Autumn 2022 $6.95
A Diabetes WA Member Magazine
MOVING
LIVING WITH
covid
EATING
well
If you’ve got it, we get it
well
From the Editor
member magazine! Welcome to the autumn edition of your e just experienced in After the record-breaking summer we'v remember what cooler Western Australia, it can be hard to – days grow shorter, weather is like. But as the – still warm like no other. it's clear this is going to be an autumn s are on the rise across At the time of writing, COVID-19 case lly as some feared, atica dram as our state, although not yet know that living with We . virus as we adjust to living with the those already living for erns conc COVID presents particular cated this issue dedi e we'v on, with diabetes. For that reas ID and the risk it COV nd arou ce to exploring the latest scien etes. diab 2 type or 1 presents to those with type ad about their We speak to experts at home and abro ider how to best experiences dealing with COVID, cons answer some of the big prepare for being exposed to it, and mnists also look at how questions around the virus. Our colu immunity. diet and exercise can help boost our . Life goes on, even if Of course, it's not all about the pandemic next few months. Inside things will look a bit different for the of recipes, advice from mix l usua this mag, you'll also find the ber stories. As mem and res our educators, lifestyle featu – no matter yone ever for g always, I hope there's somethin be. what your own story might e colourful than it has in You'll notice this issue looks a bit mor to design and I'm very the past. We're taking a new approach too! excited by the results. I hope you are Happy reading! Myke
Contents From the Chair ..................................................................... 1 Your Voice/Our Actions ................................................. 2 Talking Science Can the Mediterranean diet prevent diabetes?................ 3 Can blood pressure medication reduce your risk?......... 4
From the Cover Living with COVID (and diabetes).......................................... 5 COVID & diabetes: what do we know?................................ 6 COVID & kids with diabetes..................................................... 8 COVID in the UK........................................................................ 10 The big questions..................................................................... 12
On the Line ............................................................................ 14 Workshop Calendar Webinars update...................................................................... 16
Living Well Editor Myke Bartlett Editorial & Advertising Enquiries Diabetes WA, PO Box 1699, Subiaco, WA, 6904 Phone 1300 001 880 Email media@diabeteswa.com.au Editorial submissions should be sent to Diabetes WA, care of the above address. All care will be taken with contributions however no liability for loss or damage to unsolicited materials will be accepted. Disclaimer The opinions expressed in articles and the claims made in advertising materials presented in Diabetes Matters are those of the authors and the advertisers respectively, and do not necessarily reflect the view of Diabetes WA, unless stated. The information provided is for the purposes of general information and is not meant to substitute the independent medical judgment of a health professional regarding specific and individualised treatment options for a specific medical condition. No responsibility is accepted by Diabetes WA or their agents for the accuracy of information contained in the text or advertisements and readers should rely on their own enquiries prior to making any decisions regarding their own health. Thanks to Diabetic Living magazine. Contributors Denise Brownsdon, Natalie Jetta, Marian Brennan, Narelle Lampard, Jessica Weiss. Photography DWA staff, Shutterstock. Design Diabetes WA – Subiaco Office Paul Dubczuk, The Marketing Mix. Level 3, 322 Hay Street, Subiaco WA 6008 Print Postal Address: Vanguard Press PO Box 1699, Subiaco WA 6904 Diabetes WA Diabetes WA – Belmont Office diabeteswa.com.au 172 Campbell Street, Belmont WA 6104 Diabetes Helpline: 1300 001 880 Postal Address: PO Box 726, Belmont WA 6984 Email: info@diabeteswa.com.au
Ethical investment................................................................... 18
Moving Well An active defence.................................................................... 20
Eating Well Eating for immunity................................................................ 22
Diabetic Living recipes ................................................ 24 Aboriginal Voice ............................................................... 28 Take A Hike .......................................................................... 30 Members' Area Staying in ................................................................................... 31 Member story .......................................................................... 32 Member Benefit Partners .................................................... 33
2022-19957
AUTUMN 2022
FROM THE CHAIR
INTO THE UNKNOWN As we head into 2022, it seems clear this will be another year of uncertainty as COVID well and truly arrives in Western Australia, writes Diabetes WA chair MARY ANNE STEPHENS. Our latest issue of Diabetes Matters is designed to help West Australians with diabetes adjust to living with COVID. I write this as daily case numbers are beginning to spike ahead of the borders fully re-opening in early March. While the state government has been preparing for the next phase of the pandemic, we have been working with our health partners throughout WA and learning from our national and international counterparts about the best way to handle the transition both for our organisation and our members. This edition is full of tips and expert advice that, I hope, will ease what looks like being a very difficult few months for the diabetes community – and Western Australia more broadly. Right now, supporting our community is front of mind for us here at Diabetes WA and we want you to know that we have a range of support options available for you. Our helpline – 1300 001 880 – should be your first port of call for any diabetes-related queries you have. The Diabetes WA Helpline connects you with credentialled diabetes educators (including dietitians, nurses, exercise physiologists and pharmacists), who are experts in helping you to best manage your diabetes. The educators on our helpline can provide information, advice and counselling on all aspects of diabetes care, as well as assistance to help you problem-solve and manage any issues that arise. They can also refer you on to other healthcare professionals or services should the need arise.
We also provide access to free, clinical telehealth consultations with a credentialled diabetes educator for members living in rural WA. These personalised and confidential telehealth appointments (videoconferencing) can be arranged via the Diabetes WA Helpline, for a time of your choosing and in the comfort of your home, or together with your local GP or health care professional at their practice. We can also arrange to follow up with your normal health care professional to keep them up-to-date. We are proud to announce that the DWA Telehealth team have been selected as finalists for the 2022 WA Rural Health Excellence Award - Building Healthy Country Communities Award. The awards ceremony has been delayed by COVID, but should run later in the year. While we’re currently unable to run faceto-face workshops, we do have a range of virtual and digital programs available for you to access from the safety and comfort of your own home. If you’re unsure how to access these programs, please call our helpline on the number above. Providing digital or virtual care solutions that improve equity of access and improved consumer experience is a strategic priority for DWA and we are focussed on advancements in this area. Our MyDESMOND type 2 education and behavioural change digital program will help you set personal goals around diet, exercise, and wellbeing to support you in making sustainable healthy lifestyle choices. You can learn more about type 2 diabetes and refresh your knowledge
with our interactive and educational Discovery and Booster Sessions that mirror the DESMOND face-to-face groups. The program provides a number of health trackers including HbA1c, weight and shape, healthy eating and blood pressure – where you can selfreport your latest data and track your progress. Our digital programs use a variety of different formats including short videos, learning sessions and interactive activities for you to view as quickly or as slowly as you like. With our MyDESMOND chat forums, you also gain the sense of community you would by attending faceto-face programs. The platform also has the ability to link to wearable technology such as FitBit, Garmin and Google Fit. Whatever your diabetes needs, we will be here to support you through this next phase of COVID, whatever it entails. When you need us, make sure you give us a call. If you’re wanting support, do please attend one of our virtual education programs or, if you prefer to work at your own pace, check out MyDESMOND. I look forward to writing to you all again for our winter issue, when the Omicron wave will hopefully be a distant memory!
Mary Anne Stephens Diabetes WA Board Chair 1
YOUR
voice
Diabetes Matters wants to make sure our member voices are heard. If you have any feedback, thoughts or stories you want to share, get in touch at media@diabeteswa.com.au
What have you been telling us? Well, you joined us in marking 101 years since the discovery of insulin on 23 January. “My grandson has type 1, thanks to all the research he is one of the first generation of diabetics that can look forward to a normal life expectancy and actually get old. There were others in the family way back with both type 1 and type 2, most of those were kids when they died. I'm a type 2 of more than 20 years. I take medication but don't need insulin yet so am lucky and grateful.” Wendy Flint, Facebook “I’ve been type 1 for 33 years and even though I hate this disease, I am very grateful for all the research that has been done and is still being undertaken.” Karen Spagnol, Facebook You were almost as excited as we were to hear that the Telehealth team at Diabetes WA are finalists for this year’s WA Rural Health Excellence Awards for ‘Building Healthy Country Communities’. “Well deserved, such an important service for regional, rural and remote communities.” Jac Geraghty, Facebook You shared your concerns about kids with type 1 diabetes and COVID (see our feature on p8 for some “cautiously reassuring” news). “Why can’t our type 1 kids under the age of 16 access their COVID booster shot? This cohort were eligible for early vaccination. Now with waning coverage and increasing prevalence of Omicron, they’re unable get the protection they need.” Paul Zuvela, Facebook And, finally, you joined us in commemorating Ken and Betty Walker, who were responsible for the founding of Diabetes WA, way back in 1965! “Many, many thanks to the Walker family for their huge efforts in regard to diabetes. I went to five diabetic camps down at Bunbury and they were my saving grace with diabetes… I gave my first insulin injections at my first camp. I was flying free. What a wonderful achievement. Many, many thanks to Mr and Mrs Walker for their tireless efforts then and for the legacy they created.” Felicity Guy-Ranger, Facebook
OUR
actions
Find us online We’ve had to put our face-to-face sessions on hold, but we’re still running online workshops with NDSS to support our members as we adjust to living with COVID. In February, we ran our Healthy Snacks and Drinks webinar — which helps people with diabetes learn the benefits of choosing healthy snacks and drinks for blood glucose management, their key components and practical tips and advice – and our Healthy Breakfast Ideas webinar, in which one of our credentialled diabetes educators discussed the benefits of having a healthy breakfast with some handy examples to try. Keep an eye out for more virtual programs and sessions, including sessions outside of working hours, in the coming months! We’re also continuing to run our MyDESMOND digital diabetes education program. This free online program recognises there is no ‘one-size-fits-all’ approach to diabetes management and will inform, inspire, and motivate you as you work towards making small changes that will have a big impact on your health. To register or find out more visit: www.ndss.com.au/services/support-programs/mydesmond 2
COVID-ready videos Thanks to funding from the WA Primary Health Alliance, we’ve produced a series of videos helping West Australians with diabetes get ready for COVID. The series includes episodes for kids and their families, people from culturally and linguistically diverse backgrounds, our First Nations communities and a general guide to reducing the risk of a severe bout of COVID for people living with diabetes. You can find the videos on our Facebook page and at: diabeteswa.com.au
TALKING
science
CAN THE MEDITERRANEAN DIET HELP PREVENT TYPE 2 DIABETES? OUR DIABETES WA HEALTH TEAM BREAKS DOWN THE LATEST STUDIES AND FINDINGS TO HELP YOU UNDERSTAND WHAT’S HAPPENING IN THE WORLD OF DIABETES SCIENCE. A new study suggests that low-GI foods can enhance the positive effects of a healthy, Mediterraneanstyle diet for people at risk of type 2 diabetes, writes JESSICA WEISS We know that better understanding around food choices has a massive impact on diabetes management. Those who are newly diagnosed with diabetes often need help to become aware of how certain foods affect their blood glucose levels. One helpful measure is the glycaemic index (GI), which can help determine how much a particular food will make your blood glucose levels rise. A number of factors influence the GI of a food, including its nutrient composition, how it was cooked, how ripe it is, and how processed it is. Generally speaking, foods with a low GI raise blood glucose levels (BGL) less dramatically than foods with a high GI. The measure of BGL after eating is sometimes referred to as postprandial (or “after eating”) glucose. A new study shows that, even when eating an otherwise healthy diet, people at risk of developing type 2 diabetes have much to gain from avoiding high GI foods. It is thought that postprandial glycaemia – or a high BGL after eating – may be a cause of the insulin resistance we see in people at risk of developing type 2
diabetes. As yet, there has been little study into whether incorporating low GI foods as part of a healthy diet to avoid BGL spikes can help with prevention of developing type 2 diabetes. There is, however, an impressive amount of evidence that the Mediterranean diet (see our previous issue for details) is associated with a reduced risk of developing type 2 diabetes – even if most of that evidence is observational, rather than laboratory tested. The main health-giving benefits of that eating style are thought to be the sort of fats, the nature of the fibre and certain bioactive compounds the diet contains. The diet also tends to be comprised of low-GI foods, although the relative health benefits importance of the low-GI elements was not known. The new study examined the impact of a low-GI vs high-GI Mediterranean diet on blood glucose management among people at risk of developing type 2 diabetes. Those running the study expected to find the low-GI group of participants would experience lower postprandial BGL spikes and improved BGL management overall, compared to participants following a high-GI diet. Over 12 weeks, subjects consumed a controlled diet that was either highor low-GI. During those weeks, the average postprandial insulin surge and BGL reading was greater for those
consuming the high-GI diet, which was as expected. What was unexpected was that any improvement in either of these measures for those on the low-GI diet disappeared in the weeks after the study finished, although those on the high-GI diet continued to have higher-than-usual postprandial glucose. The greatest differences between the two groups in terms of insulin and BGL were observed at lunch. The authors of the study have concluded that consuming a Mediterranean eating style comprised of low-GI foods can lead to a measurable reduction in glucose levels after meals for people at risk of type 2 diabetes. However, any improvement in terms of postprandial insulin release appeared to disappear once the study finished, meaning that there was no lasting benefit if people didn’t keep up with the low-GI diet. There was also no measurable improvement on fasting glucose, Oral Glucose Tolerance Test (OGTT) or HbA1c on the low-GI cohort, which was not considered surprising. Given that only the low-GI version of the diet produced improvements in blood glucose variability, it appears that its focus on low-GI foods may indeed be one of the reasons that adopting the Mediterranean diet seems to bring numerous health benefits to those with, those without or those at risk of developing type 2 diabetes. 3
TALKING
science
CAN BLOOD PRESSURE MEDICATION REDUCE THE RISK OF DEVELOPING TYPE 2 DIABETES?
A new study suggests that taking medication to reduce blood pressure can help prevent a diagnosis of type 2 diabetes, writes JESSICA WEISS. High blood pressure (or hypertension) occurs when the long-term force of the blood against your artery walls is high enough that it can start to cause health problems, such as heart disease, stroke and nerve damage. The current stats suggest it affects approximately 1 in 3 Australians. It is particularly common in people with diabetes, due to the changes in blood chemistry that diabetes can cause. People with diabetes are encouraged to have their blood pressure checked during every visit to your GP – at least every six months and more often if you have been diagnosed with hypertension. We know that keeping blood pressure close to the recommended target range is a very important part of managing diabetes and reducing the risk of complications. There are five lifestyle changes you can take to help reduce blood pressure:
4
• • • • •
don’t smoke lose excess weight do regular physical activity (30 minutes each day on most days of the week) limit salt intake limit alcohol intake
For many people with high blood pressure, medication may be recommended alongside dietary and lifestyle changes. It also appears that having high blood pressure can increase a person’s risk of developing type 2 diabetes. Can effectively lowering blood pressure have any impact on this risk? A recent participant data meta-analysis of 22 studies has examined whether blood pressure medication may help prevent developing type 2 diabetes. The results from this study found that lowering blood pressure by 5mm Hg reduced the risk of a person developing type 2 diabetes by 11%. Some common drug classes of blood pressure lowering medications prescribed in Australia were found to have a greater impact on this risk than others. The exact reason for this variation in types of blood pressure lowering medications was not investigated in this study, however. This study highlighted the importance of regular blood pressure monitoring and taking blood pressure lowering medications as prescribed, not only for the well-studied benefits to your heart and cardiovascular system but for the additional reason of preventing type 2 diabetes. Speak to your health care provider if you have any questions about your blood pressure management.
LIVING WITH
covid
COVID In a special bonus-length feature section, we look at the latest science around COVID-19 – usually just referred to as COVID – and ask what West Australians with diabetes can expect as our state finally opens its borders to the pandemic.
(AND DIABETES)
LIVING WITH We speak to experts from Australia and overseas about their experiences, consider how best to prepare for living with COVID, answer key questions, and give special consideration to how children and teenagers with diabetes might be affected. 5
LIVING WITH
covid
COVID
& DIABETES: WHAT DO WE KNOW? Professor Timothy Davis tells MYKE BARTLETT what lessons we've learned about the COVID risk to people living with diabetes. Two years into the pandemic, there’s still a lot we don’t know about COVID. The emergence of such a successful new virus has meant that we’ve had to watch the research – which usually happens quietly in the background – play out in real time. The medical advice regarding how best to protect yourself from the virus may continue to change with each new variant, but Professor Timothy Davis, Professor of Medicine at the University of WA and a consultant physician and endocrinologist, says we have learned a lot over the past two years – particularly when it comes to how COVID interacts with diabetes. One important point of concern is that people with diabetes who catch COVID are more likely to suffer a severe bout. While people with type 1 diabetes tend to be at increased risk, Davis says there is particularly powerful evidence that people with type 2 diabetes are more likely to be hospitalised. “In the United States, one estimate was that 40% of people on hospital wards with severe COVID had type 2 diabetes. In Australia we know about 5% of people have type 2 diabetes, in the States it might be up towards 8%, so that's an over representation on the wards. We know that the risk of ending up on a ventilator and dying is increased as well.” Davis says this increased risk is bound up with the fact that a lot of people with type 2 diabetes have other risk factors for bad outcomes with COVID, including obesity, heart disease and old age. But some of the early Chinese data around the virus suggested that people whose diabetes was poorly controlled did much worse than those with more stable blood glucose levels. “What I'm trying to tell my patients at the moment is that if they’re older, and they’re overweight, and they’ve got heart disease or respiratory disease, or they're in some way immunosuppressed for whatever reason, then they should try and manage their blood sugar levels as best as they can,” Davis says. “Because the evidence is that glycemic control is quite an important risk factor for severe COVID and bad outcomes.” One of the more unexpected risks from COVID associated with diabetes is an increased likelihood that those infected may go on develop type 1 diabetes. Further research may make this link more concrete, but other viruses including coxsackie and some enteroviruses are already known to be triggers for developing type 1. 6
LIVING WITH
covid
“The epidemiological data suggests that where there’s been a COVID wave, there’s more type 1 diabetes than we’d expect,’ Davis says. “Not a lot is known about it yet, but COVID may be another viral trigger that in susceptible individuals makes or contributes to an earlier presentation.” Another COVID-induced problem is one that affects people with diabetes who haven’t yet been diagnosed. As outbreaks overwhelm the health system, patients are presenting late to hospital – often having progressed to ketoacidosis – because they are worried about catching the virus there. So what can people with diabetes do to lower their COVID risk? “Get double vaxxed and boosted, if the time is right for that. Vaccination remains our main weapon against people ending up very sick with the infection. Despite the vaccine sceptics and anti-vaxxers, the evidence from the eastern states is that there are lots and lots and lots of cases, but not that many hospitalisations or deaths, fortunately, compared to the earlier waves, when we had no vaccine. You’d be pretty silly if you ignored that evidence showing vaccines work in a real world setting.” Davis is keen to stress that, despite a flood of misinformation to the contrary, the vaccine presents no great threat to anyone with – or without – diabetes. “It’s worth reassuring people who don't have diabetes, that the vaccine won’t precipitate diabetes. There have been no cases where young people have been vaccinated and then developed type 1 diabetes. People with diabetes may see their sugars go up temporarily, as they can with any acute inflammation like you get after any vaccination. If it lasts more than a few days, it may be something else that's put the sugar up and not the vaccination.” Davis also encourages people with diabetes to do whatever they can to avoid catching the virus, in line with public health recommendations such as social distancing, mask wearing and sanitising. Staying as healthy as possible is also essential, which means managing your blood glucose levels and keeping up with any medical appointments. “That includes things like eye screening and foot care, podiatry assessments. I think some hospital outpatient clinics and GP practices will insist on full vaccination status before they'll see somebody face-to-face. But if you're worried you can do telehealth. Remote consultations are less than ideal, but they're at least something that keeps patients on track with their glucose control and avoiding complications.” Given the recent uncertainty of supply lines as the eastern states weathered a major outbreak around Christmas, it might also be worth stocking up on essential supplies. “If you’re a type 1 patient, make sure you've got enough insulin supplies to last you for at least a few months.” And if the worse comes to worst and you do catch COVID? Davis says it’s best to be prepared and to be ready to adjust your medication schedule as needed. “Any acute infection, and COVID is no exception, triggers a stress response and activation of what's called counter regulatory hormones that tend to push your sugar up, sometimes to very high levels. People with diabetes should have sick day rules where they may need more insulin, even though they're not eating when they’re sick. This means increased frequency of blood glucose monitoring, a low threshold for getting in touch with whoever's looking after your diabetes, and making sure that you do take yourself to the local emergency department if you think that you're not doing well.” Even though Omicron seems to cause less pneumonia than previous variants it’s important to be aware that things can get worse very quickly. “People who think they are on the way to significant deterioration should act quickly and get into the hospital and get assessed. Even if they're not admitted, they’ve done that very important thing to try and head off any deterioration that might require hospitalisation and ICU care.” 7
LIVING WITH
covid
COVID
There have been mixed messages about the dangers of COVID for children with diabetes. MYKE BARTLETT speaks to Dr Craig Taplin, endocrinologist at Perth’s Children’s Hospital, to sort the facts from the myths. What do we know about COVID and children with type 1 diabetes? The situation is still evolving and we’re still trying to understand, as best we can, how this directly impacts upon children and adolescents with type 1 diabetes. We know from overseas reports that in adults with type 1 there is an increased risk of a more complicated COVID course. We have taken that information on board. That said, anecdotally, our conversations with colleagues elsewhere in Australia have been cautiously reassuring in that severe illness or more complicated COVID infections in youth with diabetes seem to be uncommon, and the volume of phone calls for extra support would seem to be similar to a standard viral season. We hope that’s a reflection of what we might see here in Western Australia as well.
Are any youth with type 1 likely to be at greater risk? We don't have a good sense yet of whether there’s a subset of youth with type 1 diabetes who would be at risk of a more severe illness, but it may be that youth with higher blood glucose levels may have a higher risk of a more complicated disease course as was seen in adults. But, we don’t really know; extrapolating from the adult experience must be done cautiously because adults with longstanding diabetes may have other comorbidities that could also be associated with a more severe COVID course, for example hypertension or cardiovascular disease. If children with type 1 are generally healthy and are doing their best with their families to achieve the best glucose control that they can, then the risks for a complicated infection would seem to be low.
Do we know much about the risk to children overall? The latest data that we’ve seen suggests the rate of hospital admissions for children with COVID is somewhere around 1% of all infections. In other words, probably around about one in 100 children will need to be admitted to hospital for COVID associated illness and most will have a relatively short stay. The rate of intensive care admissions for kids appears to be somewhere around one in 1,000. In children with type 1 diabetes, it's likely to be similar.
Is the lower rate of hospitalisations that we’ve seen in Australia because of our high vaccination rates? It might be due to a number of factors. One is that, yes, vaccination rates have been very high across the country and that’s almost certainly had an effect in lowering the admission rate because what vaccination does best is prevent more severe COVID illness. The other thing that’s probably worth saying is that the rate of hospital admission for the other variants, such as the Delta variant, for example, may have been higher in children than it has been for the Omicron variant. We’ve now got a less severe, if very infectious, variant circulating in the community. That combined with a high vaccination rate suggests that most kids will have a reasonably mild illness and, in fact, may have an asymptomatic infection.
8
ID
LIVING WITH
AND KIDS
covid
WITH DIABETES
How can families of youth with type 1 diabetes – and the youth themselves – best prepare for the coming of COVID? Firstly, get vaccinated in line with the health guidelines. We strongly support that as a Diabetes Service. The risk of side effects from the vaccine don't appear to be any higher in kids with diabetes than they do in the general population. The second thing is to know that people with type 1 diabetes are no more likely to get a COVID infection in the first place than youth without diabetes. The third thing that we would always say is to make sure that families know their sick day management plan – what to do in the presence of fever or acute viral symptoms, what to do in terms of glucose monitoring, and when and how to deal with ketones in the presence of an acute illness. At this point, we don’t see the need to change the standard sick day management plan from one that families will have used many times before for things like influenza or any other acute infection. The sick day information can be found in Section 7 of our Patient Handbook – for families who haven’t needed to use it before or recently, now would be an excellent time to review this information! It is also important to have a back up plan in case of the need to isolate – have enough supplies of insulin, pens and needles, infusion sets if they’re on an insulin pump, enough sensors glucose test strips and, importantly, enough ketone strips. Think about access to healthy food, and supplies to treat hypoglycaemia in case that occurs. It’s also worth reminding families that standard medications – things like paracetamol and ibuprofen, when used as directed – are fine for people with type 1 diabetes. Remember, though, that paracetamol may affect the accuracy of some of the continuous glucose monitoring systems and thus it’s important to have a backup blood glucose fingerstick testing plan for that situation.
What about parents who are worried about attending hospitals or clinics for fear of infection during an outbreak? We want families to know that we will remain engaged in frequent clinic follow up with the goal to maintain appointments at least once every three months. Over recent weeks, we’ve been adapting to a telehealth-based model for much of this care where we can and where it is appropriate, although face-to-face care can continue when it’s considered to be clinically necessary at our main hospital. There are safety procedures in place at the hospital too for visitors and staff alike. We have not cancelled any clinics, but many of those visits will be converted to telehealth where appropriate. And, importantly, we're still here to provide support in between clinics, just as we always were. For more information about COVID and kids see https://youtu.be/JtcoVdakODs
GET READY FOR
COVID
1.
Get vaccinated
3.
Make sure you've got extra supplies
2.
Make sure that you've got a sick day plan so you know what to do and how to contact the team
4.
Know that for most children COVID is a mild illness
9
covid
HELPING
LIVING WITH
THROUGH As Western Australia adjusts to life with COVID, we can look to the UK for lessons on how to best help people living with diabetes, writes MYKE BARTLETT When the UK went into lockdown in March 2020, the country was overrun by the pandemic in a way that West Australians can hardly imagine. Hospitals were overwhelmed and essential services ground to a halt. The need to help people with diabetes manage their journey didn’t go away, however. At Leicester Diabetes Centre (LDC), the team worked hard to provide patients with the information they needed to care for themselves in the middle of a disaster. Given Diabetes WA’s strong relationship with LDC – we have partnered with them for more than a decade to bring their DESMOND diabetes self-management program to Western Australia – it made sense to ask them what we might expect here as we adjust to living with COVID. Rachel Gardner, the centre’s Project Marketing Manager, says the team’s main priority during the first outbreak was making sure people with diabetes could access information and support, even when face-to-face appointments weren’t possible. “We wanted to make sure that we were supporting anybody that has diabetes,” Rachel says. “We wanted them to know that they could come to our website, that we had videos on there, about starting insulin, about hypos, things to look out for, exercise. Basically, we took a back-to-basics approach. Because people weren't going to be able to go to their doctors, they needed to think a bit more about looking after themselves.” Bernie Stribling, Assistant Director at LDC, says there was a particular awareness that a lot of people would be newly diagnosed with diabetes without being able to access the usual support and services.
10
“What we found is that routine care across GP practice just stopped. People had Dr Google and that was it. Even two and a half years later, some newly diagnosed people still haven't gotten to the appointments. You had a lot of isolated people.” One gesture that had an immediate impact was making the MyDESMOND online workshops available free for three months. “We thought, let's just give them access to a solid piece of information that educates them about self care. It gave patients an opportunity to realise they don’t have to rely on other people and healthcare professionals, because they’ve got the skills.” West Australians are fortunate as Diabetes WA has already made these MyDESMOND workshops available, to ensure education programs continue as face-to-face sessions are postponed. At LDC, they found that moving towards a virtual model meant DESMOND sessions became accessible to people who might previously have struggled or been reluctant to attend. As people in lockdown got used to doing everything virtually, attendance numbers for MyDESMOND went through the roof. “Because we had this huge waiting list, we put everybody online and guess what? It just worked. I think as healthcare professionals, we have this perception that we couldn't possibly go virtual, because we've never done it that way,” Bernie says. “But suddenly the person who's living with diabetes realises they just need the support and that they've got the answers themselves.” Education became an important tool in helping people deal with the pandemic – and the damaging effects
LIVING WITH
covid
THE HORROR lockdowns had on people’s mental health, diabetes management and exercise regimes. This education, which was delivered as a series of virtual programs, included information on what a pandemic actually was and how best to protect yourself, with a particular sensitivity towards the city’s ethnically diverse population. Diabetes WA has secured funding to make these extra sessions available for West Australians.
A key element of the pandemic response was encouraging people with diabetes to get vaccinated. LDC put a range of strategies in place to stress the importance of vaccination and to allay fears generated by widespread misinformation. “We had GPs phoning people and we put together videos, with one specifically aimed at ethnic minority groups,” Rachel says. “We had a few celebrities do a video and experts saying, please go and get vaccinated – it’s OK. Those kind of messages really helped people's perception as well.” Bernie says that one positive to emerge from the pandemic, and the multi-systemic nature of COVID, will be a shift towards a more holistic model of patient care, where the patient is more involved in navigating their diabetes journey. This means the LDC will be expanding its education program to reach out to medical professionals across a much broader spectrum. “Some of the work we’ve just started doing is our healthcare professional training,” Rachel says. “We’re not just going to be looking at nurses and GPs, but also at practice receptionists, pharmacists and other health workers, to make sure they too are educated about diabetes, and how they can help and support people. It’s about looking at the whole of the person, rather than just this one thing that they've come in for.” 11
LIVING WITH
covid
THE
BIG
Our experts give straightforward answers to your knotty COVID questions.
Am I more likely to catch COVID? If you have diabetes, you are no more likely to catch COVID than anyone else. There is strong evidence that people with diabetes are more vulnerable to developing a severe illness if they do catch COVID, however.
What happens if I do catch COVID? Everyone’s COVID experience will be different, so there is no predicting whether you will experience a mild or severe illness. Most people with diabetes will experience a mild illness, but it’s important to note that what medical professionals call “mild” can still make you feel extremely unwell. “Mild” COVID simply means your illness can be managed at home. Moderate or severe illness may require medical assistance or hospitalisation. People with diabetes, whether type 1, type 2, gestational or other types, are more vulnerable to developing a 12
severe illness if they do get COVID, although the risk of serious illness in young people with type 1 diabetes is still thought to be very low.
because of related complications. COVID is not just a respiratory illness, but a multi-systemic virus, meaning it can affect many different parts of the body.
It is a good idea for people with diabetes to prepare for possible hospitalisation. Follow a sick-day management plan that you have discussed with your diabetes educator. The aim of such plans is to make sure you know how to manage insulin or other diabetes medications, check for and interpret blood ketone levels (type 1 diabetes only) and blood glucose levels when you're sick. Always tell healthcare professionals treating you that you have diabetes. The WA Health Department has introduced a WA COVID Care at Home scheme, available for those assessed to be at higher risk of hospitalisation. Register if you catch COVID and a health professional will be in touch to assess your risk to see if you could benefit from monitoring your health at home.
Your risk of getting very sick from COVID is likely to be lower if your diabetes is well-managed. If you have a history of heart disease or kidney disease or have a high HbA1c, you may be more at risk. Other factors including your age, your ethnicity and your weight can affect that risk.
Why is COVID more dangerous for people with diabetes? People with diabetes seem to be more at risk of a severe bout of COVID
Inflammation associated with diabetes might also play a role. Because people with diabetes may already have some inflammation in their system, inflammation associated with COVID might get worse more quickly. Blood flow because of clotting problems or circulation issues could be exacerbated by COVID. Even if your diabetes is well-managed, COVID, like any illness, can make your blood glucose levels go all over the place. This is because your body produces stress hormones when you are unwell, causing the liver to release glucose into the blood to give you energy to fight off the illness. If your body can’t produce enough insulin to cope with
If I have diabetes, can I still have the vaccine? All eligible Australians living with diabetes are encouraged to get vaccinated against COVID. Vaccines approved for use in Australia by the Therapeutic Goods Administration, including those made by Pfizer, Moderna, AstraZeneca and Novovax, are suitable for people living with diabetes.
this, your blood glucose rises, making it harder to manage your diabetes. If the body does not have enough insulin to cope with these rising blood glucose levels, a person may even require urgent medical assistance to manage their diabetes. For example, people living with type 1 diabetes may be at increased risk of diabetic ketoacidosis. Aside from the virus itself, some of the treatments for COVID (for example steroid medications) may also cause glucose levels to change.
Does it matter what type of diabetes you have? Children and teens with type 1 diabetes appear to be at a lower risk of severe COVID than older people with type 2 diabetes. This may be because being older is an additional risk factor for COVID, as are the sort of illnesses and conditions people develop as they age.
How can I reduce my risk of becoming more unwell with COVID? The most important step you can take to protect yourself from a severe case
LIVING WITH
covid
of COVID is to keep up-to-date with your COVID vaccinations. At present, the health guidelines recommend two doses followed by a third booster dose. An additional vaccination is recommended for those who are severely immunocompromised, although it is important to note that people with diabetes are generally not considered immunocompromised.
It is also important that you follow the latest health advice about wearing face masks, maintaining social distancing and practicing good personal hygiene. You can call our helpline on on 1300 001 880 and ask to speak with a credentialled diabetes educator.
Being vaccinated might not prevent you getting symptomatic illness, but the evidence is – even with Omicron – that your risk of serious illness or hospitalisation is greatly reduced after three doses.
As with other types of diabetes, women who are pregnant and have gestational diabetes (GDM) are not more likely to get COVID. However, there is some evidence that suggests that pregnant women are at greater risk of becoming more unwell with COVID, whether they have GDM or not.
You can also strive to maintain glucose levels within your target range as much as possible to further reduce your risk. Research has shown that having a high HbA1c or being overweight can increase your risk of becoming seriously ill from COVID. Additionally, maintaining a healthy, balanced diet and being physically active will help your immune system.
I have Gestational Diabetes (GDM)– what is the risk to me?
It is recommended that women with GDM are vaccinated against COVID and manage their blood glucose levels to reduce their risk. For individualised advice regarding COVID and pregnancy, it is recommended you talk to your health care team.
Although many claims have been made about the importance of supplements such as vitamin D, there is currently limited evidence that they will help. 13
ON THE
line
The Diabetes WA Helpline provides free comprehensive access to personalised diabetes management advice and support from a credentialed diabetes educator. Meet our educators as they share some of the common concerns they hear from our members.
Christine Carne Christy is a credentialed diabetes nurse educator who has worked in the diabetes field for more than 20 years in various roles including diabetes research, children’s diabetes and community diabetes education. For the past seven years she has been employed at Diabetes WA in clinical, telehealth and community education roles. Being a country girl at heart, Christy’s passion is to assist people living in regional and remote WA. After spending two years establishing the Diabetes Telehealth Service for regional WA, she is now focussed on providing her expertise on the Diabetes WA Helpline. She says empowering people with diabetes, their family, and carers to troubleshoot and self-manage their health via the helpline is especially rewarding.
Why do I need to report my diabetes to the Government of Western Australia Department of Transport (DoT) for my driver’s licence? Driving is a complex skill, both physically and mentally, and if you have diabetes, you may need to take extra precautions to ensure road safety for yourself and others. By law all drivers in WA are required to notify the DoT of any permanent or long-term mental or physical health conditions or treatments that may impair their ability to drive a motor vehicle. These are referred to as reportable medical conditions. Reporting any medical condition to DoT means you are helping to keep our roads safer, as well as avoiding potential fines and insurance implications! The DoT also needs to be updated if or when there is a change in the previously notified condition or treatment. Diabetes is one such reportable long-term condition that may affect your ability to drive, either due to having: • hypoglycaemia (low blood glucose levels less than 4 mmol/L) or hypo-unawareness (not experiencing symptoms of low blood glucose levels) • diabetes complications involving the eyes (changes in vision), feet (nerve damage) or heart (changes to heart rate, blood pressure etc.) Reporting a medical condition only takes a few moments and can be done online by visiting the DoT website and completing the ‘Report a Medical Condition’ form (‘Notification of Driving Impairment’ forms are also available at licensing centres or authorised agents). Once the DoT has received your notification they will inform you on what action, if any, is required next. If your diabetes is managed by diet and exercise alone, you may be able to drive without any licence restrictions. However, you are still required to have regular reviews with your treating doctor to track any progression of your diabetes. If your diabetes is managed by certain glucose lowering medication, insulin or if you have a commercial licence, you may be required to undergo a medical review to assess your ‘Fitness to Drive’. These assessments may need to be repeated every one to five years. A ‘Fitness to Drive Declaration’ is usually sent to you from DoT approximately 12 weeks prior to the expiry of your licence. This is to make sure that your driving ability is not impaired, which keeps you and other road users safe. Most people with diabetes can make an appointment with their GP to have their ‘Fitness to Drive” medical assessment completed and lodged electronically. Some people however may require a referral from a GP to an endocrinologist or consultant physician specialising in diabetes to conduct this assessment and review their diabetes management. Sometimes accessing a diabetes specialist in a timely manner can be difficult, due to waitlists, lack of appointment availability and associated costs (if seeing a private specialist). People with diabetes on multiple medications or those with commercial driver’s licences are encouraged to have a current referral to a diabetes specialist from their GP. This may require advanced planning! Diabetes Australia and the NDSS have provided simple tips to support safe driving in the ‘Diabetes and Driving’ booklet, available from the NDSS website. Our helpline is available to anyone living in WA for the cost of a local call. Contact us on 1300 001 880 or email info@diabeteswa.com.au for further information. People living with diabetes in regional WA can also access our diabetes health professionals including an endocrinologist via the Diabetes Telehealth Service. 14
ON THE
line
Nyaree is a registered nurse who has been working as a diabetes educator for 20 years. Nyaree has a passion for working in Aboriginal health and rural health. Even though she has worked at Diabetes WA for five years, she still lives in Toodyay and continues to provide diabetes services in the Wheatbelt. During her nursing career, Nyaree has worked overseas in England, Ireland and Angola. As a diabetes educator, she has worked in the Gascoyne, Wheatbelt and Perth, as well as providing some diabetes group sessions in various remote Aboriginal communities. Nyaree enjoys jogging and hiking. Competing in an ultramarathon and completing the Cape-to-Cape hike are among her personal highlights.
I’m not feeling well and my blood glucose levels have gone up. What should I do? This is a common enquiry we get on our helpline, from people with either type 1 or type 2 diabetes.
ONTHELINE
Nyaree Lawler
When you are unwell or have an infection, the body releases stress hormones, such as adrenaline and cortisol, as it prepares for the ‘fight or flight’ response. These stress hormones increase the amount of glucose going into your blood stream from the liver, as well as making it harder for insulin to work, which allows glucose to enter the cells and be used for energy. This is the body’s way of getting enough energy (glucose) in the blood to ‘fight’ the illness.
As our glucose levels increase, we need more insulin. So what does that mean for people with diabetes who may not be producing any insulin themselves, or may not be able to produce enough extra insulin?
A sick day plan can help you. This is a plan that you follow when you have an infection, or when you feel unwell. Having a plan can also help you be prepared if you contract COVID-19. The plan will guide you on how to manage your diabetes during this time and includes information on how often to check blood glucose levels, how often to check for ketones if you have type 1 diabetes, how much fluid to drink to prevent dehydration, what medications you may need to stop taking, and, most importantly, when to seek medical assistance. For people who are using insulin to manage their diabetes, the sick day plan will guide you as to how much insulin to have and how often. This is particularly important for people with type 1 diabetes because if you don’t have enough extra insulin then you can develop diabetes ketoacidosis (DKA), which is a serious and life-threatening condition. Whether you have type 1 or type 2 diabetes, having higher glucose levels, in this case due to illness, can cause dehydration as the body tries to excrete more glucose through the urine. Your sick day plan will suggest how much fluid to have each hour to try and prevent dehydration. Illnesses that cause vomiting or diarrhoea can drive your glucose levels too low because the glucose from food or drink may not be absorbed properly. This situation can be difficult to manage, especially for people with type 1 diabetes, because they need to continue to have some insulin, or they may develop DKA. Again, how to manage this situation will be part of your sick day plan. You may be interested in attending one of Diabetes WA’s online webinars that focus on sick day plans and sick day management – we have specialised sessions for type 1 and type 2. Book by visiting our website or calling our helpline on 1300 001 880. Next time you are talking to your GP or credentialled diabetes educator, ask them for a sick day plan. There are sample plans readily available, but they will need to be personalised for you according to the type of diabetes you have and the medications you are on. If you have diabetes, are unwell and you are not sure what to do, please seek urgent medical attention.
15
Diabetes WA Webinars Webinars in April
Day
Date
Times
Glycaemic Index
Monday
4.4.22
11am – 12pm
Annual Cycle of Care
Monday
4.4.22
2pm -3pm
Label Reading
Monday
4.4.22
6pm – 7pm
Sick Day Management for People with Gestational Diabetes Tuesday
5.4.22
10am – 11am
COVID-19 and Diabetes
Tuesday
5.4.22
1pm – 2pm
Healthy Snacks and Drinks
Tuesday
5.4.22
6:30pm – 7:30pm
Healthy Breakfast Ideas
Wednesday
6.4.22
12pm – 1pm
Carbohydrates - What are they really?
Wednesday
6.4.22
2pm – 3pm
Type 2 Diabetes and Medication
Thursday
7.4.22
11am – 12pm
Mediterranean Style of Eating for Type 2 Diabetes
Thursday
7.4.22
3pm – 4pm
Managing Insulin in type 2 diabetes
Friday
8.4.22
12pm – 1pm
Sick Day Management for People with Type 2 Diabetes
Friday
8.4.22
7pm – 8pm
Staying on Track
Monday
11.4.22 12pm – 1pm
Popular Apps for Diabetes Management
Monday
11.4.22 6pm – 7pm
Type 2 Diabetes and Physical Activity
Tuesday
12.4.22 10am – 11am
Healthy Meal Ideas
Tuesday
12.4.22 2pm – 3pm
Sick Day Management for People with Type 1 Diabetes
Wednesday
13.4.22 10am – 11am
Gestational Diabetes and Physical Activity
Wednesday
13.4.22 2pm – 3pm
Looking after your feet
Thursday
14.4.22 9am – 10am
Type 2 Diabetes and Technology
Thursday
14.4.22 12pm – 1pm
Your Long Term Health and Type 1 Diabetes
Tuesday
19.4.22 12pm – 1pm
COVID-19 and Diabetes
Tuesday
19.4.22 3pm – 4pm
Healthy Snacks and Drinks
Tuesday
19.4.22 6pm – 7pm
Sick Day Management for People with Type 2 Diabetes
Wednesday
20.4.22 3pm – 4pm
Label Reading
Wednesday
20.4.22 7pm – 8pm
Carbohydrates - What are they really?
Thursday
21.4.22 12pm – 1pm
Type 1 Diabetes and Physical Activity
Friday
22.4.22 12pm – 1pm
Mediterranean Style of Eating for Type 2 Diabetes
Friday
22.4.22 3pm – 4pm
Healthy Breakfast Ideas
Tuesday
26.4.22 10am – 11am
Type 1 Diabetes and Technology
Wednesday
27.4.22 12pm – 1pm
Type 2 Diabetes and Medication
Wednesday
27.4.22 6pm – 7pm
Blood Glucose Monitoring
Thursday
28.4.22 10am – 11am
Annual Cycle of Care
Thursday
28.4.22 12pm – 1pm
Popular Apps for Diabetes Management
Thursday
28.4.22 3pm – 4pm
Healthy Meal Ideas
Friday
29.4.22 12pm – 1pm
COVID-19 and Diabetes
Friday
29.4.22 3pm – 4pm
Glycaemic Index
Friday
29.4.22 6pm – 7pm
For more information or to book into any of these workshops, visit diabeteswa.com.au, call 1300 001 880 or email bookings@diabeteswa.com.au
16
Diabetes WA Webinars Diabetes WA’s series of online educational webinars offers a convenient way to hear about a variety of hot topics on diabetes from our credentialled diabetes educators from the comfort of your living room. Free for Western Australians who are registered on the NDSS, the webinars are held via Zoom, with new sessions added regularly. Scan the QR code to book into a webinar:
Webinars in May
Day
Date
Time
Webinars in June
Day
Date
Time
Looking after your feet
Monday
2.5.22
6pm
Healthy Snacks and Drinks
Thursday
1.6.22
2pm
Sick Day Management for People with Gestational Diabetes
Tuesday
3.5.22
6pm
Carbohydrates - What are they really?
Thursday
1.6.22
6pm
COVID-19 and Diabetes
Tuesday
3.5.22
6pm
Glycaemic Index
Tuesday
7.6.22
3pm
Healthy Meal Ideas
Wednesday
4.5.22
6pm
Tuesday
7.6.22
6:30pm
Managing Insulin in Type 2 diabetes
Wednesday
4.5.22
6pm
Popular Apps for Diabetes Management COVID-19 and Diabetes
Wednesday
8.6.22
3pm
Healthy Snacks and Drinks
Friday
6.5.22
6pm
Healthy Meal Ideas
Wednesday
8.6.22
6pm
Carbohydrates - What are they really?
Friday
6.5.22
6pm
Type 2 Diabetes and Physical Activity
Thursday
9.6.22
4pm
Sick Day Management for People with Type 2 Diabetes
Friday
6.5.22
6pm
Sick Day Management for People with Type 2 Diabetes
Thursday
9.6.22
7pm
Label Reading
Monday
9.5.22
6pm
Friday
10.6.22 2pm
6pm
Mediterranean Style of Eating for Type 2 Diabetes Staying on Track
Friday
10.6.22 4pm
COVID-19 and Diabetes
Monday
9.5.22
Annual Cycle of Care
Tuesday
10.5.22 6pm
Type 2 Diabetes and Technology
Tuesday
10.5.22 6pm
Diabetes in Pregnancy
Wednesday
11.5.22 6pm
Sick Day Management for People with Type 1 Diabetes
Wednesday
11.5.22 6pm
Your Long Term Health and Type 1 Diabetes
Thursday
Looking after your feet
Monday
13.6.22 1pm
Carbohydrates - What are they really?
Monday
13.6.22 4pm
Type 2 Diabetes and Medication
Monday
13.6.22 6pm
12.5.22 6pm
Type 1 Diabetes and Technology
Tuesday
14.6.22 4pm
Healthy Snacks and Drinks
Tuesday
14.6.22 6pm
Wednesday
15.6.22 9am
Wednesday
15.6.22 11am
Type 1 Diabetes and Physical Activity
Friday
13.5.22 6pm
Sick Day Management for People with Type 1 Diabetes
Healthy Breakfast Ideas
Friday
13.5.22 6pm
COVID-19 and Diabetes
Mediterranean Style of Eating for Type 2 Diabetes
Monday
16.5.22 6pm
Annual Cycle of Care
Wednesday
15.6.22 2pm
Type 2 Diabetes and Technology
Thursday
16.6.22 10am
Blood Glucose Monitoring
Monday
16.5.22 6pm
Label Reading
Thursday
16.6.22 2pm
Glycaemic Index
Tuesday
17.5.22 6pm
Monday
20.6.22 10am
Popular Apps for Diabetes Management
Tuesday
17.5.22 6pm
Managing Insulin in type 2 diabetes
20.6.22 2pm
Tuesday
17.5.22 6pm
Sick Day Management for People with Gestational Diabetes
Monday
Gestational Diabetes and Physical Activity
21.6.22 2pm
Wednesday
18.5.22 6pm
Type 1 Diabetes and Physical Activity
Tuesday
Staying on Track COVID-19 and Diabetes
Wednesday
18.5.22 6:30pm
Blood Glucose Monitoring
Tuesday
21.6.22 5pm
Looking after your feet
Thursday
19.5.22 10am
Healthy Breakfast Ideas
Tuesday
21.6.22 7pm
Type 1 Diabetes and Technology
Thursday
19.5.22 1pm
Mediterranean Style of Eating for Type 2 Diabetes
Wednesday
22.6.22 3pm
Your Long Term Health and Type 1 Diabetes
Wednesday
22.6.22 6pm
COVID-19 and Diabetes
Friday
24.6.22 4pm
Carbohydrates - What are they really? Thursday
19.5.22 3pm
Type 2 Diabetes and Medication
Monday
23.5.22 11am
Sick Day Management for People with Type 2 Diabetes
Monday
23.5.22 2pm
Label Reading
Tuesday
24.5.22 3pm
Healthy Meal Ideas
Tuesday
24.5.22 6:30pm
Type 2 Diabetes and Technology
Wednesday
25.5.22 12pm
Sick Day Management for People with Gestational Diabetes
Wednesday
25.5.22 3pm
Healthy Breakfast Ideas
Thursday
26.5.22 3pm
Managing Insulin in type 2 diabetes Friday
27.5.22 2pm
COVID-19 and Diabetes
Friday
27.5.22 4pm
Mediterranean Style of Eating for Type 2 Diabetes
Monday
30.5.22 6:30pm
Sick Day Management for People with Type 1 Diabetes
Tuesday
31.5.22 10am
Glycaemic Index
Friday
24.6.22 6pm
Staying on Track
Tuesday
28.6.22 4pm
Sick Day Management for People with Type 2 Diabetes
Tuesday
28.6.22 6pm
Healthy Meal Ideas
Wednesday
29.6.22 10am
Label Reading
Wednesday
29.6.22 2pm
Carbohydrates - What are they really?
Thursday
30.6.22 9am
Healthy Snacks and Drinks
Thursday
30.6.22 12pm
17
LIVING
well
PUTTING YOUR MONEY WHERE YOUR
HEART
IS
A new book helps those of us without a lot of financial knowledge put our money where it will do us – and the world at large — some good, writes MYKE BARTLETT. Making money and being ethical don’t always seem to go together. Even if we don’t buy into the 80s maxim that Greed Is Good (popularised by the lead character of the 1987 film Wall Street), there’s a sense that making moral compromises is often necessary where money is concerned. Many of us worry that we simply can’t afford to be as ethical we might like. A new book argues that investing in ethical businesses might be easier than you think — with benefits for the environment, your sense of wellbeing and, crucially, your bank balance! Nicole Haddow, author of The Ethical Investor, says she had never thought about being an investor. “There was always a mental barrier,” Nicole says. “I had an idea in my head that it was going to cost me thousands just to get started.” A bit of research revealed that there is now a range of sophisticated micro 18
investing apps that allow beginners to start small at minimal financial risk. “I started buying shares by apps and that helped me understand what I could afford, what was appropriate, how the market was performing, and also gave me the confidence to go further. So the barrier to entry is not what it used to be.” The Ethical Investor is Nicole’s second book, following on from Smashed Avocado, which offered a guide to rentvesting — where first homebuyers purchase an investment property in an affordable area, but continue to rent a home in a more desirable location. It was a practice that had worked very well for Nicole, until an extraordinary year threw everything into chaos. “At the start of 2020, we had terrible bushfires and a pandemic started. My tenant moved out of my property, and I was in a situation where I needed to sell. So I did sell the property. The
challenge for me was, what do I do next? I wanted to be in a position where my money wasn’t all in one investment.” Most of us are already investors, of course, even if we haven’t given it much thought. Our superannuation funds are investing our money in stock they hope will pay off enough to allow for a comfortable retirement, but Nicole says she had never investigated where that money was actually being invested. “I hadn’t been giving a great deal of thought to my superannuation,” Nicole says. “And when I did call my super fund and ask where my money was invested, they couldn't give me the information that I needed.” When she looked into ethical alternatives, it quickly became apparent that many ethical funds were happy to be far more transparent about what they would do with her
LIVING
well
DISCLAIMER: Anyone interested in investing must seek independent financial advice. Diabetes WA does not endorse any investment strategy.
money. Changing to a fund that matched her own personal ethics was easy to do, after a bit of research, and has meant that she is now far more engaged in how her super is performing. “That's something that I hadn’t considered before. I'm now watching how they perform, knowing that I don't need to stay with them. If it doesn't work, I can move elsewhere. I think the thing that people need to understand is that they do have choice, they do have power. And if they're not happy with the performance of their fund, they can find another one.” Some might worry that supporting environmentally friendly causes or other ethical companies might mean a financial sacrifice. Surely it’s more profitable to invest in companies that aren’t bound or regulated by ethical concerns? Nicole says that simply isn’t the case.
“If we talk logically about where the world is going, I don't see that something like traditional mining, for example, is necessarily a good investment. Renewables have a huge potential. Generally speaking, environmentally responsible investment is outperforming the ASX benchmark. I don't think people should think that ethical investment means taking a loss.” While investors should feel confident in supporting forward-looking companies, Nicole does add that not every investment is the same and people should seek expert financial advice before sinking their money into shares. She’s also aware that ethics are a very personal thing and, while she isn’t pushing her own beliefs onto any other would-be investors, suggests that beginners dig a little deeper into what any company means when it describes itself as ethical — as there is no strict criteria. “You need to go in with your eyes wide open, a lot of companies will
say that they're considered to be ethical or sustainable. There’s not a lot of regulation around putting a sustainable label on a financial product. So there’s a bit of effort required to make sure that you're comfortable with the decision you're making.” For Nicole, being more mindful of where her money is going has brought her a great sense of wellbeing. She has chosen to invest her super in a company run by women, as a means of addressing the financial inequalities many women face. Other investors may be driven by environmental concerns such as addressing climate change. Choosing where your money is spent is a small and easy step towards changing the world, Nicole says. “I really, really like that I personally can move the needle. It might be very small in the grand scheme of things, but I think as more people look into this, there is a huge opportunity to drive significant change.” 19
MOVING
well
Diabetes WA educator MARIAN BRENNAN explains why exercise can not only make us feel better – but can also help us ward off viruses such as COVID. Many in our diabetes community are worried about contracting COVID, given reports from overseas suggesting they are more likely to experience severe illness. Others have been concerned about how the illness might interfere with their already complex diabetes management. When we feel much is out of our control, it is important to focus on things that we can do to reduce our risk. One small but significant step is to increase our levels of physical activity. Physical activity has many wonderful benefits. We know exercise can reduce 20
our risk of developing heart attack, stroke, some cancers and the longterm effects of diabetes. It can improve bone and muscle health, mental well-being, and maintain and improve blood glucose levels. But did you know physical activity can also improve our immunity? Researchers have been looking into the effect of physical activity on our immune system since the early 1990s, but there has been a surge in research over the past decade. We now know that engaging in regular physical activity is associated with a 31% lower risk of contracting infectious diseases, including COVID. Although having diabetes doesn’t mean you’re more likely to get COVID, it does mean you’re at greater risk of
experiencing more severe symptoms. The good news is regular physical activity is also linked with a 37% lower risk of severe symptoms and COVIDrelated deaths.
Why does exercise lower the risk of severe COVID? Well, we know that physical activity stimulates immune cells in the blood and tissues which enhances our immune response. Physical activity also reduces inflammation in our blood vessels which can decrease your risk of severe COVID symptoms (as well as diabetes-related complications). As we get older, our immune system becomes less robust. Incredibly, physical activity slows down these effects of ageing, meaning we can have a stronger immune system for longer!
MOVING
There are also some early signs that exercise may improve the effectiveness of some vaccines, including the influenza and pneumococcal vaccines which are recommended annually for those living with diabetes. Studies looking at influenza vaccines found a significant increase in antibody levels after vaccination in those who were physically active. Some experts believe the same may be true for COVID vaccines, but more research is required to confirm this.
How much physical activity are we talking here? Consistently participating in at least 150 minutes of moderate intensity physical activity per week will put you in the best position to maximise your
immune system. Moderate intensity activity is the type of activity that makes your heart rate and breathing increase to a point where you might find it tricky to hold an uninterrupted conversation. Some research suggest that taking part in 150 minutes per week of moderate intensity physical activity in the weeks before taking a vaccine can actually increase its efficacy.
Can too much physical activity compromise our immune system? There is some research to suggest that very high exercise loads can actually increase the risk of infections. But this may be more applicable to athletes with heavy training loads and the added stress of competition, travel,
well
lack of sleep, large crowds (and greater exposure to infection), and special dietary needs. Moderate to vigorous physical activity between 60–600 minutes per week has not been shown to increase the risk of infection. Many people find that having a plan and being prepared can reduce the stress and worry associated with COVID. Now is a great time to start thinking about how you might be able to fit in a bit more physical activity in your day so that you can maximise its protective qualities. Find out more about our workshops at: www.diabeteswa.com.au/manageyour-diabetes/programs-andresources 21
EATING
well
EATING TO BOOST
OUR IMMUNE SYSTEM
The pandemic has seen lots of rumours about diets and superfoods that help ward off COVID, but can eating actually improve immunity? Diabetes WA dietitian NARELLE LAMPARD investigates. With winter approaching and COVID circulating, now is the time to focus on keeping our immune systems strong. One way to do this is by eating plenty of healthy foods. Optimising our nutrition can help us resist infection, strengthen our immune response and recover from illness more quickly. Despite what some might claim, there are no magic foods that can completely protect us from bacterial or viral infections. What is true is that we all need adequate energy and nutrients for our immune system to function properly, and not eating well can compromise that. Instead of hunting down superfoods, the best advice is simply to eat a wide variety of nourishing foods – foods that will support our immune system to function at its best. Likewise, while vitamin supplements are often sold as being ‘magic bullets’ to ward off illness, studies suggest you’re
much better off just eating good food! What does good food look like? When it comes to boosting immunity, there are two key dietary elements: 1.
foods that provide an abundance of vitamins, minerals and antioxidants
2.
foods that promote a healthy gut microbiome.
Vitamins, minerals and antioxidants If it’s to work efficiently, your immune system relies heavily on a range of nutrients being readily available within the body. A deficiency in any of these can alter immune function. We know that people who lack Vitamin D (which most Australians get from exposure to sunlight), for example, are at increased risk of a wide range of health conditions including osteoporosis and rickets.
Vitamin A
Eggs, dairy products, oily fish (salmon, tuna, sardines) and liver. Beta-carotene, which is converted into Vitamin A is found in orange-coloured vegetables and fruits such as carrots, sweet potato, pumpkin, apricots and mango.
Vitamin C
Citrus fruits (oranges, mandarins, lemons, limes), kiwifruit, green leafy vegetables (spinach, broccoli, kale, cabbage), berries, tomatoes and red capsicum.
Vitamin D
Oily fish (salmon, tuna, sardines), eggs, milk and mushrooms exposed to light.
Vitamin E
Wheatgerm oil, spinach, seeds (sunflower seeds, tahini), nuts (almonds, hazelnuts), avocado and salmon.
Zinc
Seafood (oysters, mussels, crab), lean meat, tofu, legumes, nuts (cashews), seeds, liver, chicken, milk and wholegrains.
Iron
Lean red meat, chicken, fish, green leafy vegetables, legumes, eggs, nuts, pumpkin seeds, fortified breads and cereals. Eat these with food containing Vitamin C to boost absorption.
Selenium
Brazil nuts, fish and seafood, meat, chicken, dairy, eggs, wholegrains, sunflower seeds and legumes. Compounds with names such as flavonoids, polyphenols, lycopene, lutein, allicin and anthocyanins. Found in abundance in plant-based foods, some examples include:
Antioxidants
Fruits and vegetables – blueberries, cranberries, spinach, artichoke, tomatoes, red cabbage, beetroot and corn. Legumes, nuts and seeds – beans, pecans, walnuts and chia seeds. Herbs and spices – Turmeric, cumin, paprika, cinnamon, garlic, ginger, chilli, basil, coriander, parsley, thyme, rosemary, oregano, sage. Other – green tea, coffee, red wine, dark chocolate and honey in small amounts.
22
EATING Healthy gut microbiome Over the past few years scientific research is proving that there is a connection between the bacteria in our gut and the functioning of our immune system (see our Spring Issue from last year). A healthy gut microbiome can send anti-inflammatory and virus-fighting signals to the immune system. The wider the variety of plant fibre you eat, the healthier and more diverse the bacteria in your gut will be. Try these ideas to encourage healthy gut bacteria: •
•
•
include prebiotics – high-fibre foods such as legumes (lentils, chickpeas, split peas and beans), vegetables, fruits, nuts and wholegrains add probiotics - fermented foods with bacteria and yeasts such as yoghurt, kombucha, kefir, sauerkraut, kimchi include healthy fats – olives, avocado, nuts, seeds, extra-virgin olive oil and oily fish (salmon, mackerel, sardines)
•
reduce added sugars and artificial sweeteners
•
prepare fresh whole foods at home and limit ultraprocessed, packaged and takeaway foods.
well
SYSTEM 7 NON-FOOD IMMUNE BOOSTERS:
1.
Sunshine – 10 minutes outdoors to top up your
2.
Be physically active – move your body
3.
Sleep well – aim for 6-8 hours per night
4.
Minimise stress – slow-down, relax
5.
Vitamin D levels
and enjoy life
Limit your alcohol intake – moderation is
the key
6.
Drink plenty of water
7.
Avoid smoking
As with any change to your diet, do consult your health professionals. Not every food option will suit everyone, so feel free to pick and choose the elements that work for you. The best approach is to be more conscious of the food choices we’re making and the effect they might have on our wellbeing. This winter, let’s eat well to stay well!
MEAL IDEAS Breakfast
Rolled oats or natural muesli
Multigrain toast
+ fresh or frozen berries
+ eggs, baked beans or cottage cheese
+ nuts or seeds
+ avocado
+ milk or natural yoghurt
+ tomato, spinach, mushrooms
Multigrain sandwich, wrap or crackers
Lunch
+ chicken, egg, tuna or cheese + hommus or avocado + lettuce or baby spinach leaves, tomato, carrot, cucumber
Dinner
+ olives, chickpeas or bean mix + corn, roasted sweet potato or beetroot Mixed vegetable soup
+ beef, seafood or tofu
+ lentils, split peas, beans or barley
+ brown basmati rice
+ herbs & spices
+ onion, garlic, ginger, chilli
+ sourdough or soy-linseed bread
Hommus + vegetable sticks 1 row dark chocolate Plain popcorn Olives, cherry tomatoes Hard-boiled egg
Drinks
+ tinned salmon or tuna
Colourful vegetable stir-fry
Fresh fruit – orange, banana
Snack Options
Colourful mixed salad
Water, green tea, herbal teas
Fresh fruit – kiwifruit, apple, apricot Unsalted nuts or seeds Natural yoghurt Multigrain crackers + cheese, tahini or nut butter Roasted chickpeas Water, coffee, kombucha 23
Cook's Tip
flavour, you For a change of ham with saltcan replace the e d salmon and th reduced smoke with crumbled grated cheese low-fat ricotta.
QUICHE LORRAINE 24
DIABETIC Serves: 6 Prep: 15 mins Chill: 20 mins Cook: 1 hr Difficulty: Medium 2 sheets (240g) Simply Wize Gluten Free Puff Pastry 4 x 60g eggs 185ml (¾ cup) skim milk Freshly ground black pepper 40g gluten-free salt-reduced leg ham, finely chopped 35g (1⁄3 cup) reduced-fat grated cheese 3 x 250g trays cherry tomatoes on vine Rocket leaves, to serve (optional)
living
1. Preheat oven to 170°C (fan-forced). Line an oven tray with baking paper. Spray a 20cm (base measurement) loose-based flan tin with cooking spray. Put tin on prepared tray. Prepare pastry following pack instructions, rolling out to 3-4mm thick. Line tin with pastry, trimming to fit. Place in the fridge for 20 minutes. 2. Cover the pastry with a piece of baking paper and fill with baking beans or rice. Bake for 15 minutes. Remove the paper and beans and bake for a further 5 minutes. Remove pastry from the oven and increase oven temperature to 180°C (fan-forced). 3. Whisk the eggs, milk and pepper in a medium bowl. Sprinkle the ham and cheese over the pastry case. Pour the egg mixture over the filling. Bake for 25-30 minutes or until the filling is set. Set aside for 10 minutes before removing from the tin. 4. Meanwhile, line a small oven tray with baking paper. Put the tomatoes on the prepared tray. Spray with cooking spray. Roast for 15 minutes or until tomatoes have softened. Remove from oven and set aside. 5. Sprinkle the quiche with rocket leaves, if you like. Serve with roasted tomatoes.
Nutrition Information PER SERVE 940kJ, protein 11g, total fat 8g (sat. fat 4g), carbs 26g, fibre 4g, sodium 317mg • Carb exchanges 11/2 • GI estimate low • Gluten free • Lower carb
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25
DIABETIC
living
SAUSAGE TRAY BAKE
26
DIABETIC
living
Serves: 2 (as a main) Prep: 10 mins Cook: 55 mins Difficulty: Easy 1 red onion, cut into wedges 4 small Carisma potatoes, unpeeled, thinly sliced 4 drained artichoke hearts (in vinegar), halved 100g cherry tomatoes 4 green shallots, halved lengthways 2 Peppercorn Pork & Red Onion Sausages, cut into chunks 1 tsp fennel seeds 1 small lemon, cut into wedges 1 tsp olive oil Freshly ground black pepper 400g can butter beans, drained and rinsed 100ml salt-reduced vegetable stock or gluten-free stock 50ml water 2 Tbsp pesto or gluten-free pesto
1. Preheat oven to 180°C (fan-forced). Toss the red onion, potatoes, artichokes, tomatoes, green shallots, sausages, fennel seeds and lemon wedges together in a baking tray or ovenproof dish. Drizzle over the oil and season with pepper. 2. Roast for 20 minutes, then add the beans, stock and water. Roast for a further 35 minutes. Remove from the oven, swirl through the pesto.
Nutrition Information PER SERVE 2330kJ, protein 30g, total fat 26g (sat. fat 5g), carbs 46g, fibre 24g, sodium 985mg • Carb exchanges 3 • GI estimate low • Gluten-free option
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For more great recipes and articles check out the latest issue of Diabetic Living.
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27
ABORIGINAL
voice
GETTING READY FOR COVID The COVID outbreak is disrupting face-to-face services, but Diabetes WA will always be available to help people in Aboriginal and remote communities manage their health, writes NATALIE JETTA As I write this, we’re seeing news of confirmed COVID cases in the remote Mantamaru Community, aka Jameson, which is located 1000km east of Kalgoorlie. People who know about or live on the Ngaanyatjarra Lands have been concerned about the virus getting in there, partly because vaccination numbers are pretty low. It does worry me that the rate of vaccination in Aboriginal and remote Communities is not where it should be. Back in January, Western Australia’s Aboriginal population had the worst rate of vaccination anywhere in the country and it’s still not improving fast enough. With the borders open, it’s so important that everyone — particularly those in remote areas — get their COVID jab as soon as possible. I know there’s always an understandable concern when there’s a big push around some new medicine and I know there’s a lot of bad information out there. It’s natural that people find themselves listening to grapevine gossip and getting scared of the unknown. Especially when you don’t have easy access to actual facts or professional advice. Part of our preparation for living with COVID has been to make sure that West Australians with diabetes — wherever they are living — have easy access to support and advice 28
whenever they need it. Although we won’t be running face-to-face sessions for a while, we will be running online workshops and we’ll also be sharing the latest information and health advice through our website and our dedicated Facebook page. You may already have seen our new COVID video which I hope will be an antidote to some of the misinformation that’s out there. If you don’t have easy access to technology, but can’t — or don’t want to — leave the house to find support, you can always give us a call. Our Telehealth services remain open and ready to provide you with the help you need to manage your diabetes in a time of COVID. This is really important if you’re living in a remote community and you’ve just been diagnosed with diabetes. Getting access to the usual face-to-face help might not be so easy in the middle of an outbreak. Hopefully, you’ll still be able to make appointments with a clinic in your area, but get in touch with us for all your needs around diabetes education and support. If you can’t call our telehealth service, you can always get in touch through our Facebook page. We’ll do our best to get back to you quickly. One of the biggest disruptions to my
work life is that we won’t be running our DESY education sessions for a little while, as travel in and out of remote Communities has been severely limited. We know how important these sessions have been to Aboriginal people living with diabetes and I hope that we can get them up and running again in the near future. We’re also having conversations about how we could effectively offer an online version of the session, while being aware that not everyone living in remote Communities has easy access to a reliable internet connection. Metro sessions are also on pause, sadly. My colleague Kathy Lemon has been busy lately delivering diabetes education to newly trained Aboriginal Health Workers at Marr Mooditj Training Centre. She has also been running Smarts sessions at Ngulla Mia (Perth’s Richmond Wellbeing Centre). We delivered MonitorSmart and our Feltman training program and had intended to deliver FootSmart, until the current outbreak made that impossible. We had also scheduled a DESY session at Nidjall Waangan Mia in Mandurah in March that will hopefully be rescheduled. The Smarts sessions for Aboriginal people living with diabetes are a new initiative for us. Although the material hasn’t been especially adapted in the
ABORIGINAL
voice
ve easy If you don’t ha g y, but lo o n h c te to s s acce ’t want to can’t — or don use to find o h e th e v a le — an always c u o y t, r o p p u s give us a call.
way that our DESY sessions have been, the sessions have been delivered by a diabetes educator who is culturally safe and works a lot within an Aboriginal Community. We were really pleased to see how well those sessions were received and look forward to offering them again as soon as possible. I know the next few months might be very difficult for all West Australians, particularly those living in Aboriginal and remote Communities. Again, I do encourage you to get vaccinated and do what you can to make sure you’re as ready as you can be to deal with COVID. As you've seen in the rest of this magazine, getting on top of your diabetes management can also
make a big difference to the sort of disease you might experience if you are exposed to COVID. That’s where we can help, so do keep an eye on our website, on our Facebook pages and, if you need help or advice, make sure you give our Telehealth service a call on 1300 001 880.
Diabetes WA’s Telehealth Service is a free education and clinical support service for people living with diabetes in rural and remote areas of WA. It is open Monday to Friday 8:30am – 4:30pm. 29
TAKE
a hike
WORKING OUT FROM HOME Getting out and about can become a daunting thought when summer (or a COVID outbreak) is in full swing, writes DENISE BROWNSDON. This summer was a record breaker and – as I know all too well – sometimes (often) those long, hot spells really test your willpower to leave the airconditioned comfort of home. Then there is the frustrating reality of COVID and the limitations it can put on what we want to do. Now, probably more than ever, we need to be staying active. We aren’t travelling as much and, because of lockdowns and restrictions, many of us are reducing how active we are. For our physical and mental wellbeing we need to keep moving. Some people may not feel comfortable in the current climate to be heading to an indoor gym but that doesn’t mean you can’t be doing something!
There are a number of trainers holding outdoor training sessions at local parks. Get on to your local community Facebook page and ask about the ones around you. Many offer you a free trial for the first time too, which is a great way to see if the trainer and workout style will suit you. If you’re not ready to be in a group environment, what about an early morning or evening walk or jog? It’s easy to social distance in both of these options. There are also trainers providing online guided workouts in real time (or ones that are pre-recorded to do when it suits you). This style was my favourite during our previous lockdowns. And there are some great free Metafit style workouts available online, and you can download a free Tabata style timer for your phone too. Metafit is body weight based (so no equipment required) and easy to modify if you aren’t able to do some exercises. When I first started at the gym I was unable to do sit ups so I sat on the floor or a weight bench and did little abdominal crunches and I progressed from there. The key to working out from home is staying accountable. Schedule it into your day and treat it like any other
important appointment that you can’t cancel or postpone. Grab your towel and water bottle and head outside (it doesn’t matter what size space you have either as you can scale the exercises to suit your location) and just get active (plus the fresh air makes it so much more enjoyable)! It’s 20-30 minutes of working up a good sweat and then you can relax. My knee recovery is coming along well too. I must admit I got a bit frustrated with how slowly it was going so I had a good chat with my physiotherapist and my trainer. Together we made some changes to my program to mix things up a bit. I’m now able to join back in on some of the circuit classes with some modifications. I’ve recently been able to increase the weights I lift as well – all because I’m listening to my body and integrating suggestions from the physio. I finally was able to get a couple PBs (personal bests) for myself in the gym which has definitely boosted my confidence and determination! Don’t be afraid to share your achievements with other people. I felt a bit weird at first sharing photos online about my achievements with my friends but after I did, a few friends messaged me telling me that it inspired them to think about what could they do to get started. If I can help inspire one person to make changes, then I’ve succeeded. While we all continue work through the chaos of COVID-19 and the constant changes it brings, stay positive and remember to make your health a priority!
30
STAYING
in
STAYING IN THIS AUTUMN With major public events on hold, it’s time to think about keeping entertained indoors, writes MYKE BARTLETT. Film Last Night in Soho (DVD, Blu-ray, Stream)
Young fashion designer Eloise is obsessed with the Swinging Sixties. What luck then that, on moving to London, she finds herself able to travel back to the capital’s 1960s heyday and experience life in its glamorous Soho clubs. Or is she just dreaming that she can? The line between dreams and reality soon becomes blurred, as Eloise discovers that nostalgia can hide some dark truths about what the past was really like. From director Edgar Wright (Hot Fuzz, Baby Driver), Last Night is part-mystery, part-ghost story and one of the most colourful and surprising films in ages. The soundtrack is ace too.
Television Get Back (Disney+)
Sticking with the 60s, Peter Jackson’s epic documentary about The Beatles made for a perfect Christmas present for fans of classic music. If the thought of eight hours has been putting you off, rest assured that it makes for increasingly addictive and absorbing viewing, as the Fab Four race the clock to write songs, record an album and perform a surprise concert like no other. It’s like sport for music nerds — will our team triumph? More than that, it’s an incredible document of creativity, as Paul McCartney summons timeless hits such as Get Back and Hey Jude out of thin air. At the end of the day, who wouldn’t want to spend eight hours in a room with one of the greatest bands ever to make music?
Mindwandering by Moshe Bar (Bloomsbury)
Daydreaming gets a bad rap, but this new book argues that it’s key to being creative — and can also brighten your mood. Cognitive scientist Moshe Bar looks at the cutting-edge research behind our brain’s tendency to distraction, to wander, to worry or talk to itself about things that don’t always seem important (or relevant)! His easy to read style helps us consider what to think about, how to stimulate creativity by dwelling on our memories, how we can come to understand ourselves better, ways of thinking that might cheer us up, and how we can avoid getting distracted by knowing when it’s time to rein our brains in.
Everyone In My Family Has Killed Someone by Benjamin Stevenson (Penguin)
The murder mystery can feel as tired as it does tried and true. In his third novel, Aussie comedian Benjamin Stevenson takes great joy in twisting the format to breaking point (having clearly outlined the 10 rules of detective fiction with a fold-ready dogear at the start of the book.) His hero is summoned to a family reunion at a suitably remote spot and soon the deaths begin. Smart, funny and an irresistible blend of modern and old school, this should please fans of Agatha Christie, The Thursday Murder Club and Knives Out.
Book The Leviathan (Bloomsbury)
History and myth entangle in this compelling and entertaining new mystery from a debut UK author. Thomas, a soldier in the English civil war, returns home to find his father ill and his sister making accusations of witchcraft. His rationality is tested to its limits as death encroaches and he tries to work out what is going on. What connects the current dark events to a shipwreck years earlier — and something ancient stirring beneath the waters? With echoes of Sarah Perry's superb The Essex Serpent, this intelligent and beautifully written novel is perfect for the lengthening autumn nights.
The Mother by Jane Caro (Allen & Unwin)
Walkley Award winning journo and social commentator Jane Caro turns her hand to thriller writing in this tense and complex new novel. Recent widower Miriam is a devoted mother and grandmother who starts to wonder if all is well with her youngest daughter Ally. Has Ally’s relationship with her husband become toxic — and dangerous to herself and her children? When the police can’t intervene, Miriam decides to take action on her own. But how far will she go to protect her family? Tackling topical issues of domestic violence, this is a compelling read. 31
MEMBERS
stories
SHINING
BRIGHT Last Christmas, Greg Forknall’s family lit up the town in the memory of a loving husband, father, grandfather and friend. A special Christmas light show outside a family member’s home in Piara Waters helped raise money for Diabetes WA, inspired by Greg’s life-long desire to help others. His widow LISA FORKNALL tells his story. Greg was a good man who dedicated his life to caring for his family and making life better for everyone else. He and I were high school sweethearts from when we were 14 and married 10 years later. As a teenager Greg was awarded the highest honour in Scouting, the Queen Scout Award, and was named Junior Citizen of the Year for Bunbury. He also volunteered for the State Emergency Service. He always found the time to volunteer despite working around the clock. Around his 21st birthday, Greg was looking quite gaunt and was diagnosed with type 1 diabetes soon after. There were tough times early on when, without modern technology such as blood glucose monitors, Greg had to get used to injecting himself with insulin using frighteningly large needles and had to move quickly from injecting twice a day to four times a day. He never let his diabetes get in the way. He always had his barley sugars at the ready, but things were a lot easier when he got his first insulin pen and blood
32
glucose monitor. In his younger days, Greg played a lot of football and hockey and remained a keen sailor, competing in overnight races along the West Australian coast. He also built a successful career as a senior accountant and chief financial officer for companies including BHP Biliton, Worley Alumina and Westralian Sands. He did work long hours and travelled quite a bit, but he always managed his diabetes. He figured out how to adjust his insulin and food to different time zones when he had to fly to the other side of the world. In 2010 Greg was diagnosed with bowel cancer but continued working throughout chemotherapy because of his dedication to his work and family. He saw cancer as a small hiccough in his life, but nine years after going into remission, he was admitted into hospital with a heart attack. He had no pain but felt short of breath and needed to rest constantly. Within 20 minutes of the paramedics diagnosing Greg in his hotel room, he was on the operating table at the local hospital, having a stent put in. He stayed in hospital for a few days to recover, but found his diabetes soon got out of control because he initially wasn’t allowed to manage his diabetes himself. After insisting on self-management, he got back on top of things. We learned at the ward that people with diabetes don’t usually feel pain during a heart attack. That’s why Greg didn’t know he was having one. We were also surprised at the number of people with diabetes in that cardiac ward.
Having survived a massive heart attack and bowel cancer, Greg joked that he wasn’t worried about COVID-19 as the pandemic began. Sadly, just as we were preparing to retire, he died from heart failure soon after Christmas in early 2021. When I found him in bed, it looked like his heart had stopped, but I knew he’d had a full check-up in November and his cardiologist said everything was fine. I was surprised to hear the confirmation from the coroner’s office that it was his heart. I guess it was just Greg’s time. Greg is much missed by his family, including son Chris and daughter Nicolle. The Christmas light show to raise money for Diabetes WA was actually the brainchild of Nicolle’s husband Steve DiConza. He and Nicolle had originally thought about raising funds for the Heart Foundation but Greg’s five- and eight-year-old grandsons said they remembered Pop having his needle and decided the family should raise funds for people living with diabetes. Having the light display and raising funds was a lovely way to remember Greg. Diabetes WA would like to thank Lisa Forknall for taking the time to share Greg’s story and the Forknall family for raising money for Diabetes WA to continue to support people living with diabetes and advocate for their needs.
MEMBERS
area
Train Your Brain Puzzle 1 (Hard, difficulty rating 0.72)
3
1
6
Note that each of the 3 by 3 boxes must also contain the
2
numbers 1-9. (Answers below)
1
4
7
9
1
2
1
4
9
4
6
5
3
9
2
8
7
8
3
9
5
5
8
2
1
3
7
6
4
2 3 8 7 5 4 6 1
5 8 3 1 6 2 7 9
9 5 6 2 4 1 3 8
3 2 7 9 1 6 4 5
6 4 5 8 3 7 9 2
1
7
4
6
6
8
6
4
1
2
2
8
4
5
7
8
5
4
6
9
8
7
The aim of the game is to fill the entire 9 by 9 grid - which is made up of nine 3 by 3 boxes - with the numbers 1-9.
8
3
8
9
6
7
3
4
5
9
3
3
5
Give your brain a good workout with this number-crunching Sudoku puzzle.
9
2
4
Generated by http://www.opensky.ca/sudoku on Mon Feb 28 06:40:06 2022 GMT. Enjoy!
2021-015
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* Data based on the number of users worldwide for FreeStyle Libre family of personal CGMs compared to the number of users for other leading personal CGM brands and based on CGM sales dollars compared to other leading personal CGM brands. 1. Notifications will only be received when alarms are turned on and the sensor is within 20 feet of the reading device. An urgent low glucose alarm is available with the FreeStyle LibreLink app. 2. FreeStyle Libre 2 User’s Manual. 3. Data on file, Abbott Diabetes Care. In a study conducted by Abbott Diabetes Care, most users agreed that getting glucose readings from the sensor was less painful than getting glucose readings from finger pricks. FreeStyle, Libre, and related brand marks are marks of Abbott. Information contained herein is for distribution outside of the USA only. Abbott Australasia Pty. Ltd., Abbott Diabetes Care, 666 Doncaster Road, Doncaster, Victoria 3108, Australia. ABN 95 000 180 389 ADC-54103 v1.0
