Winter 2019 $6.95
A Diabetes WA Member Magazine
YOU & Y SUPPOR OUR T CREW
TEAM DIABETES If you’ve got it, we get it
From the Editor Th ere is no “i” in tea m – but the re is in Dia bet
es.
“I” (me) when it comes And sometimes that’s ok…to focus on etimes you need to be to health. Living with diabetes, som top of your blood glucose self-focused, to ensure you stay on best possible way. levels and manage your health in the it all on your own. But that doesn’t mean you should do to suppor t someone There is a whole team that is needed medical professionals living with diabetes. Whether they be ne community for some or family and friends, or even an onli features all those involved people. This edition of the magazine e living with diabetes. in the team that helps to suppor t thos help you and to hear Turn to page 9 to read how they can member of ‘Team Diabetes’. their perspective on their role as a Are there any that surprise you? a new feature in We always like keeping it fresh and rs – reflects your feedback. Diabetes Matters – #DiabetesChatte ion of the magazine received Our recent “What’s your Stor y” edit ed our readers want to gur such a positive response that we fi ing about. So, we have talk know what people with diabetes are g the trending topics that introduced this new segment featurin ia channels, or the med people are discussing on our social Diabetes Helpline. our on d common questions that being aske Turn to page 35 to take a look. Diabetes WA team. Our We also have new members of our you to our four new Chair, Dr Moira Watson, introduces Diabetes WA Board. Directors, recently appointed to the Meet them on page 3. etes Week 14-20 July. Finally – don’t forget, it’s National Diab to raise awareness about The theme – ‘It’s About Time’ aims early treatment for all the importance of early detection and itsabouttime.org.au types of diabetes. Find out more at
From the Chair .......................................................................... 3 Perspective ................................................................................ 4 Who’s in the Driver’s Seat? ................................................... 5
Diabetes News
Sustainable Health Review ................................................... New Insulin on the PBS .......................................................... HBF Run Review ....................................................................... Where Have We Been This Autumn? .................................
6 6 7 8
Team Diabetes
Who’s in Your Team? ............................................................... 9 Working with Your Team ...................................................... 21 The Hidden Pathologist ....................................................... 22
Workshop Calendar
Plan Your Sessions ................................................................ 24
Research News
Research Round-up ............................................................... 26 Diabetes Research WA Update ......................................... 27
Enjoy!
Natash a
Living Well WINTER 2019
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. Photography DWA staff, magazine contributors, Shutterstock, Pacific Magazines Design Brigitte James Print Quality Press Diabetes WA Diabetes WA – Subiaco Offi ce diabeteswa.com.au Level 3, 322 Hay Street, Subiaco WA 6008 Postal Address: Diabetes Helpline: 1300 001 880 PO Box 1699, Subiaco WA 6904 Email: info@diabeteswa.com.au Diabetes WA – Belmont Offi ce 172 Campbell Street, Belmont WA 6104 Postal Address: PO Box 726, Belmont WA 6984
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Contents
A Cleaner Slate ...................................................................... 28 Keep Sight ............................................................................... 30
Moving Well
Top 20 Sports ...........................................................................31
Diabetic Living
Recipes ..................................................................................... 32
In the Community
Having An Impact .................................................................. Scott’s Achievement ............................................................. #DiabetesChatters ................................................................ Tell Us Your Story ................................................................. Burning Questions ................................................................
34 35 35 36 36
Shared Pathways
Aboriginal Health Forum ..................................................... 37
Eating Well
Boost Your Family’s Immune System ............................. 38 Winter Stews and Soups .................................................... 39
Members’ Area
Members’ Puzzle and Competition ................................... 41 Member Partners .................................................................. 42
What’s On
Dates for your Diary ............................................................. 43
We recognise that diabetes is a complex condition. At Diabetes WA we are committed to providing a team approach to providing diabetes support, education and care. While ‘multidisciplinary’ is a term generally used by health professionals when speaking about health services, the approach is synonymous with how the care of a person living with diabetes should be managed. At Diabetes WA we use a collaborative team effort of health care professionals and other individuals to provide support to the person living with diabetes and their family or carer. Recognising who is in your team and making the most of their skills will allow you to find the support you need to manage your condition. Who participates in your team will depend on your type of diabetes, the services available in your particular location, the health care setting, the stage of diabetes and your individual needs. This issue of Diabetes Matters features those health professionals and individuals that are available to be a part of your team and explores how they can support you to live well with diabetes.
Changes to your Diabetes WA Board ‘team’ The Diabetes WA Board has recently been going through an evolution. Director Jim Dodds resigned, moving to Queensland with his family. Jim contributed greatly to the development of our organisation during his seven years on the Board and will be missed. We wish him the best with his new endeavours. The new constitution places no restraint on the number of members on our Board, allowing us to resource it with a broad range of skill-sets and a variety of expertise. We are therefore excited to be looking to the future with the appointment of four new highly experienced and skilled Directors to our Board. These appointments increase Diabetes WA’s Board to eleven Directors and bring new skills and experience in commercial governance, public health and business strategy. Each of these Directors will
Watson Dr Moira
From the Chair
help to further strengthen and expand Diabetes WA’s health services to reach the growing numbers of people living with, or at risk of, diabetes across WA. The appointments will ensure we maintain the very effective governance of Diabetes WA and enable us to respond to the growing challenges diabetes is placing on WA communities, the WA health system and the WA economy. You can meet our new Directors below. Diabetes is an ever-changing condition and we are positioning ourselves for different options. The reforming of your Diabetes WA Board team will strengthen our capacity to appropriately govern the organisation as we move into the future. Until next time …
Dr Moira Watson Diabetes WA Board Chair
Michael Ferguson has 40 years’ experience in commercial and corporate litigation and advice, with a focus on competition and regulation and anti-trust matters. He is a member of The Law Society of Western Australia, the Law Council of Australia and its Competition and Consumer Committee in Western Australia, and is Chair of Trustees of the Legal Contribution Trust. He is currently a partner with Squire Patton Boggs.
Margaret Pyrchla has over 20 years’ experience across financial services and energy industries in accounting, corporate finance, regulation, governance, strategic planning, project management, process improvement, and audit and assurance. She has previously worked for Ernst and Young, the Australian Securities and Investments Commission and is currently Head of Regulation & Investment Management at Western Power.
Fiona Lander is a Doctor of Medicine and a lawyer, currently working with McKinsey & Company (Australia) as a strategic consultant in healthcare, including advisory work concerning Federal Government healthcare, digital and innovation strategy, and aged care business unit strategy. Fiona also has experience in global health policy, international human rights law and emergency medicine.
Hannah Tagore is a communications professional with extensive non-profit, government, emergency management, crisis communications, brand and reputation management experience. She has previously been Head of Communications at Alzheimer’s Society in the UK and was Chief Media Officer for the British Prime Minister. She is currently Chief of Staff and Director of Communications at the Department of Fire and Emergency Services.
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perspective
The Black Box of Healthcare A passion for science led Ian Cooper into a career in pathology and medical science. The CEO of Western Diagnostic Pathology also lives with type 1 diabetes. He says having the condition gives him a relatively unique insight into the importance of diagnostics in a person’s health journey. Here he gives his perspective on the crucial, yet hidden, role pathology plays in diabetes management. I have always been fascinated by science ... So I feel lucky to have forged a career in a field I’m passionate about. I’ve worked in medical research and also in pathology laboratories, where medical samples are analysed for diagnosis and monitoring. As a person with type 1 diabetes, my career has given me a unique understanding of how absolutely essential pathology services are to diabetes management. We have all had an HbA1c test, but have you ever wondered who conducted the test, and how they did it? It will have been one of the thousands of medically trained pathologists and medical scientists working in pathology laboratories across Australia.
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Technology may move fast but the highly trained people working in medical laboratories remain the gold standard for detection and diagnosis. Next time you have a pathology test, spare a thought for the legions of expert medical professionals you never see, who are working alongside your doctors. I am proud to be among them. We have made more of a contribution to your health than you may realise! Read more about the hidden role of pathology on page 22.
Ian Cooper is CEO of Western Diagnostic Pathology
Pathology is sometimes called “the black box of healthcare”. Out of view from the general public, staff work around the clock to produce results that help Australia’s 1.2 million known people living with diabetes to keep their health on track and help diagnose some of the estimated half a million Australians unaware that they even have the condition.
Ian Cooper is a trained medical
Increasingly sophisticated and complex medical technology reduces the turnaround time for your results, despite the fact that the number of tests being run each year increases. For some people, finger prick tests are being replaced by sensors giving an instant glucose reading from scanning a mobile phone across your arm.
laboratories across Australia.
scientist who has spent his career in both medical research and practicing laboratory medicine in a number of pathology This experience has provided him with insights into one of the most important but least known areas of medicine and a domain where Australia leads the world.
WHO’S IN
the drivers seat
Tips for talking to your health care professional There’s nothing worse than coming out of an appointment feeling that it was too rushed. Or that you’re leaving with questions you thought were too trivial to ask. To make get the most out of your appointments, prepare a bit before you go, and it will make all the difference.
Ask questions It’s an old cliché, but there really is no such thing as a silly question. Diabetes is complicated and managing it can be difficult. If you’re not sure about anything, just ask. Write down any questions you think of and bring them with you. Run through them again at the end of your appointment to make sure nothing’s been missed. You should feel comfortable asking for time to write things down during the appointment too – like results, medical terms, or things for you to follow up on at home.
Be prepared
Plan ahead
Appointments can be frustratingly short for both you and your healthcare professional. By thinking about what you’d like to discuss beforehand you can get what you need out of the appointment. Bring a checklist with you and tick off what you’ve covered as you go. Remember you can ask about any checks that are due or are not yet booked.
If you have a lot to discuss then book a double appointment. This will give you plenty of time to talk, and you won’t feel rushed. Your healthcare professional will also have more time to help you plan.
Bring back-up If you think you’d feel better having someone with you, bring them along. Sometimes that can really help if you’re the type of person who worries afterwards about what was said and if you’d understood it all.
Take the lead Tell your doctor what you want to talk about at the start of the appointment. It means you won’t be wishing you’d asked something you didn’t after the conversation is finished, and can get all the information you need.
Be honest Try to be honest. There’s no point in being vague or pretending you’re doing better at something than you are. Be clear so that you get the care you need. The more honest you are the better the advice will be. Though this can sometimes be embarrassing, it’s really important to your wellbeing. Whatever your problems are, be as descriptive as possible. See page 9 for additional tips on how to work with each of your health professionals.
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DIABETES
news
The WA government releases the Sustainable Health Review report The Sustainable Health Review Panel has published its final report in April. The report has eight enduring strategies and 30 recommendations which seek to drive a cultural and behavioural shift across the health system. The WA Department of Health says these strategies were developed following extensive engagement, are informed by evidence and best practice, and were consistently reinforced in discussions with stakeholders in metropolitan and country areas. The eight strategies are as follows; 1. Commit and collaborate to address major public health issues.
New Multidisciplinary Foot Ulcer Clinic at Sir Charles Gairdner Hospital Sir Charles Gairdner Hospital has commenced a weekly outpatient Multidisciplinary Foot Ulcer Clinic. The comprehensive service will meet the needs of patients with complex diabetes-related foot complications. It brings together the specialties of vascular, infectious diseases, endocrinology, podiatry and nursing, and will provide care to patients with limb-threatening foot ulcers and infections, as well as other complex foot disorders such as Charcot neuroarthropathy. You will need a referral from your GP to attend the clinic so speak to your doctor if you are interested in learning more.
Heart Health Checks now covered by Medicare for eligible people New data from the Heart Foundation reveals that almost 13 million adult Australians are at risk of heart disease. One risk factor is diabetes. “The good news is that Australians aged 45 years and over, and Indigenous Australians from 30 years, can now see their GP for a Heart Health Check covered by Medicare to manage their risk of heart attack or stroke in the next five years,” said Heart Foundation chief medical adviser Garry Jennings.
2. Improve mental health outcomes. 3. Great beginnings and a dignified end of life. 4. Person-centred, equitable, seamless access. 5. Drive safety, quality and value through transparency, funding and planning. 6. Invest in digital healthcare and use data wisely. 7. Culture and workforce to support new models of care. 8. Innovate for sustainability. The report also included some key facts relevant to diabetes; • People who live in lower socioeconomic circumstances face much poorer health outcomes, with diabetes 2.6 times as high compared to people in the highest socioeconomic group. • Chronic diseases are responsible for 73 per cent of deaths in Australia. $715 million of hospital costs in WA were attributed to chronic conditions in 2013. 6
New faster-acting insulin on PBS from 1 June A new fast-acting insulin aspart (FiASP) that allows patients to take the treatment immediately before a meal, will be listed on the Pharmaceutical Benefits Scheme from 1 June for the treatment of type 1 diabetes. The product, marketed by Novo Nordisk, has a more rapid onset and shorter duration of insulin action, than previous insulin aspart formulations. The insulin received TGA approval almost 2 years ago and has been available in Europe since early 2017 and the US since early 2018. It is similar to NovoRapid insulin, with the addition of nicotinamide (a form of Vitamin B3) which accelerates the absorption. To find out more ask your doctor or visit www.pbs.gov.au/info/news
Needles and syringes co-payment The WA Department of Health has confirmed that the Needles and Syringes Co-payment funding will continue for another year. This means the government will continue to pay the fee gap of these products to ensure that needles and syringes remain free for people with diabetes. The scheme is valued at around $750,000 and Diabetes WA are proud that we were instrumental in acting as advocates to see the funding scheme continued.
DIABETES
news
HBF RUN FOR A REASON It was a beautifully sunny 10th HBF Run for a Reason on Sunday 19 May, with over 33,000 people taking part. Diabetes WA had 44 people fundraising on the day who raised over $26,000 (and counting!) for Western Australians living with diabetes.
Ashton Reynolds — $3583 Lisa Falcinella – $2809 Lucy Lee — $2638 Elizabeth Harris — $2040 Megan Watson — $1212 Left to right (clockwise): Ashton Reynolds checking BGLs; Lisa Falcinella; Lisa Falcinella with daughter Ashlyn with type 1; Nina Gelbke (DWA Ambassador); Matt Pontel and Jake O’Brien; Aaron Perkins half marathon.
Top Fundraisers
Another big thank you to our volunteers who braved an early 1.7 degree start to run the Diabetes WA hydration station. 7
Where Have We Been This Autumn DIABETES
news
Wandoo Rehabilitation Prison visit Our Community Education Coordinator, Chrissie Skehan and Aboriginal Health Coordinator, Natalie Jetta recently represented Diabetes WA at a Women’s Health Expo at Wandoo Rehabilitation Prison. Wandoo, a medium-security facility, is WA’s first dedicated alcohol and other drug rehabilitation prison for women in custody and houses 77 residents aged between 20 and 60 years. “The Clinical Nurse Manager at the prison approached us,” Chrissie said, “looking for health agencies to attend the expo to share health and safety information with the women, as part of their rehabilitation and integration back into the community.”
Australian Practice Nurse Association conference
“The women were very engaged asking questions and collecting resources,” Chrissie continued. “They were given a questionnaire relating to each of the health issues at the expo and had to engage with each stall to get the answers to the questions before taking any give-aways.”
Jennifer Sweeting from the Primary Care Engagement team recently represented Diabetes WA at the Australian Practice Nurse Association (APNA) annual conference in Adelaide. She gave presentations on DESMOND for type 2 self-management and FootSmart, programs delivered through the NDSS, and discussed evaluation outcomes around patient activation and empowerment.
Many of the women commented that they knew someone close to them with diabetes. “There was a lot of interest in our Healthy Eating guides, with the women commenting on the recipes, saying they were looking forward to trying them.”
Jennifer also presented posters on primary care pathways and DESMOND evaluation outcomes.
DESMOND Training in QLD DESMOND Australia trainers Sheryl Moore and Kylie Mahony from Diabetes WA provided two days of DESMOND training to 10 Queensland health professionals from a range of health backgrounds including dietetics, nursing and pharmacy.
Training participants
Completion of the training enables health professionals to deliver the DESMOND Newly Diagnosed Foundation Module for people with type 2 diabetes. Attendees at the training were from a wide geographical spread across Queensland including Bundaberg, Townsville, Gympie, Cairns, Kingaroy, Mackay and Mareeba, enabling great reach for the program delivery across the state. Feedback from the day was very positive with comments such as; “I feel privileged to be a part of this program”; “great opportunity to be involved in client self-management education”; and “it opens your eyes to a new way of delivering education and it is evidence-based which is important.”
More than 1,000 teachers across 42 schools were trained in diabetes care. Medtronic 670G Insulin Pump Diabetes WA Educators Nyaree, Mandy and Bec attended training for the new Medtronic 670G hybrid closed loop insulin pump. “It’s one step closer to an ‘artificial pancreas’, helping to ease the daily burden for people managing type 1 diabetes. This is just the start of the next revolution in insulin pumps, watch this space,” Nyaree said. 8
Jennifer at the conference
ABC Radio Health Services Operations Manager, Sophie McGough was interviewed on ABC Radio regarding recommendations for the WA government on the prevention and management of type 2 diabetes. The recommendations were outlined in a report launched by the Education and Health Standing Committee, led by Janine Freeman MLA, Member for Mirrabooka. In 2018, Diabetes WA provided a submission to the committee’s inquiry regarding type 2 diabetes management and prevention.
TEAM
diabetes
Team Diabetes Feeling better, staying active, eating well, reducing your reliance on medication, managing your BGLs ... to reach your goals, you need support every step of the way. Finding the right team of skilled health professionals, and supportive family and friends, will help you manage your diabetes and get the most out of the health care services available to you. Many people can be part of your health care team to help you live well with diabetes. Your own “Team Diabetes” should include a variety of health care providers who each play a role in your health. And of course, the management of diabetes does not solely consist of drug treatment, i.e. medication and insulin. It can be very complicated with lifestyle management, diet and exercise regime to be considered. There are side-effects from medication and particular benefits to weigh up. It’s important to take into account the mental, physical, medical health and wellbeing considerations of your condition. Who you see and how often varies from person to person and depends on how long you have lived with diabetes. When first diagnosed for example, you may need more support and input from your health care professionals. At certain times of your life you may need further support – such as pregnancy or as you grow older. People with type 2 diabetes may need more input
from health care professionals if their condition progresses and management needs change. People with type 1 diabetes may want to discuss their current management with their endocrinologist to have someone to bounce ideas off. You may want to change your pump or CGM or find out about a new option for management. There are a number of health professionals who you may need to see regularly, and others who you might call on or be referred to at times. Many of their roles overlap, but each person has their own area of expertise and training. And then there is the support network of family and friends who are just as essential to your wellbeing.
YOU are Team Leader of “Team Diabetes” In this feature we outline some of the key players of the multidisciplinary health care team who can offer support to a person living with diabetes.
It should be remembered though, at the start of this list should always be YOU – You are the most important member of your health care team. After all, you are the one who is affected by diabetes and cares for it every day. Only you know how you feel and what you’re willing and able to do. You do the exercise. You make and eat the foods on your meal plan. You take the medicine or inject the insulin. You check your blood glucose levels and keep track of the results. You deal with the stress of it all. And of course, you are the first to notice any problems. Your health care team depends on you to talk to them honestly and to tell them how you feel. If you are struggling to work out what is happening with your diabetes, never suffer alone. Reach out to the appropriate health care professional so you can work together on solving the issues. The following are the people and health professionals you may wish to have in your health care team.
Not sure where to start? Call the Diabetes WA Helpline on 1300 001 880 and we’ll help you to connect to the right team. 9
TEAM
diabetes
The Research Scientist Professor Grant Morahan BSc (Hons), PhD, Laboratory Head, Director of Centre for Diabetes Research, Harry Perkins Institute of Medical Research What role do you think research plays within the team that helps to support a person living with diabetes? Researchers around the world are tackling the problems of diabetes at many levels. Because there are so many aspects of research, some may seem far removed from the daily life of a person who has diabetes, while others are more directly relevant. People should be aware that there are a lot of researchers trying to find ways to prevent or cure diabetes, or to manage it better. Every day we are closer than before thanks to all these researchers. Key Research Projects My own group at the Centre for Diabetes Research at The Harry Perkins Institute for Medical Research specialises in genetics. We played a major role in the largest ever family-based genetic study into type 1 diabetes (T1D). The outcome of this project was the discovery of over 50 genes that affected the risk of developing T1D. We also had a very interesting research project led by Dr Fang-Xu Jiang which identified the precursor of the insulin-producing
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beta cells and found a way to develop these in the lab. After this maturing process they were able to cure diabetes in an animal model. Unfortunately, this project ran out of funding, so we were not able to extend the work any further. Another major project was “The Gene Mine” which we produced in Perth. This is the most powerful resource for gene discovery and generating models of human diseases. In a project supported by Diabetes Research WA, our team produced a mouse model of diabetic retinopathy which perfectly recapitulated the human disease. The study is now based in Beijing, where it is the focus of several projects of the Chinese Academy of Medical Sciences. One of these projects will find the optimal combination of genes and diet to prevent conditions like type 2 diabetes. Currently, we are involved in a very big project to discover the environmental triggers that contribute to T1D. For many years, we have known there are both genetic and environmental factors that cause T1D, and as mentioned above, we now know what the genetic factors are. This new study, called the Environmental Determinants of Islet Autoimmunity (ENDIA) Study is a nation-wide pregnancy to early life study into the causes of T1D. It involves several teams of researchers, each bringing special skills to the study. One team looks at what viruses the children are exposed to; another
finds what bacteria or even fungi they encounter; another studies the diet and lifestyle of the family. We are going to analyse the genetics, integrating the genetic factors with all these environmental variables. Anyone interested in the ENDIA study can find out more here: endia.org.au We are still hoping that other people can join the study, so please check out the site. Future Projects Together with Diabetes WA and Diabetes Research WA, I am planning a very important project to develop a test that can predict a person’s risk of developing diabetic complications like kidney failure. We have made a breakthrough in genetic analysis, allowing us to define “genetic risk signatures” that predict a person’s future health outcomes. Previously we have done this to predict a person’s risk of developing melanoma, and (if they get melanoma) their chances of surviving it, as well as the risk of heart attack if they have high blood pressure. All of these tests outperform “gold standard” clinical tests that doctors rely on. We think that identifying those people most at risk of developing diabetic complications — right at the time they are diagnosed with diabetes — will allow better management and prevention of these complications. In the long run, new drugs can be developed based on the genetic signatures that we define. WATCH THIS SPACE for more information to come.
TEAM
The Dietitian Narelle Lampard, Accredited Practising Dietitian/ Credentialled Diabetes Educator What service does a dietitian provide? Accredited Practising Dietitians have university qualifications in nutrition and dietetics. We provide individual dietary counselling, medical nutrition therapy and group dietary therapy. How do you help people with diabetes? Every person with diabetes is different, so I try to understand their individual needs by exploring their type of diabetes, medications, complications or other health problems, cultural background and taste preferences or intolerances and their activity levels and weight goals. I also consider
their budget. I then provide tailored, practical information about healthy food choices, label reading, cooking ideas and meal plans. As a diabetes dietitian, I pay particular attention to carbohydrate-containing foods, as these have the biggest impact on blood glucose levels – reducing added sugars, choosing quality carbohydrates that are high in fibre and low GI, and discussing quantity and distribution over the day. Why are you an important part of ‘Team Diabetes’? There is so much confusion and conflicting advice out there about what to eat to manage diabetes. A dietitian will provide you with dietary information that is based on scientific evidence, personalised to your individual situation. We will help you to stabilise blood glucose levels through diet in the short-term, but
diabetes
also develop eating patterns that will be sustainable, reduce the risk of complications and keep you healthy in the long-term. Do you have a story you could share? Working as a diabetes dietitian at Fremantle Hospital over many years, I have had the privilege of encouraging patients with type 2 diabetes to adopt consistent dietary improvements and physical activity, which has enabled them to lower their blood glucose levels, lose weight, reduce medications and feel better. At Diabetes WA, many participants who attend my ShopSmart supermarket tours express a sense of relief at the wide range of healthy foods they can eat, and participants of the CarbSmart sessions describe it as having found the piece of the diabetes management puzzle that they were missing.
The Psychologist Dr Melanie Burkhardt, Clinical Psychologist, Fiona Stanley Hospital What service does a clinical psychologist provide? Clinical psychologists apply the science of behaviour in their consultations with individuals, couples or families, to understand, prevent and alleviate psychologically-based distress, and promote wellbeing and personal development. They also provide consultation to other health care professionals and undertake research aiming to improve patient experience and health outcomes. How do you help people with diabetes? The burden of daily management of diabetes can be significant and may lead to diabetes-specific stress and burn out. I work in a multidisciplinary diabetes team including endocrinologists, diabetes nurse
educators and dieticians. For the most part, I assist people who experience problems in living with diabetes and related complications and provide behavioural self-management support that aims to improve their self-care, reduce the burden on health and wellbeing and improve quality of life and functioning. The support offered can be in the form of one on one, couple or family consultations or group programs that we run at the hospital. Why are you an important part of ‘Team Diabetes’? Self-management is central to diabetes care. This requires not only knowing what to do, but actually doing it. Knowing that something is important does not always equate to taking action. Psychologists understand that making and sustaining behavioural changes can be very hard for people. This is where clinical psychology can make an important contribution: supporting individuals to improve their self-care through applying principles of behavioural self-management and
addressing barriers to overcome personal struggles with diabetes. Do you have a story you could share? Fear of low blood glucose or hypoglycaemia is a common presentation for psychology input, which not only affects diabetes management, but can interfere with an individual’s daily functioning across multiple areas of life. For example, a young man with insulin dependent diabetes who presented for treatment with me had a high level of anxiety about potential ‘hypos’ and would selfmanage by avoiding any changes in routines to try to avoid uncertainty and unpredictable variations in his blood glucose. He had ceased playing a muchloved team sport, put in a lot of effort to avoid disruptions to his daily routines, including holidays away. He tested his blood glucose levels very frequently and also carried excessive amounts of hypo food/treatment with him daily. The burden of self-care and impact on quality of life was substantial.
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TEAM
diabetes
The Pharmacist Alison Ilijovski, Accredited Pharmacist/ Credentialled Diabetes Educator What service does a pharmacist provide? Pharmacists may work in all environments where medications are used, but most commonly in community-based pharmacies and health-systems, such as hospitals. A community pharmacist is responsible for safe and effective supply of any prescribed or over-thecounter medications. They also offer services such as Diabetes Medscheck within the pharmacy, liaison with other allied health professionals, and can conduct blood pressure and blood glucose reviews or assist you with self-management skills to be able to complete these at home. Within a hospital environment, pharmacists are involved in safe and effective management of your medications through clinical service on wards as well as within in-patient
and out-patient dispensary. They offer advice in relation to dose, dosage form, interactions and possible adverse effects. They also ensure there are no contraindications with medications already being taken and arrange discharge medication and instructions. Accredited pharmacists, such as myself, provide medication management services, such as a home medicine review (HMR), which requires a referral from your GP. The pharmacist reviews your medications within your home to ensure optimal use. A medication management plan is then developed together with your GP. An HMR is a useful service if you have recently been discharged from hospital, if you are experiencing any problems with your medications or if you are taking a number of medications and want time within your own environment to discuss their management. How do you help people with diabetes? As an accredited pharmacist I complete HMRs, which are usually for people with diabetes. I will visit the
patient within the home and discuss all the details of each of their medications; prescribed and over the counter, including any creams, inhalers, injections. It is a chance for me to describe other services available to them at their local pharmacy and review blood pressure and blood glucose levels as well. Why are you an important part of ‘Team Diabetes’? Pharmacists are a trusted member of the healthcare team. We are able to support, guide and educate people with diabetes around medications and how these can impact overall health. We have a knowledge base that can span much more than medications. It’s good to keep in mind that an HMR is also a time to discuss lifestyle factors that can impact disease states especially for a chronic disease such as diabetes. We will discuss nutrition, physical activity, smoking, alcohol and support systems in place. It is also a time that we can discuss their GP management plan and annual cycle of care.
Support Group Leader Zara Secker – Face 2 Face Support Group in Armadale What service does a support group provide? An outlet to discuss concerns, share experiences, and have opportunities for learning.
How do you help people with diabetes? Providing an avenue for people to discuss things with others who have been experiencing the same sorts of issues and perhaps even get some hints and tips on how to handle their issues. Why are support groups an important part of ‘Team Diabetes’? They help people to feel like they’re not alone with what they’re experiencing which has a liberating effect on the person. It’s comforting to know that you’re not strange because
you’re going through this by yourself. It makes the condition less alienating. Do you have a story you could share? Following a presentation by a guest speaker at a support group meeting, one of our members asked the speaker to come over to her place to demonstrate the diabetes product she was speaking about more fully to see if it helped her at all. She said the tips she received at the face to face demo were invaluable and she wanted to continue her learning at home.
Registering with the NDSS enables access to a range of Government approved diabetes-related products including: subsidised testing strips for checking blood glucose levels, free insulin syringes and pen-needles (if you require insulin), subsidised insulin pump consumables, and information services on managing life with diabetes. If you are not already registered with the NDSS, find out more at NDSS.com.au 12
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The Granddaughter Sally Robson, Grandfather with type 2 diabetes What role do you play in your grandfather’s diabetes journey? I’ve only ever known my grandfather with diabetes. I’m 27 years old and he is now on insulin to manage it, as it has progressed over time. Though it is in one side of the family, his condition has been caused by a poor diet and lack of exercise – lifestyle choices. He hurt his back and retired in his forties, and I think that has stopped him being as active as he could have been over the last 40 years. I think my role is that of a ‘nagger’. I’m often at him to eat better and to move more. Though he has decreased mobility, there is still more he could be doing. It is probably his dietary choices that I find most frustrating. I try to subtly encourage him to consider his diabetes when making food choices and to keep it front of mind in his day-to-day life.
How do you support him with his diabetes? I could probably do more to help, but I also don’t want to get too annoying with my preaching! We do talk about it though, particularly when he isn’t managing his levels or eating well. He has a lot of complications and I think they have developed because he doesn’t pay his diabetes the attention it really needs. When he has to go to hospital I sometimes drive him, like for his eye surgery. Just being there for him, to talk to about it, is something I try and do. He is in a bit of denial though and feels “there is no changing me now”. Why are you an important part of his ‘Team Diabetes’? Diabetes and heart disease are pretty strong in my family. His father died from a heart attack very young. I feel like sometimes I need to remind him of that, hoping it will be a wake-up call for him. I think my whole family plays an important role in his ‘team’.
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He has a lot of health issues so does need our support in many ways. He writes them off as part of ageing, but it is absolutely related to his diabetes – he is very overweight and has had a couple of heart attacks. He also has eyesight and foot problems; all common complications of diabetes. Do you have a story you could share? Interestingly, my dad is the complete opposite to my grandfather. He is active and eats well. I feel like both Mum and Dad have learned from my grandfather’s mistakes. My grandma (his wife) is now quite worried about her own risk of developing type 2. She hasn’t got many signs but is also overweight and watches how my grandfather struggles with it. She has started sending me her blood glucose level readings weekly to see whether I think they are ok. I just want them both to be healthy and happy and I think if they encouraged each other to be a little healthier and more active, it would make a big difference. So, perhaps that is my role.
The Pathologist John Crothers, Chair of Pathology Awareness Australia What service does a pathologist provide? A pathologist is a physician who studies body fluids and tissues, helps your primary care doctor make a diagnosis about your health or any medical problems you have, and uses laboratory tests to monitor the health of patients with chronic conditions. Pathology is the study of disease, or any condition that limits the quality, length or enjoyment of life. From the time a new life is created to the time it ends, pathology is involved. Pathology touches every facet of medicine. How do you help people with diabetes? In diabetes, pathology is absolutely central. The whole blood haemoglobin
A1c (HbA1c) is used to monitor long‐term glycaemic control. The measurement indicates a person’s average blood glucose level during the previous 90 days. This information is used to make decisions on diabetes management. Why are you an important part of ‘Team Diabetes’? There are over 500 pathology laboratories Australia-wide which process tests for 1.25 million Australians living with diabetes. For every diabetes test performed, at least ten people are involved including collectors, couriers, medical scientists, technicians, IT specialists, registrars and pathologists. Pathology tests help to give you an idea of how you are going with your diabetes management and what changes may be required to reduce your risk of complications.
Do you have a story you could share? We hear many personal stories of how pathology has changed people’s lives – often in a dramatic and unexpected way. I know of a laboratory in Melbourne that made a test result on a Friday evening and discovered, unexpectedly, that a life-threatening leukemia had been diagnosed in a seven-year-old girl and she needed immediate medical attention. The girl’s GP was not available, as it was a weekend, so the laboratory sent an ambulance directly to the young girl’s house and she was admitted to hospital. I’m delighted to say that she has made a full recovery and has recently visited the laboratory to meet the medical team that saved her life. It’s a wonderful story. See page 22 for our more extensive interview with John Crothers exploring pathology. 13
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Local Diabetes Organisation Andrew Wagstaff, CEO, Diabetes WA What service does a local diabetes organisation provide? At Diabetes WA we inform, educate and support thousands of Western Australians, helping you to better manage your diabetes, which in turn enables you to lead happier, healthier lives. We are a non-government, community-based organisation working within the Western Australian community to provide education and coordinate services for those living with diabetes and/or related chronic conditions, as well as those identified as at risk of diabetes. A state-based diabetes organisation is valuable as we have insight built on local knowledge and existing relationships and collaborations within the local health care environment. We work with other local community organisations to have a more significant impact on the prevention, reduction and management of chronic conditions.
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For 30 years Diabetes WA has also delivered the Commonwealth Government’s National Diabetes Service Scheme, a federally funded program of diabetes services to support those people living with diabetes in WA. How does your service help people with diabetes? State-based diabetes organisations can not only provide education and support, but can give people living with diabetes a voice, by helping to shape state health care policy. We support the development of capacity within the health system to maximise the quality and availability of service options to those with diabetes and/or related conditions, as well as those at risk of diabetes in WA. We also help by advocating on relevant matters and collaborating in, engaging in and funding research, related to services that prevent or reduce the impact of diabetes. We offer the Diabetes WA Helpline, which is a telephone service manned by credentialled diabetes educators who are trained to help you to best manage your diabetes. They can provide information, education, and counselling on all aspects of diabetes care, as well as helping you to problem solve and manage any issues that arise.
Why is a diabetes organisation an important part of ‘Team Diabetes’? Being a member of your state-based diabetes organisation means you are kept informed and have access to free workshops and programs to learn more about self-managing your condition. Being empowered to confidently manage your condition is a powerful tool and makes your whole ‘team diabetes’ stronger. Do you have a story you could share? Over my 10 years as CEO of Diabetes WA, the feedback we have received from people who attend our various self-management education workshops has given us a real insight into how we help them to learn more about their condition and become energised to better manage it themselves. Sheila attended DESMOND in Esperance recently, she said: “DESMOND was brilliant! I have just been diagnosed, so I was a bit confused before I went. The workshop taught me a few things about my diet that I could improve on straight away. It was worth bringing my husband because he does all the shopping, and to help me remember everything. I was very impressed with learning about how diabetes affects my body, using a diagram of a person. I really enjoyed it and would thoroughly recommend it.”
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The General Practitioner Dr Alan Wright What service does a GP provide? The general practitioner (GP) is the Gatekeeper for Team Diabetes. He or she will have assessed the patient to determine diabetes risk and then will have ordered blood tests to confirm the diagnosis of diabetes. The GP then sensitively informs the patient that they have diabetes and what needs to happen to successfully manage the condition. In the case of a type 2 diagnosis, the GP will analyse the blood results and determine whether the person can be treated with lifestyle adjustment alone, or whether they need to be started on medication immediately. The aim of the GP is, in partnership with the patient, to maintain good management of the person’s diabetes to prevent or limit complications of diabetes such as retinopathy, neuropathy and kidney disease.
In addition, the GP addresses those conditions, such as coronary artery disease, to which people with diabetes are more susceptible. How do you help people with diabetes? The GP utilises members of the diabetes treatment team, who each have a specific role to play in the management of diabetes. These roles include, but are not limited to, education about the condition, advice regarding diet and exercise, assessment of the nerves and blood supply to the feet, and assessment of the eyes to determine complications such as retinopathy or cataracts. Team members send reports back to the GP and, in conjunction with their own findings, he or she coordinates the management of the patient in the light of these findings. The diabetes annual cycle of care is a checklist for reviewing your diabetes management and general health. Your GP will do this review to help you and your diabetes health care team manage your diabetes, and to
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reduce your risk of diabetes-related complications. It’s important to do an annual cycle of care to identify any health concerns early and to discuss the best treatment with your doctor and diabetes health professionals. The GP recognises that the patient is a vital part of the management team and ensures that they are able to make informed decisions about the management of their condition. Why are you an important part of ‘Team Diabetes’?” It is essential that people living with diabetes have a good relationship with their GP because they need an individual who has been trained to have a good understanding of all aspects of the required care. As the GP, it is my responsibility to hold the holistic management of my patient with diabetes together over the course of years, discussing any changes of management that may be necessary over that time and working with the patient to reduce the impact of the condition on their life.
The Exercise Physiologist Carly Luff, Accredited Exercise Physiologist/ Credentialled Diabetes Educator What service does an exercise physiologist provide? An exercise physiologist is an allied health professional who is specially qualified to prescribe exercise for those living with injuries, pain or chronic conditions. We deliver both individual appointments and group programs, depending on what you would prefer. Your GP can refer you to an exercise physiologist or you can visit essa.org.au to find one near you. How do you help people with diabetes? An exercise physiologist can help you to find an exercise or physical activity plan that is suitable for you. We can talk
to you about what you want to achieve, how exercise and physical activity can help and work with you to create realistic and achievable goals. We can also help you to overcome any barriers that are getting in the way of your plan, such as motivation, time or other commitments, just to name a few! Why are you an important part of ‘Team Diabetes’? Physical activity and exercise are very useful tools to help people living with diabetes manage their blood glucose levels, as well as their blood pressure, cholesterol, weight and mental wellbeing. This can help to reduce the risk of long-term complications or assist with the management of complications if already present. I believe exercise is an essential part of managing diabetes and there is no one-size-fits-all approach. Too often I have seen people disliking exercise or doing a routine
that doesn’t suit them, then becoming disinterested over time. There is plenty of support and resources available to find something sustainable and help you move more. Do you have a story you could share? Richard is 56 years old and walks six kilometres, four to five times per week and has made some changes to his eating. After introducing exercise into his routine, Richard says, “my blood pressure has dropped significantly and is now 109/69 (from memory it was previously around 160/90) and my HbA1c has decreased from 9.5% to 6.2%. Hopefully with the support I’m receiving from family, friends and colleagues and my self-commitment to my diet and exercise I’ll get to my goal weight of 89kg – the weight I was in August 1995 – and live to see my 11and 13-year-old daughters graduate, get married and have children.” 15
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The Podiatrist Kymberlie Loveday, Jandakot Podiatry What service does a podiatrist provide? A podiatrist helps patients with diabetes to manage foot health and prevent any foot-related complications that could occur due to diabetes. How do you help people with diabetes? Patients living with diabetes come in regularly for routine care, such as callus removal and nail cutting. This helps reduce any risk of them creating a wound themselves. A neurovascular test, which tests nerve function and circulation, is carried out at least once a year to monitor any deterioration, that could lead to complications.
We tend to treat patients with ulcers by reducing pressure to help the area heal. We also offer regular appointments for wound dressings, to keep the area clean. Why are you an important part of ‘Team Diabetes’? “Prevention is better than cure”. I have seen many patients that come in with diabetic ulcers that could have been prevented due to them trying to cut their own toe nails, or not creaming their feet regularly, or simply walking bare foot. We encourage people to visit a podiatrist every six months. Do you have a story you could share? A patient I had been seeing for a year, was regularly coming in to the clinic for podiatry care to prevent complications from type 2 diabetes. One day he came in for his appointment and I had noticed callus forming at the bottom of his big toe.
The patient was neuropathic (loss of sensation) and so could not feel anything at the bottom of his foot. After removal of the callus there was a very deep ulcer that had formed. On further observation, there was a piece of wood measuring approximately five centimetres that was embedded into the sole of his foot. The patient recalled walking barefoot in his shed to look for something. It took several re-dressing appointments and antibiotics from the doctor to finally get the area to heal. I explained the importance of always wearing shoes even if he was only walking for a few minutes. This is a form of protection for the feet. It prevents you from stepping on things and stops cuts from occurring which can lead to infections, ulcers. If not treated well, it can lead to loss of limbs.
The Ophthalmologist Assoc Prof Angus Turner, Ophthalmologist, Lions Eye Institute and Director Lions Outback Vision, Western Australian of the Year recipient What service does an Ophthalmologist provide? An ophthalmologist is a doctor that specialises in the medical and surgical care of eyes. Ophthalmologists differ from optometrists and opticians in their levels of training and in what they can diagnose and treat. As a medical doctor who has completed university and at least eight years of additional medical training, an ophthalmologist is licensed to practice medicine and surgery. How do you help people with diabetes? Diabetes can affect the eye and if there are changes that are severe, having laser treatment or eye injections 16
can really help prevent vision loss and improve eyesight. If cataracts cause blurring of vision earlier due to diabetes, then this surgery can also help. Lions Outback Vision provides specialist eye-care services to remote areas of WA. As part of the team for eye care, I hope to be available for the patients who need specialist input. The optometrists can screen for diabetic eye disease changes and the Aboriginal health workers can also take pictures to detect changes and then refer to me and colleagues, when needed, for surgery or specialist care. Why are you an important part of ‘Team Diabetes’? We play an important role in preventing the complications of latestage eye disease caused by diabetes. High blood glucose levels can damage your eyes over time, but the problems are preventable if you have your eyes checked or screened regularly. Cataracts and glaucoma can also be associated with diabetes. There are
certain parts of eye care that need an eye specialist. This is where an ophthalmologist comes in. Glasses may help the vision and assist in reading, but the things going on at the back of the eye need attention with a check at least every year. Do you have a story you could share? Some patients have a condition that causes swelling at the back of the eye, which can be treated very effectively with a needle up to eight times a year. This sounds terrible, but actually the procedure is painless and makes a big difference. I have one patient who is the ‘nomad of the year’ so I have given up tracking him down from Meeka, to Hedland and Halls Creek. He just rings me once a month without fail and tells me where he is, so he can get his injection to keep driving! Getting to all the remote spots around our big state is a real challenge but at Lions Outback Vision we do our best to be as close to home as possible for people.
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The Dentist Dr Ernest Yeo, Dental Practitioner, Photogenic Dental What service does a dentist provide A dentist will provide a comprehensive examination, diagnosis and treatment of the health of your teeth and mouth. They can also conduct x-rays, oral photos, laser and 3D scans to record the health of the existing oral environment and to teach you about your existing dental health and current and future risks. They can provide education on oral hygiene practices and dental related dietary advice. How do you help people with diabetes? Dentists can often be the first health professional to detect that you may have diabetes by identifying signs in your oral health. Good oral health helps improve management of diabetes and can reduce the risk of
other complications including heart disease and stroke. Dentists can assist with treatment and maintenance of gum/periodontal health, including scaling, cleaning and root-planing. They can also advise on managing side effects of medications such as dry mouth and bad breath. Why are you an important part of ‘Team Diabetes’? Visiting your dentist regularly allows us to manage oral disease and help to avoid more major complications from developing, by working in combination with other health professionals. We take a holistic health approach from head to toe and provide education, advice and support. Do you have a story you could share? Being personally and holistically cared for by an entire dental team is especially valuable for clients with possible medical issues that can complicate treatment and care.
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We had a long-term client with type 1 diabetes that had finished a long crown procedure. Towards the end of her visit, she started to be very emotional, confused and disoriented. All the staff recognised this was out of character and that she was having a hypoglycaemic episode. We took her to a private room, sat and talked to her calmly, gave her some glucose tablets and called her husband to collect her. She insisted on leaving, but our team stopped her from driving. She returned a few days later with a lovely card and gift of thanks from her husband. We pride ourselves at Photogenic Dental on our personalised old-fashioned service and this was a very proud moment for our practice to truly holistically care for one of our clients. It showed us how valuable our service is to clients with medical issues such as diabetes, both for their oral health and their overall health and safety.
The Credentialled Diabetes Educator Christine Carne, Credentialled Diabetes Educator/ Registered Nurse What service does a diabetes educator provide? Credentialled diabetes educators (CDEs) are specialists in diabetes who support people to selfmanage their diabetes effectively. We can be the first point of call when you are wanting more information, support and/or motivation in the management of your diabetes and can act as the link between other health professionals. CDEs have an in-depth knowledge of all aspects of diabetes and can recognise when you need to see other members of your health care team, for example, an optometrist or podiatrist. How do you help people with diabetes? While a GP can manage a patient’s care and treatment, a CDE can empower you to manage your own
diabetes. We teach, coach and guide you to understand diabetes and how it affects your own personal life, setting personal goals to meet required lifestyle changes and ultimately improve your health. We can also help to organise tests and screenings for diabetes complications, which will vary depending on your diabetes, lifestyle and age. Credentialled diabetes educators are required to participate in ongoing professional development within the specialty of diabetes education so are specialists in their field. You can locate a CDE on the ADEA website. Why are you an important part of ‘Team Diabetes’ CDEs often have more time than a GP to focus on you and your health. We can access resources and health professionals, provide up to date information and teach you selfmanagement tools to enable you to manage your own diabetes and health. Think of us as personal coaches that
empower you to look after your health yourself! Nowadays it is often easier to stay in touch with a CDE who can use face-to-face appointments, videoconferencing and phone calls as a way to communicate with you. Do you have a story you could share? As a facilitator of diabetes selfmanagement workshops (DESMOND) I complete follow-up phone calls, if requested by a participant. On completing a call to an elderly pensioner who was feeling overwhelmed and tearful, who was living with a number of chronic health issues, she told me, “You have made me feel much better by just talking things through with you. You are a wealth of knowledge and I feel so much more informed and able to take the next step on my own.” I think it demonstrates what a difference that feeling of empowerment and support can make for people, at any age.
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The Endocrinologist Dr Meg Henze Dr Henze works with the Diabetes WA Telehealth team to consult with regional patients via videoconference. What service does an endocrinologist provide? Endocrinology is the field of hormonerelated diseases. An endocrinologist can diagnose and treat hormone issues and the complications that arise from them. Hormone imbalances are the underlying reason for a wide range of medical conditions. Endocrinologists specialise in the glands of the endocrine (hormone) system. The pancreas is the gland involved in diabetes as it produces the hormone insulin. How do you help people with diabetes? I help people with diabetes by having the expertise to help manage their condition and assisting to coordinate their care amongst a multidisciplinary team. Often people with type 2 diabetes can be managed safely by their GP but sometimes their condition
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has progressed to the point they need specialist input or there are other factors that make their care more complex. Type 1 and rarer forms of diabetes usually benefit from input by an endocrinologist as these can be trickier to manage and benefit from the detailed knowledge base of a specialist. When discussing insulin pumps, glucose-sensing technologies, avoiding hypoglycaemia and providing specialist reviews for driver’s licence medicals, it helps to have specialist knowledge and experience. Why are you an important part of ‘Team Diabetes’? It is essential that people living with diabetes, particularly type 1, have a good relationship with their endocrinologist and see them regularly to optimally manage their condition. This will help to avoid short-term complications such as hypoglycaemia, and long-term complications such as damage to eyes, kidneys and feet. Their endocrinologist will also be well placed to advise them about newly emerging technologies for managing their diabetes, such as new glucose monitors and sensors, new insulin formulations, or pumps.
Do you have a story you can share? I am passionate about delivering endocrine services to rural and remote patients who otherwise would have difficulty accessing this kind of specialist service. Having grown up in a regional town, I understand the difficulties faced by patients outside the metropolitan area in accessing appropriate care. In my regional work I have been lucky enough to see and assist many patients who haven’t had an endocrinology review for many years. In some cases, they had been misdiagnosed or given suboptimal treatment, which I was able to identify and improve upon. I met a patient recently who had been diagnosed with type 1 diabetes in his 30s and had been on insulin for the past 30 years. When I reviewed the history, it didn’t quite add up. Subsequent investigations showed he in fact had type 2 diabetes and was producing his own insulin. This meant that we could cease insulin injections and start him on oral therapies. He couldn’t believe that after 30 years of injections he would be able to stop because they weren’t needed. His life has changed enormously!
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The Social Worker Kirsty BrowneCooper, Senior Social Worker, Perth Children’s Hospital What service does a social worker provide? The social worker at Perth Children’s Hospital (PCH) is part of a multidisciplinary team also consisting of an endocrinologist doctor, diabetes nurse educator and dietician. Every child who is newly diagnosed with type 1 diabetes is seen by a social worker at the hospital and has an initial assessment, which offers counselling in adjusting to living with the condition. We also inform parents of the practical matters and local support available. A social worker is present at the outpatient three-monthly diabetes review clinics and offers assessment and counselling to patients as required. How do you help people with diabetes? I have a lot of respect for children living with diabetes and their parents. Chronic
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health is underestimated in its day-today demands. I help children and their parents to look at the best ways they can make diabetes fit into their daily lives without it being too intrusive. This week I helped a young boy re-organise his lunchtime diabetes routine at school to ensure he was with his mates and ready on the siren, so he didn’t miss out on the fun that school lunchtime offers. Burnout is a big area of concern and I like to focus on the strengths within the person to assist in decreasing burnout from the day-to-day expectations of type 1 diabetes.
routine which has helped her to feel a lot happier in herself and more confident to face year 12 exams.
The impressive ongoing research and updates of technology within type 1 diabetes care is amazing, but it also comes with its own challenges. The continuous glucose monitors have added a lot to diabetes care but also have the added stress of “notime-out”. We have been working on strategies with families to cope with this. Recently I saw a beautiful young girl who was feeling consumed by her phone. With some counselling and planning, we changed her phone
Recently I saw a teenage boy who lacked motivation, had stopped looking at his CGM and had stopped bolusing before meals. He was feeling “tired of living with type 1 and with the questions from his peers”. Together we teamed up with his parents who became more involved and created a buddy system at school. We also invited his siblings to support him at mealtimes. Sharing that you have type 1 diabetes can help others better understand the condition.
Why are you an important part of ‘Team Diabetes’? Social work is an invaluable part of the team. We are the go between of medical management and emotional care. ‘Science is an art’ and adding social work to the ‘art’ improves care. I have to thank the PCH diabetes team who are very inclusive of social work intervention. Do you have a story you could share?
The Blogger and Advocate Frank Sita, blogger type1writes.com What service does a blogger provide? I simply write about my life with diabetes. I can also be frequently found scrolling through my social media feeds keeping myself up to date on all things diabetes. Blogging has also provided me with opportunities to travel to industry events such as the annual Diabetes Congress, where I’m able to network with industry, get updated on the latest research and experience some of the new tools and technologies. I’ve also had the privilege of speaking in front of healthcare professionals, where I can offer the unique perspective of a person with diabetes outside of a clinical setting.
How do you help people with diabetes? I don’t intentionally set out to help other people with diabetes. Nor would I be qualified to do so! But I guess people who’ve read my blog often feel that they can relate to my stories in some way. Whether it be recounting a nasty hypo at 3am, or trying to explain diabetes to yet another member of the extended family. Diabetes is an extremely isolating condition to live with, and when we share our stories we don’t feel so alone in what we are dealing with. Why are you an important part of ‘Team Diabetes’? It’s really important for people with diabetes to be represented and to have input into decision making. Among healthcare professionals, pharmaceutical companies and diabetes organisations. Nothing about us without us. I also feel
really strongly about passing on any information that I’m lucky enough to obtain in my travels. A few short years ago I was living in relative isolation with my diabetes, relying on only the information made known to me through my healthcare team. The wealth of knowledge that I accumulated from the DOC (Diabetes Online Community) was life changing. Do you have a story you could share? I receive emails and messages every week. They all have one resounding theme. ‘Me too.’ Once again, diabetes is an extremely isolating condition to live with. Having peer support, whether it be from reading my blog or from connection to another person with diabetes, can be life changing.
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Aboriginal Health Worker Liz Narkle, Aboriginal Health Worker What service does an Aboriginal health worker provide? Aboriginal health workers provide culturally-safe healthcare to Aboriginal individuals, families and community groups. Key roles include advocating for Aboriginal clients in order to explain their needs to other health professionals, educating or advising other health professionals on the delivery of culturally safe health care, and adapting the roles they perform to local health needs and contexts. How do you help people with diabetes? We provide education on what foods are good for our clients and help them with monitoring for diabetes self-care. We also advise on the specialists they might need to see and service providers they need to meet with. A big part of our job is advocacy. Aboriginal people are sometimes not confident to talk to health professionals, so need someone to talk to them on their behalf. They communicate with me over the phone and then I recommend
a specialist and if they then don’t want to call them, I will do it. I will check that they have transport or whether they need someone to go with them to the appointment. We also do home visits and field work. We need to be very community-oriented and actively engaged with our communities. We provide holistic care – not just physical health, but spiritual, cultural and family health as well. We even speak to them about their finances. We provide support in every aspect. Why are you an important part of ‘Team Diabetes’? An Aboriginal health worker is someone that an Aboriginal person can relate to. We are someone who understands who they are and has been in their shoes. We’re something familiar. Giant hospitals and medical clinics can be overwhelming so if they see another Aboriginal face, they can feel more comfortable. If they are from a remote area, and they are traveling from there to Perth, they need someone to connect with. Aboriginal people, particularly those who are older and more fragile, rely a lot on their families. We spend time
liaising with a client’s family to decide what the best care is for them. We inform families about care plans, but we need to be open to listening to the family members and be available, sometimes at short notice. Do you have a story you could share? Recently I visited an older man who was neglecting his health a lot. He had recently moved to a new area and hadn’t seen his GP or nurse or health worker in over a year. He wasn’t really up to going to appointments, as he believed that if you go to a doctor or hospital then you are going to die. This is not uncommon, as they have seen so many relatives go into hospital and never come out. His hands were cold, and his feet had lots of wounds that weren’t healing, all obvious signs of diabetes. We were able to talk to his family and convince him to see his doctor. He would not leave his home, so we got the doctor to come to him. From there he was able to express why he was afraid and then was willing to come to the clinic with a transport driver and, after much consultation, we finally got him on medication.
Other Specialists You might also be referred to a variety of specialists such as those below, if there are any complications with your diabetes and general health.
• Gastroenterologist – specialises in problems with the stomach and digestive system and can help with things like diabetic gastroparesis (delayed stomach emptying).
• Paediatrician – specialises in the care of children, and can help families manage the specific-needs that a child has with diabetes. • Physiotherapist – works on muscular and physical aches, pains and abnormalities, as well as joint problems, posture etc. • Neurologist – specialises in diagnosing and treating nerve damage and neurological disease, such as diabetic neuropathy. • Cardiologist – specialises in the heart and cardiovascular system. • Nephrologist – specialises in disorders of the kidneys. Remember that at the end of the day YOU are the person managing your diabetes. However, all of these people are there for you when needed and you should always seek support and not try to do it all alone. For information on Medicare entitlements, including assessments, dental procedure claims and group service sessions, visit medicareaustralia.gov.au
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How to best work with your health care team As we have discussed, a team approach to diabetes care can effectively help people cope with the vast array of complications that can arise from diabetes. How can you best work with some of the key members of this team to ensure you get the best benefit from the services they provide? Work with your pharmacist;
Work with myself;
• Make a list of all medicines, the exact doses, and include over–the-counter medicines, vitamins, and herbal supplements.
• Be more active — walk, play, dance, swim, and turn off the TV.
• Update and review the list with your pharmacist every time there is a change.
• Eat a healthy diet — choose smaller portions, more vegetables, and less salt, fat, and sugar.
• Ask how to take your medicine and generic brand options to get the best results at the lowest cost.
• Quit if you smoke or use other tobacco products — tobacco use increases the risk of diabetes complications developing.
• Ask about new medicines that you can discuss with your doctor.
• Ask all your health care providers to share your medical results with your other health care providers.
Work with your podiatrist;
• Learn more about self-managing your diabetes by attending Diabetes WA education programs and other workshops.
• Get a full foot exam by a podiatrist at least once each year. • Learn how to check your feet yourself and do it daily. • See your podiatrist immediately if you develop any foot pain, redness, or sores. • Ask about the best shoes, with the right fit for you. • Make sure your feet are checked at every visit with your GP.
Work with your optometrist/ophthalmologist; • Ask for a full eye exam with dilated pupils each year. • Ask how to prevent diabetic eye disease. • Ask what to do if you have vision changes and see your specialist as soon as you notice anything different.
Work with your dental provider;
• Seek support from family and friends who can motivate you to stay on track. • Do your best to manage the “HBCs” of diabetes: > HbA1c. This test measures average blood glucose levels over a period of three months. Generally, the goal is less than 7% for many people but your health care provider may set different goals for you. > Blood Pressure. High blood pressure may cause heart disease and increase your risk of diabetes complications. > Cholesterol. Bad cholesterol or LDL (Low Density Lipoprotein) builds up and clogs your arteries.
• Visit your dental provider at least once a year for a full mouth exam. • Learn the best way to brush your teeth and use dental floss. • Ask about the early signs of tooth, mouth, and gum problems. • Ask about the link between diabetes and gum disease so you remain informed. 21
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The Hidden Pathologist The health professional seeing thousands of patients a day. Pathology services are a vital and integral part of health in Australia and contribute significantly to the good health of all Australians. Pathologists are the doctors that you never see, yet they are deeply involved in a patient’s care. Pathology is a medical specialty that determines the cause and nature of diseases. It is the bridge between science and medicine and underpins every aspect of patient care, from diagnostic testing and treatment advice, to using cuttingedge genetic technologies and preventing disease. Pathology is not only about blood. Scientists examine and test body tissues (from biopsies and pap smears, for example) as well as bodily fluids (from samples including blood and urine). The results from these pathology tests help doctors diagnose and treat patients correctly.
Australians currently enjoy amongst the highest quality and most accessible pathology services in the world. Every Australian receives their first pathology test just days after they are born. The Guthrie or heel-prick test is a blood test that screens for serious genetic conditions. From then on, we rely on blood tests, biopsies and a multitude of other pathology tests to prevent, diagnose and treat infections, allergies, chronic diseases, cancers and countless other medical conditions.
The Australian Medical Association (AMA) says that pathology tests are ordered in relation to one in every five encounters between patients and general practitioners, and one in every two encounters between patients and specialists.
100 pathology tests are performed every minute in Australia Sixty per cent of Australians will have at least one pathologytesting episode each year, and many with chronic conditions will have far more. It goes without saying that people living with diabetes fall into the latter category. 22
Medical scientist performing HbA1c test
TEAM
diabetes
We spoke to John Crothers, Chair of Pathology Awareness Australia, about his field and asked him why pathology plays such a crucial role, particularly in the lives of people living with diabetes. Q: Many people would not realise the important role that pathology plays in, not only diagnosis but also management of, diabetes and the prevention and detection of complications. Can you explain why it is so important? A: It’s a part of your healthcare which is largely unseen and unknown by most people, but it’s estimated that around 70% of medical decisions rely on information from pathology tests. In laboratories across Australia, specialist doctors called pathologists, and medical scientists work around the clock to find the medical answers your doctors need to know. Approximately half the population have some form of pathology investigation every year so it’s reassuring to know that Australian pathology has among the highest quality standards in the world. This means that overall healthcare provision can be of a high standard – after all if you don’t know what’s wrong with a patient, how can you treat them?!!
Q: The campaign for Pathology Awareness Australia is Know Pathology Know Healthcare – the group was formed in response to the public misconception or ignorance about the value of pathology. Do you think this is improving? A: Public curiosity around pathology has been steadily growing for years. Many people are blown away when they learn how much is involved behind the scenes to generate medical diagnoses. There are approximately 35,000 people involved in pathology in Australia, from enormous laboratories operating 24/7 in capital cities, to regional labs delivering crucial work for their communities. The Know Pathology Know Healthcare website – knowpathology.com.au – contains a multitude of stories and information about what happens inside the engine room of healthcare.
Q: What would you like people to keep in mind when they are with the phlebotomist (the medical technician who takes blood), being asked to supply a sample, or are looking into their pathology results? A: There is a dedicated team behind every single medical test result. This is the culmination of decades of best practice and investment into cutting edge medical technology. Many other countries are envious of the high quality of Australian pathology, so we are very lucky here. And if you want to know more about the test that your doctor has ordered, visit the Know Pathology website where there is information about pathology tests in plain English. In many cases the earlier a condition is detected then the better the outcomes can be, or adverse outcomes avoided. This is particularly true with diabetes where regular testing to monitor the condition is absolutely essential for good management.
There is no diabetes without pathology!
John Crothers with Cathy Freeman OAM, during a tour of a laboratory to learn more about the role of pathology in diabetes management.
John Crothers is a trained medical scientist and worked in several laboratories before taking up a role at a diagnostics company. He has been Chair of Pathology Awareness Australia since 2013 and is Regional Director of Australia and New Zealand with Abbott Diagnostics. 23
Workshop We have a range of workshops and services that can help you on your health journey. Self-management Workshops Diabetes WA runs a number of education programs, held as two-to three-hour workshops, to help you manage your diabetes and improve your health. ShopSmart – this supermarket tour or classroom session helps you decode food labels. FootSmart – everything you need to know about caring for your feet. MonitorSmart – master the art of blood glucose monitoring. CarbSmart – unravel the mystery of carbohydrates with this carb counting masterclass. MedSmart – understand what your medications are, what they do and how to address any concerns you have. Living with Insulin – everything you need to know about using insulin; including equipment, hypos and blood glucose levels. Ready Set Go, Let’s Move – make exercise part of managing diabetes each day, with your own step by step plan. Note: This is not a fitness program. Insulin Pump Workshop – learn about the features of your pump and how to get the most out of it with this hands-on session.
Type 1 Technology Night Explore pumps, CGMs and flash monitoring and meet with device company representatives to find out the pros and cons. 24
Perth Metro
Armadale Armadale Aveley Banksia Grove Banksia Grove Banksia Grove Banksia Grove Bassendean Bassendean Bassendean Beckenham Boya Boya Boya Butler Butler Butler Cannington Clarkson Cockburn Cockburn Cockburn Cockburn Dayton Dayton Dayton Girrawheen Girrawheen Heathridge Lakelands Mandurah Mandurah Mandurah Melville Melville Melville Melville Melville Mindarie Mirrabooka Mirrabooka Mirrabooka Mirrabooka Mirrabooka Piara Waters Rockingham Rockingham Rockingham Secret Harbour Secret Harbour Secret Harbour Secret Harbour Secret Harbour Southern River Wanneroo Wellard West Leederville West Leederville West Leederville West Leederville West Leederville West Leederville Willetton
DESMOND DESMOND DESMOND DESMOND MedSmart CarbSmart MonitorSmart MonitorSmart FootSmart DESMOND DESMOND DESMOND Classroom ShopSmart MedSmart FootSmart ShopSmart Living With Insulin DESMOND (FULL) Insulin Pump Workshop MedSmart MonitorSmart ShopSmart DESMOND DESMOND CarbSmart DESMOND DESMOND DESMOND Classroom ShopSmart Living With Insulin Connect with Diabetes DESMOND DESMOND DESMOND FootSmart MedSmart DESMOND CarbSmart DESMOND Ready Set Go - Let's Move Classroom ShopSmart DESMOND (FULL) ShopSmart FootSmart DESMOND DESMOND Classroom ShopSmart FootSmart DESMOND MedSmart Classroom ShopSmart Ready Set Go – Let's Move CarbSmart CarbSmart ShopSmart DESMOND (FULL) DESMOND (FULL) CarbSmart FootSmart DESMOND MonitorSmart DESMOND ShopSmart
22 August 6 September 15 August 4 July 10 July 10 July 13 September 15 July 19 September 28 September 20 August 28 August 20 September 20 September 1 July 1 July 30 August 20 July 4 September 21 June 21 June 21 August 31 August 29 July 10 September 19 September 2 August 13 September 5 August 4 July 15 July 27 July 14 September 5 August 23 August 23 August 10 September 27 September 17 August 28 June 9 July 16 July 23 July 6 August 24 September 24 August 2 September 2 September 9 July 30 July 30 July 20 August 29 August 9 August 26 September 24 June 11 July 26 July 26 July 8 August 15 August 16 September 11 September
Calendar WA Regional
Albany
DESMOND
Albany Albany Bunbury Bunbury Bunbury Busselton Esperance Esperance Geraldton Geraldton Geraldton Geraldton Kalgoorlie Northam South Hedland South Hedland South Hedland
DESMOND DESMOND DESMOND DESMOND DESMOND DESMOND DESMOND DESMOND DESMOND DESMOND DESMOND DESMOND DESMOND DESMOND DESMOND DESMOND DESMOND
16 & 17 July (two half days) 13 August 25 September (FULL) 26 July 23 August 20 September 5 September 26 June 27 August 15 July 16 August 9 September 27 September 28 August 12 July 3 July 14 August 25 September
Free to Diabetes WA members an d NDSS registr ants
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 desktop computer. The sessions cover a wide range of diabetes-related topics such as chronic kidney disease, diabetes retinopathy and gestational diabetes. To find out more or to register for any upcoming sessions call 1300 001 880 or go to our website.
For more information or to book into any of these workshops, visit diabeteswa.com.au, call 1300 001 880 or email bookings@diabeteswa.com.au 25
RESEARCH
news
Research Round-Up
It’s great news for people in Europe A new treatment has been approved for use in Europe for people with type 1 diabetes. Zynquista (sotagliflozin) is an oral tablet which inhibits the SGLT-1 and SGLT-2 proteins that influence how the intestines and kidneys absorb glucose, resulting in improved diabetes management.
It’s good news for people who love the sun Healthy, middle-aged adults exposed to more bright sunlight in the 7 days before providing a blood sample had lower levels of markers indicating risk for insulin resistance vs. adults exposed to less sunlight, according to findings published in The Journal of Clinical Endocrinology & Metabolism.
It’s bad news for lovers of baked goods Consumption of propionate, a food ingredient that’s widely used in baked goods, animal feeds, and artificial flavourings, appears to increase levels of several hormones that are associated with risk of obesity and diabetes, according to new research led by Harvard T.H. Chan School of Public Health.
Helping to prevent amputations A new blood transplant patch is being trialled that could prevent diabetes-related amputations. The treatment, called LeucoPatch, has been trialled in more than 200 hospitals in Europe. The patch contains the patient’s own blood and is placed on limb ulcers to assist in the healing process. Half a cup of blood is taken from the patient and is spun in a centrifuge, causing the denser red blood cells to sink to the bottom, while the less dense white blood cells rise to the top. This process also separates out fibrin, an even less dense protein that forms a mesh-like substance which acts as a scaffold in wounds. Blood can clot on to this to form a healing scab and healthy new skin cells can begin to grow. The fibrin is pressed into a semi-solid round patch, which also contains white blood cells that help to kill bacteria and viruses, and platelets, which help blood to clot. The patch is then placed on the wound and covered with a loose dressing. After a week, it starts to break down and is replaced with another patch, and the process is repeated until the wound heals.
Diabetes drug shown to protect against kidney disease A study published in the New England Journal of Medicine has found that the type 2 diabetes drug, canagliflozin, could reduce kidney and heart failure. The study recruited 4401 patients living with diabetes and kidney disease from 34 different countries. Key findings from the study included: • The number of people with diabetes developing kidney failure or dying from either renal failure or cardiovascular disease was reduced by 30%. • Hospitalisation for heart failure was reduced by 39%. • The risk of major cardiovascular outcomes was reduced by 20%.
Puzzle Solution (from page 41) 26
The study involved more than 260 patients with hard-to-heal diabetic foot ulcers. Half were treated with the new LeucoPatch and half received standard treatment, such as debridement and regular dressings. After six months, 34 per cent of the LeucoPatch group saw wounds heal completely, compared with just 22 per cent in the control group. Furthermore, they healed faster, with more LeucoPatch patients ulcer-free after just three months of treatment.
“This definitive trial result is a major medical breakthrough as people with diabetes and kidney disease are at extremely high risk of kidney failure, heart attack, stroke and death,” lead author Prof Vlado Perkovic, of The George Institute for Global Health, said. “We now have a very effective way to reduce this risk using a once daily pill.” Researchers say the results, which were presented at the ISN World Congress of Nephrology in Melbourne recently, can be implemented immediately as the drug is already available.
Please note: The information on this page is a snapshot of the latest advances in diabetes research. Please keep in mind that research findings will not necessarily apply to your individual situation and this information should not be used to make decisions about treatment and management without the input of a health professional.
RESEARCH
news
Research to help prevent blindness by Diabetes Research WA executive director Sherl Westlund
Well this year is racing by and National Diabetes Week will soon be upon us once more. This year, we’re planning another informative diabetes research event in Perth and would love to see you there – you can check out our website for more details. In the meantime, we’re excited to announce that Western Australian-made technology that aims to help prevent blindness in people with diabetes has been approved for use by Australian and Singaporean authorities. The artificial intelligence-based screening system for diabetic retinopathy (DR) was recently supported by an $80,000 Diabetes Research WA grant to CSIRO and the exclusive licensee, TeleMedC, has now rolled it out to more than 30 clinics in Singapore, following approval by the country’s Health Sciences Authority. Regulatory approvals have also paved the way for it to be rolled out to major hospitals in Australia. The technology gives rise to potentially being able to detect DR earlier because it can be used to screen patients in a primary care clinic instead of having to be referred to an eye specialist, which can cause delays in diagnosis. From here, the focus of TeleMedC will shift to taking it to Malaysia, Cambodia and some South Asian countries and they’re waiting for approval to use it in the US and Europe also. With 1 in 3 people with diabetes affected by DR and 1 in 10 developing a vision-threatening form of it, this is important work. We’re also sending a big ‘congratulations’ to Dr Aron Chakera, one of our previously funded researchers, whose important work into reducing cases of post-transplant diabetes has been accepted for publication. This research can be found in the May/June 2019 edition of Diabetes & Metabolic Syndrome: Clinical Research & Reviews.
Aron Chakera
If you’d like any further details on our support of leading Western Australian research into diabetes, head to diabetesresearchwa.com.au (08) 9224 1006
27
LIVING
well
A Cleaner Slate Is there an ugly truth behind some beauty products? A recent article in Marie Claire Australia magazine (No 282 Feb 2019) presented some chilling statistics. Among shocking facts such as: in eight years, the Great Barrier Reef will be dead; 500 million kilograms of textiles are dumped in landfill in Australia each year; and the fashion industry is the second biggest polluter in the world (behind oil), Marie Claire said that the average woman applies 515 chemicals onto her skin every day, with 60 per cent absorbed straight into the bloodstream. Scary right? The article continues on to say that half of Australian women would prefer to use natural skincare products but are yet to make the switch.
The average woman applies 515 chemicals onto her skin every day, with 60 per cent absorbed straight into the bloodstream. “The beauty industry has an ugly secret,” claims The Global Healing Center in the US. “Most skin care products contain harmful chemicals that could potentially harm your health, and even make ageing worse. Your makeup, face cream, skin moisturiser, or cleanser may deliver short-term smoothness and brightness, but it also may disrupt your hormones, expose you to cancer-causing chemicals, and deliver dangerous toxins that age your skin.” We are now more aware than ever of what we put into and onto our bodies and how this can affect our health and wellbeing. Karen Rullo, Director of natural skin, body and hair care company, Dianne Caine Australia says “What we put into our bodies, usually through our mouth, often gets the main focus when we are wanting to avoid toxins or chemicals. But many people don’t realise that our skin is the largest organ in the body and much of what we put onto our skin gets absorbed right into our bloodstream.” Our bodies are a product of our environment, absorbing everything we need to thrive; from the food we eat, to the air we breathe and the materials and substances we touch, our bodies reflect the choices we make. Whilst we all do our best to make the right choices, research has shown that in the modern world most of us have some level of unavoidable man-made chemicals stored in or passing through our bodies. 28
With our skin being our first barrier to fight illness and disease, it is a window to our internal health. It is the body’s largest elimination organ, and also a canvas where toxicities, nutrient deficiencies, food sensitivities and hormonal imbalances can show up. In fact, problems with the skin can sometimes be the first sign that a person has diabetes.
Love the skin you’re in To understand why it’s important, let’s take a quick look at the role of skin and how chemicals can affect it;
• Your skin is a fully functioning organ, no different to your
liver, heart, kidneys and brain. It serves to both protect you from and interact with the world outside of your body. One of the many important roles of your skin as an organ is detoxification.
• Glands associated with hair follicles produce the oils
and sweat that maintain the barrier. The nervous system controls these glands and if damage occurs and the skin dries out, small cracks can occur which signifies the barrier has been broken. Moisture from beneath the skin can then leak out and lead to more cracking, which can increase the risk of infection and skin discomfort.
• Skin contains many bacteria and micro-organisms that work in synergy with the immune system in your skin. Like the bacteria in your digestive tract they can be beneficial or inflammatory and damaging. Chemicals in products you use on your skin can alter the balance of bugs on your skin.
• Consider that medical patches, such as hormone
replacement therapy and nicotine patches, are used because of the effective absorbent nature of skin. Toxins and chemicals eaten in food has to get past your liver first before it can cause damage in your body. But there is no chemical processing plant and filter like your liver that helps to protect you from nasties absorbed into your body via your skin.
• Diabetes can accelerate the natural process of your skin
drying out as you age. High blood glucose levels and damage to the small blood vessels and nerves, common in people with diabetes, can sap the skin of essential moisture. So it is important to find and use a moisturiser you are happy with.
• Your skin has its own cycles and rhythms. It heals,
regenerates and detoxifies over night while you’re sleeping and using the wrong products can interfere with this process.
LIVING
All in good time
well
Natural products, containing elements usually found in extracts of plants or herbs, have been used for centuries. Though often more expensive to create, it is understood the benefits outweigh the risks, with some skincare ingredients being linked to cancers, eczema and pollution. They have come a long way over the past ten to twenty years. Thanks to high-tech advances in formulating natural ingredients, they are no longer only available to those with a specific health need. In the past, it was also often accepted that natural products didn’t perform as well as their synthetic counterparts, which Karen says is no longer the case. “Natural plant oils are packed full of nature’s super-ingredients and can create powerful, effective formulations,” she says. “If you read the ingredient list, you’ll see that many synthetic skincare products do in fact use natural components, as they are so effective, but they also throw in the nasties to extend shelf-life or add a specific scent.”
So what are these nasties? We are speaking of all these toxins and chemicals that can do you harm, but what should you be looking out for in your products’ ingredient list? Well Karen says, there are too many to mention, but these are the tops ones to avoid where you can;
BHA and BHT Butylated compounds, the most common of which are BHA and BHT, are used as preservatives in both food and skin. The main concern with these chemicals is their potential for endocrine disruption (messing with your hormonal system) and what’s known as ‘organ system toxicity’. Children and pregnant women are most at risk. There is also evidence that suggests a strong possibility as a carcinogen and California requires a warning on lip products that contain these chemicals. These little nasties are probably lurking in your lip balm, lipsticks, sunscreen, deodorant, hair products, fragrances and moisturisers.
Polyethylene Glycols PEGs (polyethylene glycols) are petroleum-based compounds that are widely used in cosmetics as thickeners, softeners, and moisturecarriers. Depending on manufacturing processes, PEGs may be contaminated with measurable amounts of ethylene oxide, which the International Agency for Research on Cancer classifies as a known human carcinogen. They also are used to enhance ingredient penetration, which is a good thing for safe ingredients but a very bad thing for toxic ingredients.
Parabens Parabens are preservatives that prevent the growth of bacteria in cosmetic products. But, they also have oestrogen-mimicking properties
that are associated with increased risk of breast cancer. These chemicals are absorbed through the skin and have been identified in biopsy samples from breast tumours. It’s estimated that around 85 per cent of skincare products contain parabens and are listed on your skincare ingredients as methyl paraben, ethyl paraben, propyl paraben, butyl paraben and isobutyl paraben.
Do your research Karen says that if you are still unsure, then research is key. “Look online at the countless articles about natural versus synthetic products and you’ll see why this is such a hotly discussed topic,” she says.
Phthalates Phthalates help ingredients stick to your skin and are a common ingredient in fragrances. Several studies have shown that they are endocrine-disrupting chemicals that can cause hormone balance issues for both women and men. Studies have also found that they may alter metabolism and result in weight gain. Sometimes they’re disguised with acronyms, such as DBP, DEHP, DMP, DEP.
Triclosan Triclosan is an antibacterial and antifungal substance in many hand soaps and hand sanitizers, as well as deodorants, skin cleansers, and toothpaste. At very low doses, triclosan is an endocrine disruptor which can affect your thyroid and reproductive hormones. After finding evidence of liver damage in mice and reviewing extensive evidence of its endocrine disrupting properties, in 2016, the FDA in the US banned triclosan in personal antibacterial products and is working on getting them out of hospitals.
Keep in mind that you cannot stop the ageing process, but you can manage it. The Australasian College of Dermatologists says while moisturisers, cleansers and lotions can absolutely make a big difference and slow the ageing process of your skin, and keep it moisturised, they describe sunscreen as by far the most beneficial, age-busting product available. “Without a daily skincare regimen that includes a generous dose of sunscreen (SPF 30 or higher) on all sun-exposed skin, no other anti-aging products matter,” they state. Look out for zinc-based sunscreens or those with natural ingredients.
Dianne Caine Australia have recently become a new Member Benefits Partner of Diabetes WA. Take advantage of your special members’ discount – details on page 42. For your chance to win a luxurious skincare pack from Dianne Caine Australia valued at $200, check out our Members Area on page 41 and enter our Winter competition. 29
LIVING
well
Put yourself first and keep an eye on your eyes When Judith Daw experienced some blurriness in her eyes, she was a busy foster mum and carer who always put others’ needs before her own.
The 65-year-old retiree from Albany, who has been living with type 2 diabetes for about ten years, noticed the blurriness about three years ago. However, she postponed having an eye test for another 12 months. Judith responded to our social media post introducing the KeepSight program
Around the same time as the blurriness started, Judith’s husband was diagnosed with a life threatening abdominal aortic aneurism. With so much focus on her family’s health, as well as her caring responsibilities, Judith didn’t realise her own blood glucose levels had been rising. “I was going through a lot,” she admitted. When she eventually found time to see an optometrist, he immediately sent her to a specialist eye doctor. “He (the specialist) told me that within two weeks I would possibly have been blind in my left eye,” Judith said. “He then had to do injections in my eyes and I had to have them done every four weeks.” For the past two years Judith has required regular appointments with her specialist for treatment in both eyes. The good news is the treatment has been highly effective and she will soon only need check-ups going forward. Managing her blood glucose levels has also contributed to the improvement in her eyes.
Prevent diabetes related blindness in the blink of an eye check.
“You definitely have to put yourself first. I would never ignore it again. It isn’t that hard to do if you’ve got the support at home, which I do have,” she said. “I would advise people to have regular eye checks. Just go and have it done, rather than just leave it.” Around 630,000 Australians, or about half of all people living with diabetes, are at risk of vision loss or blindness because they aren’t having their eyes checked regularly. This means eye damage is often identified too late, when treatment is less effective and more costly. Diabetes WA is supporting Diabetes Australia’s new national KeepSight campaign. It is designed to make it easier for people to remember to have regular eye checks. Once registered with KeepSight, participants receive reminders and prompts to have regular diabetes eye checks with their provider of choice. Costs are usually funded by Medicare. To register or to find our more go to keepsight.org.au. 30
visit www.keepsight.org.au today
MOVING
well
Australia’s Top 20 Sports and Physical Activities Sport Australia has released the latest annual data from its AusPlay survey, Australia’s largest and most comprehensive sport and physical activity survey launched in late-2015. The survey found that 63 per cent of Australians interviewed in 2018 participated in sport or physical activity at least three times per week compared to 59.9 per cent in 2016. Walking was the most popular activity overall, followed by fitness/gym, swimming, running/athletics and cycling rounding out the top five. The first team sport on the list is football (soccer) at #6, with aussie rules (AFL) ranked at #12. WA varied slightly in its popularity order, with football (soccer) at #8 and AFL ranking 9th. Sport Australia CEO Kate Palmer says it’s encouraging to see a gradual increase in physical activity levels of Australians but warns it will require much more improvement and longterm behavioural change to combat Australia’s inactivity crisis. “The positive news in this data is that it shows Australians are making the effort to get moving because they are becoming more aware of the importance of sport and physical activity to their health and wellbeing,” Kate says. “It’s a small step in the right direction, but we’re still falling a long way
behind when it comes to meeting recommended physical activity guidelines. For example, research tells us only 19 per cent of children meet the recommended one hour of physical activity a day. “Our general lifestyles are becoming more sedentary than ever before because of things such as technological advances, so that makes it critically important to find dedicated time for sport and physical activity in our lives.” It is estimated physical inactivity now contributes to the deaths of 16,000 Australians every year; almost 14 times the national road toll. The activities we participate in evolve as we age. Swimming is a key skill in our formative years, while team sports are popular around the early teens for social as well as physical development. Fitness/gym becomes a key motivation from late-teens onwards, while walking is the number one activity from 35 onwards. “The message here is there’s a sport or physical activity to keep you moving throughout your entire life,” Kate says.
Top 20 participation sports and physical activities *Based on annual participation (organised out-of-school activities only for children 0-14; all activities for adults 15+)
1.
Walking (Rec)
8,783,064
2.
Fitness/Gym
6,874,541
3.
Swimming
4,505,531
4.
Running/Aths
3,334,693
5.
Cycling
2,359,660
6.
Football (socc)
1,767,288
7.
Tennis
1,202,011
8.
Bush walking
1,189,493
9.
Basketball
1,017,968
10. Golf
1,015,150
11. Yoga
984,362
12. AFL
913,668
13. Netball
901,903
14. Cricket
798,618
15. Dancing (Rec)
688,293
16. Pilates
585,706
17. Surfing
508,015
18. Gymnastics
489,058
19. Touch football
464,721
20. Martial arts
316,826
Read more about the survey at sportaus.gov.au 31
Roasted beet, fennel and lamb salad Prep time: 10 mins Cook time: 20 mins
Serves 2 (as a main meal)
1 bunch baby beets, trimmed, peeled, cut into thin wedges 300g lamb leg steaks, trimmed of fat Freshly ground black pepper 1 stick celery, diagonally sliced ½ small head fennel, outer layer removed, very thinly sliced 30g rocket leaves
Horseradish cream 2 tbsp fresh lemon juice 1 tbsp horseradish cream Freshly ground black pepper
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1. Preheat oven to 200°C (fan-forced). Line a small roasting pan with baking paper. Place beet wedges in pan and spray with cooking spray. Roast for 20 minutes or until very tender. Set aside. 2. Heat a chargrill pan over mediumhigh heat. Spray lamb steaks with cooking spray and season with pepper. Add lamb to pan and cook for 2 minutes each side for medium, or until they are cooked to your liking. Transfer to a plate, cover loosely with foil and then rest for 2 minutes.
3. Combine celery, fennel and rocket in a bowl. Diagonally slice lamb steaks and add to salad. Toss to combine. 4. To make horseradish cream, whisk all ingredients in a small bowl. 5. Divide salad between two plates. Drizzle with horseradish cream and serve.
Nutrition Info
Per Serve 1350kJ, protein 37g, total fat 10g (sat. fat 3g), carbs 17g, fibre 8g, sodium 385mg • Carb exchanges 1 • GI estimate low • Gluten free • Lower carb
Three-grain porridge Prep time: 5 mins Cook time: 5 mins
Serves 18 (as a breakfast)
300g rolled oats 300g spelt flakes or quinoa flakes 300g barley flakes or rice flakes 300ml skim milk or water, per serve 1 tsp agave nectar and 100g sliced strawberries, per serve
Nutrition Info
1. Working in batches, toast the rolled oats, spelt and barley flakes in a large non-stick frying pan over medium heat for 5 minutes or until golden. Set aside to cool. Transfer to a large airtight container. 2. Combine 50g oat mixture with milk or water in a small saucepan. Cook, stirring occasionally, over medium heat, for 5 minutes or until oats soften. Drizzle over nectar and top with strawberries to serve.
Per Serve Using rolled oats, spelt & barley flakes: 925kJ, protein 7g, total fat 2g (sat. fat 0g), carbs 38g, fibre 8g, sodium 16mg • Carb exchanges 2½ • GI estimate low Using quinoa & rice flakes: 960kJ, protein 7g, total fat 3g (sat. fat 0g), carbs 40g, fibre 6g, sodium 13mg • Carb exchanges 2½ • GI estimate medium
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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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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 31/12/19. 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 for about eight years.
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
INTHE
community
Having an impact Diabetes WA are passionate about making a difference to the hundreds of thousands of Western Australians affected by diabetes, whether they are living with it, at risk of developing it or supporting a family member with the condition.
Your support will help to fund our work in six key areas: raising awareness, education, support services, advocacy and community activities.
Kids Camp
Supporting Diabetes WA will enable us to continue our work, with activities such as our recent bi-annual Kids Camp and our free Education Workshops in Roebourne.
The ‘Rock Star’ kids camp held in April for 11- and 12-year-olds wasn’t all fun and games, though there was lots of fun to be had! Diabetes WA and Perth Children’s Hospital hosted a three-day camp designed to give children living with type 1 diabetes the opportunity to try new things in a safe and structured environment, with other kids in a similar situation to them. To increase their skills, confidence and independence in managing their diabetes, the children also attended formal and informal education sessions structured to increase their understanding of type 1 diabetes in various situations.
DESMOND workshops Jennifer Sweeting and Natalie Jetta recently delivered DESMOND education for type 2 workshops to groups in Roebourne and Karratha. Hannah Castledine, Nutrition Coordinator at Pilbara Population Health, emailed recently with some lovely feedback about the workshops; “Just wanted to provide some quick feedback on our week in Karratha with your brilliant staff Jenn and Nat. It was so valuable to watch them both deliver – they had great rapport with both groups (Karratha and Roebourne sessions). They were so effective in engaging participants and communicating with them, I was so impressed, and it was wonderful to watch. I really learnt a lot from them. I left both the regular DESMOND and Aboriginal DESMOND feeling so inspired and motivated to continue my own pathway towards DESMOND accreditation as a facilitator. Thanks for helping us provide this service to our region – there is such a need and we really appreciate your help.”
Natalie (left) and Jennifer preparing for Aboriginal DESMOND in Roebourne
If you are interested in donating, fundraising or leaving a bequest, visit the Diabetes WA website and click on the ‘Get Involved’ tab or email our fundraising team: fundraising@diabeteswa.com.au 34
INTHE
community
He did it! Scott stepped up for Diabetes Last edition we featured an article on Scott Drysdale who was climbing Jacobs Ladder to raise money for Diabetes WA. Well he has done it – A massive THANK YOU to Scott Drysdale, who completed 200 circuits of Jacob’s Ladder in West Perth, which consists of 242 steps, over 24 straight hours from 5 to 6 April. This is the equivalent of climbing and descending over 8000m or going up and down 48,000 stairs, nearly the height
of Mount Everest. What an amazing achievement!
diabetes, including kidney and heart failure.
Scott’s life has been indirectly affected by diabetes as both his father and step father are living with type 2 diabetes. In the last 12 months, Scott’s father has had serious health complications due to his
Despite an injury to his Achilles heel, Scott raised awareness about diabetes and also exceeded his goal of raising $5,000 funds for Diabetes WA, raising $6100, including cash donations on the day.
#DiabetesChatters In this new segment we will feature the trending topics on our social media channels, the common questions coming in on our
Diabetes Helpline or your responses to a specific social media post. What ARE people with diabetes talking about? #hottopics.
“Having family support�
“CGM ďż˝ hoping it’s more affordable soonâ€?
“My pump!! The week I got my pump my BGL’s were the best they’d ever been, 30 years post-diagnosis.� “Great diet and fitness.�
“Low carb, family and friends support�
“Taking insulin!� “My father has improved hugely with a low-fat vegan diet�
“I’m strict low carb lots of healthy fat and meat. Different strokes for different folks.� “CGM – hands down best invention ever� “Testing, testing, testing.�
“CarbManager is also a good app with a diabetes option for net carbs and a few other options�
“Pump, CGM, low carb and intermittent fasting�
“Exercise of the more specific kind. Work just isn’t the same. Swimming is best for me.â€? “Acceptance of your condition from the moment of diagnosis.â€? “Exercise! Especially HIIT workouts đ&#x;’Ş ďż˝â€?
Our Facebook Post 35
INTHE
community
All in the Family By Nola Hosking
Mine is a lifelong form of type 2 diabetes. Impossible? Not if you are descended from, or related to, the Coppin or Finlay families. Sarah Coppin arrived in Australia over a hundred years ago and married William Finlay, the first Mayor of Albany. Their son, William James Finlay, was my grandfather, and his son, Wilfrid Lennard Finlay, was my father. This type of diabetes is a direct parent-to-child form, so my father and grandfather must have had it. Neither man knew, though both showed signs of diabetes. Sarah and her daughter, Charlotte Finlay, were diagnosed with diabetes by a simple method: the doctor tasted the patient’s urine. If it was sweet, the patient was diagnosed with diabetes. Charlotte knew her mother’s history – when Sarah’s cut foot became infected, her leg was amputated without anaesthetic.
Diabetes diagnoses were made by a simple method: the doctor tasted the patient’s urine. We invite you to tell us YOUR story Have you overcome adversity? Have you got any tricks and tips for other people living with diabetes? Perhaps your story can help others? Let us know – we would love to hear about your journey. Send it by post or email: Diabetes Matters Stories, PO Box 1699, Subiaco WA 6904 media@diabeteswa.com.au
Burning Questions Q: I’m considering having a cortisone injection for a painful hip issue. Will it affect my glucose levels? Abigail, type 1 diabetes
Charlotte took enormous care of herself and walked miles daily. She stuck to a sugar and fat-free diet. She lived to 93. I am apparently very like Charlotte. When I constantly had various illnesses, my parents believed I was diabetic, though doctors didn’t believe I was. Finger prick blood tests did not show it. This form of diabetes is difficult to diagnose. I started teaching in 1959 with a class of 54 small children. Relief staff were few so when severe migraine headaches struck, unless I was vomiting, I went to school. This continued to age 42, when an allergist sent me to an endocrinologist who ordered a five-hour glucose tolerance test. He wondered why I cheered when he broke the news that I am diabetic. Today, I adhere to a strict diet, medication and exercise routine. I’ve had no migraine headaches since my diagnosis and treatment. I am 80, have three children and am happy and well.
A: Diabetes WA Diabetes Educator Carly Luff says… Some people living with diabetes may need steroid medications to help them manage other health conditions, including arthritis. A steroid injection into the joint or muscle may cause blood glucose levels to rise soon after having it and its effects may last from 3 to 10 days. It may be important to monitor your BGLs more frequently than normal to keep track of any changes. Steroids raise blood glucose levels in two ways: They reduce the action of your insulin (increase insulin resistance) so less glucose is able to move out of the bloodstream to be taken up by the muscles, resulting in a high blood glucose level. They can also cause the liver to start releasing extra glucose into the bloodstream. It can be helpful to talk to your doctor or diabetes educator before having the injection for advice about how this may affect you and how to adjust your insulin or diabetes tablets accordingly.
If you have a diabetes-related question that you would like answered, email it to community@diabeteswa.com.au. Alternatively, you can call the Diabetes WA Helpline between 8.30am and 4.30pm weekdays on 1300 001 880. 36
SHARED
pathways
Diabetes WA Aboriginal Health Forum Working together today for a stronger tomorrow Taking place on 30 May, the annual Diabetes WA Aboriginal Health Forum featured keynote speakers from across Australia. The day’s program showcased innovative programs and initiatives from those working in Aboriginal Health, along with a discussion of the latest diabetes research.
Angus Turner: Director, Lions Outback Vision How Lions Outback Vision provides eye health services to rural & remote areas Dr Turner is a West Australian eye doctor with a passion for helping rural and disadvantaged communities. He works tirelessly with the Lions Outback Vision team to provide sight-saving treatment in remote and isolated areas of WA. Dr Turner is currently working to establish a dedicated eye health hub in Broome. He is an Associate Professor at the University of Western Australia and was awarded Western Australian of the Year 2019.
Olufemi A Oshin: Consultant Vascular Surgeon, Royal Perth Hospital Digital diabetic foot health Olufemi was appointed consultant vascular surgeon at the Royal Liverpool Hospital in the UK before commencing his fellowship at Royal Perth Hospital in 2017. Since arriving in Australia, he has built upon his strong interest in lower limb peripheral arterial disease and diabetic foot care and has recently pioneered a telehealth multidisciplinary foot clinic. Olufemi has recently been awarded a Medical Research Foundation Grant for diabetic foot research.
Rebekah Beacham: Clinical Midwife, Registered Nurse, Credentialled Diabetes Educator, King Edward Memorial Hospital Looking to the Lands – supporting women in remote communities Working closely with a nurse practitioner and the obstetric team at King Edward Memorial Hospital, Rebekah is involved in diabetes in pregnancy antenatal clinics and education. She recently participated as a diabetes educator in indigenous women’s obstetric and gynaecological health trips to the Ngaanyatjarra Lands, and is currently involved in telehealth diabetes education and pregnancy planning for Western Australia and Christmas Island.
Sean Taylor: Exec Dir Aboriginal Health Practitioner of Top End Health Service, NT Government Improving diabetes care & management in remote primary health care settings Sean is a descendent of the Dauareb Tribe, one of the eight tribes of Mer Island in the Eastern Torres Strait region. He has over 20 years of clinical experience in Aboriginal and Torres Strait Islander health working across Australia in a range of academic and research interests, as well as clinical practice. Amongst his other qualifications, Sean completed a Doctor of Public Health (Research) focusing on diabetes care and management in remote communities.
Susan Drmota: Credentialled Diabetes Educator, South West Aboriginal Medical Service Snapshot of diabetes care in WA’s South West Susan is coordinator of the South West Aboriginal Medical Service Chronic Disease program, and holds post-graduate qualifications in midwifery, leadership & management, emergency nursing and diabetes education. Her nursing experience includes roles in Geraldton, South Africa, Papua New Guinea, Carnarvon, and Christmas Island. She now coordinates the care and provision of health education for clients living with chronic conditions and mentors team Aboriginal health staff.
37
EATING
well
Boost your family’s immune system this winter The winter chill is here and so too are the dreaded winter colds and ‘flu. While nothing can completely stop a cold in its tracks, a healthy immune system can help ward off the germs that cause colds and the flu. A healthy immune system can even minimise a cold’s duration. Good nutrition is essential to a strong immune system. Ensuring your family eats a healthy, balanced diet will provide their bodies with important immunity-boosting nutrients such as vitamin C, vitamin B6, vitamin E, iron, zinc, beta-carotene, protein and selenium. Whether you’re food shopping, preparing a meal or packing a lunchbox, the following tips will help you feed your family’s natural defence systems and better their chances at warding off unwanted colds and ‘flu.
Garlic will give the most benefit to your immune system when chopped and then left to stand for 10-15 minutes before adding to the pan. Healthy lunchbox treats. Luckily winter is citrus fruit season. Fill lunchboxes with freshly cut orange pieces, a rich source of vitamin C, and a well-known flu-fighting essential. Mandarins are in season now too and they are a less-messy lunchbox option. Also pop in some kiwi fruit and some raw snow peas and celery sticks too. Include extra veggies at dinner time. Try to include at least one or two vegetables with a good content of Vitamin C e.g. the brassica family (cabbage, Chinese cabbage, Brussels sprouts, broccoli), tomatoes, capsicum, potatoes (unpeeled). Vitamin C-rich foods at meals also help to increase your body’s absorption of iron from food. Make a casserole. With a casserole you are able to use economical cuts of meat (blade steak, chuck steak, chops) with slow cooking methods. Red meat is high in zinc and iron, two minerals which boost the immune system. Legumes 38
(chickpeas, kidney beans, soy beans) are an excellent protein source, low fat, high fibre, low GI and economical. A casserole with meat, vegetables and a can of beans is a great way to boost your ability to fight disease, as well as being real comfort food. Enjoy soup. Soup doesn’t have to be complicated as there are many good soup mixes available to use as a base. With lots of vegetables, some beans or lentils and maybe some meat, soup is the perfect food to build your immune system. If you do succumb to winter bugs there may be some truth to the reputation of chicken soup’s restorative powers. Drink plenty. Even though the temperature outside is chilly, we still need to be drinking adequate fluids to stay hydrated. Water is the healthiest drink option there is. It’s also the cheapest. Include garlic. Garlic is a great disease fighter as well as adding flavour to meals and food. Garlic will give the most benefit to your immune system when chopped and then left to stand for 10-15 minutes before adding to the pan. If garlic is cooked straight after it’s chopped, you are not getting the full health benefit. Choose foods containing Vitamin D. Sometimes called the sunshine vitamin, Vitamin D has been shown to help support the immune system. In winter when the weather is often bad and the angle of the sun is low it makes it harder to get enough vitamin D from exposure to the sun. In this case food becomes an important source of vitamin D. Oily fish like salmon, mackerel and sardines are good sources of vitamin D. Fortified foods such as breakfast cereals, milk and yogurts are also worth considering consuming during the winter months. Reprinted with permission amityhealth.com.au
Winter is coming ...
EATING
well
Healthy winter stews and soups to keep you warm The chill in the air is probably enough to make you want to snuggle under the doona with a nice cup of tea, while tender meat simmers away in an intoxicating broth in a pot on the stove or in the slow cooker. Slow-cooked casseroles and super-healthy stews and soups make for a satisfying supper and are a winter staple. Packed with nutritious ingredients they are the ultimate feel-good comfort food. There is something about slurping back the juices from a simmering slow-cooker stew that is good for the soul. Here are three hearty recipes to keep you warm all winter long.
Lamb Shanks with Mash Serves: 2
Ingredients Olive or canola oil spray 1 lamb shank 1 tbsp plain flour Pepper to taste 1 onion, chopped 4 cloves garlic, chopped 1 stalk celery, chopped 1 carrot, chopped 10 mushrooms 1 400g can no-added-salt diced tomatoes 1 tbsp worcestershire sauce 1 tbsp dried rosemary, or 15cm if using fresh 1 tbsp plum jam 1 cup water 1 tsp reduced-salt vegetable stock powder 2 potatoes, chopped 30mL low-fat milk
Method 1. Preheat oven to 160°C. 2. Toss lamb with flour and pepper in a bag. Heat oil in a large non-stick frypan. 3. Shake extra flour off lamb and pan-fry until brown on all sides (about 5 minutes) and place in a large casserole dish (best if dish has a lid). 4. Add all vegetables except tomatoes and potatoes to the frypan and cook for 5 minutes, stirring often until they begin to colour slightly. 5. Add the tomatoes, worcestershire sauce, rosemary, jam, water, stock powder and leftover flour from the plastic bag. Stir well and bring to the boil.
Recipes used with permission from LiveLighter. LiveLighter® State of Western Australia 2019: livelighter.com.au
6. Pour tomato-vegetable mixture over the lamb, cover with a lid or foil and bake in the oven for at least 2 hours. Remove the casserole a couple of times during cooking and ladle the sauce over the top of the meat to baste. After 2 ½ to 3 hours the meat should fall off the bone. 7. To prepare mash, microwave or boil potatoes till a fork goes easily into the pieces. Add milk and pepper and mash well with a fork or potato masher until you get the texture you like. Variations: • Swap one of the potatoes for sweet potato or a cup of peas to add more colour to your plate. • Make this dish gluten-free with gluten-free flour. • To make this dish seafood-free, replace Worcestershire sauce with half soy sauce, half tomato sauce.
Nutrition Information per serve Energy 2103 kJ Protein 38 g Fat, total 18 g — saturated 6g
Carbohydrate 39 g — sugars 25 g Sodium 685 mg Fibre 11 g
39
EATING
well
Crab and Corn Chowder Serves: 4
Ingredients Olive or canola oil spray 1 large brown onion, diced 2 sticks celery, diced 2 cloves garlic, crushed 2 medium potatoes , peeled and diced ¼ head cauliflower, cut into florets 400g no-added-salt corn kernels (reserve liquid) 500mL salt-reduced chicken stock Pepper to taste 250g raw or cooked crab meat Chives, chopped, to serve Method 1. Heat a large pot and spray with oil; add onion and celery. 2. Cook for 2-3 minutes over medium-high heat, stirring often, until vegetables have softened. 3. Stir in garlic and cook for 1 minute until fragrant. Add potato, cauliflower, corn including the water it is canned in, stock and pepper to taste; stir until well combined.
Hearty Sweet Potato and Lentil Soup Serves: 6
Ingredients Olive or canola oil spray 1 large onion, diced 2 carrots, peeled and diced 2 sticks celery, diced 3 cloves garlic, crushed 1 tbsp ground cumin 1 small zucchini, diced 500g sweet potato, peeled and diced 2 x 420g cans no-added-salt brown lentils, undrained 1L salt-reduced chicken stock 500mL water Fresh coriander, chopped, to serve 40
4. Bring to the boil and simmer on medium heat, partially covered, stirring occasionally for 10-15 minutes until vegetables are tender. Remove pot from heat. 5. Ladle 2 cups of soup into a large heatproof jug and puree with a stick blender. Alternatively, add 2 cups of soup to a food processor bowl. Return puree to soup pot and place on medium heat. 6. Stir in crab and simmer, uncovered, until raw crab meat is barely cooked, or cooked crab meat is warmed through. 7. Ladle soup into bowls; season with pepper and sprinkle with chives, if desired.
Method 1. Lightly spray a large pot with oil and place on medium to high heat. 2. Add onion, carrots and celery. Cook for 5 minutes, stirring often, until vegetables have softened. 3. Stir in garlic and cumin, cook for 1 minute until fragrant. 4. Add zucchini, sweet potato, lentils (including the water they are canned in), stock and water; stir until well combined. 5. Bring to the boil and simmer, partially covered, for 20 minutes until vegetables are tender. 6. Ladle soup into bowls and sprinkle with coriander, if desired.
Hint: If no-added-salt corn is not available, drain corn of brine and add to soup with 200 mL of water. Variations • Substitute a diced leek for onion. • Include 1 small zucchini, diced. • Substitute 250g fresh corn kernels cut from 2-3 cobs of corn and 200mL water for canned corn. • Replace crab with a shredded cooked skinless chicken breast.
Nutrition Information per serve Energy Protein Fat, total — saturated
906 kJ 16 g 4g 0.4 g
Carbohydrate 25 g — sugars 7g Sodium 655 mg Fibre 7g
Hint: Increase the amount of water for a thinner soup, or process half the soup with a blender or stick mixer for a thicker texture. Variations • To make this soup vegetarian or vegan, use meat-free stock eg. vegetable stock or “chicken-style” stock. • Add one thinly sliced fresh long red chilli to the onion for some spice and serve with a dollop of natural yoghurt.
Nutrition Information per serve Energy 1055 kJ Protein 14g Fat, total 8g — saturated 0.6 g
Carbohydrate 34 g — sugars 10 g Sodium 731 mg Fibre 9g
Diabetes WA
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Every country across the world has their own word for ‘Hello’. Can you find them in this word search? Answers can be found at the bottom of page 26.
Competition
Winter
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To enter, complete the competition slip below and mail to: Membership – Dianne Caine 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 2019. 41
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5–11 August
Denta l Healt h Wee How’s yo u r o k r al h e alth De
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The Kellion Victor y Award s is a special event, hoste d in WA by Diabetes WA , to recognise people who have lived with ins ulin-dependent diabetes 50 years or more. The Ke for llion Victor y Medal celeb rates the achievement of living a fulfilling life wit h diabetes and aims to ins pire younger people to reach their potential. Medals are awarded for 50, 60, 70 and 75 years living with the condition of . The Kellion Carers Award is also bestowed to rec ognise the many years love, dedication and sup of port a spouse, family me mber or close friend ha given to the Victor y Me s dal winner. Awards will be presented during National Diabetes Week in July. To find out more about the awards email us at community@diabeteswa .com.au or call 1300 001 880.
You are invited to the Diabetes WA Ken Walker Lunch 2019 2019 keynote speaker
Challenging the status quo
When:
Friday, 13 September 2019
Professor Barry J. Marshall,
Join Perth’s corporate and political leaders and be inspired by Western Australia’s own Nobel Laureate, Professor Barry J. Marshall. Hear about his role in revolutionising medicine’s treatment of peptic ulcers and stomach cancer, and the importance of perseverance, tenacity and vision in challenging the status quo in a global industry.
Venue:
Fraser’s Restaurant, Kings Park
Time:
11.30am for 12.00pm start. Concludes at 2.30pm with networking to 3.30pm.
Nobel Laureate, AC FRACP
2019-024
FAA FRS MBBS.
Support Diabetes WA’s mission to enhance the quality of life for the 10% of Western Australians living with or at risk of diabetes.
Tickets: $165 per ticket or $1500 per table of 10 (price includes GST) Book:
Visit diabeteswa.com.au or email events@diabeteswa.com.au
2019-061
Kellion Victory Awards
28
National Diabetes Week 14–20 July 2019
people are diagnosed
with diabetes
every day 2019-68
in Western Australia.
We make sure they don’t face it alone.
Call our helpline on 1300 001 880