Diabetes Matters Autumn 2018 by Diabetes WA

Autumn 2018 $6.95

Alcohol and Diabetes

Weekly Meal Plan

Gourmet Diabetes Eating Out Tips

Have Your Cake And Eat It Too

NEWS • RECIPES • RESEARCH • PEOPLE • EVENTS • FITNESS

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tender, zesty, mouth-watering. moist, gooey, crispy, creamy, velvety, s and prett y useful when it comes All prett y fabulous descriptive word to food, right? kilojoules, glucose, bolus, hypo, Now try BGL, insulin, carbohydrate, l in, sugar, sodium. Also prett y usefu glycaemic index, saturated fat, prote fun. so quite words when it comes to food, but not be fun… and fabulous and se, cour of can, But dining with diabetes delec table, gooey and gourmet. gh on the magazine and it came throu We recently asked for your feedback ming whel over about food was the loud and clear… FOOD! Information d like to see more of in your woul you what to came it request when magazine. So we have addressed it. discuss some of the things you need In this Gourmet Diabetes feature we debate for people living with to think about in the never-ending food how to decipher them (page 14). and diabetes. We talk about food labels to promoting their products and oach appr their Marketers can be tricky in work out what is best for you when it is useful to know the best way to ket shelves. Obviously the best choosing your food from the supermar food labels. need stuff – the fresh fruit and veg – don’t that you can follow if you are needing We also include a weekly meal plan week off from planning your meals some guidance and want to take the compiled 13 recipes and other have (page 16). Thanks to LiveLighter, we a balanced meal plan that is meal suggestions to provide you with yone is different, so make sure you diabetes-friendly. Remember that ever ensure it suits you. assess your own circumstances to for that too! If you love dining out – we’ve got tips ack and ideas. This is YOUR magazine Thank you once again for your feedb to what you want to be reading ant relev and we want to make sure it is y’ with advances in diabetes technolog about. (FYI – ‘Being kept up to date for 22 page see – t abou s to read was a close second on your list of thing ). arch rese t the lates Enjoy,

Natash a

AUTUMN 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 Diabetes Meals Online, Sherl Westlund, Alison Climie-Holmes, Treva Anderson, Verity Charles, Kaarin Patterson, Anne Finch, LiveLighter, GI Symbol Foundation, Murdoch Books Photography DWA staff, magazine contributors, Shutterstock, LiveLighter, Murdoch Books Design Brigitte James Print Quality Press Diabetes WA www.diabeteswa.com.au Diabetes Information and Advice Line: 1300 001 880 Email: info@diabeteswa.com.au

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

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

Diabetes News Evaluation Framework Celebrated .........................................6 Across Cultures .............................................................................7 FIFO Life ........................................................................................... 7 HBF Run for a Reason ................................................................. 8

Gourmet Diabetes Here’s Cheers ...............................................................................10 Tips for Eating Out ......................................................................12 Food Labels ..................................................................................14 Shop Smarter ...............................................................................15 Weekly Meal Plan ........................................................................16 Recipes Recipes Recipes ..........................................................17

Education Planner Plan Your Sessions .....................................................................20

Research News Research Round-up ....................................................................22 Diabetes Research WA Update ...............................................23

In the Community Quiz Master Tribute ....................................................................24 Diabetes Meals Online ...............................................................25 Q&A ..................................................................................................26

Shared Pathways Rural and Remote Supply ........................................................27

Living Well Feeling Overwhelmed ...............................................................28

Moving Well Incidental Exercise ......................................................................30

Eating Well Breakfast and Lunch Recipes .................................................32 Have your Cake and Eat It ........................................................34

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

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

Meet Our Team

From the Chair Welcome to 2018. With our previous issue, we invited you to give us your feedback on this magazine and your membership with Diabetes WA. We were pleased to receive many responses. Your opinions are valuable and they included praise, constructive criticism and some great ideas for topics that you would like to read more about.

Dr Moira Watson

From your feedback, we learned that the greatest support many of you are seeking is with managing the daily challenges that living with a chronic condition presents. Amongst other things, you asked for more tips on healthy eating, a weekly meal plan, a list of foods to avoid, advice on the glycaemic index of foods, supermarket tips, exercise ideas, information about education opportunities, and updates on new research and technology that might ‘cure’ diabetes, or make managing it just that bit easier. We also learned that you want to hear from your own community. Knowing that there are others out there experiencing what you are experiencing and dealing with the same challenges you face can be reassuring. Reading about how they are conquering these challenges, in real life circumstances, may just be the boost needed to try a new approach, program or recipe. This “Gourmet” edition of Diabetes Matters will hopefully provide some of the information you may be seeking. You also provided feedback on your Diabetes WA membership. Many of you value the advice and support you receive from the team here, and appreciate being kept up-to-date on the latest developments, receiving discounts on products and knowing there are people out there trying to make a change. A membership with Diabetes WA not only gives you access to this magazine and product discounts, but also provides offers from our member benefits partners and free and discounted education workshops, programs and seminars. Visit our website to make sure you are making the most of your membership. In some exciting news for the organisation, and in another step to ensure we are reaching those living in our regions, Diabetes WA has just signed a contract with the WA Department of Health to pilot the ‘Let’s Prevent’ program in the Greater Bunbury region. This two-year contract is the result of our longterm engagement with both sides of government through the Diabetes WA Parliamentary Diabetes Support Group. The ‘Let’s Prevent’ program is part of the DESMOND family of health education programs, designed to help people who are at risk of diabetes and cardiovascular disease, putting the person at the centre of their own care. A project manager has been appointed and work is underway on the early stages of the program. We invite you to continue speaking to us. Diabetes is a community issue and it is important that we all work together to beat this chronic condition. Being informed + feeling supported are essential in managing life with diabetes, and we want to ensure that Diabetes WA is a valuable part of that equation. Until next time… Dr Moira Watson Diabetes WA Board Chair

•

The articles in Diabetes Matters are informed by the wealth of knowledge that we are fortunate to have access to within our organisation. Below are some of the talented DWA individuals that have contributed to this edition.

Paul Powell Warehouse Coordinator Paul is responsible for managing all of our diabetes products and NDSS resources and then ensuring orders are filled and delivered from DWA’s Belmont warehouse. He joined the organisation in October last year, coming to Australia from the UK 6.5 years ago. Paul is a crucial part of our rural and remote supply product scheme. (see page 27)

Alison Climie-Holmes Accredited Practising Dietitian Alison created our weekly meal plan and article on discretionary foods. She has 20+ years of experience working with children, adolescents and adults, particularly in the area of diabetes. With a Bachelor of Science (Hons) in Nutrition and Dietetics, Alison has worked in clinical, community and private settings in both the UK and Australia. Alison now consults for Diabetes WA when needed. (see pages 16 and 34)

Julie Day Julie is Diabetes WA’s Customer Service Manager, based at our Belmont office. She joined the organisation eight months ago and brings with her a breadth of experience in customer service within the finance and health industries. She is responsible for managing our team of customer support service officers and the call centre. 3

perspective

Education and Empowerment General Practitioner Dr Alan Wright believes that all members of the community need to be involved with the management and prevention of diabetes, not only those diagnosed with the condition. A Diabetes WA board member for six years, Alan has a special interest in the biopsychosocial impact of diabetes on individuals and communities and believes there is no one-size-fits-all approach to treatment and support. Below he gives us his perspective. The most common type of diabetes in the community is type 2 and the most common presentation is an elevated blood sugar or HbA1c on routine testing. Usually the person has not been unwell, but suddenly he or she has become a person with a condition that has the potential to reduce their life expectancy and possibly their quality of life. Though some people do have warning signs, for many, this news is unexpected.

While a diagnosis of type 1 diabetes often means hospitalisation or referral to a specialist, when a patient is diagnosed with type 2 diabetes, my first referral is always to an education program such as DESMOND. Here the person will have access to a diabetes educator and obtain information about other allied health support systems. With this in place I will also refer to a podiatrist and an optometrist/ophthalmologist.

Overcoming obstacles

To some in the health industry they have now become a ‘patient’, but we in the industry should not forget that when the ‘patient’ is not in our clinic, they are a person, with a family, friends, commitments. They worry about those responsibilities. What impact will this newly discovered condition have on the people in their lives? Is it going to affect their ability to do their job, so that they can meet any monetary commitments needed to maintain their current lifestyle? These are questions we need to address early and reassure the individuals that, in many ways, with a few changes in lifestyle, it can be business as usual.

There are obstacles to overcome in the management of diabetes - by health professionals, patients and the health system as a whole. Perhaps the biggest obstacle is the lack of resources to prevent it from happening in the first place, particularly in the case of type 2 diabetes.

With a diagnosis of type 1 diabetes, often detected in childhood, the person is usually unwell and hospitalisation is frequently the result. This diagnosis and the complexity of management can be quite challenging for the person and their family and friends.

Diabetes, regardless of the type, is becoming increasingly more common and many people with type 2 diabetes still remain undiagnosed and untreated. This impacts our community and the sooner we address the obstacles that stand in the way of management and prevention of the condition, the more effective our health system will be.

Managing diabetes Once diagnosed, it is important to encourage people to actively participate in the management of their condition and to understand what it means personally. There are changes in lifestyle, new medications to consider, regular health checks to schedule, and all this on top of their normal routine. The key to managing diabetes is to be involved and make informed choices. I believe the keys to becoming engaged effectively are education and empowerment. As I often tell my patients with diabetes, I am there to support them to achieve their goals in managing diabetes. People are all different and therefore a ‘one-size-fits-all’ approach doesn’t always work. For example, GPs have guidelines for the management of diabetes of every type. 4

We need to remember that they are guidelines, not a recipe. People have different influences in their life such as cultural, social and financial circumstances, accessibility to health services, different treatment regimes and health beliefs. Therefore, management of diabetes, including goals and targets must be approached through consultation with the individual and must remain fluid throughout the life journey of the person.

Accessibility to those resources that do exist is also a significant obstacle for some, and addressing this is the responsibility of all involved in diabetes care. A large proportion of the population don’t have timely access to allied health and specialist services or medication due to economics, geography or age.

Dr Alan Wright is a GP and is involved in GP education, particularly in the area of diabetes, men’s health and obstructive respiratory disease. He has served on a variety of boards, including the Advisory Board of Andrology Australia, and the Board of Asthma WA. He has been a Diabetes WA board member since 2012.

WHO’S IN

the drivers seat

Your Choice In this new regular segment of the magazine, we explore ways in which you can live well with diabetes. The greater your confidence, the more likely you are to adopt a behaviour or attitude; to try something new or to make an informed decision and undertake a course of action. “Instead of taking control of a person’s health and telling them what to do, it has been shown that increasing their confidence and equipping them with the tools they need to manage their own health ensures they embrace their own informed choices, which in turn encourages sustainable change”, Diabetes WA’s Health Operations Manager Sophie McGough says. By taking ownership of diabetes management, you can become empowered to find solutions to your own health issues and choose how you wish to best manage them.

When you’re next visiting your GP, speak to him/her about drawing up an Annual Cycle of Care. When it comes to finding ongoing support, it is a good idea for your initial focus to be on self-education. Become informed, understand your condition and learn how to better manage it. Diabetes WA’s programs are focused on empowering people by equipping them with the knowledge, skills and confidence to manage and live well with diabetes. The abbreviation of the DESMOND program stands for ‘Diabetes Education and SelfManagement for Ongoing and Newly

Your Annual Cycle of Care can include information on: • blood glucose levels (BGLs) and target ranges • BMI and weight • HbA1c and target ranges • blood pressure and cholesterol and their target ranges • eye and foot health • current diet and future healthy eating goals • current physical activity levels and future goals • smoking status and plans for quitting (if you smoke).

Analysis has shown that on average, you only spend eight hours a year at your GP. So how do you ensure you get the most out of the time you do spend in the GP office? And where can you get ongoing support to manage your condition? The Annual Cycle of Care is a tool designed to help you and your healthcare team keep your diabetes care on track. Developed between you and your doctor, the Annual Cycle of Care is a document that gives details of your diabetes management strategies, goals and targets. It also serves as a reminder as to when you are due for important tests, such as eye tests or kidney function tests. Diabetes changes over time, so what helps you manage diabetes today may not be as effective next year. Regularly revisiting your Annual Cycle of Care 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.

Diagnosed’, with education and selfmanagement being the key words. It is a free workshop designed to support people living with type 2 diabetes. The program is intended to provide you with a non-judgemental space where you can plan how you would like to manage your diabetes. It is based on a philosophy of personcentred education that establishes individual needs and responds to and adapts to the preferences, needs and values of all people in the group.

Inserted into the middle of the magazine, you will find a booking form that you can use to sign up or register for any of our education programs and workshops. We encourage you to use it to learn more about your diabetes and take the first step in finding out how you can make a difference to your own health. 5

DIABETES

news

Evaluation framework receives international attention Natasha Watson, Diabetes WA’s Research and Evaluation Manager, recently represented the National Diabetes Services Scheme (NDSS) at the International Diabetes Federation Congress in Abu Dhabi. She was invited by conference organisers to present a poster on the NDSS National Evaluation Framework, which measures the quality and outcomes of NDSS programs delivered nationally throughout Australia including DESMOND and the SMART series. “For the first time, we are measuring the impact of all NDSS self-management diabetes education programs in a structured and systematic way across Australia,” Natasha explained. Natasha with her NDSS Evaluation Framework poster

Natasha with fellow conference delegates 6

Diabetes Australia has contracted Diabetes WA to produce the NDSS National Evaluation Framework. The framework measures significant and tangible education outcomes, including how empowered participants become to manage their diabetes, and whether they are feeling less diabetes-specific distress following participation in a program. The conference attracted over 5000 people from 152 countries. A number of representatives from other countries expressed a strong interest in learning from Australia’s achievement of a National Evaluation Framework, including Denmark, the Netherlands, Korea and South Africa. Many commented on the magnitude of such a feat, in achieving consensus in evaluation tools and processes. Well done Natasha!

DIABETES

news

Across Cultures

Participants at one of the workshops

FIFO Life Jennifer being interviewed

Thank you

Diabetes doesn’t discriminate, affecting all cultures and walks of life. Language barriers can prove challenging for people from different cultural backgrounds living with diabetes in Australia, limiting access to essential information about how to manage their condition. To help overcome these barriers Diabetes WA, in conjunction with the Multicultural Services Centre, conducted eight diabetes information sessions in February for 194 attendees from Italian, Macedonian, Vietnamese, Burmese, Indian, Serbian and Chinese backgrounds. Interpreters were on hand to translate our educators’ explanations of how diabetes affects the body and how to live well with the condition.

Jennifer Sweeting, our Pilbara Diabetes Management Strategy Coordinator, is dazzling FIFO radio audiences on Red FM’s “FIFO Life” program. Every fortnight Jenn features on the program, discussing diabetes-related topics, including diabetes signs and symptoms, myth-busting common misconceptions about diabetes, and the significance of diabetes and mental health. If you’re in the Pilbara, listen out for Jenn’s dulcet tones coming through your airwaves.

Thank you to those that donated to our Christmas Appeal in 2017. Without the support of our community, we cannot continue the work we do. Thank you for your generosity. 7

DIABETES

news

This year is YOUR year! Join us at the HBF Run for a Reason

The HBF Run for a Reason will take place on Sunday, 27 May 2018. Time to get those running shoes out and start training! Registrations are now open so start fundraising to show your support for Diabetes WA. How to Take Part 1. Visit Us: Go to the Diabetes WA website and click on the banner to register and start your fundraising page 2. How Far Can You Go?: Choose your event course and sign up, then follow the prompts and emails to set up your fundraising page 3. Gather Your Crew: Invite your family and friends to join you! 4. Get Busy Sharing: Talk to everyone you know and ask them to support you. Share your page on social media. Hold a fundraising BBQ or morning tea. Introduce a free-dress day at work for a gold coin donation.

Feel like you can’t walk or run in the event this year? You can help in other ways! We need volunteers to run the DWA water station located along the course on the day. To ﬁnd out more visit diabeteswa.com.au

Choose your course:

4km, 12km or half marathon. Last year our generous fundraisers raised an incredible $40,742 for Diabetes WA. This year we have set ourselves the goal of $50,000! We can do it together!

If you’re not planning to fundraise yourself, jump onto our page and support someone who is!

HBF Run For A Reason Sunday 27 May 2018

Last year Carly Pink-O’Sullivan raised $7,340 for Diabetes WA with her 12km run as part of her campaign to raise awareness about the difference between type 1 and type 2 diabetes and share the realities of the condition. “Having type 1 diabetes shouldn’t stop you from leading a healthy and active lifestyle. It’s been hard, but diabetes has changed my life for the better. Now I’m working towards a career as a diabetes educator”.

DIABETES

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Our Ambassadors Verity Charles – Centre for the West Coast Fever netball team type 1 diabetes

Verity Charles is living proof that people with type 1 diabetes can achieve their dreams. Verity is one of netball’s most dynamic mid-courters and plays centre for the West Coast Fever. Diagnosed with type 1 diabetes when she was 17 years old, Verity tests her blood glucose several times per day, including before and after every game, and administers insulin by injection. Originally from Grafton, NSW, Verity was living with a friend’s grandparents in Sydney when she was diagnosed.

She was constantly thirsty, but had assumed it was because of all the netball training she was doing. “It was a total shock, because none of my family have diabetes, and I didn’t know anyone with diabetes. My first two questions to the doctor were about whether I could still play netball, and whether I could still eat chocolate,” Verity recalls. Being an elite sportsperson with diabetes means that Verity needs to be more careful with her diet, and keep firm control of her blood glucose levels in training, particularly just before a game. She doesn’t use an insulin pump because she can’t wear one on court, but her teammates have all been taught how they can help Verity if she has a “hypo” on the court.

“I decided to become an ambassador for Diabetes WA because I want to give a bit back. I would love to inspire even one young girl with diabetes who wants to be an athlete, or help one mother whose child has been diagnosed.”

“I need to be a lot more careful about dehydration, and I’ve noticed that things like simple infections seem to affect me more than most people. There’s a lot more to having diabetes than just eating a few jellybeans here and there!”

Kaarin Patterson – A keen runner with the Perth Running Club type 2 diabetes

and taught me more about the right fuels and management for high activity. Running my first half marathon two years ago, (even though I came third last!) was the biggest victory for me in proving to myself that despite my diabetes, I really can do anything”

Kaarin says: “I was diagnosed with type 2 diabetes 12 years ago. While a part of me was relieved to finally have an answer as to why I’d been feeling so terrible for so long, mostly I was utterly terrified. Terrified of what it meant for my life, my health and the future. So I started gathering as much information

as I could. As I started to understand what diabetes was, I decided that I was going to control my condition, I wasn’t going to let it control me. I’ve always been pretty active since my diagnosis, but learning to run was a game changer for me. It gave me an even greater respect for my condition

“I’m running for Diabetes WA to raise awareness and money for research to find a cure - not just for myself, but for my sister, my friends, my friends’ kids and for all of us out there with diabetes.”

Kaarin is pairing up with Sarah Jamieson - Head Coach of the Perth Running Club and a triple Olympian, Commonwealth Games silver medallist and current Australian record holder over 1500m. They will be holding FREE training sessions in March and April for anyone who registers on the Diabetes WA fundraising page and raises funds for DWA during the HBF Run for a Reason. To find out more visit our website.

Visit our website to register and start fundraising. diabeteswa.com.au Look for the banner on our home page. 9

GOURMET

diabetes

Here’s Cheers: Alcohol and Diabetes While there is a connection between diabetes and alcohol, there is no reason why people with diabetes must give up alcohol completely. Alcohol does affect blood glucose levels and contains a lot of kilojoules, but with a few precautions and careful management, it is possible for people living with diabetes to enjoy a couple of drinks from time to time. Alcohol affects different people in different ways, regardless of their health conditions. It has a confusing effect on the body. Moderate amounts of alcohol may cause a spike in blood glucose levels, but on the other hand, drinking too much alcohol can cause your blood glucose levels to drop too low. Alcoholic drinks can be quite high in sugar which can raise your blood glucose level. Some beers, ales and ciders have more carbohydrates than spirits and dry wines. If you like mixed drinks, you could choose to try diet mixers or soda water. It’s always a good idea to eat something along with your drinks, or beforehand, to compensate for the expected drop in blood glucose levels and carry some quick-acting carbohydrate with you (like jellybeans) just in case you experience a hypo. For people using insulin or certain types of diabetes medication, hypoglycaemia (blood glucose levels less than 4 mmol/L) is a risk with alcohol consumption.

How is alcohol processed in the body? The body treats alcohol as a drug, not as a food product. When you drink any type of alcoholic beverage, your liver starts working to “detoxify” the body of this “poison”. Essentially, the liver has to break down the alcohol into less harmful substances. This takes, on average, about two hours. While the liver is efficient, it can only do so much at one time. And handling alcohol is its 10

number one priority. So, this means that while your liver is busy managing the effects of that glass of chardy, it may not pick up on the fact that your blood glucose levels are starting to drop and release glucose to prevent it going too low as it normally would. This effect can last for many hours after you drink.

Drunk and disorderly Alcohol may also mask the symptoms of hypoglycaemia, meaning you and others around you may not realise you are having a hypoglycaemic event. Hypoglycaemia’s symptoms can be particularly dangerous when you’re drinking because people can mistakenly think that you’re drunk and may not realise you need urgent medical help. Slurring, confusion and abnormal behaviour are often signs of drinking too much. Many people, young adults in particular, have stories of being mistreated by others or the police, thinking they were acting drunk and disorderly when in fact they were having a hypo. In order to avoid hypoglycaemia, you may wish to monitor your blood glucose levels more frequently when drinking. Keep in mind, the risk of hypoglycaemia could also increase the morning after you’ve slept following heavy drinking.

Long-term effects Drinking excessively can contribute to weight gain as alcohol is high in kilojoules, and hence increase your risk of diabetes-related complications

and other health conditions. One standard drink of alcohol provides the same kilojoules as a small steak! One pint of beer can be equivalent to a slice of pizza. Additionally, if you have nerve damage as a result of diabetes, drinking alcohol can make it worse and increase the pain, tingling, numbness and other symptoms. If you are uncertain about other alcohol choices, talk to your GP, diabetes educator or dietitian about drinking alcohol safely. For more information: An NDSS Fact Sheet on alcohol can be found on the Diabetes WA website under Manage your Diabetes/Resources.

GOURMET

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A handy list of do’s and don’ts when enjoying a drink 1.

Know your limits and remember your standard drink sizes.

2. Never drink on an empty stomach or when your blood glucose is low. It’s best to drink with your meal or right after it. This is especially important for those on insulin and/or medication. 3. Do not replace food with alcohol in your regular meal plan. Especially if you use carbohydrate counting to plan meals, do not count alcohol in your plan as a carbohydrate choice. 4. Drink slowly. Allow your body to break-down each drink so it can better cope with the intake. 5. If you are hitting the pub with some friends, wear a medical bracelet that says you have diabetes. This simple step could save your life in case of an emergency.

Moderation is the key! Guidelines for alcohol consumption are the same for people with diabetes as they are for the general population. Try not to have more than two standard drinks per day for both men and women, while having regular alcohol-free days. A standard drink contains 10g of alcohol. It’s important to know what a standard drink is for different types of alcohol so you can monitor your intake. When in doubt, test your blood glucose to see how alcohol affects you. It’s easy to over-estimate when pouring a standard drink, so it’s a good idea to:

• check the number of standard drinks on the label of the bottle/can

• measure out a standard drink into a

glass, so you know what it looks like

• be aware that many wine glasses can hold two or more standard drinks.

6. Follow every drink with a glass of water to stay hydrated. 7.

Don’t add sweet mixers to your spirits. Choose plain water or soda water instead.

8. Limit your intake to 2 drinks to play it safe. 9.

Monitor your blood glucose levels a little more closely than you may otherwise.

10. Make healthy food choices whilst drinking. Don’t let your reduced inhibitions alter your decision-making. Swap the chips and pizza for some nuts or cheese to snack on while you enjoy your drink. 11

GOURMET

diabetes

Tips for Eating Out Having diabetes should not limit your enjoyment of eating out. There are a number of ways you can manage your diabetes if you tend to eat out on a regular basis. Here we provide some healthy options for you to choose from. Vietnamese

Asian Meals

• Pho soup

Asian meals offer a great variety of healthy options – you just need to be smart with your menu choices. There are three steps to healthy balanced menu choices:

• Fresh rice paper rolls filled with prawns, chicken or tofu

• Smart Carbs: choose low GI rice (avoid Jasmine rice), sushi, noodles or dahl

• Fresh salads with rice noodles

• Add some protein for fullness – marinated tofu, stir fry beef or chicken, steamed seafood or fish, tandoori chicken or sashimi

• Stir fried beef, chicken with vegetables

• Fill your plate with vegies (at least half your plate)

• Steamed fish or seafood

• Clay-pot dishes with eggplant or fish

• Stew or meat braised dishes

Chinese

Thai

• Clear soups with wontons and vegetables

• Tom yum soup

• Steamed dumplings • Stir fry chicken or beef with a sauce based on soy, ginger, garlic or chilli • Seafood dish such as whole steamed fish or stir fried prawns or scallops • Stir-fried or steamed green vegies • Smaller serves of steamed or boiled rice and fresh rice noodles

• Noodles in soups rather than fried pad thai–style noodles • Thai salads or stir fried vegetables • Seafood and vegetable braised dishes • Stir fried combinations of tofu, seafood, meat, chicken or pork with nuts, vegetables and sauce (avoid coconut milk based curries)

Indian • Tikka or Tandoori based chicken, fish or seafood • Beef, chicken, seafood curries • Vegetable-based curries with chickpeas (channa) or cottage cheese (paneer), fresh salads and side dishes such as cucumber raita, pickles • Dahl – a great low GI side dish • Basmati rice – make sure you keep to ¼ of your plate and fill up with vegies

Japanese • Sushi with seafood, chicken or vegetables • Sashimi • Miso or Ramen soup • Teriyaki or Teppanyaki style meats or seafood • Shabu shabu (slices of beef cooked quickly in broth with vegetables) • Sides such as seaweed salad or edamame (young green soy beans) 12

GOURMET

Mexican & Spanish Mexican and Spanish meals based on fresh seafood and grilled meats and salads offer lots of healthy alternatives. Avoid loads of cheese and sour cream. • Bean and salsa dips • Black bean or gazpacho soup • Freshly cooked seafood or fish • Enchiladas (corn tortilla filled with meat, chicken or beans) • Burritos (filled flour tortillas) and fajitas • Salad based dishes • Seafood paella

Italian Pasta cooked al-dente is low GI – just be careful of serve size. Often an entrée serve of pasta will be sufficient. Avoid creamy sauces and lots of cheese and stick to tomato or vegetable based sauces. Load up on fresh salad and avoid deep fried and crumbed seafood and meats.

The Elusive Glycaemic Index Carbohydrate is an essential part of our diets, but not all carbohydrate foods are equal. The Glycaemic Index (GI) is a relative ranking of carbohydrate in foods according to how they affect blood glucose levels. Carbohydrates with a low GI value (55 or less) are more slowly digested, absorbed and metabolised and cause a lower and slower rise in blood glucose and, therefore (usually), insulin levels. Studies around the world show that following a low GI diet significantly helps people with diabetes improve their blood glucose levels. There is

• Improve blood glucose levels by reducing blood glucose spikes. • Reduce insulin resistance.

• BBQ or marinated seafood dishes

• Improve markers of average blood glucose levels (HbA1c).

• Entrée-sized pasta with tomato (Napolitana), bean (fagoli) or seafood (marinara) sauce, without cream • Cannelloni with ricotta and spinach • Roast or chargrilled fillet of beef, lamb loin or poultry • Garden salad with olive oil and balsamic vinegar • Caprice salad with tomato, basil and fresh mozzarella

significant evidence that low GI diets not only decrease the risk of developing type 2 diabetes but also assist in improving the management of diabetes.

Low GI Diets have been shown to:

• Minestrone soup • Grilled seafood or fish

diabetes

• Improve blood cholesterol levels, particularly LDL cholesterol. • Increase feelings of fullness after eating and reduce hunger between meals. • Increase the rate of weight loss, reduce waist circumference. • Help prevent weight regain over the longer term.

These are all important for managing diabetes and reducing the risk of long-term diabetes-related complications. The good news is that the nutritional recommendations for people with diabetes are similar to the healthy eating recommendations for the general public, so there is no need to prepare separate meals or buy special foods. This helps make healthy eating easier and more inclusive, as friends and families can enjoy the same healthy and delicious meals together.

• Vegetarian pizza • Gelato, sorbet or fresh fruit

Reproduced with permission: GI Symbol Foundation: www.gisymbol.com

GOURMET

diabetes

Deciphering Food Labels Don’t rely on “health” claims on food packaging and labels as your guide. Instead learn a few simple label reading tips to choose healthy foods and drinks from the supermarket shelves. Packaging of foods is based on marketing to maximise sales. Those creating the packages are doing their best to ensure their product is the most visually appealing choice on the shelf. This often means they will do anything, including making misleading claims about the health of their food, to sell more product. Food labels can be very confusing and tricky to understand. Often we don’t have the time to spend trying to work out what they mean and how to use them. Words such as ‘light’, ‘lite’, ‘lower

fat’, ‘reduced’, and even ‘organic’ can all mean slightly different things. For example, using the word ‘light’ on a product can be a description of the colour of the product, (i.e. light brown sugar) not that it is necessarily lighter in kilojoules. However, a few quick tips can make shopping for healthy food a whole lot easier and quicker. By learning the basics and knowing what nutrition information to look for, you can make the best choice for your health and avoid unnecessary saturated

fat, added salt, added sugars and kilojoules. Labels on most packaged food must meet strict requirements that include information for people with food allergies, food additive listings and food storage instructions. Avoid the pretty colours and fancy words on the front of the package and check out the nutrition panel, usually located on the side or the back of the product, for the most reliable and accurate information.

Image Source: eatforhealth.gov.au

GOURMET

diabetes

SUPER CARD KEY ≤ less than or equal to

≥ greater than or equal to

VEGETABLES & LEGUMES Per 100g

FAT - total

Fresh, frozen & dried

No added fat

Canned

≤ 5g

Frozen chips, wedges & fries

≤ 5g

Legumes

No added fat

Aim for at least 5 serves each day 1 serve = 1/2 cup of cooked vegies OR 1 cup of salad.

FRUIT Per 100g

FAT - total

Fresh, frozen, dried & canned

Shop Smarter Have you ever gotten to the checkout counter in the supermarket and the last thing you see is a wall of chocolate and soft drink? This isn’t by accident. Companies spend millions of dollars to tempt you from your shopping list, particularly as you are waiting idle in the line. Many dietary decisions are made at the point of purchasing food at the supermarket, but do you know what is really going into your trolley? ShopSmart is a two-hour supermarket tour that will help you make healthy choices while shopping. You can learn how to decode food labels and spot the techniques used to trick you into buying unhealthy food. A classroom workshop is also available for those that like a desk, pen and paper. The next time you’re pushing the trolley around the supermarket, follow these tips from Diabetes WA and LiveLighter that recently appeared in the West Australian newspaper. • Don’t look for meal inspiration from the supermarket shelves. Draw up a meal plan before you go. It’s much easier to be disciplined about what you buy if you know what you need when you walk through the door. • Write a list of what you need before you head to the shops and stick to it.

• Don’t shop hungry — that’s just a recipe for impulse buying. • Choose a small basket or trolley that’s the right size for what you’re planning to buy. Any bigger and you might be tempted to fill it with items you don’t need.

No added fat

Aim for 2 serves each day 1 serve = 1 medium piece OR 2 small pieces OR 1 cup diced, cooked or canned OR 30g dried OR 1/2 cup of 100% fruit juice.

DAIRY AND ALTERNATIVES Per 100g/100ml

FAT total

Calcium

Milk and alternatives

≤ 2g

120mg

Yoghurt, custard & dairy dessert

≤ 2g

100mg

Ice cream & frozen dessert

≤ 3g

Cheese

≤ 20g

Aim for 2 1/2 –4 serves each day 1 serve = 1 cup milk OR 200g yoghurt OR 40g cheese.

MEAT, MEAT ALTERNATIVES, POULTRY AND SEAFOOD Per 100g

FAT - total

• In the supermarket business there is a saying — “eye level is buy level” — so be aware that those items you don’t need to reach down or stretch for are also the ones that are the biggest profit items for the supermarket. So, make sure you check the lower shelves for the best bargains or healthier options.

Beef, veal, pork, lamb

• Supermarkets are designed with staples such as bread and milk located at the back of the store so they can market all their other products to tempt you to buy along the way.

Aim for 2-3 serves each day. 1 serve = 65g cooked meat (90 - 100g raw) OR 80g cooked chicken (100g raw) OR 100g cooked fish (115g raw) Include 2-3 serves of oily fish a week – fresh, canned or frozen.

• Shopping local and seasonal will help keep costs down.

Per 100g

FAT total

FIBRE

Breakfast cereals

≤ 5g*

≥ 6g

Breads & mixes

≤ 5g*

≥ 5g

Pasta, noodles, rice

≤ 5g*

Savoury biscuits

≤ 5g*

≥ 3g

The Super Card is a pocket-sized resource that provides information about what a serving size is and how many serves to aim for in each food category, giving you tips on what to look for when buying food. Attend a FREE ShopSmart program to receive a copy.

Choose lean cuts

Poultry

Remove skin and fat

Tofu, tempeh, meat substitutes

≤ 5g*

Sausages, rissoles, canned meats

< 10g

Processed luncheon meats

≤ 3g

Convenience meals

≤ 5g*

Fish & seafood

<5g saturated fat

BREADS AND CEREALS

Aim for 3 - 6 serves each day 1 serve = 1 slice of bread OR 2/3 cup of breakfast cereal flakes OR 1/2 cup cooked rice/pasta.

SNACK FOODS Look for products which contain ≤5g* fat/100g, ≥3g fibre/100g, ≤450mg sodium/100g & ≤600kj/serve. *May contain 5 - 10g of total fat provided that saturated fat is less than 1/3 of this amount.

GOURMET

diabetes

Weekly Meal Plan Do you sometimes feel like you are constantly thinking about what to eat, when to eat it, how to cook it or where to buy it from? Feeding yourself, and the family, can be an exhausting task, particularly when you have diabetes to consider. To alleviate some of your brain-strain, dietitian Alison ClimieHolmes has curated a suggested weekly meal plan for those that are looking for some inspiration. The plan is based on the LiveLighter program, administered by the WA Department of Health in partnership with Heart Foundation WA and Cancer Council WA. The recipes have been selected from their new 3-2-1 Meal Plan program, using the Australian Dietary Guidelines, and then assessed to ensure they are suitable for people living with diabetes.

Breakfast

If you’re finding it hard to break the habit of treating yourself to something sweet after dinner or you find you’re still hungry between meals - see Alison’s article on page 34 for tips on treats and discretionary food – Can you have your cake and eat it too?

Lunch

LiveLighter © State of Western Australia 2018. For more healthy recipes and tips visit www.livelighter.com.au

Dinner

Monday

1 piece of fruit with 2 weetbix Sandwich with tuna or egg, and 200ml of low fat milk. If avocado and salad desired add a tbs of natural or low fat flavoured yoghurt

Grilled Fish with Salsa (recipe on page 17)

Tuesday

A boiled egg and slice of wholegrain toast with avocado and tomato

Tropical Fruit Smoothie (recipe on page 32)

Spaghetti Bolognaise (recipe on page 17)

Wednesday

Homestyle Baked Beans (recipe on page 32)

Chicken and salad wrap

Salad Nicoise (recipe on page 17)

Thursday

1 english muffin, ½ cup ricotta Pantry Pasta cheese with 1 cup of berries, (recipe on page 33) and either a 200ml low fat yoghurt or 1 cup of low fat milk to drink

Spicy Pumpkin Soup (recipe on page 18)

Friday

Breakfast Smoothie (recipe on page 32)

Zucchini Slice (recipe on page 33)

Fish and Chips (recipe on page 18)

Saturday

½ cup rolled or steel cut oats cooked in 250ml low fat milk and a few tablespoons of stewed fruit or berries and low fat yoghurt

Mexicorn Salsa Toast Topper (recipe on page 33)

Fragrant Chicken and Noodle Lettuce Wraps (recipe on page 19)

Sunday

Toastie made with baked beans and low fat cheese

Mixed green and vegetable salad, served with cold roast beef

Chicken Cacciatore (recipe on page 19)

GOURMET

diabetes

Grilled Fish with Salsa

Spaghetti Bolognaise

Salad Nicoise

Prep: 10 mins Cook: 20 mins Serves: 2

Prep: 10 mins Cook: 15 mins Serves: 2

Ingredients 2 corn cobs 1 tomato, chopped 1 Lebanese cucumber, chopped ½ avocado, chopped ½ capsicum, chopped 1 red onion, finely chopped 1 lime olive or canola oil spray 240 g firm white fish fillet

Ingredients 120 g spaghetti or other pasta olive or canola oil spray ½ onion, chopped 1 clove garlic, chopped 200 g beef mince 1 stalk celery, finely chopped 1 carrot, grated 1 x 400 g can no-added-salt diced tomatoes 1 tbs Worcestershire sauce 2 tsp dried mixed herbs ¹/³ cup low-fat cheese, grated

Ingredients 2 eggs 180 g tuna in spring water, drained 2 potatoes, chopped 1 cup frozen green beans 2 cups lettuce 1 tomato, chopped ¼ cup olives 2 tsp Dijon mustard 2 tsp lemon juice 2 tsp olive oil

Method 1. Place corn (with green husk still on) in a microwave-safe bowl with a tablespoon of water. 2. Microwave, covered, on HIGH (100%) for 4 minutes or until just tender. 3. In a medium bowl, add tomato, cucumber, avocado, capsicum, onion, coriander, pepper and juice of ½ a lime. Mix gently to combine. 4. Heat a griddle or large non-stick pan on medium-high heat. 5. Remove husk and lightly spray corn with oil then cook, turning frequently, for 5 minutes or until lightly charred; set aside. 6. Lightly spray fish with oil then cook for 2-3 minutes each side or until browned and cooked through. 7. Serve fish with corn, salsa and remaining lime. Nutrition Information per serve Energy Protein Fat, total — saturated Carbohydrate — sugars Sodium Fibre

1893 kJ 37 g 17 g 3g 30 g 14 g 140 mg 15 g

Method 1. Cook spaghetti according to packet instructions. 2. Spray a frying pan with oil. 3. Gently cook onion and garlic until soft. 4. Turn up the heat and add the mince and cooked till browned, breaking it up with a wooden spoon. 5. Reduce heat to medium, add in celery and carrot and cook for 3-5 minutes, stirring occasionally. 6. Add tomatoes, Worcestershire sauce, pepper and herbs to the pan. Cook for 5 minutes with a lid on, then stir, remove lid and cook for 5-10 minutes to thicken up. 7. Top spaghetti with the bolognaise sauce and a sprinkle of cheese. Variations • Add a grated zucchini, a can of lentils and another can of tomatoes to stretch this sauce to feed 4. Nutrition Information per serve Energy Protein Fat, total — saturated Carbohydrate — sugars Sodium Fibre

2135 kJ 35 g 15 g 7g 51 g 14 g 462 mg 11 g

Method 1. Place eggs in a small saucepan, cover with cold water and bring to the boil. Simmer for 6 minutes, drain and refresh with cold water. Once cool, peel eggs and cut into quarters. 2. Place potatoes in a medium-sized saucepan and cover with water. Bring to the boil and simmer for 6 minutes. Add green beans and simmer for another minute until they are bright green and potatoes are tender. 3. Drain beans and potatoes and refresh with cold water. 4. Cut potatoes in half and add to a large serving bowl with lettuce, beans, tomatoes and olives, topped with eggs. 5. Mix mustard with lemon juice and olive oil. 6. To serve, add drained tuna and a drizzle of mustard dressing. Nutrition Information per serve Energy Protein Fat, total — saturated Carbohydrate — sugars Sodium Fibre

1811 kJ 29 g 12 g 2.5 g 46 g 5g 679 mg 12 g

GOURMET

diabetes Spicy Pumpkin Soup Prep: 10 mins Cook: 15 mins Serves: 4

Nutrition Information per serve Energy 1457 kJ Protein 12.7 g Fat, total 4.5 g — saturated 0.7 g Carbohydrate 58.1 g — sugars 24.4 g Sodium 431 mg Fibre 10.6 g

Method 1. Heat oil in a large pot and fry onion, garlic, cumin and curry powder for 2 minutes. 2. Add the rest of the ingredients and simmer for 10 minutes or until the vegetables are just soft. 3. Use a stick blender, normal blender or food processor to blitz the soup till smooth. Add more water if you prefer a runnier soup. 4. Serve with a slice of toast and a spoonful of yoghurt.

Fish and Chips Prep: 15 mins Cook: 25 mins Serves: 2 Ingredients 500 g sweet potato, cut into wedges olive or canola oil spray ½ cup breadcrumbs 1 tsp dried mixed herbs 1 egg 200 g firm white fish fillet 1 cup mixed salad or baby spinach leaves 1 tomato ¼ cucumber ½ lemon Method 1. Preheat oven to 230° C and line a baking tray with non-stick baking paper. 2. Spread potatoes in a single layer on a tray, spray liberally with oil and bake for 15 minutes on top shelf of the oven. 3. Combine breadcrumbs and herbs in a shallow dish. Fill a separate shallow bowl with beaten egg. Dip fish in egg wash, shake off excess so it is damp but not wet. Add fish to breadcrumb mixture, turning to make sure it is well coated and gently press on crumbs. Spray liberally with oil. 4. Turn wedges over and add the fish to the tray. Bake for 10 minutes until fish is golden and cooked through and wedges are crisp. 5. Divide between plates and serve with salad and lemon on the side.

Ingredients 1 tsp canola oil 1 onion, chopped 3 cloves garlic, chopped 2 tsp ground cumin 2 tsp curry powder 3 cups pumpkin, peeled and chopped into 2cm cubes 1 small sweet potato, peeled and chopped into 2cm cubes 2 medium potatoes , peeled and chopped into 2cm cubes 1 apple, peeled, cored and quartered 1 tsp reduced-salt vegetable stock 1 litre water 4 tbs low-fat natural or Greek yoghurt, to serve 4 slices wholemeal or multigrain bread, to serve

Variations Roast the vegies in the oven first for a sweeter, more intense flavour

Nutrition Information per serve Energy 2067 kJ Protein 38 g Fat, total 10 g — saturated 1g Carbohydrate 57 g — sugars 16 g Sodium 396 mg Fibre 11 g

For breakfast and lunch recipes, see pages 32–33.

GOURMET

diabetes

Fragrant Chicken and Noodle Lettuce Wraps Prep: 25 mins Cook: 10 mins Serves: 2

Nutrition Information per serve Energy 2075 kJ Protein 33 g Fat, total 17 g — saturated 7g Carbohydrate 45 g — sugars 11 g Sodium 564 mg Fibre 9g

Chicken Cacciatore Prep: 10 mins Cook: 20 mins Serves: 2 Ingredients 1 ½ cup pasta shapes, to make 2 cups cooked olive or canola oil spray 200 g skinless chicken breast, chopped ½ onion, chopped 2 cloves garlic, chopped 1 capsicum, chopped 100 g mushroom, chopped 1 x 400 g can no-salt diced tomatoes 1 tomato, chopped 2 tbs salt-reduced tomato sauce ¼ cup olives 1 sprinkle chilli flake, optional ½ cup basil leaves Method 1. Cook pasta according to packet instructions. Drain well and set aside. 2. Place a large non-stick frypan on high heat and spray with oil. Add chicken and stir-fry for 4 minutes until browned but not completely cooked. Remove chicken from pan and set aside. 3. In the same pan, cook onion till softened, stirring often. Add garlic, capsicum, mushrooms and and fresh tomato and cook for another 3 minutes. 4. Add tinned tomatoes, chicken and olives, season with chilli flakes and simmer for 5 minutes or longer if times permits. 5. Mix cooked pasta and basil through sauce and serve with black pepper.

Nutrition Information per serve Energy 2154 kJ Protein 48 g Fat, total 6g — saturated 1g Carbohydrate 58 g — sugars 20 g Sodium 641 mg Fibre 13 g

Ingredients 1 clove garlic, finely chopped ¾ cup coriander stalks and leaves, chopped 2 tbs lime juice 2 tbs white vinegar 1 tbs sweet chilli sauce 200 g chicken tenderloin 100 g rice noodles 2 tsp red curry paste 1 x 165 g can reduced-fat coconut milk 8 leaves lettuce 1 carrot, grated 2 spring onion, finely chopped 1 cup bean sprouts 1 Lebanese cucumber, thinly sliced 2 tbs unsalted peanuts, crushed Method 1. Mix garlic and half the coriander with the lime juice and vinegar. Combine half of this mixture with sweet chilli sauce to make dipping sauce. 2. Use the other half of the coriander mixture to marinate the chicken for at least 20 minutes. 3. Cook noodles according to packet instructions. 4. Cook curry paste, stirring for a couple of minutes, until fragrant. Add coconut milk, stir and simmer for 1 minute. Remove from heat and mix in noodles. 5. Cook chicken pieces over high heat for 3-4 minutes each side. To serve Place chicken in a lettuce cup leaf. Top with noodles, vegetables, coriander and peanuts. Spoon over a little dipping sauce and roll up to eat.

Education Have you considered attending a workshop but didn’t get to it? Make 2018 the year you take action!

The Smart Series 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 helps you decode food labels ('Classroom' format also available). 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 – everything you need to know about your medications.

Type 1 Technology Night Learn about pumps, CGMs and flash monitoring. Free session, bookings essential. Visit our website for more information and upcoming dates.

Perth Metro Armadale Armadale Armadale Armadale Armadale Armadale Belmont Belmont Belmont Belmont Belmont Belmont Dianella Dianella Fremantle Greenwood Helena Valley Helena Valley Joondalup Joondalup Joondalup Joondalup Joondalup Joondalup Joondalup Melville Melville Melville Melville Mirrabooka Mirrabooka Mirrabooka Morley Riverton Riverton Rivervale Rivervale Rockingham Rockingham Rockingham Rockingham Subiaco Subiaco Subiaco Subiaco Subiaco Subiaco Subiaco Subiaco Subiaco Subiaco

ShopSMART (Classroom) DESMOND CarbSMART MeterSMART DESMOND ShopSMART FootSMART ShopSMART (Classroom) CarbSMART CarbSMART MedSMART DESMOND Connect ShopSMART ShopSMART ShopSMART DESMOND DESMOND FootSMART CarbSMART DESMOND MedSMART ShopSMART DESMOND ShopSMART (Classroom) CarbSMART MeterSMART DESMOND DESMOND DESMOND FootSMART CarbSMART ShopSMART DESMOND DESMOND DESMOND DESMOND DESMOND DESMOND ShopSMART DESMOND MeterSMART DESMOND MedSMART DESMOND FootSMART CarbSMART ShopSMART (Classroom) DESMOND CarbSMART DESMOND

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Planner

Diabetes WA offers a 15 p er cent discount on health professional training and updates to members.

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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. * DESMOND sessions are heading to Broome. Dates are yet to be confirmed. Get in touch with Diabetes WA or Boab Health Services if you’re interested in attending.

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 21

RESEARCH

news

Research Round-Up The latest in diabetes research

It’s great news for rice lovers A new low-GI rice is on the cusp of being available in supermarkets. Derived from the already lauded low-GI Doongara long-grain rice, this new variety will be incorporated into a bolder medium grain, giving people with diabetes and other carb-conscious buyers an alternative.

It’s good news for people with Alzheimer’s The type 2 diabetes drug Liraglutide may also help to reverse memory loss, a Lancaster University study has found. The drug, marketed as Victoza and Saxenda, was shown by researchers to play a part in reducing brain degeneration, which occurs in Alzheimer’s disease.

It’s bad news for shift workers A UK study has found that shift workers are more likely to develop type 2 diabetes. People working irregular or rotating shifts were 44% more likely to have type 2 diabetes, after taking account of other established risk factors.

3D bioprinter to revolutionise type 1 treatment cells from a protective bioink into a printed scaffold suitable for transplant.

Professor Wallace (image credit: UOW Media)

In an Australian first, researchers at the Australian Research Council (ARC) Centre of Excellence for Electromaterials Science (ACES), based at the University of Wollongong (UOW) have designed and built a customised 3D bioprinter that promises to revolutionise treatment for people with type 1 diabetes. The printer will be capable of delivering insulin-producing islet

The Pancreatic Islet Cell Transplantation (PICT) 3D Printer was officially handed over to South Australian Minister for Health Peter Malinauskas for use at the Royal Adelaide Hospital (RAH), by ACES Executive Director and Australian National Fabrication Facility Materials Director, Professor Gordon Wallace. The RAH is the first hospital in Australia to receive this cutting edge biomedical printing device. The PICT Printer will be developed further with funding from an ARC Linkage, Infrastructure, Equipment and Facilities grant.

Wearable patch to manage type 2 diabetes Researchers at the National Institute of Biomedical Imaging and Bioengineering are working on an alternative therapeutic approach to regulating blood glucose levels for people with type 2 diabetes using a painless wearable skin patch that can last up to several days. The study, published online in Nature Communications, was performed with mice to test the ability of the patch to respond to blood chemistry and manage glucose automatically. Scientists used alginate for the patch, a sticky natural substance that’s extracted from brown algae, mixed with a formula of biochemical particles that stimulates a body’s insulin production when it’s needed and shuts off when normal

blood glucose concentration is obtained. This was all poured into a microneedle form to create the patch. Alginate is a pliable material that has the ability to ‘poke’ the dermis, rather than break the skin. The dissolvable microneedles make the patch a responsive delivery system for the formula to be absorbed by the body over a period of time, rather than all at once. The study, published online in Nature Communications, showed that just a 1.5cm square of the patch on mice could control blood glucose levels for a week. Researchers said the patch would need to be modified for use with human skin, including scaling up the size and extending the microneedle.

Australian report The Australian Government has released a report about the incidence of insulin treated diabetes in Australia, including 2016 data. The report includes interactive graphs by age, sex, trends, population groups (Indigenous status, remoteness and socioeconomic

groups), and geographic areas (state and territory, Primary Health Network and statistical area level 3) for type 1 diabetes and insulin-treated type 2 diabetes. aihw.gov.au/reports/diabetes/ incidence-insulin-treated-diabetesaustralia-2016/

Please note: The information on this page is a snapshot of the latest advances in diabetes research. Please keep in mind that research findings will not necessarily apply to your individual situation and this information should not be used to make decisions about treatment and management without the input of a health professional.

RESEARCH

news

Welcome to another year of exciting research from Western Australia! by Diabetes Research WA executive director Sherl Westlund

We’re thrilled to let you know about our newly-funded projects for 2018; we trust you’ll find them as fascinating and important as we do. Diabetes and the Microbiome

Upping the Diabetic Retinopathy Fight

One of our new grants, awarded to Curtin University researchers, could help reduce cases of type 2 diabetes linked to the use of cholesterol-lowering statin medications.

Our second grant for 2018 is helping pave the way for the early detection of diabetic retinopathy, the leading cause of blindness in working-age adults globally.

Prof Fergal O’Gara

Professor Fergal O’Gara’s team has found in a mouse study that statins drive changes in the body’s gut bacteria, which can trigger the development of type 2 diabetes.

Independent studies report up to a 12 percent increase of new type 2 cases among patients taking statins. “In our study, mice experienced higher fasting blood glucose levels and weight gain,” said Professor O’Gara. “We discovered the changes in gut bacteria were linked to the activity of a key protein receptor called PXR which is known to be involved in lipid and glucose metabolism. Both of these pathways are also altered in type 2 diabetes.” Our $80,000 grant will help the team investigate how the PXR and gut bacteria axis is modulated during statin use and how to prevent these negative effects, which may ultimately lead to the development of new probiotic-type therapeutics to counteract the impact of the statin. The research team is now recruiting West Australians with pre-diabetes as part of this research; to find out more contact jose.caparros-martin@curtin.edu.au.

Prof Yogi Kanagasingam conducting an eye scan.

WA-based Professor Yogi Kanagasingam, research director of the CSIRO’s Australian e-Health Research Centre, will use the funding to support the next phase of the development of a new artificial intelligence-based screening system for the condition.

Once implemented, the world-first technology will for the first time allow GPs to screen patients for diabetic retinopathy and refer those cases in need of specialist treatment, prioritised by the severity of their symptoms. “At the moment only ophthalmologists and optometrists can test for the condition so patients are waitlisted or have to be sent to another faraway clinic, meaning patients do not follow up in most of the cases and the chance of early detection is often lost causing irreversible loss of sight,” explained Professor Kanagasingam. “The current regime is also costly because patients who we ultimately discover don’t need that specialised care are also on the waiting list so this technology is poised to be a gamechanger.” An initial trial at the GP Superclinic at Midland Railway Workshops revealed GP screening using this technology found it was as effective as a specialist in detecting signs of diabetic retinopathy and grading its severity.

As always, thank you for your generous support; we could not offer these grants without our donors. For information, please visit www.diabetesresearchwa.com.au or call (08) 9224 1006.

IN THE

community

Tribute to a Quiz Master It is with sad hearts that we write of the loss of a dedicated, generous and vivacious man, Perth police officer Ian Anderson. Ian lost his battle with melanoma late last year. The annual Ian Anderson Quiz Night was legendary and raised a massive $39,000 for Diabetes WA. Ian coordinated and hosted the quiz night every year since 2005, and was awarded the Significant Fundraiser Award at the 2015 Diabetes WA Excellence Awards.

We had many wonderful holidays together, and he loved cruising in particular. There was always a trip being planned and one to look forward to. Hong Kong was one of his favourite places, which we always had to include as a stopover en route to the UK or North America. It was important for him to go back to the UK every alternate year to visit his family and friends, and of course a game at Anfield Stadium. I always used to joke that I came second to the Liverpool Football Club.

Diagnosed with type 1 diabetes in 1988 as a 25 year old, Ian forged a successful career, initially as a chef, and then as a Police Officer in the WA Police Force. According to Ian, adjusting to diabetes was difficult at times, especially balancing irregular working hours and dealing with a number of complications, so he started fundraising to help others.

Here his wife, Treva, pays tribute to this generous man. “One of the things that made me most proud of Ian was his dedication to Diabetes WA and the quiz nights he held for them annually. The entire event was organised by him, including writing the questions, canvasing for prizes and being MC. Oh and the jokes. Let’s not forget about the jokes, and how he always laughed before the punch line. His laugh was very infectious; one of the things I loved about him. There was always a section on his beloved Liverpool and their football club too.

Ian had already joined the police when I met him, and loved his job - it was refreshing to meet a man that did. It was one of the things that attracted me to him. He wasn’t interested in rising up the ranks, preferring to be on the road doing ‘real police work’, as he would call it. Some of his closest friends are those he met in the force. Up until the very end, he was thinking of new roles he could do with the change in his health.” The Quiz Master and his quiz night will be dearly missed by many.

IN THE

community

Delivering to your door When Elly was diagnosed with type 1 diabetes, her mother Leonie, who was not a keen cook, found herself needing a way to make meal times easier. Realising there must be many others in the same situation, Diabetes Meals Online was born. “Elly was diagnosed in June 2013 and, like many diagnoses of type 1 I’m sure, this came out of the blue for us, with no diabetes history in the family,” Leonie says.

with diabetes to make appropriate meal choices. “We just want to help people like us,” Leonie says. “Anything to make life with diabetes that little bit easier is a bonus I think.”

Elly had been losing weight and drinking a lot of water but it wasn’t until her mum found her almost in a coma and rushed her to the emergency room that she was diagnosed. There followed some difficult months for Elly’s family while they all learned about diabetes and how best to support her.

Last year Diabetes Meals Online was awarded the 3AW/Momentum Energy Small Business of the Year award and this year they are planning to expand the menu with more breakfast, lunch and dinner options. You can read more about their story and view the menu at diabetesmealsonline.com.au

“Managing her diet was stressful for both Elly and I,” Leonie reflects. “There were lots of recipes to choose from online and in specialised cookbooks but neither of us was a particularly keen cook! After lots of research, and thinking about how we could make meal time easier, we decided to start a business delivering ready-made, dietitian-approved meals.” They hired a chef and a dietitian, and invited a leading diabetes educator on board to help advise them, and formed Diabetes Meals Online. The meals created, including hot pots and casseroles, meet strict nutritional criteria, are all gluten-free, and provide at least 2-3 serves of veggies or legumes. They are pressurecooked in a special pouch to ensure

a long shelf-life, which means they don’t need refrigeration and can be delivered Australia-wide. Every meal is under 1700 kilojoules, contains minimal or no added sugar, contains between 4-40gm carbohydrates and 2-20gm fat, and have a uniquely colour-coded carbohydrate and sugar content identification system to help people

Leonie and Elly have generously donated a $50 Diabetes Meals Online voucher to give away. For your chance to win, send us your details: Name, Phone number, Address and Email address By Post: Meals Online Competition Editor Diabetes Matters PO Box 1699 Subiaco WA 6904 By email: membership@diabeteswa.com.au Entries close 1 June 2018.

Tell Us Your Story Overwhelming feedback from our readers tells us that you want to hear how others are coping with facing the challenges that you are facing. We invite you to tell us your story. Have you overcome adversity? Have you got any tricks and tips for other people living with diabetes? Perhaps your story can help others. Let us know – we would love to hear about your journey. Send it by post: PO Box 1699, Subiaco WA 6904 Email it to us: community@diabeteswa.com.au 25

IN THE

community

Q &A

I have a daughter with type 1 and we have an evergrowing collection of sharps containers at home, as our local chemist no longer takes them. I was talking to my hairdresser and she is having the same problem. Can you advise where I might be able to go to get rid of them? The end result is potentially the incorrect disposal of sharps as I am tempted to just put them in my bin if my container collection gets too large! Lesley, mother of a daughter with type 1 diabetes. DWA Diabetes Educator Sheryl Moore says… Firstly, it’s good to see that you are being vigilant about the safe disposal of your daughter’s needles. The Diabetes WA offices in Subiaco and Belmont offer a sharps collection service. We will take your full container and dispose of it, but keep in mind you will need a replacement container, as we don’t empty them on the spot. New containers can be purchased at our offices and pharmacies across the state.

With the weather starting to change, my wife is worried I am more likely to get the ﬂu just because of my diabetes. I have told her it doesn’t make any difference as I am otherwise healthy. Am I right? Almon, type 2 diabetes.

Sheryl says…. You are right, though your wife is good to be cautious. You are no more likely to get a cold or another illness if you have diabetes. However, people with diabetes are advised to get flu shots. This is because any illness can make diabetes more difficult to manage, and people with diabetes who do get the flu may be more likely than others to go on to develop more serious complications from the infection.

If Subiaco and Belmont aren’t convenient for you, you can also look online - www.safesharps.org.au allows you to enter your suburb and find a sharps disposal location close to home. We do encourage people to get in touch with us if they are having trouble finding a sharps disposal location in their area. With a collection of statements, we can advocate on their behalf to try to ensure that sharps collection points become more widely available.

If you have a diabetes-related question that you would like answered, email it to community@diabeteswa.com.au. Alternatively, you can speak to a member of the Diabetes WA Education Team. Call the Diabetes Helpline between 8.30am and 4.30pm weekdays on 1300 001 880. 26

SHARED

pathways

Rural and Remote Product Supply Scheme Changes to the National Diabetes Services Scheme (NDSS) in 2016 saw the development of a new contract arrangement that meant state and territory diabetes organisations were no longer involved in the provision of diabetes product supply. A gap in service provision was identified by Diabetes WA in the transition to the new pharmacy-based supply scheme. Diabetes WA engaged with the Federal Government to provide a product supply service to aboriginal medical services and people living in rural and remote locations that may be disadvantaged in the new NDSS supply arrangements. The program has been crucial to isolated people and communities and has provided a constant supply of products for Indigenous and non-Indigenous people living with diabetes.

asked to provide standing orders for a number of Aboriginal medical services because of the consistently high volume of product required each quarter. The program has also allowed Diabetes WA to facilitate Indigenous NDSS registrations that would otherwise not have been possible, giving the Federal Government objective information about the extent of diabetes within Indigenous communities in regional and remote areas. Figures shown are for 2017

The value of this service was highlighted during the emergency preparation prior to recent cyclone Joyce in the Kimberley region. Diabetes WA was able to send blood glucose test strips, meters and insulin pump consumables to six centres in the region to mitigate supply challenges.

Strips

Feedback received from Aboriginal health workers has been extremely positive in the schemeâ&#x20AC;&#x2122;s second year. The ongoing relationship has seen a growth in requests for diabetes product and specific educational materials. Recently we were

Sharps

23,900 5,900 27

LIVING

well

Feeling overwhelmed by your diabetes? Whether you have only recently been diagnosed or have been living with diabetes for many years, understanding and taking care of your diabetes can be overwhelming. It is not uncommon for people living with diabetes to experience periods of frustration, guilt, worry and fatigue. We are only human! Helping our pancreas and our insulin to work as they should is a tough gig!

Trying not to let the numbers ‘rule’ you, will go a long way in improving your emotional well-being. Often, people without diabetes don’t understand. “What is so hard about pricking your finger every now and again?...just don’t eat sugar, that’ll fix it.” Diabetes does not live in isolation from other day to day stressors. As with life, there are days were everything goes

to plan and everything feels effortless – “diabetes is not a big deal, I can do this”. Then there are days when we feel we shouldn’t have gotten out of bed – “diabetes is hard, I don’t know if I can do this”. On these days it is easy to get swept up by things like the worry of long-term complications; or that the last BGL was not within target range; or the feeling that you have failed in your diabetes management. It is not hard to see how these feelings might then start to affect other aspects of your day to day life including work, relationships, school and managing the kids. Not surprisingly, this is a time where it is not uncommon for people to ‘give up’ on their diabetes in order cope with other aspects of their life. Looking after your emotional well-being will go a long way to preventing and managing diabetesrelated distress.

Looking after your emotional well-being First and foremost it’s important to acknowledge it is not just about the numbers. Blood glucose monitoring is a great guide to help us make management decisions about our diabetes, but it is just that, a guide. Trying not to let the numbers ‘rule’ you, will go a long way in improving your emotional well-being. Think of your readings as just one piece of the puzzle, that one number is not a reflection of who you are. If monitoring is getting too much for you, you may consider taking a ‘break’ from monitoring for a while. It is very important to discuss this with your doctor or diabetes educator first though, as they can help you find a safe way to take a short break from this aspect of your management.

LIVING

well

If you feel you are experiencing a crisis or emergency situation, phone Lifeline on 13 11 14 or call 000.

Revisit your goals

You’re not alone

Disordered eating

If you are feeling overwhelmed by your current diabetes goals, or feel as though you are not achieving them – that is OK. You might find that revisiting your goals may help you find some perspective. You do not have to achieve everything NOW. It is ok to make your goals slightly smaller and easier to achieve. Being able to achieve your goals, even if you perceive them to be small, will give you more confidence and make you feel better about your progress. It is important to make your goals SMART - Specific, Measurable, Action-based, Realistic and Time-specific. This way it is much easier to get started and to know when we have actually achieved our goal. Most importantly, don’t forget to reward yourself! You are dealing with a complex condition, not to mention dealing with the rest of your life – achievements are worth celebrating!

It’s important to realise that you are not the only one experiencing stress. Try to connect with people or friends who might be experiencing similar struggles. There are a number of support groups around. You’ll find a list of diabetes support groups in different areas of WA on our website.

Living with diabetes places a lot of focus on food, weight, and body image. Sometimes, this can lead to an unhealthy relationship with food, or disordered eating. If you feel like you are battling with the balance and focus, you are not alone. There are others also experiencing the same challenges, there are things you can do to change your relationship with food and there are people who can help you.

diabeteswa.com.au/manage-yourdiabetes/live-well Sometimes you might find that talking with a health professional such as a psychologist, diabetes educator or your treating doctor can help you find way to cope with the demands of diabetes. You can talk to your GP or Diabetes WA about how to access these services – often there are very affordable or free options.

Find a series of NDSS emotional health factsheets on the DWA website, under Manage Your Diabetes/Resources, for example “Diabetes and disordered eating”.

We can help: Call 1300 001 880 to talk to a diabetes educator.

MOVING

well

Incidental With all this gourmet eating, we need to make sure we can counteract it with some exercise. Even healthy eating counts as kilojoules and it is all about balancing what goes in and what goes out. That doesn’t mean you have to rush to the gym to sweat it out on a treadmill. If you’re time poor, or gyms just aren’t your thing, then that’s where incidental exercise can come in. Incidental exercise is any physical activity that is built up during the day; from walking to the bus to vacuuming. It’s the exercise that happens when you’re not even thinking about it. But sometimes it IS good to think about it. While we all get some incidental exercise without realising it, focusing on ways to increase your incidental activity each day, is an easy way to increase your exercise quota and keep your metabolism going, without committing to a brand new fitness regime.

MOVING

well

Exercise Try these easy, sustainable not-really-exercise exercises to get you moving. 1. Take the stairs.

6. Talk and move.

From the office to the train station, doctor’s appointments or at the shopping centre, there are so many opportunities to increase our fitness by taking the stairs. Stair climbing increases your heart rate, tones your leg muscles and the best part is… it’s free!

When speaking on your mobile or cordless phone at home, pace around or tick some things off the to-do-list around the house at the same time.

2. Watch TV standing up. Scientists have predicted that for every hour you sit down watching TV, you knock 22 minutes off your lifespan! Next time you watch your favourite television show do it standing up. Alternatively, take advantage of the ad breaks – walk around, cook dinner or tidy the room while the ads are on. Use each ad as a timer to do some squats or shuffle your feet.

3. Ditch the remote control. If standing up to watch TV doesn’t appeal to you, then leave your remote control on top of the TV and get up every time you want to switch the channel. It gives a whole new meaning to the term ‘channel surfing’!

4. Park your car further away. Do you slowly drive up and down in the parking area at the shopping centre to try to get the closest spot to the entrance, while ignoring the open spaces further away? Not only could you have walked there sooner, you’d have worked some mild cardio into your day, too. Park further away at the shops when doing your food shop or better yet walk to the shops and leave the car at home.

7. Count your steps. Many experts recommend you hit 10,000 steps a day, and a pedometer will help you do the counting. If you’d rather not invest in a pedometer, there are plenty of step-counting smart phone apps to help you. If you’re not quite at 10,000, then aim to increase the total number of steps taken by 10 per cent each week.

8. Squeeze and lift. We all spend hours standing in queues – at the bank, the post office, the supermarket etc. Use the time to squeeze your bottom, pull in your stomach muscles and do calf and toe raises. (Remember to do it unobtrusively!)

9. Clean. The household duties need to be done so why not use them to your advantage? Put some music on and mop the floor, clean the bathroom, vacuum the carpets or dust those corners, particular the high ones.

10. Get outdoors. Mowing the lawn, raking the fallen leaves, weeding and washing your car sure aren’t easy jobs. But they are necessary. Instead of putting them off, get out there and get stuck in.

5. Carry your shopping. Only needed a couple of items from the supermarket? If you can handle the load, leave the trolley behind and carry your bags to the car/home/office. Free arm weights! Alternatively, use a shopping basket instead of a trolley while cruising the aisles. By doing this, you’ll give your upper body a workout.

EATING

well

Weekly Meal Plan Breakfast and Lunch Recipes These breakfast and lunch recipes from our weekly meal plan on page 16 will help you to spruce up the daylight hours.

Homestyle Baked Beans

Prep: 5 mins Cook: 20 mins Serves: 4

Ingredients olive or canola oil spray 1 medium brown onion, diced 2 cloves garlic, crushed 1 tbs low-salt tomato paste 1 tbs low-salt tomato paste 1 tsp smoked paprika 400 g can low-salt diced tomatoes 1 tbs salt-reduced tomato sauce 1 tbs Worcestershire sauce 420 g can low-salt cannellini or butter beans, drained and rinsed 3 tbs parsley, finely chopped 4 slices wholegrain bread, toasted Black pepper, to taste

Breakfast Smoothie Prep: 3 mins Serves: 2

Ingredients 2 cups low-fat milk ½ cup low-fat natural yoghurt 1 ripe banana 2 tbs rolled oats

Method 1. Place oats, sultanas, juice and water in a 2-litre container with a lid. 2. Spray oil in a medium saucepan and cook onion and garlic over medium heat until softened. 3. Add the tomato paste and smoked paprika. Stir through and cook for 1 minute. 4. Add the can of tomatoes, including juice, tomato sauce and Worcestershire sauce. Mix well and bring to the boil. 5. Reduce the heat and simmer uncovered for 10 minutes until slightly thickened. 6. Add in the cannellini beans and stir until heated through. 7. Remove from heat, mix in the parsley, pepper and serve on toast.

Nutrition Information per serve Energy 819 kJ Protein 9g Fat, total 3g — saturated 0.5 g

Carbohydrate 30 g — sugars 9g Sodium 517 mg Fibre 9g

Variations • Add 1 thinly sliced fresh long red chilli to the onion for a spicy light lunch. • Replace cannellini beans with canned salt reduced haricot, butter, borlotti or red kidney beans.

Method 1. Place all ingredients in a blender, mixing until smooth and well combined. 2. Serve immediately in a tall glass.

Nutrition Information per serve Energy 991 kJ Protein 15.4 g Fat, total 4.6 g — saturated 2.3 g

Tropical Fruit Smoothie Prep: 5 mins Serves: 2

Ingredients ½ ripe banana, frozen, roughly chopped 1 mango cheek, frozen, roughly chopped ½ cup canned pineapple in natural juice, undrained 1 cup low-fat milk pulp of 1 large passionfruit

Method 1. Place frozen fruit, pineapple and milk into a blender jug; blend until smooth. 2. Pour into 2 serving glasses and spoon pulp of half a passionfruit on top of each smoothie. Tip: Mango flesh and ripe peeled bananas can be frozen in ziplock bags for use in smoothies and fruit sorbet. Freeze for several hours or overnight before blending.

Carbohydrate 33 g — sugars 26.8 g Sodium 155.6 mg Fibre 1.7 g

Nutrition Information per serve Energy 592 kJ Protein 6g Fat, total 2.1 g — saturated 1.2 g

Carbohydrate 23.5 g — sugars 22.7 g Sodium 53.3 mg Fibre 2.7 g

EATING Pantry Pasta

Prep: 10 mins Cook: 15 mins Serves: 4 Ingredients 1 tsp oil 1 onion, chopped 2 cloves garlic, chopped 1 carrot, grated ¼ zucchini, grated 2 tsp dried mixed herbs black pepper to taste 1 x 400 g can no-salt diced tomatoes 1 x 400 g can no-salt brown lentils 1 tbs Parmesan cheese 120 g spaghetti or other pasta

Zucchini Slice

Prep: 30 mins Cook: 45 mins Serves: 6 Ingredients 5 eggs black pepper 1 large zucchini, grated 400 g carrot, sweet potato or pumpkin, peeled and grated 1 ½ cups canned corn kernels or frozen peas, drained 1 medium brown onion, peeled and diced 2 tsp dried mixed herbs ¾ cup wholemeal self-raising flour 1 cup reduced-fat cheddar cheese, grated olive or canola oil spray 3 large tomatoes, sliced, optional green side salad, to serve

Mexicorn Salsa Toast Topper Prep: 5 mins Serves: 1

Ingredients 1 slice wholegrain bread, toasted 2 tbs reduced-salt corn kernels ¹/³ Lebanese cucumber, chopped 1 tbs fresh coriander, roughly chopped 2 slices red onion, finely diced 1 tbs no-added-salt red kidney beans chilli flakes, optional

Method 1. Cook pasta according to packet directions and drain. 2. Heat oil in a saucepan, add onion and garlic and cook until soft. 3. Add carrot and zucchini, stirring until well mixed. Lower heat, cover and cook for 5minutes. 4. Add tomatoes, lentils, herbs and pepper to vegetables, turn up the heat and simmer for 5 minutes. 5. Remove from heat and serve over pasta. Sprinkle with cheese. 6. Serve with a garden salad.

Method 1. Preheat oven to 200°C (180ºC fan forced). 2. Whisk eggs in a medium jug, season with black pepper and set aside. 3. In a large bowl combine remaining ingredients except tomato. Add eggs and stir mixture until well combined. 4. Spray a large baking dish with oil. Pour in zucchini mix and flatten with a spoon. Cover with tomato slices arranged in a single layer. 5. Bake for 40-45 minutes or until firm and golden brown. 6. Rest in the pan for 10 minutes before dividing into 6 pieces and cutting into slices. Serve with a green side salad.

well

Nutrition Information per serve Energy 1085 kJ Protein 14 g Fat, total 4g — saturated 2g

Carbohydrate 37 g — sugars 7g Sodium 336 mg Fibre 9g

Variations Use up whatever fresh or frozen veggies you have in this sauce. Pumpkin, eggplant, and green beans all work well.

Nutrition Information per serve Energy 1220 kJ Protein 19 g Fat, total 9g — saturated 4g

Carbohydrate 29 g — sugars 10 g Sodium 450 mg Fibre 7g

Variations Substitute other vegetables including baby spinach, cherry tomatoes, broccoli florets, chopped asparagus or mushrooms, grated parsnip or potato and add fresh parsley, basil or dill.

Method In a bowl, mix all the topper ingredients. Spread over toast and serve.

Nutrition Information per serve Energy 642 kJ Protein 6g Fat, total 2g — saturated 0.2 g

Carbohydrate 26 g — sugars 4g Sodium 331 mg Fibre 5g

EATING

well

Can you have your by Dietitian Alison Climie-Holmes

Everyone loves a treat, but whether we like it or not, we all know that, to stay healthy, we need to use discretion when it comes to choosing those treats. Is it all bad news or can we have our cake and eat it too?? We eat for many reasons, not just for fuel, and we do want to enjoy our food. So what are ‘discretionary foods’? Well that would be the technical term for those treat foods we all love, that we need to use our discretion with! The Australian Dietary Guidelines lists examples of discretionary foods as the following: “most sweet biscuits, cakes, desserts and pastries; processed meats and sausages; ice-cream and other ice confections; confectionary and chocolate; savoury pastries and pies; commercial burgers; commercially fried foods; potato chips, crisps and other fatty and/or salty snack foods; cream, butter and spreads which are high in saturated fats; sugar sweetened soft drinks and cordials, sports and energy drinks and alcoholic drinks”.

A recent survey showed that discretionary foods make up 35% or 1/3 of the total daily energy intake of Australians.

The bad news is these foods tend to be energy dense, i.e. too many kilojoules from fats, usually saturated fats and from sugar and other high GI carbohydrates. They are also mostly nutrient poor, i.e. not enough of the useful things like vitamins, minerals and protein. The 2011-12 National Nutrition and Physical Activity Survey reported that 63 per cent of adults and 25 per cent of children in Australia were overweight or obese - an increase on previous results. Shockingly, discretionary foods made up 35 per cent or 1/3 of our total daily energy intake.

But I’m hungry and it’s two hours till lunch! So how do we decide upon a snack when we are looking for something extra? Firstly do not confuse snacking with discretionary food intake. Snacking is an occasion of eating or drinking outside of the usual peak eating times, such as breakfast, lunch or dinner. Though it is often associated with bad-for-you foods, when it’s done right, snacking can be a healthy habit that may help you manage your weight and balance your diet. At the end of the day it is a balance of overall daily kilojoule intake versus overall daily energy output. What goes in across a day (food) + what goes out (exercise!). When you go too long without eating, you may become so hungry that you might end up reaching for those discretionary foods in desperation. Snacking can help keep your hunger levels on an even keel, especially on days when your meals are spaced further apart due to ‘life’ commitments. However, it’s important to make healthy snack choices and to then keep your meals to a reasonable size so your overall daily energy intake doesn’t creep up. Many people with diabetes believe they need to have snacks between meals. This is not necessarily the case. Sometimes individuals on insulin or certain medications may need a snack to prevent their blood glucose going low (hypoglycaemia). Your individual requirements should be discussed with your health professional.

EATING

well

cake and eat it too? Decision Time - Discretionary Food Alternatives • A serve of treat food should be roughly equal in size to half the palm of your hand or the size of a tennis ball. i.e. mini muffin no bigger than a tennis ball, portion of potato chips the size of a tennis ball. A serve of chocolate is roughly four squares. • Acceptable daily intake would be 0 to 2 serves. The less activity you do the less you should have. Also, the older we are, unfortunately, the less we should have.

Discretionary / treat food Healthier option Sausage roll

Make and freeze single portions of lower-fat sausage rolls. Use lean meat and add grated vegetables. Low fat puff pastry or, instead of puff pastry, use filo pastry. Make size of half your palm rather than your hand size.

Pizza

Instead of a whole pizza choose half and some salad. Choose thin and crispy rather than deep pan. Choose less meat particularly chorizo and salami types. Choose less cheese. Choose more vegetable toppings.

Butter

Avocado is more nutrient dense and lower in fat and salt. Hummus is higher in fibre and lower in fat than butter.

Packet of potato chips

Pop some corn kernels into a paper bag and gently fold the top of the bag over to stop them escaping. Place in microwave for approx 2 mins...listen for popping to start. It will increase, then, when it slows down again it is time to remove the bag from the microwave. Flavour with tabasco, chilli flakes, mild curry powder or cinnamon. Or eat a small handful of raw almonds or walnuts or both. Chew slowly.

Cream

Use light versions of cream, i.e. Philadelphia extra-light cream for cooking or use light ricotta, add a teaspoon of icing sugar to each 100g to make it sweet for whipping. Add a dash of skimmed milk if necessary.

Chocolate

Instead of milk choose dark chocolate. Instead of a crème egg choose a small hollow egg. Instead of a large Lindt bunny choose 3-5 small ones and still save kjs and fat!

Slice of banana bread

Slice of raisin toast with 1 tsp of butter is half the energy and more than half the fat and sugar.

Ice creams

Choose mini versions like Bulla mini splits frozen yoghurt, Zilch no added sugar, Plain low fat ice cream in various flavours. Make your own with fruit and low fat yoghurt and place in ice cream moulds. Keep portion sizes to the size of that tennis ball.

EATING

well

What’s all the fuss about grazing? Some people function better, they believe, if they eat little and often. Some people say this also helps them not to over-eat or make poor food choices. Eating little and often is often termed ‘grazing’ and is quite a trend nowadays. Grazing platters and grazing tables are appearing more at events, on social media and on menus. It’s important to remember that if you choose to eat this way, then grazing and snacking can mean more opportunities in the day for making poor food and drink choices as well as over-eating. It tends to need more planning and organisation to make sure the food chosen is nutrient dense and not excessive. There is no right or wrong way to eat but rather, we need to think about what might suit our individual needs best and ensure we are most likely to choose healthier foods.

What about fasting? There is mounting evidence to say that a period of fasting is important to our health, weight control and longevity. This is not to say you have to have days without eating, as this could be considered the 12 + hours between your evening meal and your next morning meal i.e. 7pm –7am. But it is ok to feel hungry sometimes. It might not be pleasant, but may also mean you really enjoy that next meal when it comes.

Risky snacking times that need some planning: • In front of the TV

Nutritious snack ideas:

• At sports games

• Glass of plain low fat milk

• At the movies

• A small tub of low fat, low sugar yoghurt

• Out of the house and hungry

• Vegie sticks with hummus or tzatziki

What to do:

• Piece of fruit - tennis ball size / what can ﬁt in a cupped hand, level.

• Have nutritious snacks pre-prepared and in easy reach. • Take healthier snacks with you to outings so you aren’t tempted by the snack bars.

• 2-3 cups plain popcorn • 2 wholegrain crackers with low fat cream cheese and tomato, avocado or hummus

• Shop after eating so you’re not overly hungry which • A handful of corn chips and salsa leads to buying poor choices and have a shopping • A small handful of nuts and seeds. list with you rather than cruising the aisles. 36

Diabetes WA

MEMBERS

Autumn

area

Competition

Win a SuperVeg Cookbook by Celia Brooks SuperVeg celebrates the power and flavour of plants by shining the spotlight on 25 of the most health-giving vegetables on the planet. In this heartfelt homage, vegetable expert Celia Brooks explores the formidable nutritional benefits of each veg, providing a wealth of supporting information including selection, preparation and cooking techniques. Starting as a private chef for film director Stanley Kubrick, Celia Brooks moved onto TV presenting, consulting and writing about food for several UK publications, including The Times, the Evening Standard and BBC Good Food Magazine. SuperVeg is her ninth cookbook. Murdoch Books have given us a copy of SuperVeg to give away. Publisher: Murdoch Books RRP: $39.99

To enter, complete the competition slip below and mail to: Diabetes Matters – Autumn 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 June 2018.

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Mar till Jul Mar till Jun Connect with Diabetes The easiest way to get star ted on your

diabetes journey! Connect with Diabetes is a free diab etes information session for people who are at risk of diabetes, people living with type 2 diabetes, or anyo ne who would like to know a bit more about the cond ition. The focus lies on t ype 2 diabetes. Pres ented by Diabetes WA health professionals, the session enab les you to: • find out if you or your family are at risk • better understand diabetes and the importance of self-management • find out what you are entitled to receive under the NDSS • find out what local health services are available in your area • make small changes to live a hea lthier life with your loved ones New dates and venues are being confi rmed weekly for Connect sessions throughout the year. Visit the What’s On page of our website to find out about upcomi ng sessions near you. diabeteswa.com.au

24- 25 March st e W h t l ea Rural Hnference Co nnual

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Real Solutions Real Support Obesity Surgery WA offers a multidisciplinary team approach to provide the best level of care for people with obesity. It is well known that obesity is a high risk factor for developing type 2 diabetes which can lead to serious complications such as blindness, amputations, stroke and reduced life expectancy.

Dr Harsha Chandraratna Surgeon

Dr Bill Gong Surgeon

Dr Andrew Kiyingi Surgeon

Surgical Options for Diabetes

The good news is that losing weight can improve your type 2 diabetes. Our extensive experience in weight loss surgical options, including gastric sleeve and gastric bypass, can stabilise and improve your blood sugar levels. In as many as 3 out of 4 patients, their blood glucose levels return to normal with either reduced or no requirement for medications. Poorly controlled type 2 diabetes leads to slow and irreversible organ damage. Don’t wait until it’s too late. Come in and have a discussion with one of our specialist doctors to learn more about how Obesity Surgery WA can help you. We offer real solutions with real support.

Call 9332 0066 to make a start towards a healthier life.

Sleeve Gastrectomy Roux-en-Y Gastric Bypass Omega Loop Gastric Bypass

Subiaco • Murdoch • Mandurah

www.obesitysurgerywa.com.au

Old Habits Are Hard To Break

Remember: We have a new number

1300 001 880

Diabetes Information and Advice Line

Our specialised diabetes educators are here to help.