Winter 2018 $6.95
Diabetes + Women Flip for our men’s cover
NEWS • RECIPES • RESEARCH • PEOPLE • EVENTS • FITNESS
ctive Her Perspe nifer Sweeting
by Guest Contributor - Jen are from Mars and women are from While I don’t necessarily think men different creatures in many ways. Venus, I do believe that we are very d anyone in the office, I can often be foun I am an anthropologist and if you ask es renc diffe the ur; avio and human beh prattling on about social connections e of those differences may be traced som how and en; between men and wom back to our ancestors. would have sat in silence for hours In our evolutionary past, groups of men lly mammoth that might cross their hunting prey, focusing on that one woo s, women would have been gathering seed path. Meanwhile, back in the village, d ene ngth stre they as en with other wom weaving baskets and rearing children ily fam her and an wom a ensure that social bonds. That social capital might return from the hunt. not did man r thei if r afte ed would be look l we now pick up our prey from the loca While many things have changed and s age did we s way e in many of the sam shops, men and women certainly act s as he ‘hunts’ for the buffalo on the focu le sing a ago. My husband often has little list of jobs and details as I tend to our modern plains, and I have a running , man a as and age eng and ng ythi ut ever village. As a woman, I want to talk abo own without talking to a soul. he often works through things on his when it comes to our health and In my opinion, we act in a similar way It seems to me that women engage with engagement with the health system. than men. Perhaps this is because of the health system to a greater extent ments for (planned) immunisations and childbirth and the subsequent appoint means women manage their health (unplanned) gastritis... I don’t think this to our GP, friends or family about our better, but we may be more likely to talk d it. health and seek support when we nee ls, - whether it is with health professiona It is that engagement I want to highlight g livin is that life your in e or someon family and friends, or your own diabetes have different strategies around may en wom and men le with diabetes. Whi is etes gender neutral. Diabetes-related the way we approach our health, diab ific to men or women and everyone distress or complications are not spec is empowered with education and selfbenefits when the person with diabetes . management skills and social support you are a man or a woman, with or As you read through this issue, whether nce of engagement, connection and without diabetes, remember the importa one get from connecting and supporting social support, because the feeling we another is universal.
WINTER 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 Jennifer Sweeting, Melinda Morrison, Rachel Zinman, Sherl Westlund, Murdoch Books, Pacific magazines Photography DWA staff, magazine contributors, Shutterstock, 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
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Jennifer Sweeting is Diabetes WA’s Pilbara Diabetes Strategy Coordinator and holds a master’s degree in Anthropology and Public Health. She is an amateur blogger, a mother of two and is happily married to her modern-day caveman.
Women’s Contents Her Perspective Jennifer Sweeting .......................................... 2
Women’s Matters Diabetes and Women .................................... 3 In Good Company ........................................... 6 Pedicure Pampering ..................................... 8 Preparing for Pregnancy ........................... 10
Diabetic Living Recipes ............................................................ 12 A New Partnership ...................................... 13
Living & Moving Well Yoga for Diabetes ......................................... 14 Q&A ................................................................... 15
Research News Research Round-up ..................................... 16
Members’ Area Members’ Puzzle and Competition ......... 17
IN THE MIDDLE From the Chair ................................................ 1 Diabetes Research WA Update .................. 2
Diabetes News DAFNE in Albany ............................................. 3 Medication on PBS ......................................... 3 Generous Supporters ................................... 4
Education Planner Plan your Sessions ........................................ 5
Event News HBF Run for a Reason .................................. 7
Members’ Area Member Partners .......................................... 9
What’s On Dates for your Diary ..................................... 10
Women’s Matters … Why is my magazine back-to-front?
This unique issue of Diabetes Matters features what is known as a “flip-cover”. One half of the magazine is dedicated to women, and one half of the magazine is dedicated to men. There is then a middle section in the centre where we feature all the essential parts of our magazine we wouldn’t want you to miss out on. Though men and women share many common issues and challenges when managing their diabetes, there are some that are unique to the XX and XY chromosomes. Read on to learn more.
Despite statistics revealing that men have a slightly higher chance of developing diabetes than women, once diagnosed, studies have shown that the challenges are greater, on average, for women than men. This inequality was revealed in a 2007 study in the Annals of Internal Medicine that found that, between 1971 and 2000, death rates fell for men with diabetes, while rates for women with the condition didn’t budge. Additionally, the difference in death rates between women who had diabetes and those who didn’t more than doubled, and while men with diabetes live 7.5 years less on average than those who don’t have the condition, among women the difference is even greater at 8.2 years.
something happens that strips them of this advantage. Data shows that the risk for heart disease is six times higher for women with diabetes than those without. With men, diabetes increases the risk for heart disease two to threefold. Data also shows that women with diabetes are more likely than men with the condition to find it harder to manage blood glucose levels, to be obese, and to have high blood pressure and unhealthy cholesterol levels. (diabetesforecast.org)
So the question is: why the disparity? It is most likely a combination of factors, according to the study. At the core of it, the bodies of men and women are, of course, not the same so differences in physiology are certainly involved.
What compounds the female predicament is that heart disease is more deadly in women with diabetes than it is in men with the condition. Another 2007 study published in the European Heart Journal found that the association between diabetes and death by heart failure was stronger for women than it was for men.
Gender Play In the general population, women live longer than men, largely because of their lower rates of heart disease. Yet, when women develop diabetes,
This greater risk may stem in part from biological differences in how women and men experience heart attacks. For both, the most common
warning sign of a heart attack is chest pain or discomfort in the upper body. However, women are more likely than men to experience only nausea, shortness of breath, and back or jaw pain during a heart attack. If a woman experiences these but doesn’t recognise them as heart attack warning signs, she may not seek treatment, lowering her chances of recovery. Another diabetes complication, kidney disease, is also worse for women than men. In general, men have a higher risk for kidney disease, but that distinction again disappears with the appearance of diabetes. Hormones have a big role to play in this. Kidney disease often doesn’t affect women until they get to menopause, a time when oestrogen levels naturally fall. Studies have indeed found that lower oestrogen levels are associated with kidney disease, but it’s not known whether there’s a cause-effect relationship or exactly how the lack of 3
oestrogen may contribute to kidney disease. It’s also possible that high testosterone is to blame.
Hormonally Speaking Frequent hormonal changes in a woman’s body can cause emotional, physical or mental instability. And remember, insulin is itself a hormone, so it is inevitable that sex hormones and insulin will affect each other. At all stages of life, from puberty through to postmenopause, women experience a continuous cycle of hormonal fluctuations that affect brain chemistry and, therefore, their moods and bodies, which can present obstacles for managing diabetes and blood glucose levels. A study by the Queensland Clinical Trials and Biostatistics Centre at the University of Queensland showed that the fluctuating hormones associated with the menstrual cycle, childbearing, and menopause can affect the body’s sensitivity to insulin and make it more difficult to predict and maintain stable blood glucose levels. Some birth control pills can also increase blood glucose.
Attitude In addition to the physiological differences, many studies indicate that men and women have different attitudes and behaviours related to diabetes care. Females are generally more sensitive to illnesses and more willing to seek medical advice that often require additional, intrusive treatments. Women have a greater interest and concern for diabetes and are more likely to perceive symptoms (Anderson, Fitzgerald, & Oh, 1993). It’s been shown that women make greater use of diabetes services and have a larger network of people with whom to discuss medical problems. According to an Australian literature review, some of these differences may have evolved from the roles that men and women traditionally have played within the family structure, with women having greater responsibilities for family health.
Unique to Women
The risk of a urinary tract infection (UTI) is higher in women who have diabetes. UTIs develop when bacteria enters the urinary tract. These infections can cause painful urination, a burning sensation, and bloody or cloudy urine. If left untreated, there’s the risk of a kidney infection. UTIs are common with diabetes due to high blood glucose levels which can lead to poor circulation and the inability of white blood cells to travel through the bloodstream and kill infections.
Female sexual dysfunction Many women with diabetes experience sexual problems. Interestingly, as noted in our men’s section, the overwhelming majority of results for Google searches and literature reviews on complications specific to men with diabetes, centred on sexual issues and erectile dysfunction. In contrast, many of the articles that were sourced on women and diabetes claimed that “research about sexual problems in women with diabetes is limited.” Despite this lack of research, it is important to also address this issue for women. Sexual problems may include:
• • • •
decreased vaginal lubrication, resulting in vaginal dryness uncomfortable or painful sexual intercourse decreased or no desire for sexual activity decreased or absent sexual response
Decreased or absent sexual response can include the inability to become or remain aroused, reduced or no sensation in the genital area, and the constant or occasional inability to reach orgasm. Causes of sexual problems in women with diabetes include nerve damage (diabetic neuropathy), reduced blood flow to genital and vaginal tissues, and hormonal changes.
Polycystic ovary syndrome
High levels of glucose in the blood triggers the growth of yeast or fungus in the body. An overgrowth of yeast caused by the candida fungus can cause vaginal yeast infections, oral yeast infections, and vaginal thrush. These infections are common in women.
This disorder can increase the risk of developing diabetes. It occurs when the adrenal gland produces a higher amount of male hormones. Women who have polycystic ovary syndrome (PCOS) have immature follicles in their ovaries that form large cysts or lumps. While the egg does mature within the follicles, the follicles do not break open in order to release the egg. Signs of PCOS include irregular periods, excessive body or facial hair, weight gain and acne. It can also cause infertility and a type of insulin resistance. This results in elevated blood glucose levels and increases the risk of developing diabetes.
When the infection develops in the vaginal area, symptoms include itching, soreness, vaginal discharge, and painful sex. Oral yeast infections often cause a cottage-cheese coating on the tongue and inside of the mouth.
While not strictly a complication of diabetes by definition, gestational diabetes is an issue that all women planning a pregnancy need to be aware of. It is different from type
So what are the symptoms, complications and increased risks associated with both type 1 and type 2 diabetes that are unique to women?
Vaginal and oral yeast infections
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Urinary tract infections
Gestational diabetes
So What’s a Girl to Do? There are steps you can take to avoid or reduce the effects of diabetes complications and manage symptoms.
1 and type 2 diabetes because it’s specific to pregnant women. According to Diabetes Australia, gestational diabetes is the fastest growing type of diabetes in Australia, with 12% - 14% of pregnant women likely to develop it. The hormones of pregnancy interfere with the way insulin works. This causes the body to make more of it. However, for some women, this still isn’t enough insulin, and they develop gestational diabetes. Gestational diabetes often develops later in pregnancy. According to the National Institute of Diabetes and Digestive and Kidney Diseases, pregnant women diagnosed with gestational diabetes early in pregnancy may actually have had diabetes prior to pregnancy without realising it. In most women, gestational diabetes goes away after pregnancy, but having gestational diabetes significantly increases the risk of developing type 2 diabetes down the track. (see page 10 for our article on pre-pregnancy planning for women with diabetes)
Be Mindful While not unique to women, these complications occur significantly more frequently in women than in men.
Depression Research suggests that diabetes doubles the risk of depression compared to those without diabetes and it is almost twice as common in women as in men. While this is mostly thought to be due to the difficulty of coping with all the life changes and tasks that accompany both forms of diabetes, it may also be due to the direct effects of the condition on how the individual thinks and feels.
Eating disorders Another potential mental health issue for people with both type 1 and type 2 diabetes is distorted thinking about body size, especially among young women, which can lead to eating disorders. A healthy eating plan is a central part of managing diabetes, alongside medication and regular physical activity. This means that a person with diabetes has to focus on their food intake, over a long period of time, which can sometimes lead to a problematic relationship with food and eating. Insulin manipulation and other disturbed eating behaviours are strongly associated with poor metabolic management and an increased risk of early diabetes complications.
Keep a check on those fluctuating hormones. It is almost impossible to completely manage your hormone levels so being mindful that they will affect your diabetes is key. It may be necessary to increase your glucose level checks around your period, as hormone changes may affect your levels in a way you are not expecting. You will soon learn what to look for and adjust your medication or diabetes management accordingly. Hormone replacement therapy may be an option for women going through, or leading up to, menopause. It is important to educate yourself with the symptoms of menopause and diabetes as some women mistake symptoms of menopause to be issues with their diabetes management and vice versa. Some birth control pills can increase blood glucose. If you are taking birth control, ask your doctor about switching to a low-dose birth control pill or discuss the best options with him/her. Birth control may also regulate heavy and painful periods which in turn can make it easier to manage your diabetes. Regular health checks. According to the Annals of Internal Medicine 2007 study previously quoted, women with diabetes should be tested for heart disease risk factors, like high blood pressure or unbalanced blood fats more frequently, and treated swiftly. They also recommended that health history related to female biology should be taken into account more seriously for preventing diabetes and for managing it once diagnosed. Being aware of the increased risk of specific complications for women with diabetes, like kidney disease for example, ensures you and your doctor will be more likely to identify any symptoms early. UTIs. Drink plenty of fluids (mostly water) and if you do have recurring UTIs, consider drinking low-sugar cranberry juice (not cranberry juice cocktail) or taking cranberry supplements. Cranberries are thought to contain substances that prevent bacteria from sticking to the bladder wall. Eating yogurt that contains healthful bacteria can help, or take a probiotic supplement that contains lactobacillus rhamnosus or lactobacillus reuteri. Wear cotton underwear and urinate frequently – don’t hold it for too long. Talk it up. If you think you might be depressed or are struggling to cope with your diabetes management, seek help right away. Your doctor or diabetes educator can refer you to a mental health professional. Keep talking to family and friends about the way you are feeling as just speaking about what’s on your mind can ease the stress. Infections. If you do find yourself with a yeast infection, there are over-the-counter and prescription medications to treat it. Maintaining stable blood glucose levels can help you to potentially avoid yeast infections altogether. Regular exercise, reducing your carb intake and choosing low-glycaemic foods may also help. General health and fitness. While biology is important, it isn’t everything. There are lifestyle choices you can make, like exercising regularly and eating well, to improve your health and avoid diabetes complications. Maintaining a healthy weight, avoiding smoking and having a good relationship with your health care team are all important factors in managing your diabetes well. 5
In Good
As proof that diabetes really does affect everyone, these famous faces are living with either type 1 or type 2 diabetes or were diagnosed with gestational diabetes when they were pregnant. Verity Charles – type 1 Diagnosed with type 1 diabetes when she was 17 years old, our HBF Run for a Reason Ambassador Verity Charles is living proof that people with type 1 diabetes can achieve their dreams. Verity plays centre for the West Coast Fever netball team and says she would love to inspire even one young girl with diabetes who wants to be an athlete.
Theresa May – type 1
Halle Berry – type 1
The Prime Minister of the United Kingdom, Theresa May, lives with type 1 diabetes and is the first world leader to have the condition. She was diagnosed with type 2 diabetes in 2013 following a blood test to assess significant weight loss. However, the tablets she was prescribed by doctors failed to work and subsequent tests revealed that she actually had type 1. Managing type 1 diabetes in a highprofile job required adjustments. In an article with UK magazine, Balance, Theresa May explained: “I go to a lot of functions where I am eating and I speak at dinners, so that brings an added complication. When I’m going to do a debate or speaking at a conference, I have to make sure that I’ve tested and know where I am, so I can adjust as necessary.” In fact, she had to break the House of Commons’ rules on not eating in the Chamber when she ate some nuts during a debate without being seen by the Speaker. While playing a vital role in the running of a country and successfully managing her type 1 diabetes, Theresa May is a tribute to not letting diabetes stand in the way of what you do with your life. 6
Oscar-winning actress Halle Berry is known for her roles in films such as Monster’s Ball, X-Men, and Die Another Day. In 1989, at the age of 19, the now 51-year-old actress went into a diabetic coma during a taping of the television show Living Dolls, and was later diagnosed with type 1 diabetes. Since then, Berry has talked openly about managing her diabetes, even going so far as to controversially claim she had been cured by weaning herself off insulin in 2007. She now “considers herself to be in the type 2 diabetes bracket”. Many experts speculate that she is either confused or was simply misdiagnosed and had type 2 diabetes all along.
Marcia Hines – type 1 Marcia Hines has lived with type 1 diabetes for more than 30 years. The Aussie music icon manages her condition with regular exercise, a healthy diet and the occasional treat. In 2010, she starred in Sweet Talk - My Life with Diabetes in a bid to build awareness and education.
Company Salma Hayek – gestational Actress Salma Hayek had gestational diabetes while pregnant with her daughter, Valentina in 2007. Best known for her Academy Awardwinning portrayal of Frida Kahlo in the movie Frida, she has, in recent years, become a self-assigned spokesperson for gestational diabetes. With a family history of diabetes, she speaks about the importance of raising awareness of the condition, and ways to eat well during pregnancy.
Patti LaBelle – type 2
Mary Tyler Moore – type 1
On her website, American singer Patti LaBelle, who has a family history of diabetes, opens up about her diagnosis of type 2 diabetes. “I passed out on stage ... and the doctor came back to me and said, ‘Did you know you were a type 2 diabetic?’ And I said, ‘I had no idea,’” she states. She has since written healthy cookbooks, and called herself a ‘Divabetic’ - a combination of ‘Diabetic’ and ‘Diva’ - in People magazine in December 2008.
The late actress was diagnosed with type 1 diabetes at age 30, when she was hospitalised after having a miscarriage. A routine blood test at the hospital showed a very high blood glucose level. “They put me on insulin right away,” she told Larry King in 2005. She played an active part in promoting diabetes research and was the international chairman of the Juvenile Diabetes Research Foundation in the US. She died January 25, 2017.
Mariah Carey – gestational When singer Mariah Carey was pregnant with twins Monroe and Moroccan, now six, she was diagnosed with pre-eclampsia and gestational diabetes. Mariah recalls in a recent magazine that it was “a really difficult pregnancy” and has openly said that she won’t be adding to her family.
Cathy Freeman – type 2
Billie Jean King – type 2
Cathy Freeman’s pre-diabetes turned into type 2 after the birth of her daughter, Ruby, almost seven years ago. Despite a family history of the condition, the diagnosis came as a shock to the Olympic gold medallist who believed she would be safe from “lifestyle” diabetes. Cathy’s since been committed to raising awareness that Indigenous Australians are three times more likely to develop the condition.
The tennis great says as an athlete she’s always been mindful of diet and exercise, but when she was diagnosed with type 2 diabetes in 2007, she had to focus even more. The subject of 2017 film, Battle of the Sexes, said in a magazine article, the hardest change was cutting back on carbs and sugars. She tells people who are diagnosed: “Just know that you can live a normal, wonderful, terrific, active life.” 7
Pedicure Though not exclusive to women, a pedicure is often a bit of pampering that many women treat themselves to. It’s a simple act of indulgence: sinking into a comfy massage chair and surrendering to an adept technician who rubs away tension, kneading lotion into thirsty skin. In fact, the process of getting a pedicure often has less to do with perfectly polished nails and more to do with taking time out of your day to relax. Professional pedicures can help your toes look their best and pamper your feet, but too often poor sanitation practices, shared tools, and the work of overzealous nail technicians can result in skin injuries or infections. So before you kick off your shoes, consider the potential downsides of pedicures. Pedicure problems can happen to anyone, but if you have diabetes, you need to be especially careful about protecting your feet. An infection can raise your blood glucose levels, which, in turn, can interfere with proper healing and increase your risk of serious complications like ulcers or even, in the worst cases, amputation. “People with diabetes are at risk for a number of complications. Foot infections are common. If you develop a break in the skin, even the smallest nick, it can develop into a significant complication,” Diabetes WA diabetes educator Marian Brennan says.
with Diabetes WA ch u to in t o g s er g Jennifer Ro her story; recently to share nded set diabetes. I atte
th late on I was diagnosed wi o, ag s ar ye t five months later six rly “Nea a type 2 patient, bu as s m ra og pr on many of the educati pendent. became insulin- de time pedicure at a at myself to a first tre to ed cid de I , holiday find I had a nail Recently before a four weeks later to ish rn va il na e th moved shopping mall. I re ould be infection. le with diabetes sh reading that peop or ld to e use of ing th d be an er n infectio I do not recall ev cause of the fear of be s, lon urred sa e inc n es th tio major infec wary of attending urance cover on a ins no is e er Th s. sharp instruments. ked if I had diabete and I was never as s, lon sa d e es th of at any s aware of this an make their patient to rs cto do d an s ator I would like all educ agazines.” shed in diabetic m bli pu be to an article
So it is important to be cautious, but people living with diabetes can still indulge in a pedicure, as long as you do your homework and are picky about your salon. If done well, pedicures can ensure that feet are clean and hydrated, which is important when you are managing diabetes. Before you schedule a pedicure, check with your doctor to make sure it’s okay to have one. If you are healthy and complication-free, getting a pedicure doesn’t pose a threat the way it does for people with the foot complications of diabetes. But if you have an infection, ulcer, cut, or neuropathy, don’t book an appointment. An open wound is an open door for any bacteria that may be in the foot basin’s water, and nerve damage will make it hard for you to tell if you’ve been cut or if the bath’s water is too hot. 8
Pampering Once you get the green light, do your feet a favour and learn what to look for — and what to avoid — at nail salons. Taking a few basic precautions can significantly reduce infection risks and lead to a safer, more pleasant experience.
• Know when to postpone a pedicure. If you currently have any infections, cuts, or open sores on your legs, feet, or toenails, skip the salon since these will make you even more vulnerable to problems. Instead, contact your doctor for a referral to a podiatrist.
• Avoid shaving your legs for a day or two before your pedicure. Shaving
can leave tiny nicks in your skin (even if you can’t see them) and increase the chance of infection. It’s fine to shave afterward.
• Stick with a salon that is clean and practices impeccable sanitation. Tell the manager you have diabetes and ask about their sterilisation procedures; reputable salons will be more than happy to show you how they operate. Foot baths should be cleaned and disinfected between customers. Clippers and other tools should be washed and sanitised in a disinfecting solution or a surgical autoclave, which uses pressurised steam to sterilise instruments.
• Better yet, invest in your own nail kit and bring it with you. Though it’s
unlikely that you will get an infection from shared nail polish, play it safe and bring your own.
• Make a morning appointment. If you can, schedule your appointment early in the day so that you are one of the first customers.
• Let your technician know you have diabetes before the pedicure
begins. Ask them to be very gentle and avoid doing anything that can scratch or injure the skin. Don’t hesitate to speak up if you don’t like what the technician is doing — your health is too important.
• Keep the technician informed of protective practices. Ask the technician not to cut nails too short, as this can encourage ingrown toenails and lead to infection. Make sure toenail edges are not sharp; they should be rounded off with a file.
• Skip any services that can injure the skin. Never allow the technician to
cut your cuticles or use any sharp instruments on your skin or under your toenails. Instead, after your feet have been soaking for a few minutes and the skin around your toes is soft, cuticles can be gently pushed back with an orange stick.
• Request gentle pampering. Pumice stones or abrasive tools are okay
for calluses and rough areas, but ask the technician to be very gentle. Vigorous scrubbing is not necessary and can easily scratch or leave microscopic tears in the skin, making you more susceptible to infection.
After your pedicure is finished, keep an eye on your feet and legs for any signs of redness or infection. If you notice anything unusual, call your doctor right away.
Pedicure vs Podiatrist “Remember not to confuse a beautician’s pedicure with a visit to a qualified podiatrist who will check on the health of your feet and ensure that you aren’t developing any complications,” Marian says. This an essential part of your annual cycle of care and shouldn’t be overlooked. One our member benefit partners, Podiatrist Perth, offers a 10% discount on the initial consult for Diabetes WA members, so take advantage of the offer and keep on top of those toes. Visit podiatristperth.com.au for more information.
Become FootSmart Feel like you need some more practical tips on how to look after your feet? Want someone to show you what to do? Diabetes WA offer the FootSmart program - a FREE 90 minute session that will teach you all you need to know about checking and caring for your feet. Visit our website to book yourself into a session near you. Search for SMART programs on diabeteswa.com.au
DIY Pedicure at Home If the risk of using a nail salon just sounds too high to you – DIY a home pedicure. Ideally, you should wash and inspect your feet daily, so why not turn the chore into a treat. 1. Wash. Clean feet are healthy, so perform this task daily—not just for a pedicure. 2. Exfoliate. Get rid of the dry skin that prevents full moisture absorption with a pumice stone. 3. Moisturise. Rub a thick moisturiser into feet, avoiding the area between toes. 4. Clip. Cut toenails straight across to prevent ingrown nails. 5. Soften. Stop cuticles from cracking by rubbing them with a soothing oil. 6. Polish. Have fun and choose any colour that suits your mood.
(source: everydayhealth.com)
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Preparing for give you the best possible start for a healthy pregnancy”. It is recommended that you have a review of your diabetes, and general health, at least three to six months before you start trying for a baby. “A review of your diabetes management should include advice on glycaemic targets, blood glucose self-monitoring and a review of current diabetes medications,” Melinda explains. “Your diabetes health professionals can provide an update on managing high blood glucose levels and sick days, prevention and management of hypos, as well as healthy eating for diabetes and pregnancy nutritional needs.”
Becoming a mother is one of the most memorable moments in a woman’s life, but for women with diabetes, pregnancy also involves a lot of planning and preparation. Women with diabetes can have a healthy baby, but there are extra risks to be aware of. Each year in Australia, approximately 11 births in every 1000 are to women with pre-existing diabetes and the prevalence of type 1 and type 2 diabetes in pregnancy is increasing.
While these risks sound alarming, we know that with careful planning, the risks can be significantly reduced. Remember that most women with diabetes will have a healthy baby.
If you have type 1 or type 2 diabetes and are planning a family, it is best that you become pregnant at a time when your diabetes is well managed and there are no other health issues. Preparation prior to pregnancy and diabetes-specific care gives you the best chance of a healthy pregnancy and a healthy baby.
Melinda Morrison, who is the National Lead for Diabetes in Pregnancy for the National Diabetes Services Scheme*, explains how managing blood glucose levels in early pregnancy and effective preconception planning can improve pregnancy outcomes for women with diabetes.
Pregnancy and diabetes risks Having diabetes can increase the risk of complications during pregnancy, including birth defects and pregnancy loss. The risk is higher when blood glucose levels before and during early pregnancy have not been within the target range. High blood pressure, pre-eclampsia, and an increased risk of having a large baby are also possible complications that can develop. 10
“The first eight weeks of pregnancy is the time when a baby’s major organs develop, so it is important that blood glucose levels are as close to target as possible at conception and in early pregnancy,” she says. “Research tells us that diabetes specific prepregnancy care can reduce the risk of health problems during pregnancy. So getting the right information and advice, as well as the necessary health checks, before you fall pregnant can
Your health care provider might also suggest scheduling preconception appointments with an obstetrician, a diabetes educator, a registered dietitian or other specialists. If you are not sure who to contact to obtain this advice, or if you live in a rural area where services are limited, ask your GP about Diabetes Telehealth or shared care with a major hospital, or visit our website diabeteswa.com.au for more info.
Contraception It’s important to use effective contraception until you are ready to start trying for a baby. It is possible to fall pregnant as soon as you stop using contraception, so it’s important to continue using contraception until your diabetes is well managed and your body is at its optimal state to fall pregnant. A healthy pregnancy is worth the wait. If you are sexually active and aren’t currently using contraception, your doctor can advise the most appropriate contraception for your circumstances.
Glucose targets Diabetes WA credentialed diabetes educator June Lee says, “We recommend that women with diabetes seeking to conceive strive to achieve blood glucose and haemoglobin
Pregnancy A1c (HbA1c) levels as close to normal as possible, when they can be safely achieved without undue hypoglycaemia.”
HbA1c targets may differ between type 1 and type 2 so it is vital to discuss your individual blood glucose and HbA1c targets with your diabetes health professionals, including how you can reduce your risk of hypoglycaemia (hypos).
it might be necessary to introduce insulin earlier if you are not already using it.
High-dose folic acid Folic acid can help reduce the risk of certain birth defects. Women with diabetes need to have a higher dose of folic acid than women without diabetes. Start taking high-dose folic acid every day for at least one month before trying to fall pregnant. Your doctor may recommend you take half to one 5mg tablet, depending on other supplements you are taking.
General health and fitness As well as reducing diabetes-specific risk factors, it is also important to focus on your general health and fitness while preparing for pregnancy. Visit your GP who can advise you about blood tests, vaccinations and the nutrient supplements you need to take before pregnancy.
Complications screening Your doctor should conduct a full diabetes complications screening prior to pregnancy, or if you have already fallen pregnant, as soon as possible. Your eyes, kidneys, thyroid and heart/blood pressure should all be checked, along with your vitamin D levels, an assessment for peripheral neuropathy and, for women with type 1 diabetes, a screening for coeliac disease. Pregnancy may accelerate the progression of preexisting diabetes complications so it’s important to know the ‘state of play’ before becoming pregnant.
Review of medications If you are currently taking any medication, including medication to manage your diabetes, it will be necessary to review them to ensure they are safe for use in pregnancy. Many diabetes medications are harmful to a developing foetus, and
A healthy eating plan and regular physical activity can help with aiming for a healthy weight before becoming pregnant. Your food choices are not only important for providing nourishment for both you and your baby, but are also an integral part of your diabetes management and general health. If you need a refresher, speak to your dietitian or book into one of Diabetes WA’s education programs to get some practical tips.
You’re ready to start a family So you’ve had the green light and you’re ready to start trying for a baby. Once your pregnancy is confirmed, what’s next? Looking after your diabetes is important throughout your pregnancy. Well-managed diabetes can help reduce the risk of complications during pregnancy, including high blood pressure and the chance of your baby growing too big. There are a number of ways that pregnancy will affect your body and your diabetes. These changes will affect your blood glucose levels and insulin requirements. You may also experience more hypos in early pregnancy and your hypo symptoms may change. Keep in mind, you will need to have your diabetes management reviewed more often during pregnancy. Article sources: pregnancyanddiabetes. com.au, Diabetes Management Journal Feb 2018; NDSS Pregnancy and Diabetes Factsheets; Diabetes & Primary Care Australia Vol 2 No 2 2017 *The National Diabetes Services Scheme is an initiative of the Australian Government administered with the assistance of Diabetes Australia.
pregnancyanddiabetes.com.au
Emotional well-being When there are so many things to think about it’s not surprising that women with diabetes sometimes feel worried, stressed, anxious and uncertain while preparing for pregnancy, during pregnancy and once the baby is born. These feelings are very normal and may come and go at different stages of your pregnancy journey. It’s important to talk about how you are feeling with a loved one or health professional. If you feel you need further support, ask your diabetes health professionals about the support that is available locally.
If you are living with diabetes and are planning a pregnancy now or in the future, or you know someone who is, the NDSS has information available to help you. Some brochures can be found on the Diabetes WA website, but you can also visit pregnancyanddiabetes.com.au to access NDSS resources, factsheets and checklists. 11
DIABETIC
living
LEMON BERRY PUDDING CAKE
Lemon Berry Pudding Cake Prep: 20 mins Cook: 3 hours Serves: 6 (as an occasional dessert)
Ingredients
125g punnet blueberries and/or raspberries 110g (½ cup) sugar, plus extra 1 tbsp 40g (¼ cup) plain flour Zest of 1 lemon 60g light margarine 3 x 60g eggs, at room temperature, separated 250ml (1 cup) skim milk 3 tbsp fresh lemon juice
Method
1. Spray a small slow cooker with cooking spray. Sprinkle berries over base of slow cooker and sprinkle with 1 tbsp sugar. 2. Combine ½ cup sugar, the flour and lemon zest in a medium bowl. Add margarine and egg yolks. Beat on low speed to combine. Add milk and lemon juice. Beat until well combined. 3. Wash and dry beaters. Using electric beaters whisk egg whites in a medium bowl until soft peaks form. Fold egg whites into batter until combined. 4. Carefully pour batter over the berries in the cooker, spreading out evenly. Cover and cook on high-heat setting for 2½-3 hours or until cooked. Set aside for 10 minutes before serving.
Nutrition Information per serve Energy Protein Fat, total — saturated Carbohydrate Sodium Fibre • Carb exchanges 2 • GI estimate medium
12
864kJ 6g 7g 2g 30 g 103 mg 1g
DIABETIC
living
Exciting New Partnership Diabetes WA is always on the lookout for new ways to benefit our members.
COMING SOON!
When the opportunity presented itself to partner with Pacific Magazines we jumped at the chance. With a portfolio of market-leading magazines and websites, the partnership is a perfect fit. Pacific is the publisher of Diabetic Living – the healthy lifestyle magazine for people living with diabetes. With an abundance of expert-endorsed health information, delicious dietitian-approved recipes and news on advances in health from around the world, Diabetic Living helps those living with diabetes, and those who care for them, make informed decisions every day. The magazine is a fabulous accompaniment to your members’ magazine, Diabetes Matters. In a special offer for Diabetes WA members, Pacific is offering an enormous 41% discount on the cover price of Diabetic Living. See the advertisement below to find out how to subscribe today and claim your member discount. Additionally, each issue of Diabetes Matters will feature two delicious recipes from the Diabetic Living collection. This Winter edition features a sweet dessert in our Women’s section and a ‘Dude Food’ recipe in our Men’s section – though really, these recipes will be appreciated by any hungry person – male or female!
Look out in the Spring edition of Diabetes Matters for more information on another new member benefit soon to be offered as part of our partnership with Pacific. Members will have the opportunity to obtain a discount on subscriptions to Better Homes & Gardens magazine and Women’s Health magazine. Watch this space …
SPECIAL OFFER FOR DIABETES WA MEMBERS
Get 6 issues of Diabetic Living for only $28 Each issue of Diabetic Living comes filled with delicious and healthy recipes, lifestyle tips and conveniently delivered to your door. Eat better, feel better, live better with Diabetic Living.
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TIPS TO
Need a weight loss jumpstart? Try tinkering with your everyday routine to drop a few kilos and gain energy
SAVE
41%
Fill up on fruit and veg
3 Enlist help
Reduce kilojoules (and carbs) by sprinkling blueberries instead of croutons onto green salads and mixing in lots of capsicum, celery and cucumbers. Non-starchy vegetables such as broccoli, greens and tomatoes contain less carbohydrates than other vegies but still pack a nutritional punch.
6
Get your zzzzzzs
1
Walk it off
Thirty minutes of walking burns about 630 kilojoules – and you don’t have to do it all at once. Briskly stroll to a nearby park to eat your lunch. Or, instead of watching your kids’ or grandkids’ sporting events from the sidelines, keep an eye on the action while walking around the field. Make sure you check your feet before and after walking, and always wear sneakers to protect from injury.
TIP
Take extra carbohydrates before and during exercise to prevent hypoglycaemia. Discuss with your doctor or dietitian first.
Make an appointment with a dietitian or nutritionist to work up a meal plan that can help you lose weight. And, if you haven’t exercised before, ask your health care provider to time your medication and meal schedules to suit your workouts.
5
4
Skimping on sleep can cause weight gain, add stress and compromise your immune system. When University of Chicago researchers restricted 10 dieters’ sleep to less than six hours a night, the dieters lost only half the amount of fat (and more muscle) than when they got more than eight hours. Sufficient shut-eye is also key for blood glucose control.
healthy healthylife SHALL WE PLAY A GAME MC:T1 – a modified version of the popular digital game Minecraft – is the brainchild of a Brisbane father who was inspired by his son’s diagnosis with type 1. Designed to help PWD learn how to manage their condition, the game sees players walk around the Minecraft world, but with the addition of monitoring their insulin and blood glucose. The father’s start-up was recently given a grant by the Queensland University of Technology to build the game MC:T1 (Minecraft for Type 1 Diabetes) and develop an educational plan for health professionals and parents. Visit magikcraft.io and research.qut.edu.au/dmrc for more.
Look at your blood glucose-lowering medications with your provider. Some newer medicines, such as Liraglutide and Byetta, may aid in weight loss.
Turn off the TV
7 Get fit during the commercials When watching TV, get up and do one minute of jumping jacks or a minute of knee raises when the commercials come on. Researchers at the University of Tennessee, Knoxville, found that stepping in place during commercials burns an average of 620 kilojoules in about 25 minutes.
84 JANUARY/FEBRUARY 2017 diabetic living
www.subscribetoday.com.au/DL/DWA TERMS AND CONDITIONS: Diabetic Living is published bi-monthly. Offer valid for Australian delivery only. Offer ends 30/06/19. Subscriptions may not include promotional items packed with the magazine. Pacific Magazines Pty Ltd is collecting your personal information for the purpose of processing and managing your subscription. As a subsidiary of Seven West Media Limited, Pacific will handle your personal information in accordance with Seven’s Privacy Policy, which is available at subscribetoday.com.au/privacy-policy.
&
The latest facts & global news on diabetes, body image, broccoli & positivity
Review your medications
A recent review of more than 50 studies confirms that too much screen time is linked to consuming fattening fast foods, energydense snacks and high-calorie drinks.
Latest News
YOUR
Q
15 tune up
living well
Blog life
From online forums for PWD to advice from professionals, these inspirational blogs cover the daily struggles of PWD, as well as giving tips on how to live a healthy life with diabetes.
• DIABETES STOPS HERE (diabetesstopshere.org) Produced by the American Diabetes Association, and born from their movement ‘Stop Diabetes’, this blog shares stories of courage, love and resilience from people living with both type 1 and type 2 diabetes.
• DIABETIC FOODIE (diabeticfoodie.com)
Shelby is a keen foodie who also has type 2 diabetes. Firmly believing “a diabetes diagnosis is not a dietary death sentence”, she shares many healthy, delicious and diabetic-friendly recipes for readers to enjoy.
• DIABETES SISTERS (diabetessisters.org/blogs)
There are separate blogs for type 1 and type 2 diabetes, with the goal of helping readers living with diabetes have healthier, fuller lives. The online forums are a safe place for women to freely share information.
STEP 1
Over the past 20 years, University researchers at Finland’s on a of Tampere have worked could potentially prototype vaccine that developing in prevent type 1 diabetes is not a cure, nor children. Although this altogether, it will it eliminate diabetes immunity. Clinical will, hopefully, provide 2018, although trials are set to begin in the results will not be apparent years. eight for about
A
ASK
SH
Health & Fitness
A DR M
R
Should I avoid bread if I have diabetes and am trying to lose weight?
Let’s get physical Aerobic exercises (such as walking, jogging and light cycling) are associated with a reduction in glycemia, in comparison to a temporary increase in glucose levels during anaerobic exercises (such as sprinting, heavyweight lifting and interval sports, such as hockey). Both forms of exercise produce hypoglycemia in the
88% of Australian girls with type 1 desire a slimmer body, and 76 per cent of boys were not happy with their bodies. The stats came from a study conducted by Deakin University researchers of Australians aged between 13 and 19 who have lived with type 1 diabetes for more than 12 months. It further found that only 43 per cent of the boys studied specifically wanted to lose weight.
individual’s late recovery, which often occurs while sleeping. However, it is less common for PWD who are more physically active to get diabetic-related eye disease and kidney disease, and they also have a better chance of reaching the ideal targets for blood pressure levels, glycated haemoglobin levels and a healthier body mass index (BMI).
Confused about glucose? Diabetes Australia has recently launched a new Position Statement on the importance of glucose selfmonitoring. Being a rapidly changing area, the new Position Statement makes it easier for individuals to better selfmanage their condition, discuss the technologies available for glucose monitoring – as well as the pros and cons – and the evidence behind them. It’s all online for your perusal. To read the new Position Statement, visit diabetesaustralia.com.au.
Dr Marsh says: I get asked
this a lot. Many people think bread is something to avoid, yet the right type of bread can be a healthy carb choice. It is often lower in carbs and glycemic index (GI), and higher in fibre and nutrition than other carb choices such as cracker biscuits, rice, pasta, potato and many processed breakfast cereals. The best choices are dense, grainy breads – the ones with lots of visible grains and seeds. These breads have more nutrition and fibre, and when the grains are still intact, rather than milled into flour, they have a lower GI. If you don’t like grains, or can’t manage them due to dental or digestive problems, wholemeal sourdough bread is the next best option. There’s good evidence that eating more wholegrains can help with weight management. They also provide important vitamins and minerals. Bread is an easy way to get more grains in your diet. ➤ Dr Kate Marsh, advanced accredited practicing dietitian and credentialled diabetes educator Email your questions to: diabeticliving@pacificmags.com.au Post: Diabetic Living, Q&A: Health, GPO Box 7805, Sydney, NSW 2001.
12 JANUARY/FEBRUARY 2018 diabetic living
1300 668 118
and quote T8CDKZZA
13
LIVING & MOVING
well
Yoga for Diabetes Rachel Zinman was diagnosed with LADA type 1 diabetes (Late-onset Autoimmune Diabetes in Adulthood: similar to type 1 but diagnosed in adulthood) at the age of 42, nearly 25 years into her career as a yoga teacher in Australia. After initially being shocked at her diagnosis, once she came to terms with the condition, she decided to write a book to share her personal story and to show others how yoga has helped her, alongside insulin therapy, to manage her diabetes.
source of her diabetes was autoimmune and that eventually she would require insulin therapy.
Rachel first looked for answers in the holistic health community only to discover that, though many holistic approaches can support the body and the immune system, they can’t cure type 1 diabetes.
Yoga for Diabetes includes practical tips to incorporate yoga into a daily diabetes management plan and includes breathing, mindfulness and lots of information about how to find the right yoga for, not only the type of diabetes one has, but the individual constitution. “Yoga has helped me so much and I would love people living with diabetes to know that there are simple things they can do every day to reduce stress and achieve more balanced glucose levels,” Rachel says. Rachel was diagnosed through a routine blood test, and made the wrong assumption that she had type 2 and could reverse it, even though the doctor told her the 14
There is a history of type 2 in my family, on my mother’s side, but no one that we know of with type 1.”
“As my search progressed my symptoms worsened and it was actually the fear of permanent nerve damage that woke me up,” she says. “I had to accept the diagnosis and go on insulin or lose the feeling in my hands and feet. As a yoga teacher, focused on my health, I couldn’t believe how out of hand I had let things get - going on insulin was my way of coming to terms with reality.” “When I was first diagnosed I felt shocked, ashamed and completely devastated,” Rachel reflects. “I didn’t know that type 1 has no known cause or cure, so I assumed I’d done something wrong.
Rachel believes that yoga works because the breathing and stretching gives the practitioner direct access to the nervous system. “If we can calm the nervous system - which is on high alert - then there is a chance that a
LIVING & MOVING reduction in cortisol will also help to stabilise blood glucose levels.
Vata (air and space) Pitta (fire and water) and Kapha (water and earth) and how these work together.
“I find yoga helps with my diabetes in a few different ways. I sleep better, digest better and am more sensitive to Insulin. I’m also less reactive and more responsive to my experience of living with diabetes. Instead of getting caught up in my fears or feeling like I am not handling my management I have a more loving and accepting attitude towards myself and the condition.”
Rachel believes that if you are looking to reduce stress, better manage your blood glucose levels and are wanting to try yoga, but aren’t quite sure if yoga is for you, her book will gently guide the way with inspiring beautiful photos, and easy to implement practices for anyone at any stage or age. “You don’t have to be fit or flexible to do yoga,” Rachel says. “You can do yoga
Rachel works specifically on poses which work with the digestive system, like twists and forward bends, and restorative yoga to calm her nervous system. She also likes to do postures which work the thigh muscles (like chair pose and warrior pose) to help her muscles burn glucose for fuel.
Q
I am currently 23 weeks pregnant with my second child and have my glucose screening test coming up. I was previously diagnosed with gestational diabetes and found the test to be a long process. Have you got any tips for my appointment this time around? Victoria, previously diagnosed with gestational diabetes.
sitting in a chair or even lying in bed and, in conjunction with your insulin regime, can provide many benefits to assist you in managing your diabetes.” Rachel is giving away a copy of her book, Yoga for Diabetes, to TWO lucky readers. She will also be generously donating a portion of the WA sales of her book to Diabetes WA. Yoga for Diabetes is available online at Amazon.com.au and Booktopia.com.au
For your chance to win, send us your details: Name, Phone number, Address and Email address By Post: Yoga for Diabetes Competition Editor Diabetes Matters PO Box 1699 Subiaco WA 6904
People have been looking to Ayurveda, the ‘sister science’ of yoga, to help manage their diabetes for over 4,000 years. The practice looks at the functional elements in the body, called Doshas, which consist of
Q &A
well
By email: membership@diabeteswa.com.au Entries close 1 September 2018.
A
DWA Diabetes Educator Nyaree Lawler says… Yes, the oral glucose tolerance test takes two hours, which is a long time to sit around a waiting room. However, it is the most accurate way to diagnose gestational diabetes and is an important screening tool to help keep your baby healthy. Try to get to the pathology centre as soon as it opens, before everyone else gets there, as that will reduce the time you have to wait to get the test done. If you have other children, see if you can find someone to look after them for you, or take plenty of toys and snacks for them. Have some food ready for yourself to have once the test is done, as you won’t be allowed to eat during the test. Take a good book, have a playlist ready on your iPod or use the time to catch up on emails. You might even get time for some online shopping! Do keep in mind, that if you are once again diagnosed with gestational diabetes, it is a good idea to have another oral glucose tolerance test 6-12 weeks after the baby is born and then every 1-2 years, due to the increase risk of developing type 2 diabetes down the track.
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. 15
RESEARCH
news
Research Round-Up It’s great news for cheese lovers
The FDA has granted permission for a Belgian company to begin a clinical trial for a type 1 diabetes treatment that uses a bacterial strain also used in cheese production. ActoBio plans to begin a PhaseIb/IIa study for its drug, AG019, to treat early-onset type 1 diabetes. The oral capsule contains lactococcus lactis, a type of bacteria used to produce cheese and buttermilk.
It’s good news for PWD* and eating disorders A study of women with diabetes and eating disorders found that women who stopped restricting their insulin maintained a healthy weight, while those who continued to withhold insulin actually gained weight over time, showing that ‘people with eating disorders can get better and not be fearful of weight gain.’ *PWD: People with Diabetes
It’s bad news for women with the KLF14 gene Oxford researchers have identified the KLF14 gene which, in women, decides whether they store fat around their waist (which increases the risk of type 2 diabetes by 30%) or hips (which does not increase the risk of diabetes).
16
Longer breastfeeding tied to lower diabetes risk for mothers Mothers who nurse their babies now have another reason to continue as long as they can: longer periods of breastfeeding are associated with a lower risk of diabetes even decades later, a U.S. study suggests. Researchers examined data on 1,238 mothers without diabetes at the outset. Over the next 25 years, 182 women developed diabetes. Compared to women who didn’t breastfeed at all, mothers who nursed babies for at least six months were 48 per cent less likely to develop diabetes. “There could be greater health benefits for women from breastfeeding than previously recognized,” said lead study author Erica Gunderson of the Kaiser Permanente Division of Research in Oakland, California. Overall, 34 per cent of women in the study nursed infants for up to six months, 22 per cent breastfed for six to
12 months, and 19 per cent nursed their babies for a year or more. 25 per cent did not breastfeed at all.
Among women who didn’t breastfeed at all, 10 of every 1,000 typically developed diabetes each year, the study found. That dropped to fewer than 7 cases for every 1,000 people each year for women who nursed babies for up to six months, fewer than 5 cases for women who nursed up to one year and fewer than 4 cases for mothers who breastfed for longer. The study also showed that, though a diabetes diagnosis after pregnancy was much more common among women who developed gestational diabetes while they were pregnant, longer periods of breastfeeding were still associated with a lower risk of diabetes later on. Source: JAMA Internal Medicine
Antioxidants may decrease cardiovascular risk in women with type 1 The high oestrogen levels that typically afford younger women protection from cardiovascular disease appear to instead multiply their risk if they have type 1 diabetes, researchers say. A new study is examining the blood vessel health of these women during normal oestrogen peaks and valleys and seeing whether treatment with over-thecounter antioxidant supplements can help restore protection. Epidemiological data indicates women with type 1 diabetes have 2-3 times greater risk of cardiovascular disease than men with type 1, which could be related to oestrogen levels, among other factors. Oestrogen seems to be key in the early, rapid aging of their cardiovascular system. The study is showing early evidence that in diabetes, the sex hormone oestrogen produces a double whammy that increases levels of damaging oxidative stress while dramatically decreasing blood vessels’ ability to dilate. More typically oestrogen does just the opposite. “When you have diabetes, oestrogen turns into a bad guy,” Dr. Ryan A.
Harris, lead physiologist for the study, said. “It actually causes blood vessel constriction when you have high levels of oestrogen.” “Even isolated in a dish, when you put oestrogen on a blood vessel, it dilates, and when you put it on a diabetic blood vessel, it contracts.” “Once we can identify why oestrogen causes vasoconstriction instead of vasodilation in these women, then we could introduce non-pharmacological treatments throughout the menstrual cycle that could ultimately reduce their cardiovascular disease risk,” Harris said. Researchers will use the natural high and low points of the sex hormone over the course of the participants’ natural cycle and will look at vascular health before and two hours following treatment with antioxidant supplements, such as vitamins C and E, or placebo. The team expects the response of those treated to normalise to that of healthy controls. Harris’ lab has already seen an increase in blood vessel health at peak oestrogen periods even in women without type 1. Source: news-medical.net
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.
Diabetes WA
MEMBERS
area
MIND MATTERS Give these head-scratchers a try. QUESTION 1 If you started spelling out numbers (one, two, three and so on) how far would you have to go until you found the letter ‘A’? QUESTION 2 I am a solitary word, 5 letters long. Strike my first letter, and I am still the same. Strike my next letter, and I am yet still the same. What word am I? QUESTION 3 Emily loves cats and she keeps some as pets. All but two of them are completely black. All but two of them are completely white. All but two of them are completely ginger. How many cats does she have in total? See answers at the bottom of this page
Women’sWinter
Competition
Learn how to keep your hormones happy with Belinda Kirkpatrick and Ainsley Johnstone. WIN! Discover how to feel your best and balance your hormones, naturally. Healthy Hormones is about making small and realistic changes to help your body function at its optimum level. A guide to understanding your hormones, providing easy ways to manage symptoms and hormonal conditions through diet and lifestyle. Healthy Hormones also features 50 deliciously healthy family recipes, specially created and styled. Our lovely friends at Murdoch Books have given us a copy of Healthy Hormones to give away. Publisher: Murdoch Books RRP: $35.00
To enter, complete the competition slip below and mail to: Diabetes Matters – Women’s Winter 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 September 2018.
Answers: 1. One thousand 2. Alone – Lone (cross out the A = Lone) One (cross out the L = One) 3. Three cats (1 black, 1 white, 1 ginger) 17
IN THE
middle
From the Chair
The recent release of the state budget was big news in WA health, and Diabetes WA has not been immune to the impact of the state’s debt reduction. The McGowan Government handed down a budget which aimed to continue to deliver their election commitments, while also investing in infrastructure. The government unveiled a four-year expenditure plan totalling some $37 billion in health, with $655 million total infrastructure. The key challenge for Government, as many of us know, is WA’s underlying financial position. Total public sector net debt peaks at $40.9 billion at 30 June 2020. With a focus on debt, expenditure growth has been reigned in and is forecast to average only 1.2% p.a. over the next four years. Most economic commentators would agree that reigning in the state’s ballooning debt is the responsible course. The state’s financial malaise has impacted Diabetes WA. We have seen our donations and fundraising results being curtailed, while at the same time we have seen our direct operating funding being reduced at both a Commonwealth and State level. It is of concern that our Diabetes WA Telehealth for Country WA program, which was awarded in November 2017 at the WA Health Excellence Awards, is now struggling to find an agency sponsor and faces the real prospect of being discontinued. Your Diabetes WA management team is working very hard to find some solutions here in what clearly are very challenging times. And now, to address the unusual presentation of your magazine this issue – the male/female ‘flip-cover’. In this Winter edition of Diabetes Matters, we explore the inherent differences
between men’s and women’s experiences of diabetes. This includes the risk of being diagnosed with the condition, the propensity to develop complications, and the way males and females tend to approach diabetes management. All is not fair in love and glucose intolerance. The prevalence of diabetes among adults is higher for men (4.9%) than women (3.8%). Overweight men are more prone to develop type 2 diabetes than are overweight women, and type 1 diabetes is the only major organ-specific autoimmune disorder not to show a strong female bias. The way males and females tend to approach their diabetes management and the disparity between men and women utilising healthcare services can also affect their health outcomes. The results of a small-scale study (Canadian Family Physician, 2008) that looked at whether men and women with diabetes have different psychosocial, behavioural, and clinical characteristics at the time of their first visit to a diabetes education centre, concluded that women were more likely to have a family history of diabetes, previous diabetes education, and higher expectations of the benefits of self-management. The study provided evidence that diabetes prevention, care, and education need to be targeted to men and women differently, stating that primary care providers should encourage men to attend diabetes selfmanagement education sessions and emphasise the benefits of self-care. In a recent data review of Diabetes WA’s DESMOND type 2 education program attendance, we were especially
Dr Moira Watson
pleased to note that 43% of our attendees (Jun 2016 – Mar 2018) were men. This is in contrast with the data on men’s engagement with health services and a statistic we are especially proud of. As part of another recent evaluation of our DESMOND and SMARTs selfmanagement programs, we looked at the impact on attendees of participating in one of our group education programs. The data showed that there was a significant increase in diabetes empowerment, indicating that people have the skills, confidence, and selfefficacy to effectively self-manage their diabetes, immediately after attending a DESMOND or SMARTs program. Whether we have a battle of the sexes or perceived gender inequality, this data demonstrates that support from others – male or female – and education are crucial to help those living with diabetes to best manage their condition. Speaking of support; on a final note, I invite you to join us at our Corporate Lunch on 7 September at Fraser’s Restaurant to hear the fascinating Mr Michael Chaney AO speak. Visit our website or see the box below for more information. Until next time … Dr Moira Watson Diabetes WA Board Chair
Diabetes WA Annual Corporate Lunch Keynote speaker, Mr Michael Chaney AO, Chairman of Wesfarmers Limited, will be speaking about corporate social responsibility and asking whether the Banking Royal Commission has changed the way we should think about it.
Date: Friday, 7 September 2018 Venue: Fraser’s Restaurant, Kings Park Phone: Bree Johnston on (08) 9436 6267 Email: events@diabeteswa.com.au RSVP: Friday, 17 August 2018 Tickets: $165 per ticket or $1500 per table of 10 (Price includes GST)
Walton Consulting 1
RESEARCH
news
News from our researchers and an Exploring Diabetes event in July by Diabetes Research WA executive director Sherl Westlund
Gosh, this year is flying by so fast – primarily for us because we’ve been busy with a flurry of research being published. We’re so pleased to be able to share this news from our funded researchers with you below and also at our upcoming National Diabetes Week event. The Explore Diabetes Expo is on Wednesday July 11 from 8.30am to 11.30 – more details can be found at our website.
“This is the reverse of the expected direction seen with normal ageing and in Alzheimer’s disease, where the right hippocampus is usually larger than the left,” said University of Western Australia School of Psychological Science PhD candidate Nicole Milne.
Diabetes and the Brain
“What this suggests is that in type 2 diabetes, this area of the brain is more vulnerable to damage, resulting in significantly poorer cognitive functioning.”
WA researchers have taken another step forward in understanding the cognitive impact type 2 diabetes has on the brain, which could ultimately help reduce or prevent the complication. They’ve discovered that cognitive problems (like memory difficulties, poor attention, and slower speed of thought), which are known to be more common in type 2 diabetes, are likely to be caused by damage to the right hand side of an area of the brain linked to memory and learning. Type 2 also brings an increased risk of developing dementia but the cause of these changes is unknown. Funded by a Diabetes Research WA top-up scholarship and published in the Brain & Behavior journal, the study revealed that in those participants who had one side of the hippocampus larger than the other, the right hand side was smaller.
Earlier phases of the study revealed slower thinking skills and right hippocampal abnormalities in those with type 2 diabetes could be an early warning sign of dementia and Nicole Milne that type 2 diabetes could dramatically affect the everyday thinking skills of up to one-in-three adults aged 60 and older. “What remains to be uncovered is exactly what is causing this damage to occur in those with type 2 diabetes and by investigating that, it may open up new ways of preventing such devastating consequences,” Ms Milne said.
Immune System Puzzle Piece Found The WA-made world-leading next generation genetic resource the Gene Mine has been used to solve a new piece of the immune system puzzle which could lead to progress in tackling cancer and autoimmune and inflammatory diseases like type 1 diabetes and lupus. Together with colleagues from Croatia’s Glycoscience Research Laboratory, WA’s Centre for Diabetes Research has confirmed that genetic variation has a strong influence on an essential function of the immune system known as immunoglobulin G (IgG) glycosylation. They discovered five genes linked to the process and also pinpointed the amino acids in proteins that can affect it.
Professor Grant Morahan said the findings, published in the prestigious international journal, Nature Chemical Biology, were fundamental to biochemistry: “Changes in IgG glycosylation have been observed in cancer, autoimmune diseases like type 1 diabetes, lupus and rheumatoid arthritis, as well as in pregnancy and ageing, so this work may also have Prof Grant Morahan implications for generating a better with Sherl Westlund understanding of those conditions.”
See you on July 11!
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. 2
DIABETES
news Medication added to PBS
DAFNE visits Albany In a first for Diabetes WA, our educators took one of their “shows” on a new road and conducted a DAFNE workshop in Albany. Recognising the need for further support in this region, DAFNE (Dose Adjustment for Normal Eating) is designed for adults with type 1 diabetes and provides information
on carb counting, insulin dose adjustment, managing illness, reducing hypos, alcohol intake and exercise. The Albany workshop was deemed a success and received positive feedback, with evaluation conducted with participants showing they felt more confident in managing their condition.
In some great news for Australians with diabetes, Toujeo, a stronger, longer-lasting insulin, was added to the Pharmaceutical Benefits Scheme (PBS) on 1 April, reducing the cost of a script from $700 to $39, or $6.40 for concession holders. Type 2 medications Glyxambi (empagliflozin/ linagliptin), dulaglutide (Trulicity/ Eli Lilly), Qtern (dapagliflozin/ saxagliptin) tablets, as well as eight other diabetes meds, have also been added to the PBS list.
Leeuwin Adventure Eighteen-year-old Kaela Blackburn and 17-year-old Ryley Butson set sail on the adventure of a lifetime recently, thanks to the generous supporters of Diabetes WA. The year 12 student (Ryley) and the soonto-be plumbing apprentice (Kaela), both living with type 1 diabetes, were selected from applicants seeking the opportunity to join the crew on this year’s Leeuwin Ocean Adventure Youth Explorer voyage.
“I did things that I never thought I would do in my life,” Ryley said as he
disembarked the ship. “I learned a lot about myself, and my fellow sailors became like a second family.”
“I loved learning what all the lines (ropes) are for, and made some amazing friends on board,” Kaela said. The Leeuwin adventure provided Kaela and Ryley with the opportunity to develop their independence and leadership skills, and to demonstrate that young people living with diabetes can be as brave and adventurous as their friends who aren’t managing a chronic condition.
Have you attended a DESMOND type 2 workshop? join our private Facebook group to continue your DESMOND diabetes journey
The DESMOND diabetes support group is a free closed Facebook group for Western Australians who have type 2 diabetes and have attended a DESMOND workshop. The purpose of the group is for members to support each other to achieve the goals we have all set at the workshop, and share ideas about living with diabetes.
How to join: 1. Log in or create your personal Facebook account 2. Search for “DESMOND diabetes support group” 3.
Click on the “join” button and follow the prompts +1 Join
Diabetes WA has created this group with the support of the National Diabetes Services Scheme (NDSS). Diabetes WA supports the group however the opinions shared by people in this group are not necessarily those of Diabetes WA or the NDSS. The National Diabetes Services Scheme is an initiative of the Australian Government administered with the assistance of Diabetes Australia. For more NDSS Information 1300 136 588 or ndss.com.au
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2018-98
You are invited to
DIABETES
Generous support gives opportunities to young people Thanks to a generous donation from fundraisers at a high tea held in conjunction with Santa Maria College in memory of Laura Gray, some young people living with type 1 diabetes were able to participate in two activities that they may not otherwise have had the opportunity to do. Living in Kalgoorlie, 11-year-old Ryan Oberlin-Brown had never met another person with type 1 diabetes, until he attended our April Kids Camp, hosted by Perth Children’s Hospital and Diabetes WA. Travelling to Perth for the camp can be very difficult both logistically and financially for some families, so Ryan’s mother, Vanessa, was
Ryan (far left) learns some superhero moves with his fellow camp buddies
over the moon when Diabetes WA offered to help pay for Ryan’s camp fees. The cost of flights to Perth for Ryan and his father, as well as accommodation for his father so that he could be nearby, were also covered. Ryan was joined by 35 other kids on the three-day camp who embraced the theme and became superheroes, having a ball while learning about managing their
diabetes. The camp was Ryan’s first time away from home, but he breezed through the experience, enjoying the abseiling and the flying fox and making several friends that he plans to stay in touch with. “Ryan has been a different boy since he came home from camp. He has a much better attitude and seems to have realised how important it is to look after his health,” Vanessa said. The fundraising money also gave five teenagers living with type 1 diabetes, and their parents/ guardians, the opportunity to learn how to cook from scratch at Jamie’s Ministry of Food. The teens were grateful to participate in the world-renowned cooking course and learned to make delicious, nutritious, simple and affordable, diabetes-friendly meals through hands-on cooking. With an emphasis on fresh produce and nutrition, the group received lots of Jamie Oliver’s hints, tips and shortcuts along with his incredible recipes.
news
ON SALE NOW!
Just
$70
gives you
o Get your $20,0 ver of va 00 lue copy of the 2018/19 Entertainment Book from Diabetes WA to receive $200 of bonus offers! The Entertainment Book is packed with hundreds of discounts and offers that can be used at Perth’s (and Bali’s!) best local restaurants, bars, cafes, hotels and attractions. Available as a traditional hard-copy book or as a digital app for your Apple or Android device, your membership gives you over $20,000 worth of valuable offers valid through to 1 June 2019. For each book sold, Diabetes WA will receive 20 per cent of the proceeds, which will go towards supporting those living with, affected by and at risk of diabetes. Both Digital and Hard Copy Entertainment Books cost $70.00 and are available now.
To order your copy, go to: www.entbook.com.au/8728v6 email fundraising@diabeteswa.com.au or call 1300 001 880. Participants in Jamie’s Ministry of Food
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Education
We have a range of workshops and services that can help you on your health journey. Self-management Workshops Diabetes WA runs a number of education programs, held as two-to three-hour workshops, to help you manage your diabetes and improve your health. ShopSmart – this supermarket tour or classroom session helps you decode food labels. ShopSmart supermarket tour dates and locations were yet to be confirmed at time of print. Check our website for updated details.
FootSmart – everything you need to know about caring for your feet. MeterSmart – master the art of blood glucose monitoring. CarbSmart – unravel the mystery of carbohydrates with this carb counting masterclass. MedSmart – understand what your medications are, what they do and how to address any concerns you have. Living with Insulin – everything you need to know about using insulin; including equipment, hypos and blood glucose levels. Ready Set Go, Let’s Move – make exercise part of managing diabetes each day, with your own step by step plan.
Advanced Pumping Workshop Learn about the features of your pump and how to get the most out of it with this handson session.
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Perth Metro
Armadale Armadale Armadale Armadale Armadale Armadale Armadale Belmont Belmont Belmont Belmont Cockburn Central Ellenbrook Ellenbrook Ellenbrook Ellenbrook Ellenbrook Helena Valley Helena Valley Helena Valley Helena Valley Helena Valley Helena Valley Joondalup Joondalup Joondalup Joondalup Joondalup Joondalup Joondalup Joondalup Kwinana Mandurah Mandurah Mandurah
ShopSmart DESMOND ShopSmart (Classroom) CarbSmart MeterSmart DESMOND Advanced Pumping DESMOND MeterSmart DESMOND CarbSmart DESMOND DESMOND CarbSmart Living with Insulin DESMOND FootSmart DESMOND MedSmart DESMOND FootSmart Living with Insulin ShopSmart (Classroom) ShopSmart (Classroom) DESMOND Ready Set Go, Let's Move DESMOND ShopSmart (Classroom) MedSmart CarbSmart DESMOND DESMOND DESMOND Connect with Diabetes DESMOND
28 June 19 July 24 July 10 August 14 August 25 August 13 September 23 June 6 July 28 July 28 September 22 August 2 July 27 July 28 August 30 August 20 September 14 July 25 July 13 August 31 August 17 September 26 September 19 June 11 July 20 July 11 August 21 August 5 September 10 September 27 September 29 September 14 July 14 August 6 and 13 September (two half days) Melville DESMOND 23 July Melville DESMOND 8 September Mirrabooka CarbSmart 25 June Mirrabooka CarbSmart 10 July Mirrabooka FootSmart 12 July Mirrabooka DESMOND 6 August Mirrabooka Ready Set Go, Let's Move 16 August Mirrabooka DESMOND 18 September Rockingham DESMOND 11 August Rockingham FootSmart 23 August Rockingham MedSmart 23 August Rockingham MeterSmart 19 September West Leederville DESMOND 14 September Willetton FootSmart 7 August Willetton DESMOND 11 September
Planner WA Regional Goldfields Great Southern Great Southern Great Southern Great Southern Great Southern Great Southern Kimberley Midwest Midwest Midwest Midwest Midwest Midwest Pilbara Pilbara Pilbara Pilbara Pilbara Pilbara South West South West South West South West South West South West South West South West South West Wheatbelt Wheatbelt Wheatbelt Wheatbelt Wheatbelt Wheatbelt Wheatbelt
Esperance
DESMOND
7 and 8 August (two half days) Albany DESMOND 9 July Cranbrook DESMOND 31 July Denmark DESMOND 16 August Tambellup DESMOND 29 August Albany DESMOND 12 September Kojonup DESMOND 24 September Broome DESMOND TBC* Geraldton DESMOND 23 July Kalbarri DESMOND 30 July Jurien Bay DESMOND 13 August Dongara DESMOND 17 August Geraldton DESMOND 27 August Geraldton DESMOND 14 September South Hedland Walking Away 18 July South Hedland DESMOND 8 August Tom Price DESMOND 9 August South Hedland Walking Away 29 August Tom Price DESMOND 13 September South Hedland DESMOND 19 September Margaret River DESMOND 6 July Donnybrook DESMOND 19 July Busselton DESMOND 3 August Manjimup DESMOND 8 August Bunbury DESMOND 16 August Bunbury DESMOND 1 September Augusta DESMOND 7 September Bunbury DESMOND 10 September Bridgetown DESMOND 19 September Northam DESMOND 25 July Narrogin DESMOND 31 July Merredin DESMOND 9 August Lancelin DESMOND 27 August Narrogin DESMOND 12 September Northam DESMOND 26 September Northam Connect with TBC* Diabetes
Diabetes WA offers a 15 p er cent discount on health professional training and updates to members.
Connect with Diabetes A 2.5 hour free presentation for people with type 2 diabetes, carers, families and those at risk of diabetes. Connect with Diabetes enables you to understand and manage your diabetes and learn about food choices.
DESMOND DESMOND – Diabetes Education and SelfManagement for Ongoing and Newly Diagnosed is a one day workshop designed to equip those living with type 2 diabetes with the knowledge and skills to better manage their condition. DESMOND can help you achieve lower HbA1c, weight reduction, greater physical activity, reduced diabetes distress and better overall health outcomes.
Telehealth The Diabetes Telehealth Service for Country WA is available to those living out of the metropolitan area. One-on-one appointments via video-conferencing can be arranged through your doctor, or contact Diabetes WA on 1300 001 880.
Upskilling for health professionals in country WA The Diabetes Telehealth Service upskilling sessions are typically 1–2 hours in duration and are easily accessed via a desk top computer. The sessions cover a wide range of diabetes-related topics such as chronic kidney disease, diabetes retinopathy and gestational diabetes. To find out more or to register for any upcoming sessions call 1300 001 880 or go to our website. * Dates are yet to be confirmed. Get in touch with Diabetes WA if you’re interested in attending.
For more information or to book into any of these workshops, visit diabeteswa.com.au, call 1300 001 880 or email bookings@diabeteswa.com.au 6
EVENT
news
HBF Run For A Reason
Stefan
Carly
Despite the rainy weather, a record-breaking 33,000 people participated in the HBF Run for a Reason on 27th May. Sixty-five of these participants were registered with the Diabetes WA team, with 40 of them raising funds to help us to continue our work helping people living with diabetes in WA.
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More than $21,000 (and countin g) raised by ou r generous fundraisers!
Jackson
OUR TOP FUNDRAISERS: ($ amount accurate at time of print)
Stefan Papalia – $2,223 to date – Stefan’s dad passed away from diabetes complications last year. Setting his fundraising goal at $250 he shared his page on social media and watched it grow to $700 within 24 hours and then continue growing. Carly Pink-O’Sullivan – $2,214 and increasing. Carly has type 1 diabetes and was our top fundraiser last year. Jackson Plange-Korndoerfer – over $1,000 Pete Ferguson – over $1,000 Kaarin Patterson – HBF community ambassador, raised $926.
YOUR DIABETES DESERVES A MEDSCHECK Free*
Managing type 2 diabetes day to day can sometimes be tricky. That’s where a free* Diabetes MedsCheck at your local Friendlies Pharmacy can help. We offer a private consultation with a pharmacist, during which you’ll receive practical and professional advice, tips to manage your meds effectively and make the most of your blood glucose monitoring equipment.
Private consultation with a pharmacist
Advice on how to manage and make the most of your medication
Leave with an action plan
Ask your Friendlies pharmacist for more details or book online at friendliespharmacies.com.au
*Medicare and health criteria apply. Speak to your pharmacist or visit friendliespharmacies.com.au for further details.
8
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Real Solutions Real Support Obesity Surgery WA offers a multidisciplinary team approach to provide the best level of care for people with obesity. It is well known that obesity is a high risk factor for developing type 2 diabetes which can lead to serious complications such as blindness, amputations, stroke and reduced life expectancy.
Dr Harsha Chandraratna Surgeon
Dr Bill Gong Surgeon
Dr Andrew Kiyingi Surgeon
Surgical Options for Diabetes
The good news is that losing weight can improve your type 2 diabetes. Our extensive experience in weight loss surgical options, including gastric sleeve and gastric bypass, can stabilise and improve your blood sugar levels. In as many as 3 out of 4 patients, their blood glucose levels return to normal with either reduced or no requirement for medications. Poorly controlled type 2 diabetes leads to slow and irreversible organ damage. Don’t wait until it’s too late. Come in and have a discussion with one of our specialist doctors to learn more about how Obesity Surgery WA can help you. We offer real solutions with real support.
Call 9332 0066 to make a start towards a healthier life.
Sleeve Gastrectomy Roux-en-Y Gastric Bypass
Subiaco • Murdoch • Mandurah
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www.obesitysurgerywa.com.au
WIN $10, 000 in ou r Raffle Its raffle time on
8–14 July National Diabetes Week
Buy a raffl e ticket fo ce again! r the work we do in th your chance to win $10,000 a e commu calling 13 00 001 88 nit y. Tickets are on nd suppor t Diabete s WA and ly $2 and 0 or onlin c e at diabe Raffle to b teswa.au an be purchased b e drawn 3 raffles.co y 1st m.au. 3rd Septe August and result sp mber on th e website ublished .
The biggest diabetes awareness even t of the year, National Diabetes Week, is running 8–14 July. This year’s campaign “It’s About Time” aims to raise awa reness about the importance of early detection and early treatme nt for all types of diabetes. If you would like to host your own awa reness raising activity during National Diabetes Week, cont act us for an information pack at media@diabeteswa.com.au or call 1300 001 880. Further information can also be foun d on our website.
7 Septembe r WA s e t e b a i D 018 2 h c n u L e ptember Corporat e on 7 S e
y o ur ing plac nch is tak to mark the date in to lu te a r o t e al corp make sur ney AO will presen Our annu urant, so ha ta . C s s l e r e R to a c s h r e ic e s unit y r, Mr M at Fras and comm st speake diar y. Gue s of the corporate ble email member book a ta 36 6267. to r o n o informati call 08 94 For more teswa.com.au or e b ia events@d 10
T E G T ’ DON SED! CONFUiabetes Matterws o
fD as t o h n t i o i t g i n d i This e cover”, mean ted version is a “flipovers in the prinne for men. front c for women, o ding we have – one of online rea rk – so, o er For easerdered the artw v o c s i h t re - o hard copy, e h t d e n h a t n in dow ld be e d i s p u is ou w e n i z a mag d to read. flippe
Winter 2018 $6.95
Diabetes + Men
Flip for our women’s cover
NEWS • RECIPES • RESEARCH • PEOPLE • EVENTS • FITNESS
ive His Perspe- RobctStra han
by Guest Contributor s not to be farmers. As a young man I am of the first generation of Strahan farm and even now, when I enter my I spent every moment I could at the I am home and I belong. grandparents’ old farm, it feels like and stressful job, with a large number Being a successful farmer is a complex le ers are brilliant at keeping things simp of uncontrollable variables. Good farm a ing mak I’m ther whe I’m not sure of and focusing on efficiency. Whenever voice in my head, asking me what le’s unc my hear I not, correct decision or yield there will be. ges in our society. Life has become These farming challenges reflect chan gical innovations have made it almost increasingly complicated and technolo ories. unrecognisable from my childhood mem ager trying to bamboozle my uncle and I have a memory of a young bank man money to buy a fancy new tractor. The convince him that he needed to borrow make his final decision NOT to buy the clarity of thought my uncle showed to if day, there was no yield. He knew that tractor was faultless: at the end of the ibly, sens it e drov and on the old tractor he continued his regular maintenance out of it at no extra expense. s year e mor nty he would get ten or twe nce of a supportive community. It used Farmers also understand the importa middle of doing something important, to frustrate me when we were in the our dirt road, as I knew this would and I would see a neighbour driving up think we had time for. I now realise that mean a long conversation that I didn’t important, and often it resulted in us these conversations were incredibly all given a hand by somebody. It made us either helping someone out, or being us. than just stronger and part of something bigger ers’ approach when managing our farm Men, in particular, need to take this and deal with complicated information health. We need to engage in change ded actions, maintaining our health in to determine the ‘yield’ from our inten to chat to our friends and family - you a sensible way. We need to take time are help each other. Health professionals would be surprised how often we can s step t wha and erst und to Try help you. a valuable resource and are there to then make an informed decision as to and th heal your rove imp to you can take worth the effort. whether you think that the reward is h in his fifties. Had he taken this approac My father developed type 2 diabetes he If er. bett ly cant ifi sign n would have bee to his health, I imagine his experience aps perh ges, chan ll sma e he could mak had felt empowered and realised that ificant yields in health improvement. sign with ided prov n bee he would have
WINTER 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 Rob Strahan, Dr Nick Mabbott, Sherl Westlund, Murdoch Books, Pacific Magazines Photography DWA staff, magazine contributors, Shutterstock, 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
3
Rob Strahan says he has been a bit of a journeyman throughout his career, spending almost 30 years in the health industry, the majority as a career paramedic. He has also worked in sport and recreation for people with disabilities, as a trade or instruct at an acute psychiatric unit, a hospital orderly, and recently completed a graduate certificate in Health Promotion.
Men’s Contents His Perspective
Rob Strahan ..................................................... 2
Men’s Matters
Diabetes and Men ........................................... 3 In Good Company ........................................... 6 Asking for Help ............................................... 8 Q&A ..................................................................... 9 Beyond Midnight ........................................... 10
Diabetic Living
Recipes ............................................................ 12 A New Partnership ...................................... 13
Living & Moving Well
State of Play ................................................... 14
Research News
Research Round-up ..................................... 16
Members’ Area
Members’ Puzzle and Competition ......... 17
IN THE MIDDLE From the Chair ................................................ 1 Diabetes Research WA Update .................. 2
Diabetes News
DAFNE in Albany ............................................. 3 Medication on PBS ......................................... 3 Generous Supporters ................................... 4
Education Planner
Plan your Sessions ........................................ 5
Event News
HBF Run for a Reason .................................. 7
Members’ Area
Member Partners .......................................... 9
What’s On
Dates for your Diary .................................... 10
Men’s Matters … Why is my magazine back-to-front?
This unique issue of Diabetes Matters features what is known as a “flipcover”. One half of the magazine is dedicated to men, and one half of the magazine is dedicated to women. There is then a middle section in the centre where we feature all the essential parts of our magazine we wouldn’t want you to miss out on. Though men and women share many common issues and challenges when managing their diabetes, there are some that are unique to the XX and XY chromosomes. Read on to learn more.
Men are from Mars, Women are from Venus – the famous 1992 book, written by American author John Gray, has established this title as a common phrase when speaking about the different challenges women and men face. But what about when it comes to diabetes? Are men and women that different? According to statistics from Diabetes Australia, the prevalence of diabetes, particularly type 2 diabetes, rises with age and is higher in men (4.9%) than in women (3.8%). Interestingly, among Indigenous Australians this statistic is reversed - women are more commonly affected by diabetes than men (Minges et al., 2011).
American Diabetes Association.
Mortality due to diabetes is also greater in men than women. Between 1980 and 2005, the age standardised death rate with diabetes as the underlying cause of death in men has increased at an average annual rate of 0.7% while in women it has decreased at an average annual rate of 0.5% (Australian Institute of Health and Welfare 2008).
A Google search of “male complications diabetes” will inevitably bring up articles dominated by sexual issues within the top 5 results. With sex being a topic that is highly important to many men, the wealth of information on this topic is wide. After all, elevated blood glucose levels affects your whole body, even your most private parts.
One theory about why there is a greater incidence of type 2 diabetes in men is, as a very general rule, men tend to avoid talking about their health, and they therefore tend to be less healthy than women over the course of their lifetimes, according to the
Unique Complications
Being less inclined to focus on their health and see their doctor can also affect the way men manage their condition once they have been diagnosed. Not paying attention to, or following up on, signs of a diabetesrelated complication can lead to more dramatic results.
Men can experience many of the same diabetes complications as women, such as nerve damage and eye problems, but there are a few issues that are exclusive to men — and you
may not even realise they’re linked to your diabetes. Though there are many common symptoms and side effects of diabetes that are shared by both genders, here we focus on those unique to men.
Low testosterone Having diabetes doubles your risk for having low testosterone, according to the results of many studies. A drop in the hormone can cause symptoms such as low energy, muscle loss, depression, and sexual problems, including low libido and erectile dysfunction (ED). An article by Brian Karet in the journal Trends in Urology & Men’s Health (Sept/Oct 2012) discusses a six-year study where 587 men with type 2 diabetes were split into three groups: those with normal testosterone levels (above 10.4nmol/l); those with low testosterone levels (below 10.4nmol/l) who were not treated with testosterone replacement therapy; and 4
those with low testosterone levels treated with testosterone replacement therapy for two years or more during the follow-up period.
Though orgasm can still be achieved, a lack of ejaculation can cause infertility.
He says that this study showed for the first time that low testosterone puts men with at a significantly increased risk of death. Of the 182 men living with diabetes with untreated low testosterone, 36 died during the six-year study, compared to 31 of the 338 men with normal testosterone levels (20 versus 9 per cent). Furthermore, only five of the 58 men living with diabetes who were given testosterone replacement therapy died during the study (8.6 per cent), indicating significantly better survival compared to the nontreated group.
As mentioned above, consistent high blood glucose levels can also cause damage to the nerves that control your bladder. As a result, you may be at risk of urological issues, such as an overactive bladder and urinary tract infections. Men with diabetes can also experience urine retention, in which nerve damage leads to incomplete or infrequent urination. It can affect your quality of life and may also cause kidney damage over time.
The article explains that this is the first study to show that testosterone treatment can improve not just metabolic outcomes but survival in men with type 2 diabetes and testosterone deficiency; however, larger studies are needed to confirm cardiovascular benefit in men living with diabetes with low testosterone levels.
Erectile dysfunction More than half of men with diabetes over the age of 50 have a problem with impotence. Another name for impotence is erectile dysfunction, or ED. Having ED means the penis often fails to get or stay hard enough for sex. According to a July 2017 report published in the journal Diabetic Medicine, men with diabetes are 3.5 times more likely to experience ED than men who don’t have diabetes, and are also likely to experience it 15 years earlier than other men. ED can happen when high blood glucose levels damage small blood vessels or nerves. In order for a man to achieve an erection, significant blood flow to the penis is required. However, damaged blood vessels can affect blood flow to the penis. Diabetes can also lead to nerve damage that affects communication between a man’s penis and his brain, which may make it more difficult for him to maintain an erection. Diabetes medications can also cause sexual side effects like ED. It can be treated, but can’t always be reversed. Addressing ED as soon as symptoms begin is the best way to increase the likelihood of improving the condition.
Retrograde ejaculation Another diabetes-related sexual dysfunction symptom in men is reduced amounts of ejaculation, or retrograde ejaculation. Retrograde ejaculation is a condition in which the semen goes into the bladder, rather than out of the body through the urethra. Diabetes and damage to the blood vessels causes nerve damage to the muscles that control the bladder and urethra, which results in this problem. 5
Urological issues
Mister Chatterbox Historically, men have not been comfortable discussing issues about their health, particularly conditions like diabetes, depression or sexual dysfunction. In many cases, these health issues can be treated. The first step is to discuss these concerns with your doctor. If you’re embarrassed or having a hard time talking about them, write down your symptoms and questions and bring the list with you to your next office visit. Start the appointment by saying that you have some issues you’d like to have addressed. Another option is to share them before you even arrive for your visit. Call or send your doctor a note prior to the visit so they know what you would like to discuss. It is also crucial that you discuss all medications and supplements with your doctor to avoid any potentially harmful drug interactions. Share any changes in your sleeping pattern or other lifestyle habits with your doctor as well. Treating your mind can help the problems affecting the rest of your body. Whatever the treatment decisions, you should never feel ashamed or embarrassed if your sexual function is affected by diabetes. Reaching out to your doctor can be the first steps to living a healthier life overall, with a better sex life. It’s also important to address any sexual concerns with your spouse or partner. Knowing that your symptoms are related to your diabetes and being able to say that there’s a concrete physical reason for them might make it easier to strike up a conversation. Talking openly will also help ensure that you get support from your loved one, which is vital in managing life with diabetes. If you are struggling to cope, it does not make you less of a man. No man (or woman) manages diabetes perfectly. Get the help you need to get back on track. Talk to someone you trust. That could be a family member or friend, your health care provider or someone else with diabetes.
Take that first step and go from there. Once you are coping better, everything will look brighter and you will have the energy to tackle diabetes.
Action Man The next step is taking action. Men are more likely to have urological and sexual problems if their blood glucose levels are not wellmanaged, if they have high blood pressure or high cholesterol, or if they smoke, are overweight, are older than 40, or are physically inactive. Many of the diabetes complications mentioned can be altered or improved by lowering these risk factors, where possible.
Improving testosterone levels A doctor can test for low testosterone, and it can be treated with testosterone replacement medication, such as injections, patches or gels. Your doctor may also refer you to a urologist or endocrinologist. Low testosterone is also linked to metabolic syndrome — a cluster of risk factors, such as high blood pressure and excess fat around the waistline, that increases the risk of heart disease, diabetes, and other chronic health problems. You can treat metabolic syndrome by getting these risk factors under good management - exercising, losing weight if it is an issue, eating healthy foods, and quitting smoking if you smoke.
Some medicines for high blood pressure, depression and anxiety can cause ED. So, changing your medication, if it is an option, may also help. If a test shows you get erections when you sleep, you do not have ED. In that case, it may be a psychological issue and speaking to a counsellor may help.
The Y Chromosome So though the majority of diabetes complications are shared by both men and women, the ones that are unique to those with the Y chromosome, need their own unique approach to treatment and prevention. Being aware of these complications and risks is the first step in addressing them. The ‘takeaway message’ here is to be informed and talk – with your doctor, with your partner, with your diabetes educator, with your support system. Challenging as this may be for some men, it is an important part of your diabetes management.
Addressing erectile dysfunction First, be clear what erectile dysfunction (ED) is not. You do not have ED if:
• • • •
you can’t get an erection once in awhile you have less sexual desire you ejaculate too quickly you can’t ejaculate
ED means you can’t get or keep an erection. While you can’t reverse damage to nerves and blood vessels in your penis, you can prevent further damage by lowering your HbA1c. If you don’t yet have ED, help keep it that way. Prevent nerve and blood vessel problems by:
• • •
trying to keep your blood glucose levels as close to stable as you can, not smoking or drinking too much alcohol, and trying to keep your blood pressure under control.
Although not suitable for every man, a doctor may prescribe medication to enhance blood flow and improve a man’s ability to maintain an erection. There are several medications a doctor can prescribe to enhance blood flow and improve a man’s ability to achieve an erection, such as sildenafil (Viagra) and tadalafil (Cialis), however, these medications are not suitable for people with high blood pressure or heart conditions. If you think you might have ED, you should talk to your health care provider about it. By figuring out the cause of the issue, it can assist in deciding how to treat it. You doctor may review your medications, test to see if you get erections while you sleep and test for blood vessel and nerve damage.
Gettin’ jiggy with it Sex is a form of rigorous physical exercise, so, like any other activity that involves physical exertion, it has an effect on your blood glucose levels. If you find yourself dripping in sweat, throat going dry and your heart hammering in your chest, it might not be just a moment of passion, there is a fair chance that your blood glucose level has rocketed down.
How to maintain your glucose levels in the moments of passion: • Stock your bedside table with quick fix supplies of glucose biscuits, sugar syrup, juices boxes, bars, insulin and a glucometer in case your levels go low during sex. • Remember that lovemaking is not necessarily a marathon. If you sense a drop in your glucose levels or feel fatigued, communicate that with your partner. Check your levels when you can and refuel yourself with a snack before you’re back for another session of passion. • Drunk sex might sound fun, but alcohol is notoriously known to cause dramatic depletion of blood glucose levels. If you’re wanting to get intimate with your partner after a couple of drinks stick to alcohol that is high in sugar content and make sure you have eaten something while drinking. 6
In Good Company
Fame doesn’t protect against chronic health conditions and these well-known identities are proof of that. Living with either type 1 or type 2 diabetes, many are using their experience to raise awareness of the condition. Tom Hanks – type 2 Oscar-winning actor Tom Hanks announced he has type 2 diabetes when late-night host David Letterman commented on his newly slim figure in October 2013. “I went to the doctor and he said, ‘You know those high blood glucose numbers you’ve been dealing with since you were 36? Well, you’ve graduated. You’ve got type 2 diabetes, young man.’ He takes full responsibility for his type 2 diagnosis and has been very candid about his struggle with the condition, and even called himself a ‘total idiot‘ in dealing with it initially. He told the Radio Times: “I’m part of the lazy American generation… I was heavy. You’ve seen me in movies, you know what I looked like. I was a total idiot.” The actor has also said he is now working towards a target weight set by his doctor so he can reduce the risk of complications linked to diabetes.
Rob Palmer – type 1 TV tradie Rob Palmer found out that he had type 1 diabetes when he was just seven-years-old. ‘Everyone’s favourite chippie’ and father of three, is typically upbeat about his health, saying speaking up about the condition is the best thing you can do. Despite winning the celebrity television dance competition, Dancing with the Stars, in 2010, he admits that the show was challenging for him: “I checked my blood glucose levels more than usual, required more insulin and ate less food.” He is Ambassador for Medtronic’s CGM Guardian Connect and presents publicly about his experience with the condition to help others.
Peter O’Toole – type 1 Peter O’Toole is internationally recognised for playing T. E. Lawrence in the classic film Lawrence of Arabia (1962), for which he received his first nomination for an Academy Award for Best Actor. He was nominated for this same award another seven times and holds the record for the most Academy Award nominations for acting without a win. Severe illness almost ended his life in the late 1970s, when his stomach cancer was misdiagnosed as resulting from excess alcohol consumption. He underwent surgery in 1976 to have his pancreas and a large portion of his stomach removed, which resulted in a type 1 diabetes diagnosis. The actor died in 2013 at the age of 81.
Larry King – type 2 American talk show host, Larry King suffered a heart attack and underwent bypass surgery in 1987, which inspired him to stop smoking and start a healthier routine. So when he was diagnosed with diabetes in the mid-1990s, he says it was a surprise. In an interview with Diabetes Forecast, the magazine of the American Diabetes Association, he said, “I was already exercising. I was pretty much watching my diet, so I kind of took it as, ‘Now? Now I get diabetes?’” He says, although there was a history of diabetes in his family, it wasn’t something he’d thought much about. His aunt lived with the condition, but because she never actually looked sick, King says, “Diabetes was just a word to me.” 7
Nick Jonas – type 1 Singer, songwriter and actor Nick Jonas, was diagnosed with type 1 diabetes just over 10 years ago at the age of 13, while touring with his brothers. He noticed a dramatic change in his body and mood, feeling irritable all the time. While his diagnosis was overwhelming at first he says, in some ways, it was better to be just thrown in and given everything at once. “It was a real shock and also a bit of a relief,” he said on website ontrackdiabetes.com. “I knew that something was wrong physically and it was a relief to be able to put our finger on what it was.” Nick wears a CGM and uses an insulin pump. He co-founded not-for-profit organisation Beyond Type 1, in 2015, with the goal of raising awareness around the differences between type 1 and type 2 diabetes and to specifically build the community for people living with type 1. The organisation is leveraging the power of social media and technology, to create a safety net for people and to change what it means to live with a chronic condition.
George Lucas – type 2 Star Wars and Indiana Jones creator, filmmaker George Lucas was drafted for the Vietnam War at 23 years old, just after he graduated from university. During his physical, the doctors discovered that he had type 2 diabetes and was unable to join the fight. Said to have inherited the condition from his paternal grandfather, the 74-year-old is an example of what you can achieve despite a diabetes diagnosis.
Jamie Cripps – type 1 Shortly after the St Kilda AFL club recruited Jamie Cripps in 2010 he was diagnosed with type 1 diabetes. He learned to live with his insulin dependency whilst experiencing his first pre-season as an AFL player. Jamie, whose father also has type 1, now plays for the West Coast Eagles, and said in a West Australian newspaper article, “The most important thing I’ve learnt is that it can’t stop me from doing what I want to do. You pretty much live around your diabetes but playing footy helps me keep my mind away from it, and I’ve got the people and facilities here at the club to help me out.”
Jack Perkins – type 1 Australian V8 Supercar driver, Jack Perkins, was diagnosed with type 1 diabetes at the age of 21, shortly before the penultimate round of the 2007 V8 Supercars Championship Series. His diagnosis forced the son of six-time Bathurst 1000 winner Larry Perkins, to step down from the full-time drive position. After learning to manage his condition and passing his fitness tests he returned to the track in the V8 Supercar Development Series. Jack Perkins has become a spokesperson for Diabetes Australia, and has held several events to raise money and awareness.
Wasim Akram – type 1 Famous for being one of the ‘finest fast bowlers ever seen in the world’, Pakistani cricket player Wasim Akram was first diagnosed with diabetes in 1997, in the middle of a Test cricket series. He says the news had a terrible impact on him and it took him nearly six weeks to accept the diagnosis. Wasim commented on sportskeeda.com: “I was only 29 years old at the time. I thought my life was gone — no more cricket. But, my wife gave me mental strength. It’s just mental discipline. Temptations are there. I feel like having biryani every night — naans and kulchas, and niharis. But I avoid it.” Retiring from cricket in 2003, he has raised awareness about the importance of diet, exercise and discipline to manage the condition. 8
Face it like Daily Grind of Diabetes
The stigma still exists: “Real men” don’t whine about their physical, mental or emotional problems. They work it out, suck it up or walk it off. Why do some men feel that asking for help is a sign of weakness? It seems like a matter of pride to rely on oneself for many men, and selfreliance is clearly seen as a strength. Men’s reluctance to seek help may be one of the factors responsible for the higher rates of morbidity and mortality among men (American Journal of Public Health 2003). Beliefs about masculinity and manhood that are deeply rooted in culture and supported by social institutions play a role in shaping the behavioural patterns of men in ways that have consequences for health.
use. Help-seeking is considered to be the recognition of a health concern together with the range of actions that result, one of which is the use of health services.
Men are generally socialised to project strength, individuality, autonomy, dominance, stoicism, and physical aggression, and to avoid demonstrations of emotion or vulnerability that could be construed as weakness. These factors can combine to increase health risks.
The review also outlines a number of interesting observations relating to the pattern of help-seeking and health service utilisation by men. First, the initial approach by men for seeking help for health-related issues tends to be indirect. Men tend to view their partners and friends as a primary resource for help.
Such beliefs about masculinity can lead men to either take actions that harm themselves, including eating poorly, or to refrain from engaging in health-protective behaviours, such as seeing a doctor. This is reflected in documented lower male engagement in preventive health care visits, which can in turn contribute to differences in health outcomes. A 2006 article in the Medical Journal of Australia looks at men’s helpseeking behaviours and health service 9
A study reviewed in the article found that men consult doctors (specifically GPs) less often than women do. More generally, men use all services within the health care system to a lesser extent than women, and women have a greater acceptance of, and consequently use of, health care services.
In circumstances where men do seek primary health care, they are more likely than women to focus on physical problems and are less likely to disclose mental and emotional problems. Men also appear to spend less time with health practitioners during their visits than women, and receive less advice about changing risk factors for illness, particularly during general check-ups.
Aside from the obvious physical repercussions of not paying attention to your health and not seeking support from health professionals when it is needed, people living with diabetes have the added responsibility of selfmanagement of their condition, such as daily monitoring and medications management, worry about the future and distress about the impact of diabetes on various aspects of life. Many people with diabetes describe feeling frustrated, fed up, overwhelmed or ‘burned out’. For men who are less likely to admit that they are struggling to cope with the daily grind of their diabetes management, there is significant risk of developing depression or other mental health issues. Depression can affect the ability to perform tasks, communicate and think clearly, which can interfere with the ability to successfully manage diabetes. It was only a decade ago that psychologists began to realise the potential contribution of their expertise to diabetes and its treatment. According to reported studies, the last ten years have witnessed a significant increase in the amount of research conducted in this area.
Depression and Men Mental health is just as important as physical health. Joe Nelson reflects on men’s frequent hesitation to ask for help in his 2007 blog. “As with any machine, the body begins to break down, and even with regular maintenance – such as exercise, meditation, good food – it is still going to develop some minor problems,” he says on the website diabetesselfmanagement.com. “But I guess it only makes sense to take it in for a bit of overhaul work—you know, that beyond-thesurface look into the deeper depths of this temple. The physical aspect of this feat is often daunting for us guys; after all, aren’t we supposed to be able to just pick ourselves
a man (and ask for help!) up and keep on moving? And then there’s another arena we rarely want to examine: the mental aspect of our health. Depression and anxiety may go undiagnosed for years.”
All Too Familiar?
He speaks of “grumpy old men” and “workaholics,” and that depression in men is often misunderstood because the symptoms are not always the classic indicators of depression. Symptoms such as edgy emotions, quickness to anger, isolation, always working, watching excessive TV, loss of interest in sex, thoughts of suicide, and poor energy may be incorrectly attributed to the aging process, and thought might not be given to the possibility that something could be done about it, particularly if the man is hesitant to speak up himself. It is important to understand that depression and anxiety are very treatable. Research demonstrates that both psychotherapy, such as counselling, and medication can have a real impact. If someone is opposed to one of these treatments, the other is likely to be effective. If one treatment is not useful, then a combination of treatments may be more useful.
Q &A Q
I am a pensioner living alone and I find cooking for myself tough. I know I shouldn’t be eating takeaway meals, but sometimes it feels like the only option. If I am going to get a takeaway meal are you able to recommend the top three to choose from? Mervyn, type 2 diabetes.
A
If this is sounding all too familiar to you and you think you might need support, don’t feel that you are not coping by asking for help. This is an important way of coping. It is important, too, to remember that each of us has the ability to learn new coping skills and develop relationships with people who can provide support. Depression is not just a low mood but a serious illness. Feeling overwhelmed and finding it hard to do normal activities can have a serious impact on diabetes care and outcomes. If you are having mental or emotional problems, or are struggling with managing your diabetes, consult your GP, diabetes educator or a professional therapist. Often a spouse, relative or close friend can point out the signs and suggest resources. To be a truly “strong man,” have the courage to get the help you need now. If you are needing support or someone to talk to, speak with your diabetes health professional, your GP or call Lifeline on 13 11 14 for crisis support.
DWA Dietitian Narelle Lampard says … My biggest tip when choosing a healthier takeaway option is to look for the inclusion of plenty of colourful salad or vegetables. Some examples include: 1. Burgers, Wraps or Rolls Include grilled or barbequed skinless chicken, lean meat, tuna/salmon or egg, plus plenty of salad. Skip the extra cheese, bacon and dressings. Ask for wholemeal or multigrain bread if available and go for a grilled chicken burger/wrap or a chicken/donor kebab. Try and avoid the big takeaway chains, such as McDonalds or Hungry Jacks, though Subway is a good choice. 2. Asian Try a simple stir-fry with lean meat, chicken or seafood with steamed rice or noodles, eg. beef in black bean sauce, chicken and cashew nut, chilli-basil beef or chicken. Other good options include sushi or a clear noodle soup with seafood, greens & bean shoots. 3. Pizza or Pasta Choose a vegetarian pizza on a thin-style crust or select a pasta with a tomatobased sauce eg. napolitana or marinara.
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. 10
Beyond Sleep and well-being go hand in hand, and getting a good night’s sleep is just as important to your overall health as eating well and exercising regularly. Dr Nick Mabbott is a Fatigue Risk Management Specialist and is passionate about changing the way people think and feel about obtaining adequate sleep and improving their physical and mental health, safety and productivity. Here, Dr Mabbott writes about how sleep also plays a vital role in the development of type 2 diabetes. Getting enough quality sleep at the right times can help protect your mental health, physical health, quality of life, and safety. A lack of quality sleep day after day, night after night can place an enormous strain on your nervous system, body and overall health. The damage from sleep deficiency can occur in an instant, such as a car crash, or it can harm you over time and raise your risk for some chronic health conditions, including diabetes. A recent analysis of 10 research projects, involving over 107,000 people, found that the risk of developing type 2 diabetes was highly linked to length of sleep, initiating sleep and maintaining sleep1.
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Unfortunately, the Western environment is interfering with natural sleep patterns. People are generally now sleeping less than they did in the past, and sleep quality has decreased as well. In our busy society, many of us are not getting the quality seven to eight hours of sleep that our bodies need to perform at our best. The increasing amount of shift work, particularly in men, is also wreaking havoc on people’s sleep patterns and their ability to function efficiently. The table below contains information gathered from providing training to around ten thousand miners and construction employees.
DAYSHIFT
NIGHTSHIFT
Dayshift employees working 12-hour shifts report averaging 6 hours of sleep per night.
Nightshift miners working 12-hour shifts report averaging around 5 hours of sleep per day.
Deficit of 1.5 hours of sleep per day of work.
Deficit of 2.5 hours of sleep per night of work.
7 day roster equals 10.5 hours of sleep debt.
7 night roster equals 17.5 hours of sleep debt.
At least 2 (possibly 3) days to catch up the sleep debt.
At least 3 (possibly 4) days to catch up the sleep debt.
Midnight Dr Eve Van Cauter and her team at the University of Chicago have conducted numerous experiments on sleep and type 2 diabetes. In 2004, they utilised (mean age) 22-year old subjects and for six nights only allowed them to obtain four hours of sleep2.
The subjects all started the experiment with no type 2 diabetes symptoms and blood glucose baseline measures were normal. After six nights of four hours of sleep, all the subjects had blood glucose levels in the pre-diabetic range. Findings indicated that the chronic sleep loss was associated with:
• • • • •
decreased glucose tolerance (inability for the cells to take up glucose); decreased leptin levels (hormone that sends message to brain to stop eating when full); increased Ghrelin levels (increases hunger); increases in evening cortisol levels (normally decreasing at this time of day), and adverse cardiovascular effects.
It took around seven nights of catch up sleep (averaging 9.3 hours each night) to pay back the sleep debt and stabilise back to normal glucose tolerance levels. In 2007, a team also led by Dr Van Cauter, had subjects obtain eight hours of sleep for three nights in a row. However, every time a subject moved into deep sleep (as indicated by slowwave sleep signals), they were moved/shaken enough to take them out of deep sleep (but not enough to waken them). After only three nights of eight hours sleep (without deep sleep), all subjects again became pre-diabetic. Once again, it took around a week to return to normal. For years we have discussed managing or avoiding type 2 diabetes using two tools - namely, diet and exercise. The great thing about the research discussed in this article is that we now realise that there are three tools to combat type 2 diabetes. If you are in the pre-diabetes range or have already been diagnosed with type 2 diabetes, check your sleep to see if you can make improvements. For a healthy adult, you require between seven and nine hours of sleep every night. If your sleep is too short, affected by constant awakenings or if you have a sleep disorder, please see a professional to help you get better sleep.
A healthy adult should aim for between 7 & 9 hours of sleep every night. FOR A HEALTHY NIGHT’S SLEEP:
• • • •
Try to go to sleep at the same time each night. Try and keep the same wake time every morning. Your sleep time should be 8-9 hours before your alarm is due to go off. Correct any sleep disorders you or your partner may have.
• • • •
Have a dark, quiet and cool room to sleep in. Avoid taking stress or anxiety to bed. Do a brain dump and jot things down before sleep. Ensure others around you respect your sleep. Keep your bedroom as a sanctuary for sleep. No kids or pets!
Dr Nick Mabbott is the Director of Beyond Midnight Consulting and has over 22 years of experience with sleep and fatigue risk management. This includes conducting research, investigating fatigue incidents, providing fatigue risk assessments of organisations and rosters, and delivering training to well over 10,000 people. His clients range from mining and resources, to transport and logistics, construction, health, forestry, rail, education and a host of other organisations. beyondmidnight.org
Article References
1 Cappuccio, F.P., Strazzullo, P., D’Elia, L. and Miller, M.A. (2010). Quantity and Quality of Sleep and Incidence of Type 2 Diabetes. Diabetes Care, Volume 33, Number 2, February. 2 Spiegel, K., Tasali, E., Penev, P., Van Cauter, E. (2004). Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Annals of internal medicine, Vol. 141, Issue 11, pp. 846-850.
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DIABETIC
living Madras Lamb Curry Inspired by the lamb saag, this curry uses lean lamb steaks cut into chunks. We’ve swapped the spinach for more robust kale, slow-cooked to tender perfection, and added chickpeas, which count towards your five-a-day. Prep: 15 mins Cook: 6 hours (low) Serves: 4 (as a main)
Ingredients
1 large brown onion, halved, thinly sliced 3 tbsp Madras curry paste or gluten-free curry paste 400g can salt-reduced chopped tomatoes 2 tsp Massel salt-reduced vegetable stock powder 1½ tbsp red lentils, rinsed and drained 425g can salt-reduced chickpeas, undrained 1 tbsp grated ginger 1 tsp cumin seeds 1 cinnamon stick 100g kale leaves, inner core removed, chopped 300g lean lamb leg steaks, fat trimmed, finely chopped 210g (1 cup) SunRice Doongara Low GI Brown Rice, cooked following directions, to serve
Method
1. Put the onion, curry paste, tomatoes, stock powder, lentils, undrained chickpeas, ginger, cumin seeds, cinnamon stick, kale and lamb in a slow cooker. Add onethird of a can of water. Stir. Cover with the lid. 2. Cook on low-heat setting for 6 hours or until lamb and vegies are tender. Serve with the rice.
Nutrition Information per serve Energy Protein Fat, total — saturated Carbohydrate Sodium Fibre • Carb exchanges 4 • GI estimate low • Gluten-free option
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2040J 28g 13g 2g 59g 418mg 9g
DIABETIC
living
Exciting New Partnership Diabetes WA is always on the lookout for new ways to benefit our members.
COMING SOON!
When the opportunity presented itself to partner with Pacific Magazines we jumped at the chance. With a portfolio of market-leading magazines and websites, the partnership is a perfect fit. Pacific is the publisher of Diabetic Living – the healthy lifestyle magazine for people living with diabetes. With an abundance of expert-endorsed health information, delicious dietitian-approved recipes and news on advances in health from around the world, Diabetic Living helps those living with diabetes, and those who care for them, make informed decisions every day. The magazine is a fabulous accompaniment to your members’ magazine, Diabetes Matters. In a special offer for Diabetes WA members, Pacific is offering an enormous 41% discount on the cover price of Diabetic Living. See the advertisement below to find out how to subscribe today and claim your member discount. Additionally, each issue of Diabetes Matters will feature two delicious recipes from the Diabetic Living collection. This Winter edition features a ‘Dude Food’ recipe in our Men’s section and a sweet dessert in our Women’s section – though really, these recipes will be appreciated by any hungry person – male or female!
Look out in the Spring edition of Diabetes Matters for more information on another new member benefit soon to be offered as part of our partnership with Pacific. Members will have the opportunity to obtain a discount on subscriptions to Men’s Health magazine. Watch this space …
SPECIAL OFFER FOR DIABETES WA MEMBERS
Get 6 issues of Diabetic Living for only $28 Each issue of Diabetic Living comes filled with delicious and healthy recipes, lifestyle tips and conveniently delivered to your door. Eat better, feel better, live better with Diabetic Living.
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TIPS TO
Need a weight loss jumpstart? Try tinkering with your everyday routine to drop a few kilos and gain energy
SAVE
41%
Fill up on fruit and veg
3 Enlist help
Reduce kilojoules (and carbs) by sprinkling blueberries instead of croutons onto green salads and mixing in lots of capsicum, celery and cucumbers. Non-starchy vegetables such as broccoli, greens and tomatoes contain less carbohydrates than other vegies but still pack a nutritional punch.
6
Get your zzzzzzs
1
Walk it off
Thirty minutes of walking burns about 630 kilojoules – and you don’t have to do it all at once. Briskly stroll to a nearby park to eat your lunch. Or, instead of watching your kids’ or grandkids’ sporting events from the sidelines, keep an eye on the action while walking around the field. Make sure you check your feet before and after walking, and always wear sneakers to protect from injury.
TIP
Take extra carbohydrates before and during exercise to prevent hypoglycaemia. Discuss with your doctor or dietitian first.
Make an appointment with a dietitian or nutritionist to work up a meal plan that can help you lose weight. And, if you haven’t exercised before, ask your health care provider to time your medication and meal schedules to suit your workouts.
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4
Skimping on sleep can cause weight gain, add stress and compromise your immune system. When University of Chicago researchers restricted 10 dieters’ sleep to less than six hours a night, the dieters lost only half the amount of fat (and more muscle) than when they got more than eight hours. Sufficient shut-eye is also key for blood glucose control.
healthy healthylife SHALL WE PLAY A GAME MC:T1 – a modified version of the popular digital game Minecraft – is the brainchild of a Brisbane father who was inspired by his son’s diagnosis with type 1. Designed to help PWD learn how to manage their condition, the game sees players walk around the Minecraft world, but with the addition of monitoring their insulin and blood glucose. The father’s start-up was recently given a grant by the Queensland University of Technology to build the game MC:T1 (Minecraft for Type 1 Diabetes) and develop an educational plan for health professionals and parents. Visit magikcraft.io and research.qut.edu.au/dmrc for more.
Look at your blood glucose-lowering medications with your provider. Some newer medicines, such as Liraglutide and Byetta, may aid in weight loss.
Turn off the TV
7 Get fit during the commercials When watching TV, get up and do one minute of jumping jacks or a minute of knee raises when the commercials come on. Researchers at the University of Tennessee, Knoxville, found that stepping in place during commercials burns an average of 620 kilojoules in about 25 minutes.
84 JANUARY/FEBRUARY 2017 diabetic living
www.subscribetoday.com.au/DL/DWA TERMS AND CONDITIONS: Diabetic Living is published bi-monthly. Offer valid for Australian delivery only. Offer ends 30/06/19. Subscriptions may not include promotional items packed with the magazine. Pacific Magazines Pty Ltd is collecting your personal information for the purpose of processing and managing your subscription. As a subsidiary of Seven West Media Limited, Pacific will handle your personal information in accordance with Seven’s Privacy Policy, which is available at subscribetoday.com.au/privacy-policy.
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The latest facts & global news on diabetes, body image, broccoli & positivity
Review your medications
A recent review of more than 50 studies confirms that too much screen time is linked to consuming fattening fast foods, energydense snacks and high-calorie drinks.
Latest News
YOUR
Q
15 tune up
living well
Blog life
From online forums for PWD to advice from professionals, these inspirational blogs cover the daily struggles of PWD, as well as giving tips on how to live a healthy life with diabetes.
• DIABETES STOPS HERE (diabetesstopshere.org) Produced by the American Diabetes Association, and born from their movement ‘Stop Diabetes’, this blog shares stories of courage, love and resilience from people living with both type 1 and type 2 diabetes.
• DIABETIC FOODIE (diabeticfoodie.com)
Shelby is a keen foodie who also has type 2 diabetes. Firmly believing “a diabetes diagnosis is not a dietary death sentence”, she shares many healthy, delicious and diabetic-friendly recipes for readers to enjoy.
• DIABETES SISTERS (diabetessisters.org/blogs)
There are separate blogs for type 1 and type 2 diabetes, with the goal of helping readers living with diabetes have healthier, fuller lives. The online forums are a safe place for women to freely share information.
STEP 1
Over the past 20 years, University researchers at Finland’s on a of Tampere have worked could potentially prototype vaccine that developing in prevent type 1 diabetes is not a cure, nor children. Although this altogether, it will it eliminate diabetes immunity. Clinical will, hopefully, provide 2018, although trials are set to begin in the results will not be apparent years. eight for about
A
ASK
SH
Health & Fitness
A DR M
R
Should I avoid bread if I have diabetes and am trying to lose weight?
Let’s get physical Aerobic exercises (such as walking, jogging and light cycling) are associated with a reduction in glycemia, in comparison to a temporary increase in glucose levels during anaerobic exercises (such as sprinting, heavyweight lifting and interval sports, such as hockey). Both forms of exercise produce hypoglycemia in the
88% of Australian girls with type 1 desire a slimmer body, and 76 per cent of boys were not happy with their bodies. The stats came from a study conducted by Deakin University researchers of Australians aged between 13 and 19 who have lived with type 1 diabetes for more than 12 months. It further found that only 43 per cent of the boys studied specifically wanted to lose weight.
individual’s late recovery, which often occurs while sleeping. However, it is less common for PWD who are more physically active to get diabetic-related eye disease and kidney disease, and they also have a better chance of reaching the ideal targets for blood pressure levels, glycated haemoglobin levels and a healthier body mass index (BMI).
Confused about glucose? Diabetes Australia has recently launched a new Position Statement on the importance of glucose selfmonitoring. Being a rapidly changing area, the new Position Statement makes it easier for individuals to better selfmanage their condition, discuss the technologies available for glucose monitoring – as well as the pros and cons – and the evidence behind them. It’s all online for your perusal. To read the new Position Statement, visit diabetesaustralia.com.au.
Dr Marsh says: I get asked
this a lot. Many people think bread is something to avoid, yet the right type of bread can be a healthy carb choice. It is often lower in carbs and glycemic index (GI), and higher in fibre and nutrition than other carb choices such as cracker biscuits, rice, pasta, potato and many processed breakfast cereals. The best choices are dense, grainy breads – the ones with lots of visible grains and seeds. These breads have more nutrition and fibre, and when the grains are still intact, rather than milled into flour, they have a lower GI. If you don’t like grains, or can’t manage them due to dental or digestive problems, wholemeal sourdough bread is the next best option. There’s good evidence that eating more wholegrains can help with weight management. They also provide important vitamins and minerals. Bread is an easy way to get more grains in your diet. ➤ Dr Kate Marsh, advanced accredited practicing dietitian and credentialled diabetes educator Email your questions to: diabeticliving@pacificmags.com.au Post: Diabetic Living, Q&A: Health, GPO Box 7805, Sydney, NSW 2001.
12 JANUARY/FEBRUARY 2018 diabetic living
1300 668 118
and quote T8CDKZZA
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LIVING & MOVING
well
The State of
As children and teenagers, many of us had the experience of participating in recreational sporting clubs such as footy, teeball and basketball. Not only were they a good place to bond with our friends (and make new ones), they also got us moving and helped foster a competitive – and cooperative – spirit. Yet as adults, a lot of people don’t tend to consider organised sport as a feasible pastime. The health benefits, both physical and mental, for adults who join their local club and play sports are great; the challenge is getting people to do so as they age. In addition to keeping the body strong, regular exercise can reduce the risk of heart disease, high blood pressure, stroke, and some cancers, and assist with managing diabetes. It can even improve cognitive function.
But if keeping the body moving is so good for us, why do so many adults who played sports when they were young stop doing so? Many people state that between work hours and family activities, there just doesn’t seem to be enough time in the day. Studies have found that access and health issues are also barriers to grown-ups joining in.
“As kids, we learn to play and as adults we like to learn and achieve new things too. We all like success, and generally that doesn’t change with age.” We talk a lot about the physical benefits of sport, and adults are told by everyone from the media to doctors to family members that being active is important, particularly if you are living with diabetes – we should aim for at least 30 minutes of exercise every day. Active people are healthier and have more energy. They also sleep better and feel more confident and happy. As well as the medical benefits already mentioned, regular exercise can also improve coordination, balance and flexibility. Of course, it’s not just the physical aspect of recreational sports that can benefit adults – it also works on the mental and psychological sides. Playing a sport as part of a team – whether just for fun or on a competitive level – can do wonders for mental health and self-esteem. It can be the perfect stress buster at the end of a long work day, as well as good motivation to get out and get moving – even if you don’t want to. You won’t want to let your team down, right?
An article from a US newspaper notes that “though research shows that fitness results vary by individual, there are valid socio-emotional health benefits to participating in group or team sports, in either a competitive or recreational setting.” The article goes on to discuss how important goal-setting is for adults, as well as the motivation that comes when you feel obligated to show up and be part of a team. Having a scheduled practice, it says, is also good for simply getting people out of the house and being social, which can be a struggle if a person is susceptible to depression, isolating behaviour, or loneliness. Being a part of a sporting club can potentially give that person the motivation and drive to get out and be around other people, as well as a boost in selfesteem and confidence. (benningtonbanner.com)
Community sport helps build friendships, improves health and wellbeing, strengthens communities and makes for a better quality of life.
Although playing recreational sports may have fallen by the wayside as we’ve grown up, it’s just as rewarding – maybe even more so – to play them as adults. Given that they grant everything from our recommended daily exercise, to a chance to socialise, to a renewed sense of goal-setting and competition, maybe it’s time to explore the physical and psychological boosts that playing community sports can provide. 15
LIVING & MOVING
Play
Keen to Play?
When you contact a sporting club ask;
Winter sports
• Can I play even if I have never played before?
• • • • • • •
Soccer Futsal (International rules soccer) AFL Rugby League Hockey Rugby Union Netball
well
• How will I know which team to join? • Can I come and try the sport before joining? • When are the training sessions and where is the training ground? • What time does the training start and finish? • When and where are the competition games played? • What equipment do I need? Do I have to bring it along or will it be provided?
Summer sports
• How much does it cost to play, are there any extra costs besides registration fees?
• • • • • •
• When are the registration days and times?
Cricket Water Polo Baseball Softball Athletics Touch Football
• Are there other expectations of the players? (sportandrecreation.nsw.gov.au)
Sports played all year round • • • • • •
Tennis Basketball Volleyball Badminton Martial Arts Golf
Not quite up to running around? Volunteer to help – become a coach or assistant coach, run the water at the local footy game or score for the team.
Visit the WA Department of local Government, Sport and Cultural Industries to find a sporting club in your area that might suit you; www.dsr.wa.gov.au/clubs 16
RESEARCH
news
Research Round-Up It’s great news for sun lovers
New diabetes drug may also treat obesity
Scientists believe they have discovered a drug that can combat both diabetes and obesity.
Vitamin D, which can be absorbed through diet, sun exposure or supplements, could reduce inflammation in people with type 2 diabetes, researchers from Monash University have concluded after analysing 20 randomised controlled trials.
It’s good news for men with type 2 Men with type 2 diabetes are less likely to develop prostate cancer than people without diabetes. However, it’s not all good news - the mortality rate is higher once the cancer is diagnosed.
It’s bad news for big bellied men A study has shown that men are more at risk of developing type 2 diabetes than women after putting on weight, as they tend to store more belly and deep fat around the abdomen than women, including putting on more fat around the liver.
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T D P P ERS EV E R O C N OL D OSC H R E I L L OU T B I M P I MB S F A T R T R I K ENE S S V T A N E X T E RMI O Y P
S R I NG L A UL AT E I H V EX ED S R NT ASY P ME A N O C NAT E T
Crossword Solution 17
Semaglutide, a pharmaceutical drug used for the treatment of type 2 diabetes, initially developed to help manage blood sugar levels in people with diabetes by Novo Nordisk – a Danish pharmaceutical company – has been found to help obese people lose weight, according to a study conducted at the University of Leeds. Researchers pitted semaglutide, a glucagon-like-peptide 1 (GLP-1) against a standard therapy combo of diet, exercise and placebo. The chemical structure of semaglutide is very similar to that of GLP-1, a naturally-occurring hormone that is thought to act on the appetite control centre in the hypothalamus region of the brain, reducing feelings of hunger. Drugs that mimic GLP-1, or increase its levels in blood, work by stimulating insulin secretion from the pancreas and signal fullness to limit further food intake. For 12 weeks, half of the 28 clinically obese test subjects in the study received a weekly dose of semaglutide, while the other half were given a placebo – neither group knew which they were getting. At the end of that period, they were invited to a testing centre to have their body weight and body composition recorded, where they were given a lunch and evening meal. They were told to eat as much as they wanted in order to feel “pleasantly full.” The
amount that each person consumed was noted, along with their food-type preferences. The whole 12-week process was then repeated, with the placebo group now receiving semaglutide and vice-versa. It was found that when given the meals, the people receiving semaglutide ate considerably less than their placebo-taking counterparts, and showed less of a preference for high-fat foods. More specifically, it was noted that on average, their daily energy intake (which indicates the amount of food consumed) was 24 per cent lower than that of the placebo group. This in turn resulted in them experiencing an average weight loss of 5 kg over the 12-week period. “What was striking was the potency of the drug’s action,” says Prof John Blundell who led the study team. “We saw results in 12 weeks which may take as long as six months with other anti-obesity medication … The drug reduced hunger but also cravings for food and the sensation of wanting to eat – and these had previously been thought to stem from different parts of the brain.” After the success of the second phase, the clinical trial is to undergo a third phase, believed to last for up to four years, before hopefully being released to the public.
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.
Diabetes WA 1
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MEMBERS
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Quick Crossword
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Across
5 Steadily continuing a task despite difficulties (11)
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1 Stepped (4) 2 Propriety of conduct (7) 3 Coppers (5) 4 Most foolish (8) 5 Tending to discourage (11) 6 Increases speed (7,4) 10 Text written for an opera (8)
14 Activity of imagining 12 Vegetable (7) improbable things (7) 15 Lachrymose (5) 16 Resemblance (8) 17 Ditch dug to protect 17 Have in mind (4) a castle (4) 18 Destroy utterly (11) Solution on opposite page * reproduced from The Guardian
Men’sWinter
Competition
WIN! Ditch the Dead Weight with Mike Rolls Often in personal or professional development the sole focus is how to get more of something. Mike Rolls turns this idea on its head and asks, “What could we potentially get rid of to make our lives lighter, freer and more meaningful?” Mike Rolls was a sports-mad teenager when he contracted a deadly disease and found himself fighting for his life. When Mike regained consciousness, he had lost his right leg, half his left foot, two fingers and part of his nose, and had extensive internal injuries. His parents were told he had a five per cent chance of survival. More than just a triumph-over-adversity story, Mike’s Ditch the Dead Weight combines personal experience with proven scientific research and a practical methodology for letting go of anything that no longer serves you. Practical, plainspeaking, humorous and inspiring, Mike is an incredibly engaging narrator and a great role model for people of all ages. A copy of Ditch the Dead Weight could soon be motivating you! Thanks to Murdoch Books we have one copy to give away. Publisher: Murdoch Books RRP: $29.99
To enter, complete the competition slip below and mail to: Diabetes Matters – Men’s Winter 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 September 2018. 18