Winter 2022 $6.95
diversity+ diabetes
A Diabetes WA Member Magazine
TAKING A DIFFERENT APPROACH
healthy RECIPES
LIVING
well
If you’ve got it, we get it
From the Editor
member magazine! Welcome to the winter edition of your back we received on I was absolutely delighted by the feed ys wanting to make sure our last issue. As the editor, I’m alwa readers, which means this magazine really connects with its t works. listening to you when you tell us wha munity is a diverse We’re well aware that the diabetes com is unique, no two of ey one. Just as everyone’s diabetes journ e looking at how we’r e, our readers are the same. This issu etes in Australia. diab t that diversity affects the way we trea n – what does natio ural We are the world’s most multicult can we make How tice? prac that mean when it comes to best care, no and ort supp sure that everyone receives the best be? t migh nd grou matter what their particular back ased risk of diabetes We look at the facts around the incre istically diverse for Australians from culturally and lingu e from? What can backgrounds. Where does that risk com our diabetes educators we do about it? We hear from one of program to increase its about how she tailored an education ities. And we take a look effectiveness for particular commun ly observe Ramadan. at how people with diabetes can safe rse as our readership! Of course, our contents are just as dive advice on preparing Alongside the main features, you’ll find after injury and how cise exer to for pregnancy, on returning g diabetes. There’s agin man e to follow a vegetarian diet whil ies and more! stor ber mem also the usual news, recipes, Happy reading! Myke
Contents A Word From Us ................................................................. 1 Your Voice, Our Actions ................................................. 2 Diabetes News Commitment to subsidise type 1 technology.................... 3 State budget announcements ............................................... 4
Talking Science Food insecurity in youth increases risk ............................ 5 New education program reduces hypo risk ..................... 6
From the Cover Diversity & diabetes ................................................................. 7 What are the risks?................................................................... 8 Listening to the people you need to help ........................ 10 Ramadan and diabetes .......................................................... 12
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, Carly Luff, Christine Carne, Jane-Anne Gardner 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: Glide Print 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
On the Line ............................................................................ 14 Workshop Calendar ........................................................ 16 Living Well Planning for pregnancy ........................................................ 18
Moving Well Can exercise delay the onset of type 1 diabetes? ....... 20
Diabetic Living recipes ................................................ 22 Aboriginal Voice ............................................................... 24 Take A Hike .......................................................................... 26 Members' Area Staying in .................................................................................. 27 Members stories .................................................................... 28 Member Benefit Partners .................................................... 29
2022-20080
WINTER 2022
A WORD FROM US
LOOKING TO THE FUTURE When you’re working in the health sector, it’s important to take the long view. As the pandemic has shown us, planning ahead can make a significant difference to health outcomes. This is particularly true for diabetes. We know the sort of risk factors that make a diagnosis of type 2 diabetes more likely in the future, so it is important to act and plan now to reduce the risk of rates rocketing in the years ahead. Over the past few months Diabetes WA has been reflecting on our strategy and thinking about the specific groups who might require more focus and support in the future. Nearly half a million West Australians (around one fifth) are currently at risk of or are living with diabetes and every day another 31 people are diagnosed with either type 1, type 2 or gestational diabetes. Diabetes WA strives to give a collective voice to these people and recognises that some at-risk groups have needs that are unique to their backgrounds and circumstances. This might include people living in regional and remote communities, people who are living with diabetes complications or people from diverse backgrounds. This issue of Diabetes Matters focuses on Culturally and Linguistically Diverse (CALD) groups as we know that more than a third of Australians diagnosed with diabetes were born overseas. This puts them at a heightened risk of diabetes, compared to people born in Australia. You can read more about
how diabetes impacts upon different communities in this issue’s main feature looking at diversity and diabetes. When looking at how diabetes affects different communities, it's important to acknowledge the risk to our First Nations peoples. Aboriginal and Torres Strait Islander people are disproportionately affected by diabetes and its complications. Five years ago, Diabetes was the second highest cause of death for Aboriginal and Torres Strait Islander people in WA. The evidence shows us that diabetes tends to affect Aboriginal people earlier in life and more aggressively. More than half – 60% – of WA’s known cases of children with type 2 diabetes are Aboriginal. That statistic is all the more stark when you consider only 6.8% of the state’s children and young people are Aboriginal. Diabetes WA will continue to work hard with stakeholders to develop a strategy to address the burden of diabetes in Aboriginal Communities. Our new five year strategy, which will guide us from this financial year through to 2027, places our members at the centre of our services and programs and we will be actively seeking more opportunities to engage with and hear directly from you over the
coming months. We will be asking you for your opinions and feedback around our services, membership offerings and other important initiatives as this feedback will help to shape our future. The last two years have been uniquely difficult for many West Australians. We’re proud that, despite the restrictions and lockdowns, we’ve been able to continue to provide a vital service to people across the state who are living with – or supporting people living with – diabetes. Even when face-to-face workshops haven’t been possible, we’ve been able to adapt and connect with those who need us through virtual sessions. And, of course, we’ve continued to offer our vital Telehealth service to those in regional areas. We’re looking forward to a big year ahead working with you, our members, and thinking about how we can best meet your needs. Thank you for your support. We hope we can continue to support you throughout the next financial year – and beyond!
Melanie Gates Diabetes WA CEO Mary Anne Stephens Diabetes WA Board Chair 1
95 2022 $6. Autumn
YOUR
voice, OUR actions
A Diabetes
well
MOVIN
LIVING WITH
What have you been telling us?
G
covid
We’ve had a lot of great feedback on our Living With COVID issue thank you to everyone who took the time to get in touch. One member called to say it was the best one she had read in ages! Hopefully we can keep up the high standard this time around.
well
EATING
Of course, the arrival of COVID in Western Australian put a big hole in everyone’s plans for the past few months. At Diabetes WA, we had to put our face-to-face sessions on hold, but our free virtual workshops have proved very popular. As you'll see on page 16, our in-person sessions will be available more consistently in the months ahead.
If you’ve
e get it got it, w
Good news!
Getting exercise right
Virtual workshops aside, April and May were big and busy months at Diabetes WA. As you’ll see across the next couple of pages, the WA state budget and Australian federal election gave us lots to talk about. The big news from the election was that every Australian with type 1 diabetes would now be eligible for subsidised access to continuous glucose monitoring (CGM) and flash glucose monitoring technology. This was something Diabetes WA has long been advocating for. Our members were delighted.
Early in May, we marked Mother’s Day (8 May) by noting that gestational diabetes (GDM) is on the rise – around 4000 pregnant Western Australian women are diagnosed with GDM each year during pregnancy. We marked International Day of Families (15 May) by remembering the vital role families play in supporting people with diabetes. We observed National Sorry Day (26 May) and celebrated National Reconciliation Week (27 May–3 June). And our resident exercise guru Marian Brennan (our accredited exercise physiologist and credentialled diabetes educator) spent Exercise Right Week (23–27 May) sharing videos, articles and tips on the best way to safely get active. You can find her articles on our website at diabeteswa.com.au.
"The best thing that happened to me. Especially travelling on my own. Safety for me and everyone else." Jan Adams, Facebook "Wonderful news for everyone who needs it." Keithleigh Griffin, Facebook "I'm so happy about this news! I just hope it won't lead to a shortage in sensor availability, etc." Mason Edwards, Facebook "About bloody time. Great news." Gai Walker, Facebook Some members were eager to see if CGM made a difference to their diabetes management. "I use test strips which cost $15 for 100 and last me about a month. But will try this and see if it helps me keep my sugars under control as testing is quicker and easier." Kim Riley Some members hoped the subsidy would one day be extended to Australians living with type 2 diabetes. "Insulin dependent type 2 here and I’ve been paying for these sensors ever since using insulin. Can’t imagine managing this without the sensors to be honest. I keep getting told how good my management of BGL is, but it’s purely down to the CGM. Much less of a burden on the health system using these, they should all be subsidised, it’s a no brainer!" Jason French, Facebook
Diabetes on the catwalk One last bit of excitement. Lila Moss, model and daughter of supermodel Kate Moss, was flooded with praise and thanks for confidently displaying her blood glucose monitor (that helps her to manage her type 1 diabetes) on her arm in a recent joint campaign for Versace X Fendi [pictured below]. Moss also walked a runway last year drawing attention to her Omnipod (insulin pump) that was on full display on her hip. It’s a great example of representation in the mainstream, which helps to destigmatise diabetes and the vital technology that helps people manage it. We hope that the cycle of invisibility for people with diabetes has finally begun to breakdown.
Photo credit: Lila Moss • Instagram
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 2
zine ber Maga WA Mem
DIABETES
news
DIABETES WA WELCOMES COMMITMENT TO SUBSIDISE
TYPE 1 TECHNOLOGY
A bipartisan commitment to lower the cost of vital technology will make a profound difference to thousands of West Australians living with type 1 diabetes. As of 1 July , all Australians living with type 1 diabetes will be eligible for subsidised access to continuous glucose monitoring and flash glucose monitoring technology. This development follows election commitments made by the new Labor government during the campaign. Under the existing Continuous Glucose Monitoring Initiative only a limited number of people with type 1 were able to access fully subsidised glucose monitoring technology. These changes will mean that people who are not currently eligible would only be required to pay $32.50 per month to access the technology. From July, thousands of West Australians – regardless of their
birthdate or bank balance – will now have cheap access to technology that might previously have put them under considerable financial pressure. Continuous and flash glucose monitors are small wearable devices that monitor glucose levels automatically, providing readings every few minutes and allowing the wearer to see their glucose levels on their smart phones. By reducing the need for finger prick checks and giving more information to people with diabetes and their healthcare team about glucose trends, they help the wearer to better manage their health journey and reduce the risk of complications. Melanie Gates, CEO of Diabetes WA, says the funding commitment is a great win for the type 1 community. "Diabetes WA has long been calling for better, equitable access to vital technology for West Australians with type 1 – our thanks to all the organisations and individuals who
helped make this happen," Ms Gates says. "Right now, a Continuous Glucose Monitor can cost someone living with diabetes as much as $5,000 a year. Cheaper and wider access to this technology means fewer health complications, better long-term outcomes and an easing of the burden on our health system." Diabetes WA works closely with people living with type 1 diabetes using this technology and we look forward to expanding this support. "We know this announcement will have a profound impact on the lives of thousands of West Australians," Ms Gates says. "Diabetes WA will be working hard to make sure this change is implemented effectively to guarantee quick and easy access for those who need it.”
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DIABETES
news
STATE BUDGET ANNOUNCEMENTS
May’s state budget contained a number of funding announcements designed to help better manage diabetes in WA’s Aboriginal communities. This year’s state budget, delivered by the McGowan Labor government, may have been overshadowed by the federal election, but contains vital funding commitments for the WA diabetes community. This funding will be of particular importance to the state’s Aboriginal Communities and demonstrates the importance of Diabetes WA’s advocacy in that area. The commitments include:
• • • •
$7 million to deliver Aboriginal midwifery services – a key step in improving the management of gestational diabetes and one Diabetes WA has long advocated for $3.7 million to establish the Aboriginal Health Practitioner profession in WA $55.2 million for telehealth services which provide crucial patient care to those who don’t need an emergency department $920,000 for planning and design of a new renal dialysis centre in Halls Creek – which will prevent people from the area having to travel or move to Perth to receive dialysis.
This last funding commitment is important, as Aboriginal people living in remote areas have 20 times the incidence of end stage renal disease compared with the national average. Diabetes is the leading cause of preventable dialysis. While the funding is very welcome, the opening of new dialysis centres across rural and remote WA represents the failure of our health system to support people living with diabetes in those areas and prevent renal complications. Diabetes and its complications disproportionately affect the lives of Aboriginal and Torres Strait Islander people. In 2017, Diabetes was the second highest cause of death for Aboriginal and Torres Strait Islander people in WA. 4
The social and economic impacts of diabetes is often silent because generations of Aboriginal people now live with diabetes and its complications as part of everyday life. It’s likely that the prevalence rates of diabetes in remote Aboriginal communities are significantly under-reported at 13%, given that studies led by Aboriginal Community Controlled Health have found incidence rates of diabetes as high as 33%. These rates only increase with age. Across three Communities, a study found 60–70% of people over 65 years had diabetes. We also know that Aboriginal West Australians (aged 25–49 years) experience a 38 fold higher rate of major lower limb amputation and 27 fold higher rate of minor amputations. Diabetes strikes Aboriginal people earlier in life and more aggressively. There are 290 Western Australian children on the type 2 diabetes database and 60% of these are Aboriginal children. The life expectancy of a child with type 2 diabetes is 15 years less than a child diagnosed with type 1 diabetes. Some of these young people have already died from their diabetes complications. Australia has the highest recorded rate of pre-existing diabetes in pregnancy in the world, driven by an inequity of access to practical and culturally safe antenatal screening and care to support the diagnosis and self-management of diabetes in pregnancy. Causes of diabetes in Aboriginal people are very complex. The current over-simplification and stigma of type 2 diabetes being a ‘lifestyle disease’ that can easily be prevented in Aboriginal communities is not helpful and is resulting in fear and shame. Diabetes WA welcomes the new budget commitments. We also recognise and respect that to address the disproportionate burden of diabetes experienced by Aboriginal Australians, all actions and initiatives must promote self-determination and align with the Closing the Gap Priority Reform areas in the National Agreement on Closing the Gap.
TALKING
science
FOOD INSECURITY IN YOUTH INCREASES RISK OF DIABETES LATER IN LIFE
A new study shows that young adults who are worried about access to food are more likely to develop diabetes within the next decade, writes JESSICA WEISS. We’ve long known that your socio-economic status — in short, how much money you do or don’t have — is a reliable predictor of your diabetes risk. While past studies have linked food insecurity — being without access to a steady supply of nutritious food — with a range of health issues including diabetes, obesity and hypertension, a new study has now proved a direct causal relationship over time. The Washington State University study, published in May 2022, tracked 4000 young people between the ages of 24 and 32 and checked in on them again 10 years later. They found that adults who said they had been worried about food running out in the past year at ages 24-32 demonstrated higher rates of diabetes a decade on, compared to those who did not report food insecurity issues. While the study couldn’t identify the exact reason for this link, previous research has shown that households that experience food insecurity often have diets with lower nutritional values. Eating well and following the dietary guidelines can require more money and more time, making it a luxury for many families. Additionally, those living in lower socio-economic areas may find themselves too far away from sources of cheaper healthier food. The study’s author, Assistant Professor Cassandra Nguyen said households experiencing food insecurity can find themselves caught in a negative feedback loop. Food insecurity leads to a poor diet, which leads to disease risk, which creates additional health care expenses, which puts the household under further economic stress, which deepens food insecurity. And so on. While the study did not take into account differences in diabetes risk for people of culturally and linguistically
diverse backgrounds, the authors did note that the sample may have been too small to identify any pattern among specific cultural groups. In the US, there is evidence that interventions designed to either supplement diets or educate people about good nutrition have been effective in improving health and lowering the risk of health issues such as diabetes. Linking these successful interventions with strategies to identify and address food insecurity in at risk groups is a crucial next step – with lessons to be learned closer to home. Although levels of food insecurity are not currently measured in Australia, estimates suggest that between 4% and 13% of the general population are food insecure. Aboriginal Australians are at far greater risk, with food insecurity believed to affect between 22% and 32% of the Indigenous population, depending on location. Other Australians known to be more at risk of food insecurity include low-income earners, people who are socially or geographically isolated, culturally and linguistically diverse groups, single-parent households, older people and people experiencing homelessness. Strategies employed here to combat food insecurity include policy interventions, local level collaborations, emergency food relief initiatives, school-based programs and education. Child, family and community welfare organisations all have a role to play in identifying families that may be experiencing food insecurity and linking them with available support. As in the US, the most important first step is finding people and groups who might be at risk. Screening for food insecurity can be quick, discreet and easily built into existing intake or assessment processes. Doing so also allows child, family and community welfare practitioners to identify potential specific food security requirements relative to other needs being assessed and to use this information in providing or linking to the help people need. 5
TALKING
science
NEW EDUCATION PROGRAM REDUCES HYPO RISK A new UK program designed to educate adults with type 1 diabetes has been shown to significantly reduce the risk of hypoglycaemic episodes, writes CARLY LUFF. Researchers at King’s College Hospital in London have trialled a new educational program, aimed at reducing hypoglycaemic episodes which occur when blood glucose falls to a potentially dangerous low. Hypoglycaemic episodes — colloquially known as “hypos” — can be very serious if untreated, impairing normal brain function, causing confusion and sometimes proving fatal. People with type 1 diabetes will be familiar with the dangers of hypos and will be aware how essential it is to treat one with fast-acting carbohydrates to restore blood glucose levels. Nonetheless, they can be distressing for patients and their loved ones. The six-week pilot program, known as HARPdoc or Hypoglycaemia Awareness Restoration Program for adults with type 1 diabetes, was trialled with patients across three sites in the UK and one in the US between 2017 and 2021. It was funded by the Juvenile Diabetes Research Foundation International, with additional support from the UK’s National Institute of Health Research. The program, which aims to change how people think about their hypoglycaemia, is delivered by trained diabetes educators to small groups, online or face-to-face, over six weeks, followed by reinforcement at three and six months. It uses psychological theory to address unhelpful health beliefs that act as barriers to hypoglycaemia avoidance. HARPdoc educators have been trained to use psychological therapy techniques to help participants during the program. These educators are supported by the HARPdoc psychology team, while 6
people participating in HARPdoc remain under the care of their usual diabetes care provider. The patients recruited into the trial had lived with type 1 diabetes for many years. Half of the participants reported having problems with hypoglycaemia for more than 10 years, despite having access to therapies and technologies for effective insulin delivery and blood glucose monitoring. The program was particularly targeted at patients with type 1 diabetes who were experiencing repeated severe hypos, after having lost their ability to identify the early symptoms. Participants were asked to describe their thoughts about hypoglycaemia, to help them regain awareness and avoid future attacks. Half of the trial participants received the HARPdoc intervention and the remaining half were treated with a different NHS-approved program, known as Blood Glucose Awareness Testing or BGAT, which does not address the thoughts and health beliefs about hypoglycaemia. The participants were all followed for 24 months. Both programs were found to reduce hypos when offered to patients who had already completed structured education programmes. However, HARPdoc was also shown to improve mental health and reduce patients’ level of distress related to their diabetes. Participants reported lower levels of anxiety and depression on having completed the trial. This improvement in mental health, alongside experiencing fewer episodes
of severe hypoglycaemia, is seen as a great success by the researchers. Programs such as HARPdoc, which involve an element of education and reasoning, could be a cost-effective intervention, relieving physical and mental distress for adults living with type 1 diabetes. They may prove a valuable tool for people experiencing severe hypoglycaemia to use alongside their existing treatments. The intervention could also reduce a patient’s need for additional health service support over time. The success of the trial in both the UK and the US suggests it could be effectively implemented in Australia, alongside existing programs.
DIVERSITY +
diabetes
DIVERSITY
& DIABETES Where you’re from — and the language you speak — can have a big impact on your risk for diabetes. Australians from culturally and linguistically diverse (CALD) backgrounds tend to be at higher risk for conditions connected to developing diabetes, although the reasons why can be as complex to understand as they are to address. In a special feature this issue, we look at what the diabetes risks are for people from CALD backgrounds and check out some programs designed to make a difference to groups whose needs often go unheard.
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diabetes
DIVERSITY & DIABETES
WHAT ARE THE RISKS?
There have been a number of reports into why Australians from CALD backgrounds are at greater risk of developing diabetes, but little consensus into the best approach to turning the tide, MYKE BARTLETT writes. Australia prides itself on being a diverse, multicultural nation, with around a third of our population born overseas. That diversity is a strength, but it does require us to remember that different parts of our society may have needs that are very different to our own. Culturally and linguistically diverse (CALD) Australians are those born overseas in countries where English is not the main language spoken or who may have been born here but speak a different language at home. As a minority group, the needs of CALD Australians can sometimes be overlooked in favour of meeting those of the majority. Addressing this oversight is particularly important when it comes to health, as coming from a CALD background can mean you are at increased risk of conditions such as diabetes. A report compiled by the University of Sydney in 2007 looked at six broad CALD groups who were at greater risk of having diabetes. These groups were European (including 8
people from Germany, Greece and Matla), African, Chinese, Middle Eastern, Pacific Islanders and Asian (including people from the sub-continent). Each of the groups was also overrepresented when it came to risk factors for type 2 diabetes, such as obesity, cardiovascular disease, high blood pressure and gestational diabetes. Understandably, it’s difficult to pin these increased risks to any one cause. The increased risk of diabetes is thought to be due to a combination of genetic, biological, economic, behavioural and environmental risk factors. For some cultural groups, moving to a country with a Westernstyle diet seems to be associated with a rise in rates of diabetes. The prevalence of type 2 diabetes among Asian Australians, for example, has been reported to be increasing at a disproportionately high rate compared to non-Asian Australians, despite the fact that diabetes is less common throughout Asia than it is in Australia.
DIVERSITY +
diabetes
A weighty issue
a nuanced approach, Ranita says.
It’s very possible that adjusting to a different style of living, particularly for immigrants from non-Western countries, might lead to an increased risk of type 2 diabetes. Being overweight or obese is thought to account for about half of the increase in diabetes risk for Australians born overseas. New immigrants might find themselves consuming more high energy foods and, for a variety of reasons (including the sort of work available to people from CALD backgrounds), may find themselves leading a more sedentary existence, which can contribute to weight gain.
“Sometimes there’s a different understanding of, say, husband and wife dynamics. If the husband is the one who goes out to work every day, they're often more familiar with the English language. You can find yourself talking to the husband, but it’s really the wife that’s pregnant. You have to be mindful of this, and try and ensure that you’re communicating not to the husband but to the pregnant woman.”
A report from the Australian Institute of Health and Welfare (AIHW) claims that people who usually spoke a language other than English at home were more likely to be insufficiently physically active, when compared to English speakers. More than 60% of Southern and Eastern European-born people were above a healthy weight, compared to 46% of people born in Australia. Various other Australian studies have identified a high prevalence of obesity among certain culturally and linguistically diverse groups, including Middle Eastern and Mediterranean cultural backgrounds. Organisations including Diabetes WA are working on programs designed to reach these at-risk groups and help close the cultural gap (see page 10).
Closing the gap A change in lifestyle leading to weight gain is only one of the risk factors for Australians from CALD backgrounds. The impact of some of these risks might vary between the different CALD groups, but others — such as language barrier, literacy rates and lack of access to culturally appropriate care — have a widespread and consistent effect. For health practitioners, a lack of knowledge about different cultural practices can sometimes make it more complex to provide care. Diabetes WA endocrinologist Ranita Siru encountered this firsthand, when working with women presenting with gestational diabetes (see page 18). “One of the main things that we do is adjust diets,” Ranita says. “Women with gestational diabetes often need to make changes to their eating habits, particularly if they are eating too many carbohydrates. People from different ethnic backgrounds have different preferred carbohydrates, not all of which I was familiar with. We would have to adapt our serving size recommendations for these new carbohydrate containing foods.” She says that dietitians and diabetes educators rose to the challenge, quickly working out the carbohydrate content in flours and grains that weren’t covered by the existing literature, to ensure they were giving appropriate advice. “It’s important to admit that you don't know these things, but try and work out how to allow your patients to have a culturally appropriate diet with foods they’re familiar with, rather than, you know, telling them they have to eat a slice of toast at breakfast.” Navigating other cultural barriers can require sensitivity and
While we have a good understanding of the sort of intervention programs that can reduce the risk of developing diabetes, there remains a lack of knowledge about how best to reach CALD communities. There has been an increased effort in recent years to take into account different cultural approaches and practices to food when managing diabetes, Ranita says, citing recent advice sheets around diabetes and Ramadan (see page 12). “It’s unusual in Western culture to have a prolonged period of fasting through the day and to eat only at night. When it comes to insulin therapy, there are considerations about the effect of prolonged fasting and what that means, but you can’t have doctors simply saying ‘oh no, you can’t fast during Ramadan'. That’s not culturally sensitive at all. It’s great to see there are now new guidelines to assist doctors in helping people with diabetes manage insulin during that time period.”
Better understanding means better care The main obstacle to better diabetes care for people from CALD backgrounds is, as identified by the AIHW report, a lack of knowledge. Often this amounts to a lack of information about rates of diabetes in certain cultural groups here or in someone's country of birth. It can be hard to ascertain the risk of diabetes complications for some groups because country of birth is not always recorded for procedures such as lower limb amputations. The AIHW report recommends Australian health providers do more to obtain that sort of information, so that the needs of specific cultural groups can be better catered for. It’s also crucial that more studies are run into the effectiveness of intervention measures — such as the diabetes education programs run by Diabetes WA — for specific CALD groups. We know what sort of interventions work on a broad scale, but how can we make sure those programs are effective for all communities? The 2007 University of Sydney report examined studies that had been run into CALD interventions and identified a few key themes. As well as being practical, the most successful programs were consultative, collaborative and culturally appropriate. The answer, it seems, lies in listening rather than lecturing. When organisations invited communities to tell them what their needs were and collaborated to develop a suitable program, the result was a culturally sensitive intervention that had a very real impact on the lives of a diverse bunch of Australians. We may still have a lot to learn but, as Ranita says, the best way to close the knowledge gap is to first recognise that it exists. 9
DIVERSITY +
diabetes
LISTENING TO
THE PEOPLE YOU NEED TO HELP
10
DIVERSITY +
diabetes
A one-size-fits-all approach to diabetes education can be alienating to people from CALD backgrounds. DIANE LEDGER explains how she helped develop programs that met the specific needs of two communities. We’ve long known that people from diverse backgrounds can be at increased risk of diabetes. It’s one of the reasons that we developed DESY – a version of the DESMOND self-management program Diabetes WA has licensed that was specific to and culturally-safe for Aboriginal Australians. The success of that program is proof that we need to move away from a one-size-fits-all approach to diabetes education. When Diabetes Queensland (DQ) got in touch with us to say they were interested in adapting our DESMOND program for two different cultural groups, using the lessons we had learned from DESY, I was really keen to be involved. Their Pacific Islander and Arabic communities had been asking for something in relation to diabetes education, and there was nothing around that was designed to meet that need. So DQ contacted us and asked if we would work with them in adapting DESMOND again, with a different focus. The main lesson we learned in developing DESY was that the community you’re targeting has to lead the process. We built a cultural adaptation pathway with nine steps that we use when creating material for Aboriginal communities. The process highlights the need to clearly identify the community you’re wanting to reach and to speak to them before you get started. You can’t just go into a community and dump a prepared program on them without talking to them first. We’ve seen what happens
when organisations such as ours try to build these sort of targeted programs without doing the community consultation. They tend to quickly fall apart and fail their intended audience. Queensland did an amazing job of consulting with their Pasifika and Arabic communities. They established an expert reference group in which they presented community representatives with the DESMOND program and allowed the community to discuss which elements were relevant to them. Some of the main things they considered were diet and physical activity and making sure that information was appropriate and, where it wasn’t, changing it to meet the community's needs. What makes this adaptation process easier is that DESMOND is all about self-management, about empowering the individual to take control of their diabetes themselves, and I think that resonates with a lot of these community groups. It’s not about going in and saying, 'you must follow this diet and you must take this medication and do this'. It’s very much about working with the person. What we’re doing with DESY and these Pasifika and Arabic versions is extending that individualisation to a larger group. Being culturally appropriate isn’t just about the material. It also means finding educators and facilitators who are part of the community we’re trying to reach. When we find a community educator, we train them up in the DESMOND program and they work alongside a health professional to
deliver the sessions. Finding the right person isn’t always easy, but it’s critical if these programs are to succeed. In the past, we’ve tried sending in a diabetes educator who might have been briefed on the community they’re working with, but there’s always a slight disconnection between the audience and what is being presented. You don’t get the same momentum in discussions or investment from the group. It feels too much like we’re imposing ourselves if the information isn’t coming from someone who belongs to that community. The Queensland sessions have proved popular, although COVID has obviously interrupted their delivery. As the pandemic recedes, we’re seeing renewed interest from those communities, which I’m sure will build further in the coming months. Diabetes New South Wales are currently working on their own version of the program, catering to the specific needs of their local Arabic community. We’re hoping the success of DESY here in Western Australia and of the Arabic and Pasifika versions in Queensland will open the door to developing more culturally appropriate DESMOND sessions. We’d love to run those Queensland sessions in our own backyard. Greater funding will help us get those programs off the ground and we’re working hard on securing that. We know there’s a need here from a range of diverse communities and we want to make sure we’re helping them as best we can – and in the way they need to be helped. 11
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diabetes
RAMADAN & DIABETES Fasting and managing your diabetes can be difficult, but not impossible, writes CHRISTINE CARNE.
Here are some key safety tips to help you prepare for Ramadan:
The holy month of Ramadan (which this year ran between Saturday 2 April and Sunday 1 May) involves the religious practice of fasting between dawn (Suhoor) and sunset (Iftar) for all healthy adult Muslims.
RISK:
The elderly, the sick, or women who are pregnant or breastfeeding, or people with a chronic condition such as diabetes are not required to fast and can give to charity to those who are less fortunate. However, many people belonging to these groups still choose to participate in Ramadan fasting. If you are living with diabetes, you can fast, but there are a few important things to keep in mind. Fasting for Ramadan changes your usual eating patterns, medication regimens, exercise routines and sleeping patterns. These changes can lead to unstable glucose levels and complications that may include: • low blood glucose levels (hypoglycaemia) • high blood glucose levels (hyperglycaemia) • dehydration • diabetic ketoacidosis (people living with type 1 diabetes)
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Know your risk before you decide to fast. Visit your doctor or diabetes team six to eight weeks before Ramadan to understand your risk category and to have a health care assessment. There are groups of people who might make themselves ill by fasting, for example those who require insulin to manage their diabetes, are on multiple diabetes medications or have diabetes complications. If you doctor advises you not to fast, you will get the same Thawab (reward).
ADJUSTMENTS: Talk to your doctor about any medication adjustments that might be required, particularly if you are using insulin. The dosages, timings or even type of medications you use may need to be changed during periods of fasting to help manage your glucose levels.
MONITORING: Check your glucose levels more frequently during fasting. It is important to note that glucose monitoring and insulin injections do not break the fast and are important in detecting low (hypoglycaemia 3.9 mmol/L or less) or high glucose levels (hyperglycaemia 15 mmol/L or greater). The best times to check your blood glucose might include before Suhoor, morning, midday, midafternoon, before Iftar, two hours after Iftar or at any time you experience symptoms of low or high glucose levels.
Hypoglycaemia Insulin and certain glucose lowering medications can cause low glucose levels when fasting. Additionally, hypoglycaemia may be experienced when stored glucose is not released quickly enough to meet your body’s energy requirements. You must break your fast immediately if you experience hypoglycaemia. Hyperglycaemia In some people glucose levels may go higher rather than lower. For people with type 1 diabetes, it is important to check your blood or urine ketone levels when experiencing hyperglycaemia to avoid diabetic ketoacidosis.
ACTIVITY: Perform low to moderate exercise only during fasting. Tarawih prayers, such as bowing, kneeling and rising should be considered part of your daily exercise activities. Vigorous exercise is not recommended due to the higher risk of low glucose levels and dehydration.
DIETARY ADVICE: Break your fast with a glass of water. For your meals at Suhoor and Iftar ensure your meals are well balanced, with low glycaemic index carbohydrates, protein rich foods and healthy fats. Include plenty of vegetables, 2 pieces of fruit and salads for fibre. Minimise foods high in saturated fats (such as ghee, coconut and palm oils, fried foods). Snacks can be eaten 2 to 3 hours after iftar – healthy options could include popcorn, vegetable sticks and hummus or low fat yogurt.
DIVERSITY +
diabetes
ACT: All people with diabetes must break the fast if: • Blood glucose levels are 3.9 mmol/L or less (hypoglycaemic event) • Blood glucose levels 15 mmol/L or more (hyperglycaemic event) • You experience any signs or symptoms of hypoglycaemia or hyperglycaemia • Dehydration or acute illness
MONTH OF RAMADAN ENDS: In celebration of Eid-al-Fitr (end of Ramadan), avoid eating sweet foods and drinks as this will increase your glucose levels. When we celebrate with food it’s easy to consume more kilojoules than we plan to. Try to keep active. Remember to also see your doctor to assist you in adjusting your medication back to your previous dosages, times or types.
Resources: Diabetes and Ramadan a Guide to a Safe Fast (available in English, French, Bangla, Arabic, Turkish and Urdu). www.idf.org/our-activities/education/ diabetes-and-ramadan/people-living-withdiabetes.html
Using Google, search: Managing hypoglycaemia fact sheet – NDSS Healthy eating – NDSS Healthy snacks fact sheet – NDSS Managing sick days for type 1 diabetes fact sheet – NDSS 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. Christy’s passion is to assist people living in regional and remote WA being a country girl at heart herself. 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.
Can I be vegetarian if I have diabetes? The simple answer is – yes, of course! Around 2.5 million Australians (12.1% of the population) now have diets of which the food is all, or almost all, vegetarian, which is up from under 2.2 million (11.2%) four years ago. There are several types of vegetarian diets: 1.
Lacto-vegetarian: includes milk and dairy products but no meat, poultry, seafood or eggs.
2. Ovo-vegetarian: includes eggs but no meat, poultry, seafood or dairy. 3. Lacto-ovo vegetarian: includes dairy and eggs but no meat, poultry or seafood. 4. Pescatarian: includes seafood, and can include dairy and eggs, but not meat or poultry. 5. Vegan: Excludes all meats and foods of animal origin (this may include honey). 6. Flexitarian: eats a mostly plant-based diet but may have the occasional meat-based meal. There are many reasons why people follow vegetarian eating patterns – ethical, moral, cultural, religious, animal welfare and environmental concerns, financial, personal taste and, of course, for the health benefits. Researchers have found that vegetarianism may benefit diabetes management for adults with type 2 diabetes through: 1.
Greater weight loss
2. Increased insulin sensitivity and improved glucose control
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3. A reduction in heart and blood vessel risk factors (such as lowering cholesterol levels and blood pressure) These diets have also been shown to reduce the risk of other health conditions such as some types of cancer and diverticular disease. It is thought that people who are vegetarian may have a lower energy consumption, eat lower glycaemic index carbohydrates, and have a higher intake of healthy fats, fibre, plant sterols, antioxidants, micronutrients, and prebiotics than meat eaters. If you are looking to adopt a plant-based diet to potentially improve your health, a vegetarian diet might be worth trying. Remember vegetarian diets come in many forms, so it’s not always an all-or-nothing situation. You may wish to start slowly by adding in one vegetarian meal per week and build up as you get more used to following this eating style. There is generally more carbohydrate in plant-based protein sources, so it is possible that your carbohydrate intake may increase when you switch to a vegetarian diet. However, you can still pick foods that are high in fibre, select low glycaemic index options and always be mindful of your portion sizes. Remember extra or empty kilojoules can creep into any type of diet, meat free or not. Another point to consider is that vegans or vegetarians can be at risk of not getting enough nutrients such as protein, calcium, vitamin B12, iron and zinc. Consider adding foods that are rich sources of these nutrients to your diet to prevent vitamin and mineral deficiencies. A vegetarian diet does not have to be more expensive and may often be cheaper. Frozen vegetables are just as good as fresh. You can also buy canned vegetables and dried foods such as beans, peas, quinoa, lentils and rice in bulk and store for a long time. If you have more fresh seasonal vegetables than you need, you can use the leftovers in other recipes or freeze. While shifting to vegetarianism is likely safe for most adults, there are some special considerations for children and women who are pregnant or breastfeeding. It is advisable to discuss any major changes to your diet or lifestyle with your doctor. It is also recommended to be more vigilant about monitoring your glucose levels when changing your eating style. Adjustments to your medications or insulin may also be required. Be patient and give yourself time to adapt. If you need help starting, planning, or
improving your vegetarian or vegan diet then please ask your doctor to refer you to a dietitian who is familiar with both vegetarian eating and diabetes. Alternatively, you can speak with a Diabetes Educator on the Diabetes WA Helpline on: 1300 001 880 Or email: info@diabeteswa.com.au People who live in regional WA can also access a Diabetes Dietitian or Diabetes Educator for free via video conference on the Diabetes Telehealth Service. If you are looking for vegan and vegetarian recipe ideas,we recommend these websites: Diabetes Australia Recipes - Diabetes Australia (diabetesaustralia.com.au/food-activity/ cooking/recipes) Heart Foundation Vegetarian recipes (heartfoundation.org.au)
Using the Diabetes WA Helpline for Non-English Speakers How do I speak to someone about diabetes in my own language? Call the National Translating and Interpreting Service (TIS National) on 131 450 and ask them to call Diabetes WA Helpline on 1300 001 880. The Translating and Interpreting Service is available to any individual or organisation in Australia, which means non-English speakers can access services and information over the phone in their own language.
What is the Diabetes WA Helpline? The Diabetes WA helpline connects you with a diabetes educator who can provide information and advice on managing diabetes. They can help you to solve problems or issues that arise. If needed they can refer you onto other health care professionals or services.
When can I call the Diabetes WA Helpline? Monday to Friday from 8.30am to 4.30pm.
What happens when I call TIS National? 1.
Call 131 450.
2. An automated prompt will ask you which language you need. Please state the language that you require.
3. When you are connected to a TIS National operator, say the language you need again. 4. Stay on the line while the operator finds an available interpreter for you. The operator will connect you with an interpreter in the language you asked for. You will be asked to provide: •
your name
•
the name of the organisation you need to contact – Diabetes WA
•
the phone number of the organisation you need to contact – 1300 001 880
5. Stay on the phone while the operator connects you and the interpreter through to the organisation. 6. A Customer Service Officer will answer the phone 7.
Ask to speak with a Diabetes Educator (a health professional that specialises in diabetes).
Will I need to pay for the interpreter? No, the cost of the service is paid for by Diabetes WA.
What if a Diabetes Educator is not able to speak to me when I call? Leave your name, phone number and time you wish to be called back with the Customer Service Officer. A diabetes educator will contact the translating and interpreting service and call you back at or close to your selected time. The diabetes educator will speak to you with an interpreter in your own language over the phone.
If I need urgent medical assistance with my diabetes, who can I call for help?
3. Phone TIS National 131 450 and then ask for Health Direct 24 hours on 1800 022 222, see more information here: Trusted Health Advice | Healthdirect (healthdirect.gov.au)
How do I find written diabetes information in my own language? A range of resources on diabetes are available on the National Diabetes Services Scheme (NDSS) website in different languages. On the internet go to: NDSS Information in Your Language (ndss.com.au/about-diabetes/ information-in-your-own-language)
What if I am unable to access the internet to find diabetes resources in my own language? When speaking with a diabetes educator or customer service officer provide your postal address for resources to be sent to you free of charge.
What programs are available in different languages at Diabetes WA? Our diabetes educators can deliver presentations to people of all nationalities and can work with interpreters where needed. The topics we cover include: •
What is diabetes?
•
Types of diabetes
•
Prevention & risk factors for type 2 diabetes
•
Diabetes management
•
Role of the NDSS & Diabetes WA
For bookings and questions regarding this program please call: 1300 001 880 Or email community@diabeteswa.com.au
For urgent medical assistance please call an ambulance on 000 (zero, zero, zero).
How do I find out more about support groups for non-English speaking people with diabetes?
If I need help with my diabetes after hours, on public holidays or weekends, who can I call or see for help?
There are no specific support groups for people of non-English speaking background. If you would like to join a support group, you can find one on our website at diabeteswa.com.au.
Here are a few options:
If you want help in setting up a support group for people with diabetes who speak the same language as you call us on: 1300 001 880
1.
Attend your local hospital emergency department, an after-hours doctor or medical clinic. Use the National Health Service Directory to find out this information, see this link here: Service Finder Healthy (healthywa. wa.gov.au/Service-search)
2. Go to an Urgent Care Clinic, see this link here: Urgent Care | Healthdirect (healthdirect.gov.au/australianhealth-services/urgent-care)
Or send an email to: community@diabeteswa.com.au
line
ONTHELINE
ON THE
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Diabetes WA Workshops CarbSmart DESMOND For people living with type 2 diabetes. The DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed) program provides you with a welcoming and non-judgmental space where you can plan how you would like to manage your diabetes.
METRO REGION 5 July 2022
Tuesday
Armadale
11 July 2022
Monday
Warwick
21 July 2022
Thursday
Midland
27 July 2022
Wednesday
Cockburn
4 August 2022
Thursday
Scarborough
9 August 2022
Tuesday
Rockingham
18 August 2022
Thursday
Mirrabooka
24 August 2022
Wednesday
Scarborough Rockingham
31 August 2022
Wednesday
7 September 2022
Wednesday
Armadale
13 September 2022
Tuesday
Scarborough
19 September 2022
Monday
Midland
28 September 2022
Wednesday
Mirrabooka
SOUTH WEST REGION 27 July 2022
Wednesday
Bunbury
10 August 2022
Wednesday
Busselton
19 September
Monday
Bunbury
MID WEST REGION 2 September 2022
Friday
Geraldton
23 September 2022
Friday
Geraldton
WHEATBELT REGION 2 August 2022
Tuesday
Northam
15 September 2022
Thursday
Northam
GREAT SOUTHERN REGION TBA
TBA
Albany
10 August 2022
Wednesday
South Headland
21 September 2022
Wednesday
South Headland
PILBARA REGION
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
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For people living with type 1 diabetes, type 2 diabetes or gestational diabetes. CarbSmart will help you enjoy quality carbohydrates in a way that suits you and your diabetes.
METRO REGION 4 July 2022
Monday
Warwick
3 August 2022
Wednesday
Midland
15 August 2022
Monday
Cockburn
31 August 2022
Wednesday
Mirrabooka
Wednesday
Geraldton
REGIONAL AREA 14 September 2022
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:
FootSmart For people living with type 1 diabetes or type 2 diabetes. Living with diabetes means living with an increased risk of foot problems. FootSmart gives you the skills and knowledge to create a care routine that will help avoid future foot problems.
METRO REGION 4 July 2022
Monday
Warwick
3 August 2022
Wednesday
Midland
15 August 2022
Monday
Cockburn
31 August 2022
Wednesday
Mirrabooka
Tuesday
Bunbury
REGIONAL AREA 2 August 2022
ShopSmart For people living with type 1 diabetes, type 2 diabetes or gestational diabetes. ShopSmart will help you to understand how to read food labels, and what to look for when choosing healthy options for yourself and your family.
METRO REGION 27 September 2022
Tuesday
Midland
REGIONAL AREA
Ready set go - let's move For people living with type 1 diabetes or type 2 diabetes. Get support and be empowered to take the first step in making exercise a part of your routine, or perhaps increasing the amount you are already doing.
2 August 2022
Tuesday
Bunbury
24 August 2022
Wednesday
Busselton
MedSmart
METRO REGION 12 August 2022
Friday
Midland
14 September 2022
Wednesday
Warwick
For people living with type 2 diabetes. Making sense of your medications can be difficult but it doesn’t have to be. MedSmart will give you information about your medications, how they work, how to take them and how they help manage your diabetes.
METRO REGION 27 September 2022
Tuesday
Midland
Monday
Geraldton
REGIONAL AREA 12 September 2022
Living with insulin For people living with type 1 diabetes, type 2 diabetes—and who are using insulin. This program will help you understand insulin, the different products and equipment available, and the importance of looking after your blood glucose levels.
METRO REGION 11 August 2022
Thursday
Midland
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LIVING
well
PLANNING FOR
PREGNANCY Diabetes probably isn’t front of mind for most women as they start thinking about pregnancy, but it’s important to get tested for gestational diabetes, even if it doesn’t run in your family, writes JANE-ANNE GARDNER. Gestational Diabetes Melitus (GDM) is the fastest growing diabetes in Australia, even though it only affects pregnant women. There are a number of risk factors for GDM, including your ethnic background, having had a large baby previously, being on certain medications, being above the age of 35 and having had GDM during a previous pregnancy. Although many of those risk factors can’t be changed, simple changes to your lifestyle can help prevent or lessen the risk of developing GDM.
into the risk factors above your doctor or midwife should offer you an oral glucose tolerance test (OGTT) early in your pregnancy. If not, you’ll be offered the OGTT at 24-28 weeks. Prior to the test make sure that you are eating your usual diet. Don’t worry about “passing” or “failing” the test – the only people being affected by your blood glucose levels are you and your baby. It’s really important that you have your OGTT as there are risks to you and your baby if your blood glucose is not within the expected range.
Firstly, it’s important to know that GDM is incredibly common, with around 12% of pregnant women within Western Australia being diagnosed with gestational diabetes. That number is pretty staggering when you consider that of all the women who gave birth in WA in 2021 only 0.5% had been living with type 2 diabetes prior to pregnancy and 0.3% of women had been living with type 1 diabetes. If you are diagnosed with GDM, know that you are not alone and you should not feel that you have done something wrong. As we’ve seen, there are many risk factors that simply can’t be altered.
If you are wanting to reduce your risk of GDM, diet and exercise can be of immense benefit.
It’s important to get your blood glucose levels tested during pregnancy. You will be having lots of blood tests, such as checking on things like your iron stores, which help the oxygen be transported around the body and your levels of immunity against bloodborne diseases. If you fall 18
Try eating low fat, high fibre and low GI foods and getting active at least twice a day, by walking or swimming. Swimming can be especially good exercise during pregnancy as swimming or walking in water is a weightless activity and it can help with any ligament pains you might be having. If you have been diagnosed with GDM, it’s important to know that you and your baby are at an increased risk of developing type 2 diabetes in the future. However, if you continue with your lifestyle changes your risk will be reduced, as will your baby's as they will likely model their behaviour on yours. Managing your GDM is essential for the health of your baby. If your blood glucose levels are not managed during pregnancy it can lead to a
miscarriage or even a stillborn baby. Your baby could be at risk of breathing issues or might need to produce more insulin to lower their blood glucose levels – meaning your baby will grow quicker and bigger (insulin is a growth hormone) which could lead to complications and an increased risk of needing interventions during your labour. A big baby doesn’t necessarily mean the baby is healthier than a small baby. Your baby will not have diabetes when they are born but may need to have some blood tests in the first 24 hours to check their blood glucose levels. Do note that this advice only applies to women who are not yet living with diabetes prior to pregnancy. If you have diabetes and are planning to have a baby, you should try to get your blood glucose levels close to your target range before you get pregnant. Staying in your target range during pregnancy, which may be different than when you aren’t pregnant, is also important. Raised blood glucose levels can harm your baby during the first weeks of pregnancy, even before you know you are pregnant. If you have diabetes and are already pregnant, see your doctor as soon as possible to make a plan to manage your diabetes. Working with your health care team and following your diabetes management plan can help you have a healthy pregnancy and a healthy baby.
LIVING
well
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MOVING
well
CAN EXERCISE DELAY THE ONSET OF TYPE 1 DIABETES?
New research suggests that high levels of exercise can help keep type 1 at bay, writes Diabetes WA educator MARIAN BRENNAN. Type 1 diabetes is what we call an autoimmune condition, where the body’s immune system attacks its own insulin producing cells – the beta cells. This process continues until there are no beta cells left, meaning the person with type 1 diabetes can no longer produce their own insulin. Interestingly, about 60% of people diagnosed with type 1 diabetes experience a ‘honeymoon’ period, 20
where the body still produces small amounts of insulin because the beta cells partially recover (if only for a short time). During this period, some people find they do not need to inject as much insulin and find it easier to manage blood glucose levels. Some studies have also found that experiencing a honeymoon period is associated with fewer diabetes-related complications affecting the eyes and kidneys.
Exercise does have the potential to complicate diabetes management, so your health professional might have recommended you back off the exercise until you get the hang of things. While this advice may be sensible, the topic of exercise is rarely revisited later on. Even more concerning, some health professionals continue to discourage exercise even when their patient has come to grips with managing their diabetes.
I am sure I don’t need to tell those of you living with type 1 diabetes, but those first few months after being diagnosed can be very stressful.
This is a shame, as the benefits of physical activity and structured exercise are well-established for those living with type 1 diabetes. Exercise
MOVING
can reduce the risk of cardiovascular disease, improve well-being, reduce insulin requirements, and reduce mortality. Indeed, physical activity is considered an official management strategy for type 1 diabetes. What we didn’t know, until recently, was how soon we should introduce exercise as part of managing diabetes. Although this will still vary between individuals, researchers are now investigating the use of exercise much earlier following a diagnosis. Emerging research suggests that those who are more active at the point of diagnosis and in the
months following have much longer honeymoon periods – essentially delaying the onset of type 1 diabetes! A small study out of Birmingham University in the UK showed that the honeymoon period was more than five times longer (on average, 33 months versus six months) in men who undertook high levels of exercise when compared to matched sedentary individuals. When we think about the abovementioned benefits of experiencing a honeymoon period, it is exciting to see the potential exercise has for extending that honeymoon. It is also
well
perhaps a very important reminder for people living with diabetes and for diabetes health professionals to start the conversation around exercise earlier. Of course, you may not feel ready to tackle exercise, but if you’re up for it, let’s talk! If you would like to speak to our dual qualified accredited exercise physiologist and credentialled diabetes educator, Dr Marian Brennan PhD about starting or increasing your physical activity, visit Perth Physical Activity and Diabetes Institute (www.perthpadi.com). 21
Prep: 10 mins Cook: 50 mins Serves: 2 (as a main) 1 Tbsp olive oil 1 small brown onion, finely chopped 250g peeled and finely chopped pumpkin 2 cloves garlic, thinly sliced ½ tsp ground cinnamon ½ tsp ground turmeric 1 tsp cumin seeds Pinch dried chilli flakes 325ml (11/4 cups) passata 125ml (1/2 cup) water
Whether you are vegetarian or not, this is the kind of dish that will satisfy anyone. Gentle spicing helps to lift the sauce, and the yogurt and mint oil make it the kind of dish perfect for dipping hunks of bread into. 1. Heat 2 teaspoons of the oil in a medium saucepan over medium heat. Add the onion and cook, stirring occasionally, for 10 minutes or until the onion softens. Add the pumpkin and garlic. Cook, stirring occasionally, for a further 8-10 minutes or until the pumpkin edges are starting to soften. 2. Add the cinnamon, turmeric, cumin seeds and chilli flakes to the pan. Cook, stirring, for 1 minute. Add the passata, water and sugar. Stir. Cover and bring to the boil over high heat. Reduce heat to medium-low and cook, covered, stirring occasionally, for 20-25 minutes or until the pumpkin is cooked through. 3. Remove the lid from the pan and stir in the beans and most of the parsley. 4. Heat the remaining oil and the dried mint in a small non-stick frying pan over medium heat. Cook, stirring, for 1-2 minutes until the mint smells fragrant. 5. Divide the ragout between serving bowls. Top with the yoghurt and remaining parsley. Drizzle over the hot mint oil.
½ tsp caster sugar 1 x 400g can no added salt butter beans, rinsed and drained ½ bunch flat-leaf parsley, roughly chopped 2 tsp dried mint 4 Tbsp reduced-fat Greek natural yoghurt
Nutrition Information PER SERVE 1400kJ (335Cal), protein 15g, total fat 12g (sat. fat 2g), carbs 34g, fibre 15g, sodium 420mg • Carb exchanges 2½ • GI estimate low • Gluten free
22
BEAN & PUMPKIN RAGOUT
1. Season the chicken thighs with pepper. Heat the oil in a large heavy based saucepan over medium-high heat. Add the chicken and cook for 3-4 minutes each side or until lightly golden. Transfer to a plate. Add the bacon to the pan and cook, stirring occasionally, for 5 minutes or until golden. Stir in the leeks and cook, stirring occasionally, for a further 5 minutes. 2. Sprinkle the flour over the leeks and bacon and stir until combined. Add the wine and simmer for 2 minutes. Add the stock and stir well. Slice the chicken and return to the pan (don’t worry if it’s not fully cooked through at this point, it will finish cooking in the oven). 3. Stir the sour cream, peas, 1 Tbsp mustard and the tarragon into the pan. Simmer for 2-3 minutes until the mixture is thick and saucy. Add a splash more stock or water if it seems too thick Remove the pie filling from the heat. Whisk the remaining ½ Tbsp mustard with the egg in a bowl. 4. Preheat oven to 180°C (fan-forced). Spoon the filling into a pie dish with a lip and use some of the egg mix to brush the sides of the dish. Use the 11/2 sheets of pastry, trimming to fit, to cover the top of the pie dish (pushing the edges of the pieces together to join) and crimp the edges against the sides of the dish. Cut away any excess pastry with a knife. 5. Brush the remaining egg glaze over the top of the pie and make a small steam hole in the middle. Bake for 40 minutes or until the pastry is golden and puffed. Serve the pie with the steamed potatoes and greens.
DIABETIC
living
Prep: 15 mins Cook: 1 hr 15 mins Serves: 6 (as a main) 600g skinless chicken thigh fillets, trimmed of fat Freshly ground black pepper 1 Tbsp olive oil 100g lean eye bacon, finely chopped 2 leeks, sliced 3 Tbsp plain flour 100ml white wine 200ml salt-reduced chicken stock 200g light sour cream 100g frozen peas 1½ Tbsp Dijon mustard
Nutrition Information PER SERVE 2060kJ (494Cal), protein 33g, total fat 22g (sat. fat 9g), carbs 34g, fibre 8g, sodium 703mg • Carb exchanges 2½ • GI estimate low • Lower carb
1 bunch tarragon, chopped 1 x 60g egg, whisked
LOWER-CARB OPTION: Use one sheet of pastry and roll out thinner to fit your dish and replace potatoes with 500g cauliflower florets, steamed to serve.
11/2 sheets 25% reduced-fat puff pastry, thawed
PER SERVE 1830kJ (439Cal), protein 33g, total fat 21g (sat. fat 8g), carbs 25g, fibre 7g, sodium 685mg • Carb ex changes 1½ • GI estim ate low • Lower carb
400g Zarella baby Spud Lite potatoes, steamed, to serve
Dietitian's note: Consider reducing the amount of saturated fat by using skinless chicken breast and consider halving the amount of stock to lower the salt content.
400g mixed greens, steamed, to serve
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ABORIGINAL
voice
MOVING ON Moving to Port Hedland means NATALIE JETTA is in a good place to start leading face-to-face sessions in Aboriginal Communities as we emerge from the COVID hiatus. For the first time since 2020, I feel like there might be light at the end of the COVID tunnel. After two years of rolling cancellations and virtual workshops, I’m looking forward to getting back out there and running some face-to-face sessions. It’s the thing I love most about this job. I'm a social person. I love events. I love doing workshops. That first year of COVID was the worst, as all our NAIDOC week events got cancelled at the last minute, just as we were about to go out and do a whole lot of amazing stuff. But now I’m looking forward to running our first big event for Aboriginal Australians since the pandemic began. It’s a really cool one to get started with, as we’ve paired up with The Shooting Stars program – a youth mental health service for girls, based in Perth but catering for schools all over WA. They have a mental health day session coming up in Port Hedland and they’ve asked a bunch of health providers to come and have a talk to the girls about healthy eating. I’ll be talking to them about healthy lifestyles and what you can do to avoid diabetes. I’m really excited. The other big change for me is that I’ve moved from Perth to Port Hedland. Diabetes WA might be based in the South West, but we cater for our entire, massive state. I think it’ll be a real advantage for me to be based in the north and close to some of the Communities I work with. Things have
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been pretty quiet on the workshop front since I moved here in February, but I’ve used that time to start making connections and getting to know people around my new home. I've been popping down to the local clinic and met with health workers who want me to start working ASAP, but it’ll be a while until we know what the COVID situation is looking like. We all know how bad diabetes is across the remote Communities around here, but most health workers don’t have the in-depth knowledge or confidence to host diabetes sessions with their clients. Unfortunately, we’ve had to put our health professional training scheme on hold due to COVID, but we’re hoping to transform it into a virtual training module. I’m loving being up here so far – and not just because it’s so much warmer than Perth! I certainly won’t miss all the flying I had to do. But it’s a great spot from which to build on our community work in Broome and across the Kimberley and Pilbara. People in Communities are so much more likely to accept you and say yes if you're here, than they are if you’re based in Perth and chatting over the phone or email. I bump into people in the shops, I bump into them down the pub and all over the place. It's a much closer relationship. Working with Aboriginal people who are living with diabetes, I’ve seen first-and the difference it makes having
a culturally safe program like DESY. It makes the people you’re working with feel a bit more at peace and a bit more relaxed. They’re more able to take on your information and actually implement it when they leave. If they're in a workshop that hasn't been made culturally appropriate, they're going to be a bit more withdrawn, a bit more held back and not take in so much of that information. We talk a lot about the importance of culturally safe content when we’re working with Aboriginal Communities, but something that is often undervalued is culturally safe behaviour. That means the people who are coming in to work in those Communities have done cultural awareness training and also know the history and background of that town. They need to know what the Community is like, by doing some research and learning about it beforehand. When they are in that Community, they need to try to remain more open minded. You can’t just go in and tell people what to do, first you have to sit back and listen to their story. You need to start from where your client is, not from where you are. That’s how we start, by remembering that we’re guiding people in Aboriginal Communities through their own diabetes journey, not the one we might have already mapped out.
ABORIGINAL
voice
UP
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.
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TAKE
a hike
WHEN LIFE GETS IN THE WAY Staying active can be hard when life has other plans for you, writes DENISE BROWNSDON. Like everyone else, I had my fair share of goals for 2020. And, just like everyone else, I’ve found life tends to get in the way! I don’t know about you, but I can’t believe it’s July already. It seems like a good time to check in and consider how well I’ve stuck to all my new year resolutions. I do this every so often, to try to hold myself accountable to the goals I’ve set. Staying active is always top of my list these days. I admit that I had a very slack week when COVID-19 hit our household. My husband, son and I were in isolation over Mother’s Day (and my birthday) and the exercise regime went out the window. I was a lot less active than I should have been when I started a new job. I was so busy getting stuck into that and getting used to new routines that I didn’t do enough exercise after I logged off for the day. There are always chores to do and excuses to be made right? Fast forward a couple of weeks and I now have COVID-19 myself. I have made a promise to myself that I will not stay inactive during isolation this time. Obviously, I will be careful and listen to my body but while I am feeling okay, I am going to do something to get active at the end of each day. Sometimes it feels easier to make excuses than to remember just how
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easy it is to get a bit of exercise – even if you can’t leave the house! All you really need are few pieces of equipment and simple body weight exercises. I’m lucky as my trainer organised for us to purchase special kits that we can use at home if we are in isolation, so I have dumbbells, a Pilates ring, resistance bands and a skipping rope (you can find all of these items relatively cheaply online or at your local shops). Using these, I will create a workout that includes some light cardio, dumbbell work, and body weight exercises (push-ups and sit-ups). I find if I do them at a set time every day it really helps to keep myself on track. I’m starting to incorporate more step ups into my sessions now as my injured knee has improved a lot and is now able to handle more pressure. The one goal I haven’t met this year is to get out on the trail again. I really can’t wait to be able to head back out on a hike. While hiking can be enjoyable at any time of year, it’s a particularly good way to get up and moving during the cooler weather. It’s not just about the exercise. Going on hikes with the Hike Collective has led me to meet such a friendly and diverse group of people. I’ve met so many people who are passionate about hiking and love going out whenever they can (for both the beginner and
more advanced options). Each new hike also brings along newbies, who are a bit nervous when they arrive, but that quickly disappears once the hike kicks off and everyone just starts getting to know each other along the way. You get to enjoy nature at its best while you walk along and learn about the area from the experienced tour guides. On my hike through Araluen I got the opportunity to listen to other hikers, who had grown up in the area, sharing stories about the area from years gone by. Afterwards, there’s always a chance to debrief and share any photos you have taken along the way, as well as making plans to stay in touch with your fellow hikers. It’s been so easy – and so rewarding – to become part of this hiking community and connect with positive and likeminded people. Those sort of connections are what help keep you going – even when life is giving you more than enough excuses to slack off for a bit! Maybe it’s time to take a second look at your goals. If the big ones seem impossible, why not set yourself some smaller ones to get started. It’s absolutely worth it for both your physical and mental health. After all, every great journey begins with a single step!
STAYING
in
STAYING IN THIS WINTER MYKE BARTLETT unearths some cultural tidbits to keep you entertained indoors until Spring. Film How To Please A Woman (DVD, Blu-ray, Stream)
Gina is not feeling fabulous. She has lost her job and feels stuck and frustrated in a passionless marriage. All that changes when she transforms a moving company into an all-male cleaning staff for similarly disenchanted women. Soon her clientele starts demanding something more – sex, or better yet, pleasure. Can she help other women find the intimacy they seek? This cheeky Australian comedy (starring Sally Phillips) was filmed in and around Fremantle and proved a great hit at the Perth Festival earlier this year.
Television The Essex Serpent (Apple TV+)
Clare Danes and Tom Hiddleston star in this atmospheric adaptation of the acclaimed Sarah Perry novel. Widowed Cora (Danes) is an amateur natural history buff who has become obsessed with sea monsters. She travels to a remote village to help solve the mystery of a disappeared young girl (a giant sea serpent is thought to be the culprit), where she meets local vicar Will (Hiddleston). Will is married, but a spark flares between them, even if it is muffled by English propriety and intellectual antagonism (Cora is all about science, Will is a man of faith). Some great performances from the leads, a wonderfully gothic location and a tantalising promise of spookiness make this a captivating slice of slow-burn drama.
Music Dance Fever by Florence + the Machine (Universal)
UK artist Florence Welch has always thought big. When her debut record came out in 2009, the kooky singer-songwriter leapfrogged the beginner’s touring circuit and went straight to playing with the Rolling Stones and supporting the likes of U2. Her voice is no less massive — easily Britain’s most impressive set of pipes this side of Adele. This latest album might just be her best, fusing pop excitement, rock dramatics and medieval myths (a vibe described by Florence herself as “Nick Cave down the disco”.) It’s also her most personal record, tackling her feelings about ageing, motherhood, anxiety and the pandemic. It’s all those things — and great fun!
Books The Premonitions Bureau by Sam Knight (Faber)
It’s a rare thing to find a non-fiction book that truly reads like a page-turning thriller — and even rarer to find one that reads like far-fetched fantasy! Back in the 1960s, overworked British psychiatrist John Barker established an agency to discover if ordinary people really could tell the future. People from all over the UK were asked to send in their premonitions, which were then tested against real world events. Some of these predictions were eerily accurate — but what happens when a pair of reliable psychics predict Barker’s own death? Crafted from a series of superb character sketches and frank reports of disasters, this is gripping stuff.
Conspiracy by Tom Phillips and John Elledge (Hachette)
One of the most confronting things about our years of COVID is realising how, given half a chance, conspiracies can spread around the world even faster than a novel virus. Most of us probably know someone who has disappeared down the rabbit hole and become convinced that a secret world government is trying to take control via lockdowns, vaccines and 5G. This credulity is nothing new. Conspiracy explains that humans have always believed they’re being lied to (we often are) and explores what the consequences for us all might be in our post-truth age.
The Patient Doctor by Dr Ben Bravery (Hachette)
At the age of twenty-eight, Ben Bravery woke from a colonoscopy to be told he had stage 3 colorectal cancer. While the young scientist knew what this diagnosis meant medically, he was surprised how helpless he felt as a patient. After 18 months of overwhelming and aggressive treatment, he decided to retrain as a doctor, in the hope of making an important change to patient care. In this no-holds-barred account, Ben talks about overcoming the trauma of his illness and shares what he believes student doctors, doctors, patients and their families need to do to ensure that the medical system puts the patient at the very heart of healthcare every day. An inspiring and compassionate read.
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MEMBERS
stories
SAVED BY THE SCREENING LUCY SHARP moved to Australia from India as an adult and was diagnosed with diabetes soon afterwards. She says that, if it hadn’t been for the regular health screenings in her new home, she might not have found out until it was too late. I was born in Burma (now Myanmar). My mother is Anglo-Burmese but my father was Indian, so when I was 20, we all moved to India. I spent the next 17 years there, before I met my husband. He brought me to Australia on holiday and, somehow, we ended up getting married! I had no idea that was going to happen. My work in India were expecting me to go back after the holiday. That was back in 1983 and I’ve only been back to India twice since then. Once for my niece’s wedding and once after my father died. He actually died the same month that I was married. He didn’t want anyone to tell me he was ill, because he knew I’d come back and it would spoil my wedding. He had a heart attack, but I think he knew something was wrong. He said to my family, if anything happens to me, don't tell Lucy. I didn’t know he had died until after I was married, but I went back to see his grave. I was diagnosed with type 2 diabetes a few years after that, in my early 40s.
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I probably wouldn’t have found out if I had still been living in India. In Asian countries, we don’t have regular health checks. We only go to the doctor when we’re really ill. When I first came here, I didn’t go in for a check up, because I never had. But I ended up seeing a doctor for something else, she sent me for blood tests, and told me I had diabetes. On one hand, it was a surprise, because I had never really thought about diabetes. On the other hand, it shouldn’t have been a surprise as we eat so much sweet stuff in India. We love it! I love it! My doctor put me in touch with the Armadale branch of diabetes meetings and I went there for some time learning about how to manage my diabetes. I read all the pamphlets and all that stuff, but after a while I stopped going because I learned to manage it myself. I’ve done well since then. Sometimes my blood glucose gets a bit high, if I’m naughty. I haven’t had to change my diet that
much. I still eat Indian food, lots of rice and curry, but I eat Western and Chinese food too. I like to eat lots of vegetables. I’m lucky that I like to eat lots of different types of food. I have cousins who can't eat anything but Indian food. I’m happy with more variety in my diet, but the biggest change I’ve made is in portion size. I used to eat big portions, now I eat small portions. I’ve been a member of Diabetes WA for as long as I can remember. It’s good to know they’re there if I need support or if I really get in trouble with my self-management. I do pretty well. My doctor and I both know when I’ve been naughty. Right now, I’m trying to get my weight down again. That’s the only thing I need to work on. Do I have a strategy? Yes, I'm trying to reduce my weight by eating less and not eating any sweets! Lucy was talking to Myke Bartlett. This conversation has been condensed for clarity.
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YOUR WINTER DIET SAVE PLAN
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1 Tbsp olive oil 1 small brown onion, finely chopped 250g peeled and diced pumpkin 2 cloves garlic, thinly sliced ½ tsp ground cinnamon ½ tsp ground turmeric 1 tsp cumin seeds Pinch dried chilli flakes 325ml (1¼ cups) passata 125ml (½ cup) water ½ tsp caster sugar 1 x 400g can no-added-salt butter beans, drained and rinsed ½ bunch flat-leaf parsley, roughly chopped 2 tsp dried mint 4 Tbsp reduced-fat Greek natural yoghurt 1 Heat 2 teaspoons of the oil in a medium saucepan over medium
heat. Add the onion and cook, stirring occasionally, for 10 minutes or until the onion softens. Add the pumpkin and garlic. Cook, stirring occasionally, for a further 8-10 minutes or until the pumpkin edges are starting to soften. 2 Add the cinnamon, turmeric, cumin seeds and chilli flakes to the pan. Cook, stirring, for 1 minute. Add the passata, water and sugar. Stir. Cover and bring to the boil over high heat. Reduce heat to medium-low and cook, covered, stirring occasionally, for 20-25 minutes or until the pumpkin is cooked through. 3 Remove the lid from the pan and stir in the beans and most of the parsley. 4 Heat the remaining oil and the dried mint in a small non-stick frying pan over medium heat.
Cook, stirring, for 1-2 minutes until the mint smells fragrant. 5 Divide the ragout between serving bowls. Top with the yoghurt and remaining parsley. Drizzle over the hot mint oil.
Nutritional Info PER SERVE 1400kJ (335Cal), protein 15g, total fat 12g (sat. fat 2g), carbs 34g, fibre 15g, sodium 420mg • Carb exchanges 2½ • GI estimate low • Gluten free diabetic living JULY/AUGUST 2022 15
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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-58613 v1.0
