Calculating your Body Mass Index (BMI) is one way to estimate whether you are underweight, overweight, or at a healthy weight in relation to your height. Normal weight = 18.5–24.9 Overweight = 25–29.9 Obesity = BMI of 30 or greater Another useful number to know is how much fat you store around your middle. Your health is at risk if your waist measures more than: • Men – over 94cm (about 37 inches) • Women – over 80cm (about 31.5 inches). Find out more at the Heart Foundation, which also has a useful BMI calculator, see www.heartfoundation.org.nz/wellbeing/ bmi-calculator

DESTIGMATISING DIABETES “Your genes are like a hand of poker. You can have a bad hand of genes or a good hand of genes, you can win with a bad hand although it’s more difficult.” — DR GILES YEO genes that influence waist to hip ratio, ie, where you put your fat. Other genes impact on BMI, ie, how much fat you have, others impact on the brain,” he explains. Every ethnicity will be different, depending on their biology and genes. Some people are genetically more skinny and others are more likely to be fat. Can you identify people who are not yet obese but at risk of it? No we can’t, we don’t understand the biology enough to do a personalised intervention. But you can change the environment, he says. “Your genes are like a hand

of poker. You can have a bad hand of genes or a good hand of genes, you can win with a bad hand although it’s more difficult. “I can’t run as fast as Usain Bolt but if I train I can run faster. Your genes will cap you within certain limits but with your choices you can make a difference. “I’m not trying to give anyone an excuse [to blame their obesity on their genes], I’m trying to educate people, and also let medical people know that if they can motivate someone by explaining their biology, it can help them.”

A person’s weight may be dictated by their biology but that doesn’t mean they can’t do things to reduce their risk of getting diabetes – or manage it better if they have it already. The key is still moderation, eat less and move more, says Dr Yeo. But knowing the role that genes play, people can say: ‘The reason I find it difficult to do this is because I’m fighting my biology’ rather than being made to feel guilty because they are failing or ‘being bad’ in their lifestyle choices. It’s important to remember that one size doesn’t fit all, he says. The medical profession needs to be sympathetic, not preachy, and understand that for some people it’s always going to be more difficult, says Dr Yeo. Education will work for some but not others. You are the person who knows your own body best, but what works for you may not work for others. Try one way to lose weight, eat more healthily, or do more exercise. If that doesn’t work, try something else until you find what works for you and your genes.

DIABETES WELLNESS | Winter 2017

Advocate

Celebrating longevity “We should be doing more to recognise people who don’t let diabetes get in the way of living a long and healthy life.” – DIABETES NZ CHIEF EXECUTIVE STEVE CREW

Left: Winsome Johnston (centre) has been living well with type 1 diabetes for a record-winning 82 years. PHOTO: LESLEY WEBB

iabetes New Zealand is calling on every district health board in the country to celebrate the achievements of people who successfully manage their diabetes for more than 50 years. Earlier this year Waitemata District Health Board gave out 21 awards to people who are doing a great job managing their type 1 diabetes. Each of them has been living with the condition for more than half a century. One of those receiving an award was Diabetes Auckland member Winsome Johnston, 88, New Zealand’s longest surviving diabetes patient. Win has been living with type 1 diabetes since she was six years old. Win is also New Zealand’s first recipient of the HG Wells Award from Diabetes UK. It recognises those who have lived with type 1 diabetes for more than 80 years. Only two other type 1 diabetes patients worldwide have received the award. She received her award from Health Minister Jonathan Coleman, who attended Waitemata DHB’s Living with Diabetes Awards ceremony in February.

DIABETES WELLNESS | Winter 2017

He said: “Mrs Johnston is a remarkable lady who has lived through many changes in diabetes management over the years. From the days of boiling glass syringes, animal insulins and urine glucose testing, through to the five-second blood test meters and the human insulins of today. “I’d like to congratulate Mrs Johnston. Even with modern technology such as pumps, glucose sensors and continuous glucose monitoring, type 1 diabetes requires constant discipline and attention to diet, exercise and insulin treatment. “The Government understands the toll the disease takes on people’s lives. The management of this long-term condition is a major health challenge for the country.” Diabetes NZ’s chief executive Steve Crew added his congratulations to Win, saying she was a wonderful role model for young people and a true inspiration to us all. “It’s great to see Waitemata recognising the achievement of people who are living life to the full despite having diabetes. People who manage their

diabetes well are less likely to have complications and need expensive medical care from their local DHB down the line. “I would love to see other district health boards sending out a similar positive message and honouring people who have been living with diabetes for longer than 50 years. In fact we challenge other DHBs around the country to come up with a good reason not to hold Living with Diabetes award ceremonies in their local communities!” Win says it took hard work and tenacity to stay healthy. “I used to go to the clinics and see all these people without legs and arms and things and I thought I'm never going to be like that, and that was when the determination started.” Win told Diabetes Wellness magazine in 2015 that the key to living well with diabetes was having a good support network of friends and family who understand a bit about diabetes and can help when needed. Diabetes NZ members receive a Charles Burns memorial medal when they reach the 50-years-oninsulin milestone. For details, see www.diabetes.org.nz

Care

HOW DIABETES AFFECTS OLDER ADULTS

4TH DIABETES IS THE

1 in 3

PACIFIC ADULTS AGED 45 OR OVER HAS DIABETES1

Older adults with diabetes

Are 2 times more likely to develop dementia than older adults without diabetes3

1 in 5 has vision problems3

People with diabetes over 75 years are 2 times more likely to visit the emergency room for low blood sugar than the general population with diabetes.3

1 out of 6

PEOPLE OVER THE AGE OF 65 HAS DIABETES2

LEADING CAUSE OF DEATH AMONG MĀORI MEN AND THE 5TH AMONG MĀORI WOMEN2

Complications

Adults with diabetes are nearly 2 times more likely to die from heart disease or stroke than adults without diabetes.4

About 90% of older people with diabetes have type 22

2 out of 4

Lower limb amputation rates increase significantly with age, with 95% of amputations occurring in those aged 45 and over. This rare complication affects only 0.2 percent of the diabetes population in a year.5

1 in 5 people with diabetes has kidney disease and it’s most common in older adults over 70.6

aged 45-49 of Māori, Pacific or Indian descent, living in the Auckland region, have prediabetes7

Losing weight by being active for 30 minutes a day, 5 days a week and eating less fat and fewer calories prevented or delayed type 2 diabetes most effectively in adults over the age of 60 at high risk for type 2 diabetes.8

JOIN TODAY! Diabetes New Zealand is committed to helping older people deal with the challenges of diabetes. Join today to access tailored information about diet, exercise, diabetes care PLUS a year’s free subscription to Diabetes WELLNESS magazine, see www.diabetes.org.nz. References available on request, contact editor@diabetes.org.nz.

DIABETES WELLNESS | Winter 2017

Recipes

GOODNESS IN A BOWL Here are two super soup recipes that are good for the soul as well as the body. Designed to make you feel great this winter. LATIN AMERICAN CHICKEN SOUP WITH GREENS MAKES 6 SERVINGS | PREP TIME: 15 MINUTES | COOK TIME: 25 MINUTES

There’s a misconception that in Mexican cooking the only greens used are herbs, such as coriander. In fact, gathering and consuming greens goes back centuries in Mexico. Silverbeet is a hugely popular Mexican green, and it’s the base green in this soup. This is like tortilla soup without the tortilla. It’s refreshing and invigorating and, after eating it, you’ll never think of Mexican food in quite the same way again. 2 tablespoons extra-virgin olive oil 1 brown onion, diced small Sea salt 2 carrots, peeled and diced 2 stalks celery, diced 1 red capsicum, diced 1 small jalapeño pepper, seeded and diced 2 cloves garlic, chopped ½ teaspoon ground cumin ¼ teaspoon dried oregano 1 (400g) tin diced tomatoes 1.5 litres Old-Fashioned Chicken Stock (see page 33) ½ bunch silverbeet, stemmed and thinly sliced 180g cooled and thinly sliced cooked chicken (see Cook’s Note) 2 tablespoons freshly squeezed lime juice 2 tablespoons chopped coriander, for garnish ½ avocado, diced, for garnish Polenta Croutons for garnish (optional – see page 33 for recipe)

Heat the olive oil in a soup pot over medium-high heat, then add the onion, ¼ teaspoon salt, carrots, celery, capsicum and jalapeño. Sauté the vegetables until they begin to soften, 3 to 5 minutes. Stir in the garlic, cumin and oregano. Stir in the tomatoes with their juice and ¼ teaspoon salt and cook for 1 minute. Add the stock and bring to the boil. Decrease the heat to low, cover, and simmer for 15 minutes. Stir in the silverbeet and cook until it’s just tender, about 1 more minute. Stir in the chicken, lime juice and ½ teaspoon salt. Serve garnished with the coriander, avocado and polenta croutons, or store in an airtight container in the refrigerator for up to 5 days or in the freezer for up to 3 months.

Cook’s note: If you don’t have leftover chicken on hand, you can quickly poach two skinless, boneless breasts. The following method produces a delicate result by infusing the flavour of the stock liquid into the chicken. Season the breasts with salt and pepper. In a straight-sided frying pan, bring 750 ml of stock to the boil over high heat. Add the chicken, cover, and decrease the heat to low. The liquid should be just below boiling point, with its surface barely quivering. Cook for 15 minutes, then remove the chicken from the poaching liquid and let cool. Recipes extracted from Clean Soups by Rebecca Katz. Photography by Eva Kolenko. RRP$39.99. Published by Murdoch Books.

DIABETES WELLNESS | Winter 2017

LOW

CALORIE SWEETENER Measures spoon-for- spoon like sugar

SWEET PEA AND MINT SOUP MAKES 6 SERVINGS | PREP TIME: 10 MINUTES | COOK TIME: 15 MINUTES

This is my riff on a French classic, minus the cream. Green peas and mint naturally complement each other with their delightfully delicate, fresh flavours. I amplify the peas’ taste – and nutritional content – by adding pea shoots to the sauté. As for texture, the sautéed butter lettuce counterbalances the mealiness of the peas, making for a smooth consistency. Heat the olive oil in a soup pot over medium heat, then add the leek, a pinch of salt and the pepper and sauté until translucent, about 5 minutes. Stir in the peas and the lettuce and another pinch of salt. Pour in 125 ml of the stock to deglaze the pot, stirring to loosen any bits stuck to the bottom, and cook until the liquid is reduced by half. Remove from the heat. Pour one-third of the remaining stock into a blender, add one-third of the vegetable mixture, one-third of the pea sprouts and the mint. Blend until smooth. Transfer to a soup pot over low heat. Divide the remaining stock in half and repeat the process two more times. Stir in the lemon juice and ½ teaspoon salt. Taste; you may want to add an additional squeeze of lemon and a couple of pinches of salt. Serve garnished with the yoghurt, pea shoots and a bit of mint, or store in an airtight container in the refrigerator for up to 5 days or in the freezer for up to 3 months.

A bowl of soup has the wonderful ability to nourish and heal the body. From bestselling author Rebecca Katz comes this collection of 60 recipes for pure, cleansing soups intended to renew and restore. In Clean Soups, Rebecca shows you how to use wholesome stocks and soups to naturally detox and stay energised yearround. Try her recipes and see how one simple bowl can make a huge difference in how you feel. Clean Soups by Rebecca Katz, published by Murdoch Books, RRP$39.99

2 tablespoons extra-virgin olive oil 1 large leek, white part only, rinsed and chopped Sea salt ¼ teaspoon freshly ground black pepper 300g frozen peas, defrosted, or 465g freshly shelled peas 1 small head butter lettuce, torn into pieces 1 cup pea sprouts 2 tablespoons coarsely chopped mint, plus more for garnish 1.5 litres Old-Fashioned Chicken Stock (see page 33) 1 tablespoon freshly squeezed lemon juice, plus more if needed 6 tablespoons full-fat plain yoghurt, for garnish Pea shoots, for garnish (optional)

Perfect to use in your favourite food or drink recipes. Add a delicious, sweet taste with fewer calories.

For delicious recipes, visit

club

.co.nz

Families

Race to

WIN Harry Winmill has just competed in his first triathlon aged seven. He’s come a long way since being diagnosed just three years ago, as mum Corrin explains.

THE DIAGNOSIS

Harry was four years old when he was diagnosed in March 2014. My sister-in-law made a passing comment that she noticed Harry was looking quite skinny but we hadn’t really noticed. What we did notice was the extreme thirst for a couple of months, he was constantly drinking water every time he walked past a tap! I was teaching on the day Harry was diagnosed. I received a call from his daycare saying Harry wasn’t feeling very good. He was lying on the couch when I arrived with no energy so I took him to the GP. They ordered us to get blood tests that day. We went

home and got the phone call at 5.30pm. The doctor said to us “the blood test shows your son has diabetes, an ambulance is on its way!” It was a very emotional and frightening night. We were greeted at Dunedin Hospital’s Emergency Department by a doctor friend of mine, which made a big difference in a scary and foreign situation. The team of doctors and nurses in the children’s ward were fantastic. Harry and I ended up staying in hospital for about six nights and Matt (Harry’s dad) or Granny came down every day from Oamaru with our other son Hunter to visit. Starting the final leg: Harry (left) completed the entire race without stopping – a 50m swim, 4km bike and 1.5km run.

Seven-year-old Harry Winmill completed his first triathlon in March, three years after diagnosis.

DIABETES WELLNESS | Winter 2017

Harry in hospital when he was diagnosed in March 2014 aged four years old.

Harry with mum Corrin, dad Matt, brother Hunter and sister Hollie

Harry has always coped really well. At the start I was often chasing around the house trying to give him an insulin injection. Not that he was scared, we just had to try and keep him still in one place long enough to give him his dose. Harry has always been a good eater so keeping up with his food intake has always been a challenge! Harry turned five years old on 5 December 2014 and two weeks before his birthday we were lucky enough for him to be put onto an insulin pump. The pump has been really good in terms of allowing us to keep up with his eating habits and a lot less invasive than the injections. THE TRIATHLON

Harry’s friend from school signed up for the triathlon a few months ago and we just thought we’d give it a go too. Mosgiel was a wee way from home so it was a quite a big effort to travel down to Dunedin the day before, stay the night with our friends, and then check in before 8am on the Sunday morning. On the day it was quite difficult getting Harry’s blood sugar

reading right before the race. I usually aim for his blood glucose to be about 10 before sport. The kids’ breakfast was at 8am when his race was to start at 10. The kids were given Weetbix, yoghurt and fruit salad which is a high carb meal. By 10am he was hungry again as we walked past a food tent so we let him have another snack. So by the time he started his race he probably had too much insulin on board which put me slightly on edge as the risk of going low is always in the back of my mind. I had notified the organising team that he had diabetes but really there was no action plan in place. He wore his blue wristband and I assumed there was a medical team there in case of any emergencies. I tried not to think of worst-case scenarios. We have been lucky so far not to return to hospital for any diabetes reasons but I suppose you just keep on living life and deal with anything that comes up. Harry had a great time at the triathlon and was pretty stoked at doing the whole thing without stopping. Matt and I are really proud of him! I think we will back again next year.

A gift of a lifetime Every day, an average of 40 New Zealanders are diagnosed with diabetes. A gift in your will is a powerful legacy to ensure your desire to help and support people with diabetes lives on. No matter how big or small, your bequest will make a world of difference in helping Diabetes New Zealand to support the 257,000 New Zealanders with diabetes to live full and active lives.

For a confidential discussion, please contact Sue Brewster sue@diabetes.org.nz 027 569 7777

Care

THE BIG

SNORE Sleep apnoea affects more than 24,000 New Zealanders. Rose Miller explains this common condition that can have major implications for health.

noring may be the butt of many a joke, but for a lot of New Zealanders it’s no laughing matter. And it’s not just a problem for those who have to listen to the noise – snoring can have serious implications for the snorer’s wellbeing, too. Snoring is a key symptom of obstructive sleep apnoea (OSA), a chronic and progressive sleep disorder with potentially serious health consequences. During deep sleep the muscles in our throats relax. For someone with OSA, the muscles become so relaxed that part of the airway is closed off and the person stops breathing. The level of oxygen in the blood drops, and the sleeper will choke and gasp

DIABETES WELLNESS | Winter 2017

then wake up for a moment and begin to breathe again, quickly falling back to sleep and rarely remembering waking. This can happen hundreds of times a night, and the moments without oxygen might last up to or over one minute. A person with OSA may often have no idea they have a problem – a family member or bed partner might be the first to notice signs of sleep apnoea. They may still feel sleepy when they wake, and have a headache and dry throat. Daytime sleepiness is one of the most common symptoms and sufferers may often need to take daytime naps. Someone with OSA may also experience problems with their memory, may feel grumpy and irritable, have mood changes, morning headaches, and have difficulty concentrating. They could have chronic exhaustion and lose interest in sex. Some of these symptoms can be put down to other causes, such as stress, which is why OSA can often be missed. OSA affects about 9% of men, 4% of women, and 3% of children

between 2 and 12 years of age in the general population. OSA is most common in men over 50. It is more common if a person is overweight.Excess weight on the outside of the throat increases pressure on the inside of the throat, which narrows the airway. That being said, while being overweight is commonly associated with OSA, up to 20% or more who have been diagnosed with OSA are not overweight. Other risk factors include alcohol, and taking tranquillisers or sleeping tablets. Left untreated, sleep apnoea has been linked to high blood pressure, heart disease, stroke, memory loss, obesity, and insulin resistance, a precursor to type 2 diabetes. The good news is that successful treatment (see panel) may reduce the risks of these ailments. What is less well known is the possible association between OSA and type 1 diabetes. OSA is prevalent in those with type 1, but more studies are necessary to understand the link.

THE LINK WITH TYPE 2 DIABETES The International Diabetes Federation (IDF) wants to raise awareness of the association between sleep apnoea and type 2 diabetes. One in five people with type 2 diabetes are thought to have OSA and up to half may have some form of sleep breathing disorder. Overweight and obesity may play a role, but some recent studies show an association between the two conditions that is independent of overweight/obesity. OSA may also affect glycaemic control in people with type 2 diabetes. The IDF is calling for further research into the links between the two conditions and urging healthcare professionals to adopt new clinical practices to ensure that a person with OSA is considered for diabetes and vice versa. For more details, see www.IDF.org.

TREATMENT

Lifestyle changes will be recommended for milder OSA cases. The most significant thing you can do is to try and lose weight – even a small loss can improve symptoms. Other recommendations include avoiding alcohol for at least a few hours prior to going to sleep. Don’t use sleeping tablets or tranquillisers, and try to sleep on your side rather than on your back. A specially designed dental appliance or device can help to hold the jaw and tongue in a particular position to help maintain an open airway. These need to be fitted by a specialist dentist or orthodontist and are most effective in cases of mild OSA. Continuous positive airway pressure (CPAP) is the most common treatment for OSA. It involves the use of a pump that delivers low-pressure air into the airways via a mask fitted to the nose. It is worn during sleep and delivers enough pressure to keep the airway open. Surgery may be an option to address specific abnormalities that contribute to the airways obstruction, for example removing tonsils and adenoids, correcting abnormalities in the nasal passages, and removing excess tissue from the back of the throat or tongue. Surgery for OSA, though, is rarely performed.

Sleep apnoea and me I had been feeling really sleepy during the day along with having other OSA symptoms. A friend with OSA suggested I talk to my GP about getting a sleep study done. My GP referred me to a sleep clinic and an OSA evaluation. The study was done at my home and involved a sleep specialist wiring me up to a small wearable monitor with about 30 leads. It’s painless but a bit uncomfortable. Off I went to bed, and in the morning the specialist came back to remove the leads, with the data from my night’s sleep captured on the monitor. The next stage was discussing the results of my test with the specialist. You can be diagnosed with mild, moderate, or severe OSA, based on the number of times an hour that you stop breathing (apnoea) or how reduced airflow is to your lungs (hypopnea). I was diagnosed with moderate OSA and we discussed treatment options suitable to my lifestyle and diagnosis. I opted for weight loss and an oral device. Since then I’ve lost around 10kg, and there have been definite improvements in my OSA. My mouth device has really helped reduce my snoring and improve the quality of my sleep. I’m less tired during the day, and I am continuing on the weight loss journey. – Rose Miller

If you think you might have symptoms of sleep apnoea, see your GP. DIABETES WELLNESS | Winter 2017

Move

EXERCISE & AGEING What happens to our bodies as we age? Craig Wise offers some advice on staying active in middle age and in our senior years.

e tend to slow down as we get older for a number of reasons including ill health, weight, balance issues or chronic pain. If we are lucky, becoming a senior means more focus on lifestyle and enjoying the finer things in life rather than coping with the stresses of a 9-5 work day and/or bringing up young children. So I reckon it’s important to ensure we have the ability to get the most out of it – after all life is for living. There have been a number of studies, many in Scandinavia, that show physical activity to be the number 1 contributor to a long life – even if you don’t start to become physically active until the later years. Physical activity will not only add years to your life – it can also

DIABETES WELLNESS | Winter 2017

add life to your years. It is more fun to be playing with children and grandchildren than just sitting and watching them play. Plus the memories it creates for them are priceless. It also sets an good example, especially as our lives become more sedentary. As you age the decision to become physically active can be one of the best and most important healthy choices you can make but it’s important to do it safely. The same activity guidelines apply for older adults as they do for anyone – 150 minutes a week of moderate activity is recommended. Moderate activity means increased breathing but still being able to hold a conversation. But guidelines are guidelines, and anything is better than nothing. A lady in her 80s regularly passes one of my 50-year-old clients when he is out walking. She told him she only took up walking after her husband passed away at the age of 63. She walks just over 7km every day and feels as strong as an ox! ACTIVITY AT 40

This is the time when the major physiological changes happen in our bodies – gravity catches up with us, our metabolism slows, lean muscle decreases and fat increases. For women, there are also the added hormonal changes to factor in. This is the age that resistance

training becomes crucial. Previously cardiovascular activity may have been enough but now it’s no longer the case, while still important it is now about slowing down the loss of muscle mass and strength – weakening muscles in your 40s can spell disaster in the future. Resistance (weight) training three times a week is the ideal, covering the whole body. Physical activity at this age sets a good platform for the future, because by now those aches and pains have begun to appear. When being active, especially with the resistance training, concentrate on the quality not the quantity. Learning to do it right now will pay off in the future. ACTIVITY AT 50

In our 50s any loss of muscle mass and toning begins to really show. Often, early signs are a change in your posture. It is at this age that we see the classic signs of shoulder slump from years of driving a desk. Incorporating yoga, tai chi or dance into your physical activity each week is great for balance, and as we age the stability these disciplines give us becomes increasingly important. Dancing is also a good cardio activity – two birds with one stone, as my Nan used to say. It also important to concentrate on functional exercise, exercises that mimic tasks we perform on a regular basis. For example, doing squats will help you stand up and

sit down in later life and deadlifts (lifting a weight from the ground to your waist) are a movement that mimics picking up children/ grandchildren or bags of shopping. ACTIVITY AT 60+

In our 60s we tend to find those mid-life niggles have fully developed into diagnosable issues, such as arthritis or joint issues. But these aches and pains shouldn’t be seen as a viable reason to stop exercising – or even a reason not to start. As long as they are well managed, you can still exercise and you may find doing more activity will relieve some symptoms. Maintaining flexibility into our senior years, coupled with strong bones and muscles, is seen as a key to injury prevention. By the time that we are into the 60+ age group a significant amount of bone density reduction has occurred and, especially in women, we see a lot of osteoporosis. And don’t forget men get osteoposis too. Even if you aren’t active in your 60s or 70s, it’s never too late to make inroads towards prevention. Resistance training increases bone density and, coupled with a good stretching routine, can help to overcome such issues, even for those well into their 70s. You are never too old to start exercising. I regularly line up against 70 and 80 year olds at the start of half-marathons and local fun runs. Running might not be your goal but it can be your inspiration.

Getting going TIP 1

TIP 2

TIP 3

TIP 4

PLAN AHEAD Stop and have a look at yourself and your current situation and consider any health concerns before you start on a new fitness activity. People with diabetes may need to adjust timing of medications or meals. It may be necessary to adjust your medication. A chat with your health professional is always a good place to get advice.

START SLOWLY When you do start, begin slowly and build up, especially if you haven’t been physically active for a while, or if you are beginning an activity that you haven’t done before.

EXERCISE WITH A FRIEND: Many people find that getting support by being active with family or friends means they get more out of their active time because they can motivate and encourage each other.

LISTEN TO YOUR BODY: Physical activity should never make you feel pain or cause dizziness. If you find that you are regularly experiencing pain or discomfort after physical activity (especially in the joints or chest) you may need to reconsider your activity choice or seek advice from a medical or fitness professional.

As with starting all physical activities, especially if you have a chronic issue such as diabetes or hypertension, it is a good idea to chat with your health professional about what is right for you.

DIABETES WELLNESS | Winter 2017

Technology

NIGHTSCOUT 101 Carla Adlington looks at the Nightscout project and explains how it has transformed her diabetes management.

fter following months of online chatter about the “Nightscout Project”, I still didn’t really understand what it was. A blood glucose sensor that connects to a transmitter that connects to the Cloud that connects to your smartphone that connects to a smartwatch that connects to… huh? It sounded complex and expensive because you have to understand a bit about electronics and there’s a cost for the smart bits of kit. However, with the help of online step-by-step instructions and support from my “type 3” who loves new gadgets, I’m set up with blood glucose monitoring that anyone can see, anytime.

DIABETES WELLNESS | Winter 2017

WHAT IS THE NIGHTSCOUT PROJECT?

Nightscout (CGM in the Cloud) is an open source, DIY project that allows real-time access to continuous glucose monitor (CGM) data via a personal website, smartwatch viewers, or special apps available for smartphones. It was developed by parents of children with type 1 diabetes and has continued to be developed, maintained, and supported by volunteers. When first implemented, Nightscout was a solution specifically for remote monitoring of Dexcom G4 CGM data. Today, there are Nightscout solutions available for Dexcom G4, Dexcom Share with Android, Dexcom Share/G5 with iOS, Medtronic, and Freestyle Libre. HOW DOES IT WORK?

A small sensor measures blood glucose levels under your skin. A transmitter attached to that sensor sends data wirelessly to a receiver, which transmits the data to a smartphone. The smartphone with Nightscout software downloads the data and transmits

it to the Cloud (a shareable web-based server), where it can be accessed for viewing on a smartwatch, laptop, tablet, or other smartphones. HOW DO YOU GET SET UP?

The first step is to decide which continuous glucose monitor (CGM) system you’d like to use. The big three at the moment are the Dexcom G4 or G5, Medtronic Enlite, and Abbott Libre (the Libre is technically not a CGM on its own, as it can only pick up readings when you scan it, but there are options to link it to be continuous). The system can be complex to set up – it takes anywhere from 30 minutes to several hours – but members in the CGM in the Cloud group are always willing to provide assistance. The Nightscout website provides all the information needed to set CGM in the Cloud up, depending on which CGM system you’re using. The extra hardware pieces can be sourced online, and you’ll need to learn a little bit about how to solder which is easy to pick up from online videos.

Continued from page 27

WHY IS SENDING DATA TO THE CLOUD IMPORTANT?

It makes CGM data available not just to the person holding the CGM receiver, but to anyone who has access to the Cloud. Blood glucose data can be picked up from a receiver in Auckland and viewed by a partner in Queenstown, or from a child’s receiver at a sleepover to a parent’s tablet 10 kilometres away. The ability to monitor remotely takes away the guesswork and provides assurance, “a safety net” for people in your support system, parents, relatives, children, friends etc. It’s also a really useful tool for medical teams to check in and assist with adjustments. For me, being able to look at my watch or phone to check my levels as I go through my day is life changing – after years of having to finger prick or carry around a receiver! WHAT ELSE IS COOL ABOUT IT?

CGM in the Cloud is also an inspiring story of patient advocacy. Nightscout is the work of families balancing diabetes who took technology development into their own hands to improve care; bypassing the sometimes slow processes in government and industry that can delay innovation. The organisation isn’t about money, it’s about helping others with diabetes. While the system has its drawbacks (it is technology after all!), the group’s mission is definitely worth recognition. Having diabetes is not a choice but we can choose the tools we use to manage it and, personally, I’m grateful to have options. For more information, see www.nightscout.info

Disclaimer: Information in this article is for informational purposes only and is not intended to replace advice from your health professional. According to Nightscout’s website, people shouldn’t use any information or code to make medical decisions.

OLD-FASHIONED CHICKEN STOCK MAKES ABOUT 6 LITRES | PREP TIME: 10 MINUTES | COOK TIME: 3 HOURS

Some things you learn at your father’s knee. But chicken stock? I learned that at my mother’s elbow, watching from my perch on the yellow Formica kitchen benchtop as she recreated her Nana’s chicken stock note by note. Onions, carrots, celery, chicken… it’s country-style, old-time comfort in a pot. I can’t think of a better way to get vital nutrients, with a flavour that will leave you longing for more. 3kg organic chicken backs, necks, bones and wings 2 unpeeled white onions, quartered 4 unpeeled large carrots, cut in thirds 2 stalks celery, cut in thirds 6 sprigs thyme 4 unpeeled cloves garlic, halved 1 large bunch flat-leaf parsley 1 bay leaf 8 black peppercorns 8 litres cold, filtered water, plus more if needed Sea salt

POLENTA CROUTONS MAKES 250 G | PREP TIME: 10 MINUTES | COOK TIME: 25 MINUTES

250g ready-to-serve polenta, cut into 1cm cubes 2 teaspoons extra-virgin olive oil 1 teaspoon sea salt ½ teaspoon freshly ground pepper Herbs, such as parsley, thyme or rosemary (optional), finely chopped Bread croutons are so yesterday, but these are a fantastic update, especially if you can’t eat gluten and are normally crouton-deprived. In the old days, I used to stand by the stove stirring polenta forever. Now it’s so much easier, as precooked polenta blocks are available in many supermarkets. Cube ’em;

Rinse all of the vegetables well. In a 12-litre or larger stockpot, combine the chicken, onions, carrots, celery, thyme, garlic, parsley, bay leaf and peppercorns. Add the water, cover and cook over mediumhigh heat until the water comes to a boil. Decrease the heat so the bubbles just break the surface of the liquid. Skim off the scum and fat that have risen to the surface. Simmer, partially covered, for about 3 hours. Add more water if the vegetables begin to peek out. Strain the stock through a finemesh sieve or colander lined with unbleached muslin into a clean pot or heat-resistant bowl, then stir in salt to taste. Bring to room temperature, then store in an airtight container in the refrigerator. Skim off as much fat as you can from the top of the broth, then portion into airtight containers. Store in the refrigerator for up to 5 days or in the freezer for up to 6 months. Cook’s note: The stock will cool faster in smaller containers. Make sure it’s refrigerated within 4 hours of cooking. add olive oil, salt and spices; and toss – then bake. In 25 minutes you have croutons. Best of all, you can make a lot because they freeze and reheat well. Preheat the oven to 200°C. Line a rimmed baking tray with baking paper. In a bowl, toss all of the ingredients together until the polenta is well coated. Spread the polenta cubes on the prepared baking tray, making sure they aren’t touching. Bake for 25 minutes or until golden brown and crisp on the outside. Store in an airtight container in the refrigerator for up to 3 days or in the freezer for up to 1 month.

DIABETES WELLNESS | Winter 2017

Eat

Our nutrition expert Helen Gibbs explains the best breakfast options for better health.

What’s for breakfast?

often get asked about the importance of breakfast for nutrition and weight loss. People get confused because there is conflicting research about what foods make the best breakfast and even whether you should eat breakfast at all. Professionally I’m a fan of eating a breakfast that enhances the nutritional quality of the whole day’s eating – that means eating a healthy morning meal. Research shows that the majority of people who have successfully lost weight eat breakfast most days per week. Breakfast needs to be big enough so you are less likely to make poor choices mid morning or midday, because you are hungry. If you struggle with eating breakfast, it can help to think about it as “breaking the fast” when you and your body feel ready.

If you can’t eat first thing in the morning, I suggest taking an appropriate choice for breakfast to your workplace and eating it just before you start work or mid morning. However if you are taking insulin, or sulphonylureas (such as gliclazide or glipizide) in the morning, you will need to time breakfast to reduce your risk of hypoglycaemia. Historically breakfast would have been leftovers supplemented with a “pease-pudding” – a thick-grain porridge. Our forefathers were onto it, this would have been a pretty healthy start to the morning. Latest research suggests breakfast should have some wholegrain starchy food, plus protein, and at least one serving of vegetables or fruit. Eating 90g of whole grains a day reduces the risk of a whole range of lifestyle diseases, according to recent studies.

The simplest way to get the 90g a day is to ensure that you have 30-45 g of wholegrain cereal food at breakfast time. Rolled oats are a wholegrain. A serving of porridge also gives you 12% of an adult’s recommended daily protein intake. Add some low-fat natural yoghurt and a serve of fruit and you have a healthy breakfast. I recommend making porridge from scratch, it’s quick, cheap and healthy because you control how much sugar and fruit is in it. Shop-bought granola, muesli, and instant porridge sachets can be packed with hidden sugars. However there are some lowsugar muesli options coming onto the market (see our story overleaf). Weetbix is 97% wholegrain, this means that just 3% of the ingredients are not from a wholegrain. It’s low in sugar and salt but has less protein per serve

Recipe for a healthy breakfast A portion of wholegrain starchy food + protein + at least one serving of vegetables or fruit.

+ WHOLEGRAIN

DIABETES WELLNESS | Winter 2017

+ PROTEIN

VEG/FRUIT

than porridge. Add some low-fat natural yoghurt and fruit for a balanced start to the day. It may take you several weeks, but if you can get used to fruit being your source of sweetness on your cereal, you are reducing your free-sugar intake and increasing your healthy fruit servings. Good quality wholegrain bread – dense grainy bread rather than the white bread with bits in it – is another good breakfast option. Two slices will give you around 30g of whole grains. Then add some protein. One of the big recent changes in nutrition is the acceptability of eggs. People with diabetes can now have six to seven eggs a week – that’s up to one a day. Other good protein options include baked beans (reduced sugar and salt is good but not vital), 30g of cheese, or 125g of a reduced-fat natural yogurt. Adding vegetables, for example tomatoes, mushrooms, or leftover vegetables from the night before, is a great way to help us meet our recommended five veges a day. Try two slices of wholegrain bread with sliced avocado and cherry tomatoes and a drizzle of lemon juice and good quality olive oil for a delicious healthy breakfast. Many people ask me if smoothies are an OK start to the day. Smoothies are fine if they fit the protein + wholegrain + fruit/vege recommendations above. For example, if you make your smoothie with 1 serve of fruit (80-100g), 125ml reduced fat yoghurt (or 200ml milk) and 30g of oats, you have a nicely balanced start to the day. You could also try chia seeds to replace some or all of the oats, but smoothies made with grains will thicken on standing, so you may need a spoon! Finally, try writing a daily roster of healthy family breakfasts and stick it on the fridge. For example, porridge on Monday, baked beans on toast on Tuesday, and so on. Then everyone in the family knows what’s coming each day, there will be fewer arguments, and your kids or partner might even make breakfast for you. A fine way to start the day!

Profile

Clare Robinson couldn’t find a healthy low-sugar breakfast cereal so she started making her own.

THE MAKING OF

MUESLI W

“Not everyone has the time or wants to make their own breakfast cereals. After 20 years working in the food industry, I decided to take the plunge and take my creations to the market.”

DIABETES WELLNESS | Winter 2017

ith more homegrown foodie enterprises taking off around the country, Clare Robinson’s boutique muesli business is part of New Zealand’s growing “real food” movement. Before setting up Te Atatu Toasted, Clare worked as a production operations manager, and in quality control and training roles, for some of New Zealand’s biggest food manufacturers, including Fonterra, Tegel Foods and Hansells NZ. But in 2012, Clare decided to strike out on her own and started making and selling healthy breakfast cereals. “I could see food manufacturing becoming more processed and food becoming more refined and full of low nutritional ingredients – which is bad news for the future of our health. I thought there was a gap for breakfast cereals that contained only real ingredients such as whole seeds, nuts and grains and were flavoured with just a little sweetness from Hawke’s Bay apples and King Country honey. “I had been making my own breakfast cereal for years – mostly out of being unable to find an everyday muesli I liked made from just great ingredients and nothing else,” she explains.

“Not everyone has the time or wants to make their own breakfast cereals. After 20 years working in the food industry, I decided to take the plunge and take my creations to the market.” Clare, whose business is based in Auckland, says she wants to help people make and eat real food that’s delicious and nutritious. “Cereals are often bulked out with low nutritional ingredients like highly refined barley, wheat, rice and corn and have high levels of salt and sugar. We can easily chomp our way through four teaspoons (20g) of sugar at breakfast and that is just the cereal – no toppings – and still be hungry by mid morning! “I have spent a great deal of time and completed a lot of research developing my cereals. I want to make breakfast cereals that are wholesome, with every ingredient only in them for a beneficial reason. But above all they also need to taste delicious. “When you eat food made only with good ingredients, you need less of it to be satisfied – so it’s great for optimum health and weight control. We give a free 50gm portion spoon with all new orders so people know how much to eat.”

BREAKFAST IN A JAR

TOASTED OAT CAKES

This healthy, low-sugar recipe creates a delicious bircher-style muesli breakfast.

These are delicious on their own or with cheeses and chutneys.

1/3 cup (50g) Te Atatu Toasted Healthy Blend cereal 1/3 cup (50g) kiwifruit, chopped* 1/3 cup (80g) plain unsweetened yoghurt 1/3 cup (80g) milk (we used light blue) Place everything (cereal, chopped up kiwifruit, yoghurt and milk) in a jar (350ml approx) Close the lid tightly and give it a good shake to mix everything together. Place in the fridge, ready for brekkie in the morning. In the morning, pour into a bowl. Garnish with extra pieces of kiwifruit if desired.

*You can substitute with the same amount of other fruit depending on the season.

MAKES APPROX 25

180g Te Atatu Toasted Healthy Blend cereal 50g plain flour ½ tsp salt 1 tsp baking powder 65g butter ¼ cup milk – approx. Combine all dry ingredients in a food processor and blitz for a minute, then add the butter and blitz again until well mixed. Add the milk as you mix until it starts to get sticky and almost forms a ball. If it gets too sticky, simply sprinkle with more flour when rolling out. Roll out very thin on a well-floured surface, then use a biscuit cutter to cut the shapes. Place on a cooking tray. Bake at 180°C fan-bake for 15 minutes. Alternatively, roll straight out onto a well-floured baking tray and then use a knife to score vertically then horizontally to make a grid of biscuits and cook it straight in the oven like this. The biscuits perhaps don’t look as good as ones cut with a cutter – but they taste just as nice and it is a lot easier!

SPECIAL READER OFFER Te Atatu Toasted is a wholefood cereal range, made in New Zealand with only natural ingredients. The company’s Healthy Blend Muesli is 97% sugar free and contains no refined sugar. It is also very low in salt. Readers can get 20 per cent off their first order of any Te Atatu Toasted Healthy Blend Muesli purchased from www.teatatutoasted.co.nz. The offer is available for casual purchases or our great-value monthly subscriptions Just enter the discount code HEALTHYME at the checkout. Offer expires 31 August 2017.

DIABETES WELLNESS | Winter 2017

Ruby’s world

Ruby McGill learns that life with a newborn baby is not always straightforward.

BREASTFEEDING & BASAL RATES Baby or not, managing your diabetes can be as unpredictable as New Zealand’s weather.

djusting to life with a new baby can be exhausting at the best of times – throw a type 1 breastfeeding mother into the mix and the game becomes even more gruelling. I’d spent nine months fine tuning my blood glucose levels with the Hutt Hospital diabetes team to ensure our newest family member, Felix, arrived safe and healthy. My insulin requirements increased during my pregnancy but as I held our little man for the first time, they dropped drastically. We were prepared and reduced my carbohydrate ratios, basal rates and insulin sensitivity factor. I thought I was one step ahead. I was wrong. I woke in the middle of the night sweating and convinced I had squashed my baby, even though I could see him fast asleep in the crib next to me. Why was I wide awake? Why did my body feel so heavy? Why was I scared?

The penny finally dropped – my blood sugars were low (2.4 mmol/L – 43 mg/dL). Okay diabetes you won this round. The next morning we tweaked my medication again. I couldn’t be discharged from hospital until my blood sugars were under control. Four days after our little man was born I was sent home. Now the fun begins! With a bit of forward planning and insulin adjustments, people with T1 can navigate their way through most things unscathed, but breastfeeding introduces a set of different challenges. Feeding a new baby, ondemand, is so unpredictable it was almost impossible to avoid a drop in blood sugar levels after each feed. Surviving on broken sleep, caring for a new baby, and being smashed by constant daily hypos was a recipe for disaster. I had to do something. The Freestyle Libre glucose monitor from Australia was invaluable because I was testing a lot! Using the Libre I was able to test my blood sugars while carrying a crying, wriggly baby by simply swiping the reader across the sensor in my arm. When our little man slept, which didn’t happen all that often in the early months, or in the evening when my husband was

home, I’d prepare and carb count a variety of snacks to get me through each feed. With the swipe of my sensor I knew my blood sugar levels, and with a little trial and error (like so many things diabetes related) I knew what kind of snack I needed to combat the expected drop in sugars. Sometimes I got this wrong and would reach for more food or correct with extra insulin. During these first few months I was mentally prepared to run my blood sugars a little higher than normal to avoid going hypo. My go-to snacks included: 150g fresh cut strawberries = 6g carbs, 1 x pot of Fresh ’n Fruity Lite yoghurt = 7-8 g carbs, 4 x crackers with cheese = 15g carbs, juice box: Small = 18g carbs, Large = 26g carbs. Before I knew it, our little man was three months old and we had found our rhythm. I could predict when he would sleep and feed (as much as that’s possible with a baby). Breastfeeding no longer knocked me around and the hypos settled down. My premade, carb-counted snacks remain within arm’s length, because baby or not, people living with diabetes know managing it can be as unpredictable as New Zealand’s weather.

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

DIABETES WELLNESS | Winter 2017

Helping to Manage Your Diabetes

Diabetes Care

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Sharps Containers Available in a range of sizes.

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Diabete-ezy™ Test Wipes

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Glucose Gel & Tablets

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0800 106 100 | info@mediray.co.nz Shop online at www.mediray.co.nz Always read the label and follow the manufacturer’s instructions.

Taps no. CH3147

NEW. THE METER THAT TALKS!

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

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

Uses funded CareSens N Test strips

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

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