Spring 2018 $6.95
A Diabetes WA Member Magazine
AGES & STAGES
of Diabetes
NEWS • RECIPES • RESEARCH • PEOPLE • EVENTS • FITNESS
From the Editor not
does Dia betes spa ns a lifetime. It is a condition that or any stage
at any age discriminate and can affect any one the senior years. of our lives - from birth through to diagnosis, there are At each age and stage after a diabetes selves. For a child different challenges that present them young adult it may be it may be first star ting school, for a ty or independent moving out of home and off to universi young families are or travel. Many adults with busy careers giving their diabetes time-poor and must ensure they are and the decision to management the attention it needs, real life adjustment. e som retire for older adults can take between these stages As we move through life, transition to independently can also prove challenging. Learning er their parents care, manage their diabetes, after being und can be testing for and ensuring they are eating properly le living with type 2 some young adults. Equally for peop on, diet and exercise, diabetes that is managed with medicati a transition that can be becoming insulin-dependent can be scar y and confronting. ers attempts to address This Spring edition of Diabetes Matt each age and stage just some of the challenges faced at tify with some iden of the life span. You may be able to challenges and not with others. Enjoy,
Natash a
Contents From the Chair .............................................................................. 3 Perspective .................................................................................... 4 Who’s in the Driver’s Seat? ....................................................... 5
Diabetes News Australasian Diabetes Congress ............................................. Corporate Lunch .......................................................................... National Diabetes Week ............................................................. Let’s Prevent ..................................................................................
6 6 7 7
The Ages & Stages of Diabetes Kids & Teens .................................................................................. 9 Young Adults ................................................................................ 14 Adults ............................................................................................. 17 Over 60’s ...................................................................................... 20
Education Planner Plan Your Sessions .................................................................... 24
SPRING 2018 Editor Natasha Simmons 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 James Beckett, Buy West Eat Best & Anna Gare, Pacific Magazines, Mary Anne Stephens, Murdoch Books, Perth Children’s Hospital, Joanna Pearce, Sophie Mudd, Shannon Maloney, Joyce Ingram Photography DWA staff, magazine contributors, Shutterstock, Murdoch Books, Perth Children’s Hospital, Buy West Eat Best Design Brigitte James Print Quality Press Diabetes WA diabeteswa.com.au Diabetes Information and Advice Line: 1300 001 880 Email: info@diabeteswa.com.au
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Diabetes WA – Subiaco Offi ce Level 3, 322 Hay Street, Subiaco WA 6008 Postal Address: PO Box 1699, Subiaco WA 6904 Diabetes WA – Belmont Offi ce 172 Campbell Street, Belmont WA 6104 Postal Address: PO Box 726, Belmont WA 6984
AGM and Board Election Join us at our AGM .................................................................... 26
Research News Research Round-up .................................................................. 28 Diabetes Research WA Update ............................................. 29
In the Community Kellion Victory Medals ............................................................ 30 Riding for Awareness ................................................................ 31
Living Well Seeking Support ........................................................................ 32
Moving Well Walk and Talk ............................................................................. 34
Shared Pathways Aboriginal Health Forum ........................................................ 35
Diabetic Living Recipes ......................................................................................... 36
Eating Well Buy West Eat Best .................................................................... 38 Recipes ......................................................................................... 39
Members’ Area Members’ Puzzle and Competition ....................................... 41 Member Partners ...................................................................... 42
What’s On Dates for your Diary ................................................................. 43
Watson Dr Moira
In typical spring style, Diabetes WA has been doing a review of the ways in which we provide service to our members. We have also been working diligently to better expand our relevance to the Western Australian diabetes community.
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From the Chair
We recently undertook a comprehensi ve market research project that looked at perceptions of Diabetes WA and peop le’s attitudes and beliefs towards diab etes in general. In the research 1314 people (46% men, 54% women) with diabetes completed a 20-minute online survey that found that , predominantly, all those surveyed appe ared to have a good understanding of the serio usness of their diabetes, believe there are steps they can take to improve their quality of life and health outcomes, and feel they are personally capable of taking thes e steps. We were proud to learn that our hard work is paying off and 80% of people surveyed were aware of Diabetes WA when prom pted, and 57% believe that our range of services are relevant to them. While 57% is good , it does show us that we still have som e work to do. Interestingly, we found that 39% incorrectly think that being on the NDS S means that they are already members of Diab etes WA. Finding it difficult to attend an education workshop due to location or timing was cited as a barrier to becoming more invo lved in our programs, and not being aware of all Diabetes WA have to offer also pres ente d as a small issue. Something we found particularly enco uraging within the results was that, overwhelmingly, those that are mem bers of Diabetes WA feel more engaged, more informed and more proactive about their diabetes than non-members. Of our curr ent and potential services, information and education were considered most impo rtant, followed by our role as advocates for the WA diabetes community. This quarter’s activities also included National Diabetes Week (8 July, see page 7), rolling out our Let’s Prevent program in the South West (page 7) and our Ann ual Corporate Lunch (page 6). We used the opportunity of National Diab etes Week to launch our new $1 million prevention program in Bunbury, aime d at improving the future health of Sou th West residents. The Let’s Prevent program , funded by the State Government, is a free health initiative designed to help adults avoid or delay type 2 diabetes, heart disease or stroke. We are invigorated by the interest the launch generated amongst residents and local health providers and are looking forw ard to the anticipated success of the pilot program. Spring is host to our annual Diabetes WA Corporate Lunch and this year we held another successful event. We were plea sed to have Mr Michael Chaney AO, Cha irman of Wesfarmers Limited, as our keynote speaker and his presentation about corp orate social responsibility inspired many in the room. Several of our stakeholders in attendance commented on what an exce llent opportunity it was to learn from his extensive experience. Finally, our Annual General Meeting will be taking place on 25 October at our Subiaco office. Information can be found on page 26 and all members are invited to atten d. We would love to see you there, but if you are unable to make it, we have inclu ded a proxy voting form on the back of the cover sheet enclosed. Until next time… Dr Moira Watson Diabetes WA Board Chair
• 3
perspective
Support Networks When Diabetes WA board member Mary Anne Stephens first came to Australia from the US more than 24 years ago, she never realised how much of the country she would get to see. Now, as a member of the board of the WA Country Health Service, she visits a regional town every two months, and says it is clear that chronic conditions are having a real impact on these communities. Here she reflects on what she believes are the major issues within the older ‘age & stage of diabetes’ and offers her perspective on her passions; health and remote communities (and a little on sport too). When I joined the Diabetes WA board three years ago, I hoped that my expertise in ‘crunching numbers’ would be valuable to the organisation and therefore, in turn, benefit at least some of the 126,000 people living with diabetes in Western Australia. What I didn’t recognise was how much the appointment would teach me. How it would open my eyes to the broad range of issues that living with a chronic condition can cause and the impact that has on people’s lives. Not just on physical health, but on their mental health and their ability to remain independent, particularly as they age, and as the risk of more health complications increases. I am a passionate sportswoman and was reminded, while watching the recent FIFA World Cup, of how important a support system is. With the introduction of the VAR (video assistant referee) system to this year’s Cup, on-field referee decisions are now backed by a video review ‘panel’ consisting of a group of referees, in another location, that review the match with the aid of video replays and alert the referee if he’s made a serious error. With the introduction of VAR, if a referee knows they can review a decision and that there are others there who have their back, it becomes inherently less arbitrary. As such, everyone has more faith in the system, so there are fewer frustrated outbursts and less of a need for a referee to be the one and only decision-maker. This is shown in the statistics: with no red cards in the first 14 matches, it was refreshing to watch the game without as many dives and dramatic disputes. Though this analogy may seem obscure, think of it from the perspective of a person living within their community. If you know someone (or a group of ‘someones’) has your back; that is familiar and reliable; who is there to help you if you need them; who understands your situation and can step in to support you; then it gives you the confidence to make decisions, take some positive risks and to continue living your life independently knowing you have a back-up system in place to support you in your time of need. A friend, Glenda, was diagnosed with type 1 diabetes in her early 40’s and found the diagnosis difficult, realising her life 4
would change dramatically. Her husband, Steve, was her support person for more than 20 years before he passed away from lung cancer three years ago. Glenda is now in her late sixties, is on her own at home, but her community of friends and neighbours have stepped in to the void that Steve left. Despite needing to check her own levels in the middle of the night to avoid having a hypo, the last thing she wants to do is uproot and move away from her community and into a residential facility. She is otherwise healthy and still relatively young and capable, but she needs support in caring for her chronic condition. Providing Glenda with services that will allow her to stay at home means she can maintain her established support network and stay within the community who watch out for her. I’m a strong advocate for improving and investing in home care programs that provide people with the medical and wellness support they need, while allowing them to stay in their community for as long as possible.
Government policy is also shifting, urging people to utilise the home health care model, with the introduction of the Commonwealth Home Support Programme (CHSP) alongside the introduction last year of consumer directed care with Home Care packages.. This funding enables individuals to stay at home and remain active in their communities, focusing on their health and wellbeing amongst a strong support network. As a Baby Boomer myself, I know that as we edge ever closer to old age we are going to disrupt the aged care sector. I am confident in saying that many of my generation will not want to move from their homes as they age. Due to improved health care and technology, we are generally more independent and capable of staying at home longer. I believe this is the enabler that will keep us all healthier and better able to manage whatever comes our way. We need to crunch the numbers and look at the stats: for every person that we can keep in their own community, how much do we save and how much better is that for them? Forcing them into residential care or encouraging people to leave their homes and communities when they don’t feel ready, means that their mental health becomes at risk and that puts further burden on the health system.
Mary Anne Stephens is the Chief Financial Officer for Amana Living Incorporated, an aged care services provider, and has been a Diabetes WA board member since 2015. She is also on the board of the WA Country Health Service and is a selfconfessed mad sportswoman. She has resided in WA for 7 years and believes there is nowhere like it, saying she is here to stay.
WHO’S IN
the drivers seat
Knowledge Is Power In this Driver’s Seat edition, Jennifer Sweeting, Diabetes WA Pilbara and Primary Care Coordinator, uses an analogy of ‘locks and keys’ to describe what happens in the body when you have diabetes. Whether you are newly diagnosed, or have been living with diabetes for many years, this summary may make it easier to explain to others the intricacies of your condition. What do we need for fuel? Our bodies get energy from the foods we eat, including carbohydrates. They are broken down and turned into glucose, which then enters the bloodstream and transfers into our muscles and cells to give our body energy, much like petrol provides fuel for a car.
What does insulin do in the body? Glucose needs help to get into our muscles and cells, as our muscles have ‘locks’ on them. For glucose to move from the bloodstream into those muscles, we need a ‘key’ to unlock them - enter insulin. Insulin is a hormone, Insulin made by the pancreas, which acts as a ‘key’ to open the ‘locks’ around our cells including muscles. This allows glucose to move from the bloodstream into the muscles, where it can be used for energy. After we eat carbohydrates, our blood glucose levels rise, and cells in the pancreas (called beta cells) are stimulated to release insulin into your bloodstream. Insulin helps keeps your blood glucose level from getting too high (hyperglycaemia) or too low (hypoglycaemia).
Our muscles and liver also store glucose for times we need energy, such as when we are exercising, sleeping or are unable to eat. Acting as a ‘pantry’, the liver releases glucose into our bloodstream in those times when we need it. If we continue to eat too much food, and the liver has stored all of the glucose it needs, that extra glucose is stored as fat, often around our mid-section.
When you have type 1 diabetes, the cells in the pancreas that produce the insulin ‘keys’ have been destroyed by the immune system and the pancreas is no longer able to make any insulin ‘keys’ at all. Insulin injections or an insulin pump are therefore needed to provide the body with insulin.
What effect does diabetes have?
pregnancy, some of the POOPED OUTDuring hormones produced by the placenta the action of insulin ‘keys’. The PANCREAS block pancreas then needs to produce
When you have type 2 diabetes, the extra glucose that is stored as fat may also ‘rust our locks’ and make it difficult for ‘locks’ to be easily opened by the insulin ‘keys’ that our pancreas is producing. This is called insulin resistance. When the pancreas can’t make enough keys to open the ‘locks’ around muscles, we often call this a ‘pooped out pancreas’ because it just can’t keep up with the demand for ‘keys’, resulting in higher blood glucose levels. glucose
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extra ‘keys’ to keep blood glucose levels in the normal range. If the pancreas is unable to produce enough insulin, blood glucose levels rise and gestational diabetes develops. This may go away after having the baby, but does increase the risk of type 2 diabetes for the mother, later in life.
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For more information on insulin and diabetes visit our website: diabeteswa.com.au/manage-your-diabetes/resources or call our Helpline on 1300 001 880. glucose
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DIABETES
news
Australasian Diabetes Congress Adelaide played host to the Australasian Diabetes Congress in August, and Diabetes WA was well represented at the premier event. Health professionals working in the field of diabetes gathered to discuss the latest diabetes clinical and basic research and to share new insights into clinical practice. Diabetes WA educators and evaluation team members presented two plenary sessions and three posters;
Presenter
Topic
Natasha Watson Plenary session on improving behavioural health Venus Miller Kylie Mahoney Alison Ilijovski
indicators in people with type 2 diabetes: outcomes from DESMOND Australia Plenary session on the DESMOND program improving patient activation in regional Western Australians Poster: The core behaviours that novice DESMOND educators find challenging Two Posters: Diabetes Telehealth for gestational diabetes and a review of the Diabetes Telehealth program Evaluation coordinator Venus Miller received great feedback for her session on the impact of our DESMOND program, which is aimed at strengthening the role of people living with type 2 diabetes in self managing their healthcare. She discussed the significant positive effect on patient activation, further confirming the importance of diabetes selfmanagement education as an integral aspect of diabetes care.
Diabetes educator Alison Ilijovski’s posters on Diabetes Telehealth demonstrated how the program Alison with her posters has continued to grow in relation to gestational diabetes, with women being contacted via video or telephone for initial education within 24 hours of the Diabetes Telehealth Service receiving a referral. By offering prompt and frequent face to face contact the women are empowered to acquire self-management skills essential for a healthy pregnancy as early as possible. The figures displayed on the Diabetes Telehealth poster also impressed attendees, showing that, since its inception in March 2015, the program has helped people with diabetes 2463 times, saving an average of 656km travel per person.
Diabetes WA Corporate Lunch Frasers Restaurant in Kings Park was abuzz with members of Perth’s business community who came together on 7 September for Diabetes WA’s Annual Corporate Lunch. Attendees were engaged by Mr Michael Chaney AO, Chairman of Wesfarmers Limited, as he spoke about corporate social responsibility and whether the Banking Royal Commission has changed the way we think about it. His presentation challenged those present to consider the impact the recent APRA report on the Commonwealth Bank may have on boards in respect of their historical focus on shareholder returns, rather than community welfare. 6
National “It’s about time” was the theme again this year as we promoted National Diabetes Week from 8 to 14 July. Raising awareness about the importance of early detection and treatment for all types of diabetes, we reminded people to look out for the ‘4 T’s of Type 1 diabetes’: • Toilet – frequent toilet visits • Thirsty - unable to quench thirst • Tired - more tired than usual • Thinner – recent weight loss
Let’s
As part of National Diabetes Week, Diabetes WA launched the new $1 million health program, Let’s Prevent, dedicated to helping adults Prevent avoid or delay type 2 diabetes, heart disease or stroke. Let’s Prevent – now being piloted in the South West – aims to equip participants with practical information and skills so that they can decide how they want to improve their lifestyle, and by how much. The program is open to those deemed “at risk” of type 2 diabetes, heart disease or stroke. “There are many factors that can put a person at risk of these conditions – for example family history plays a big part. If a person’s mum, dad, brother or sister has type 2 diabetes, they could be at risk too,” Deb Schofield, Diabetes WA General Manager of Health Services, said.
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our website assessment tool (diabeteswa.com.au/whatsyour-risk) on the radio and had some fun on social media with a photo competition.
We also encouraged people to check their risk of type 2 diabetes, and if it is high, to see their doctor and ask about having a fasting blood glucose test. We promoted
And finally we launched our Let’s Prevent pilot program in Bunbury which was well-received and is running successful now throughout the area. See below for more information.
“Fortunately there are many steps people can take to avoid or delay such conditions, and that is where Let’s Prevent comes in.”
the four main risk factors associated with chronic conditions. Around 77% of adults living in the City of Bunbury either smoke, consume an unhealthy amount of alcohol, are obese or undertake little or no physical activity.
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We told the story of Frank Sita, which was seen by readers of the West Australian and community newspapers, relaying how the then 17 year old was busy with university assignments when he became totally exhausted and constantly thirsty. His doctor told him he had a virus, and that he should rest for a few days. Three days later he was rushed to hospital, sick, panting and wondering if he was dying. The emergency doctor realised that he had diabetic ketoacidosis, the potentially life-threatening complication of the type 1 diabetes. “I presented to my doctor with all four T signs of type 1 diabetes – Thirsty, Tired, Thinner, and going to the Toilet a lot”, Frank said. “In hindsight, it’s hard to believe that we weren’t able to recognise the symptoms earlier!” Now 26 years old, Frank is managing his diabetes well, testing the latest diabetes technology and writing about his experiences in his blog.
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Our clinical services manager, Rebecca Flavel, provided comments on the growing issue of diabetes to many community newspapers and was interviewed on RTR FM. Pharmacies, GP clinics and hospitals all came on board to promote the “It’s About Time” message, displaying our posters and talking about recognising the signs of diabetes with their patients and visitors. We also presented Kellion Awards to six people, recognising their achievement of living with diabetes for more than 50 years.
Prevent Deb explained that Let’s Prevent is not a weight loss or exercise program, but a health program that supports people to make small, positive changes to their lifestyle that can make a big difference to their health in the future.
Let’s Prevent begins with an initial face-to-face group session, and from there participants are offered support for the next 12 months via telephone, email and further group sessions. Any South West residents at risk of a chronic condition can attend the Let’s Prevent – sessions are now being run in Bunbury, Busselton, Capel and Harvey.
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If you or someone you love might be interested in attending, visit our website: diabeteswa.com.au/lets-prevent or phone 1300 001 880. 7
AGES &
stages
The Ages & Stages of Diabetes Diabetes is a long-term condition which affects people at different stages of their life. An individual’s needs will change over time and there are unique challenges that are often faced at each phase of the life cycle. Young children rely on their parents and teachers to help them with treatment and it is important that someone is there to guide their food intake. For teenagers, who are often busy with school and their social life, diabetes can be a bit of a pain. Young adults may be thinking about getting a job, going away to university or travelling. Adults may be used to a routine with their treatment if they have been diagnosed some time ago, but many adults are only just being diagnosed, particularly with type 2 diabetes, and they are only just learning to adjust to their new health care requirements. Many adults are time-poor and have others relying on them whether it’s within their career or family. Older adults need to be more aware of the risk of complications developing. Retiring from full-time work and becoming more sedentary can cause its own problems.
Ages and Stages Defined When we are talking about ages and stages of diabetes, it is important to acknowledge that each person is an individual and individuals will move through these stages differently, regardless of their chronological age or, for that matter, their diagnosis.
8
Maturity levels, life experiences, outside influences, peer groups and any other health conditions will all affect how a person approaches their navigation through the life cycle. The terms used to categorise the groups we have chosen to discuss in our feature articles can be debated. What does “young” mean exactly, and how old is “old”? For the purposes of this issue of our magazine, we define our ages and stages as the following;
• • • •
Kids and Teens: 0-17 years* Young Adults: 18-30 years Adults: 31-60 years Over 60s: 60+ years
*Though Perth Children’s Hospital does transition kids to adult care at the age of 16 years, we have chosen to extend our category by one year, before moving on to the ‘young adults’ phase, when a child legally becomes an adult at 18 years. This is when alcohol and independent living are generally introduced and can present themselves as a unique challenge when it comes to diabetes management.
Transition The biggest challenge for each age and stage is usually transitioning between them. A move from dependence to independence with self-management of a young person’s condition is a big one. Within other stages, challenges include; transitioning from primary school to high school, where there is less hand-holding by teachers; moving from high school to university; university to workplace; workplace to retirement; retirement to aged care facility, where you once again become more dependent on others for your diabetes care. There are also shifts that are not age-related challenges, such as the transition from pre-diabetes to diagnosis, or medication to insulin.
We’re not all the same Diabetes affects people of all ages, and despite our summarisation within this magazine, we are mindful that everyone will have their own experiences with the condition.
AGES &
stages
Kids& Teens 0-17 years
Life changes for the whole family when a child is diagnosed with diabetes. Many parents worry about how diabetes will affect their child’s life. How it may affect their future. How they can continue to live a normal life. This life phase is often about adjusting to a diabetes diagnosis. As type 1 is the most common, but not only, form of diabetes diagnosed in young people, adjusting to life dependent on insulin is a huge challenge within this stage of life. At the pointier end of this stage is the transition to independence and this can be a challenge to parents/carers as well as the young person living with diabetes. Diabetes Australia recently reported that at 30 June 2018, there were 8,330 people living with diabetes aged 15 years or under; 7,662 of these living with type 1. Additionally, over the last 12 months 1,378 people under the age of 15 years received a new diagnosis of type 1 diabetes, which is equivalent to 37% of people newly registered with type 1 diabetes on the National Diabetes Services Scheme (NDSS). Children or teenagers who have recently been diagnosed with diabetes may struggle with their emotional reactions to their condition and the reactions of others, and have concerns about going back to school. Teenagers with diabetes may also worry about things like sex and drinking alcohol, or be confronted with choices around smoking and illicit drugs (see ‘Young Adults’, page 14, for more information on these issues). A child and their family will need a period of adjustment after diabetes is diagnosed. They must establish a routine for blood glucose monitoring
and injecting, learn how to count carbohydrates, see diabetes health professionals regularly and cope with fluctuating blood glucose levels. New challenges may arise as a child moves through different life stages.
Misdiagnosis Symptoms of type 1 diabetes, previously called juvenile diabetes due to it most commonly being diagnosed in children, tend to develop rapidly over a period of a few weeks while type 2 diabetes symptoms develop more slowly and may go undiagnosed for months or years. According to a 2012 survey from Diabetes UK, only 9 per cent of parents were able to identify the main symptoms of type 1 diabetes, as they are behaviours that are relatively common for kids to experience due to a number of reasons. The symptoms, such as increased thirst and urination, hunger, weight loss, fatigue and irritability, can often be blamed on late nights, a busy schedule or an over-zealous child, rather than a lifethreatening condition. In many cases, children with type 1 diabetes are not diagnosed until they are seriously ill. Health professionals, too, may fail to identify the signs of diabetes in children, which can lead to serious complications such as diabetic ketoacidosis (DKA), the leading cause of mortality in children with type 1 diabetes.
A study, published in the journal Archives of Disease in Childhood, of 261 children aged eight months to 16 years who had been diagnosed with type 1 diabetes, found that by the time children under the age of two years received their diagnosis, 80 per cent of them had already developed DKA.
Type 2 complications Until recently almost all children and teenagers with diabetes had type 1, but now more young people are developing type 2 diabetes due to increasing rates of maternal and childhood obesity. If managed poorly, the progression of type 2 is much faster than for adults, and they seem to be at higher risk for complications earlier in life, such as kidney and eye disease than children with type 1 diabetes. There is also a greater risk of high blood pressure and high cholesterol levels, which raises the risk for blood vessel disease. Type 2 diabetes in children is often associated with obesity, which may contribute to these higher risks. Because of this, early detection of type 2 diabetes and attention to managing overweight in younger people is crucial, as is offering a caring, non-judgemental approach.
Dependency on carers With the identification of these symptoms being the responsibility of a parent, it is no wonder that the bulk of 9
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the responsibility of managing a child’s diabetes comes down to their parents and/or carers, until the child can learn to self-manage their condition over time. A child’s diabetes diagnosis brings with it a variety of challenges for parents, and can mean changes to the whole family routine. With type 1, it is often necessary to check children throughout the night which can upset parents’ sleep patterns.
Safety is the primary concern and it is important that those who accompany the child know exactly what to do in case of an emergency and have the most up-to-date contact information at hand (physician, parents, guardians) and know where their diabetes supplies are. Recognising the important role that teachers can play in assisting young people to manage their diabetes, Diabetes WA have developed a range of resources and training programs for early years, primary school and secondary school settings (see our website for more information).
The desire to be ‘normal’ Living with and managing diabetes every day can be a struggle. Children and teens are commonly concerned about:
• treated differently or • being delicately, as if they are ‘sick’, out amongst their peers as • standing special or different, with constant parental • coping questions about their food intake, feeling like they are a burden on the family,
how they are feeling and whether or not they have taken their insulin, and
extra attention from parents • getting or others, which may cause jealousy among other siblings. 10
Though an insulin pump or CGM makes managing diabetes easier, when kids deem their insulin pump or CGM a fashion faux pas, it’s tough to get them to stick with their treatment plan. And some may want to return to needles to avoid having to accessorise with a pump. Challenges come when children enter adolescence. With their newly gained independence, the desire to have control over their treatment becomes stronger, whether the decisions they make are beneficial or not. It’s normal for children or adolescents to feel sad, angry and fed up with their diabetes at times. After all, diabetes is a lifelong condition, so the tasks and skills needed to manage it must be continued over a lifetime. If children struggle with their diabetes management due to feeling depressed, anxious or overwhelmed, it is important to seek help from a diabetes health care team or GP.
influence on their child’s response to having diabetes, particularly if they were diagnosed as a child or young adolescent. Parents who are confident and reassuring help their children maintain a positive, resilient attitude towards their situation, whilst parents who are fearful and overprotective can diminish confidence in a young person’s ability to cope. Though the analysis surveyed young adults (see page 14 for more information on this age group), the participants reflected on their experience of their diabetes diagnosis as a child or teen. The report showed that, whilst the majority of young adults (66%) said that the support of family or partners had played a big role in helping them to cope better with having diabetes, they also felt it would be useful if parents were shown how they can be supportive, without taking over the lives of their children.
TRANSITION There are a number of challenges with the transition between stages for young people, but they all focus on one key element – handing over the responsibility of care. For very young children, diagnosed at an early age, the start of school is a significant change for children with diabetes and their families. It is essential that the school is aware of how to manage a child’s diabetes and the parents have to have the confidence to hand over this responsibility, while also ensuring their young child is capable of identifying and communicating their diabetes needs.
Growing independence As children grow and mature, they learn to care for themselves. This is also true for diabetes-related tasks. It’s important to keep in mind that every child is different so any advice about what is suitable at each age should be recognised as a guideline only. A 2006 needs analysis of young adults conducted by Diabetes Australia states that qualitative research suggests that the way parents react to their child’s diagnosis can have a big
When is the right time to hand over the reins? There is not an exact age when children can assume some of their diabetes care either with supervision or on their own. Independent self-management of diabetes depends on the child, their age, their individual personality and capabilities as well as their developmental stage. Age is one of the factors to use when making this decision, however, there are several other important factors to think about including developmental level, the interest shown by the child and whether there are any other health issues or concerns. Children should be encouraged to start helping with their diabetes care when they can follow simple instructions
AGES & and make simple choices. They can begin self-care as they show they are able to do the tasks for diabetes care correctly and consistently.
Giving your child more responsibility when they are not ready can result in hyper/hypoglycaemia as well as feelings of failure and low self-esteem.
It is a fine balance between capability and independence. A common problem is to push the child into more responsibility before they are ready.
A practical way to guide a child to independent self-management of their condition is to transition from doing all the tasks for the child, to watching
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the child doing the tasks, to confirming that the tasks are being done as they should and then eventually, to keeping up communication with your child and checking in on how they’re feeling about things.
Diabetes Responsibility by Age Age
Diabetes-related responsibility Communication about diabetes
Infants & Parent administration for all tasks toddlers
3-6 years
7 - 12 years
• Parent supervision for all tasks learns to cooperate for • Gradually BGL tests and insulin • Inconsistent with food choices • Gradually learns to recognise hypos • Little concept of time • Can learn to test BGLs age 10 or 11, can give insulin on • Atoccasion • Can make own food choices • Can recognise and treat hypos 11 or 12, can be responsible for • Byremembering snack, but may still
need reminders from alarm watches, teachers or parents
13 - 17 years
of doing the majority of • Capable injections and BGL tests but still needs some parental supervision to make decisions about dosage
• Knows which food to eat recognise the • Gradually importance of BGL management
Don't understand why they need to have injections or get their fingers poked. Make BGL testing and giving insulin part of your child's daily routine, like nappy changes. Perform diabetes care quickly and gently, in a soothing manner, and reassure your child with calming words. Rely on parents for their diabetes care. Explain diabetes-related tasks in simple terms. Parents can also help them feel some sense of control by letting kids tell them where they'd prefer to have their insulin injection and which finger to use for a BGL test.
Be supportive, but don't push as your child takes on self-care responsibilities. As kids grow, they become more interested in independence and more sensitive about being different from their peers. Offer praise for self-care responsibility, but tolerant of setbacks. Avoid being overprotective, and reinforce that kids with diabetes can do anything that other kids can do. Discuss how having your child take responsibility for diabetes can make it easier to go to fun events like parties and sleepovers.
Teens may make poor decisions regarding their diabetes care because of peer pressure, the fear of being different from their friends, and a feeling of invincibility. It's important to talk about drugs, alcohol, sexuality, and other issues with your teen and how they could affect their diabetes and overall health. Avoid lecturing and express concern in a caring manner. Peer or online support groups may help.
to prevent later complications
Article sources: medicalnewstoday.com; childrensal.org, Diabetes Australia, kidshealth.org
My biggest challenge is … I find it hard to adjust to having diabetes even after three years. Trying to get on with life; school, sport and friends – add diabetes into the mix and it becomes very hard. It sucks, but what’s life without its challenges, hey? Sophie, 16 years, type 1. 11
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Prototype makes insulin ‘fun’ Product designer Renata Souza has created a prototype colourful insulin pen and illustrated tattoo kit, which aims to teach children with type one diabetes how to inject themselves and reduce the stigma of the condition. Thomy is a colourful insulin-injecting kit designed by 24-year-old Renata Souza in the US. The kit consists of a chunky, colourful insulin pen, with a big handle that aims to be better-suited to children’s hands, a shorter needle to make it easier to reach and a button at the top that changes colour to indicate when someone is finished administering insulin and can release the needle. The set also uses temporary tattoos to help children remember where they have previously injected the insulin, avoiding complications at the injection site. The rub-on, temporary, non-toxic tattoos show rotating needle injection points incorporated into different graphic designs, such as a solar system. The tattoo is black, with the injection points in colour. Just before administering the insulin, a child or their parent can rub the coloured dye spot off with an alcohol wipe and travel clockwise when a new injection is needed. This shows exactly where it has
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been injected previously and has the added benefit of consistently cleaning the area prior to injecting. “Not only is this something fun that might make kids more inclined to want to inject themselves, but it will teach them to self-manage their condition and be independent from a young age,” said Souza. “There have been great developments in science and mechanisms, but humanising products is really lacking in the medical field,” she continued. “The existing pens are robotic and unnatural. If people like the way something looks and works, and they can identify with it, research has shown this increases patient compliance and so aids condition management.” Thomy is currently a prototype project only. Souza is seeking a company to partner with to manufacture and sell the product globally. For more information visit renatasouzaluque.com/thomy/
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Perth Children’s Hospital In a staged opening, Perth Children’s Hospital (PCH) began welcoming patients mid-year, with its first outpatient clinics taking place on 14 May, elective surgery commencing on 28 May and the emergency department officially opening on 10 June. Construction of the $1.2 billion new facility started in 2012 and was due to open in August 2015. Lead in the water attracted much media coverage and brought construction progress to a standstill, causing major delays. These challenges were overcome however and the result is a new facility that surpasses expectations. The PCH emergency department is almost double the size of the previous Princess Margaret Hospital’s with 298 beds, and the hospital also has twice as many theatres with 12. We asked Jaimee Paniora, Acting Clinical Nurse Consultant / Diabetes Educator at PCH some questions about the new facilities:
What facilities are available to help families with kids living with or newly diagnosed with diabetes? We have our multidisciplinary team consisting of diabetes nurse educators, social workers, dietitians, endocrinologists/doctors and psychological services to cover newly diagnosed education as inpatients after the initial diagnosis. The aim is to teach the essentials and ensure the family feel equipped and safe to go home with the necessary knowledge and essential diabetes supplies. They will then return to our newly diagnosed clinics for follow up education with the clinic team. Following this, families attend clinics every three months for review and have access to our triage phone line and email which allows both newly diagnosed families and existing families to contact educators for advice and information as required.
Is there anything exciting and new at the new hospital that wasn’t at PMH? There are lots of new and exciting things to see at PCH. There is Fun on Four (the hospital’s main recreation area), interactive features and creatures through the main areas, and lots of bright lights and colours. In regards to the diabetes clinics and services, we have colourful teaching rooms with interactive smart screens, and an updated newly diagnosed file which is much more colourful than the previous one, and includes links to online videos put together by our very own educators. We also have new sections in the file relating to the latest technology so families can gain knowledge about the latest management options. Checking in is automated and can let families know if waiting times are longer than expected. We also have an electronic calling system, not unlike an airport (so we have been told by our families).
Tell us a little about the clinics, support networks and outpatient programs for kids with diabetes. We continue to have our regular clinics for families to attend every three months. We also have a new seminar room for group education for pump workshops, CGM workshops and newly diagnosed group education. We run children’s diabetes camps in conjunction with you guys at Diabetes WA, which gives children the opportunity to meet others with diabetes. The camp is staffed by diabetes educators, a camp doctor and dietitian and has input from the psycho-social team. This is often the first time parents have not had to care for their child overnight.
Key Features of Perth Children’s Hospital
• 298 beds • 75% single rooms to 12 multi-use theatres, • Up including an intraoperative MRI outpatient and day• Increased stay capacity mental health • Co-located inpatient unit for under-16s Department 88% • Emergency bigger than PMH’s beds in each standard • Parent inpatient room • Parent lounges on every floor • 3500sqm of green space recreation hub • Anandinnovative play area • Five retail food outlets check-in option for • Electronic outpatient appointments • Helicopter landing pad alerts for parents • Telephone when child is close to being called into their appointment
Entertainment System • Patient that opens a treasure chest of age-appropriate TV & movies, radio, video games and education resources 13
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Young Adults
18-30 years Young adulthood is a critical time for the development and integration of lifelong diabetes management skills, and research is starting to identify unique challenges faced by young people with diabetes as they age into adulthood. The challenges of the day-to-day management of diabetes can be even more pronounced in young people as compared to older adults with diabetes. Young adults often have complex lives and are balancing many competing priorities such as romantic relationships, starting a family, work/ career, travel, and financial responsibilities. This can make it even more difficult to do all of the necessary tasks to effectively manage diabetes, and the emotional burden may be felt more acutely. Most young adults experience multiple transitions during this developmental period, including changes in lifestyle (i.e. education, occupation, living situation), changes in health care, and shifting relationships with family members and friends. In so many respects, young adults with diabetes are no different from any other young adults in Australia. Like other people their age, they want to go out, have fun, stay up late, and sleep in. They want independence, and to make their own choices. But young adults with diabetes must navigate these transitions while also assuming increasing responsibility for their diabetes care and overall health. To say that transition is a big focus for this age group, is an understatement. Independence and experimentation is what life is often all about at this stage and throwing diabetes management into the mix can sometimes be a risky concoction.
Transition to adult health care Young people will often move from a children’s diabetes service to an adult diabetes service when they are around 16-18 years old, generally about the time they are finishing school. Most children’s hospitals have a diabetes educator or nurse, known as a transition coordinator, who is responsible for organising the move to an adult clinic, ensuring the young person is ready. Continuity of medical care is essential for appropriate diabetes management and, as such, much research has focused on the challenges of transitioning from paediatric 14
to adult diabetes care. In 2011, the American Diabetes Association released a position statement highlighting the specialised needs of young adults during this transition. Though aimed at the issue of diabetes in the United States, this position statement offered many useful suggestions to optimise care of young adults with diabetes (type 1 specifically), including: preparing for adult medical care at least one year prior to transfer, if not sooner; promoting appropriate assumption of independent diabetes care responsibilities in adolescence and young adulthood; assisting young adults with compiling a comprehensive written medical history to bring to adult care providers; increasing young adults’ knowledge about the adult health care system; facilitating referrals to adult medical care; and recognising the challenges associated with diabetes care in young adults, including gaps in medical care, competing lifestyle and psychosocial concerns, and risky behaviours such as disordered eating and poor adherence to prescribed medical regimens (Diabetes Care, 2011). So why is the transition considered so difficult? The effective use of adult health services is a life skill that has to be learnt. People with diabetes need to learn this from a young age. The magnitude of this task is emphasised by the numerous differences between the paediatric and adult health care settings. The major difference between the two settings is in the expected roles of the patient. In the paediatric system the patient is part of the family team, whereas in the adult system, the patient is expected to be an informed and autonomous individual. There is a formal element to this in that hospitals require adults to provide informed consent to receive treatment. (Diabetes among young Australians 2012. aihw.gov.au) Education and support throughout this transition period, from primary care providers such as GPs, allied health professionals and specialised diabetes educators, is an invaluable resource that should not be overlooked.
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Diabetes self-management The Young Adults with Diabetes Needs Analysis, conducted by Diabetes Australia in 2006 (previously referenced) showed that around half of those who were diagnosed with diabetes during childhood or their early teens had taken on responsibility for management and self-care by the age of 15, and almost all had done so by the time they reached 18. The report also showed that for most young adults, the biggest challenges associated with living with diabetes include staying positive and motivated, sticking to a routine, maintaining self-management and avoiding temptation. Early adulthood appears to be a particularly challenging time for young adults with diabetes as they make the transition from the relative predictability and stability of the school environment to university and/or work. Routines are disrupted, money is often tight and managing diabetes can seem like an insurmountable challenge. As they move through this life stage towards their thirties, time management and learning how to ‘juggle’ diabetes with a hectic work and life schedule become the biggest challenges and the cost of health care can become a resentment. Some young adults may also start worrying about their future, including complications and how diabetes will impact on starting a family. “It’s a busy time of change and it is easy for diabetes management to slip to the bottom of the list,” Diabetes WA Clinical Services Manager and Diabetes Educator Rebecca Flavel says. “But even if you have missed a few appointments at your clinic, it is never too late to re-engage with your health service.” Some common challenges faced at this life stage are outlined below. Though not exclusive to this age group, taking on the responsibility for self-care while learning about the world and figuring out your place in it can pose a significant challenge for many young people. Strong support networks are vital at this stage to provide
on-going guidance, education and encouragement, as well as social and emotional support.
Leaving the nest Whether it’s moving out of home or relocating further afield, such as interstate or overseas, moving from under the watchful eye of family care requires education and planning. Figuring out how to survive and thrive on your own is a big job for any young adult who’s living away from home for the first time, but it’s particularly complicated for those with diabetes. Many people worry that leaving the safety net of family behind when they move out means they’ll need to manage their diabetes alone, but that’s not the case, or recommended. “You have to find another set of safety nets,” Rebecca says. “Diabetes is managed better when you have support and it is important to find that support network in your new environment.” “Tell those close to you that you have diabetes and educate them on how to treat a hypo if you have one,” recommends Rebecca. “Find a diabetes clinic and pharmacy nearby that supplies what you need. Know your nearest emergency facility, ensure you have the phone numbers in your phone that you will require and use phone apps for reminders about
appointments, BGL checks and line changes if you have an insulin pump.” Independent living also means cooking and making some sensible food choices. Many young adults have never had to do this for themselves while living at home and learning what is healthy, while still being quick and easy to put together, is another skill to take on board. Understanding the amount of carbohydrate in meals and snacks is an important part of the dietary management of diabetes, and this attention to detail is not always a strong skillset in young adults, distracted by junk and fast foods. Young adults need to make these decisions through trial and error (within limits) and will soon learn what eating pattern will keep them healthy and reduce the risk of diabetes-related complications, and how specific foods and meals impact on their BGLs. An adult child leaving the family home can also be a challenge for parents and there can be confusion about how much attention he or she may pay to their diabetes care. Will they now be ordering their own supplies? Who will make appointments with doctors? It’s important that parents don’t nag, but it’s equally important to make sure all aspects of care are covered and open communication is key in this circumstance. 15
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Alcohol and drugs Temptation presents itself to young adults in many ways, and one of the common ones is alcohol and drugs. Some may consider it a rite of passage, but the party scene doesn’t always mix well with diabetes. This is not to say that people living with diabetes can’t have fun and indulge in a drink but there is no way of safely ignoring giving insulin and checking BGLs, so anything that impairs someone is going to make it harder to take care of themselves. That includes recreational drugs and alcohol. Alcohol can lower blood glucose and cause hypoglycaemia, especially after falling asleep. Young people who have overindulged may think that they’re vomiting from drinking, when in fact it can be a sign of the dangerous condition diabetic ketoacidosis. Expecting young adults not to experiment is unrealistic. It is important to be aware of how to safely manage drinking alcohol with diabetes, i.e. eating to prevent blood glucose levels from dropping and not drinking to excess. “It is also important to ensure that at least one person you’re with, preferably who isn’t drinking, knows you have diabetes and how you might act if your blood glucose levels drops,” Rebecca says. “Sometimes the symptoms of low BGLs are similar to what you might find in someone who’s had too much to drink.”
Eating disorders have substantial risks for a person living with diabetes. “Diabulimia”, as it has been called in the media, represents people with typical eating disorder symptoms using insulin restriction to also control their weight, leading to mismanagement of their diabetes. This can lead to catastrophic complications, including increased risk of hypos and higher rates and earlier onset of diabetes complications such as nerve damage, eye and kidney disease and heart conditions.
Hitting the road Another skill set introduced in this age group is obtaining a license. People with diabetes can hold a driver’s licence or learner’s permit as long as their diabetes is well managed. A medical report must be provided before a driver’s licence or learner’s permit can be issued. You must also inform the licensing authorities if you develop diabetes and already have a licence. The main concern of the licensing authorities is the possibility of hypoglycaemia occurring while driving and longer-term diabetes complications like eye problems can sometimes cause issues down the track. In most cases, if you manage your diabetes by insulin you will require a medical certificate every two years, and if you manage it by tablet every five years. Article resource: Young Adults with Diabetes Needs Analysis 2006. diabetesaustralia.com.au
Eating disorders Eating disorders are a considerable issue for many people living with diabetes. They are a serious mental health issue that involve preoccupation with control over one’s body weight, shape, eating and exercise. They most commonly develop in the adolescent and young adult years and affect more women than men. Managing diabetes is a complex balancing act with a big focus on food consumption and exercise. This intense focus can sometimes lead to a problematic relationship with food and eating. Research suggests that females with type 1 diabetes are approximately twice as likely to develop an eating disorder or disturbed eating as their peers without diabetes. Meanwhile there is a lot of social pressure about body weight and image. Young adults, though often gaining confidence, can be very body conscious and it can be difficult to find the right balance between enjoying eating and socialising and managing diabetes.
Useful Resource The NDSS has produced an excellent resource for this age group, Moving on Up. Designed specifically for young people with type 1 diabetes and their parents or guardians about the transition from paediatric to adult health care services, this resource focuses on the challenges and opportunities that young people face as they become young adults; how they can live well with diabetes through this time and, importantly, the responsibilities they have for their own diabetes care and the support they can expect to receive. It is available for download at ndss.com.au/young-people
My biggest challenge is … … at the moment is self-care. With work, appointments, diabetes appointments, family commitments, social life and extra-curricular activities there is a lot going on all at once. Finding time to manage my condition appropriately (such as treating lows or taking a sick day) amongst doing all the other stuff can be hard, but it is something that I am working on every day. Shannon, 25 years, type 1. 16
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Adults 31-60 years Adults live diverse lives. But one constant for many people at this stage of life is too little time. Juggling many roles and duties, it can be hard to squeeze everything in and this is made even more challenging when you have a condition that requires daily attention such as diabetes. While biological factors come into play as we age, there are other factors which impact diabetes management as well. One of the most common reasons people give for not looking after their health is that they are “too busy”. A new job means there is less time for exercise, or getting home late means picking up a pizza on the way. A new baby might mean those extra kilograms haven’t yet been shifted and gradually the bigger dress size becomes the “new normal”, or checking blood glucose levels the next time the baby goes down for a nap becomes an unfulfilled prophecy. Full-time employment, starting a family or looking after a young or growing family, climbing the corporate ladder, and generally focusing on the needs of others can all be real challenges for time-poor adults that have multiple conflicting demands on their time. Health will often take the lowest priority and when you are living with diabetes, this can cause some real issues.
Crunching the numbers While members of this age group do not represent the largest collective percentage of people currently living with diabetes in Australia – that privileged title belongs to the Over 60’s – they do still represent 32 per cent of the population of those diagnosed. And interestingly, according to June 2018 NDSS statistics, the 30-39 year age bracket does represent the highest percentage of those newly diagnosed in the last 12 months. The significance of this figure is emphasised by the fact that of the 30,360 newly registered within this age group, 25,609 were diagnosed with gestational diabetes. Though this may not come as a surprise, as this is the most common age bracket for falling pregnant, it is still a concern, as developing gestational diabetes can have repercussions later in life. Having gestational diabetes, even if it ‘goes away’ once the baby is born, significantly increases the chance of developing type 2 diabetes down the track. It is also worth noting that type 1 diabetes is not predominantly a ‘condition of childhood’ as previously believed, but is similarly prevalent in adults. NDSS statistics
show that more than 36 per cent of type 1 diabetes cases in Australia are diagnosed after the age of 30. But many of those with type 1 diabetes after the age of 30 are thought to have type 2 diabetes at first, and not initially treated with insulin to manage blood glucose levels. Research by the University of Exeter Medical School found that, on average, it took a year for those with type 1 diabetes who had been misdiagnosed with type 2 to be put on insulin. It is believed that type 1 diabetes is harder to recognise and correctly diagnose in adults because far more people develop type 2 diabetes in later life. Type 2 accounts for 97 per cent of diabetes cases between the ages of 31 and 60.
Mixing it up As a whole, this age group is a real melting pot of different stages of diabetes. There are adults who have been living with diabetes for many years and are either ‘experts’ confidently managing their condition, or perhaps are getting a little stale on their diabetes management, and have become lax on giving it the attention it needs. There are also those who have been newly diagnosed, and are just learning how to self-manage their condition. In the case of some lifestylerelated type 2 diagnoses, there might also be guilt or regret associated with that diagnosis. Within this age bracket, there is also a large proportion of people who are at risk, or have been diagnosed with pre-diabetes and are working to get a handle on their health and avoid progression of the condition. All of these stages of diabetes present their own challenges. Support groups, education programs and diabetes clinics can provide help with addressing the needs of the individual.
Put your oxygen mask on first So back to the issue of day-to-day life getting increasingly busier and more demanding and what this means for diabetes. Despite good intentions, positive diabetes behaviour change is often near the bottom of our ‘to-do’ list. Ironically, making time for diabetes means you will be making more time. Not paying attention to blood glucose levels can 17
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leave you feeling unwell, meaning every other daily task is harder to complete. A trip to hospital also certainly doesn’t fit into many people’s busy schedules. There is some irony in ensuring you allow more time to focus on your health, to give yourself more time to achieve everything that needs covering off in the day. Putting the needs of others before your own, means there is a chance you won’t be there for them if you become unwell. When you fly on an airplane, the flight attendant instructs you to put your oxygen mask on first, before helping others. This is an important metaphor for those who run around taking care of everything and everyone else except themselves.
Diabetes distress Trying to manage a crazy schedule can also lead to diabetes distress (also known as diabetes-related distress). It is a feeling of frustration, worry, anger, and guilt about diabetes. People with it also often feel like there is too much to think about and do every day in order to take care of the condition. Some feel as if they have to think about diabetes all the time. That mental load is the extra burden of having diabetes. Almost 50 percent of people with diabetes will feel distress at some point (diabetesforecast.org). It’s important to remember that feeling overwhelmed by diabetes and its management is something many people face at times throughout life. Diabetes distress makes you feel bad— mentally and emotionally—and can affect your physical health. Reaching out to your diabetes care team and your support network can often provide some relief. 18
TRANSITION Depending on where you are in your diabetes journey, transition for this age group may mean adjusting to becoming insulin-dependent after managing type 2 diabetes with medication for some time; focusing on the avoidance, or the development, of complications of the condition; and some people may be adjusting to a diabetes diagnosis. Diabetes can also impact on relationships over time and this may come into play at this stage of life.
Becoming insulin-dependent For many years, insulin was considered a last-case treatment for type 2 diabetes. If blood glucose levels were not able to be managed with oral medications like Metformin, dietary changes, and exercise, people with type 2 would occasionally be given either rapid-acting insulin to use on an as-needed basis, or (even more rarely) would be put on an intermediate or long-acting insulin regimen. With the increase of type 2 diabetes onset at a younger age, however, researchers believe that insulin treatments for people with type 2 are going to increase dramatically over the coming years. 2018 NDSS statistics show that 24 per cent of people living with type 2 require insulin to manage their diabetes. A younger onset age means an increasingly large portion of the population with type 2 diabetes will have had it for a significantly longer time. Taking advantage of technology that is now available can help with this transition. Insulin pumps and continuous glucose monitoring devices (CGMs) can ease the burden of administering insulin.
Avoiding complications Chronic complications of diabetes usually appear after several years of elevated blood glucose levels. Diabetes complications often share the same risk factors, and one complication can make other complications worse. For example, many people with diabetes also have high blood pressure, which in turn worsens eye and kidney diseases. Diabetes tends to lower HDL
(“good”) cholesterol and raise triglycerides and LDL (“bad”) cholesterol, which increases the risk for heart disease and stroke. Smoking doubles the risk of heart disease in people with diabetes. Complications usually develop over a long time often without any symptoms. That’s why it’s so important to make and keep doctor and specialist appointments even if you feel fine. Early treatment can help prevent or delay diabetesrelated health conditions and improve overall health. This means it is a crucial time to be focused on health and exercise to try and keep well and avoid those complications developing. Careful diabetes management can reduce the risk of these lifechanging complications developing. Everyone’s diabetes is different. Some people will still have complications even with consistent diabetes management. Health problems can develop in spite of a person’s best efforts. Feeling discouraged and frustrated may mean slipping into unhealthy habits, delaying monitoring BGLs, or skipping doctors’ appointments. That’s when your health care team can help you get back on track, from setting goals and reminding you of your progress to offering new ideas and strategies.
Managing relationships Relationships can be a significant aspect of this lifespan stage. They are often formed, solidified or being maintained, and living with diabetes, or being diagnosed, can impact significantly on relationships. The management of diabetes benefits from the help of a supportive partner. A study published in Diabetes Care 2013, looking at the impact of diabetes on adult relationships, discusses four main challenges that were identified by focus groups: 1) level of partner involvement, emotional impact of diabetes on the relationship, and concerns about safe child-rearing; 2) understanding the impact of hypoglycaemia; 3) stress of potential complications; and 4) benefits of technology. Outcomes of the study suggested that, although partner involvement
AGES & varies, there exists significant anxiety about hypoglycaemia and future complications, by both the person living with diabetes and their partner, and self-care was a source of conflict that may increase relationship stress. The study emphasised that partner support is highly valued, and the use of technology has a positive influence. More detailed comments described increased emotional distance, sexual intimacy problems, difficult decisions about if, and when, to have children, caring for young children with the constant threat of hypoglycaemia, and a general increase in relationship stress. It’s important to recognise that many participants also provided positive comments, saying diabetes had had no impact on their relationship and that the need to care for a partner had indeed brought them closer. Another study (everydayhealth.com) of people whose partners had type 2 diabetes found that those who tried to exert control over their partners’ dietary behaviour felt particularly stressed and burdened. The emotional strain of dealing with diabetes can also cause communication difficulties that can lead to sexual dysfunction in relationships. As people living with diabetes transition through this life stage, maintaining a healthy and supportive relationship with their partner can become challenging. Whether one or both partners have diabetes, communication is key to remaining open and loving and to strengthen emotional bonds, which in turn will help navigate through the changes that diabetes requires over time.
stages
Tips to help you “put on your oxygen mask” Eating well: Sometimes it’s hard to eat healthier foods, especially if you have limited time to cook or shop during the week. Unfortunately this can increase the likelihood of eating convenient, less healthy foods.
• • • • • • •
Have a cooking day on a “day off” from work– then freeze meals for the week ahead. Get your groceries delivered – or ask someone else to do your shopping for you. Prepare vegetables after you’ve bought them so they’re ready to cook e.g. portion broccoli/cauliflower into florets. Invest in a slow cooker – so it does most of the work. Share cooking and cleaning responsibilities with other members of your family. Try to limit the number of times you go to the supermarket – one big trip versus three small trips can save you lots of excess time caused by travel and long check-out lines. Delivery services such as Uber Eats now deliver a lot more than just pizza. Healthy meals can easily be ordered from local restaurants and delivered directly to your door. Pre-prepared meal plans, such as those delivered by Hello Fresh, can also help you to stay healthy, without the trip to the shops or trying to plan meals for the family.
Physical activity: Exercise can feel like a chore, especially when you’re time poor.
• • • •
Exercise in three 10-minute sessions over the day rather than one chunk of 30 minutes. Longer durations are inconvenient to schedule – whereas, 10 minutes of exercise could easily be done within a lunch break, or before/ after breakfast or dinner. Increase incidental activity, such as taking the stairs or parking further away. It’s not a requirement to go to the gym to get fit, maybe dancing, football or walking the dog is more your thing. Choosing something you like will be less of an effort, reducing procrastination. Incorporate a relaxation activity in your weekly/daily routine such as yoga, meditation, mindfulness, or breathing exercises. This can promote further energy and productivity.
Remembering not to forget: Forgetting is easy when there’s a lot to do.
• • •
Set reminders or alarms to assist you. This can be useful for medication doses, glucose monitoring, exercise, or even eating a meal. Phone apps can be useful too – some apps can alert you dependent on your location and list of things to do, e.g. buy milk if you’re near the supermarket. Look for the Apple Workflow app, or use Apple reminders or Google Keep. Limit your risk of running out of diabetes supplies and save time. Instead of making numerous trips to the pharmacy, try to buy more supplies when you visit. Make a list of your pharmaceutical supplies, that way when you need more it will help to ensure nothing is forgotten.
Source: Dr Sultan Linjawi; myhealthexplained.com
My biggest challenge is … … finding the time to make sure I eat and exercise appropriately. Working full-time, being a mum to a very energetic four-year old and now pregnant again, making sure myself and my family have nutritious diabetes friendly meals and for me to find the time to exercise is becoming increasingly difficult. This is especially the case being in my mid 30s when what used to work in my 20s doesn’t anymore! Jo, 36 years, type 2. 19
AGES &
stages
Over 60s Sixty-five per cent (818,582 as at June 2018) of people with diabetes in Australia were aged 60 years or older, and older people make up a considerable proportion of Australia’s population. According to the Australian Institute of Health and Welfare, around 3.7 million Australians (15 per cent of the population) were aged 65 and over in 2016. The ageing of the overall population is a significant driver of the diabetes epidemic. Although the burden of diabetes is often described in terms of its impact on working-age adults, diabetes in older adults is linked to higher mortality, reduced functional status, and increased risk of hospitalisation or admission to residential care. Consistent with the wider population, the most common type of diabetes reported by people aged 65 and over was type 2 diabetes - accounting for more than nine in 10 cases. The rate of self-reported diabetes for this age group has more than tripled over the last two decades - from 5.5 per cent in 1989–90 to 17.4 per cent in 2014–15. This increase is likely due to a number of factors including: an increased prevalence of risk factors, improved public awareness, better detection techniques, improved survival through management techniques, and an ageing population. (AIHW 2017) Older people may experience health care in various settings, such as the hospital, an assisted living facility, or at home. The approach to their care can affect their health and function and helping them maintain the best quality of life should be the main principle of diabetes management for carers providing them with support. 20
Though many people will remain completely independent and capable until well into their 80s, some people may need support earlier. Transition challenges can present themselves at this stage of the lifespan when people living with diabetes move from the workplace to retirement (ensuring they remain active and engaged is important); from living independently to moving into an aged care residential facility; the loss of a partner can mean the loss of a carer; and physical and mental changes can make it difficult to continue self-managing their condition.
Ageing or diabetes? The well-known symptoms of diabetes, such as urinating excessively and feeling thirsty all the time, are not as obvious in the elderly as in young people. Symptoms of type 2 diabetes, such as feeling tired and lethargic, can often be misinterpreted as just part of the normal ageing process. As a result, older people with diabetes may remain undiagnosed until damage has been done. Once diagnosed, these misinterpretations can continue. Getting older can mask some diabetes symptoms, which could lead to hypo or hyperglycaemia. Symptoms such as
shaking or dizziness may be attributed to standing up too quickly rather than an indication that blood glucose levels are dropping. As you get older warning signs of a hypo can also change and become less obvious.
Care needs for older people Most areas of care in diabetes are relevant to all age groups, however, there are some specific changes that happen with age that may affect diabetes management. Some older adults may have had diabetes for a long time, others may be more recently diagnosed, particularly in the case of type 2. The primary goal of diabetes management in older adults is to achieve balance between optimal glycaemic management to prevent and/or slow the onset and progression of acute and chronic complications, while avoiding hypoglycaemia and its consequences. Many older people also have other conditions as well as diabetes, and this can complicate diabetes management. For example, high blood pressure or high levels of certain fats in the blood can speed up the progression of common complications of diabetes,
AGES &
such as kidney problems, eye problems, foot problems and heart and blood vessel problems. People with diabetes whose blood glucose levels (BGLs) are high are more prone to infections than people with balanced BGLs, so having regular vaccinations against flu and pneumonia can become important. In some cases dietary advice for the older person with diabetes may differ from general recommendations. In particular, older people in care homes are often more likely to be underweight than overweight and there is a high rate of undernutrition. It may not always be appropriate to reduce the fat, salt and sugar for every older person with diabetes so the decision needs to be made which will have the lesser impact on health. Poor oral health, effects of some drugs on the digestive system, limited mobility, dexterity or vision can all cause discomfort associated with eating. Fluid intake is often lower in older people which can cause dehydration, particularly during bouts of illness. (diabetes.org.uk)
Increased hypo risk Older people may have added risk factors which can lead to a hypo, such as;
• • • •
prescribed four or more medications chronic kidney problems poor food intake having other illnesses or conditions.
Hypo warning symptoms can also become less obvious, and some have no symptoms at all. This may mean that the first signs noticed by a carer or loved one are:
• • • •
inability to concentrate personality change morning headaches sleep disturbance
stages
Mental health Depression is more common in people with chronic conditions but is particularly common in older people. An American study found that in communities of older adults with diabetes, the prevalence of depression was 33% (Diabetes Care 2001). Particularly with older people living in care homes, mental health screening on admission and annually is often carried out. Depression may also go unnoticed in older people with complex health problems. Painful neuropathy, foot ulceration and adverse effects of medication can all contribute to depression, along with the burden of the daily management of diabetes. The risk of dementia also increases with age. Anything that affects mental well-being may affect the ability to successfully self-manage diabetes. Simple tests to screen for depression or dementia are available from GPs and health clinics. Recognising these issues at an early stage can help limit their longer term impact. 21
AGES &
stages
It’s complicated People over the age of 60 years may be more likely to have chronic health conditions in addition to diabetes. Long-term diabetes may also mean they have already developed complications from the condition, the risk of which increases with age. Diabetes can result in a number of acute and chronic health conditions, including heart attack and stroke, kidney damage, vision loss, nerve damage (neuropathy) and delayed wound healing. Older adults with diabetes are also at substantial risk for both acute and long-term cardiovascular complications of the condition. These additional health problems can make it more difficult to manage diabetes and overall health. Being under the care of several different health care providers, or taking multiple medications, can make it challenging to find a balance. For example, a medicine may be useful in treating one health problem, but it might make another issue worse. Management of type 2 diabetes in older people using medication is more complex. For older people, the benefits of intensive glucose management need to be weighed against the associated risks, such as the impact of medications on the kidneys and the risk of interaction with other medicines used for managing multiple conditions, which is common for this age group. 22
TRANSITION Coping with retirement Many people look forward to retirement after decades of work, while others may find themselves there unexpectedly. Either way, it’s a big transition. A little planning can help to ease the move into this next phase of life with diabetes. Knowing that health insurance and Medicare allowances are in order takes the pressure off a sudden change in income. Finances can take a hit with retirement, depending on how well superannuation has been accounted for, and health care costs for a chronic condition such as diabetes can be significant. Maintaining an active mind and body is also important during retirement. Exercise can help improve blood glucose management and stave off some complications but it is also important for brain health. Sitting around with no place to go isn’t good for anyone’s mental health, so it’s important to make plans and feel you still have a purpose to maintain self-worth. No longer having to fit structured work into your life can be a real positive too. Finally having some spare time to enjoy yourself is a luxury many people long for. Use this time to grow your support network by joining local clubs or becoming more involved in your community to ensure you remain
active. You can also join a diabetes support group (see page 33 for a list of support groups) to meet people that can relate to the challenges of living with a chronic condition. Get retirement ready – speak to a financial advisor about how to manage your finances before you retire, know your numbers (not just your BGLs) and track all of your diabetes-related expenses so you know what you are working with.
Managing self-care Physical changes with age may affect the ability to self-care. Ageing involves physical and mental changes that affect sight, hearing, memory, sensation, balance and mobility. These kinds of changes can make it difficult to continue to take care of ourselves and stay independent. Age is the most significant factor for common eye conditions like glaucoma, cataract and macular degeneration. Failing eyesight and reduced mobility may lead to a reduced level of daily foot care, meaning early problem signs are missed. Urinary incontinence can be a symptom of many conditions, including poorly controlled diabetes and changes in kidney function. To assist with self-care, education strategies also require adaptation for ageing. Learning new diabetes selfmanagement skills may be difficult for older people, increasing the need for education to proceed in a simple, step-
C ome a to a Dia long MedSma betes WA r U n d e r s t t w o r k sh o p . a n d w ha t yo u r medicati o ns a w ha t t h r e a n d ey d S ee our Educatio o. n Plann on p age er 24 for d a t e s n e w o r k sh o p a r yo u .
like manner. Cognitive dysfunction, depression and functional disabilities (such as poor eyesight, hearing deficit, and a decline in dexterity) are important issues to consider when assessing the older adult’s ability for self-care. Involvement of family members or friends may be required to ensure appropriate self-care and adherence to treatment programs and this is where a transition from independence to dependence on others for diabetes management can take place. The development of dementia and memory loss can significantly affect a person’s ability to self-manage their diabetes as they age. People with diabetes have an increased risk of developing dementia, 20 per cent chance compared to a 10 per cent chance in the general population. Achieving the right balance of food, medicine and physical activity can be difficult, especially for people who have dementia. Forgetting medications, BGL testing or whether insulin has already been administered can have dire consequences. As the dementia progresses an increasing number of daily diabetes tasks need to be done by other people.
Loss of a partner or carer Diabetes can be a significant load to bear for those that have been diagnosed, but there is no doubt that it also has a significant impact upon partners too. Many partners take on the role of carer for their spouse living with diabetes. So what happens when that partner passes away. Many people with diabetes speak of their husband or wife checking on them throughout the night to avoid or treat a night-time hypo. Partners are often there to remind someone to take their medication, recognise symptoms of low blood glucose or to book appointments for the person living with diabetes. The loss of this ‘live-in carer’ in a person’s life, particularly when dementia or memory loss may set in with age, can impact on a person’s diabetes management. Establishing a support network within the local community, i.e. neighbours or fellow church members, and maintaining a strong relationship with a GP or diabetes clinic, who can advise the person on a new and reliable approach to diabetes management, is a good way of adjusting to this life change.
For more information visit our website: diabeteswa.com.au/ managing your diabetes/resources for downloadable NDSS booklets on ‘Managing your diabetes as you age” and “You and your health care team (over 65’s).”
AGES &
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Tips to avoid medication interactions Taking multiple medications for various health conditions can put you at risk of medications clashing and causing a reaction. Here’s how to steer clear of problems: a list of all your • Make medications and their dosages. Include vitamins, herbs, overthe-counter medicines, and dietary supplements. Keep this with you at all times in case of a medical emergency.
you visit your healthcare • When provider, bring your actual medications with you. This way they can be sure the directions on the bottles are up-to-date.
sure you know why you • Make are taking each medicine, how and when to take it, and what the common side effects are.
for a Diabetes Medscheck • Ask at your pharmacy. possible, have all your • Ifprescriptions filled at the same pharmacy. This way, your pharmacist can alert you if the medications you are prescribed could interact with each other.
to your GP about a • Talk Home Medicine Review and a pharmacist can come to you. For more information visit nps.org.au/medicines-line or call 1300 MEDICINE (633 424)
My biggest challenge is … … I socialise quite a lot and meet friends at the coffee shop. With all the sugary goodies on the counter it can sometimes be hard to resist temptation. Though now and then I do have one, I usually just have my coffee. I’m alright at home and am quite healthy overall, but when I am out and my friends are having a treat, it can be hard to say no. Joy, 81 years, type 2. 23
Education
We have a range of workshops and services that can help you on your health journey. Self-management Workshops Diabetes WA runs a number of education programs, held as two-to three-hour workshops, to help you manage your diabetes and improve your health. ShopSmart – this supermarket tour or classroom session helps you decode food labels. ShopSmart supermarket tour dates and locations were yet to be confirmed at time of print. Check our website for updated details.
FootSmart – everything you need to know about caring for your feet. MeterSmart – master the art of blood glucose monitoring. CarbSmart – unravel the mystery of carbohydrates with this carb counting masterclass. MedSmart – understand what your medications are, what they do and how to address any concerns you have. Living with Insulin – everything you need to know about using insulin; including equipment, hypos and blood glucose levels. Ready Set Go, Let’s Move – make exercise part of managing diabetes each day, with your own step by step plan. Insulin Pump Workshop – learn about the features of your pump and how to get the most out of it with this handson session.
Type 1 Technology Night Explore pumps, CGMs and flash monitoring and meet with device company representatives to find out the pros and cons. 24
Perth Metro Armadale Armadale Armadale Armadale Armadale Armadale Armadale Bassendean Belmont Belmont Belmont Belmont Cockburn Cockburn Ellenbrook Ellenbrook Ellenbrook Ellenbrook Ellenbrook Helena Valley Helena Valley Helena Valley Helena Valley Joondalup Joondalup Joondalup Kwinana Mandurah
DESMOND FootSmart Ready Set Go - Let's Move DESMOND Connect with Diabetes Living with Insulin MedSmart DESMOND Living With Insulin Ready Set Go - Let's Move DESMOND Classroom ShopSmart DESMOND DESMOND DESMOND Classroom ShopSmart MedSmart MeterSmart DESMOND DESMOND CarbSmart DESMOND MeterSmart ShopSmart FootSmart DESMOND DESMOND DESMOND
Melville Melville Melville Midland Mirrabooka Mirrabooka Mirrabooka Mirrabooka Mirrabooka Pearsall Riverton Riverton Rockingham Rockingham Rockingham West Leederville Willetton Willetton Willetton
MedSmart DESMOND DESMOND ShopSmart Living With Insulin MeterSmart DESMOND CarbSmart Classroom ShopSmart Type 1 Technology Night DESMOND DESMOND DESMOND Insulin Pump Workshop CarbSmart DESMOND MedSmart CarbSmart DESMOND
1 October 12 October 22 October 3 November 21 November 30 November 5 December 23 October 31 October 21 November 1 December 17 December 20 October 26 November 10 October 18 October 12 November 29 November 3 December 6 October 19 October 14 November 14 December 2 October 30 October 29 November 17 November 6 & 13 December* (two half days) 17 October 29 October 17 November 2 November 8 October 24 October 7 November 20 November 23 November 30 October 16 October 19 November 20 October 20 November 11 December 26 October 4 October 1 November 13 December
Planner WA Regional DESMOND Workshops Goldfields Goldfields
Esperance Esperance
Goldfields Goldfields Great Southern
Kalgoorlie Kalgoorlie Albany
Great Southern Great Southern Great Southern Kimberley Midwest Midwest Midwest Midwest Midwest
Albany Katanning Mt Barker Broome Dongara Geraldton Geraldton Geraldton Kalbarri
Pilbara Pilbara Pilbara Pilbara South West South West South West South West South West Wheatbelt
Karratha South Hedland South Hedland Tom Price Bunbury Bunbury Busselton Collie Harvey Jurien Bay
Wheatbelt
Southern Cross
8 October 27 & 28 November (two half days) 15 October 30 November 30 & 31 October (two half days) 3 December 14 November 8 October 26 October 9 November 12 October 12 November 10 December 15 & 22 October (two half days) 24 October 31 October 12 December 15 November 15 October 15 November 5 October 30 October 30 November 8 & 10 October (two half days) 7 November
Diabetes WA offers a 15 p er cent discount on health professional training and updates to members.
Connect with Diabetes A 2.5 hour free presentation for people with type 2 diabetes, carers, families and those at risk of diabetes. Connect with Diabetes enables you to understand and manage your diabetes and learn about food choices.
DESMOND DESMOND – Diabetes Education and SelfManagement for Ongoing and Newly Diagnosed is a one day workshop designed to equip those living with type 2 diabetes with the knowledge and skills to better manage their condition. DESMOND can help you achieve lower HbA1c, weight reduction, greater physical activity, reduced diabetes distress and better overall health outcomes.
Telehealth The Diabetes Telehealth Service for Country WA is available to those living out of the metropolitan area. One-on-one appointments via video-conferencing can be arranged through your doctor, or contact Diabetes WA on 1300 001 880.
Upskilling for health professionals in country WA The Diabetes Telehealth Service upskilling sessions are typically 1–2 hours in duration and are easily accessed via a desk top computer. The sessions cover a wide range of diabetes-related topics such as chronic kidney disease, diabetes retinopathy and gestational diabetes. To find out more or to register for any upcoming sessions call 1300 001 880 or go to our website. * Dates are yet to be confirmed. Get in touch with Diabetes WA if you’re interested in attending.
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 25
Notice of 2018 Diabetes WA Explanatory notes General Meeting of the members Notice is given that the 2018 Annual will be held; of Diabetes WA Ltd (Diabetes WA) Date:
Thursday 25 October 2018
Time:
5.30pm (WST)
3, 322 Hay Venue: Diabetes WA offices. Level
Street, Subiaco
Agenda:
s 1. Financial statements and report
report, the directors’ report and the
To receive and consider the financial ended 30 June 2018 auditors’ report for the financial year
2. Re-election of directors
the following ordinary resolutio To consider and if thought fit, pass separate ordinary resolutions: ctor of Diabetes WA; (a) To re-elect Alan Wright as a dire (b) (c) (d)
ns as
of Diabetes WA; to re-elect Paul Vivian as a director of Diabetes WA; and to re-elect Gary Walton as a director ctor of Diabetes WA. to re-elect Andrew Burnett as a dire
3. Appointment of auditors
the following ordinary resolution: To consider and if thought fit, pass ointed under section 327B(1) of the That BDO Audit (WA) Pty Ltd be app of Diabetes WA . Corporations Act 2001, as auditors 880 or P to Marina Aiyathurai on 1300 001 For catering purposes, please RSV member Any u by Friday 19 October 2018. marina.aiyathurai@diabeteswa.com.a to attend. who has not RSVP’d is still welcome included ld like to vote, a prox y form has been If you are unable to attend and wou mpanying your magazine. on the reverse of the address slip acco By order of the Board:
These explanatory notes have been prepared to provide members with sufficient information to assess the merits of the resolutions contained in the accompanying notice of Annual General Meeting of Diabetes WA to be held at Level 3, 322 Hay Street on Thursday, 25 October 2018 at 5.30pm (WST).
1. Financial statements and reports Section 317 of the Corporations Act 2001 (Cth) (Corporations Act) requires the last financial year’s financial report, the directors’ report and the auditor’s report to be laid before the annual general meeting. There is no requirement either in the Corporations Act or in Diabetes WA’s constitution for members to approve the financial report, the directors’ report or the auditor’s report. Members will be given the opportunity at the meeting to ask questions and comment on these reports.
2. Re-election of directors Each of the directors standing for re-election will retire at the Annual General Meeting and stands for reelection in accordance with Diabetes WA’s constitution. (a) Re-election of Alan Wright as a director of Diabetes WA
Andrew Wagstaff Chief Executive Officer 10 September 2018 Diabetes WA Ltd ACN 610 729 612
26
Alan was appointed to the Board of Diabetes WA in 2012. He is a General Practitioner with extensive experience in the management of diabetes. He is passionate about opportunistic preventive care, particularly in the setting of men attending their GP. He has considerable experience in the military and credits his service with his sound organisational skills.
Annual General Meeting Alan has served on a variety of Boards, including current membership of Relationships Australia WA and past service on the Board of Asthma WA and Andrology Australia. He is active in education and held the position of the Chair of Communication and Clinical Practice at the School of Medicine at the University of Notre Dame Australia until 2012. In addition he is very active in GP education, particularly in the areas of diabetes, men’s health and obstructive respiratory disease. Alan brings to Diabetes WA a sound knowledge of the biopsychosocial impact of diabetes on individuals and the community. The Board (other than Alan Wright), recommends members vote in favour of the resolution to re-elect Alan Wright. Alan Wright does not make a recommendation due to his personal interest in this resolution. (b) Re-election of Paul Vivian as a director of Diabetes WA Paul joined the Diabetes WA board in July 2010 and is a proven marketing and product professional with over 28 years of experience in financial services management roles in the British, Irish and Australian markets. He is currently General Manager – Products and Pricing for Bankwest and has extensive experience in product development and management, brand development and positioning, marketing communications and CRM. Paul is a designated Responsible Manager at Bankwest and brings retail marketing skills, together with broader commercial experience gained through managing the Products business at Bankwest.
many changes and challenges that have occurred in the management of diabetes during that time. In a professional capacity Gary has championed the need to build strong commercial management principles and procedures within the not for profit environment and since joining the Board has worked closely with Diabetes WA management to achieve these outcomes. The Board (other than Gary Walton), recommends members vote in favour of the resolution to re-elect Gary Walton. Gary Walton does not make a recommendation due to his personal interest in this resolution. (d) Re-election of Andrew Burnett as a director of Diabetes WA Andrew joined the Diabetes WA board in July 2009 and is Chair of the Governance Committee. Educated in South Africa, and later at Oxford where he was a Rhodes Scholar, Andrew Burnett is Of Counsel at Squire Patton Boggs (AU) with more than 30 years’ experience in HR & IR law and workplace safety issues. He advises clients on the broader strategic and commercial issues involved in mergers and acquisitions, restructuring, insolvency and redundancy. He has extensive practical experience consulting to and litigating for corporate clients, in both private and public sectors.
Paul is a graduate of the Leadership WA programme and a Member of the Australian Institute of Company Directors.
Andrew’s experience includes advice on major corporate mining acquisitions in Western Australia, training EPCM Contractor’s workforce on the amendments to the Mines, Safety and Inspection Act (WA), significant safety and health prosecutions, advising the transport and oil and gas sectors (on shore and off shore) on strategic safety and health issues and providing industrial relations advice on change management in the workplace.
The Board (other than Paul Vivian), recommends members vote in favour of the resolution to re-elect Paul Vivian. Paul Vivian does not make a recommendation due to his personal interest in this resolution.
The Board (other than Andrew Burnett), recommends members vote in favour of the resolution to re-elect Andrew Burnett. Andrew Burnett does not make a recommendation due to his personal interest in this resolution.
(c) Re-election of Gary Walton as a director of Diabetes WA
3. Appointment of auditors
Gary is Chair of the Board’s Finance, Audit and Risk Management Committee and was appointed to the board in 2010. He is a Chartered Accountant and Consultant and was previously the Chief Executive Officer of the WA Football Commission and the Chief Operating Officer of the Fremantle Football Club.
BDO Audit (WA) Pty Ltd was first appointed in 2009. Diabetes WA seeks member support for the appointment of BDO Audit (WA) Pty Ltd as the auditors of Diabetes WA. The Board are satisfied that BDO’s Audit Partner Rotation Policy complies with professional audit standards.
Gary has had type 1 diabetes since he was 12 and has personally experienced the 27
RESEARCH
news
Research Round-Up
It’s great news for walnut lovers A UCLA study of more than 34,000 American adults suggests that those who consume walnuts may have about half the risk of developing type 2 diabetes compared to adults who do not eat nuts.
It’s good news for koalas with diabetes Quincy Koala, of the San Diego Zoo, has been equipped with the latest Dexcom sensor to allow zookeepers to monitor his diabetes without having to do “ear pricks”.
It’s bad news for yoyo dieters Monash University researchers have found that mice who yoyo diet (bouts of calorie restriction followed by normal eating) ended up the same weight as mice on a high calorie diet, but also had worse blood glucose tolerance, indicating a higher risk of type 2 diabetes.
Generic drug may reverse type 1 diabetes long-term A newly released study by a US hospital shows that patients who had been treated with the bacillus Calmette-Guerin (BCG) vaccine — an inexpensive, generic vaccine used around the world to prevent tuberculosis (TB) — had normal blood glucose levels eight years after a clinical trial. The research, published in the journal npj Vaccines, shows that, while it took three years for patients to see results from the vaccine, two doses of the drug spaced four weeks apart were still having a lasting impact eight years later. “It’s the first trial showing (long-term reversal of diabetes), and more trials are on the way,” Dr Denise Faustman, director of the Massachusetts General Hospital immune-biology laboratory and principal investigator of the trial said. “Scientifically it’s pretty cool.” The study details how the vaccine genetically alters the body’s white blood cells so they process glucose, making up for the pancreas’ inability to produce insulin to do the same. Faustman has been working for over a decade on trials of the treatment, first in mice and then in humans. In addition to follow-ups with patients from the phase 1 clinical trial, a phase 2 clinical trial is ongoing, dependent on funding. The goal of the latest clinical trial is to replicate results from the first phase, as well as to analyse the dosing necessary to make the vaccine work quickly. Used in China, Africa and South America to vaccinate against TB, the BCG vaccine has been used 4 billion times over the last 100 years. Last year alone, 100 million doses of the vaccine were given to newborns. Because TB isn’t common in Australia, children here do not receive the vaccine. Faustman’s trial is only one of several happening internationally on BCG. There is ongoing research into the drug’s effect on multiple sclerosis in Italy, and on food allergies in Australia.
(from page 41)
Ages & Stages Puzzler – Solutions 28
Please note: The information on this page is a snapshot of the latest advances in diabetes research. Please keep in mind that research findings will not necessarily apply to your individual situation and this information should not be used to make decisions about treatment and management without the input of a health professional.
RESEARCH
news
Bright Western Australian minds by Diabetes Research WA executive director Sherl Westlund
As we head into the warmer weather again, we’re reflecting on how thankful we are for research and for the bright Western Australian minds that dedicate their careers and lives to researching all forms of diabetes. Our funded researchers are having a fabulous year releasing some great findings; we hope you enjoy reading about them.
Type 1 Diabetes & Exercise Performance
Reducing Post-Transplant Diabetes Impact
One of our funded research projects has found that high blood glucose levels in people with type 1 diabetes don’t negatively impact exercise performance.
Another of our funded studies has shown earlier detection of high blood glucose levels and a new treatment approach can reduce the impact of post-transplant diabetes (PTDM) in patients undergoing kidney transplants.
It’s hoped the findings, which have been presented at The American Diabetes Association’s 78th Scientific Sessions and the Australasian Diabetes Congress, will encourage those with the condition to stay active. Dr Karen Rothacker, a Perth Children’s Hospital endocrinology and diabetes fellow who supervised the research, described the results as a surprise. “We suspected exercising with high blood glucose levels could have a negative effect on athletic performance and thought this belief, coupled with Karen Rothacker difficulties in managing high blood glucose levels, may be deterring some type 1 diabetes patients from staying active,” she said. “We discovered that while young people with type 1 should strive for good glycaemic control while exercising, for its well-established long-term benefits, it may not be necessary to aggressively treat high blood glucose before and during exercise to optimise sporting performance. “We’re hopeful this information will give this group confidence that even if, despite their best intentions, their blood glucose is high prior to sport, they still have the potential to perform well, they’ll continue to participate.”
Nearly half of all people who receive a new kidney will develop PTDM, which is sparked by immunosuppressive therapy, within 12 months of surgery. This serious complication can make organ rejection more likely and lead to an increased risk of death, as well as predispose patients to health complications linked to diabetes. Renal physician Dr Aron Chakera said his team had discovered that using a newer oral antidiabetic drug was very beneficial. “Instead of using the conventional medications to treat post-transplant diabetes in these patients, we used the newer DPP4 Aron Chakera inhibitor linagliptin and found this fresh approach could reduce the long-term risk of impaired blood glucose control,” he said. A year after their kidney transplant, only 15 per cent of patients who developed post-transplant diabetes mellitus still needed the medication to help manage their blood glucose levels – the other 85 per cent were able to stop the treatment because their beta cell function and insulin resistance were improved to a level that matched patients who did not have PTDM. An earlier phase of the study found fructosamine could be a superior test to the usual HbA1c method to diagnose new onset diabetes earlier in these patients.
diabetesresearchwa.com.au | (08) 9224 1006.
29
INTHE
community
Father and daughter celebrate diabetes victory
When Barrie Lancaster (79) was awarded with a Kellion Victory Medal to celebrate living with diabetes for 50 years, his daughter Kim Edwards was particularly proud – and is hoping to receive one herself one day. Barrie was diagnosed with type 1 diabetes when he was 28 years old. Several years later his daughter Kim was also diagnosed with type 1 diabetes, at age twelve. “I was scared, angry and sad because I loved lollies and I knew that diabetes meant I would have to be very disciplined with my diet. Dad was devastated because he believed it was his fault. He wrote me a lovely letter explaining that living with diabetes is not the end of the world,” Kim recalled. Barrie started looking after himself more carefully, to set a good example for Kim, and the pair attended appointments with diabetes educators and endocrinologists together. “We were always very close, but the experience of diabetes brought us even closer. Only someone with diabetes really understands what it’s like to live with the condition,” Kim said.
Over the years they have both enjoyed the care and support of Helen Lancaster, Barrie’s wife and Kim’s mother. Helen was proud to receive a Carer’s Award as part of the Kellion Victory Medal presentations. While Kim has the latest diabetes technology – a continuous glucose monitor and insulin pump – Barrie has continued with the traditional methods of finger pricks and insulin injections to manage his diabetes. He is philosophical about his achievement of fifty years with diabetes.
Barrie with daughter Kim
“I just take one day at a time, follow the rules and do my best,” he said. Kim is upbeat about the impact of diabetes on her life. “It makes you healthier and more health-conscious, because you have to be,” she said.
Barrie’s box of equipment from the 70’s
Kellion Medals Diabetes WA presented nine Kellion Victory Medals during National Diabetes Week in July, which recognise Australians who have lived with diabetes for more than 50 years. We also presented four carers awards, celebrating the support loved ones give to those living with diabetes.
30
70 years: Joan Ware
60 years: Ann Morris 50 years: Barrie Lancaster, Raymond Dennison, Tracy Copes, Felicity Ranger, Anne Snow, Jennifer Davison, Elizabeth Hanson. Carer awards: Helen Lancaster, Barbara Jo Dennison, Mavis Evans, Wendy Stephens Photos from left to right: Ann Morris with supporters Annette Kelsall and Bob Elkins; Felicity Ranger; Raymond Dennison with wife Barbara Jo Dennison; Joan Ware (centre) with family Peter Ware, Sandra and Lee Hayter; Tracy Copes with parents Mavis and Stan Evans
INTHE
community
Riding and raising awareness With canine companion ‘Snotty’ in tow, Herb Boltong set out in April to circumnavigate Australia on his electric bike to show that people with diabetes can lead highly active lives. When the 74 year old cyclist was diagnosed with type 2 diabetes ten years ago he was shocked. Otherwise healthy with no history of diabetes in his family, he did not expect the diagnosis. He quickly decided to learn all he could about diabetes, attending workshops run by Diabetes WA to gain advice on better managing his health.
Although it was not his intention at the outset, Herb has been raising awareness about diabetes on his journey, talking about his health story as well as his adventures.
“Being diagnosed with diabetes was an eye-opener that actually helped me change my life for the better,” Herb said.
Initially heading north to ride clockwise around the country, Herb is in no rush, saying he is aiming to finish his trip in about 12 months-time from his initial starting date.
Since his diagnosis Herb has ridden the Munda Biddi trail from end to end, and also walked the Bibbulmun track end to end. He noticed that the exercise helped to bring his blood glucose levels down into his target range. When the idea of riding around Australia developed in Herb’s mind, he bought a custom-made Scorpion electric tricycle for the trip and a trailer for his gear and his kelpie, Snotty.
Regularly covering about 90km a day, Herb says he has met some wonderful people, with passers-by stopping him to take a photo, have a chat or give him a cool drink.
Herb is maintaining a regular blog chronicling his trip with hilarious anecdotes about his adventures, the companions that join him along the way and the trials and tribulations of life on the road. To follow Herb’s journey, go to herbandsnotty.wordpress.com
Tell Us Your Story Overwhelming feedback from our readers tells us that you want to hear how others are coping with facing the challenges that you are facing. We invite you to tell us your story. Have you overcome adversity? Have you got any tricks and tips for other people living with diabetes? Perhaps your story can help others. Let us know – we would love to hear about your journey. Send it by post: “Diabetes Matters Stories” PO Box 1699, Subiaco WA 6904 Email it to us: community@diabeteswa.com.au 31
LIVING
well
Seeking Support Diabetes can sometimes feel like a lonely condition. At times, you might feel like you are the only one who is confused, frustrated and struggling. In truth, you are far from alone. Finding a support group can provide you with the opportunity to share personal experiences and feelings, coping strategies, and learn how others manage their condition.
Why join a support group? A diabetes support group can:
• • • • • • •
help you to feel understood
In most instances, the diabetes support groups in Western Australia are led by individuals living with diabetes rather than diabetes educators or other health professionals. They are run for and by their members who determine what they need and how their needs can best be met.
lead to important friendships and connections create a diabetes community, where you are not the only one with the condition provide a place for group members to work through issues help you manage your stress and lessen your risk of diabetes burnout offer group members a chance to learn from each other’s experiences; and provide a forum for sharing information and resources.
The benefits of diabetes support groups have also been demonstrated by scientific research. According to some studies, members of diabetes support groups have experienced a greater reduction in HbA1c levels, better blood glucose level management and were better able to adopt healthy lifestyle behaviours and stick with them. Many groups also provide online support, so you don’t even have to leave your home if you find face-to-face groups too confronting or living in an isolated area.
32
Who runs support groups?
Start your own support group Support groups can be small or large, meet face-to-face or online, meet occasionally or regularly, but they all have the same objective; to support people living with diabetes. If you are interested in setting up a support group, Diabetes WA would love to help you. For more information email our community relations team at community@diabeteswa.com.au or call us on 1300 001 880. We can provide you with resources to help you start a group and promote your contact details to other people who might be interested in your area.
Other resources Support Groups Association WA WA – is the peak body for self help and support groups in WA. connectgroups.org.au Diabetes Counselling – offers group counselling and support via Facebook. diabetescounselling.com.au
LIVING
Find a support group
well
Type 1 support groups AREA GROUP
CONTACT
Online myD Group – Young adults with type 1
myd.ndss.com.au
Facebook group for young people with type 1 diabetes.
Online WAIT (Western Australian Insulin Takers) 30+ year olds, but all are welcome. Online support on Facebook. Meet up socially, also hold occasional events.
Online Telethon Type 1 Family Centre Parents Online
Closed Facebook support group for parents or primary carers of young people with type 1 diabetes. Type 1 Diabetes and Pregnancy – Bump, Baby and Beyond (Australian women) Closed Facebook support group for Australian women living with type 1 diabetes and pregnancy.
Online T1 Carers & Adults Night’s Out Closed Facebook support group for carers and adults with type 1 diabetes. Meets up socially and holds occasional events.
Julie-Anne Watson 0439 288 879 westernaustralianinsulintakers@yahoo.com.au Search Facebook: Telethon type 1 Jessica Ward (Perth contact) jessiw79@hotmail.com Search Facebook: Type 1 Diabetes and Pregnancy – Bump, Baby and Beyond Jaclyn Workman Search Facebook: T1 Carers & Adults Night's Out
Mixed support groups: type 1 and type 2 diabetes Online
Bridgetown Northern Perth Rockingham
Yanchep & Two Rocks Diabetes Walking Group
DESMOND Diabetes Support Group Closed Facebook support group for people in WA living with type 2 diabetes who have attended a Diabetes WA DESMOND workshop. Diabetes Support Group Meetings 10.00am on the 1st Tuesday of the month at the Old Convent. Diabetes Support Group Meetings 9.30am on the 4th Thursday of the month at the Innaloo Sportsman’s Club.
Search Facebook: DESMOND Diabetes Support Group
Joyce Ingram 9761 4208
Gwen Stonehouse 9204 1510 jvarisch@yahoo.com.au Diabetes Support Group June Streeter Monthly meetings at Spill the Beach Café, Rockingham. 9527 3850 To find out when the next one is coming up please junehs@bigpond.com contact June Streeter. Diabetes Support Group June Sims Meetings 10.00am on the 3rd Wednesday of the month. 9561 1174 ljsims@bigpond.com Perth Diabetes Walking Group James Beckett Meets at 10.00am every Wednesday 9421 1733 Central City Health Professionals meetup.com/en-AU/Diabetes-Walking-Group-CCHP 12/370 Wellington Street, Perth
Specialised support group Nedlands
Peripheral Neuropathy Support group for people with Peripheral Neuropathy Meets 2nd Monday of the month – the Niche in Nedlands (Passmore Room).
June or Ron Gascoigne 9296 7190 junegascoigne@westnet.com.au
For more information on each support group contact the support group leader.
33
MOVING
well
Walk and Talk Nowadays there are more tools than ever to help people to look after their health, get fit and manage their diabetes or pre-diabetes. But what about free, good oldfashioned pavement pounding? Science shows that placing one foot in front of the other leads to some seriously impressive mental and physical benefits. In a 2017 study, conducted at the Lawrence Berkeley National Laboratory in California, researchers compared the results of 33,060 runners in the National Runners’ Health Study and 15,045 walkers in the National Walkers’ Health Study. They found that the energy used for moderate-intensity walking and vigorous-intensity running resulted in similar reductions in risk for high blood pressure, high cholesterol, diabetes and heart disease over the study’s six year period. Walking is also a great choice for people with knee, ankle and back problems and people who are overweight or obese. It is a lower impact exercise and can be done for longer periods of time.
Central City Health Professionals – who are associated with one of our Member Benefit Partners Podiatrist Perth – run a weekly walking group, leaving from Perth City, which brings together people living with, or at risk of developing, diabetes. Lead by allied health professionals, such as podiatrists, physiotherapists and exercise physiologists, the walking group provides a supportive environment for like-minded individuals looking to exercise, share advice and provide and gain support from others in a similar situation to themselves. James Beckett is a physiotherapist and currently leads the group, along with exercise physiologist Jenna O’Neill. “I saw a program on SBS where they started a twice-weekly walking group based on research they had done on the benefits of walking,” James says. “The results were life changing for some of the participants, especially considering it was such a simple concept. We have a large client base who are living with diabetes and when I noticed that was nothing on offer in Perth in the way of weekly walking groups for people with the condition, we thought it would be a great way to help both our existing patients and others in the community.” “We have a broad range of ages, occupations and people from all different walks of life in our group,” James says. “Everyone seems to have something to offer each other from their experiences living with diabetes or in their quest to improve their lifestyle, physical and mental health.
While the physical benefits are notable, the mental boost that can be gleaned from adding a walk to your daily routine may be more immediate. Another US study, conducted in 2016 by the Department of Psychology at Iowa State University, showed that just 12 minutes of walking resulted in an increase in ‘joviality, vigour, attentiveness and selfconfidence’ versus the same time spent sitting. So what about the combination of walking AND talking and, even better, talking with people who have the same shared experiences as you? People who understand the challenges you face when living with a chronic condition, and may even be able to give you some advice about managing your diabetes? 34
“Walking with others that have shared experiences allows members to exchange information and ideas that they have found useful in managing their symptoms.” The group meets each week, either in front of the Central City Health Professionals clinic, located at Perth Train Station, or within the city centre. The routes are available prior to each week via the website mapmyrun.com. Further details are provided when you join.
For more information about the Diabetes Walking Group contact James Beckett on 9421 1733 or visit meetup.com/en-AU/Diabetes-Walking-Group-CCHP
SHARED
pathways
Aboriginal Health Forum 2018 Diabetes WA played host to another successful Diabetes WA Aboriginal Health Forum on 27th June. Showcasing innovative programs and initiatives, the latest diabetes research and keynote speakers from across Australia, the free forum was attended by health professionals working in the area of diabetes and Aboriginal health. Around 80 attendees had the opportunity to expand their knowledge in the sector of Aboriginal health, particularly around type 2 diabetes, and learned about programs that have had a positive impact on this community.
Presenters included David Follent from the 1 Deadly Step Program NSW; staff from Moorditj Djena: An Aboriginal Podiatry and Diabetes Service; Leigh Black from Mawarnkarra Health Service told ‘Helena’s Story’; and Odette Pearson from the SA Aboriginal Diabetes Strategy 2017/2021 presented on the program’s development and where it is now. Evaluation and feedback from the day was very positive with a number
of attendees commenting that the opportunity to all be in the same room together to discuss diabetes and Aboriginal health is almost as valuable as the information presented on the day. “Fantastic speakers - I learned a lot about services I didn’t know existed and about interesting projects that are helping people who attend. I am looking forward to next year’s forum,” wrote one participant on their feedback form.
For more information on aboriginal health and diabetes visit: aboriginalhealthdiabeteswa.com.au 35
White Chocolate Pudding with Macadamia Crust Prep time: 55 mins (+ overnight chilling) Cook time: 40 mins
Serves 12 (as an occasional dessert)
150g (1 cup) plain flour 1 tsp baking powder 2 x 60g eggs, at room temperature 110g (½ cup) sugar , plus 2 tbsp 125ml (½ cup) skim milk 2 tbsp light margarine 1 tsp vanilla essence 60g (¹⁄³ cup) raw unsalted macadamia nuts, finely chopped
White Chocolate Pudding
3 tbsp sugar 4 tsp cornflour 310ml (1¼ cups) skim milk 2 egg yolks (from 60g eggs) 60g white cooking chocolate, chopped 1 tbsp fresh lemon juice 1 tsp light margarine 1 tsp vanilla essence
1. For the white chocolate pudding, pudding combine sugar and cornflour in a medium saucepan. Gradually whisk in milk. Cook, stirring, over medium heat until mixture thickens and starts to bubble. Reduce heat to low and cook, stirring, for 2 minutes. Remove pan from heat. 2. Whisk egg yolks in a medium bowl. Gradually stir in about ½ cup of hot mixture into egg yolks. Return yolk mixture to remaining hot mixture in saucepan. Bring to a gentle boil, stirring. Reduce heat to low and simmer for 2 minutes. Remove pan from heat. Stir in chocolate, lemon juice, margarine and vanilla essence. Place pan in large bowl filled with iced water. Stir for 2 minutes to cool quickly. Transfer mixture to medium bowl. Cover with plastic wrap. Place in fridge for at least 2 hours to chill. 3. Preheat oven to 180°C (fan-forced). Line a 20cm (base measurement) round spring-form cake tin with baking paper, allowing paper to extend above the top of the tin. Sift flour and baking powder in a small bowl. 4. Put the eggs in a large bowl and whisk, using an electric hand mixer, on high speed for 4 minutes or until thick. Gradually whisk in the sugar, beating on medium for 4-5 minutes or until light and fluffy. Beat in flour mixture until just combined. 5. Heat milk and margarine in small saucepan over medium heat until margarine melts. Add milk mixture and vanilla to egg mixture. Beat until combined. Spoon into tin and spread out. Bake for 20 minutes. Sprinkle with nuts and the 2 tbsp sugar. Bake for 5-10 minutes more or until a skewer inserted into middle comes out clean. Set aside in tin for 10 minutes. Carefully transfer to wire rack. Set aside to cool. 6. Using long serrated knife, knife cut cake in half horizontally. Spread cut side of cake bottom with white chocolate pudding. Add cake top, nut side up. Serve.
Nutrition Info
PER SERVE 922kJ, protein 5g, total fat 9g (sat. fat 2g), carbs 30g, fibre 1g, sodium 81mg • Carb exchanges 2 • GI estimate medium 36
Chicken Pho
Prep time: 30 mins Cook time: 8 hours 10 mins (on low) or 4 hours 10 mins (on high)
Serves 6 (as a light meal)
170g fresh shiitake mushrooms 7cm piece ginger, peeled and sliced 1 tbsp coriander seeds 4 whole cloves 1kg bone-in chicken thighs, skin removed 1.5L (6 cups) water 500ml (2 cups) salt-reduced or gluten-free salt-reduced chicken stock 1 large brown onion, sliced 30g dried porcini mushrooms, rinsed, drained and broken 1 tbsp brown sugar 5 cloves garlic, sliced 125g dried rice noodles, soaked (see Cook’s Tip) 2 bunches Asian greens, trimmed, chopped, steamed Coarsely grated carrot, slivered red onion, sliced chillies, coriander leaves, Thai basil, and/or lime wedges, to serve (optional)
Cook’s Tip
1. Remove and reserve stems from the shitake mushrooms. Thinly slice the caps. Transfer the sliced mushrooms to a bowl, cover and put in the fridge until required. 2. Place the shiitake stems, ginger, coriander seeds and cloves on a double thick 20cm piece of muslin. Bring up corners and tie closed with string. 3. Place the spice bag, chicken, water, stock, onion, porcini mushrooms, sugar and garlic in a slow cooker. Cover and cook on low for 8 hours or on high for 4 hours. Remove and discard the spice bag. 4. Remove the chicken from the cooker. Remove the meat from the bones. Discard the bones. Coarsely shred the chicken. Cover and set aside. Stir the reserved shiitake mushrooms and noodles into the broth. Cover and cook for a further 10 minutes. 5. Divide the greens between serving bowls. Ladle the noodle mixture over the greens. Add the shredded chicken. Top with carrot, onion, chilli, coriander, basil and lime wedges, if using.
Nutrition Info
PER SERVE 1090kJ, protein 25g, total fat 7g (sat. fat 2g), carbs 21g, fibre 5g, sodium 413mg • Carb exchanges 1½ • GI estimate low • Gluten-free option • Lower carb
To soak rice noodles, place in a large heatproof glass bowl. Cover noodles with boiling water. Set aside for 5-7 minutes or until noodles are tender but still firm, stirring occasionally.
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EATING
well
Buy West Eat Best in Spring Spring is the ultimate season for fresh produce. As the days get longer, so too does the list of fresh ingredients on offer. Bright and refreshing, lighter recipes come into play after we have indulged in the comfort food of winter.
Go for produce that is in season and is grown in WA. It usually provides better value for money and tastes better than fruit and vegetables that have travelled the world or come out of months of cold storage. The Department of Primary Industries and Regional Development’s Buy West Eat Best program is celebrating their 10 year anniversary. The program was born after a petition to the West Australian newspaper, which saw more than 50,000 people demand more accurate labelling of where food comes from.
How to make a good choice when shopping local Look out for the Buy West Eat Best logo – When you see the distinctive green bite mark Buy West Eat Best logo you can be assured that you are buying quality food and beverages that have been grown, farmed, or fished and produced right here in Western Australia. Know what local produce is in season – Knowing and buying Western Australian fruit and vegetables during the peak growing season means you are usually eating them at their best quality and when they are in abundance, lowering the purchase costs. Supporting restaurants supporting local – The Buy West Eat Best initiative not only supports Western Australian food and beverage producers but also our food service industry. The Buy West Eat Best restaurant members actively choose to support the ‘eat local’ philosophy within their dining menus. See buywesteatbest.org.au for a list of restaurants that are members of the initiative.
Diverse WA climates Western Australia is home to a number of diverse horticultural growing regions which vary in climate from the tropical north to the subtropical and temperate south. Climate differences allow fruit and vegetables to grow across different parts of the state all year round, extending the typical seasons for WA grown produce. This year round abundance and variety of WA produce makes supporting local easy. For further information, follow Buy West Eat Best on Facebook, Instagram, Twitter and You Tube or head to buywesteatbest.org.au 38
Eat Local Choosing West Australian grown in-season fruit and vegetables, where possible, supports WA growers and their communities. It also helps to reduce the impact our food system has on our environment - through food processing, packaging, storage and the transport involved in getting food from where it is grown to the place it is eaten.
In Season Fruits Apricots Avocadoes Bananas Berries – blueberries, blackberries, raspberries Cherries Grapefruit – pink/red Guava Honeydew Melon Lemons & Limes Loquat Mandarins Mangoes Nectarines Oranges Passionfruit Papaya Pineapple Rockmelon Strawberries Watermelon
September – November Vegetables Asian Greens Artichokes Asparagus Beetroot Broccoli Cabbage Cauliflower Capsicums Eggplant Green Beans Lettuce Mushrooms Peas, Sugar snaps and Snow peas Pumpkin Rhubarb Silverbeet Spinach Sweet Corn Tomatoes Zucchini
EATING
well
Have a go at creating these recipes from Anna Gare that celebrate some lovely WA spring produce.
Aromatic Mount Barker Chicken and Pork Hot Pot Serves: 6 Ingredients 500g Mount Barker chicken thighs, cut in half 500g Plantagenet Pork, cut into pieces 500ml salt-reduced chicken stock ¼ cup salt-reduced soy sauce ½ cup rice vinegar ½ cup water 1 tbsp brown sugar 6 spring onions, sliced 4 garlic cloves, peeled thinly sliced 2cm nob of ginger, peeled and thinly sliced 1 to 2 red chilli, sliced 1 tsp whole black peppercorns 1 tsp whole white peppercorns 2 to 3 star anise 1 stick cinnamon 8 potatoes, sliced into 2cm pieces (approx. 650g) 1 bunch baby carrots, peeled ½ small savoy cabbage, cut into 4 wedges Fresh coriander for serving
Method 1. Preheat oven to 180°C. 2. Place chicken and pork pieces into a 4 litre heavy based casserole pot. 3. Pour over the stock, soy, vinegar and water. 4. Add the brown sugar, spring onions, garlic, ginger, chilli and spices. 5. Scatter potatoes over the top. 6. Cover with baking paper and lid and bake in oven for 1 hour. 7. Remove from oven to add the carrots and an even layer of cabbage on top. Cover and bake a further half hour or until the vegies are just cooked.
To Serve Serve in bowls, evenly distributing all the vegetables and then spooning over the chicken, pork and broth. Scatter with fresh coriander leaves. Any left overs are delicious the next day.
Nutrition Information per serve Energy 1458 kJ Protein 41.2 g Fat, total 6.3 g — saturated 1.7 g Sodium 780.3 mg Fibre 5.9 g Carbohydrate 26.0 g — sugars 9.1 g
39
EATING
well
Beef Tacos with Hot Green Sauce Serves: 4 Beef and Marinade 1 large grass fed sirloin steak approx. 500g 1 heaped tsp smoky paprika 2 cloves garlic, finely chopped Pinch salt and pepper Squeeze lemon juice Dash of olive or grape seed oil Salsa ½ small red onion, finely diced 2 medium tomatoes, seeds removed and finely diced 1 clove garlic, crushed 1 small chilli, deseeded and finely diced Juice of 1 lime Dash olive oil Salt and pepper to taste
Hot Green Sauce Generous bunch coriander, approx. 100g (including roots, stems and leaves) 1 or 2 green jalapeno chillies 1 clove garlic Juice of 1 large lime or lemon 1 tbsp olive or grape seed oil pinch of salt 2 tsp sugar Extras 12 small corn tortillas (warmed in oven) 1 to 2 avocadoes, skin and pip removed and mash flesh ¼ iceberg lettuce, shredded ½ small tub light sour cream
Nutrition Information per serve Energy 2485 kJ Protein 37.7 g Fat, total 28.7 g — saturated 8.4 g Sodium 281 mg Fibre 8.9 g Carbohydrate 41.4 g — sugars 8.3 g
Method 1. Combine beef marinade ingredients together in a bowl and marinate beef, set aside on bench to bring to room temperature. 2. To make salsa - Combine all ingredients together in a bowl and season to taste. 3. To make hot green sauce - Blitz all ingredients together in a blender until vibrant green and smooth. Taste for a balance of flavours and adjust accordingly. Pour into a serving jug. 4. Cook steak on a hot plate for approximately 4 minutes each side or until medium rare, allow to rest for few minutes in warm place and then thinly slice. 5. Heat tortillas in hot oven for 5 minutes to warm through. To Serve Serve all ingredients down middle of the table for family to make their own.
Recipes provided by Anna Gare and the Buy West Eat Best program. 40
Diabetes WA
MEMBERS
area
Find the following words in the puzzle. Words are hidden
Answers can be found at the bottom of page 28
Spring
ADULTS AGE ALCOHOL CAREER COMMUNITY FAMILY INDEPENDENCE OLDER RETIREMENT SCHOOL SELF MANAGEMENT SOCIALISING STAGE SUPPORT NETWORK TATTOOS TEENS TRANSITION TRAVEL YOUNG
Competition
My Asian Kitchen cookbook give away! WIN!
A celebration of modern Asian cooking, in 100 healthy, flavour-packed traditional and modern dishes. Bao buns, pho, sushi, poke bowls, gyoza, ramen and kimchi have devotees on every high street - now Jennifer Joyce shows how easy it is to create these zingy, fresh, healthy flavours at home. From grilled sticky skewers and steak tacos, salads, rice bowls and dumplings, to prawn katsu bao and miso-glazed ribs, this is an adventure in the dazzling diversity of modern Asian cooking. Jennifer’s exquisitely simple recipes, no-nonsense explanation of ingredients, hand-drawn diagrams and beautiful photographs are all you need to start cooking in your very own Asian Kitchen. Our lovely friends at Murdoch Books have given us TWO copies of My Asian Kitchen to give away. Publisher: Murdoch Books RRP: $39.99
To enter, complete the competition slip below and mail to: Diabetes Matters – Spring Members’ Competition PO Box 1699, Subiaco WA 6904 or email your entry and details to membership@diabeteswa.com.au
Good luck! Name:
Diabetes WA Membership Number:
Address: Contact number:
Email address:
Entries close 1 December 2018.
41
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7-14 October Week h t l a e H l a play. WA Ment , work &
Raffle Diabetes WA run three raffles each year. A $2 ticket puts you in the running to win a first prize of $10,000 cash. There are also runnersup prizes of $1000 and $500. Your cont ribution goes a long way in helping us to provide the diabetes community with education, services and programs. Raffle to be drawn 21st December. Tickets can be purchased by calling 1300 792 998 or emailing fund raising@diabeteswa.com.au
25 Octobe r WA ting s e t e b Dia eral Mee Gen l a n d o ur u n n t to atte m at our A e g r fo .30p don’t
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14 Novembe r Seniors Have a Go Day Mark this date in your diar y to try a range of activities, source senior-specific services and information, enter free raffles and enjoy a free tea or coffee at the Have a Go News hospitalit y marque. Diabetes WA will be there with a stal l, so come and say hi.
, learn re we live bout communit y e h w ts r is all a ealth sta ere we Mental H ental Health Week r y day wh e v e to M o r, g we ek aims This yea s settings of others. The we u io r a v e unities by being and th t the well being in WA comm out for one r o p p u s can well look e mental por t and rning to increas each of us to sup h discussion – lea g lt in a g e a a h tal nd b d; encour oting men g feelings, good a alth m o r p ; r e tal he ressin anoth ge’ of exp awareness of men a u g n a ‘l the aise g help. nuing to r e stigma of seekin ti n o c d n a th estern d reduce A by the W ppor ted by issues an W in n u r , su k is tal Health h ealth Wee Mental H ssociation for Men alia, Mental Healt tr A s u n a A li n a r Austr Weste nment of the Gover and Lotter y west. ion Commiss .org.au w.waamh h m : e r o Find out m
14 November World Diabete s Day
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Real Solutions Real Support Obesity Surgery WA offers a multidisciplinary team approach to provide the best level of care for people with obesity. It is well known that obesity is a high risk factor for developing type 2 diabetes which can lead to serious complications such as blindness, amputations, stroke and reduced life expectancy.
Dr Harsha Chandraratna Surgeon
Dr Bill Gong Surgeon
Dr Andrew Kiyingi Surgeon
Surgical Options for Diabetes
The good news is that losing weight can improve your type 2 diabetes. Our extensive experience in weight loss surgical options, including gastric sleeve and gastric bypass, can stabilise and improve your blood sugar levels. In as many as 3 out of 4 patients, their blood glucose levels return to normal with either reduced or no requirement for medications. Poorly controlled type 2 diabetes leads to slow and irreversible organ damage. Don’t wait until it’s too late. Come in and have a discussion with one of our specialist doctors to learn more about how Obesity Surgery WA can help you. We offer real solutions with real support.
Call 9332 0066 to make a start towards a healthier life.
Sleeve Gastrectomy Roux-en-Y Gastric Bypass
Subiaco • Murdoch • Mandurah
Omega Loop Gastric Bypass
www.obesitysurgerywa.com.au
Leaving a gift of a lifetime Help us continue to meet the growing need for services and support for the Western Australian diabetes community. A gift in your will is a valuable way of supporting Diabetes WA. No matter what size, your gift will provide a lasting legacy and will support those living with and affected by diabetes in WA. Whether you are writing your first will, or updating your current one, please consider leaving a gift to Diabetes WA. You can make a difference to the lives of countless Western Australians. A gift will honour you, or someone close to you, for generations to come.
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If you would like to know more, please call the bequest team on 1300 001 880 or email bequests@diabeteswa.com.au