Diabetes Matters Summer 2018/19 - The Cost of Diabetes

Summer 2018/19 $6.95

A Diabetes WA Member Magazine

If you’ve got it, we get it

From the Editor gn tha t we We are excite d abo ut our new cam paibet . lau nch ed in Nov em ber on Wo rld Dia es Day ,

g someone who does Sometimes having diabetes, or lovin ands what you are going erst means that it feels like no one und n - If you’ve got, we get paig cam through. Our new promotional and we hope helps etes diab by it – speaks to people affected to help. See page 7 for them (you) to realise that we are here . an introduction to our new message to people living with the Understanding what diabetes means impact it has on your the condition, also means recognising ters talks about The Mat etes Diab bank balance. This edition of ition has on the cond the t effec the Cost of Diabetes, including l and social toll it can take.

WA health system and the emotiona I found myself getting While researching for this magazine, , study results and over whelmed by the figures, statistics it is important to but … comparisons. So many numbers enormous impact of the show recognise that these studies living with the condition, e thos only Not diabetes on Australians. general Australian but those who support them and the e as a surprise to you; our taxpayer. I am sure this doesn’t com readers affected by diabetes. tips throughout this edition Hopefully some of the money-saving e ways to reduce your own of the magazine help you to find som of that money saved can go spending a little. And perhaps some r for you and your family. towards creating extra Christmas chee World Diabetes Day in Finally, as mentioned we celebrated ce of having a support rtan November, emphasising the impo . Take a look at all that etes diab crew when you are living with we got up to on page 8. usted! I need a holiday!

Phew, with all of this going on - I’m exha stmas break too.

Chri Hopefully you get to enjoy one over the Enjoy the festive season!

Natash a

Contents From the Chair .......................................................................... 3 Perspective ................................................................................ 4 Who’s in the Driver’s Seat? ................................................... 5

Diabetes News ADMA Conference ....................................................................

Google.org Impact Challenge ...............................................

South Hedland Rotary Team ................................................

CGM Subsidy .............................................................................

World Diabetes Day 2018 .......................................................

6 6 7 7 8

The Cost of Diabetes Dollars and Cents .................................................................. 10 Reduced NDSS Co-Payments ............................................ 15 Ready for Retirement ............................................................ 16 Health Insurance Tips ........................................................... 18 Time Poor ................................................................................. 19 Emotional and Social Costs ............................................... 20

Education Planner Plan Your Sessions ............................................................... 22

Research News 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 Abigail Koch, comparethemarket.com.au, Pacific Magazines, Paul Vivian, Murdoch Books, Femi Oshin, Frank Sita, ASIC MoneySmart, Walter Aldridge, Bob Johnson Photography DWA staff, magazine contributors, Shutterstock, Murdoch Books, Pacific Magazines Design Brigitte James Print Quality Press Diabetes WA diabeteswa.com.au Diabetes Helpline: 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

Research Round-up ............................................................... 24 Diabetes Research WA Update .......................................... 25

In the Community Kids Camp ................................................................................ 26 Super Support ........................................................................ 26

Tell us Your Story Walter and Bob ...................................................................... 28

Moving Well Buff on a Budget ................................................................... 29

Diabetic Living Recipes ..................................................................................... 30

Shared Pathways Indigenous Foot Health ....................................................... 32

Eating Well Simple Festive Entertaining ............................................... 33 Special Guest .......................................................................... 34 Recipes ..................................................................................... 35

Members’ Area Members’ Puzzle and Competition ................................... 37 Member Partners ................................................................. 38

What’s On Dates for your Diary ............................................................. 39

Watson Dr Moira

It’s time for something fresh. We want people living with, and affected by, diabetes in WA (including you, our valuable members) to know that we understand what you are going through and are here to offer support.

From the Chair

If you’ve got, we get it.

We have launched a new campaign to remind Western Australians about Diabetes WA. The campaign aims to let people know we are here for them and that we understand. The brand line “If you’ve got it, we get it” tells people living with diabetes that if you have this condition, then the team at Diabetes WA know what you are going through and are here to help. Read more about our new campaign on page 7.

We are committed to enhancing the quality of life of all people living with diabetes. One of the many reasons we are working to prevent the development of chronic conditions and their complications, is the financial impact they are having on people who are affected as well as our health system.

The cost of diabetes to individuals and government is substantial and is greater in those with complications.

In this issue of Diabetes Matters we explore the financial, social and emotional costs of diabetes and how it affects people’s quality of life, their back pockets, as well as health system budgets.

World Diabetes Day on 14 November gave us another opportunity to bring diabetes into the public spotlight. With a focus on family support, we told real-life stories of people living with the condition. See our article on page 8 showcasing all the activities we were involved in on the day.

As a not-for-profit organisation we rely on funding and donations. That’s why we were extremely pleased when Diabetes WA’s project was short-listed for a $1million Google.org Impact Challenge grant. The Google.org Impact Challenge supports organisations creating a better future through technology and this year attracted some 350 applications.

Though we were pipped for one of the grand prizes, as one of only ten finalists we received $250,000 to help fund the engagement work we do to combat diabetes in remote Aboriginal communities through telehealth technology. The grant will allow us to continue to make a difference in our remote WA communities.

As we come to the end of the year, it is good to reflect on all we have achieved. Our Annual Review 2017/2018 INNOVATION was released at our AGM in October and is a valuable summary of our highlights and activities over the last financial year. Please contact us if you would like a hard copy of this document, or visit our website at diabeteswa.com. au/annual-review to view our interactive online version and the accompanying audited financial statements.

May the festive season be a joyous and safe one for you and your families.

Until next time…

Dr Moira Watson Diabetes WA Board Chair

Festive Season Opening Hours Diabetes WA offices will be closed from 24 December 2018, returning to normal office hours from 2 January 2019. The Belmont office will be open on Monday 31 December, then closed again on New Year’s Day. Our Call Centre will still be taking calls, with reduced staff, and will only be closed Christmas Day. 3

perspective

The Impact of Prevention Paul Vivian, Diabetes WA board member and General Manager (Products and Pricing) for Bankwest, believes there should always be some sort of government safety net to cover the most vulnerable in society; young and old. With many people living with diabetes falling into this category, he says it’s clearly in the government’s best interests to invest in diabetes prevention to reduce future costs, but at times, it’s also down to us. Here, he gives us his perspective.

While we report that around six per cent of the population are living with diabetes in Australia, we also recognise that it is likely more, with the higher than average incidence rate of diabetes amongst the indigenous population and undiagnosed cases estimated to be another 40 per cent again. Given the scale, it’s not hard to see the impact diabetes is likely having on the WA health system.

Research indicates the direct costs of diabetes in 2018 are $20.2 billion, comprising $4.3 billion in direct healthcare, $1.8 billion in direct non-healthcare and $8.5 billion in government subsidies. With WA accounting for 10 per cent of the national population, we can infer that we’re spending $430m in direct diabetes healthcare in WA annually, with $850 million in subsidies.

While it essential for the government to invest in diabetes prevention to reduce these costs, where it does get difficult is the extent to which government should fund products and insulin where the impact is avoidable. In my opinion it would be sensible to ensure at-risk and minority populations are protected, with the other subsidies being income dependent.

Workplaces are also supporting this drive for the prevention of ill-health that will impact on their own workforce.

Becoming increasingly concerned about the whole health of their employees, many businesses are focused on looking after their most valuable resource.

Living a healthy lifestyle, encouraging exercise and better dietary choices will all help to prevent future cases of diabetes and other chronic conditions. At Bankwest, we have cycle racks and showers and colleagues are encouraged to cycle in. We also have free yoga classes at lunchtime and annual colleague-led events to promote healthy eating.

Perth’s a great place (perhaps the greatest) to get outside for a walk or a bike ride – we need to make the most of it.

The theme of this edition of the magazine talks about the Cost of Diabetes, and while some costs are unavoidable when living with the condition, there is also a lot that people can do to improve their own money management in general.

It’s amazing how little many people really think about their finances and opportunities to make savings or to spend less.

Something as simple as understanding what you’re spending your money on can really open your eyes.

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There are savings to be had by taking the time to analyse your spending, considering where your money is going and looking at whether making changes - like switching your utility provider, your mobile phone plan or even your bank - can make you better off. Negotiating with your existing provider, by doing a bit of desk research and understanding what’s being offered, can also lead to a reduction in your bills.

Making a budget and sticking to it can also help by creating a little self-discipline.

Money management tips aside, reducing the impact of diabetes on government coffers and on our own hip pockets will benefit everyone in WA. The more we can do to prevent chronic conditions, the better for the individual, the health system and the economy.

Paul Vivian has been a board member with Diabetes WA since 2010. He has more than 28 years’ experience in financial services management roles, both in Australia and overseas, and is currently General Manager (Products and Pricing) for Bankwest. Paul’s background in finance and marketing is helpful in understanding broader stakeholder groups and how they view diabetes and its challenges. He plays an important role on the Board by helping to guide the commercial aspects of the business, advising on how we fund our activities and identifying opportunities to develop income streams.

WHO’S IN

the drivers seat

Know what to ask for

Did you know that Diabetes WA education programs and workshops – including DESMOND – are funded outside of the Medicare system? By registering with the NDSS, you are eligible to access up to $250 worth of additional diabetes education, delivered by Diabetes WA, throughout Western Australia.

Asking your GP to refer you to one of our programs will not count as one of your ‘five rebatable allied health visits’ you may be eligible for through the Medicare Benefits Schedule (MBS) each year.

revisiting your GP Management Plan with your doctor will allow you to discuss adjustments to your care, which in turn can help to identify problems early on and reduce your risk of serious complications.

The MBS helps GPs to plan and coordinate the health care of their patients with a chronic condition, such as diabetes.

You and your GP may have a GP Management Plan in place to support you in achieving your health goals. You may also require ongoing care from a multi-disciplinary team, in which case Medicare provides five rebatable visits to allied health providers involved in your ongoing care. This could include a podiatrist, dietitian, or diabetes educator, to name a few.

While you are discussing your GP Management Plan with your doctor, ask him or her about incorporating a Diabetes WA education program into the plan.

A common misconception by people living with diabetes is that asking your GP to refer you to one of Diabetes WA’s free education workshops or programs will use one of these allocated Medicare rebatable allied health visits. This is not the case. Learning how to better self-manage your diabetes at a DESMOND type 2 workshop or at one of our Smarts programs will equip you with some practical tips and will not use any of your rebatable allocated physio, podiatry or dietitian appointments.

In fact – you may just find that the information we offer at our workshops provides you with the information you have been looking for from one of these allied health providers.

Talking to your GP is a great place to start, but remember: a GP referral is not actually necessary to attend one of our programs. You can book yourself in by visiting our website or giving us a call. mbsonline.gov.au says: MBS items (81100 to 81125) are available for group allied health services for patients with type 2 diabetes. These items apply to services provided by eligible diabetes educators, exercise physiologists and dietitians, on referral from a GP or medical practitioner.

Services available under these items are in addition to the five individual allied health services available to patients each calendar year (refer to items 10950 to 10970).

Regular visits to your GP is an important part of your diabetes management. So make the most of your appointment.

Unlike the individual allied health services under items 10950 to 10970, there is no additional requirement for a Team Care Arrangement in order for the patient to be referred for group allied health services.

Developing a GP Management Plan with your doctor is a great way to keep track of your diabetes management strategies, goals and targets. This document forms an action plan for keeping on top of recurrent checks. Regularly

Visit our website to find out more about the Diabetes WA programs and workshops that are available. diabeteswa.com.au or call 1300 001 880 5

DIABETES

news

ADMA Conference The Diabetes WA evaluation team recently presented at the Australian Disease Management Association (ADMA) national conference in Melbourne.

Research and Evaluation Coordinators James Strickland (below right) and Dr Denise Demmer (below left) discussed the impact Diabetes WA programs have on participants. James demonstrated how the DESMOND workshop for people with type 2 diabetes increases participants’ likelihood of actively managing their own health. Denise presented on the lasting impact our MedSmart and CarbSmart workshops have on people with diabetes by empowering them to better manage their condition, with that sense of empowerment being sustained for at least three months following their participation.

Inquiry into the role of diet in type 2 diabetes prevention and management The State Government has announced an inquiry into the role of diet in type 2 diabetes prevention and management.

Due to table their report in April next year, the inquiry will consider several aspects, including: cost of type 2 diabetes to • The the community adequacy of prevention and • The intervention programs use of restrictive diets to • The eliminate the need for type 2 diabetes medication

measures to encourage • Regulatory healthy eating and cultural factors affecting • Social healthy eating aspects of healthy • Behavioural eating and effective diabetes self-management

Google.org Impact Challenge Diabetes WA were recently finalists in the Google.org Impact Challenge that awarded a total of $5.5 million to not-for-profit innovators and social entrepreneurs using technology to tackle social challenges.

Diabetes WA’s General Manager of Health Services and Evaluation, Deborah Schofield (pictured right), travelled to Sydney to deliver a 90-second presentation to a panel of judges. She did an excellent job and, while we didn’t win one of the top prizes of $1 million, as one of only ten finalists, Diabetes WA received $250,000 to invest in our project, Bringing Care Closer to Country.

Bringing Care Closer to Country has been bringing telehealth technology and community engagement to remote Aboriginal communities for more than three years. Aiming to reduce barriers to diabetes care, it builds on the first and only allied health-led Diabetes Telehealth model, which has already saved over a million kilometres of travel for people living with type 2 diabetes.

With this project, Diabetes WA is leading the way in addressing health inequity in rural and remote Aboriginal communities and is applying learnings to other telehealth services in Australia.

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DIABETES

news

Exceptional If you’ve got it, we get it dedication to DESMOND Having diabetes can be an isolating experience.

A team of allied health professionals delivering the DESMOND program in the Pilbara have been named category winner for Rural and Remote Practice at the 2018 Rotary Allied Health Team Excellence Awards.

The group, based in South Hedland, were recognised to have shown exceptional dedication and commitment to improving the health and wellbeing of Pilbara residents with diabetes.

Diabetes WA Pilbara and Primary Care Coordinator, Jennifer Sweeting, who works closely with the South Hedland team sang their praises. “The team have been truly committed to scheduling and delivering DESMOND, referring into the program and overcoming any barriers that have arisen,” she said. “They included DESMOND as their core business and have been nothing but positive when it comes to the collaboration and relationship with Diabetes WA since we conducted training with the group in 2017.”

Because of the South Hedland team, people with type 2 diabetes in the Pilbara are receiving structured diabetes self-management education for the first time.

Congratulations and thank you to Hannah, Eunice, Kate, Laura and Kianna.

From left: Eunice Asare (Community Dietitian), Hannah Castledine (Nutrition Coordinator), Kianna Barker (Health Promotion Coordinator), Kate Wilson (Diabetes Educator). Absent: Laura Moylan

After all, you have a condition that many of your family and friends may never really understand. They may not understand the symptoms, the dietary requirements, the medication management, changes to your lifestyle and the anxiety that can come with the condition.

How can someone unaffected by diabetes relate to having to get up twice a night to stick your daughter with a needle to make sure she wakes up in the morning? As you get up from the table three times during dinner at the restaurant, because something you ate has sent your blood glucose soaring, it may feel like the people around you are looking at you, and wondering why.

But we totally get it and have seen everything this condition can throw at people. The Diabetes WA team of educators and health professionals have spoken to people living with diabetes at every end of the spectrum of the condition - from pre-diabetes to people living with life-changing complications through no fault of their own. You can do everything “right” and yet your blood glucose levels can still be unstable, and we get that.

On World Diabetes Day we launched our new campaign – If you’ve got, we get it.

It is about reassuring people that there are educators and health professionals at Diabetes WA who understand your individual situation.

If you’ve got diabetes – the team at Diabetes WA understand what you are going through.

This campaign of short online videos is about empathising with people living with diabetes by showing scenarios only you can appreciate. Whether it’s blurred vision, problems with your feet, fatigue, or any of the other symptoms you might be experiencing, we get it.

Look out for us around WA on the radio, Spotify, in The West Australian Newspaper and online.

We’d love to hear your feedback – let us know what you think.

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0 Call 130

$100m boost expands CGM subsidy More than 37,000 eligible people living with type 1 diabetes will be given access to wearable blood glucose monitors as the Federal Government rolls out a $100 million package to extend the CGM Subsidy Initiative over the next four years.

From 1 March 2019 the subsidy, which will enable people to save up to $7,000 a year and has already been made available to nearly 9,500 young Australians, will include: with type 1 diabetes who are • women pregnant, breastfeeding or actively planning pregnancy;

with type 1 diabetes aged 21 • people years or older who have concessional status, and who have a high clinical need such as experiencing recurrent severe hypoglycaemic events; and

and young people with conditions • children similar to type 1 diabetes who require insulin. This includes a range of conditions such as cystic fibrosis related diabetes or neonatal diabetes.

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DIABETES

news

World Diabetes Day We celebrated World Diabetes Day on 14 November to raise awareness of the escalating health risk posed by diabetes.

The theme for World Diabetes Day this year was Diabetes and the Family, emphasising the importance of family support for people living with diabetes. Thanks to Jean Misko, Ruth Pascoe, Lily Drage, Theresa Oswald and Zandyn Graham who shared their family support stories on our social media channels.

Right: Zandyn Graham and his family featured in our social media campaign Far Right: As did Theresa Oswald and husband Rick.

We kept ourselves busy as did our generous supporters.

VAULT Fitness Cycle of Care Spin Challenge VAULT Fitness hosted the #CycleofCare Spin Challenge in the foyer of St Martins Tower to raise awareness and funds for Diabetes WA. Participants made a $20 donation to register and formed teams of six or more to pedal their way through a sweaty 20 minute session.

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The challenge saw teams taking part from AusIndustry, Robert Half, Regus Perth, VAULT Fitness SMC, AngloGold Ashanti, Knight Frank Australia, VIX Technology, Calibre/Rio Tinto Australia, Ausenco, Chubb and Diabetes WA. The winners: Distance travelled: Korda Mentha with 147km in 20 mins!

Most calories burned: Calibre Group with 3336 calories Highest wattage: Calibre with an average of 289W Biggest team: Korda Mentha

Thanks also to Waxworks Urban Spa Perth, C Restaurant, Aloha Poke Perth, Voltage Espresso for donating prizes and catering and to FineCutz for donating $5 from every haircut on the day.

Below and Right: Participants in the VAULT Fitness Cycle of Care.

More than $7,000 was raised on World Diabetes Day through

community events and fundraising efforts. Thank you to everyone who generously donated to help people living with diabetes in WA.

14 November 2018

FUN FACT:

World Dia betes Day is celebrated ever y yea r on 14 Novem ber as this is the bir thday o f Sir Frede rick Banting, w ho co-disc overed insulin alo ng with Ch arles Best in 19 22 .

Seniors Have a Go Day Our team attended the Seniors Recreation Council of WA Inc.‘s community event – Have A Go Day. They chatted to people about living with diabetes and provided healthy living tips.

Below: Diabetes WA’s Jarnia Davies and an expo attendee.

Esperance Community

Thanks to the coordination of Esperance resident Ian Campbell, who lost his wife to diabetes complications, Nulsen Primary School, Esperance Primary School and Esperance Senior High School raised awareness and more than $900 for people living with diabetes in WA by holding free dress days across the week. A tremendous effort from the Esperance community! Thank you!

Above: Ian Campbell with students from Nulsen Primary School

The Importance of Pathology Diabetes WA Health Services Operations Manager, Sophie McGough, had the chance to rub shoulders with some influential people when she attended two pathology laboratory tours in Perth thanks to Know Pathology Know Healthcare.

She joined the Hon Julie Bishop MP to discuss how pathology influences diabetes management. And then met the ‘invisible doctors’ that provide HbA1C test results for people living with diabetes in WA with Federal Member for Tangney Ben Morton and Federal Member for Fremantle Josh Wilson MP. Jean Misko, who lives with type 2 diabetes, also joined them on the tour.

Right Above: Back (L to R): John Ivey (Principal Scientist Haematology), Dr Patricia Martinez (A/Director Pathology), Chris Caltsounis (A/General Manager), John Blennerhassett (A/Principal Scientist Biochemistry), John Crothers (Chair Pathology Awareness Aust).

Front (L to R): Josh Wilson MP, Mark Carson (Medical Scientist in Charge), Sophie McGough Right Below: The Hon Julie Bishop (left) and Sophie McGough observe pathology in action

You may have heard the Diabetes WA team being interviewed on: - 6iX with Tim Gossage - Hit FM Bunbury - ABC Goldfields - Red FM - Sonshine FM - ABC Southwest - ABC Northwest - Heritage FM

You may have also seen our articles about World Diabetes Day in: - The Southwest Times - The Esperance Express - Have a Go News 9

THE COST OF

diabetes

The Cost of Diabetes When we speak of the cost of diabetes there are many more components than just monetary expenditure - though the financial figures are significant and debated across the globe.

We can speak of the economic burden of this chronic condition – to the individual and to the Australian health system.

There is the emotional cost with the everyday demands of managing diabetes impacting a person’s emotional well-being, which may lead to diabetes-related distress, diabetes burnout or depression.

The stresses and demands of living with diabetes can sometimes have a social cost and affect interpersonal relationships as well. The pressure on families supporting the person living with diabetes can be significant.

The physical, mental and social effects of diabetes are inter-related, influencing short- and long-term health.

Consider the cost of the time spent on diabetes management - measuring blood glucose levels, attending specialist appointments and having sick days that are sometimes unavoidable and the impact that can have on people’s lives.

Even within those personal financial expenses, we can analyse the obvious costs – paying for medication and consumables each month, and then the ones you might not associate directly with a diabetes expense, such as the loss of income with early retirement due to complications or a loss of productivity due to illness.

Any way we look at it - diabetes has a substantial cost, both to the health care system and to the individual.

But it is not all dire. Here in Australia, we are lucky to have the support of government subsidies, and easy access to medical assistance, medications, insulin and supplies.

Though living with a chronic condition can cost a pretty penny, it could be a lot worse, as is the case in many other countries around the world.

And of course, you have the support of Diabetes WA and our free services, workshops and access to information.

Telehealth services are available to those living in isolated communities and our prevention programs, currently active in the South West of the state, are aiming to help you delay or prevent the development Call our of diabetes.

Helpli

ne on 1300 0 01 880 to access a credentiall e d diabetes e ducator for FREE Research shows a number of different total estimates summarising the direct financial cost of diabetes

Dollars and Cents

to Australians in 2018, but the figure is estimated to be between $14 billion and $20 billion per annum and is predicted to increase to at least $30 billion by 2025 (Medical Journal of Australia, 2016).

A report, the silent pandemic and its impact on Australia (2012), from the Baker IDI Heart and Diabetes Institute, with input from Diabetes Australia and the Juvenile Diabetes Research Foundation, states the average annual healthcare cost per person with diabetes is $4,025 if there are no associated complications. However, this can rise to as much as $9,645 in people living with type 2 who have developed both micro- and macrovascular complications, and up to a huge $16,698 for people with type 1 diabetes and similar complications.

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When comparing this to someone who is not living with diabetes, it is significant. The Australian Diabetes, Obesity and Lifestyle study collected data on the use of health services and health-related expenditure by 6101 participants in 2004–2005. Though this study is now 14 years old, the numbers are still relevant. The study showed that annual direct healthcare costs for a person living with diabetes are 131 per cent higher than for someone with ‘normal’ glucose tolerance.

THE COST OF

diabetes

So what does this mean for the average West Australian with diabetes?

Do the numbers match up? For blog-writer Frank Sita, it is quite accurate and, for him, means the following …

One young man’s tally

The cost of having diabetes for a year The following is an extract from a blog post featured on type1writes.com. The article is re-printed with permission from author Frank Sita, who lives with type 1 diabetes.

Frank says: “The topic of conversation over dinner on Friday night was annual incomes, and how they stack up against all of our living expenses. Then, as if trying to prove his point, my Dad asked me how much all of my diabetes expenses would add up to.

I guess I’ve never really done the sums before, for a few reasons. My diabetes and broader health are non-negotiable expenses, drummed into me by parents (second only to eating). Obviously here in Australia, we are extremely lucky that most of the essentials are heavily subsidised, and I’ve never genuinely struggled to make ends meet. I’ve also received a great deal of support from my family in terms of meeting the costs associated with my diabetes care.”

Frank’s tally of annual expenses directly related to managing his diabetes in the 2016/17 financial year. Frank uses an insulin pump to manage his type 1 diabetes.

Test Strips – $918.50 I would go through at least 15 test strips to monitor my blood sugar each day.

That’s 5,475 test strips a year. Or 55 boxes of 100 test strips a year.

A box of test strips will set me back $16.70, which costs me a beautiful $918.50 each year.

Infusion Sets – $217.10 I would change the infusion set on my insulin pump every three days. That’s a total of 122 infusion sets each year.

Or 13 boxes of 10 sets per year.

A box of infusion sets will set me back $16.40, which totals a fantastic $217.10 a year.

Insulin Cartridges – $54.50 I replace the insulin cartridge in my pump once a week. That’s 52 cartridges each year. Or 5 boxes of 10 cartridges per year.

A box of cartridges sets me back $10.90, which adds up to a cool $54.50 each year.

Private Health Insurance – $918 I wouldn’t want to be without a private health insurance policy. It covers the cost of any hospital visits, treatment, as well as rebates on other services such as dental and optical. It’s a small price to pay for the peace of mind, as well as the $9,000 insulin pump that was fully covered under my policy!

I renew my policy annually, which set me back an awesome $918 this year.

General Practitioner – $16 I would only visit my GP if I need something. Such as an examination, a signature, or a fresh script of insulin in between endocrinologist (endo) visits.

Or if I’m dying. I might visit my GP twice a year.

After a Medicare rebate, I’m usually left to pay $8 out of pocket, which adds up to an awesome $16 per year.

Diabetes Educator Sessions – $100

A 3ml cartridge of NovoRapid insulin lasts me roughly 7 days. That’s 52 cartridges a year. Or two scripts per year, each containing five boxes of five NovoRapid cartridges.

While I see an endo for free at the hospital, I choose to see a diabetes educator privately. Private education gives me invaluable support and one-onone time that the public system simply does not allow for. I would visit my diabetes educator five times annually.

A script of NovoRapid penfill cartridges sets me back $38.80, which is a cheap as chips $77.60 per year.

After a Medicare rebate, I am left to pay $20 out of pocket for each session, which totals a cool $100 a year.

Insulin – $77.60

Hypo Treatment – $40 My go-to treatment for hypos are Skittles. I buy them in party buckets.

I would buy four party buckets a year.

A party bucket of skittles sets me back $10, which totals a nice $40 a year.

Grand Total – $2,341.70 “It costs me $2,341.70 to live with diabetes for a year. That’s not even factoring in the intangible costs. It’s a fair chunk of my annual income. It saddens me, because it would definitely make a dent in a few bills at home, among other things.

However, I also count myself fairly lucky, because I know that my counterparts overseas might not be as fortunate as me. If I have to live with diabetes, then there’s no place in the world that I’d rather live with it than in Australia.”

Frank Sita, a young adult living in Perth, was diagnosed with type 1 diabetes in 2010. After managing his diabetes with daily injections for six years, he began using an insulin pump. Frank writes a popular online blog about life with type 1 diabetes and is also a freelance writer, public speaker and a strong advocate for people living well with diabetes. Find his blog at type1writes.com 11

THE COST OF

diabetes

The debate on the cost of insulin around the world The U.S. website STAT reports on a new study (Gotham D, Barber MJ, Hill A: Production costs and potential prices for biosimilars of human insulin and insulin analogues. BMJ Global Health 2018) which suggests that manufacturers could make both human and analogue (synthetic) insulins at low costs and still pocket a profit.

After analysing expenses for ingredients, production, and delivery, among other things, the researchers contend that the price for a year’s supply of human insulin could be US$48 to US$71 a person and between US$78 and US$133 for analogue insulins, which are genetically altered forms that are known as rapid or long-acting treatments. Examples of analogue insulins in Australia include Humalog, Apidra and NovoRapid.

Put another way, the study estimated the cost of production for a vial of human insulin is between US$2.28 and US$3.42, while the production cost for a vial of most analogue insulins is between US$3.69 and US$6.16, according to the study in BMJ Global Health. Meanwhile, the median prices paid by more than two dozen countries for human insulin were 1.2 to 1.8 times greater than estimated prices.

The study authors, who cited the 2016 global study, Addressing the Challenge and Constraints of Insulin Sources and Supply (ACCISS), that examined government procurement prices paid and other data, argued their findings suggest the introduction of more insulin manufacturers and greater competition would lead to sizable savings in most countries. They also maintain that existing insulin makers 12

could set “significantly lower prices while still making a profit,” but they concede more companies would have to enter the market for this to occur.

“It is unacceptable that governments and people are paying so much more than the cost of production for insulin.

Estimating the cost of production for hepatitis C treatment was instrumental in getting dramatic price cuts. This needs to happen now for insulin,” said Dr Margaret Ewen, global pricing coordinator for Health Action International, a not-for-profit advocacy group that backed the ACCISS study.

While out-of-pocket expenses for insulin in Australia are reasonable compared to many countries (see graphs on opposite page), our Government is still footing the bill for the price margin.

STAT goes on to quote a co-author of the BMJ Global study; “Anyone with type 1 diabetes should be able to buy insulin for under $100 per year, including the long-acting forms,” said Andrew Hill, a study co-author and senior visiting research fellow at the University of Liverpool.

“Pharmaceutical companies cannot justify charging governments $532 per person per year in the U.K. and $1,251 in the U.S., let alone similar amounts in low- and middle-income countries.”

The worldwide debate on the cost of insulin is heated and costs continue to rise across the world amid ongoing controversy. Another 2016 study discussed in the Journal of the American Medical Association found the price for a millilitre of insulin climbed 197 percent from US$4.34 per to US$12.92 between 2002 and 2013.

How do we compare to the rest of the world?

While diabetes does place a significant financial burden on the person living with the condition, we have some good support systems here in Australia.

The Government plays important roles in maintaining access to affordable, high-quality medicines, devices and services to support people with diabetes in self-management and treatment. The Australian Government provides support to people with diabetes through the National Diabetes Services Scheme (NDSS), the Pharmaceutical Benefits Scheme (PBS), the Insulin Pump Program and Medicare. This keeps the cost of medication and supplies relatively low and accessible.

Specifically, insulin is heavily subsidised in Australia, through Medicare and the PBS, and test strips, needles and insulin pump consumables are heavily subsidised through the NDSS. Diabetes-specific healthcare is also supported through the public system, with access available to diabetes educators, dietitians and endocrinologists.

Not-for-profit organisations, such as Diabetes WA, are also supported by state and national government funding and grants and are able to provide free education workshops and support services to anyone registered on the NDSS. Access to Medicare and private health insurance is also not measured or accessible based only on income and socio-economic status, as it is in some other countries.

According to a world-wide study conducted by T1 International, Americans have the world’s highest out of pocket costs for insulin and other life-saving diabetes supplies, without accounting for average monthly income.

THE COST OF The US even ‘beat’ war-torn Syria, a place where access to diabetes supplies is disrupted by bombings and blockades. When average income is taken into account, according to the survey, Ghana has the dubious honour of being number one for monthly out of pocket diabetes costs as a percentage of their average monthly income.

In the US, insurance status and age – as in Medicare eligibility – can impact both the cost and coverage of diabetes medications and supplies.

The survey showed that people in the US with diagnosed diabetes incur average medical expenditures of $16,752 per year, of which about $9,601 is attributed to diabetes.

People with diagnosed diabetes, on average, have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes.

To cover the costs associated with diabetes management, people around the world pay anything from 0% to 118% of their monthly income.

diabetes

Diabetes Cost as Share of Monthly Income

Rapid-Acting Insulin

Average Out of Pocket Cost in $/ml

The afore-mentioned T1 International survey, called The Insulin & Diabetes Supply Survey, was conducted in March 2016 and looked at prices people pay out-of-pocket for their diabetes costs.

Respondents were asked:

• the type of insulin they take • how they take their insulin • the out-of-pocket cost for their insulin • what type of test strips they use out-of-pocket cost of their • the test strips out-of-pocket costs for other • their diabetes management (appointments, syringes, etc) They compared monthly out-of-pocket costs for diabetes with average monthly wages in each country and explored whether people use ketone strips and the glucagon injection.

Hundreds of people completed the survey from more than 40 countries.

The information provides a wider picture of the global situation for people with diabetes, if only a snapshot.

The graphs (right) show a country comparison of two statistics taken from the survey. NB: Not all countries surveyed are shown in these graphs.

Source: t1international.com/insulin-and-supply-survey

Diabetes may be expensive, but our services and workshops aren’t – they are FREE to members. In fact attendance at one of our DESMOND workshops is valued at $250 worth of free education.

Visit our website for information on our type 1, type 2 and pre-diabetes diabetes workshops or flip to our Education Planner in the magazine centrefold to find a program that will work for you.

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diabetes

Is prevention the answer to the cost of type 2?

As we have shown with our statistics, diabetes generates a significant cost to the health system. Many experts agree that investing in the prevention of chronic conditions, and in particular type 2 diabetes, could save billions of dollars in health care costs annually.

As type 1 diabetes is currently not preventable, the approach to reducing the cost of this condition needs to focus on support for optimal diabetes management and a reduction in the development of diabetes-related complications.

In the case of type 2, in many (though not all) cases the development of this condition is preventable. As 87 per cent of people living with diabetes in Australia have type 2, a reduction in the incidence of the condition would have a substantial impact on the cost to the health system, not to mention the individual.

A report out of New York, released in October in the Food & Nutrition Journal, “The Cost and Impact of Type 2 Diabetes: Policy Recommendations for a Growing Public Health Epidemic” demonstrated that if one-fifth of the 30 million people living with type 2 in the U.S. used dietary changes to reduce their HbA1c levels by one percent, they would not only reverse the course of their diabetes, but the healthcare system would also save at least $10 billion annually and outcomes would improve measurably. If the 84 million Americans with pre-diabetes followed a similar regimen, the savings would increase even further.

Though this is yet another statistic out of the US rather than from Australia, it is a significant one. It demonstrates it only takes a small change to make a big difference.

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The Australian Institute of Health and Welfare recently released a report called ‘Potentially preventable hospitalisations in Australia by small geographic areas.’ The report outlined 22 conditions for which hospitalisation is considered potentially preventable across three broad categories: vaccine-preventable conditions, such as chicken pox and whooping cough; acute conditions such as dental conditions and pneumonia; and chronic conditions, such as diabetes complications and congestive heart failure.

There were more than 715,000 hospitalisations in Australia in 2016–17 for the 22 conditions for which hospitalisation is considered potentially preventable. This represented 6% of all hospital admissions to a public or private hospital in Australia that year. Potentially preventable hospitalisations accounted for more than 2.8 million bed days nationally—equivalent to 9% of all public and private hospital bed days.

Diabetes complications accounted for 256,883 total potentially preventable hospitalisation bed days in 2016/17.

According to the report, rates of potentially preventable hospitalisations for chronic conditions were more than three times as high in some areas of Australia compared with others, ranging from 811 per 100,000 people in Northern Sydney to 2,531 per 100,000 in Western Queensland.

In WA, the Kimberley had the highest rate of people being hospitalised for diabetes complications that could potentially have been prevented, at 463 per 100,000 people.

Evidence shows that it is much more cost effective to prevent chronic conditions than to treat them, particularly when it comes to type 2 diabetes. By continuing to encourage people to become involved in evidence-based lifestyle interventions, focus on nutrition and increase physical activity, we can support people to live healthier lives. For those already diagnosed with diabetes, education about diabetes management can prevent or delay the development of complications. Health agencies and health professionals have the tools to change the trajectory for millions of people. Using these tools wisely will save not only money, but lives, in the long run.

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Reduced NDSS co-payments for products The National Diabetes Services Scheme (NDSS) recently announced changes to the brands of some products available on the NDSS Product Schedule, however, people registered with the NDSS will still be able to access the products they need.

To ensure the ongoing sustainability of the NDSS, the Department of Health undertook a review of products subsidised under the NDSS. This included blood glucose test strips, insulin syringes and urine ketone test strips.

The changes, which took effect on 1st December, mean the cost for insulin syringes will remain the same and the cost of blood glucose test strips will either remain the same or decrease. For some people who use discontinued brands of blood glucose test strips, it could also mean a new blood glucose meter.

Most people who access subsidised products through the NDSS will receive a reduction in their out of pocket co-payment amount. There are no increases to the cost of products and no new restrictions to accessing products.

The NDSS states: “Where a person is required to change their current brand of blood glucose test strip, a clinically equivalent alternative will be available to them on the revised NDSS Product Schedule.

In addition, people needing to change their current brand of blood glucose test strips under the new supply arrangements will be able to access a free blood glucose testing meter to use with their choice of new product.

Based on clinical advice, 13mm and 12.7mm syringes will no longer be available under the NDSS. Both 8mm and 6mm syringes will continue to be subsidised under the scheme.”

The changes include:

• Several new brands of blood glucose test strips and insulin syringes will be added.

• Some existing brands of blood

glucose test strips and insulin syringes will be removed. People with diabetes who are affected will still be able to access the same types of subsidised products they need, but some brands of products will change. If someone’s usual brand is no longer subsidised through the NDSS, they can access a clinically equivalent NDSS product.

• There will be no changes to urine

ketone test strips, insulin pump consumables & continuous glucose monitoring products.

There is a transition period, from 1 December 2018 to 28 February 2019.

During the transition period, you may be able to purchase existing brands that are being removed from the list of products available through the NDSS. You will only be able to purchase these brands while existing community pharmacies stock is available. It is likely that available stock may reduce over the transition period as pharmacies sell their available stock.

If you require assistance in changing brands, you may wish to consult your healthcare team for assistance.

To see if a product is changing, or to find out more about the changes, visit the NDSS website: ndss.com.au/ important-changes-to-the-ndss

Examples of Potential Savings A person with type 1 diabetes with high blood glucose test strip usage of 10 strips per day (36.5 packs of blood glucose test strips per year), with non-concessional status will save $2 per pack, totalling to a saving of $73 per year.

An average person with type 2 diabetes (using insulin), using 6 packs of blood glucose test strips per year, non-concessional will save $2 per pack, totalling to a saving of $12 per year.

A person with type 1 diabetes who uses an insulin pump and replaces the consumables every 3 days, as well as an average of 8 blood glucose test strips per day, and who has concessional status, would save $10.50 per month or $126.50 per year.

The above examples are provided on Diabetes Australia’s website.

The NDSS is an initiative of the Australian Government administered with the assistance of Diabetes Australia. Contact the NDSS Helpline on 1300 136 588 for further information on the changes.

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Ready for retirement?

Experts estimate that to retire at 65 - the average age of retirement - you need to have enough money to support yourself for 20 to 25 years. If you are already retired, then this may already be a reality for you and planning to ensure you can live financially stress-free is a priority.

The same experts also estimate that 30 to 50 per cent of the ageing baby boomer population (those born between 1946 and 1964) will have to work beyond 65 because they don’t have enough money saved to retire as originally planned.

People living with diabetes have many of the same financial concerns as the average person living without diabetes: mortgage/s, living expenses, superannuation planning, pensions, and savings accounts. But you also have the added cost of a condition that requires constant care and supplies, as well as the potential outcome of retiring early or losing wages because of diabetes-related health complications.

A recent study from Australia (BMJ Open. 2017;7(1):e013158) showed that 16

people aged 45–64 years who exited the labour force because of their diabetes had a median weekly (personal) income of only $A393.15, whereas those employed full-time without diabetes received an income over three times greater than this amount ($A1306.81). This reduced income can lead to inadequate finances for basic healthcare and services, and a lack of superannuation savings, accumulated through employment, can result in minimal savings to cover the higher healthcare costs incurred in old age.

Though this all sounds a little dire, the good news is that there are many things people can do to be proactive about planning for retirement, or to improve their situation if already in retirement – and a lot of these tips are especially applicable to people living with diabetes.

Tips for a more ‘comfortable’ retirement The key to a retirement with less money worries, is preparation and planning. Knowledge is key, so try to become informed.

List of goals Try making a list of goals for your overall financial future or your current situation if you are already retired. Include costs for when and how you want to retire, home expenses, hobbies, employment, major purchases, possible travel plans now you have less time commitments, and healthcare costs. Estimate the dollar amount you need to reach your goals, as well as how long you think it will take to reach them.

Create an inventory of documents Next, create an inventory of important financial documents and their locations (try to give a copy to a family member or relative or keep it in a safe place).

After you’ve prepared all your financial statements and investments, assess your numbers in terms of your ability to meet your projected goals.

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Top up your superannuation

Take care of yourself

It’s also important to assess your health status. If you are currently working, you should consider the possibility that you may not be able to work well into your 60s and 70s if you have or develop diabetes-related health complications. It may mean you can’t depend on your income now to provide for you later. Consider putting more into your superannuation now to prepare for the years ahead.

Not surprisingly, the same things that doctors and specialists tell you are good for your diabetes – eating well, getting regular exercise, keeping up with routine examinations – can help you stave off excess expenses during retirement. For people living with diabetes, the benefits are even more pronounced.

The Australian Government provides super co-contributions to help eligible people boost their retirement savings.

The Australian Tax Office (ATO) states that if you’re a low or middle-income earner and make personal (after-tax) contributions to your super fund, the government also makes a contribution (called a co-contribution) up to a maximum amount of $500.

The amount of government cocontribution you receive depends on your income and how much you contribute. When you lodge your tax return each year, the tax office will work out if you’re eligible. For more information on super co-contributions visit the ATO website: ato.gov.au

Taking care of yourself and preventing or delaying the development of diabetes-related health complications can reduce healthcare costs eating up your retirement savings. While Medicare and government benefits can cover a lot of your expenses and appointment costs, it will not cover everything.

diabetes

A recent news article from USA Today cited a statistic from a US investment company that found that a couple retiring today will need $200,000 to cover health costs for a 15-year period.

Prescription medication represented around one-third of this amount, not including the costs of dental care, long-term or residential care, or overthe-counter medicines.

Unfortunately, people living with diabetes can assume their needs will be higher, so whatever you can do in the present to both prepare for and prevent an even more expensive retirement is worth spending some preparation time on.

This is especially true for type 2 diabetes, as its progression can be contained well through lifestyle choices like eating habits and exercise, thus reducing costs and complications.

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diabetes

Ways to Save: Health Insurance Health insurance can be expensive but there are ways you can save money, or at least know that you are paying for what you need and not paying for benefits you might not use.

Living with diabetes means that having health insurance, and understanding how it works for you, is critical. Most insurers will cover your insulin pump (if you need one), glucose monitor, dietary education and medication, and you don’t even need the highest level of cover.

Whether you are newly diagnosed, moving off your parents’ policy, looking to switch to a new plan or experiencing a change in coverage, there are some key questions you should ask your potential provider to help you navigate healthcare and health insurance.

Health insurance companies are by law not allowed to discriminate against people with diabetes or any other chronic condition, but they can enforce the limited waiting periods for pre-existing conditions.

We asked Abigail Koch, from comparethemarket.com.au for some tips on choosing health insurance that best suits people living with diabetes. Abigail says; It’s crucial for people living with diabetes to speak with their doctor about the treatments they may need in the next ten years. Once you know what you could face, it makes the task of finding the right health insurance policy much simpler. There are huge differences between the services and treatments that funds cover, so we recommend talking to a health insurance expert to help you find the right policy for you and your individual needs.

Depending on whether you have type 1 or type 2 diabetes, you should consider coverage for insulin pumps, eye surgery or treatment, dialysis for kidney disease and heart surgery.

When looking at your Extras or Ancillary Cover, people should consider policies that provide claimable benefits for glucose monitors, blood pressure monitors, podiatry, healthy lifestyle benefits (such as gym memberships or personal trainers), as well as optical and dental procedures.

When it comes to glucose monitors, make sure you check the policy’s annual limit, as well as any sub-limits, and how much they actually pay per monitor. It’s worth noting that some funds also limit how often you can claim on glucose monitors (for example, every three years).

Some funds will pay benefits towards continuous glucose monitors, however there’s also the cost of both the

transmitter and the sensor to bear in mind. Some funds pay benefits towards transmitters, however sensors are seen as ‘consumables’ and funds do not pay a benefit towards these.

For people who need insulin pumps, it’s important to make sure that your policy includes cover for them, as well as asking about the rules surrounding getting your initial fitting in hospital. Some funds will only pay towards the procedure and pump if you are admitted as an inpatient, whereas others will contribute even if you’re treated as an outpatient only. If you do meet the requirements, health funds will cover the insulin pump up to the Government Prosthesis List amount, which means you should also speak to your hospital and doctor about any out of pocket expenses. You can do so by asking for an Informed Financial Consent Form.

One thing that does not change between funds is the waiting period. It will always be 12 months for pre-existing conditions, and two months if the condition is not pre-existing.

It’s also good to know that no health insurance fund pays towards consumables such as test strips and insulin. Also, funds will only pay benefits towards medication if it’s not on the Pharmaceutical Benefits Scheme (PBS), if the policyholder is covered for non-PBS Pharmacy through their Extras Cover.

Health Insurance Reforms A series of reforms to private health insurance were announced by the Federal Government on 13 October 2017 and will take effect on 1 April 2019.

One of these reforms was categorising hospital insurance products as Gold/ Silver/Bronze/Basic and implementing standardised clinical categories for 18

treatments to make it clear what is and isn’t covered in policies.

therapy only covered in the Gold tier of private health insurance.

The idea of the new tiers is to help consumers understand their private health insurance and make it easier for them to shop around for a better deal.

But, the changes bring about the news that these reforms will see insulin pump

Gold tier is the highest category and the most expensive. Therefore, it is important that you speak to your health insurer about how these changes will affect you if you have, or are thinking about getting, an insulin pump fitted.

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Time poor

We all live diverse lives, but one constant for many people is too little time. Juggling many roles and duties, it can be hard to squeeze everything in —doubly hard when you have a condition such as diabetes.

For assistan ce with compa ring health insurance p olicies, go to comparethe market.com .au where they will conduct a thorough ne eds analysis and recomm end a policy that is right for you.

Reviewing how you spend your time can help you manage better.

Some diabetes tasks need to be done daily;

• Testing your blood glucose levels • Taking pills or insulin and determining how much to take and when to supplement

• Recording test results and medicine doses in your log • Exercising

Here are ways to give your diabetes the daily attention it deserves:

• Don’t feel guilty about making diabetes care a top goal. Staying healthy makes it easier to be a good employee, parent, partner, friend and son/daughter.

• Make diabetes care part of your everyday routine. You’ll be more likely to exercise, for example, if you have a time set aside for it.

Some tips; • Be clear about what you want covered and discuss this with your diabetes educator or GP • Only pay for health insurance features that you really need • Use an excess or co-payment to lower your premium • Check your insurer has a formal agreement with your health service providers • Annually review your insurance requirements and policies • Ask your health insurer if you can suspend your premiums if you travel overseas

• Use memory aids: link testing and taking medicines to things you do every day

at the same time, such as brushing your teeth. Keep your medicines and glucose meter near where you do these tasks.

• Create rituals. Do things in the same order, in the same place, at the same time, each day.

• Set a timer to remind you of your next blood test or medicine dose.

Some diabetes tasks are done only when needed:

• Reviewing your blood glucose records and food records • Testing your urine for ketones • Seeing your GP and/or specialist and • Reviewing your Annual Cycle of Care • Filling prescriptions and buying supplies • Traveling to and from, and waiting, at the clinic, pathology collection centre and pharmacy

Planning for these is much harder than fitting in daily tasks. They don’t occur regularly. The time they require is less predictable and many take hours instead of minutes. Still, there are many ways to free up time for such tasks. Start by setting personal, family, and career goals. Rank these by importance. Then look at how you spend your time each week. Ask yourself:

• Are there ways you can spend your time more usefully? Do you watch TV shows that you don’t really enjoy? Catch up on work or chores during that time instead.

• Are you using any time inefficiently? Do you go to the supermarket many times each week instead of once? Planning ahead to avoid double effort can free up large blocks of time.

If you still have too little time:

• Delegate or say “no” more often. If your partner or children have plenty of leisure time, but you are always frantically busy, something is out of whack.

• Plan your schedule around your natural body clock. Do important tasks when you are most alert and energetic.

• Cut down health care visits by doubling up. Try to see the dietitian and have blood tests done on the same day you visit your GP or specialist.

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Emotional and Social Costs Financial costs, easily recognised as you hand over money for medications and supplies, are not the only costs of diabetes. There are also the emotional and social costs of the condition to consider. There is no price, though there are statistics, that can evaluate the impact a diabetes diagnosis can have in this area.

Diabetes management requires an ongoing self-care regimen, including daily decisions concerning blood glucose monitoring, medication, diet and exercise. This often challenges people with diabetes and those who care for them, potentially affecting interpersonal relationships and indirectly affecting diabetes management.

In addition, the possibility of the development of complications and therefore the significant weight of a possible change of ability, along with the demands of self-management can contribute to emotional distress.

Emotional responses such as denial, fear, anger, depression, apathy, hopelessness, loss of motivation, shame or embarrassment and even jealousy (of those who aren’t affected 20

by diabetes) are common amongst people living with diabetes.

The emotional burden of diabetes is often greatly under-diagnosed and can lead to depression, eating disorders, anxiety, needle phobia and severe mental health conditions.

These negatively impact on selfcare which can lead to poorer glycaemic management and longterm complications. The Warwick Institute for Diabetes, Endocrinology and Metabolism (2011) reports that the cost of diabetes care for someone with severe depression is 251 per cent higher than the standard cost.

Studies suggest that depression is between 60 and 100 per cent more common in adults living with diabetes. However, data also suggests

that depression is more common only among those with diagnosed diabetes; no increase is seen among individuals with impaired fasting glucose or undiagnosed diabetes, indicating that it is the burden of managing the condition that can have the biggest impact on mental health.

Most individuals with diabetes who indicate depressive symptoms on self-report measures are not clinically depressed. Emotional distress specific to living with the burden of diabetes and its management, or diabetes distress, is more common than depression among patients and is more closely associated with problematic diabetes self-management and, as a result, fluctuating glycaemic levels.

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Social challenges Website healthtalk.org features transcripts and videos of a breadth of real people speaking about their own experiences living with various health issues.

Diabetes is one of the topics covered.

When asked about how diabetes affects their social life, many of the people (of varying ages) interviewed said that they had learned to manage their diabetes so that it didn’t affect their ability to eat out in restaurants, at friends’ houses, or in social gatherings.

A few people found other’s reactions and lack of understanding difficult, which made it harder to manage their diabetes when dining out and many said that adjusting to less alcohol at social gatherings was also challenging.

Social settings can be challenging for people who need to use insulin and manage blood glucose testing while eating out.

Some people interviewed on healthtalk.org discussed giving themselves an injection discreetly while at the dinner table, while others took their insulin in the car, on the bus or in another room. Having to leave a situation to manage your diabetes can be an isolating experience.

Measuring diabetes distress Ongoing evaluation of self-management education programs, such as Diabetes WA’s DESMOND type 2 program, show that participation considerably reduces diabetes distress.

The PAID (Problem Areas of Diabetes) Questionnaire is used, which is a selfreport pencil and paper questionnaire that contains 20 items that describe negative emotions related to diabetes (e.g. fear, anger, frustration) commonly experienced by people living with diabetes. A score is generated between 0 – 100. People scoring 40 or higher may be at the level of “emotional burnout” and warrant special attention. PAID scores in these people may drop 10-15 points in response to educational and medical interventions. An extremely low score (0-10) combined with poor diabetes management may be indicative of denial.

A PAID evaluation of participants in our DESMOND type 2 program this year showed that overall, people felt 70.4 per cent less diabetes-related distress after attending a workshop.

When eating out, some people said they asked for bread so that they could eat quickly after having taken insulin, just in case the food didn’t arrive on time. Others said that checking blood glucose levels was trickier than giving themselves injections when out socialising, while one man said that cleaning the injection site beforehand was the most awkward thing to do.

Misunderstanding the condition can be a challenge for some people. Several young people interviewed said that coping with changes in their levels and trying to be extra careful about injections and food could make them seem overcautious to their friends. Being seen as different by other children had been a problem for one girl who said she had been bullied at secondary school.

The importance of support A well-documented way to help alleviate the emotional and social costs of diabetes is to ensure you have an excellent support system around you.

Family members are often involved in the lifestyle changes that people make after they are diagnosed with diabetes, regardless of whether it’s type 1 or type 2.

Many people say that their spouses, partners and children are essential in helping them and motivating them to manage their diabetes as best they can.

Often the whole family make changes to their diet. Some people involve their younger children or grandchildren when they are doing their blood glucose tests or taking their medication or injections, so that managing diabetes becomes a natural part of family life.

Studies have shown that social support is associated with reduced diabetes distress overall. Those who reported having a strong support network had reduced total diabetes distress, reduced emotional burden of diabetes, and less diabetes-related interpersonal distress.

These findings are in line with earlier studies, which found that social support played an important role in diabetes-specific quality of life and that supportive behaviours from healthcare providers and family were significantly associated with lower diabetes distress.

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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.

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.

Note: This is not a fitness program.

Insulin Pump Workshop – learn about the features of your pump and how to get the most out of it with this hands-on session.

Type 1 Technology Night Explore pumps, CGMs and flash monitoring and meet with device company representatives to find out the pros and cons.

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Perth Metro

Armadale Banksia Grove Bassendean Bassendean Bassendean Bassendean Belmont Boya Boya Boya Brookdale Cannington Cannington Caversham Cockburn Cockburn Cockburn Cockburn Joondalup Kelmscott Kelmscott Kelmscott Mandurah Mandurah Medina Melville Melville Melville Middle Swan Middle Swan Midland Mirrabooka Mirrabooka Pearsall Pearsall Piara Waters Riverton Rockingham Rockingham Rockingham Scarborough South Perth Southern River Southern River Southern River Subiaco Wanneroo Wanneroo Wellard Wellard Wellard Wellard West Leederville West Leederville

ShopSmart DESMOND DESMOND MeterSmart ShopSmart DESMOND Classroom ShopSmart MeterSmart MedSmart DESMOND DESMOND DESMOND CarbSmart CarbSmart CarbSmart Insulin Pump Workshop DESMOND Classroom ShopSmart DESMOND MeterSmart FootSmart Living With Insulin DESMOND (FULL) DESMOND DESMOND Classroom ShopSmart FootSmart DESMOND DESMOND DESMOND ShopSmart DESMOND MedSmart FootSmart MeterSmart DESMOND Connect With Diabetes DESMOND Classroom ShopSmart FootSmart DESMOND Type 1 Technology Night DESMOND ShopSmart MedSmart DESMOND (FULL) CarbSmart DESMOND DESMOND Living With Insulin Ready Set Go - Let's Move DESMOND DESMOND DESMOND

10 January 2019 19 January 2019 11 January 2019 29 January 2019 6 February 2019 23 March 2019 17 December 2018 14 December 2018 23 January 2019 15 February 2019 30 January 2019 21 February 2019 5 March 2019 22 March 2019 14 January 2019 31 January 2019 18 February 2019 28 March 2019 7 March 2019 8 February 2019 8 February 2019 15 March 2019 15 December 2018 16 February 2019 16 March 2019 17 January 2019 17 January 2019 7 February 2019 22 January 2019 27 February 2019 12 March 2019 11 March 2019 20 March 2019 14 March 2019 14 March 2019 2 March 2019 11 March 2019 2 February 2019 13 February 2019 13 February 2019 12 February 2019 19 February 2019 29 January 2019 19 February 2019 19 February 2019 15 December 2018 11 February 2019 25 February 2019 15 January 2019 4 February 2019 8 March 2019 19 March 2019 31 January 2019 27 March 2019

Planner WA Regional

Bruce Rock Bruce Rock Bunbury Bunbury Bunbury Bunbury Busselton Carnarvon Esperance

FootSmart ShopSmart MeterSmart DESMOND FootSmart DESMOND DESMOND DESMOND DESMOND

Esperance Exmouth Geraldton Geraldton Geraldton Geraldton Manjimup Merredin Narrogin Northam Shark Bay South Hedland

DESMOND DESMOND MedSmart CarbSmart DESMOND DESMOND DESMOND DESMOND DESMOND DESMOND DESMOND DESMOND

(FULL)

19 March 2019 19 March 2019 13 March 2019 13 February 2019 13 March 2019 21 March 2019 8 March 2019 19 February 2019 26 & 27 February 2019 (two half days) 25 March 2019 20 March 2019 14 February 2019 14 February 2019 15 February 2019 15 March 2019 25 February 2019 6 March 2019 13 February 2019 15 February 2019 24 January 2019 12 December 2018

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.

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 23

RESEARCH

news

Research Round-Up It’s great news for people with support A study in Alabama has shown that, for people with diabetes and mild to severe depression, peer support reduced hospitalisations by 70% and emergency medical care by 50%, as the people were better able to manage both their blood glucose and their depression.

It’s good news for fit fathers Fathers-to-be may be able to lower the risk of their offspring developing type 2 diabetes through getting more exercise prior to conception, according to American researchers who studied sedentary and active mice.

It’s bad news for people with sore gums

Initial results of study show an end to insulin for type 2 Dutch scientists have found a way of stabilising blood glucose levels in people with type 2 diabetes on insulin, by destroying the mucous membrane in the small intestine causing a new one to grow.

In the hour-long procedure, trialled on 50 patients in Amsterdam, a tube with a small balloon in its end is inserted through the mouth of the patient down to the small intestine. The balloon is inflated with hot water and the mucous membrane burned away by the heat. Within two weeks a new membrane develops, leading to an improvement in the patient’s health.

Even a year after the treatment, the condition was found to be stable in 90 per cent of those treated. It is believed there is a link between nutrient absorption by the mucus membrane in the small intestine and the development of insulin resistance among people with type 2 diabetes.

The research team are understandably cautious (with such a small sample size), but excited by the initial results. They are also questioning whether this is a permanent treatment, or whether it is something that will have to be repeated on numerous occasions to maintain the effect.

The new discovery initially seems most suitable for borderline patients who already take pills but whose blood glucose level is high enough for doctors to advise that they inject insulin in the short term.

A larger study is now planned.

Article source: theguardian.com

Insulin storage may reduce insulin quality A German study has concluded that fluctuations in fridge temperatures may be reducing the potency of stored insulin.

New research presented at the European Association for the Study of Diabetes (EASD) Annual Meeting in Berlin, Germany suggests that insulin is often stored at the wrong temperature in patients’ fridges at home, which could affect its potency.

To prevent loss of effectiveness, insulin must stay between 2-8°C in the refrigerator or 2-30°C when carried about the person in a pen or vial.

Between November 2016 and February 2018, 388 people with diabetes living in the USA and the EU placed temperature sensors either next to their insulin in the fridge or in their diabetes bag. Temperature data was automatically measured every three minutes (up to 480 times a day) before being sent to an app and recorded on a secure database. Temperature data was recorded for an average of 49 days.

Analysis of 400 temperature logs (230 for refrigerated and 170 carried insulin) revealed that 315 (79%) contained deviations from the recommended temperature range.

People with diabetes are at greater risk of gum disease, and people with gum disease are at greater risk of pre-diabetes or type 2 diabetes. A recent Melbourne study found 57% of dental patients with gum disease had undiagnosed pre-diabetes.

“When storing your insulin in the fridge at home, always use a thermometer to check the temperature. Long-term storage conditions of insulin are known to have an impact on its blood-glucose lowering effect”, Dr Katarina Braune from Charité - Universitaetsmedizin Berlin said.

“Even gradual loss of potency introduces unnecessary variability in dosing. More research is needed to examine the extent to which temperature deviations during domestic storage affect insulin efficacy and patient outcomes.”

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.

24

RESEARCH

news

Research needed

by Diabetes Research WA executive director Sherl Westlund

A recent article highlighted research, type 2 diabetes prevention, and diabetes complications screening and prevention amongst areas that had not yet been given enough attention, despite the creation of the Australian National Diabetes Strategy 2016-2020.

The comments were made by Monash University Professor of Diabetes Paul Zimmet, an international leader in diabetes for 40 years, and underscore why organisations like ours are a critical piece of the puzzle in tackling diabetes.

At our recent 2018 World Diabetes Day event we announced three new research projects we’re funding in 2019 – the first of them to be detailed here shows how we’re playing a vital part in helping address areas listed in the Strategy document.

And, as Perth endocrinologist Dr Joey Kaye says, there’s still a need to undertake research because while we can manage diabetes, we don’t yet have all the answers to preventing health complications – or a cure.

Type 2 Diabetes & RAGE West Australian researchers racing to create a new treatment to prevent and protect people from the potentially life-threatening complications of type 2 diabetes have been awarded a Diabetes Research WA 2019 grant to fast-track their quest.

Associate Professor Kevin Pfleger and his Perth-based team from the Harry Perkins Institute of Medical Research will receive $60,000 to progress their work into a molecule called RAGE (the Receptor for Advanced Glycation End-products).

Kevin Pfleger

RAGE is a molecule that sits in the membrane surrounding cells that are injured or stressed.

“As RAGE is only present when cells are in this mode – which happens in type 2 diabetes – it’s a key target that we believe we can hone in on to help fight the detrimental effects of this condition,” A/Professor Pfleger said.

“We’ve discovered a novel way in which this molecule is activated, triggering a cascade of signalling in cells that leads to inflammation and cell injury, and we’ve found a way to inhibit this process that should, in turn, limit the complications of type 2 diabetes developing, so it’s incredibly exciting.”

The work will also harness powerful bioluminescence resonance energy transfer (BRET) technology, developed at the University of Western Australia that A/Professor Pfleger is well-known for using in his cutting-edge research and is being done in collaboration with leading diabetes researcher Professor Merlin Thomas from Monash University.

We are very excited to fund this project, which holds hope of being a significant game-changer in the treatment of type 2 diabetes as there remains an unmet need for innovative treatment strategies to manage the condition. This work also shows how Western Australia is at the forefront of advances in this field.

Congratulations to A/Professor Pfleger and his team and we look forward to sharing our other two funded grants with you in the next edition.

And, as always, we thank everyone who has generously donated to us and made the awarding of these annual grants possible.

For information, please visit diabetesresearchwa.com.au or call (08) 9224 1006.

25

INTHE

community

Arrrr … a’camping we will go!

Nine-year-old Mary Haddow has had diabetes since she was two. When she found out she would join other children her own age also living with type 1 diabetes at a two-day camp, she was very excited. As was her mother, Lauren.

“It’s going to be an amazing experience for Mary,” Lauren said before Mary attended the camp. “There will be diabetes experts on hand to look after the kids, so Mary will get to have fun and just be a kid. She’s pretty good at managing her diabetes, and I think the camp will help her to realise that she can do it for herself without Mum and Dad around.”

Ethan Pascoe met Mary at the camp (both pictured right). Ethan’s mother, Ruth, is already an experienced camp mum, as Ethan’s older sister also lives with diabetes and has attended two such camps before.

The pirate-themed kids’ camp, run by Perth Children’s Hospital with support from Diabetes WA, hosted 34 nine and ten year old kids with type 1 diabetes. The camp aims to help kids to gain more independence and self-confidence and to realise they are not alone in living with their condition.

The camp also represented an opportunity for the busy mothers, as they were able to get two full nights’ sleep without having to get up a couple of times to check their child’s blood glucose levels.

“I think the camp was an eye-opener for Ethan, as he was surrounded by kids that deal with diabetes every day as he does.”

Ruth said.

Super Support:

Grateful to Greg Greg Devereaux has lived with diabetes

for 13 years, and wanted to raise money to support Diabetes WA. He decided the best way was to assist in selling our raffle tickets. He contacted friends and Greg Deveraux 26

neighbours, and sold his first book of 20 tickets in about three hours!

Now he is increasing his efforts, and plans to sell three more books of tickets by standing out the front of two shops in his local area.

Thanks Greg for your amazing support of people affected by diabetes.

If you would like to support Diabetes WA and request raffle ticket books to sell, please call 1300 792 998.

INTHE

Super Support: Robert Half quiz night

community

Staff and clients of recruitment specialists Robert Half joined together in October for an evening of fun at their annual quiz night.

Senior manager Richard Sinden’s daughter, Lexia, has been living with type 1 diabetes since she was seven years old, so the team at Robert Half included a charity auction and raffle on the night with all proceeds going to Diabetes WA. Guests were invited to provide an item to be auctioned and, along with the raffle and donations, an amazing total of $1,925 was raised.

Lexia shared a bit about her story, leaving hand written notes on each table explaining how she was diagnosed and outlining some of her experiences when learning how to manage her condition.

“It took me a while to get used to injecting before eating anything. Every two hours I had to check my blood levels and I injected myself five or more times a day, and the bedtime one really hurt,” she wrote.

“I now have a pod that delivers my insulin and a CGM which measures my blood sugar levels. This means less injections and less finger pricks which I’m happy about. I hope some day soon I will be able to get an artificial pancreas or better, there will be a cure.”

A very big thank you to the team at Robert Half and Richard and Lexia for sharing their story and raising much needed funds and awareness for Diabetes WA. Lexia

My Story!

I was 7 years old when I was diagnosed with type 1 diabetes. I had been feeling sick for a few months, drinking a lot of water, and going to the toilet a lot. I went to the doctors on April 8th. My mum and dad just thought I had an infection. I walked into the doctors eating fruit pastels (not the best thing to have when you’re diabetic).

My blood sugar levels were 31 (very high, normally they are 7). I spent the next week in hospital with my mum and dad learning how to manage my sugar levels. I felt nervous, overwhelmed with information, and worried. Over the next year we learnt how to weigh my food after each meal and count the carbs in every meal. It took me a while to get used to injecting before eating anything. Every two hours I had to check my blood sugar levels and I injected myself 5 or more times a day, and the bedtime one really hurt. My mum and dad check me during the night and I often have to wake up in the middle of the night to treat myself.

Due to the research from organisations like Diabetes WA which is funded by generous donations from events like this one, I now have a pod that delivers my insulin and a CGM which measures my blood sugar levels. This means less injections and less finger pricks which I’m happy about. = ) I hope some day soon I will be able to get an artificial pancreas or better there will be a cure.

To be able to do that needs money, so please give generously tonight.

Lexia’s Story 27

TELL US

your story

Walter Aldridge

Walter Aldridge and Bob Johnson share their stories.

Embracing technology

By Walter Aldridge

“As most diabetics know, managing one’s HbA1c is not an easy task. Some diabetics are fortunate to manage their HbA1c with diet alone, some need medication (tablets), others need insulin - and some need two of these methods while the less fortunate ones need all three combinations.

Counting carbohydrate intake requires time, the extensive knowledge of food properties and mathematical expertise.

Tablets are fine once one is organised but the finger pricking at least twice a day is still necessary and can be worrying when results are high, and big spikes do occur.

Insulin is a great inconvenience and pain, especially when it is several times a day before meals. It is inconvenient at meetings, conventions, when travelling, visiting friends for dinner, etc.

Bob Johnson

After struggling with differing advice on recommended HbA1c target ranges

from changing doctors over the years, I would re-examine my eating habits and do a few more finger pricks to gain better management, but I found it difficult to stay on top of it.

So, I looked for a solution - my diet was already the best I could do - I like food, but not great quantities of it, and I am aware of the foods to eat without doing complex mathematical calculations. I already did regular finger pricking and insulin injections before meals when I could physically and socially manage, and was generally able to maintain HbA1c levels within my target range.

But I still had big spikes, they happen regardless of what you do or when you stray from the vigorous routine.

So I embarked on some research which brought me to Continuous Glucose Monitoring. There are several products available on the Australian market; but my preference is the model with

Vision oddities

Bob Johnson got in touch with our educators on the Diabetes WA Helpline to let us know an unusual symptom of hypoglycaemia that he is experiencing.

I always have a clock radio on the bedside table with green digits. I have noticed on the rare occasions that I have had a night time hypo, these green digits on my clock turn RED..!!

“I have had type 2 diabetes for approximately 20 years now and have been insulin-dependent for the past nine years. I want to share something that happens to me during the night when I experience a ‘hypo’ (hypoglycaemic episode).

Other than the other obvious hypo symptoms that appear at the time, this is the very first thing I do once awake, is look at my clock. I always wake up during the night if I have a hypo which I feel lucky about, as I know not everyone does.

the self-implanted sensor and a small reader. Not cheap but I thought I would try it.

Well the results are quite excellent, I am achieving the best HbA1c readings I have ever had. Plus a wealth of information such as daily average glucose readings, highs and lows within the range you set - and no finger pricking - you can take your readings every hour if you wish (or even more).

As I said not cheap but worth the initial cost if just to streamline your routine.

I hope with some pressure from Diabetes Australia and the NDSS that these machines will be subsidised by the government. It would take a great burden from diabetics and with better management, reduce future health problems and hospitalisations.”

Walter’s original letter has been altered to fit within space parameters.

Our Diabetes Educator says: Hypoglycaemia is known to affect vision, but everyone is different and may experience different warning signs.

It is great that Bob has learned what to recognise when he is having a hypo.

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: media@diabeteswa.com.au 28

Get Buff on a Budget

MOVING

well

Exercise doesn’t have to mean spending lots of money on fancy gym clothes and memberships. There are many free or inexpensive ways to get fit. For most of us that live a busy, sedentary life, any movement at ALL is better than sitting in our office, car, or bed (which probably takes up most of our lives).

Here are some great ways to exercise that are absolutely free.

Fitness apps and videos

Laps around your local oval

Swim laps at your local beach

There are lots of free apps you can download using your smartphone which explain a range of exercises you can do at home, often without equipment. You can also watch YouTube to physically see how to complete each exercise in practice.

Walking or jogging around your local sports oval is an easy way to add some cardio to your exercise routine. Use a stop watch to help track your progress and beat your personal best.

With each stroke you will engage most of the muscles in your body. It’s a refreshing way to work out outdoors.

Don’t forget to swim between the flags.

Meet some mates

Dogs are a great excuse to exercise.

To keep things exciting, try taking your dog to a new location each week.

Instead of meeting friends for drinks, meet at the local park for a game of soccer or a walk.

Use your legs Leave the car at home and walk or ride a bike to work. When catching the bus, get off a stop earlier.

Walk your dog

Enjoy a bushwalk Bushwalks are a fun way to exercise and tackling some hills is a great way to increase your fitness level. The paths are usually free and easy to access.

Getting the best gym deals Some gyms can be expensive but if you like the environment and go often enough they can be cost effective. It will take some shopping around to find a gym that suits you. But don’t sign up on the spot.

Look out for: New gym opening offers Cheaper rates if you pay cash upfront or each time you visit rather than direct debit No joining fee, or introductory offers such as getting the first month free Student/senior discounts

• • • •

Then decide what services you want from a gym: Services - Child minding, showers or group exercise classes?

Opening hours - Are they convenient or would you prefer a 24 hour gym?

Gender specific - Is it important that it is a women’s only gym?

Contract length - How long is the contract period and are you locked in?

Equipment - Is the equipment what you use and is it usually available?

• • • • •

Once you decide which gym to join always take the time to read the contract carefully before you sign it. There are often cancellation fees if you decide to end your membership early. You should also always check if there is a cooling off period.

Tips reproduced with permission from ASIC’s money saving website – moneysmart.gov.au

Exercise with the kids or grandies It’s a great idea to set kids a regular exercise routine. To keep things fun, grab a ball and kick it around in the backyard with the children after school. Or consider walking to the local shops instead of driving. Think about the area where you live and ways to engage your kids or grandkids in simple physical activities.

Group exercise can be cost effective Exercising in a group environment can increase motivation. You may feel inclined to exercise harder because of the supportive vibe.

Outdoor boot camps or group personal training You can train with friends and family to make it more enjoyable and the times and prices are often flexible. Generally you are not locked into a contract and are able to pay per session.

Sporting teams Joining a sporting team can make exercise fun and players feel valued.

Most local indoor sports centres and sport clubs are keen to get new members. Participation costs are often paid outright at the beginning of the season and can be much cheaper than a six-month gym membership.

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Barley & Broccoli Risotto Prep time: 10 mins (+ overnight soaking) Cook time: 35 mins

Serves 2 (as a main meal)

100g pearl barley (see Cook’s Tip) 2 tsp salt-reduced vegetable stock powder 2 tbsp olive oil 1 large leek, chopped 2 cloves garlic, crushed 1 cup basil leaves Juice of ½ lemon 60ml (¼ cup) water 1 bunch broccolini 30g parmesan, finely grated

Cook’s Tip

Pre-soaking the barley before cooking makes it quicker to cook and more digestible 1. Pour about 1L (4 cups) of cold water over the barley. Cover and leave to soak overnight.

2. Drain barley, reserve liquid and use it to make 500ml vegetable stock with the stock powder.

3. Heat half the oil in a medium non-stick frying pan. Add the leek and cook, stirring often, for 4-5 minutes or until it softens slightly. Remove half the leeks and transfer to a bowl. Add the barley and stock to the pan. Cover and bring to the boil. Reduce heat to medium-low and cook, covered, for 20 minutes.

4. Meanwhile, add the garlic, basil, lemon juice, water and remaining oil to the leeks in the bowl.

Use a stick blender to blitz to a paste.

5. When the barley has been cooking for 20 minutes, add the broccolini to the pan and cook for a further 5-10 minutes or until both are tender. Stir in the basil puree. Cook, stirring, for 1 minute or until warmed through (you don’t want to overheat it as the puree will lose its colour). Stir in the parmesan. Serve.

Nutrition Info

PER SERVE 2030kJ, protein 17g, total fat 25g (sat. fat 6g), carbs 39g, fibre 15g, sodium 258mg • Carb exchanges 2½ • GI estimate low

30

Gremolata-Crusted Salmon with Lentils & Spinach Prep time: 10 mins Cook time: 15 mins

Serves 2 (as a main meal)

2 cloves garlic, 1 left whole, 1 thinly sliced ¼ bunch flat-leaf parsley, roughly chopped, plus extra, to serve ½ lemon, zested, cut into 2 wedges 1 x 30g slice wholemeal sourdough bread Freshly ground black pepper 2 x 150g skinless and boneless salmon fillets 1 tsp olive oil 100g baby spinach leaves 400g can no-added-salt brown lentils, rinsed and drained 1 tbsp low-fat Greek-style natural yoghurt 1 tbsp horseradish cream 1 bunch broccolini, trimmed, steamed, to serve

1. Preheat oven to 180°C (fan-forced). Line a baking tray with baking paper.

2. Put the 1 whole garlic clove, parsley, lemon zest, bread and pepper in a small food processor. Cover and process until it forms into a crumb. Push the crumb on top of the salmon. Spray with cooking oil. Bake for 10-15 minutes or until the fish is just cooked through and the crumb is golden.

3. Meanwhile, heat the oil in a medium non-stick frying pan over low heat. Add the thinly sliced garlic and cook,

stirring, for 1-2 minutes or until the garlic softens.

Add the spinach and lentils. Increase heat to high and cook, stirring, for 2 minutes or until the spinach wilts and the lentils are heated through. Remove pan from the heat and stir in the yoghurt, horseradish and a little black pepper.

4. Divide the lentils between serving plates. Place the fish on top and sprinkle with extra parsley and lemon wedges. Serve with broccolini.

Nutrition Info

PER SERVE 2370kJ, protein 49g, total fat 24g (sat. fat 7g), carbs 32g, fibre 10g, sodium 371mg • Carb exchanges 2 • GI estimate low

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SHARED

pathways

Foot Health in Indigenous Communities Olufemi Oshin BEng MD FRCS, or “Dr Femi” as he is known to his patients, is a Senior Medical Practitioner of Vascular Surgery at Royal Perth Hospital. He is passionate about feet and feels that everybody has a role to play in diabetic foot health, including patients.

“Foot health is a very complex problem and personally I like a challenge,” Dr Femi says. “As a vascular surgeon, my skill base has traditionally been mainly about maximising blood flow to the foot, but as we have learned more about the effects of diabetes on the foot, I have realised that there is so much we do not know about foot care.”

Working within a team based at Royal Perth Hospital, comprised of several specialties including podiatry, vascular surgery, endocrinology and wound care, Dr Femi has recently taken a particular interest in Indigenous foot health in an effort to improve outcomes.

“A significant number of Indigenous Australians face major challenges to good foot health such as cost, living in remote communities, separation from family and isolation when they need to come to Perth for treatment,” he says. “Too often Indigenous people present to us in Perth with advanced problems with their feet and that frequently limits the options available to us, which can result in the amputation of a limb. This can have a devastating impact.”

Dr Femi points out that these same challenges are also present in the non-indigenous population, but when you take into account the cultural and health beliefs of some Indigenous patients, delivering the best care possible can be a very complex process.

The team at Royal Perth Hospital, who are the main referral centre for the Kimberley and the Pilbara, have developed links with community organisations such as Moorditj Djena, Diabetes WA, WA Country Health Service, Kimberley Aboriginal Medical Services, the Aboriginal Council of Western Australia and BOAB Health.

“Together I think we can really transform the way foot health is delivered in WA and perhaps even serve as an example for

32

how foot health can be improved for Indigenous patients all over Australia.”

Dr Femi has confidence that he and his “very skilled” team are getting better at saving limbs all the time. Ideally they would like to see patients with foot problems much sooner, in order to make a real difference. He believes developing a partnership with Indigenous communities, based on mutual trust and respect that is sensitive to the unique cultural issues of this population, is the key.

“Ultimately, everything we do as a team is about our patients,” Dr Femi says. “I have met some amazing people with foot problems throughout my journey as a healthcare professional and I have to confess that there is no better feeling for me than being part of a team that helps someone keep their leg and avoid a major amputation.”

He feels the process of building better service delivery to the Indigenous population will have wider benefits too. “Poor diabetic foot health is not an exclusive problem of Indigenous Australians. If we can get it right with Indigenous Australians, everybody wins.”

He also knows it is not solely about his team’s ability and sometimes there is only so much they can do to help. “I would certainly like to see more patient empowerment and education in foot health as part of the evolution of diabetic foot services in WA.”

EATING

well

Simple festive entertaining on a budget The holiday season is upon us. With it comes the hustle and bustle of Christmas shopping, family events and holiday entertaining. There’s no need to compromise on quality, flavour or abundance this Christmas if you’re on a budget and you want to keep your feast healthy as well.

The best get-togethers have fresh, yet delicious, food options that taste great and make you feel good after eating them.

That does mean physically good, but also means feeling good about the great choices you’ve made, and the fact you won’t send your blood glucose levels sky-rocketing. After all – the festive season is all about feeling good. Time with friends and family, making memories, and giving gifts to celebrate the reason for the season are all about feeling good, at the base of it.

There’s no question that Christmas is an expensive time of year and a lot of us will be looking for ways to save this season. Try these tips from taste.com.au for making your Christmas feast feel special without breaking the bank.

Work backwards Don’t pick what you want to have for Christmas lunch or dinner and plan from there. Start by determining your budget then work out what you’ll make and serve on the day. It is possible to make really great food even on the tightest budget; it just takes a bit more pre-planning, careful sourcing, and often a bit of creativity and thinking outside the square.

special meal with a bit of care. A leg of lamb on the barbecue is also delicious, goes far, and may be more affordable at your local butcher at this time of year.

Splash out on one big-ticket item Alternatively, buy that organic, glazed ham from the premium butcher or the sparkling fresh oysters and seafood from your city’s best fishmonger, and make that your centrepiece.

Starters, sides, and dessert can then all be chosen according to what is affordable or on special and your spread will still feel decadent. Think roast veggies, potato salad, couscous salad, green beans, homemade dips, and fresh fruit and ice cream or homemade trifle for dessert.

Go bargain hunting Consumers aren’t the only ones doing it a bit tough this year.

Sadly, some retailers are also struggling but this means there are plenty of specials around if you seek them out.

Shop around, both online and off, in advance and you’re likely to find big discounts on both the basics and those gourmet items that can quickly unbalance your budget.

Cut costs on drinks Alcohol is considered by most to be an essential part of the festivities but can easily spiral your budget out of control.

Plan ahead and look for discounted cases and specials and also make what you have go further with mixed drinks such as summery punches and sangria or mulled wine. Or go alcohol free and serve delicious mocktails.

Budget-friendly traditions

Take stock of your pantry

Traditional roasts, such as turkey or ham, can be extra pricey around the holidays. Even a roast chicken, with thoughtfully prepared sides and extras such as homemade sauces and stuffing, can still be turned into an excitingly

Many of us have pantries and cupboards stuffed with cans, bags and boxes languishing unused. Before you even begin planning your Christmas meal, work out what you already have that can be put to good use.

33

EATING

well

Special Guest – Recipes for the happily imperfect host If you are someone who prepares for guests by sweeping bills, laundry and newspapers behind sofa cushions, take heart! It’s possible to be an imperfect host, but happily so.

Annabel Crabb and Wendy Sharpe have released a gentle guide to turning easy basic fare into something of a celebration. You may have seen their book advertised on the ABC or in bookstores.

Their guide, Special Guest, is for when you want to say to your friends with their spouses and ten small children, ‘Why don’t you stay for lunch?’ without hating yourself afterwards.

Learn the lesson of ‘one splendid thing done well’ without regard to the hundred other things, and call the day a success.

Annabel Crabb is one of Australia’s most loved TV and media personalities. She is a Walkley-awardwinning political journalist and host of her own ABC TV shows The House and Kitchen Cabinet. Wendy Sharpe is Annabel’s oldest friend from preschool days and a recipe consultant on Kitchen Cabinet. She and Annabel have delivered countless meals and edible care packages to each other’s houses over the years.

Make either of these simple, yet delicious and healthy, recipes from Special Guest to delight your friends and family this festive season.

Images and recipes from Special Guest by Annabel Crabb and Wendy Sharpe, Murdoch Books, RRP $39.99. Photography: Rob Palmer

Annabel and Wendy reveal that hosting your friends is not about showing off; it is about delighting others. Your dining table might be decorated with a pile of unmatched socks and kids’ homework, but that’s no reason not to invite friends in for a chat, a sit-down and something delicious to eat.

As a special CHRISTMAS GIFT we have a copy of this gorgeous book to give away to a lucky winner, thanks to our friends at Murdoch Books.

To enter: Send your name, Diabetes WA membership number, postal address, email and contact number via post or email to:

By Post: Membership – ‘Special Guest’ Giveaway PO Box 1699 Subiaco WA 6904 By email: membership@diabeteswa.com.au Entries close 1 March 2019.

34

Fresh corn polenta with baked eggs & smoky tomatoes Serves: 6

Ingredients

10 roma (plum) tomatoes 2 tbsp store-bought chipotle sauce (see below right*) A generous pinch of salt and pepper 1 tbsp caster sugar butter, for greasing and dotting 6 eggs Basil leaves, to garnish Sourdough toast, to serve Fresh Corn Polenta 6 ears sweetcorn (as yellow as you can find), kernels sliced from cobs 50g butter 200g reduced-fat feta, crumbled 3 spring onions, thinly sliced

Nutrition Information per serve Energy Protein Fat, total — saturated Carbohydrate Sugar Dietary Fibre Sodium

1716 kJ 19 g 18 g 7.6 g 41 g 14 g 9g 684 mg

EATING

Annabel & Wendy say: “This is designed to be prepared the night before, when you’ve got time for pottering, stirring and slowroasting. Note that the tomatoes are three hours in the oven!

If you have an oven timer, you can set it and go to bed, then all you need do in the morning is assemble and bake. And if you have left-over polenta, spread it on toast for lunch.”

well

Fresh corn polenta with baked eggs & smoky tomatoes

Method

1. Preheat your oven to 120°C (100°C fan) and line a baking tray with baking paper.

2. Cut the tomatoes in half lengthways and lay on the baking tray, cut sides up. Mix the chipotle sauce with the salt, pepper and sugar and smear it over the tomatoes, then slow-roast in the oven for 3 hours or until sticky and slightly collapsed.

3. Next, the polenta. Stick the corn kernels in a heavy-based pan with the butter and 500 ml (2 cups) water and simmer for 15 minutes or until tender. Strain off the cooking liquid and reserve, then tip the kernels into a food processor and blitz for about 5 minutes until you have a smooth purée, adding some of the cooking liquid if needed. Return the whizzed-up corn and its cooking liquid to the pan and cook, stirring constantly, until the liquid evaporates and you have a thick paste. Just like polenta! Stir in the feta, and pepper to taste.

4. If not serving straight away, refrigerate the tomatoes and polenta overnight.

5. When you’re good to go, preheat the oven to 200°C (180°C fan). Stir the spring onions into the polenta, then divide between six buttered ramekins (if you don’t have ramekins, just put all the polenta into a buttered casserole dish). Make six deep indentations in the polenta, crack an egg into each one and dot with butter. Bake for 10–15 minutes or until the egg whites have set but the yolks are still soft. Scatter with basil and serve with toast and a couple of tomatoes on the side. *HOT STUFF: I use the sauce from a tin of chipotle peppers in adobo; if you’re using bottled chipotle sauce, test for head-blowing-offness first and adjust the quantity if necessary.

35

EATING

Annabel & Wendy say: “A quick, piquant seafood dish using the prawns you have strategically lodged in your freezer for exactly such an occasion. I know that seafood al forno doesn’t exactly scream ‘scratch lunch’, but truly, this thing really can be assembled in ten minutes.

The sauce gets its heat from garlic and chilli and its sharpness from lemon.

The recipe will serve two generously for lunch – scale up if you have more guests.”

Prawn saganaki Serves: 2

Ingredients

12 frozen raw prawns, peeled but with tails left on 1 tbsp olive oil, plus extra for drizzling 1 garlic clove, finely chopped 1 anchovy fillet, roughly chopped Large pinch of chilli flakes 1 x 400g tin of tomatoes 1 tbsp tomato paste (concentrated purée) Juice of ½ lemon 75g reduced-fat feta Basil leaves, to garnish

36

Prawn Saganaki

well

Nutrition Information per serve Energy Protein Fat, total — saturated Carbohydrate Sugar Dietary Fibre Sodium

Method

1591 kJ 26 g 17 g 5.5 g 30 g 3g 6g 694 mg

1. Preheat your grill to medium.

2. To speed-defrost your prawns, separate them out, zip them into a snap-lock bag and immerse the bag in a sink full of lukewarm water.

3. While that’s happening, place a small, oven-proof frying pan over low–medium heat and add the oil. Sauté the garlic, anchovy and chilli flakes until the anchovy disintegrates. Add the tomatoes, squishing them with your wooden spoon. Add the tomato paste and lemon juice and cook down until the sauce has lost its wateriness.

Season with pepper.

4. Okay – now it’s time for the big finish. Poke your defrosted prawns into the sauce so they’re mostly submerged. Crumble the feta over the top and drizzle with a little extra olive oil. Place under the grill and cook until everything’s bubbling, the feta has browned, and the prawns have gone pink in their tomato bath. This should take about 10 minutes.

5. Garnish with basil leaves.

Diabetes WA

MEMBERS

Summer Sudoku Fill in the grid with numbers so that every row, every column includes the numbers 1-9, without repeating any.

3

area

1

5

The solution can be found below

4

6

5 9 6 2 8 3 6 8 3 1 4 9 5 9 3 4 5 9 2

3 9 2 7 5 8 1 4 6

6 5 8 1 4 3 2 9 7

7 1 4 2 9 6 8 3 5

8 7 5 6 3 4 9 2 1

1 4 3 5 2 9 6 7 8

2 6 9 8 7 1 3 5 4

4 2 1 3 6 7 5 8 9

5 8 7 9 1 2 4 6 3

9 3 6 4 8 5 7 1 2

Summer

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To enter, complete the competition slip below and mail to: Membership – The Joyful 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 March 2019.

37

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39

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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.

2018-210

If you would like to know more, please call the bequest team on 1300 001 880 or email bequests@diabeteswa.com.au