Diabetes Matters Autumn 2020

Autumn 2020 $6.95

A Diabetes WA Member Magazine

Disability and diabetes

If you’ve got it, we get it

r From the Edito ,

we move into cooler weather As the heat of summer subsides and we’ve star ted the year. how on ect there’s no better time to refl ’s to achieve – or stick to – your New Year But whether or not you’ve managed on are you re whe er er that, no matt resolutions, it’s important to rememb own individual path. our on all are we ey, journ th your heal to this edition of Diabetes Matters seeks And speaking of individual journeys, everyday the face only not who le peop of p shine a light on a vulnerable grou , but also live with a disability. challenges of managing their diabetes ected with people who are at the In piecing together this edition, we conn onal stories of what life is like living heart of the issue and share their pers with diabetes and disability. and organisations who are key movers We also reached out to local groups help provide an insight into how WA’s and shakers in the disability space to people with disabilities to manage ort healthcare system could better supp their diabetes. disability space, the Australian Diabetes And in an exciting development in the the first Easy Read educational Educators Association has developed red for people with an intellectual tailo been diabetes resources which have a guide for health professionals on or developmental disability, as well as people with an intellectual disability ort how to better communicate and supp t this project on page 10. and diabetes. You can read more abou ay, for a Reason will take place on Sund In other exciting news, the HBF Run fun the at ities char red featu of the four May 24, and Diabetes WA is again one run event. d for Diabetes WA by our dedicated Last year, more than $25,000 was raise access to the important services and supporters, which has helped improve . g with diabetes across our vast State programs we provide for people livin raise or register for team Diabetes WA You can read more about how to fund story of our 2020 HBF Run for iring on page 22, and also read the insp in 24 has achieved some amazing feats A Reason ambassador Emily, who at . etes diab 1 type by a bid to prove that she is not defined year’s run, we’ve got you covered this for up ed sign dy alrea ve And, if you’ are you for race day and provide prep help will h with our training guide, whic n it comes to managing your blood some important tips to consider whe k up more kilometres. cloc glucose levels and insulin as you ired and empowered by this edition of With that, I hope you are moved, insp Diabetes Matters.

Happ y rea din g!

Van essa x

From the Chair .......................................................................... 3 Perspective ................................................................................ 4 Off the Diabeaten Track .......................................................... 5

Diabetes News

Industry News ........................................................................... 7 Where We’ve Been This Summer ....................................... 8 Journey to the North West ................................................... 9

Diabetes and Disability

Striving for Equality .............................................................. 10 Meet Lily .................................................................................... 15 Meet Gregg ............................................................................... 16 Meet Justin ............................................................................... 16 Go Green ................................................................................... 18

Shared Pathways

Google Impact in East Kimberley ..................................... 19

Research News

Research Round-up .............................................................. 20 Local Findings ......................................................................... 21

Moving Well

Hit the Pavement .....................................................................26

Workshop Calendar

Plan Your Sessions ............................................................... 28

Diabetic Living

Recipes ..................................................................................... 30

Eating Well

Eat, Drink, Be Merry ............................................................. 32 Recipes ..................................................................................... 34

Living Well

Blood Glucose Monitoring .................................................. 38 My Experience with MonitorSmart ................................. 40

Members’ Area

Members’ Puzzle and Competition ................................... 41

Members’ Area

Member Benefit Partners .................................................... 42

What’s On

Dates for your Diary ............................................................. 43

2020-012

AUTUMN 2020

HBF Run For A Reason ......................................................... 22 Our Ambassador ................................................................... 23 My Diabetes Story .................................................................. 24 #Diabetes Chatters ................................................................ 25 Burning Question ................................................................... 25

On the cover: The McCain Family – Emily, Lucas, Ollie and Lily

In the Community

Editor Vanessa Williams Editorial & Advertising Enquiries Diabetes WA, PO Box 1699, Subiaco, WA, 6904 Phone 1300 001 880 Email media@diabeteswa.com.au Editorial submissions should be sent to Diabetes WA, care of the above address.

All care will be taken with contributions however no liability for loss or damage to unsolicited materials will be accepted.

Disclaimer The opinions expressed in articles and the claims made in advertising materials presented in Diabetes Matters are those of the authors and the advertisers respectively, and do not necessarily reflect the view of Diabetes WA, unless stated.

The information provided is for the purposes of general information and is not meant to substitute the independent medical judgment of a health professional regarding specific and individualised treatment options for a specific medical condition. No responsibility is accepted by Diabetes WA or their agents for the accuracy of information contained in the text or advertisements and readers should rely on their own enquiries prior to making any decisions regarding their own health.

Thanks to Diabetic Living magazine, Pan Macmillan Australia Contributors Jennifer Sweeting, Grace Ashby Photography DWA staff, magazine contributors, Shutterstock, Cath Muscat.

Design Brigitte James Print Quality Press Diabetes WA – Subiaco Offi ce Diabetes WA Level 3, 322 Hay Street, Subiaco WA 6008 diabeteswa.com.au 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

Andrew

Burnett

From the When we talk about people living with disability – whether it is intellectual, developmental, psychosocial or physical – it is difficult to comprehend the everyday challenges they face.

But when you add diabetes to the mix, it adds another layer of challenges to everyday life.

Alarmingly, statistics have shown that 23 per cent of Australians living with a severe or profound disability had diabetes before the age of 25.

In the Autumn edition of Diabetes Matters, we shine a light on the co-existence of disability and diabetes, and our first port of call was to speak to the people who are at the heart of the issue.

Justin and Gregg are two Western Australians who live with a disability and diabetes, and they each offer an honest account of what their life is like on a day-to-day basis when it comes to managing the condition.

But the challenges of living with diabetes and a disability not only impacts an individual, but also those closest to them.

Joondalup mother Emily’s 11-year-old daughter Lily, who was born with Down Syndrome, was diagnosed with type 1 diabetes last year and she provides

CHAIR

a moving insight into how this has changed their lives.

We lay Gregg, Justin and Lily’s personal stories bare on pages 15 and 16 in the hope of illustrating the challenges but also the power of resilience when it comes to living with a disability and diabetes.

I would also like our members to be aware that, after a two-year period during which your Directors considered the implications for our members and for all those Western Australians living with diabetes, Diabetes WA gave the required six months notice on June 1, 2019 of its intention to leave the Diabetes Australia Federation. Therefore as of December 1, 2019, Diabetes WA officially left the Federation.

It was clear to your Directors that our two organisations now operate different business models and with the prospect of a new national organisation forming with expanded focus on Australia’s populous east coast centres, the Diabetes WA Board felt that it was appropriate for our organisation to become independent, with a view to focusing all our energies on Western Australians at risk of or living with diabetes.

In taking this step, the Directors also resolved to retain and strengthen the

relationships which Diabetes WA has with the recognised organisations in each State and Territory which serve Australians with diabetes to ensure that the mutual benefits of sharing information and resources might be realised in time.

In this spirit, we look forward to continuing our role as the WA agent of the federally-funded National Diabetes Services Scheme (NDSS), and will have more news in our next edition about the progress made on the negotiation of a new four-year NDSS agreement from July 1, 2020.

I hope that this edition of Diabetes Matters offers you an eye-opening perspective on the challenges faced by people with a disability who are living with diabetes.

Diabetes WA believes that all people with diabetes should be empowered to make informed decisions about their care, including those also living with a disability.

Our team is committed to quality improvement and would love to hear more from our members with disabilities about their lived experiences using our services and how they could be improved.

Until next time …

Andrew Burnett Diabetes WA Board Chair

Curious to know what we’ve done in the past year?

Visit our website at diabeteswa.com.au/aboutus to read a copy of our 2018/19 Annual Review.

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Fiona Lander during a visit to Afghanistan while working for the United Nations.

perspective

PASSION FOR BETTER HEALTHCARE Diabetes WA board director Fiona Lander describes how her worldly travels with the United Nations underpins her vision for better healthcare back on home soil.

From Guatemala and Kenya to Syria and Mumbai, Fiona Lander’s passion for healthcare has taken her all around the globe.

held consultations with NGOs and civil society organisations like Diabetes WA in other countries like Kenya, Russia, Hungary.”

Originally from Melbourne, Fiona graduated with a double degree in Medicine and Law in 2009, where she quickly developed an interest in health rights, law and global health.

Eventually returning to Australia, Fiona wound up in Perth, where she lives with her now husband, who is also a doctor studying to become a General Practitioner.

“I did the combined degree, because there was a recognition that problems in healthcare are becoming more complex,” she says.

Now working as a consultant on global healthcare, Fiona advises companies and governments on healthcare strategies and operations.

“So towards the end of my time in university, I tried to look for ways I could have the most impact on healthcare systems as a whole.”

However, she credits her eyeopening experience working with the UN, where she was confronted by healthcare crises most often in lowerincome countries, as a driving factor for her to continue working in the healthcare space.

After securing a role working for the United Nations, Fiona relocated to Mumbai for two years where she went on to rack up an impressive international itinerary.

“I worked all over the world on topics concerning the right to health, so essentially how people can access good, quality health services and live the highest quality life they can from the healthcare perspective,” she explains. “During that time we did missions all over the world in Guatemala, Syria, Ghana and we also 4

“I think one of the things that is most striking is travelling to countries that don’t have a universal healthcare system like we do, even thinking about it from the diabetes angle where countries don’t have a pharmaceutical benefits scheme or access to lifesaving drugs like insulin that have been around for a hundred years,” she says.

“It’s very confronting because then it just comes down to the individual’s

ability to pay and it’s really distressing seeing the impact it has on peoples’ families and the fact that illnesses which they have no control over, like type 1 diabetes, can drive a family into poverty.”

When it comes to her vision for Diabetes WA, Fiona is a strong advocate for early intervention.

Having worked on the ground in some of the poorest communities in the developing world, Fiona says in developed nations like Australia, there needs to be a stronger focus on prevention and early intervention.

“Coming into a new decade the key thing is going to be really understanding what people living with diabetes, and their families and their support networks, need,” she says.

“We’re talking about an area that has experienced really rapid changes over the last couple of decades both in terms of technological advances in diabetes care and management.

“It means we have to look at how we assist the people who are most affected in getting the information and the services they need, when they need it and how they want it.”

OFF THE

diabeaten track

Jennifer Sweeting is a primary care coordinator and DESMOND facilitator at Diabetes WA. She holds a Masters in Anthropology and Public Health. As an American anthropologist ‘Down Under’, Jennifer can often be found prattling on about the importance of human connection. She is a sleep evangelist, radio host, and writer who spends heaps of time beach combing and bush walking with her two young boys.

The things that matter ARE GOOD I am not usually one for New Year’s resolutions, as they often fall by the wayside days after the year has begun and I’ve recovered from the celebrations.

However, the start of a new year does make me think about new goals I’d like to set for myself.

One of the small changes I’ve made in my life is practising gratitude.

When I wake up in the morning, I’ve formed a new habit of acknowledging five things I’m grateful for.

We are constantly bombarded with information through social media, text messages and emails, so it is easy to feel overwhelmed.

Personally, I often feel rushed and stretched thin – racing from home to work, sport to shops – fitting in “me time” wherever I can!

Many nights, I can’t imagine doing one more thing beyond dinner, dishes, books and bed – and yet I still fall prey to the allure of ‘one more episode’ when I should be sleeping.

That said, it is important not to get bogged down by the little things and the challenges life throws at us.

I keep it super simple, and literally say them out loud: “I am grateful I have feet to stand on and eyes to see, a warm bed, a roof over my head, and healthy children who, even though they often drive me crazy, are healthy and happy.”

And it all comes back to this thought – the things that matter are good.

I don’t know when I started saying it so much, but I seem to say it more and more. It has become a standard response when engaging in conversations.

Whether you have children or not, there are so many things going on in our lives.

While my role at Diabetes WA is in the primary care space, I also deliver the DESMOND type 2 diabetes selfmanagement program once a week.

DESMOND is about empowering people to self-reflect on their journey with diabetes and make an action plan towards one small change around how they self-manage their diabetes.

My boys are healthy and happy, and we live in a beautiful beachside community where we feel we actively belong.

I moved to Australia 12 years ago and this is truly my home now. I am grateful for that every single day.

This is the first of many columns I am writing for Diabetes Matters. It is my hope that, each quarter, you’ll join me as I explore a thought or idea that makes you laugh and brings you to the present moment.

Let’s not sweat the small stuff.

Because the things that matter are good.

One. Small. Change. That’s where it all starts – with one small change, leading to another, and so on.

Delivering DESMOND has taught me so much about my world and the way I move through it. It has taught me to be a better communicator and to self-reflect.

I am so grateful I have an amazing husband, who is a hands-on dad, supporting me in all my endeavours.

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FREESTYLE LIBRE

NOW FULLY SUBSIDISED For eligible Australians living with Type 1 Diabetes*

*CHECK ELIGIBILITY: www.SubsidyChecker.com.au

A painless 1-second scan of the FreeStyle Libre sensor makes checking your glucose easier.

» Easy to use and apply. » Sensor is small, hardly noticeable1. » No finger prick calibration. Ever. » Sensor is comfortable to wear for up to 14 days. » Water resistant so you can swim, shower, or exercise2.

» Mobile capability. Get real-time glucose readings on your smartphone3. » Share glucose readings on the go. Wirelessly share reports with healthcare professionals and anyone you like.

You can do it without lancets† THIS PRODUCT MAY NOT BE RIGHT FOR YOU. READ THE WARNINGS BEFORE PURCHASE AND FOLLOW THE INSTRUCTIONS. Find out more at FreeStyleLibre.com.au This product is indicated for measuring interstitial fluid glucose levels in people (age 4 and older) with insulin-requiring diabetes. †Scanning the sensor to obtain glucose values does not require lancets. A finger prick test using a blood glucose meter is required during times of rapidly changing glucose levels when interstitial fluid glucose levels may not accurately reflect blood glucose levels or if hypoglycaemia or impending hypoglycaemia is reported by the System or when symptoms do not match the System readings.

1. In a study conducted by Abbott Diabetes Care, 91% of patients surveyed (n=123) agree that the sensor was easy to wear due to its small size 2. Sensor is water-resistant in up to 1 metre (3 feet) of water. Do not immerse longer than 30 minutes 3. The FreeStyle LibreLink app is compatible with NFC-enabled smartphones running Android OS 5.0 or later and with iPhone 7 and later running iOS 11 and later.

FreeStyle, Libre, and related brand marks are trademarks of Abbott Diabetes Care Inc. in various jurisdictions. Information contained herein is for distribution outside of the USA only. Abbott Diabetes Care, 666 Doncaster Road, Doncaster, Victoria 3108, Australia. If you have any questions, please contact our Customer Service Team 1800 801 478.

ABN 95 000 180 389 © 2020 Abbott ADC-18827 v1.0

DIABETES

news

GREATER ACCESS TO CGM SUBSIDY An additional 21,000 Australians living with type 1 diabetes can now access the Freestyle Libre flash monitoring system for free under the National Diabetes Services Scheme-funded Continuous Glucose Monitoring initiative.

The announcement, made by Federal Minister for Health Greg Hunt in February, was welcome news for the type 1 community.

The changes – which came into effect on March 1 – are expected to help 58,000 Australians save up to $2400 a year.

The Freestyle Libre is the first flash monitoring system to be included in the CGM initiative.

It works by providing an instant blood glucose reading when a compatible smartphone or reader is waved over a waterproof sensor that is worn on the back of the upper arm and can last for up to two weeks.

The Australian Government also announced that it would remove the ‘high clinical need’ requirements for people with type 1 diabetes aged over 21 who have a valid concession card.

This is in addition to children and young people under the age of 21 with type 1 diabetes or similar health conditions that require insulin such as cystic fibrosisrelated diabetes and women with type 1 diabetes who are planning pregnancy, pregnant or immediately after birth.

POLY 13523

Diabetes WA is already working to help Western Australians with type 1 diabetes who use the Diabetes Telehealth Service to apply for access to the Freestyle Libre.

For more information about eligibility and how to apply visit go.diabeteswa.com.au/cgm-subsidy/ or call 1300 001 880.

Diabetes in Schools program launches February saw the launch of the national Diabetes In Schools program, with Perth Children’s Hospital set to become the first to deliver face-to-face training to school staff in a bid to better support students living with type 1 diabetes.

The Australian Government-funded program was designed in consultation with principals, teachers, parents and health professionals to help provide school staff with an understanding of how they can better support students with type 1 diabetes.

Diabetes WA will be coordinating the program in WA, with PCH to provide face-to-face training at schools where students with type 1 have a high need.

Safety Bay mother Corrine Moseley with her daughter Lara.

The program has been praised by parents including Safety Bay mother Corrine Moseley, whose seven-year-old daughter Lara has type 1.

See more at diabetesinschool.com.au or call Diabetes WA on 1300 001 880.

Kellion Victory Medal Awards Each year, Diabetes WA presents a Kellion Victory Medal to Western Australians who have been living with diabetes for more than 50 years, or are diagnosed in 1969 or earlier.

The medal recognises the achievements of the individual for leading a fulfilling life with diabetes, while also aiming to inspire the younger generation to do the same.

Australians who support their loved ones living with diabetes are also recognised with the Kellion Carers Award.

This award seeks to show appreciation for the years of love, support and dedication a person has shown their spouse, family member or friend who is living with diabetes.

Maree and Clifton Smith were the 2019 WA recipients of the Kellion Victory Medal and the Kellion Carer Award.

If you or someone you know are interested in receiving a Kellion Victory Medal, or to nominate someone for a Kellion Carers Award, please complete the form provided in this edition of Diabetes Matters and return it to: Diabetes WA, PO Box 1699, Subiaco WA 6904.

For more information, call 1300 001 880 or email community@diabeteswa.com.au.

7

Where Have We Been This Summer

WA footcare event a success In December, 400 health professionals from across the country and beyond descended on Perth for the Western Australian Footcare Annual Meeting.

Connect with Diabetes

In February, Diabetes WA hosted two free information sessions, Connect with Diabetes, in Geraldton and Stirling, north of Perth.

Open to anyone curious to know more about what it is like to live with diabetes, the 2.5 hour sessions were created for people at risk of developing type 2, women who have had gestational diabetes during pregnancy, people with type 2 diabetes and carers, family and friends of those who are at risk of or living with diabetes.

Not only did the sessions provide an insight into the programs offered by Diabetes WA and the benefits of becoming a member, it also provided an overview of the entitlements under the NDSS.

Dr Olufemi Oshin and Dr Fiona Wood host a talk at WAFCAM.

Led by Professor Shirley Jansen and Dr Olufemi Oshin and supported by Diabetes WA, the event drew the likes of doctors, wound care nurses, vascular and podiatric surgeons and health professionals, with international identities such as Dr David Armstrong, Professor of Surgery at the University of Southern California, flying into Perth to attend.

Held over three days, the event brought together a wealth of knowledge on footcare for people with diabetes and provided a diverse array of perspectives in the world of diabetic foot care.

Diabetes WA senior manager of strategy and business development Sophie McGough described the event as a huge success.

“The energy at the event was amazing, with so many people passionate about caring for the feet of people with diabetes,” she said.

Clinical services manager Carly Luff and primary care coordinator Jennifer Sweeting delivered the event in Geraldton, which was attended by 50 people and included an interactive session around what happens in the body with diabetes.

Primary care coordinator Jennifer Sweeting meets with staff and GPs from Midwest Aero Medical Practice at local Geraldton restaurant, Keetas.

During the trip, Carly also delivered the exercise and physical activity workshop, Ready, Set, Go – Let’s Move, while Jennifer visited General Practitioners and health professionals in the area to promote the NDSS and free NDSS-funded programs delivered by local facilitators, including DESMOND and the Smart programs.

More training delivered on the East Coast In February, Diabetes WA credentialled diabetes educator Sheryl Moore travelled to Sydney where she led training for new recruits in the Facilitator Foundations and Fidelity (FFF) and Smarts training.

The 16 participants included dietitians, diabetes educators, pharmacists and exercise physiologists who attended FFF training, which aims to train health professionals in quality delivery of topicspecific self-management education programs.

Of the 16, 11 attended the Smarts training, which covers a variety of topics.

The training is a positive step towards providing health professionals with a better understanding of how they can support people living with diabetes.

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There were 16 health professionals who attended FFF training in Sydney.

JOURNEY TO THE NORTH WEST Hello readers!

My name is Rebecca Morgan-Dann, I am Diabetes WA’s Broome-based telehealth project coordinator for the Google Impact Challenge. I am a Wanambol/Kwini and Gija woman from the East Kimberley and I have strong family ties in the West Kimberley. I am very passionate about providing advocacy and culturally-safe access to health services to people of my country, where, unfortunately, diabetes is a prominent issue. I am super excited to be working on this project and invited our telehealth manager, Gill Denny, and communications coordinator, Grace Ashby, up to the region.

*Feltman® and Feltmum® are registered trademarks of the Victorian Aboriginal Community Controlled Health Organisation and Diabetes Victoria

Day one: Arriving in Kununurra I took an early morning flight from Broome to Kununurra to meet Grace and Gill, who travelled from Perth.

We met at the airport, bundled our luggage into our 4WD and headed to our accommodation. I played tour guide for the rest of the day, gave them a taste of what to look forward to for the rest of the week and showed them the sites of Kununurra.

Day two: Kununurra to Halls Creek We woke up nice and early and began our journey to Halls Creek, which was more than 380km and showcased the true remoteness of our region, but the scenery was worth it. Beautifully rugged red and green hills hugged the one lane road, with not a car in sight. On arrival to Halls Creek, which is home to around 1500 people, we headed to Yura Yungi Medical Service (YYMS) where we met with clinical operations manager Chris Loessl and health operations manager Joan Wilson. We discussed the Diabetes Telehealth Service and how it can support YYMS staff, as well as give their patients access to a credentialled diabetes educator. After the initial meeting, Gill and I showed Joan and Chris how they can use telehealth to connect their patients with the Diabetes WA team back in Perth.

Day three: Halls Creek to Kununurra via Warmun Today we headed straight into YYMS for their morning muster. Gill presented the Diabetes Telehealth Service to staff

to show how Diabetes WA can provide their staff and patients with information on healthy eating, diabetes medications, exercise and footcare. The group also discussed reasons why it may be hard for their patients, living in Halls Creek to access diabetes education and support.

Wrapping up our time at YYMA, Gill and I gave the Aboriginal Health Workers a short training session of their Silhouette Medical Imaging devices, which were funded by Diabetes WA for Aboriginal Medical Services across the Kimberley.

The devices accurately measure diabetic wounds and skin healing, which specialists in Perth can see instantly, and give advice on, via the internet. On our way out of Halls Creek, we dropped into the local IGA express to pick up some supplies for the drive back to Kununurra. There we met the store owner, Emma, who is doing her bit to provide fresh and affordable groceries to the Halls Creek community.

Day four: Kununurra to Wyndham Our first stop on our drive to Wyndham was to Ord Valley Aboriginal Health Service (OVAHS) in Kununurra. We were lucky enough to meet all the crucial members of the team, such as Aboriginal Health Workers, GPs, midwives and the chronic disease nurses, who service the Kununurra region including Wyndham and Warmun. Gill held a presentation about the telehealth service and how they can refer any patients to receive free diabetes education thanks to WA Primary Health Alliance and the

WA Country Health Service. Our next stop was Wyndham, which is about an hour drive 100kms north west of Kununurra. We arrived at Ngnowar Aerwah Aboriginal Corporation, which is a local hub for health and community services in the town. We spent time talking to local residents and gave them information on telehealth and a quick demonstration of how diabetes affects the body using the Feltman®* tool. After a quick lunch break, we went for a drive around Wyndham.

It was a very hot, humid day, so we ventured to “The Grotto” – a beautiful gorge not far from town. We went for a short hike down to the water hole for a quick dip to cool off. Later that day, we had a chance to chat to the CEO of Ngnowar Aerwah Aboriginal Corporation, Stanley, about providing telehealth services to the community.

Day fi ve: Kununurra to Broome/Perth This was the last day of our trip!

Before flying back to our respective homes, we met with Lorraine Anderson, medical director at Kimberley Aboriginal Medical Services (KAMS). We discussed all the things we learnt on the trip and created a plan to work closely with KAMS to further support all people living with diabetes in the East Kimberley. Wrapping up the trip, we met with Angus Turner from the Lion’s Eye Institute to talk about preventative measures for diabetesrelated eye complications.

Read more about the Google Impact Challenge on page 19.

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DIABETES

and disability

Striving for equality:

the challenges of living with a disability Statistics show that one in five Australians have a disability, 11 per cent of whom are living with diabetes. But when we talk about disability, there’s no one-size-fits-all definition.

Disabilities come in all shapes and sizes, from physical and intellectual to developmental, sensory, neurological and psychosocial.

Diabetes is among the leading causes of disability and, if not properly managed, can lead to lower limb amputation, vision impairment, kidney failure and cardiovascular disease.

According to a report on Diabetes and disability: impairments, activity limitations, participation restrictions and comorbidities carried out by the Australian Institute of Health and Welfare (AIHW) in October 2013, people living with diabetes are twice as likely to have a disability compared to people without.

In Australia, there are more than 500,000 people with an intellectual or developmental disability, which equates to around 3 per cent of the population.

Research has also shown that people with intellectual and developmental disabilities are up to three times more likely to develop diabetes.

But despite the higher risks of developing diabetes among the different disability populations, there has been little focus on the coexistence of disability and diabetes in the healthcare space.

Living with a disability and diabetes: what are the biggest challenges?

Not every disability is visible – some may be physical where a person needs a walking aid or wheelchair, while 10

others may be intellectual, sensory, psychosocial or developmental.

And while living with diabetes can be a challenge in itself, for people with a disability, managing their diabetes day-to-day can add another layer of difficulty to their everyday life.

People With Disabilities Western Australia (PWDWA) executive director Samantha Jenkinson said while prevention is often the key when it comes to reducing the onset of type 2 diabetes, there is a lack of educational and self-management resources for those with an intellectual or learning disability.

“One of the things we often see is that, right at that very beginning of the prevention stage, in particular for type 2 diabetes, it involves (information) about diet, exercise and a whole pile of things that are not targeted at people with disability,” she said.

“It’s not necessarily communicated in the right format for people with disability and it doesn’t take into account whether someone already has a physical disability, and what that means in terms of being able to exercise.”

Anecdotal evidence that has circulated among the different disability populations, as well as disability advocacy groups, also suggests that there is a lack of quality, equitable healthcare for people with disability compared to the non-disabled.

So much so that in December 2019, it was announced that the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability would prepare a report based on an investigation into healthcare for people with an intellectual disability.

Based on feedback from participants, the Disability Royal Commission will explore a range of issues such as communication and physical barriers, cost and funding, as well as the attitudes and assumptions by health professionals who may attribute symptoms to a person’s disability rather than to a health issue.

A hearing into health care took place in February, where the commission heard from people with intellectual disabilities as well as their parents and carers, medical practitioners, advocacy groups and government representatives.

In recent years, there have also been cases which illustrate a lack of understanding towards the specific needs of people with disabilities who are also faced with the challenges of managing chronic diseases like diabetes.

In 2018, an Australian family won an appeal to secure funding through the National Disability Insurance Scheme (NDIS) for a nurse to administer insulin three times a day for their loved one, who has an intellectual disability and type 1 diabetes.

Then in 2019, 34-year-old Colin Burchell – who has cerebral palsy and diabetes – won a legal challenge against the NDIS to fund his $15,000-a-year food bill to cover his special dietary requirements.

As a result of his cerebral palsy, Mr Burchell can only consume thickened liquid food, which comes at a huge expense.

“Sometimes people with an intellectual disability are either not given the same level of information or the same level of support to manage things because there is an unconscious bias there that happens,” Ms Jenkinson said.

DIABETES

“I guess it comes back to that idea of, if someone didn’t have a disability, there’d be an expectation that they would get the support and training to be able to administer insulin themselves.”

and disability

Mrs Lehman is well-versed on the issues that often arise for people who are trying to navigate their way around the disability support and health services sectors.

Ms Jenkinson believes that good statistics can help paint a better picture of health outcomes for people living with a disability who also have diabetes.

Drawing from her experiences as Sarah’s primary carer, Mrs Lehmann felt compelled to share her story with the Disability Royal Commission and was invited to present her submission at the health care hearing in February.

In order to build better statistics in this space, it is important for people to register with both the National Diabetes Services Scheme (NDSS) and the NDIS.

“There are a number of issues around the NDIS and health (services sector), the two spaces don’t understand each other at all,” she said.

It is also vital for people to identify their disability when they register with the NDSS.

“So you’ve got people caught in the middle who need targeted health support but they need disability support as well to be able to access that. But equally, there’s not that accessibility of health services for people with intellectual disability to have their needs catered for in a way that it can be delivered as a quality service, as is their right, like every other Australian citizen.”

“We see in the stats around people with intellectual disability and their interaction with health systems that there is a value judgement that is unconsciously happening about how much effort or information goes to people when they have a disability versus somebody that doesn’t,” Ms Jenkinson said.

“The only way we can measure if that’s changing is if we’ve got good statistics, which is why we need to have those statistics of how many people with disability actually do have diabetes and why isn’t it being measured to know if they are having the same health outcomes as someone with diabetes who doesn’t have a disability.”

Credentialled diabetes educator and founder of South Australian diabetes clinic EdHealth Australia Jayne Lehmann has experienced firsthand the challenges of caring for a loved one with an intellectual disability.

While caring for her daughter Sarah – who had Dravet syndrome and sadly passed away in December –

She added that there is a need for the health services sector to gain more insight into how inaccessible it is to people with intellectual disability.

“We need to demystify what it is to be a person with an intellectual disability,” she said.

“Many people have little contact with people with intellectual disability, but even when they do, they distance themselves, but I don’t think they realise they are doing it.

“In my work, I see a lot of discrimination around the targets that are set for people with diabetes. So they set a much higher HbA1c target because of their disability, but it’s not tangible. You need to use the same assessment process that you do for anybody.

11

DIABETES

and disability “The (Easy Read resources) are very visual, so lots of pictures and diagrams,” Ms Kafadar said.

“The videos we are creating are little animations that will be anywhere between one minute to a minute and a half long, so really short, easy to digest information.”

As part of the project, the ADEA has also developed a comprehensive guide for healthcare professionals that will cover how to communicate with a person who has an intellectual or developmental disability about their diabetes.

“Having a disability does not mean that you have a higher HbA1c target.”

Mrs Lehmann, who is also an NDIS Provider for diabetes services which includes training for disability support workers on diabetes care including administering insulin, said more work needs to be done to better equip support workers with more knowledge and training to provide care for people with disabilities.

“What I noticed is that the support workers don’t get any training around basic healthcare,” she said.

“There’s not really the resources to support the support workers to have a conversation with people about going to the doctor, so there’s a big deficit in the knowledge of support workers around disability services’ role in supporting people to access health services.”

Mrs Lehmann hopes that the opportunity for her and others to share their stories at the Disability Royal Commission hearing will help shape the recommendations in the final report, which will be delivered to the Australian Government in April, 2022.

“People with lived experience are often good problem solvers,” she said.

“They bring a whole range of other skills to their thinking around their experience. When you have that happening, it means you can work together with people who are working in the sector who are making the laws. We need all those voices, but there’s not one that should be bigger than another.”

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The journey for equality: initiatives to improve the lives of people living with a disability and diabetes.

For people living with diabetes, there are a range of support services, programs and workshops that are accessible for anyone who wants to better understand the condition and learn how to put good selfmanagement into practice.

But as it stands, there are no educational diabetes resources designed for people with an intellectual or learning disability, in particular when it comes to understanding the value and importance of good selfmanagement on their health.

In a bid to bridge this gap, the Australian Diabetes Educators Association (ADEA) is developing Easy Read educational resources and animated videos which aim to provide a better understanding of diabetes management for people with an intellectual or developmental disability (IDD), as well as resources for support workers on how they can better support a person with IDD during routine visits to a healthcare professional.

Easy Read, sometimes known as Easy English, is a way of presenting information in the simplest form and often uses a variety of images to support accompanying words or text.

ADEA project manager Janet Kafadar said the project recognises the need for accessible, educational diabetes resources within the disability space, especially given the prevalence of diabetes among the IDD community.

“We’re also creating resources for carers and for support organisations, as there has been a lot of information especially in regards to the legal framework to administering insulin, so we had a legal team do the research for us and look into whether a support worker can administer insulin, obviously with the right training, and we found that yes, it’s just different for every State,” Ms Kafadar said.

“So it’s a very big project with lots of areas to cover.”

Perth-based credentialled diabetes educator Patricia Marshall, who was involved in the original expert reference group for the project, said the idea to create the resources was prompted by concerns that people with disability have difficulty managing their diabetes.

She said this is often due to their difficulty communicating with health professionals, as well as a lack of understanding about diabetes and the importance of good self-management from both the person with disability and the disability support worker.

“So we thought we would target those three groups and provide resources to try and improve the situation,” she said.

“So with the health professionals, the emphasis has been on communication and we’ve developed a guide that starts off explaining a bit about intellectual disability, what it is, what it entails, the communication problems they may encounter and some information on how to better communicate with people with a disability. We’re also creating an online course to supplement that written guide.

DIABETES “The printed resources for people with diabetes and an intellectual disability covers a bit about what diabetes is, and eating guidelines, but also what to do when you visit a health professional.

“So it is to help people get a bit more out of their healthcare visit.”

Developmental Disability WA chief executive Mary Butterworth said the development of the Easy Read resources and animated videos are a positive outcome for people with intellectual disability who may already grapple with the everyday challenges of day to day routines in addition to managing their diabetes.

“It is wonderful news to hear that they have recognised the need for Easy Read diabetes information and are working with people with intellectual disability and their families to develop the content,” she said.

Mrs Lehmann, who was also involved in the project, said it was a positive move towards helping people with intellectual disability understand how they can better manage their diabetes.

“They are starting to look fantastic,” she said. “If you get it right for people with intellectual disability, you get it right for people with English as a second language who’ve got memory issues, people with mental health problems, immigrants, people who are feeling very stressed, it actually helps everybody.”

The resources are set to launch nation-wide in May 2020.

The NDIS: What does it cover for people with disability who are also living with diabetes?

Recent changes to the NDIS that came into effect on October 1, 2019, have been set up to help people with disability who may face limitations in the way they manage their diabetes day-to-day.

“These new arrangements clarify the boundaries between the NDIS and state and territory health services and improve the way they work together, resulting in better outcomes for people with disability,” an NDIS spokesperson said.

“Participants will now have greater certainty, confidence and choice around the health supports they need.”

For people with disability, this means they may now be able to access funding for various diabetes-related services in their NDIS plan under Improved Daily Living and Improved Health and Wellbeing.

“If a participant is unable to manage their diabetes as a result of their disability, the NDIS may fund support for the day-to-day management,” the NDIS spokesperson said.

“The NDIS does not fund diabetes equipment, including medicine and insulin, or the development of management plans already available under the Medicare Benefit Scheme.

“However, the NDIS can fund additional support such as a registered nurse or support worker to implement the diabetes management plan where the participant’s ability to manage their diabetes is impaired due to their disability.”

Additional disability-related health supports for diabetes management that may be available to purchase using NDIS funding include:

technology or support • Assisted such as a blood glucose monitor

with talking capabilities for a person with vision impairment or access to devices such as the Freestyle Libre flash monitor for a person who has limited limb mobility and is unable to monitor their blood glucose levels themselves;

with administering insulin • Assistance by a trained support worker if the person is unable to do it themselves;

from a dietitian who can • Support provide education on nutrition to

help improve overall quality of life. For example, if a person with physical disability has diabetes and needs help to shop for and prepare a healthy diet, funding may be provided.

delivery of healthy prepared • Home meals if a person has difficulty in preparing their own meals as a result of their disability.

While it is possible for individuals living with a disability and diabetes to fund a support worker to administer their insulin under their NDIS plan, there is currently no training available in WA.

and disability

Diabetes WA senior manager of strategy and business development Sophie McGough said the organisation is investigating funding opportunities to provide training in the future.

“We have also identified a significant gap in the training available in Western Australia for support workers to assist with insulin administration,” she said.

THE NDIS v NDSS: WHAT IS THE DIFFERENCE? The National Disability Insurance Scheme (NDIS) is funded by the Australian Government and implemented by the National Disability Insurance Agency (NDIA).

It aims to provide support and care to people under 65 who have a permanent and significant disability that impacts their everyday life.

Each eligible individual has their own NDIS plan, where they can purchase supports, services or equipment that can assist with dayto-day living and help improve their overall quality of life.

The National Diabetes Services Scheme (NDSS) is funded by the Australian Government and provides a range of free and subsidised diabetes supports and products for people living with diabetes. This includes a range of educational workshops and programs led by organisations like Diabetes WA and products such as continuous glucose monitors and insulin pumps.

Carers: why they play an important role in the lives of people with disabilities For people with disability who are unable to lead an independent life, the role of a carer is vital.

Carers are often family members or friends who provide unpaid support to someone who needs help as a result of their disability, illness or frail age.

Help can range from supporting someone to maintain their independence to providing care around the clock.

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DIABETES

and disability

In WA, there are an estimated 32,000 people who provide unpaid care and support to a loved one.

According to Carers WA CEO Paul Coates, the definition of a carer is often misconstrued.

“People do crossover the term carer,” he said. “It’s a person who is unpaid and caring for someone with a disability or mental illness or frail age.”

That said, when it comes to self-care, carers often put their own needs last.

“A health and wellbeing report from Deakin University listed carers as having the lowest level of health and wellbeing among all the cohorts in the study,” Mr Coates said.

“It’s well known that for people in a caring role, the main issue is isolation, and it often takes them away from their own friendship groups and even family members.”

He said the first steps towards better wellbeing for carers could be seeking advice from a counsellor or joining a peer support group.

DISABILITIES COME IN ALL SHAPES AND SIZES Whether it is a physical or intellectual disability, no two are the same. Even those who may have been born with the same genetic condition, their lived experiences may be completely different. Here are some different types of disabilities: Physical: A disability that impacts or limits a person’s ability to perform physical activities or affects their mobility.

This can include loss of limbs or genetic conditions such as cystic fibrosis, cerebral palsy and spina bifida.

Intellectual: A disability that may result in difficulties communicating, learning or retaining information. This can include Down syndrome and developmental delays.

“Carers WA run a whole range of services and we do have peer and social support groups, and they’re frequently people who are primary carers,” he said.

“It’s just a way of having a break, initially, but also having people understand where they’re coming from and what their life is like.

“A lot of them find comfort in interacting with each other.

“We also have an advisory team that can also give information and advice to people about where they can get support for the person they’re caring for, we have counselling, we have the program in the hospitals, and we get a fair few people with diabetes who get admitted, so there’s a whole range of things for carers.”

So where to from here?

While there have been some steps towards understanding the challenges faced by people with disability who have diabetes, there is still plenty of work that needs to be done to ensure they receive the best-practice health care.

Diabetes WA has been working behind-the-scenes to ensure that Western Australians with a disability who are living with diabetes aren’t left behind and have access to local support.

Diabetes WA senior manager of strategy and business development Sophie McGough hopes that the organisation can work with key disability groups in WA to expand this support in the future.

“We would love the opportunity to work with people with disability to co-design an expansion of our Diabetes Telehealth Service to improve its flexibility and responsiveness for people with disabilities,” she said.

“It has great potential to reduce barriers for people with disabilities accessing diabetes education and endocrinology services and helping to avoid long waits in uncomfortable hospital clinics.”

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Sensory: A disability that affects the senses such as sight, hearing, touch, smell and taste, which can then impact their perception of the world around them. This can include Autism Spectrum Disorder, deafness, blindness and sensory processing disorder.

Psychosocial: A disability that arises as a result of a mental illness such as anxiety and depression, that affects a person’s ability to lead a meaningful life. This can include schizophrenia, post-traumatic stress disorder, bipolar, obsessive compulsive disorder and agoraphobia.

Donations from our supporters will help us reach people with diabetes living in remote areas with little access to vital medical services. To donate, visit go.diabeteswa.com.au.

DIABETES

MEET LILY

and disability

When 11-year-old Lily, who was born with Down syndrome, fell seriously ill, her family was shocked to learn that she had type 1 diabetes.

Upon meeting Lily, it’s clear she’s just like any other 11-year-old girl – determined, bubbly and full of life.

Born with Down syndrome – a genetic condition which occurs as a result of an extra chromosome and carries a range of physical characteristics, as well as some level of intellectual disability – Lily’s parents Emily and Lucas say it hasn’t dampened their daughter’s fiery spirit and, if anything, has built up her resilience.

For the most part, Emily says Lily has been in good health.

So when she fell ill in June last year, little did they know that their lives were about to change when she was diagnosed with type 1 diabetes.

Emily sensed something wasn’t right when Lily began to lose weight and became extremely lethargic.

“I knew something wasn’t right,” she said.

After calling an ambulance, Lily was rushed to Joondalup Hospital where doctors revealed their suspicions that she may have diabetes.

“At first when they told me, I didn’t know anything about diabetes,” Emily recalls.

“Then they transferred us to (Perth Children’s Hospital) and they did other tests and confirmed she had influenza strain B and the doctor explained that it may have been the trigger for her diabetes.”

Emily admits she started to blame herself for Lily’s diagnosis.

“The first thing I thought was, ‘Oh my god I’m a bad parent’,” she recalls.

“And I did say to the doctor that she has a pretty good diet and he said ‘No it’s nothing to do with that’.”

Type 1 diabetes is an autoimmune disease where the immune system attacks healthy cells in the pancreas and stops it from producing insulin.

Research has shown that children with Down syndrome are four times more likely to develop type 1 diabetes than other children – which equates to around 1 in 60.

Emily and Lucas wasted no time in learning more about type 1 diabetes, and their first port of call was attending a weeklong series of education workshops held by Perth Children’s Hospital for families of the newly diagnosed.

“We had a whole week of education while Lily was in hospital,” she said.

“I think I still didn’t even realise the impact it would have on us. I just thought it was pretty full on, and we knew nothing before, so it was a huge learning curve for us.”

By the time Lily was discharged from hospital, she was equipped with a Dexcom G5 continuous glucose monitor which regularly provides blood glucose readings that Lucas and Emily can view on their smart phones.

“The diabetes educator made sure we had the CGM before we left hospital, which was awesome because I don’t know how we’d go without it,” Emily says.

“I think if she didn’t have a CGM, I’d worry a lot more. It helps me to keep an eye on how she’s going at all times.”

And while the CGM has made life a little easier for Lily, Emily and Lucas, their biggest challenge has been overcoming her fear of needles for her daily insulin injections.

“It was pretty traumatic for her to have all the needles and finger pricks,” Emily recalls.

“Even though she didn’t love the needles, she’d let us do it and now there isn’t even any complaints. She just knows she has to do it.”

Now on a minimum of four insulin injections a day, Emily says Lily has adapted well to the lifestyle changes that are necessary to manage her type 1 diabetes.

“It definitely has a big impact on our life as a family, I always say that Lily having diabetes has had more of an impact on us than her having Down syndrome,” Emily says.

“We just get on with it and do it, but it is every day and it’s constant. It never really stops for me.”

“A lot of the time we think of how strong she is, and I’m so proud of her,” dad Lucas says.

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DIABETES

and disability

MEET GREGG

Gregg was diagnosed with type 2 diabetes when he was just 30 years old.

Now at age 65, he faces losing his left foot.

When Gregg was diagnosed with diabetes more than three decades ago, he never knew the detrimental impact it would have on his health.

Sadly, when Gregg was first told he had diabetes, he had no idea there was a connection between the condition and an array of other health problems such as loss of vision and foot ulcers which, if left untreated, can lead to amputation.

“The doctor didn’t tell me anything. He just said I have to watch my diet, I’ve got to watch my sugar intake and drink plenty of fluids,” Gregg recalls.

“So basically, my world fell in and I thought, what do I do now? Luckily my wife is a nurse…so we went ahead and started doing things, but I still didn’t take it seriously.

“I thought, I’m 30 years old, I’ve got my whole life ahead of me. And then things

started going wrong, my eyesight started to get worse and I started getting little sores on my feet.”

Now aged 65, Gregg faces the possibility of losing his left foot, having already had three toes on each foot amputated, with recurring ulcers that have not properly healed continuing to cause ongoing problems.

On top of checking his feet daily, administering insulin four times a day and having steroid injections in his eyes every three months to help prevent loss of vision, Gregg can only get around in a custom-made boot on his left foot with the assistance of a walking stick.

As a result of his physical disability, Gregg has limited mobility which he says has stripped him of his independence.

“The biggest challenge for me is my inability to do simple things like do the

gardening or make a cup of tea,” he says.

“Without this boot or a cast, I can’t walk.

I stand up and I fall over. Because of the mobility problems with the left leg, I put more pressure on the right leg. So I’m now waiting for a knee replacement, but I can’t until the ulcers are healed, so my knee gets worse and worse.”

Despite his shortcomings, Gregg wants to share his story in the hope that it will encourage people to take their diabetes seriously.

“You’re not invincible,” he says. “This thing is not just a ‘I’ve got sugar in my blood’ - it can kill you.”

MEET JUSTIN At 22, Justin knows all too well about the challenges of living with a disability and managing his diabetes.

Born with a learning disability known as Chromosome 6, it wasn’t until Justin was in his early teens that he was diagnosed with Autism Spectrum Disorder.

Then at the age of 16, he found out he had type 1 diabetes, which he says was picked up in a stroke of luck by his mum, who has type 2 and had noticed the initial signs and symptoms.

“She knew the signs of what was happening,” he recalls.

“I blacked out once, I wasn’t feeling good and I stopped eating and I was drinking a lot and I had pretty bad health at the time...so mum decided to book me into the doctors and then they found out, if it was two to three days later, I would have been dead. So I was very lucky mum saved my life.”

Since being diagnosed with diabetes, Justin has to self-inject insulin three times a day and regularly checks his blood glucose levels.

16

“Some days it is (harder), it depends on the day. Sometimes it’s a mood thing, if someone has pissed me off I go into a funny mood.”

Understanding what foods impact his blood glucose has also been difficult.

“Trying to manage the food as well is a bit hard because I’m a sweet tooth,” he says.

His BGLs often fluctuate depending on his mood – so much so that when he’s stressed, it can soar into the 20s.

While people with autism can find it challenging when it comes to changes in their routine, Justin says he adapted to his daily diabetes management quite well.

This, he says, has been one of the biggest challenges of managing his diabetes.

“I seem to adjust to it pretty well because I knew it was live or die so I had to learn to live with it and deal with it,” he says.

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DIABETES

and disability

Go green: How to recycle diabetes supplies We all want to do our bit for the planet, but can we safely recycle diabetes supplies? Sharps need to be disposed of responsibly, no question, but there are ways to save other supplies from going into landfill.

Donate

Sharps

Electronics

Insulin pumps and other supplies including insulin are prescription products and should not be used by anyone without a valid prescription.

You can donate unwanted insulin and supplies to Insulin for Life Australia, a not-for-profit organisation that collects and distributes insulin and other diabetes supplies that would otherwise be wasted.

Hazardous material should always be disposed of in a biohazard or sharps container which meets Australian standards. This includes used needles, infusion sets, lancets, insulin containers, syringes, pump tubes and test strips. Sharps containers can be safely disposed of at public hospitals, participating pharmacies and community sharps disposal bins.

Electronic waste like pumps and blood glucose meters can be placed in an e-waste recycling drop off point.

Visit insulinforlife.org.au to find out what they will accept and where your donated supplies will go.

Plastic

Batteries Batteries from meters, pumps and CGMs can be recycled. Many supermarkets, local council offices and libraries have battery recycling bins – check which type of batteries they accept.

Visit recyclingnearyou.com.au/ batteries to find a location near you.

18

Visit safesharps.org.au for locations.

Hard plastic that is not contaminated, such as packaging and test strip containers, may be recyclable, depending on your council guidelines.

Check if there is a recycling symbol on the package. Soft plastics, like packaging, can be deposited in a REDcycle bin for recycling.

Bins are located at most Woolworths and Coles stores – for a location near you, visitredcycle.net.au

Check your local council website for guidelines.

Packaging All those paper inserts that come with your medications, needles, CGM and pump supplies are recyclable in your household recycling bin, along with the boxes they are packaged in.

Suppliers If you check the websites of suppliers of diabetes medications and supplies, you will find that they are aware of the environmental impact of the items they manufacture. But are they taking steps to reduce waste and introduce recycling programs? Check with your supplier to see if they offer a recycling program. If they don’t, you can always let them know that you would like one!

SHARED

pathways

Google Impact grants helps Diabetes WA bring quality care to the East Kimberley

By Grace Ashby

In February, Diabetes WA visited remote communities across the East Kimberley as part of the Bringing Care Closer to Home project, which was funded by a Google Impact Challenge grant.

Consulting with Aboriginal communities across the region, the project aims to tackle the prominence of type 2 diabetes by exploring opportunities to provide access to Diabetes WA’s award-winning telehealth technology.

Thanks to funding for the project, Diabetes WA has been researching the barriers faced by people living with diabetes and their healthcare teams in the East Kimberley.

“Aboriginal people are three times more likely to develop type 2 diabetes, almost seven times more likely to die from diabetes and 38 times more likely to have lower limb amputations due to diabetes complications than non-Aboriginal people, so we’d like to expand our reach to enable an effective solution for Communities living with high rates of diabetes,” Diabetes WA general manager of health services Deb Schofield said.

Despite the alarming statistics, there are limited diabetes support services available to people living in remote Aboriginal communities such as Kununurra, Halls Creek, Wyndham and Warmun.

People living with diabetes in these areas are expected to travel to Perth for appointments, which can become a 10-day round trip for a 20-minute appointment that may be cancelled.

“It is also a hassle for people who haven’t been on a bus or plane or even to the city,” said Megan Martin, Aboriginal Health Worker at Yura Yungi Medical Service in Halls Creek.

“It would just be easier if we could just call patients into the clinic for a simple teleconference for appointments.”

The Diabetes Telehealth Service will allow people living remotely to receive specialist care in their hometowns.

The organisation is exploring how this service can bridge this gap by providing

diabetes support and care via video conferencing for people who would otherwise have to travel long distances to access vital healthcare services.

Another barrier that was discussed in depth during the community consultations were language barriers between healthcare specialists and Aboriginal people.

“Every Aboriginal language is different and not everyone understands hospital jargon,” Ms Martin said.

“It would be helpful to have an interpreter or Aboriginal health liaison officer with a patient, while on telehealth, to break down the language for them and help them understand important information like why they should take the medications.”

By accessing Diabetes WA’s telehealth service within the community, patients will benefit from having their healthcare team around them in their own environment.

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news Type 1 could affect learning

RESEARCH

A world-first study has found that children with type 1 diabetes could be at risk of developing learning or behavioural issues.

Led by researchers at the Stanford School of Medicine in the USA, the study looked at what happens in the brains of children aged between seven and 14 years old with diabetes during a cognitive task.

During the study, MRI brain scans were conducted on 93 children with type 1 diabetes across five different locations, with an additional 57 children who did not have the disease forming part of the control group.

Ahead of the brain scans, all children were given standard behavioural and cognitive tests.

Among the children with type 1 who were tested, results revealed abnormal brain activity patterns that are usually seen in a range of other disorders such as cognitive decline in ageing, concussion, ADHD and multiple sclerosis.

Results also showed that abnormal brain activity was more pronounced in children who have been living with diabetes for longer.

“Our findings suggest that, in children with type 1 diabetes, the brain isn’t being as efficient as it could,” said Lara Foland-Ross, PhD, senior research associate at the Center for Interdisciplinary Brain Sciences Research at Stanford.

Source: Stanford Medical Centre

Aloe vera may reduce blood glucose levels in type 2 diabetes Researchers have concluded that oral consumption of the juice from aloe vera, a common household plant which has been used for centuries for its medicinal properties, may have the potential to lower the fasting blood glucose (FBG) and HbA1c of people living with prediabetes or type 2 diabetes.

Aloe vera has a long-standing reputation for its healing and anti-inflammatory properties, often used for burns, cold sores and other wounds. It is generally a widely accessible and affordable supplement, and most often used without any side-effects.

Studies so far suggest that aloe vera may have a positive impact on managing blood glucose levels. The prospect that it could be used in adults living with type 2 to keep blood glucose levels within range would be a welcomed development in global diabetes management.

Experts caution that more robust and extensive clinical studies are required in order to further explore and substantiate these initial findings.

Source: The Journal of Alternative and Complementary Medicine

Link between height and reduced risk of diabetes Being tall could lower the risk of type 2 diabetes.

Scientists from the German Centre for Diabetes Research and the German Institute of Human Nutrition examined the correlation between height and the risk of developing type 2 diabetes and found that, with every 10cm of additional height, there could be a 41 per cent reduced risk in men and 33 per cent reduced risk in women.

During the study, which was published in Diabetologia in December 2019, two more components of height were taken into consideration – leg length and sitting height.

It found that, in men, longer leg length may reduce their risk of developing the condition while in women, both sitting height and longer leg length may contribute to a reduced risk.

Source: Medical News Today

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.

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Local Findings CAPSULE COULD REDUCE SEVERITY OF DIABETES Researchers from Perth’s Curtin University have developed tiny capsules that could effectively treat the liver and pancreas to reduce the inflammatory effects of type 2 diabetes.

The capsules were created using bio-nanotechnologies and contain a mixture of human based bile and the drug Probucol, which is used to reduce lipids.

They are digested and absorbed into the blood stream, healing inflammation in the liver and pancreas and reducing the risk of harm to the rest of the body.

RESEARCH

news

WA researchers win bid to simplify GDM screening WA researchers have secured funding to further explore the possibility of simplified screening for gestational diabetes.

Current screening for gestational diabetes mellitus (GDM) involves an Oral Glucose Tolerance Testing (OGTT) which is done between 24 and 28 weeks of pregnancy.

While it is yet to be tested on humans, Curtin Health Innovation Research Institute’s Dr Hani Al-Salami – also the lead author of the study which was published in the Nature journal in January, said the research showed promise for the future treatment of type 2 diabetes.

Source: Curtin University

WA RESEARCHERS INVESTIGATE ‘WONDER DRUG’ WA researchers have secured funding to explore whether a so-called “wonder drug” may be able to be used to prevent a diabetes-related eye condition that can lead to blindness.

SGLT2 inhibitors – a relatively new class of oral medications that lower blood sugar levels by stopping the reabsorption of glucose in the kidney – have been shown to benefit cardiovascular and kidney health in those with type 2 diabetes.

Led by Dr Lakshini Herat, pictured above left, and funded by a grant from Diabetes Research WA, the WA team will investigate if the SGLT2 inhibitor known as Canagliflozin may also halt the development and progression of diabetes-related eye disease.

“Diabetic retinopathy, which occurs when the tiny blood vessels inside the retina at the back of the eye are damaged as a result of either type 1 or type 2 diabetes, is a leading cause of irreversible blindness worldwide, so there’s a great need to advance our treatment of it,” said Dr Herat.

During the test – which spans more than two hours – women have to fast and undergo two blood tests to measure their glucose levels before and after drinking a glucose mixture.

Higher blood glucose levels in pregnancy have been linked to an increased risk of adverse birth outcomes, with research showing that babies born to women with GDM are at greater risk of developing type 2 diabetes.

GDM can be managed with diet and lifestyle changes, with medication sometimes required.

Associate Professor and researcher Julia Marley from the Rural Clinical School of Western Australia said many women across regional and remote WA don’t complete the test.

“The current screening process for gestational diabetes is time-consuming and difficult,” she said.

“Our recent investigations demonstrate elevated expression of SGLT2 in the whole eye and retina of a diabetic retinopathy mouse model and this new funding will allow us to understand the protein’s role in the development and progression of diabetic retinopathy and its potential as a therapeutic target.

“Many women, in particular Aboriginal women, opt not to – or can’t – do it, which potentially puts their health and that of their unborn child at risk, so our aim is to simplify the testing in a bid to ensure more women have it done.”

“If successful, this research may pave the way for a clinical trial in humans with the ultimate hope that Canagliflozin may be able to be used in people with early signs of eye damage to stop them losing their sight.”

Diabetes Research WA has awarded Associate Professor Marley and her team a $60,000 grant to investigate the use of one blood test during GDM screening.

Other researchers involved in the study include UWA’s Professor Markus Schlaich and Assistant Professor Vance Matthews, and the Lions Eye Institute’s Professor Elizabeth Rakoczy.

The research will get underway this year.

Pregnant women in the Kimberley, South West and Osborne Park presenting for an OGTT will be invited to take part in the study.

Source: Diabetes Research WA

Source: Diabetes Research WA

21

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community

HBF RUN FOR A REASON

Diabetes WA is one of the four featured charities for the 2020 HBF Run for a Reason.

Last year, our fabulous supporters raised over $25,000 to help people living with diabetes access everything they need to live a happy, healthy life.

To register and start fundraising for Diabetes WA, visit our website and click on the HBF Run for a Reason banner to get started.

We are also looking for volunteers to help out on the day.

Interested? Email us at volunteering@diabeteswa.com.au

If you can’t be part of the event, you can still support us with a donation hbfrun2020.everydayhero.com/au/gluco-goers-1

INTHE

community

SUNDAY 24 MAY 2020 Meet Emily – our HBF Run for a Reason Ambassador For as long as she can remember, Emily Vuong has been living with type 1 diabetes.

Her earliest memories stem back to when she was a toddler and her mum and dad would do her insulin injections – so it’s no surprise that managing her diabetes has become second nature.

diabetes straight away, it takes years, so I’ve tried to learn as much as I can.”

first run, where she raised funds for diabetes research.

But living with diabetes has certainly had its challenges.

Since then, she has competed in various fun run events, including the New York City Marathon in November last year.

“I was diagnosed when I was 14 months old,” she says.

“As a teenager, I found it hard to feel like I was different to everyone else,” she says.

“I remember I would have needles, my parents used to do the injections. But it just felt normal, my parents were really good at distracting me, one would rattle a toy and the other one would do the jab. But I’ve never known any different.”

“I didn’t like giving my insulin at school, then when I got further into teenager-hood, because I had to be so aware of what I was eating, I had some disordered food patterns so that was quite hard.

It wasn’t until Emily was in high school that she began administering her own insulin and took full control of her diabetes management.

“My parents always included me in carb counting, giving my insulin, so I knew how to do it but they did it when they could so I didn’t have to. So when it came the time to do it myself, I could easily do it,” she says.

“I’ve had 22 years of practice and over the past few years I’ve really tried to involve myself in as much diabetes stuff as I can so I can learn. Because you can’t know everything about

“Then just the concern about the future and if you’re going to be able to have kids and all that kind of scary stuff.”

In recent years, Emily has taken to sharing her trials and tribulations on social media in the hope of painting a picture of what life is like living with diabetes.

Now with more than 4,800 Instagram followers and counting, Emily – who goes by the handle @emilysdiabetes – uses the platform to help spread more awareness of the condition.

Three years ago, she decided to take this a step further and sign up for her

“I’ve never really been much of a runner until the past couple of years – I simply didn’t think I was capable of it,” she says.

This year, she has stepped up as Diabetes WA’s Ambassador for HBF Run for a Reason, which takes place on Sunday, May 24.

While the 12km HBF run route is a significant step back from the 42.2km she clocked up through the streets of New York City, Emily is looking forward to raising more awareness of diabetes.

“I’m really excited to be an ambassador for Diabetes WA at this year’s HBF Run for a Reason because I want to show people that diabetes shouldn’t hold you back from anything,” she says.

“I have become a runner despite all the challenges type 1 has thrown at me and I’m proud to show others that it’s possible for them, too.”

Emily will be leading the Diabetes WA team on Sunday May 24 at the HBF Run for a Reason as our Ambassador. Read more about how you can help her fundraise, or how to register, on opposite page.

23

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community

My Diabetes Story

Above: Lynette Clayton, third from left, with her siblings. Â

Having lived with type 2 diabetes for most of her life, Lynette Clayton, 82, wanted to share her experience with others. Here she writes her personal account of what it has been like living with diabetes.

One of my early childhood memories was of visiting a hospital in a Victorian country town to see my grandfather, George Handley, who was in bed with his leg held up in a sling with the foot bandaged. He was the active mayor of the town when he developed an ulcer on his toe that turned gangrenous. He had been diagnosed with type 2 diabetes.

My next image of him is sitting in a large wicker chair on the concrete back verandah of his home with one leg amputated.

I never saw him alive again. I was aware that the way of life he and my grandmother led would have to change.

My grandmother would be living alone and, as there were no closer relatives in town, we would have to make the trip from a nearby town to visit her often.

My father, Erin Handley, at the age of 56, developed type 2 diabetes, as did I and two of my three siblings, and now my eldest son Ian, has turned 56, he also now has the condition.

But in my sister’s family, it has hit earlier. One son developed it in his forties and his son was born with too much insulin in his system and will probably end up with type 1 diabetes.

The changes in treatment have been immense. My father was medicated, and my mother ensured his diet was strictly adhered to. But I saw him deteriorate in his ability to walk and he finally died of a stroke just before his 80th birthday.

24

With modern medications and care, I have outlived him.

These experiences, and the fact that I was diagnosed after a bleed in one eye that required laser treatment, emphasised to me that I needed to be under a diabetic specialist as well as a GP. I bought several books from a pharmacy that acquired them from Diabetes Australia and find them helpful to go back to, to remind myself of the importance of establishing self-management daily routines of staying active, choosing a good diet, acting as a sugar gatekeeper when going to the supermarket, cooking for myself and the family each night after work, and developing habits such as wearing comfortable footwear and checking my blood sugars and my feet regularly.

I have learned not to punish myself internally for errors or when frustrated at the care necessary, but just to be thankful that I have picked up an error early and have a steady, self-managed routine to return to.

As a retired psychologist, I know that having a lively, purposed-filled life that includes gratitude to oneself and others for care and service is received, is an important attitude that contributes to a healthy mind and body.

Lynette Clayton

INTHE

#DiabetesChatters

community

In this segment, we 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.

“For a hypo 6–8 glucose Jelly Beans, or (a) can Lemonade,then fruit toast or bowl of cereal.

Just as a late night snack, bowl of cereal is my go to.”

“Muesli bar or an apple as they are cheap and portable.”

“Potato chips or chocolate mousse”

What is your go-to hypo snack?

“Mejoli (sic) dates are my go to. 1-2 and TBR 0% for 15 mins on my pump.”

Burning Questions Q: I’ve recently read that drinking coffee can impact my blood glucose levels. I enjoy my cup of coffee every day, but now I’m worried. Is this true?

-John, type 1 diabetes

A: Diabetes WA credentialled diabetes educator Christine Carne says …

Caffeine is a natural stimulant most commonly found in tea, coffee and cacao plants. Most people get it from coffee, tea, soft drinks, energy drinks or chocolate.

Synthetically produced caffeine may also be found in many common medications, including cold and flu, appetite suppressing and pain relieving (analgesic) medications. In addition, caffeine can be removed from foods in which it is naturally found through a process known as decaffeination, for example with decaffeinated coffee and tea.

Caffeine is one of a group of drugs called methylxanthines, which have several effects on the body:

stimulate the central nervous • They system; (the brain) increase the frequency of • They urination (are diuretics); stimulate the heart muscle; • They and increase smooth • They muscle relaxation, which affects body systems regulated by smooth muscles, including the endothelial system which regulates blood flow.

Coffee contains different chemicals which can both improve and impair how your insulin works which means that it may increase or decrease blood glucose levels.

Caffeine ingestion affects everyone differently. The bodily effects from caffeine also vary according to amount consumed, your genetics, age, medical conditions, your medications and many other factors.

It is therefore believed that limiting your coffee intake or choosing a decaffeinated coffee may present the

“ I need to up my kids Yoghurt pouch middle of the night hypo game.”

best option for people with diabetes, especially if you are struggling to control your glucose levels.

Remember milky coffee or coffee containing syrups will contain more carbohydrate (from the milk or syrup) which in turn will increase your glucose levels and may also lead to weight gain from the increased energy (kilojoule) intake.

Food Standards Australia and New Zealand recommend in adults over 18 years of age to consume no more than 400mg of caffeine per day (from all sources).

They also recommend a maximum of 200mg in a single serve. For example, a 50ml espresso contains 145mg caffeine and an instant coffee with one teaspoon of coffee 80mg per 250ml cup.

Note that regular consumption of large amounts of caffeine can lead to addiction.

Visit this link to check out how much caffeine you are consuming: foodstandards.gov.au/consumer/ generalissues/Pages/Caffeine.aspx

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.

25

MOVING

well

HIT THE

PAVEMENT Whether you’re gearing up for your first fun run or you’re a regular runner looking to step up your distance, training for a running event can be a great way to get fit and shed a few kilos.

Whether you want to lose weight, get fit or find the motivation to exercise, running has many health benefits.

advises to consult your GP or endocrinologist before commencing any new training program.

Marian says. “Monitor your BGLs at least every 20 to 30 minutes for activity lasting longer than 30 minutes.

For people living with diabetes, running on a regular basis can not only help to reduce the amount of daily insulin required, but can also lower the risk of stroke and, for people with type 2 diabetes, help combat insulin resistance.

TARGET RANGE FOR BLOOD GLUCOSE LEVELS

“Hopefully by checking regularly, you can avoid letting BGLs dip below 4mmol/L.”

BEGINNERS As the saying goes, slow and steady wins the race.

And if you’re tackling your first fun run, Diabetes WA exercise physiologist and diabetes educator Marian Brennan recommends slowly building up the intensity and duration of your runs.

“Couch to 5kms is a great example of a gradual exercise program and may be a good place to start for those who are new to running,” she says.

“Consider asking an exercise physiologist for a program or visit the event website for some generic programs which are safe to follow.”

It’s also worth noting that running can impact blood glucose levels (BGL) in different ways for people living with type 1 diabetes compared to those with type 2 who require insulin.

For those who have existing diabetes-related complications, problems with blood vessels in your eyes, legs, kidneys or heart, a history of heart problems or stroke or have recently experienced big fluctuations in BGLs, Marion strongly 26

Not sure what target range you should aim for during a run?

For people with diabetes who require insulin and are undertaking light to vigorous activity, Marian suggests starting with a BGL between 7 and 10mmol/L. When moving up to high intensity activities where you know your BGL will rise, aim for 5-7mmol/L, while sustaining between 5.5-10mmol/L during activity. If your BGLs are above 15mmol/L for prolonged periods of more than two hours, check for ketones as too many in your bloodstream can be life-threatening.

She adds that if your ketones are less than 0.6mmol/L, it’s safe to continue, but if it ranges between 0.6 to 1.4mmol/L, be very cautious and stick to light exercise for a maximum of 30 minutes. If your ketones are above 1.5mmol/L, Marian says exercise should be avoided.

HYPOGLYCAEMIA Hypoglycaemia – when BGLs fall dangerously low – can be difficult to recognise during exercise.

On race day, it’s worth carrying your blood glucose monitor with you and also having a hypoglycaemia prevention kit on hand.

“A person living with diabetes competing in a fun run should always carry their blood glucose monitoring device with them, especially if they are competing in the longer distances,” dietitian Ashling Turner says.

“They should also carry their usual hypoglycaemia prevention kit, which could be 15g of fast acting carbohydrates in the form of six to seven jellybeans, glucose tablets or 200 to 250ml of fruit juice.”

Ashling adds that it’s also a good idea to do your research ahead of race day to see what is provided at the various hydration stops along the event course.

“Some of the stops provide a small plastic cup of energy drink like Powerade which may assist in managing both energy and blood glucose levels,” she says.

However, some typical signs of hypos can include sweating, shaking, dizziness and increased heart rate.

If you notice signs of a hypo with falling BGLs that drop below 5.5mmol/L, you may want to consider having some fast-acting carbohydrates – think gels, sports drinks, lollies or jellybeans.

“This is why monitoring during your run is crucial, even if you feel OK,”

“If you check and notice you are having a hypo (less than 4mmol/L), stop

MOVING

running and treat the hypo as per normal,” Marian says.

“Commence running once your BGLs have come above 7mmol/L. If your BGLs drop below 2.8mmol/L or you require assistance in treating your episode of hypoglycaemia, we do not recommend activity for the next 24 hours.”

FOOTWEAR Whether you’re a beginner, intermediate or advanced runner, a decent pair of shoes is a must.

Marian recommends replacing them at least once every 12 months, or sooner depending on how often you run.

While it’s often thought that people need to “wear in” their runners, Marian says as long as your shoes are comfortable from the start, don’t rub and provide the right support, then you’re on the right track.

The biggest no-no when it comes to footwear? Running in wet shoes.

“It might be tempting to pour water over your head, but this inevitably wets your socks and shoes, creating the perfect environment for blisters,” Marian says.

“It’s also worth checking your feet before and after each run to monitor any changes. If you notice any signs of infection or inflammation, seek medical advice right away.”

EAT WELL Fuelling your body with nutritious, wholesome foods is particularly important when upping your physical activity levels.

If you’re planning on tackling the 12km run or the half marathon, Ashling says it’s worthwhile speaking to your dietitian or diabetes educator to work out a nutrition plan that will help you prepare for the longer distances.

“Every individual has different needs and practising different carbohydrate combinations before, during and after training based on individual blood glucose levels will assist in maximising performance,” she says.

While the food you eat in the lead up to the fun run is pivotal to how you will feel on race day, Ashling says there are some misconceptions about what people should eat the night before.

“There can be a misguided idea that someone competing in a fun run needs to eat a very carbohydrate heavy meal on the evening before the race,” she says.

“People living with diabetes should follow their usual routine of a varied meal, comprising of protein, vegetables and one to two serves of carbohydrates.

“It is a good idea to choose wholegrain carbohydrate varieties for their added health benefits including increased fibre, vitamins and minerals. These include brown rice, and wholemeal and wholegrain pastas and breads served with a nice variety of vegetables.”

On race day, Ashling suggests having a small breakfast or snack before making your way to the start line.

“Anywhere from one to two hours before the event should be enough

well

time for the food to settle and for our bodies to be able to use the food as energy,” she says.

“That should also be enough time to not feel sluggish from the food, which can make it uncomfortable to run.

“It is a good idea to trial what foods work for us immediately before going for a run, as some people may prefer one to two slices of toast or some cereal, whereas others may prefer a smaller piece of fruit.

“Some people may even prefer a larger meal one to two hours prior and a small snack just before starting.”

STAY HYDRATED Last but not least is ensuring you stay hydrated.

Not only can dehydration cause blood glucose levels to rise, but it can also impact your overall performance.

“Hydration is very important, particularly on hot days,” Marian says.

“Hydrating with electrolytes is a good idea, particularly if running for greater than 60 minutes. Fluid replacement during exercise is very individual and can be dependent on many factors.”

To prevent excessive dehydration during a run, Marian recommends drinking enough water to prevent losing more than 2 per cent body weight due to fluid loss.

Want to sign up for HBF Run for a Reason? See page 22 for entry details.

27

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 or 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. We are now delivering this in Chinese as well.

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.

28

Perth Metro

Armadale Armadale Armadale Armadale Armadale Aveley Aveley Aveley Aveley Banksia Grove Banksia Grove Banksia Grove Bassendean Bassendean Bassendean Bassendean Burns Beach Burns Beach Burns Beach Burns Beach Butler Butler Butler Butler Butler Cannington Cannington Cannington Cockburn Cockburn Cockburn Cockburn Cockburn Dayton Dayton Floreat Floreat Girrawheen Girrawheen Joondalup Kelmscott Kelmscott Kelmscott Mandurah Mandurah Mandurah Mandurah Mandurah Melville Melville Melville Melville Midland Mindarie Mirrabooka Mirrabooka Mundaring Ocean Reef Ocean Reef Piara Waters Piara Waters Rivervale Rivervale Rockingham Rockingham Rockingham Rockingham Secret Harbour Willetton Willetton Willetton

DESMOND Ready-Set-Go Let's Move CarbSmart Classroom ShopSmart DESMOND DESMOND DESMOND MedSmart Classroom ShopSmart Classroom ShopSmart MonitorSmart DESMOND CarbSmart DESMOND CarbSmart MedSmart DESMOND CarbSmart DESMOND Classroom ShopSmart DESMOND CarbSmart FootSmart ShopSmart Ready-Set-Go Let's Move CarbSmart MedSmart DESMOND Pump Workshop DESMOND DESMOND FootSmart ShopSmart Living With Insulin MedSmart ShopSmart DESMOND FootSmart MonitorSmart FootSmart ShopSmart DESMOND DESMOND DESMOND Classroom ShopSmart MedSmart DESMOND Connect with Diabetes ShopSmart MedSmart Classroom ShopSmart FootSmart DESMOND DESMOND MonitorSmart DESMOND DESMOND DESMOND DESMOND DESMOND Living With Insulin FootSmart CarbSmart Living With Insulin DESMOND FootSmart ShopSmart DESMOND CarbSmart Classroom ShopSmart FootSmart

3 April 17 April 15 May 15 May 2 June 16 April 19 May 29 June 29 June 6 April 6 April 30 June 2 April 21 April 26 May 26 May 8 April 1 May 25 May 10 June 15 May 12 June 12 June 24 June 26 June 15 April 15 April 7 May 4 May 11 May 8 June 15 June 15 June 22 May 12 June 26 May 5 June 20 May 20 May 6 April 7 April 30 April 23 May 4 April 29 April 29 April 6 June 9 June 24 April 11 May 30 May 30 May 20 June 18 April 28 April 30 May 28 May 12 May 10 June 17 June 22 June 23 April 26 June 22 April 2 May 8 May 8 May 25 June 13 May 3 June 18 June

Calendar WA Regional

Albany Albany Albany Albany Albany Albany Albany Bunbury Bunbury Bunbury Bunbury Bunbury Bunbury Bunbury Bunbury Geraldton Geraldton Geraldton Geraldton Geraldton Geraldton Geraldton Kalgoorlie Kalgoorlie Kalgoorlie Karratha Katanning Manjimup Moora Narrogin Northam South Hedland South Hedland

DESMOND DESMOND CarbSmart FootSmart DESMOND Classroom ShopSmart MedSmart DESMOND FootSmart MonitorSmart DESMOND CarbSmart FootSmart DESMOND DESMOND DESMOND DESMOND FootSmart Classroom ShopSmart DESMOND MedSmart CarbSmart DESMOND Connect with Diabetes DESMOND DESMOND DESMOND DESMOND DESMOND DESMOND DESMOND DESMOND DESMOND

6 April 8 May 15 May 15 May 10 June 19 June 19 June 8 April 15 April 15 April 1 May 11 May 11 May 26 May 24 June 24 April 15 May 29 May 29 May 12 June 19 June 19 June 6 May 28 May 24 June 27 May 25 June 16 June 13 May 22 April 22 June 6 May 17 June

Free to Diabetes WA members an d people regis tered on the NDSS .

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, diabetic retinopathy and gestational diabetes. To find out more or to register for any upcoming sessions call 1300 001 880 or visit 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 29

Dinner Delights Prep time: 10 mins (+ 2 hours proving) Cook time: 20 mins

Serves 4 (as a main meal) 150g (1 cup) plain flour 160g (1 cup) wholemeal plain flour 8g sachet dried yeast 160ml (2/3 cup) lukewarm water 1 tbsp olive oil 2 tsp polenta 3–4 egg tomatoes, thinly sliced 1 small red onion, thinly sliced 2 slices lean bacon, cooked until crisp, finely chopped (see Cook’s Tips) 90g (¾ cup) grated mozzarella 3 cups rocket leaves 1 tbsp balsamic glaze

1. Spray a medium bowl with cooking spray. Put the flours and yeast in the bowl of a food processor. With the motor running, add the warm water and oil and process until the mixture forms a ball. Remove and shape the dough into a smooth ball. Put the dough in the oiled bowl, turning to grease the surface of the dough. Cover and set aside in a warm place for 1½–2 hours, or until it doubles in size.

2. Preheat oven to 220°C (fan-forced). Spray a baking tray with cooking spray and sprinkle with the polenta. Roll the dough on a lightly floured

30

surface into a 20cm oval or rectangle. Put dough on the prepared tray. Bake for 8 minutes.

3. Remove the base from the oven. Top with the sliced tomato, onion and bacon.

Sprinkle over the mozzarella.

Bake for a further 8 minutes, or until the crust is golden and the cheese bubbles.

4. Top the pizza with some of the rocket (serve the rest of the rocket on the side). Set pizza aside for 3 minutes.

Drizzle with the balsamic glaze. Cut into 4 pieces to serve.

COOK’S TIP

prefer not to use a • Iffoodyouprocessor, stir together

•

both flours and the yeast in a large bowl. Stir in the warm water and oil until moistened.

Turn dough out onto a lightly floured surface. Knead until smooth and elastic, about 3 minutes. Let rise and continue as directed.

To cook the bacon, cook in a small non-stick frying pan over medium heat for 3–4 minutes, or until the bacon is crisp.

Nutrition Info

PER SERVE 1910kJ, protein 20g, total fat 13g (sat. fat 5g), carbs 64g, fibre 9g, sodium 359mg • Carb exchanges 4½ • GI estimate medium Additional information ALISON ROBERTS, SHANNON LAVERY (dietitian)

Recipes: Alison Roberts, Shannon Lavery (Dietitian) Photography: Rob Palmer Styling: Vanessa Austin Food Preparation: Sarah Mayoh

BLT Pizza

Chicken with tomatoes and olives Prep time: 10 mins Cook time: 40 mins

1. Combine the saffron threads and boiling water in a small heatproof bowl. Set aside.

2. Heat the oil in large non-stick saucepan over medium heat.

Add the onion and cook, stirring occasionally, for 7–8 minutes, or until the onion is very soft. Add the chicken and increase to medium–high heat. Cook for 2 minutes, turning often, or until lightly browned. Stir in the garlic.

3. Add the lemon rind, olives, eggplant, tomatoes, saffron liquid and stock to the pan. Bring to a simmer. Reduce heat to medium and cook, partially covered, for 20 minutes.

Remove the lid and cook for 10 minutes, or until the chicken is very tender.

4. Season chicken with pepper and divide between serving bowls. Combine mint and parsley. Sprinkle over chicken and serve.

Serves 2 (as a main meal)

Pinch saffron threads 2 tbsp boiling water 1 tsp olive oil 1 brown onion, cut into thin wedges 4 small chicken drumsticks, skin removed 3 cloves garlic, finely chopped Rind of ½ lemon, removed using a vegetable peeler 8 green olives 2 baby (slender) eggplants, chopped 400g can no-added-salt chopped tomatoes 125ml (½ cup) salt-reduced chicken stock or gluten-free stock Freshly ground black pepper ¼ cup mint leaves, chopped ¼ cup flat-leaf parsley, chopped

Nutrition Info

PER SERVE 1590kJ, protein 42g, total fat 16g (sat. fat 4g), carbs 12g, fibre 8g, sodium 571mg • Carb exchanges 1 • GI estimate low • Gluten-free option • Lower carb

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Health & Fitness

fitness

Latest News

healthy healthylife YOUR

ARE YOU

OR

SAVE

45%

FIT?

There is evidence to support the theory that being ‘generally active’, such as going for regular easy walks walks, is good for your health. But the truth is, spending time getting fitter will enable you to get the most out of life for as long as possible (ie, it can help you live longer).

Have a think about your day. Are you: • Generally active, or • Engaging in activities that are helping you get physically fitter?

The table below can help you to understand if you are doing more general activity or activities that are getting you physically fitter.

ARE YOU?

THIS MEANS YOU ARE

Taking the stairs instead of the lift Cycling

Generally active Getting physically fitter

Lifting weights or using resistance bands Hanging out the washing Dancing Vacuuming Looking after grandkids Doing an aqua class Walking for 30 minutes Mowing the lawn Going shopping

Getting physically fitter Generally active Getting physically fitter Generally active Generally active Getting physically fitter Getting physically fitter Generally active Generally active

Q

The latest facts & global news on diabetes, from new tech to nutrition findings

S Start by getting your steps up

Why is becoming physically fitter so important?

There is significant evidence that activities which improve aerobic fitness, such as walking, cycling and swimming, help to increase our lifespan and reduce the number of early deaths in a population. This is true for both men and women.

If the thought of getting more physically fit feels a little out of reach for you at the moment, start slowly by following these tips. They might take you from being generally active to being physically fitter.

You may have heard that 10,000 Y steps a day is the target to reach for healthy physical activity activity. If this feels too much for you at this point in time, we have some good news! A recent study has found a longer life can be gained if you achieve just 4400 steps a day.

Why not go for it – and reset your goals as you improve.

Remember, every journey has to start somewhere! (Find out how you can take 10,000 steps around Adelaide, on page 127.)

To get physically fit, build up gradually

If you’re not sure about how to increase your fitness, try the th progressive walking plan below to help you get started and into the physically active zone. ■

Work up to better health one step at a time

WEEK

NUMBER OF DAYS PER WEEK

WALK OUT

WALK BACK

TOTAL TIME PER DAY

1 2

3 4

5 mins 6 mins

5 mins 6 mins

10 mins 12 mins

3 4 5 6 7 8

4 5 5 5 5 5

7.5 mins 8.5 mins 10 mins 11 mins 13 mins 15 mins

7.5 mins 8.5 mins 10 mins 11 mins 13 mins 15 mins

15 mins 17 mins 20 mins 22 mins 26 mins 30 mins

If you are concerned about increasing the intensity of your exercise due to health issues or risk of injury, ask an expert. We recommend you talk to an Accredited Exercise Physiologist (AEP).

AVO

313

MILLION

women are expected to be suffering from diabetes by the year 2040.

~ International Diabetes Federation

DIET IS KEY Researchers from Edith Cowan University found up to 80 per cent of overweight people are affected by chronic disease. Their study further found those who had non-alcoholic fatty liver disease (NAFLD) had lower cardiovascular fitness, likely caused by iron deficiency. Current treatment for NAFLD (turn to page 126 for more) is to reduce weight, primarily through exercise and a modified diet.

Researchers concluded that those who improved their diet and increased iron levels had more energy for physical activity; their studies are published in the journal Clinical Gastroenterology and Hepatology.

Hepatology

Start your day right A new study from Tel Aviv University, published in Diabetes Care, has found a starch-rich breakfast (comprising bread, fruits and sweets) early in the morning could be the key to weight loss, glucose balance and improved glycaemic control in people with type 2. Researchers found that despite the 6M-diet (three meals and three snacks per day) being the previous diet recommendation for people with type 2, those who ate more in alignment with their biological clock (only three meals) achieved greater results. The aforementioned breakfast, eaten early in the morning, is followed by a substantial lunch and a small dinner (lacking in starches, sweets and fruits). Before changing your diet, discuss the best options with your healthcare team.

1 IN EVERY 2 PEOPLE with diabetes is undiagnosed. ~ World Health Organization

diabetic living MARCH/APRIL 2020 117

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ASK DRE

W

Drew says: Right now,

Today, many children and young adults are sporting an insulin pump, which automatically measures your BGLs, transmitting details to a smartphone or portable reader. As this technology takes readings of BGLs at all hours of the day for up to two weeks without the need to take finger-pricks, researchers from England’s University of East Anglia found those with memory problems (such as dementia and Alzheimer’s) could benefit from these monitors. As the elderly, especially those with memory problems, are more prone to forgetting to check their levels, or forget what to do to bring them up/down, the research, published in the journal BMJ Open, suggests monitors should be more widely available to people of all ages.

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&A

Can exercise really improve diabetes management?

Where do I start?

MONITORS FOR THE ELDERLY

Here’s how to easily kick it up a notch and improve your health

WORDS JOANNAH BRAHAM, ACCREDITED EXERCISE PHYSIOLOGIST, DIABETES NSW & ACT. PHOTOGRAPHY GETTY IMAGES

ACTIVE?

you’re probably thinking your only option is to take more medication and inject more insulin, right? Wrong!

I always say: “Exercise is a form of medicine that we can freely and happily administer to ourselves.”

Exercise is beneficial for everyone, but is particularly effective for those living with insulin resistance or type 2. It has been shown to reverse insulin resistance, and improve insulin sensitivity and body composition (it burns fat and builds muscle).

Different types of exercise have different effects on the body. To make the most of each, try to move your body every day. Walking after meals has acute benefits (i.e stabilises BGLs). Resistance training, whether at the gym with weights or simply using your body weight at home or at a park, is a great way to open the glucose gateways, which has ongoing benefits, even hours after a workout.

Find what works for you but try a range of different types. Great options include yoga, pilates or sports such as tennis or golf. ➤ Drew Harrisberg, exercise physiologist & diabetes educator diabetic living MARCH/APRIL 2020 9

1300 668 118

and quote T8CDKZZA

EATING

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EAT, DRINK, BE MERRY – AND STILL LOSE WEIGHT Qualified nutritionist and health writer Michele Chevalley Hedge wants us to ditch the guilt and enjoy what we eat and drink – and still see results.

According to Michele Chevalley Hedge, the answer is yes.

A qualified nutritionist and health writer who is passionate about helping people achieve their health goals, Michele knows what it’s like to be overweight – in fact, she vividly recalls the time where she was 10kg overweight and had never felt more miserable in her life.

But it was the decision to overhaul her health, eat healthier and shed those extra kilos that eventually saw her get her life back on track and ultimately led her to pursue a career in nutrition.

Drawing from her own lived experiences and her many years experience in nutrition, Michele released her first book, Beating Sugar Addictions for Dummies, which was a success, followed by her second book, The Healthy Hormone Diet, which also turned out to be a hit.

But with her third and latest book, Eat, Drink & Still Shrink, Michele wanted to get down to the very problem that many Australians face – the inability

to lose weight as a result of our busy, demanding lifestyles.

In a bid to help Aussies lose those extra kilos and keep it off for good, Michele came up with a 28-day ‘reset’ eating plan which is not only practical and sustainable, but still allows them to enjoy the finer things in life.

Having seen countless patients in her clinical practice who’ve struggled to lose weight and keep it off, Michele says there are two key factors that often drive an unhealthy lifestyle – a diet that comprises mostly packaged, processed foods and food deprivation, both of which often leads to binge eating and weight gain.

In her book, she lays out the foundations of how people can adopt a healthy diet consisting of mostly wholesome, unpackaged and unprocessed foods, with the odd exception of processed snacks and indulgent treats.

“Now, I live in the real world with everyone else – I have three children, I have a silly dog, I have a hundred loads of laundry, so I’m not always eating real whole foods, but most of the time, I am,” she says.

“But when I’m not, I’m making sure that the packaged foods I’m eating don’t contain a lot of hidden sugars.

For example, a lot of our yoghurts that look super healthy are packed with added sugars and sugar can be disguised in many different names.

I’m not talking about the natural sugars in fruits, vegetables and grains, and for the most part, in moderation, these natural sugars will not upset our blood glucose and our insulin.”

Should you have to go for the more convenient option of packaged foods, Michele recommends reading the nutrition label carefully.

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“So we need to become a label reader,” she says.

“Often, it’s those healthy-looking yoghurts or muesli bars or those paleo balls where the perception is ‘Oh that’s healthy’.

“What happens is they skip the brown rice and the sweet potatoes and then they’re binging on the ‘healthy’ paleo bar or gluten-free things, which are often packed with sugar.

“So that’s the big thing playing into people’s diets. There’s still this marketing biscuit section where these terms are used and are perceived as healthy, but they’re often not.”

Michele also warns against depriving yourself of certain foods, which can lead to binge eating and weight gain.

“I’m absolutely convinced that the greatest path to wellbeing is not having an extreme approach,” she says.

“So when we deprive ourselves, there’s this yo-yo effect – and while they’re trying to stick to this 500 calorie diet of eggs and celery, they’re not learning to feed themselves.

“So they’re getting weight loss without the education, and when they come off, boom, the weight goes back on.”

Photography: Cath Muscat

Can you indulge in your favourite foods, enjoy a glass of wine here and there, and still lose weight?

EATING

well

She also believes that, when it comes to striking the right balance for good health and wellbeing, there’s more to it than just eating healthy.

after dinner aren’t running a marathon or studying, so we don’t necessarily need to have those extra energy or calories on board at night.

“Whilst nutrition will have an effect on a person’s insulin, they also need to be thinking just as much about their sleep and their stress levels,” she says.

“I always talk about the knock-on effect of eating well, sleeping well and exercising well which affects not just yourself physically, but also mentally and emotionally,” she says.

“So eat well during the day and use those carbs to fuel your brain and your energy, but then at night, move to your protein and good-quality fat, and then an abundance of veggies that aren’t starchy.”

“Because both sleep and stress will have an enormous impact on people’s insulin levels and blood glucose. In fact, for some people it is the key driver of their insulin issues in diabetes. It’s not necessarily their nutrition.”

For those who may struggle to manage their blood glucose levels, Michele says it’s important to remember that a good night’s sleep and reducing stress levels can make a world of difference.

Eat, Drink & Still Shrink by Michele Chevalley Hedge, published by Plum (RRP $34.99) is out now.

“Once people start to dip their toe into the water of healthy eating, it has an effect on their sleep, it has an effect on their mood, and it has the ability to keep their blood sugar well-balanced so that they’re actually becoming present enough to connect with people.”

When it comes to practising healthy living, Michele says sleep, exercise, practicing gratitude, finding ways to bust stress and banishing guilt are her five ‘non-negotiables’.

In Eat, Drink & Still Shrink, Michele lays out a series of micro-habits under each of her ‘non-negotiables’ which are practical and, most of all, achievable, no matter what stage you’re at in your life.

Some of her micro-habits include restructuring your bedtime, eliminating ‘blue light’ from your computer, phone or laptop after dinner for a good night’s sleep, training with weights, committing to a HIIT (high-intensity interval training) session once or twice a week, and keeping a journal to remind yourself daily of what you’re thankful for.

Having dealt with a fair share of clients with pre-diabetes or type 2 diabetes, Michele is a believer of embracing complex carbohydrates like sweet potato, brown rice and quinoa, but sticking to eating these foods during the day.

“When we’re talking about people with insulin-resistance, pre-diabetes and type 2 diabetes, I like those people to use a bit of carbs particularly at breakfast and lunch, but not necessarily at dinner,” she explains.

“Because those types of good carbs, which I call energy burners or fuel for our brain and our muscles, most of us

Members’ Giveaway

We’re giving away copies of Michele’s latest book, Eat Drink & Still Shrink, to three lucky readers.

For your chance to win, see page 41 for entry details.

33

EATING

well

CASHEW QUINOA

STIR FRY Qualified nutritionist and author, Michele Chevalley Hedge believes there’s more to protein than steaks and chicken breasts. This recipe from her latest book, Eat, Drink & Still Shrink, uses high-quality vegetarian forms of protein – cashews and quinoa – and is the kind of meal you can serve to even the most passionate of meat lovers. Coconut milk helps strengthen immunity through its antifungal, antibacterial and antiviral properties, and also boosts metabolism, reduces sugar cravings and soothes the digestive system. To protect against cancer, the recipe also uses turmeric, ginger, onion, bok choy and broccoli, which also assists with reducing inflammation.

Serves 4

Method

Preparation Time: 15 mins Cooking Time: 15 mins

1. Cook the quinoa according to the packet instructions (you’ll need 2 cups cooked quinoa for the stir fry).

2. Meanwhile, heat the coconut oil in a wok over medium heat. Add the onion and cook for 2–3 minutes or until golden.

3. Add the sweet potato to the wok and stir-fry for 4 minutes or until tender.

Stir in the turmeric, ginger, broccoli and ½ teaspoon salt. Add the coconut milk, stock or water, tamari and cashews and stir-fry for 3 minutes.

4. Add the bok choy and basil and season with pepper, then stir-fry for another 3 minutes.

5. Toss through the quinoa, season to taste with salt and pepper if needed, and serve.

Ingredients /3 cup quinoa, rinsed 1 tablespoon coconut oil 2 brown onions, thinly sliced 1 cup finely chopped sweet potato ½ teaspoon ground turmeric 2 tablespoons grated ginger 2 cups finely chopped broccoli Sea salt ½ cup coconut milk* 3 tablespoons vegetable stock or water* 1 tablespoon tamari 1 cup raw unsalted cashews 1 ½ cups roughly chopped bok choy 3 tablespoons roughly chopped basil leaves Freshly ground black pepper 2

SPICE IT UP: Chop a bird’s eye chilli and add before serving.

CHANGE UP THE CARBS: If quinoa’s not for you, try brown or basmati rice.

GO NUTS: Any kind of nut will work here – use your favourite.

SWAP THE HERBS: Try coriander or lemon thyme in place of basil.

Nutrition Info Per Serve Energy 2178.3 kJ Protein 16.5g Fat – total 29.9g; saturated 11.6g Carbohydrates 45g Sodium 765mg Fibre 8g * Dietitian’s note: In order to reduce total fat and saturated fat intake, use oat/cashew milk or evaporated milk instead of coconut milk. To reduce the sodium intake, use 3 tablespoons of water instead of vegetable stock.

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EATING

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35

EATING

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well

EATING

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CHICKEN & CAULIFLOWER BAKE

WITH CREAMY TAHINI SAUCE

In this recipe from Eat, Drink & Still Shrink, Michele Chevalley Hedge says this cleaner - but still incredibly tasty - version of the traditional cauliflower bake is a fabulous source of vitamins A, C and K. It also uses chicken thighs, which are a great source of protein, and the extra fat (compared with chicken breasts) offers more flavour and iron for energy.

Serves 4

Method

Preparation Time: 15 mins Cooking Time: 30 mins Ingredients

1. Preheat the oven to 220°C (200°C fan-forced). Line a baking tray with baking paper.

2. Combine the olive oil and ground coriander in a bowl.

3. Remove and reserve half the mixture. Add the chicken to the remaining spiced oil in the bowl and toss to coat well, then set aside to marinate.

4. Use your hands to coat the cauliflower in the reserved spiced oil. Spread it out on the prepared tray, taking care not to overcrowd it, and roast for 10 minutes.

5. Stir the cauliflower and add the chicken to the tray. Roast for another 20 minutes, stirring halfway through.

6. Meanwhile, to make the tahini sauce, place all the ingredients in a bowl and mix with a fork or stick blender until smooth and creamy.

7. Serve the roast chicken and cauliflower on a bed of rocket or spinach, topped with the tahini sauce and parsley.

3 tablespoons extra virgin olive oil* 1 ½ tablespoons ground coriander (or Moroccan spice mix) 8 chicken thigh fillets, sliced 1 head cauliflower broken into florets 4 handfuls of baby rocket or baby spinach 1 bunch flat-leaf parsley, leaves picked

Creamy Tahini Sauce ½ cup tahini* ½ cup lemon juice 1 /3 cup water Splash of extra virgin olive oil

GO VEGETARIAN: Use almonds or GMO-free firm tofu for protein, roasting just as you would the chicken, reducing the roasting time accordingly NIX THE TAHINI: Replace the tahini with a soft goat’s cheese or feta, or plain Greek-style yoghurt* NEED TO ADD MORE CARBS? Serve with quinoa or brown rice, or add a serve of legumes, such as lentils or chickpeas.

Nutrition Info Per Serve Energy 2339.5 kJ Protein 42g Fat – total 38.7g; saturated 8.2g Carbohydrates 6.9g Sodium 199.8mg Fibre 7.4g * Dietitian’s note: In order to reduce total fat and saturated fat intake, reduce tahini to 1/4 cup and olive oil to 2 tablespoons, and replace full-fat yoghurt with low-fat.

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LIVING

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Blood glucose monitoring: what you need to know before you get started If you’re living with diabetes, you may find that one of your biggest challenges is keeping your blood glucose levels in check.

Regularly checking your levels with a blood glucose monitor can help you manage your diabetes and can also determine whether you are within your target range, regardless of whether or not you use insulin.

Diabetes WA credentialled diabetes educator Nyaree Lawler says a blood glucose monitor can also help you understand the effect that food, physical activity, stress and illness has on your blood glucose levels (BGL), which in turn may influence some of your decisions on how you will manage your diabetes.

Monitoring your BGLs can also prompt you to seek support from your healthcare team, whether it means asking for advice on how to make better food choices, adjusting your insulin or medication, or changing your physical activity levels.

38

How do I know what’s right for me?

While all blood glucose monitors offer the same basic function – to produce a blood glucose reading – how do you choose one that suits your needs?

“Choosing the right monitor for you is a bit like buying a car,” Nyaree says.

“Some important things to consider are cost, warranty and the availability of the strips for the monitor under the National Diabetes Services Scheme (NDSS).

“Other more personal considerations include the size of the monitor, your dexterity and capability of getting a strip for the monitor out of its container/foil, the size of the numbers on the screen or whether it has a back light – especially if you have poor

eyesight – Bluetooth capability to a phone, availability of alarms or to mark the BGL results for future reference, such as whether it was taken before or after food.”

Monitors can be purchased from a pharmacy or online either via the Diabetes WA online shop or from the monitor company directly, with prices starting from $20 up to more than $70.

It’s also worth checking whether the cost of the monitor is covered by your private health fund or DVA card.

How often should I check my blood glucose levels?

So you’ve got your hands on a blood glucose monitor, but how often should you be checking your BGL?

LIVING

Some common times people check their blood glucose levels include:

• Before breakfast (fasting) • Two hours after a meal • Before and two hours after a meal • Before bed driving and during a driving • Before trip that is longer than two hours • Before, during and/or after exercise time you have symptoms • Any that may be due to hypoglycaemia or hyperglycaemia If your BGL is out of target at around the same time of day or situation on two or more days, Nyaree says this may indicate that changes need to be made to your medication or insulin doses.

“Usually we look for a pattern of out of target blood glucose levels before making changes to medications or insulin doses,” she says.

“Talk to your health care team about the ideal target BGL range for you, as

this will vary depending on your age, how long you have had diabetes for, what medications you are taking, and any other health conditions.”

Learn all about blood glucose monitoring Need help understanding how a blood glucose monitor can help manage your diabetes?

Whether you already have a monitor or are thinking of getting one, Diabetes WA’s MonitorSmart program provides the opportunity to learn how monitors can become a useful tool in the daily management of your diabetes.

“The session is for people who are already monitoring, or for those who aren’t monitoring yet and are looking for some more information before deciding if it might be useful for them,” Nyaree says.

“It is a wonderful opportunity to learn from other peoples’ experiences as well.”

well

Things to consider when choosing a blood glucose monitor:

cost – it’s not only worth • The considering the cost of the monitor upfront but how much it will cost in the long run.

the strips subsidised through • Are the NDSS scheme?

• How long is the warranty?

I see the numbers • Can and written information on the screen?

• How easy is it to use?

I easily get the strips out • Can of their bottle/foil?

I want to be able to access my • Doreadings on my phone?

• Do I want alarms?

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LIVING

well

My experience with

MonitorSmart

We asked Diabetes WA customer service support officer Rachel Davies, who has been living with type 2 diabetes for more than 20 years, to attend a MonitorSmart session. Here, she gives us her verdict…

My name is Rachel. I’m 39 years old and have had type 2 diabetes for more than 20 years.

I was 18 when I was first diagnosed, which came as a massive shock. Since then my dedication to managing the condition has waxed and waned. At times, I’ve been extremely strict and disciplined, and at other times, I refer to it as the “head-in-the-sand” years.

For many years, I relied solely on diet control but recently I’ve needed the help of medications and more exercise as well as watching what I eat and drink. At the moment, my doctor isn’t completely happy with my HbA1c so I’m using a few different medications and trying my best to be disciplined around diet and exercise (with varying levels of success).

I’ve been testing my blood glucose levels at home with a blood glucose monitor for the last 10 years and to be honest I have mixed feelings about doing it because while I understand that knowledge is power, I also dread the negative emotional reactions when the numbers aren’t what they should 40

be. So when I found out that there was a free two-hour workshop that focused on monitoring, I thought I’d better pop along for some help.

On the day I arrived, I met a bunch of friendly faces all with type 2 diabetes like me. The facilitator of the session was bright and positive and led us through the next few hours. We learnt about how our bodies extract energy from the things we eat and drink and the mechanisms behind how type 2 diabetes causes excess glucose to remain in our bloodstream. This was helpful to give us context for what it is we’re measuring when those numbers flash up on the little screen of our monitoring devices.

She also reminded us of the potential damage that excess glucose can do to different parts of our bodies over time which helped us to understand why our doctors care about us keeping those numbers within a certain range.

We then discussed what those ranges were and why they are different before and after we eat in the morning and how they differ from the HbA1c version that we get when our doctors send us to get a blood test.

Throughout the session, there were plenty of questions popping up from around the table and the facilitator did a good job of answering whatever came at her which l found really useful. Some questions echoed ones I’ve thought of before and others had never crossed my mind. Her answers made me realise that this isn’t a

black-and-white condition and that every one of us are in a different situation or stage of the disease and so the answers to even the simplest questions can be different for each individual.

What l found really valuable about the workshop was hearing the stories, questions and answers among those in the group. It can be really isolating to have to say no to family and friends to going out for drinks or saying no to birthday cake and celebratory foods as often as l do. But in the MonitorSmart group, l felt a connection and a shared understanding of the challenges of living with diabetes. Shared worries, shared experiences, shared questions, shared frustrations and shared laughs made the weight on my shoulders seem lighter. I left the session with a sense of relief and renewed energy and motivation to continue my battle with blood glucose levels!

Diabetes WA

MEMBERS

area

Find the following words in the puzzle.

Words are hidden Bandicoot

Magpie

Bilby

Numbat

Cockatoo

Platypus

Dingo

Possum

Emu

Quokka

Gallah

Quoll

Goanna

Tasmaniandevil

Kangaroo

Wallaby

Koala

Wombat

Kookaburra

Answers can be found at the bottom of page 43

Competition

Autumn

Qualified nutritionist Michele Chevalley Hedge draws from the latest research and her years of experience in the nutrition world to create a sustainable approach to eating for good long-term health in her third book, Eat, Drink & Still Shrink.

Not only is Michele’s four-week reset eating plan full of delicious, healthy recipes but it still allows for the odd treat – including that glass of wine at the end of a busy week.

Along with the guilt-free, no-nonsense eating plan, Michele busts some oft-heard myths about health and wellness, gives some practical tips for long-term weight loss and also dishes out her easy-to-follow micro habits for sleep, exercise and food that can be easily weaved into your regular routine, no matter how busy life can get.

Thanks to Pan Macmillan Australia, we have three copies of Eat, Drink & Still Shrink, valued at $34.99, to give away.

To enter, complete your details below and send it to: Membership – Eat Drink & Still Shrink Competition PO Box 1699, Subiaco WA 6904 or email your entry and details to membership@diabeteswa.com.au

Good luck!

Name:

Diabetes WA Membership Number:

Address: Contact number:

Email address:

Entries close 1 June 2020.

The winner of our Summer 2019/20 book competition was Jane D’Arcy-Burke from Manning, who scored a copy of Dr Megan Rossi’s book, Eat Yourself Healthy. Congratulations Jane!

41

MEMBERS

area

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Fixed Fees - affordable prices Document storage service Fast friendly Service

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8AM-8PM / 7 DAYS A WEEK TEAM@HOMEVISITWILLS.COM.AU WWW.HOMEVISITWILLS.COM.AU

42

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

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The good news is that losing weight can improve your type 2 diabetes. Our extensive experience in weight loss surgical options, including gastric sleeve and gastric bypass, can stabilise and improve your blood sugar levels. In as many as 3 out of 4 patients, their blood glucose levels return to normal with either reduced or no requirement for medications.

Dr Andrew Kiyingi Surgeon

Poorly controlled type 2 diabetes leads to slow and irreversible organ damage. Don’t wait until it’s too late.

Come in and have a discussion with one of our specialist doctors to learn more about how Obesity Surgery WA can help you. We offer real solutions with real support.

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• Free specialist support helps you manage your diabetes.

• Less time spent travelling to appointments.

Referrals into the service can be made by phoning 1300 001 880 or sending in a referral form from the Diabetes WA website.

• Uses telehealth video conferencing via computer or television screen.

• Private and confidential.

The Diabetes Telehealth service is delivered by Diabetes WA in partnership with WA Country Health Service and WA Primary Health Alliance

1300 001 880 (ask for Diabetes Telehealth) (08) 9221 1183 telehealth@diabeteswa.com.au diabeteswa.com.au