Diabetes Matters Spring 2021 by Diabetes WA

Spring 2021 $6.95

sleep

DIABETES AND

If you’ve got it, we get it

A Diabetes WA Member Magazine

From the Editor What a wet few months it has been! ralian standards) and everything Given the bad weather (by Western Aust ing tucked up indoors has seemed else that is going on in the world, stay our thoughts at Diabetes Matters have like a pretty good idea. Little wonder turned to sleep. re, getting a good night's sleep isn't As you'll see in this issue's cover featu if you're living with diabetes — and always straightforward — particularly p is a relatively new area of study and neither is the science around it. Slee difference it can make to diabetes there is some controversy about the res, we first take a look at links management. Across two special featu (one of the leading sleep disorders) between diabetes and sleep apnoea . r — and what benefits that might have and then examine how to sleep bette issue also reveals the findings of Sticking with controversial topics, this h we asked members to help us our Diabetes Remission Survey, in whic ity thinks about remission and the understand what the broader commun be a topic that generates a lot of latest evidence around it. It seems to e clarity. confusion, so I hope we can offer som magazine this issue. It's my first You might notice a few changes to the my feet! What I am keen to do is issue as editor, so bear with me as I find magazine. I want to make sure make sure that Diabetes Matters is your g your stories. we're speaking with your voice and tellin you with tips and information I also want to make sure we're providing your diabetes journey an easier one. that enhance your lifestyle and make ve season, we'll be looking at the Next issue, as we get ready for the festi you decide which of them might range of diets currently on offer to help of a head start in this issue by looking work best for you. We've made a bit to help people give the gut health diet at a new book from CSIRO designed the book towards the back of the a go. You'll find two great recipes from of five copies. mag, along with a chance to win one noticed the special tear-off flap that If you're reading this, you'll also have etes WA AGM (see pages 18-19). will allow you to vote in this year's Diab heard. Please take the time to make your voice Happy reading! Myke

Your Voice .................................................................................... 2 Our Actions .................................................................................. 2

Diabetes News Latest News ................................................................................ 3

In the Community Kellion Victory Awards ............................................................ 4

Research News International ............................................................................... 6 Local .............................................................................................. 6

From the Cover Sleeping On It ............................................................................. 7 Sleeping Well ............................................................................ 10

Remission Survey ............................................................ 12 100 Stories for 100 Years .......................................... 15 AGM and Board Election Join us at our AGM ................................................................. 18

On the Line ........................................................................... 20 Workshop Calendar Workshops Update................................................................. 22

SPRING 2021

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 Denise Brownsdon, Natalie Jetta, Teena Townsend. Photography DWA staff, Shutterstock. Design Diabetes WA – Subiaco Office Brigitte James Level 3, 322 Hay Street, Subiaco WA 6008 Print Postal Address: Vanguard Press PO Box 1699, Subiaco WA 6904 Diabetes WA Diabetes WA – Belmont Office diabeteswa.com.au 172 Campbell Street, Belmont WA 6104 Diabetes Helpline: 1300 001 880 Postal Address: PO Box 726, Belmont WA 6984 Email: info@diabeteswa.com.au

From the Chair ........................................................................... 1

Living Well Living With Less: Food .......................................................... 24

Moving Well Going the Distance .................................................................. 26

Eating Well Go With Your Gut .................................................................... 28 Gut Recipes .............................................................................. 30

Diabetic Living Recipes ...................................................................................... 32

Take A Hike Take a Hike with Denise ....................................................... 35

Aboriginal Voice Aboriginal Health ................................................................... 36

Book Nook ............................................................................ 39 Members' Area Member Benefit Partners .................................................... 40 Members’ Competition and Sudoku .................................. 41

2021-041

Editor Myke Bartlett

Contents

FROM

THE CHAIR In this Spring edition of Diabetes Matters we provide you details about our forthcoming 2021 Annual General Meeting (AGM), to be held on 28 October. You’ll find profiles of Diabetes WA Board Directors standing for election and, importantly, your proxy voting forms for those of you who are unable to attend in person. I would invite you all as Diabetes WA members to cast your vote and participate in this important process.

Read more about the AGM on page 18

With the AGM drawing near, I have been reflecting on what an incredible journey Diabetes WA has had since last year’s AGM. When the COVID pandemic began in January of last year, I don’t believe anyone could have predicted the disruption and duration of this global event. I could not have imagined that in August 2021, after 208 million reported cases and tragically 4.4 million deaths, Australia would again be in the throes of a major outbreak. As your Board Chair I feel very proud of the resilience our organisation has demonstrated – and continues to demonstrate – throughout the pandemic. I look forward to sharing more on this incredible journey at the AGM. Since March the management team have been working with the Commonwealth Department of Health and Diabetes Australia to finalise the new NDSS Agreement for the period 1 July 2021 to 30 June 2024. Under this new contract the current program and service options for people with diabetes will be reviewed, with the aim of achieving greater national consistency, so that people living with diabetes have access to the same high quality services and education programs. These reviews are expected to be finalised by the end of December 2021 with implementation of the recommendations to commence from 1 July 2022. More information will be provided as details come to hand.

CEO of Diabetes WA, Andrew Wagstaff advised the Board that he has decided to take a well-earned break when his current contract ends in November this year. Andrew has advised the Board that he feels now is the right time for a transition to new leadership, as we begin a new cycle of development at Diabetes WA. Since taking on the CEO role in 2008, Andrew has lead Diabetes WA through a great period of transition. The development and adoption of a market-led business model has seen Diabetes WA connect with new partner organisations both domestically and internationally, while his commitment to change, program innovation and expansion has seen our business development and project management capabilities recognised nationally. On behalf of the Board of Diabetes WA, its staff and its members, I would like to thank Andrew for all he has achieved over his 13 years with the organisation and wish him all the best in the future. The Board of Diabetes WA has commenced a process to recruit a new CEO. To facilitate an effective transition, Andrew will continue to work with the Board and the new CEO through to 10 November.

Mary Anne Stephens Diabetes WA Board Chair

Change is also afoot within our organisation. In August, after 13 years as

YOUR

voice

Diabetes Matters wants to make sure our member voices are heard. If you have any feedback, thoughts or stories you want to share, get in touch at media@diabeteswa.com.au

100 Stories, Your Stories

We’ve had some lovely responses to the member stories we’ve been sharing as part of our celebration of 100 years of insulin. You’ll find Clement Overhue’s inspiring tale of living with diabetes for more than 50 years – and the fascinating tale of his cousin Phyllis Adams, who was the first Australian to be injected with insulin – on page 17. We also shared a video of Clement telling his own story ahead of July’s Kellion Awards ceremony (see page 4). “What a lovely man and interesting story. Phyllis Adams’ story was so touching, imagining the very first person in Australia to receive an insulin injection and all the many thousands of us who have followed her!” Mary Jones, Facebook “Congratulations to Clement on receiving this award!” Suz Fielding, Facebook John Bertoli’s story (left) about being told he had ‘copped’ two of the worst genes for developing diabetes came as a revelation to some members. “Wow, I didn’t know that being Italian put you at high risk. I’m half [Italian] too so that explains why my GP said genetically I was always going to get it.” Leonie Radalj, Facebook

OUR

actions

Talking feet

Reconciliation Walk

Diabetes WA’s credentialed diabetes educator and registered nurse Shona Vigus (below) presented at WA Podiatry Day on 25 July, talking about everything diabetes from how diabetes develops, the associated comorbidities and the latest in treatment and medication.

As part of National Reconciliation Week, Diabetes WA joined thousands of West Australians to march from WA Museum Boola Bardip to Yagan Square for the Reconciliation Walk.

“Diabetes management is constantly shifting, there are new medications, new discoveries, new technologies and evergrowing knowledge about complications and risk factors,” Shona said. “There is also a lot of misinformation about diabetes in our community that we can absorb without realising. A professional development update can really put a health professional in the shoes of someone living with diabetes and help them understand the risks associated with such a chronic condition.”

Let’s Prevent Digital is go! To mark this year’s National Diabetes Week, the WA state government presented Diabetes WA with a Lotterywest Grant Certificate for almost $500,000 to fund our Let’s Prevent Digital pilot program – an online preventative health and wellness program.

If you would like to find out more go to diabeteswa.com.au/lets-prevent-digital 2

Diabetes WA’s General Manager of Growth and Innovation Sophie McGough said Diabetes WA is committed to working under the leadership of Aboriginal Community Controlled Health Organisations to grow our Aboriginal Health Workforce of diabetes educators and telehealth support workers to provide culturally secure care. “The statistics are overwhelming, Aboriginal people are three times more likely to have type 2 diabetes compared to other Australians and are almost seven times more likely to die from diabetes related complications than other Australians,” Sophie said.

DIABETES

news

Not so sweet

New report highlights the critical need for an Aboriginal Health Workforce

A new report from the New South Wales Bureau of Health Information found that the support provided by Aboriginal and Torres Strait Islander Health Workers and Health Practitioners directly translates into higher levels of patient satisfaction and care. On World Indigenous Day, Diabetes WA raises awareness of the critical need for an Aboriginal and Torres Strait Islander Health workforce to meet the needs of our Aboriginal people and their devastating experience with diabetes. Diabetes WA’s General Manager of Growth and Innovation, Sophie McGough, says the report demonstrates the vital need to build culturally secure diabetes care and supports DWA’s current efforts to grow its Aboriginal workforce. “We’re working under the leadership of Aboriginal Community Controlled Health Organisations (ACCHO) to grow our workforce in diabetes education to provide culturally secure care to address the devastating outcomes of diabetes in Aboriginal communities,” Sophie says. “The statistics are overwhelming, Aboriginal people are three times more likely to have type 2 diabetes compared to non-Indigenous people and are almost seven times more likely to die from diabetes related complications.” Aboriginal and Torres Strait Islander Communities currently have prevalence rates of diabetes as high as 30%. Community members develop type 2 diabetes at earlier ages, are twice as likely to have diabetes than non-Indigenous people living in remote areas, have the highest rate of kidney failure in Australia and are 38 times more likely to have lower limb amputations due to diabetes. The report shows 79% of Aboriginal women who had the support of an Aboriginal Health Worker gave “very good” ratings for their overall care (during labour and birth) and 70% of Aboriginal patients who received Aboriginal Health Worker support gave the same rating. “We know that Aboriginal women are four times more likely to develop gestational diabetes and that Aboriginal communities overall experience higher rates of diabetes and associated comorbidities,” Sophie says. “This report confirms that increasing the size of the Aboriginal health workforce across the health care system is key to meeting Aboriginal and Torres Strait Islander future health needs.” Diabetes WA is working with the ACCHO sector to train Aboriginal Health workers and practitioners in Diabetes Education and Self-Management Yarning (DESY). To learn more email natalie.jetta@diabeteswa.com.au or call 1300 001 880.

As the world’s attention turned to the Tokyo Olympics, major WA health bodies – including Diabetes WA – called for an end to junk food and sugary drink sponsorships for major sporting events. Coca-Cola was named “Worldwide Olympic Partner” of this year’s Olympic Games, leading to millions of children and families around the world being exposed to advertising pushing the company’s sugar-heavy drinks. Coca-Cola is also an official partner of the Australian Olympic team, as is the global confectionery company Cadbury. Fast food behemoth McDonalds were broadcast partner of the Olympics coverage in Australia. Cancer Council WA CEO Ashley Reid said that junk food and sugary drinks are not everyday foods, yet this type of sponsorship of elite and community sports normalises their consumption. "We know that regularly drinking sugary drinks and eating foods high in fat, sugar and salt contributes to weight gain," he said. "One-quarter of children and two-thirds of adults are above a healthy weight, and we know that this increases the risk of many chronic conditions such as type 2 diabetes, stroke, heart disease, as well as 13 types of cancer. "Healthy partnerships are possible we have seen this with the successful partnerships between Healthway and Perth Glory and the West Coast Fever." The push to decouple junk food from healthy activities follows the announcement in June that sugary drinks would be banned in Western Australian hospitals as part of measures to combat obesity. This policy is said to be among the strictest in the country, with similar bans in place in Victoria and Queensland, but concerns have been raised by people living with type 1 diabetes, who fear that a lack of quick and easy access to sweet drinks could put them at risk during a hypoglycaemic episode. 3

IN THE

community

KELLION VICTORY AWARDS: A dark and stormy start to the morning didn’t dampen spirits at this year’s Kellion Victory Awards, as Diabetes WA celebrated Australians who have lived with type 1 or type 2 diabetes for 50 years or more. The turnout was immense, with some even commuting from as far away as Dunsborough and Albany.

IN THE

community

TALES OF TRIUMPH Below: Some of the award winners Held on 15 July at the Nedlands Yacht club, the event saw Australians living with diabetes (and their carers) share moving and inspiring stories about their diabetes journey. Diabetes WA Board Chair Mary Anne Stephens, who presented the awards, said it was humbling to listen to these personal tales of resilience over the years, especially from those who lived through a time when diabetes technology, education and support was limited. Opposite page (from left): Guest Simon Millman MLA with Director of Health Networks Megan Burley, Diabetes WA Board Chair Mary Anne Stephens and Diabetes WA CEO Andrew Wagstaff.

RESEARCH

news

INTERNATIONAL FINDINGS Diabetes WA’s research and evaluation team has handpicked some of the interesting developments and outcomes from diabetes research around the world.

Breath tests for diabetes? Easier testing for diabetes might be around the corner as BMJ Journals have published a review finding that breath tests give quick and accurate results. The review aimed to investigate the accuracy of breath tests in the diagnosis of diabetes mellitus by searching through a large range of medical and scientific databases. Human studies describing diabetes breath analysis with more than 10 subjects as controls and patients were included. The review found that type 2 diabetes breath test exhibited a sensitivity of 91.8%, with isotopic carbon dioxide (CO2) being the most accurate biomarker. Further validation and standardisation in subject control, breath sampling and analysis are still required. It is worth noting that this testing is not yet available and is likely some way off. HbA1C remains the gold standard for diabetes assessment and is becoming more readily accessible.

LOCAL FINDINGS

Testosterone treatment may prevent or revert type 2 diabetes in men A study led by Professor Bu Yeap from Fiona Stanley Hospital has shown that, over and above the effect of a lifestyle program, treatment with testosterone prevents or reverses newly diagnosed type 2 diabetes in men. Published in The Lancet, the T4DM (Testosterone for the prevention of Diabetes Mellitus) study included more than 1000 men aged between 50 and 74 years old who were overweight or obese. All participants were also enrolled in the WW (Weight Watchers) lifestyle program. Half of the men were injected with long-acting testosterone every three months and the other half were injected with placebo. After two years of treatment, 87 out of 413 (21%) men in the placebo group had type 2 diabetes (based on an oral glucose tolerance test) compared with 55 out of 443 (12%) men in the testosterone group. More simply, among very high-risk men who are recently diagnosed with type 2 diabetes or have pre-diabetes, those who received the testosterone were 41% less likely to have type 2 diabetes two years later compared to those in the control group. Men in both groups lost weight (on average three to four kg) and glucose tolerance normalised in 43% and 52% of men

in the placebo and testosterone groups, respectively. The testosterone group had statistically significantly greater fat mass reduction (not overall weight loss), muscle gain, waist circumference reduction, and lower fasting blood glucose. Diabetes WA’s Research & Evaluation Coordinator Jessica Jensen says the results are very promising, even if they can’t be fully extrapolated yet. The outcome is not reflective of absolute risk, or how likely each individual is to have type 2 diabetes in two years. It is a relative risk, of a testosterone-treated and lifestyle intervention group when compared to a placebo and lifestyle control group. Despite some dramatic headlines, it has not been demonstrated that going on testosterone will make men 41% less likely to get diabetes, or that 41% of all type 2 diabetes could be avoided with testosterone. It is also worth noting that the treatment group had a lot of safety-trigger events for cardiovascular health indicators (haematocrit), indicating that, however promising testosterone is, it will not be for all men as it has known cardiovascular side effects. The authors indicate they consider it premature to treat the general male population with testosterone.

Please note: The information on the research pages 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.

SLEEP AND

diabetes

SLEEPING ON IT

By Myke Bartlett

There’s a strong link between sleep apnoea and type 2 diabetes, although experts are divided on exactly how that link works. But can improving sleep have a real benefit for people with diabetes?

We all know the difference a good night's sleep can make. When we sleep well, everything seems easier, whether it’s work, parenting or just putting up with other people. But new research suggests that the benefits of sleeping soundly extend far beyond improved mental health and wellbeing, particularly for those with chronic health conditions such as diabetes. The study of sleep is a relatively new area in science, but extensive research exists around one of the most prevalent sleep disorders – sleep apnoea. Obstructive sleep apnoea (OSA) is a disorder in which, during sleep, breathing is interrupted by a blockage of the air flow, leading the body to wake itself up. Symptoms include snoring (which is also often associated with diabetes) and excessive, unexplained sleepiness during the day. There’s also a strong link between OSA, obesity and diabetes. People with OSA are more likely to develop type 2 diabetes and more than half of people with type 2 diabetes experience OSA. Untreated, both conditions can lead to cardiovascular disease.

diabetes

Professor Danny Eckert

SLEEP AND

Professor Danny Eckert is leading research in sleep apnoea at Flinders University in Adelaide. He says that, like type 2 diabetes, sleep apnoea threatens to be a silent epidemic in Australia.

“Today’s 24 hour society puts a lot of pressure on us …”

“It’s estimated more than a million adult Australians have OSA and less than 10% are formally diagnosed,” Eckert says. “There’s a huge burden of disease out there that is untreated and, of course, that feeds into other chronic health conditions like diabetes.” Sleep disorders are on the rise across the world, as we struggle to adapt to a pace of life that our bodies simply weren’t built for. Some 17% of Australians are shift workers and many are spending increasingly long times commuting for work. “Today’s 24 hour society puts a lot of pressure on us,” Eckert says. “Humans like regular sleep patterns and shift work poses a challenge to that. So does commuting. It all cuts into sleep time. The devices we’re all so linked to emit blue light, which suppresses hormones that help us get off to sleep.” These lifestyle issues also have strong links with obesity, which is a major risk factor for OSA. Around four out of 10 Australians are estimated to have poor sleep and, as with type 2 diabetes, those from lower socio-economic backgrounds or disadvantaged communities are at the greatest risk of sleep disturbance and obesity. But obesity alone doesn’t explain the strong comorbidity between OSA

and type 2 diabetes. According to Professor Jonathan Shaw, pinning down the causal link has been far from straightforward. The assumption was that OSA had direct and broad-ranging impacts on the metabolism, Shaw says. “The two major parts of it are hypoxia (oxygen starvation) and arousal — as your body realises you’re in trouble, it wakes itself up and that rush of adrenaline is potentially harmful. It’s reasonably well established that’s one of the mechanisms by which OSA can affect blood pressure.” Given his extensive expertise and research in the area of diabetes, Shaw was keen to discover if treating OSA would have benefits for those living with diabetes. Despite promising results from other studies, the trial he oversaw failed to establish any concrete benefit. “OSA has been associated with poor blood glucose control, but when we tried improving sleep apnoea to see if it improved blood glucose control, it didn’t,” Shaw says. “Treating people's OSA didn’t make any difference to the control of their diabetes. For people who were sleepy, it made them less sleepy. For those without symptoms, it didn’t make any difference.” This doesn’t mean a causal link doesn’t exist between the two conditions. Shaw says it’s possible that the causal effect runs in the other direction, so that high blood sugars have a detrimental effect on sleep but it’s also possible that both conditions

diabetes

Professor Jonathan Shaw

SLEEP AND

have some other underlying cause — perhaps psychological, neurological, biochemical, or autonomic.

we tested that. If you don’t have symptoms, you’re not getting any benefit.”

“These conditions are all connected, but not necessarily in the causal pathway we initially thought,” Shaw says. “Diabetes is associated with anxiety and depression, which in themselves bring about sleep disturbance. If you have hyperglycaemia and you’re having to get up three times a night to go to the toilet, that disturbs your sleep. There are a range of sleep disorders that are more common in people with diabetes. But almost everything is more common in people with diabetes.”

Eckert is reluctant to rule out any benefits for people with diabetes, however, even if the causal mechanism with OSA is unproven.

While the treatment for sleep apnoea can be life changing for some, many find the continuous positive airway pressure (CPAP) device – essentially a mini ventilator – cumbersome and difficult to use, meaning any benefits must be seen to outweigh that difficulty. Shaw says a lack of conclusive evidence about those benefits for people with diabetes means people shouldn’t be rushing to get tested for OSA, particularly if they are not troubled by any debilitating symptoms. “It’s not an easy test to do, you’ve got to do some overnight trials,” Shaw says. “And then what do you do with the results? You’ve either got to lose some weight, which is the treatment we’d suggest for diabetes, or we’d be trying to suggest something like CPAP. But if you’ve got no symptoms, what are you going to get out of that? It’s not going to improve your diabetes,

“The evidence in terms of whether it affects your blood glucose control is a little mixed,” Eckert says. “The reason why that might be is that it turns out 50% of the people prescribed CPAP therapy can’t tolerate it. If you do a test in laboratory conditions and carefully monitor them wearing the CPAP for a week or so things do improve. If you can use it properly for a long period of time, it does help. In the real world, people only use it for a few hours a night or don’t use it often enough.” New, less intrusive therapies for sleep apnoea, including drug therapies, are likely to be better tolerated and increase benefits for people with OSA and diabetes. Anything that improves sleep is likely to bring some benefits. Eckert points to studies that show a definite link between poor sleep and poor blood glucose management. “If you take a healthy 20-year-old and you restrict their sleep to five hours a night for five nights in a row and you measure their blood glucose level, it’s as though they’re in a prediabetic state,” Eckert says. “That’s just five nights of sleep restrictions, but it’s a profound effect. There are also very strong links between sleep apnoea and a lack of glucose control. Getting a good night’s sleep will help.”

Getting

a good night’s sleep Adults between 18 and 75 need between 7 and 9 hours sleep. Over 65 need 7 to 8 hours. the use of • Limit screens and devices before bed

sure your • Make bedroom is cool, quiet and dark

alcohol, caffeine, • Avoid cheese, chocolate, and spicy or fatty foods before bed

sleep

SLEEPING WELL

By Myke Bartlett

Getting a good night’s sleep is harder than ever in a world that never stops moving, but there are ways to ensure your body is getting the rest it needs. We take a look at some expert tips and tech to help you make the most of your time in bed. Humans need sleep. As a species we’ve evolved to effectively shut down overnight, going to bed when it’s dark and waking with the light. Our modern world has made things more complex, surrounding us with electric light and stimulants, obliging us to work unnatural hours and generally disrupting sleep patterns humans developed over millions of years.

As sleep expert Danny Eckert points out in the previous article, we know that poor sleep can have a powerful and negative impact on blood glucose management. Just five nights of restricted sleep was enough to induce a state of prediabetes in 20-year-olds without any preexisting conditions. We also know that diabetes is associated with sleep apnoea, which is a major cause of sleep disturbance. So what does the science say about getting a good night’s rest?

Why do we need sleep? According to Professor Jonathan Shaw, the answer might simply be “because we get tired”. But it’s likely the answer isn’t as straightforward as it might appear. Sleep is a relatively new area of scientific study, full of unknowns. Danny Eckert says that the latest data suggests sleep is effectively a garbage truck that cleans out all the rubbish that our brain and body has gathered during the day. If we don’t get enough sleep, we don’t get rid of that rubbish, with potentially adverse effects on every cell and organ. We also know that sleep plays an important part in memory and learning and can help stave off mental health issues.

How much sleep should I be getting? It depends how old you are, but eight hours is a pretty good rule of thumb if you’re older than 18.

What doesn’t work? Alcohol and sleeping pills are less effective than developing good sleep habits. Sleep calculator apps (part of an increasing trend for health management apps) may also not help. 10

Should I get tested for sleep apnoea? If you have diabetes, are known to snore and often feel sleepy during the day, it would be worth talking to your GP. Testing can be complicated, involving sleep studies that hook you up to equipment that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels.

What is the treatment for sleep apnoea? There is a notable overlap between the treatment of sleep apnoea and recommendations for diabetes management. Patients are encouraged to make lifestyle changes such as losing weight if overweight and exercising regularly. In addition, people should avoid sleeping on their back and use a nasal decongestant. More severe sleep apnoea may require using oral devices or a CPAP machine, which maintains a constant air pressure while sleeping, helping patients to keep their throat open. Danny Eckert believes lessintrusive therapies will be available in the future.

How do we get better sleep? One of the most important findings from recent studies is to avoid blue light at bedtime – blue light being the spectrum of light emitted by smartphones. Keeping your phone out of the bedroom entirely is recommended by several sleep experts. Sites such as the Sleep Health Foundation and the federal government’s Health Direct website also offer scientifically-tested tips. Here is a selection to get you started.

1. Have a warm bath Bathing in hot water 1-2 hours before bedtime can help you fall asleep more quickly and improve sleep quality (just make sure you get out of the bath first).

2. Avoid caffeine Some studies suggest avoiding any caffeinated drinks (including soft drinks) for three to seven hours before bed, while others recommend no caffeine after lunch time. It’s worth experimenting to see what works best for you.

3. Management of blood glucose Hyperglycaemia can disrupt sleep by overworking your kidneys, causing you to urinate more often. It may also cause headaches, increased thirst, and tiredness that can interfere with falling asleep. Hypoglycaemia may trigger nightmares, sweats or irritation and confusion when you wake.

4. Exercise more (teenagers, in particular) Teenagers fall asleep 18 minutes earlier than usual for every extra hour of moderate-to-vigorous daytime physical activity. They also sleep 10 minutes longer, according to a study in journal Scientific Reports.

sleep

6. Stay out of bed According to the Sleep Health Foundation, it's important to train your brain to link your bed with sleep and intimacy only. Avoid using your bedroom for other activities such as study, watching TV or staring at your phone.

7. Seek natural bright light in the morning Going outside or near a window after sunrise will help your body clock switch off production of the 'sleepy' hormone, melatonin. This will help reset your clock, so when it becomes darker at night, melatonin production will resume – making you feel tired.

5. Get out of bed after 20 minutes If you can't fall asleep within 20 to 30 minutes of going to bed, you should go to another dimly-lit room and sit quietly. Try not to use a screen, eat, drink or do household chores, and go back to bed when you feel sleepy. This helps your mind link your bed with sleep. 11

SPECIAL

report

DIABETES REMISSION SURVEY Most people with type 2 diabetes are optimistic about diabetes remission but confusion is widespread, according to a new survey conducted by Diabetes WA. Diabetes remission is a controversial subject. While some researchers and leading international societies (such as the Association of British Clinical Diabetologists and Diabetes UK) have recognised the possibility of diabetes remission, there has been little in the way of formal endorsement or guidelines in Australia. Some diabetes organisations have expressed concern that discussions around remission might actually distress people living with diabetes. A new survey sent out by Diabetes WA to West Australians with type 2 diabetes shows little evidence for distress. Although 25% of respondents to the survey were stressed about the concept of unavoidable progression and 17% expressed a sense of hopelessness, most respondents said reading about remission – and the current statement about remission on the Diabetes WA website – left them feeling hopeful, relaxed, and motivated. The survey was designed to establish what the diabetes community knows and thinks about diabetes remission, whether they think it is possible or worth striving for and whether they have discussed it with their health professionals. More than 2000 people completed the survey, which has given Diabetes WA a much clearer picture of how remission is understood – and how we can shape the narrative around it.

What is diabetes remission? The most common definition for diabetes remission is the achievement of blood glucose levels below the diabetes range for at least six months without surgical therapy and without taking any pharmacologic therapy (such as insulin) for at least two months. In other words, it is bringing blood glucose down through lifestyle changes alone. It is also important to note that remission is not the same thing as a permanent cure but rather an indefinite break from symptoms. This distinction seems not to be widely understood. Only 6.3% of respondents to the survey correctly identified the definition for diabetes remission. Nearly half thought that diabetes remission was achieved when any improvements were seen in blood glucose levels and another quarter thought it was achieved when there was a reduction in or cessation of one of their diabetes medications. Another 22% believed remission was a myth to give people with diabetes false hope. 12

Current research has established that diabetes remission has been achieved in some people, most notably in those recently diagnosed with type 2 diabetes. However, due to varying definitions of diabetes remission, uncertainty around whether it can be maintained long term and a lack of evidence about cardiovascular risk outcomes, this research has been welcomed with extreme caution.

Who can achieve remission? Not everyone can achieve diabetes remission. Achieving it seems to be dependent on factors such as the time living with diabetes, weight, hormones and diet. One research study has shown that diabetes remission can be achieved in about

SPECIAL

report

SHOWS MASS CONFUSION 50% of people living with type 2 diabetes for less than six years if they rapidly lose about 10 to 15kg of weight. Another study suggests that the definition of remission needs to account for a broader range of symptoms than blood glucose levels. Remission should involve an absence of diabetes complications (e.g., cardiovascular disease). This study found, by using the current definition of blood glucose levels alone, 39% of their cohort could be said to have achieved diabetes remission but, of these, two thirds had cardiovascular disease and a quarter had developed a new vascular disease while being in remission. Accounting for these complications could bring down the number of people who are likely to achieve diabetes remission from about 50% to about 5%. Given these conflicting studies, it is unsurprising that respondents to the survey were unclear about

who could achieve remission and how. Two thirds of those surveyed wrongly believed that anyone could achieve diabetes remission and a majority incorrectly believed that losing weight would guarantee them achieving remission. Understanding these misconceptions will help Diabetes WA work to communicate more accurate information to our members and the broader community. The most positive findings from the survey are that people are discussing trying for remission with their health providers, even if they know success isn’t guaranteed. Some 76% of respondents said they wanted to achieve remission as part of their diabetes management, even though they acknowledged the chance of doing so was likely to be less than 50%. Around 72% of respondents said they have already started a conversation with their health care professionals about achieving remission, reporting that the majority of these professionals had told them that remission was possible. However, this can be a source of further confusion as there are currently no health professional guidelines and there is no consensus around diabetes remission. Given 30% of health professionals told respondents that remission wasn’t possible, patients may be given different and contradictory advice depending on which health professional they visit.

Recommendations Based on the survey findings, Diabetes WA has made several recommendations to researchers, health care providers and to people living with type 2 diabetes. Firstly, diabetes remission needs to be clearly and consistently defined, based on the latest evidence. Distinctions need to be drawn between remission and improvements in diabetes management and it needs to be made clear that not everyone can achieve remission. Further study should be done into what health care professionals understand about diabetes remission and how they communicate this information to their patients. Finally, given the widespread motivation among people living with type 2 diabetes to try for remission, diabetes organisations should be providing guidelines and information to help people make decisions based on evidence, not misinformation. It’s important that diabetes remission is seen as a new area of study, where the information may be changing. Thank you to all our members who took part in this important survey – we will keep you up-to-date with the latest developments! 13

THIS PRODUCT MAY NOT BE RIGHT FOR YOU. READ THE WARNINGS BEFORE PURCHASE AND FOLLOW THE INSTRUCTIONS. Find out more at FreeStyleLibre.com.au

With optional glucose alarms and no finger pricks†

NEXT GENERATION CGM WHY PRICK, WHEN YOU CAN SCAN‡?

OPTIONAL ALARMS

FreeStyle Libre 2: Up to 14 days of continuous glucose monitoring with optional alarms and no finger pricks†

Set up optional, real-time glucose alarms1 that notify you if you go too low or too high. Alarms are customizable, easy to turn on/off and adjust sound and vibration IMPROVED ACCURACY Provides unsurpassed 14-day accuracy2 even when you’re in the low glucose range SIMPLE AND EASY TO USE Painless3 to apply and the sensor can be worn on the back of the upper arm for up to 14 days DISCREET & CONVENIENT Check your glucose reading, trend arrow and 8 hour history with a simple 1-second scan, even through clothing NO FINGER PRICKS† No finger pricks† for calibration and treatment decisions

FreeStyleLibre.com.au FLASH GLUCOSE MONITORING SYSTEM

FreeStyle Libre 2 is now fully subsidised for eligible Australians living with Type 1 diabetes. For criteria go to SubsidyChecker.com.au This product is indicated for measuring interstitial fluid glucose levels in people (age 4 and older) with insulin-requiring diabetes. †

Finger pricks are required if your glucose readings and alarms do not match symptoms or expectations.

‡ Scanning the sensor does not require lancets. * Data based on the number of users worldwide for FreeStyle Libre family of personal CGMs compared to the number of users for other leading personal CGM brands and based on CGM sales dollars compared to other leading personal CGM brands.

POLY 14671

1. Notifications will only be received when alarms are turned on and the sensor is within 20 feet of the reading device. An urgent low glucose alarm is available with the FreeStyle Libre 2 app. 2. FreeStyle Libre 2 User’s Manual. 3. Data on file, Abbott Diabetes Care. In a study conducted by Abbott Diabetes Care, most users agreed that getting glucose readings from the sensor was less painful than getting glucose readings from finger pricks. FreeStyle, Libre, and related brand marks are marks of Abbott. Information contained herein is for distribution outside of the USA only. Abbott Australasia Pty. Ltd., Abbott Diabetes Care, 666 Doncaster Road, Doncaster, Victoria 3108, Australia. ABN 95 000 180 389 ADC-42657 v2.0

100 STORIES

100 years

OUT OF THE BLUE

ELIZABETH DUNCAN had never thought about diabetes. But a shock diagnosis gave her the motivation she needed to turn her health around.

There was no history of diabetes in my family. It wasn’t on my radar at all. I’d been having symptoms for a few years, but I didn’t do anything about it. I’d been drinking so much water because I was thirsty all the time and my feet were swelling up. I actually thought I had gout, because I’d had a bad bout of that a few years before. But I had pins and needles, blurry vision, all that, but I never thought it might be diabetes. I knew a mate of mine had it, but it didn’t even cross my mind. I just thought it was getting older. So, I went in to see the doctor thinking that it was gout, but I didn't go back for the results. Instead, he rang me the next day. I was actually in the shower when he called, so my husband had to hold the phone out to me. I heard him say it wasn’t gout and thought “Oh, beauty!” Then he told me it was diabetes and I didn’t know what to think. I didn’t really understand. But I went back to see the doctor and the dietitian and it started to make sense. Because I didn’t have any family history, I knew what had caused the diabetes. I was a sugar addict. Lollies, chocolate. I loved all that. I wasn’t too bad with soft drinks, unless I was having scotch in them. But I had one last big yeehah – I ate pizza, I drank beer, I had everything I knew I wasn’t supposed to and then I went cold turkey. I knew I had to go cold turkey because I know what I’m like. If I open a packet of chips, they'll be gone in a flash. I haven’t had even one chip all year, because I just know I wouldn't be able to stop. I've been too scared to eat any chocolate in case I can't stop. It was really, really hard. I’m lucky that my husband doesn’t have much of a sweet tooth, so he was able to support me. But I knew what I had to do. I knew I had to listen and do what my doctor and dietitian said, because they told me I was heading for a stroke or a heart attack. I still go out for dinner with friends. I just tend to stick to a little bit of meat, things like pork belly bites without the

sauce. I still have my social life and I still have my champagne!

I went to one of the DESMOND sessions run by Diabetes WA, which was really good. By that point, I had already learned a bit about carb counting from a book my nutritionist recommended. But it was great to learn more about exactly how sugar affects the body. And I liked meeting other people who were going through the same thing. Our facilitator had type 1 diabetes, so she was talking from experience. It was good to hear from people who had been there. I could feel the difference changing my diet made very quickly. Within three months, my symptoms had disappeared. My HbA1c dropped from 9% to 5.5%. The biggest shock was my liver function, which was very high at 123, but I got that down to 58. And I was feeling better. When I went out dancing on the weekend, I noticed I could dance for longer and I wouldn’t get out of breath. I went for my one year check up recently and the doctor actually said he's never seen anyone turn it around so fast. I’m more or less in remission. He said he's never seen anyone lose the weight so quickly just by making those dietary changes, with no surgery or anything like that. I’m lowering my meds over the next three months and then we’ll lower them again. I’m definitely proud of myself. But I'm a little bit scared about what will happen when I’m totally off the medication. What if I did have a slip up and had a piece of garlic bread? I’ve probably only had two pieces in the whole of last year, but can I never have it? Can I treat myself with anything? I'll have to be stricter. I’ll talk to my dietitian and see what she says. But I know what’s at risk. If I had ignored that foot and walked out of the doctor’s surgery, again? My husband would be rich because I'm insured! But I don’t want that. I go around now warning people. I tell off friends who have had symptoms but don’t get themselves checked out. I tell them – you don't have to be a massively overweight person to get diabetes. Have you got eye problems? Pins and needles? Do not ignore them. Get yourself checked out.

100 STORIES

100 years

A SECOND CHANCE When his diabetes journey reached a crisis point,

STEPHEN ANDREWS underwent bariatric surgery to improve his management. I’ve had diabetes for about 12 years now. Back around 2009, I started getting headaches, sweatiness, blurred vision, wasn't sleeping. I knew something was definitely up. When I sat down at the computer the words would sort of blur, but I thought maybe it was just my eyes. But when I did a sugar test, it was clear I was having a problem. The first step was to watch my diet and improve my exercise. And that worked for a little while. Eventually, it just wasn't getting the sugar numbers down, so they put me on to Metformin. I tried that for a while, still doing the exercise and watching what was eating. My wife started buying diabetic magazines, recipes and cookbooks, and my whole family went fat free, eating healthy. Everybody gained something from it. And that seemed to work for the next five or six years.

Around about 2019, my blood sugar levels started to creep way up into the high teens. I could get it down slightly by going out and walking the dogs for an hour and a half, but it would just creep back up again. That was when I started having foot trouble. I had a crack in the skin, so I went to see the podiatrist who helped me take care of it for while. But just before I decided to have an operation for weight loss, I must have stepped on something. I ended up with an infection in my toe than turned into an abscess. It was about five millimetres deep, which might not sound like a lot, but when it’s your toe, it is. For about 12 or 14 months, I had to go see the doctor every two weeks so he could clean the wound and cut back the dead skin so it could start healing. It was clear my diabetes wasn’t improving. If I hadn’t had my toe looked at, it might not just have been my toe, it might have been my foot or my leg. The biggest challenge for me was accepting the fact that I wasn’t winning the journey I was on with my diabetes. I was at a crossroads. Do I continue injecting myself twice a day and taking

the blood pressure pills – or do I get this operation? I started off at 118.6 kilos. With diet and exercise, I got that down to 103 kilos, but it still wasn’t enough to fix it. Within a month of having the operation, I got down to 80 kilos. Now, I jump out of bed every morning. I’m up at four o’clock and eager to get going. I don’t feel tired anymore. These days, I know I have to eat healthy, but there’s so much good food out there. I stay away from all the sweet stuff. All the cakes. Getting the portion size right took a little while. Now, instead of using a dinner plate, I use a side plate. Just a little bread and butter sized plate. That works for me. And I have an exercise routine where I always take the dogs out for a proper, good march or I use the gym at work. I used to think I was a superman, that I could do anything and eat anything. I feel like having this operation has saved me. It’s given me a second chance at life. This article has been adapted from a longer interview available on our website.

100 STORIES

100 years

FAMILY HISTORY CLEMENT OVERHUE was awarded the 50 years Kellion Victory Medal at this year’s ceremony. He tells us about his journey – and his family link to insulin’s earliest use in Australia.

My cousin was the first person in Australia to be injected with insulin, back in 1922. Her name was Phyllis Adams. She was only five years old and she was nearly dead. They had been trying to control her diabetes with diet but she was pretty much on the way out when my Uncle Harry found out that Frederick Banting and Charles Best had discovered insulin. Harry had been corresponding with them in Canada and they urged the family to keep Phyllis alive until the insulin arrived by ship from Vancouver. They kept her alive with a teaspoon of peanut butter, a lettuce leaf and a glass of junket a day for eight months, she was just skin and bones. It reached her just in time. Harry met the ship in the middle of Sydney Harbour, collected the insulin and rushed it back to Phyllis where she was waiting at the pier. They still thought she wouldn’t live too long, but she grew up to have three kids and lived to 81. She married a doctor called Studley Lush who was fabulous. I was diagnosed with diabetes myself when I was 39, when I was actually learning to fly. I had to have a medical beforehand and it showed up. That was the end of my flying career. I’ve spent most of my life as a farmer in Corrigin, Western Australia. I haven't really struggled living with diabetes. The only trouble I had I suppose probably started when I was in high school and if I had to go for training for sport or anything like that, I used to have to go and have something to eat first because otherwise I’d get crook. That was probably my diabetes showing up early.

Not being able to fly anymore disappointed me. But other than that, I played footy from 1947 through to 1959 and then I took up golf and then I retired. I developed a couple of properties, not just in Corrigin but in Esperance and Manjimup. I haven’t really had any health issues. I lost a bit of weight when I first got diagnosed in 1969. But I was OK once I got on the insulin. I had three kids and none of them have diabetes, although my grandson does. He got it when he was about 12, but he’s still going strong. I don't think that people should think that they’ve got a very bad illness when they’ve got diabetes. I can’t see why you can’t lead a normal life. There’s quite a few league footballers these days who have diabetes and still get on with their lives. Diabetes never restricted me in my life really, except that I couldn’t fly aeroplanes. But there’s nothing stopping you having a really fruitful life. This has been adapted from an interview Clement gave Diabetes WA.

GUINNESS BOOK OF RECORDS PHYLLIS ADAMS lived with diabetes for 76 years, a feat which made the Guinness Book of Records. She was awarded two Kellion Victory Medals for living with diabetes for 50 and 60 years. There was no medal for someone who had lived with the disease for more than 70 years, so for her 75th birthday she was honoured with a special function. 17

NOTICE OF 2021 DIABETES WA l Meeting Notice is given that an Annual Genera (Diabetes of the members of Diabetes WA Ltd WA) will be held

Details Regarding Member Resolutions

These explanatory notes have been prepared to provide members with sufficient information to assess the merits of the resolutions contained in the accompanying Notice of Annual General Meeting of Diabetes WA Ltd.

Thursday 28 October 2021 5.30pm (AWST) Time: anic Room), Venue: The Boulevard Centre (Oce eat Flor rd, 99 The Bouleva

Election of Directors

Agenda:

Avril Fahey joined the Diabetes WA Board in 2021. She is an experienced leader and manager in the aged, community and hospital sector, having initially started her career as an Occupational Therapist. Avril has held senior roles at Silver Chain and St John of God Midland Public & Private Hospital, dedicating the majority of her career to working with older and vulnerable client populations. Along with the Diabetes WA board, Avril is also a Director on the Western Australian Cricket Association Board and a member of the School of Business and Law Advisory Board at Edith Cowan University.

Date:

1. Attendance & Apologies Meeting Minutes 2. Confirmation of Previous General Reports 3. Financial Statements & Director’s report, the To receive and consider the financial rt for the directors' report and the auditors' repo financial year ended 30 June 2021.

4. Election of Directors

the following To consider and, if thought fit, pass nary resolutions: ordinary resolutions as separate ordi of Diabetes WA (a) To elect Avril Fahey as a director ctor of Diabetes WA (b) To elect Andrew Smith as a dire ctor of (c) To elect Dr. Barbara King as a dire Diabetes WA of Diabetes WA (d) To elect Chad Stewart as a director a director of (e) To elect Steven Goldsworthy as Diabetes WA

5. Re-election of Directors

the following To consider and if thought fit, pass nary resolutions: ordi ordinary resolutions as separate as a director of (a) to re-elect Mary Anne Stephens Diabetes WA director of (b) to re-elect Dr. Fiona Lander as a Diabetes WA

6. Other Business 001 880, or email To register your attendance, call 1300 26 October 2021. AGM@diabeteswa.com.au by Tuesday

By order of the Board:

Nigel Miller Company Secretary 20 August 2021 Diabetes WA Ltd ACN 610 729 612

Each of the directors standing for re-election will retire at the Annual General Meeting and stands for re-election in accordance with Diabetes WA's constitution.

Avril Fahey

In parallel to her professional life, Avril also played cricket for the Australian Women’s Cricket team including a successful World Cup campaign in India in 1997. Avril continues to be involved in high performance sport, working with Cricket Australia as a National Selector. Living with type 1 diabetes, Avril brings this perspective to her role on the Diabetes WA board. The Board (other than Avril Fahey) recommends members vote in favour of the resolution to elect Avril Fahey. Avril Fahey does not make a recommendation due to her personal interest in this resolution.

Andrew Smith

MACS (Snr) CP Andrew joined the Diabetes WA Board in 2021 and brings with him more than 25 years’ experience in the IT and communications sector. He is currently the Head of Information and Communication Technology at Western Power and is also a senior member of the Australia Computer Society. His career includes technology, business transformation, strategic planning, commercial and program delivery leadership roles in financial services, resources, telecommunications, government and utilities sectors in the UK and Australia. The Board (other than Andrew Smith) recommends members vote in favour of the resolution to elect Andrew Smith. Andrew Smith does not make a recommendation due to his personal interest in this resolution.

ANNUAL GENERAL MEETING Dr Barbara King

MBBS, FRACP (PEM), AFRACMA, AFACHSM, CHM, AAICD Dr Barbara King joined the Diabetes WA Board in 2021. She has over 30 years’ medical experience in the public health sector. Currently a Deputy Director of Clinical Services at Fiona Stanley Hospital, she has extensive tertiary clinical experience as a Paediatric Emergency Physician, more recently moving into medical leadership and management as a Medical Director at Princess Margaret / Perth Children’s Hospitals and Albany Health Campus. Barbara is an Associate Fellow of the Royal Australasian College of Medical Administrators and is completing a Fellowship of the Australasian College of Health Service Management. Her passion is supporting and building high performing, thriving clinical teams to provide the best possible patient outcomes. The Board (other than Dr Barbara King) recommends members vote in favour of the resolution to elect Dr Barbara King. Dr Barbara King does not make a recommendation due to her personal interest in this resolution.

Chad Stewart Joining the Diabetes WA Board in 2021, Chad Stewart brings a wealth of experience in business development, strategic planning and project management in the healthcare and Aboriginal community sectors. Chad has previously worked for St John of God Health Care, the Aboriginal Health Council of Western Australia and Derbarl Yerrigan Health Service as Acting CEO. Chad is currently a Non-Executive Director with Ngala and is a member of the South West Aboriginal Land and Sea Council and Wungening Aboriginal Corporation. The Board (other than Chad Stewart) recommends members vote in favour of the resolution to elect Chad Stewart. Chad Stewart does not make a recommendation due to his personal interest in this resolution.

Steve Goldsworthy

BComm, CA, GAICD New to the Diabetes WA board in 2021, Steve Goldsworthy is the Group Chief Financial Officer of St John of God Healthcare as well as being a director for all St John of God Health Care Subsidiaries. St John of God Health Care is one of

the leading Healthcare providers in Australia with $2 billion in annual revenue and 15,000 employees. Steve also is a Non-Executive Director of private companies in childcare, property and hospitality. During his 20-year executive career he has had Executive Finance roles in Austal Ltd, Cliffs Natural Resources and Schlumberger both in Australia and Canada. He is also a member of the Institute of Chartered Accountants and Australian Institute of Company Director. The Board (other than Steve Goldsworthy) recommends members vote in favour of the resolution to elect Steve Goldsworthy. Steve Goldsworthy does not make a recommendation due to his personal interest in this resolution.

Re-election of Directors Mary Anne Stephens

MAcc, FCPA, GAICD, Chairperson Mary Anne Stephens joined the Board of Diabetes WA in 2015 and was appointed Chair in 2020. She has more than 25 years’ senior leadership experience in the financial services, IT, aged care and not-for-profit sectors. Mary Anne is a Board Member of the WA Country Health Service, a Board Member of Venues West, and Deputy Chair of Council on the Ageing (WA). She holds a Master of Accounting degree, is a Fellow of CPA Australia and a Graduate of the Australian Institute of Company Directors. Mary Anne brings extensive experience in finance, risk management, information technology and corporate governance. The Board (other than Mary Anne Stephens) recommends members vote in favour of the resolution to re-elect Mary Anne Stephens. Mary Anne Stephens does not make a recommendation due to her personal interest in this resolution.

Dr Fiona Lander

MBH, MBBS/LLB (Hons) Fiona joined the Diabetes WA Board in 2019. She is a Doctor of Medicine and a lawyer, currently working with McKinsey & Company (Australia) as a strategic consultant in healthcare, including advisory work concerning Federal Government healthcare, digital and innovation strategy, aged care business unit strategy. Fiona also has experience in global health policy, international human rights law and emergency medicine. The Board (other than Fiona Lander) recommends members vote in favour of the resolution to re-elect Fiona Lander. Fiona Lander does not make a recommendation due to her personal interest in this resolution.

If you can’t attend the AGM in person, please fill out the Proxy Voting Form you'll find inside the front cover. 19

ON THE

line

ON THE LINE

The Diabetes WA Helpline and Telehealth Service provides free comprehensive access to personalised diabetes management advice and support from a Credentialed Diabetes Educator. Meet our educators as they share some of the common concerns they hear from our members.

PRISCILLA LEE

Dietitian Priscilla grew up in Hong Kong and moved to Perth for university to study her growing passion in nutrition. She joined Diabetes WA in 2019 to provide diabetes education to clients via the Telehealth Service, our Helpline and group education workshops. Priscilla speaks English, Mandarin and Cantonese. Her areas of speciality include diabetes, weight management, bariatric surgery, nutrition, cardiovascular disease and IBS. “Now, my GP told me that I’ve got diabetes. What food can I eat? Give me a list please!” This is one of the most common questions asked by my clients with diabetes.  Then, my clients may mention, “I heard from other people, and they say that having bananas is not good for people with diabetes, is it true?”.  Feeling frustration is a normal emotional response when people are told they’ve got diabetes. Some people may feel nervous to see a diabetes dietitian because they think that their favourite foods will be made off-limits. There is a deep misconception that dietitians act as the food police, instructing people to "eat this, not that". The truth is that diabetes educators or dietitians do not ask people to totally cut out their favourite foods or carbohydrates from their diet. There are three reasons for this: 1. Carbohydrates break down into glucose in our digestive system and glucose is our primary source of energy. It affects our blood glucose levels but the levels vary depending on the amount and type of carbohydrates. 2. Food with carbohydrates provide dietary fibre, vitamins and minerals which are important to our health. 3. Carbohydrates are found in a range of foods and drinks, meaning some essential nutrients would be lacking if we completely cut out carbohydrates from our diet. (As you'll see on page 28, being more aware of the sorts and quantities of carbs we're consuming also assists gut health.) As a diabetes dietitian, my motto is “eat healthily but enjoy the good stuff too”. Generally, diabetes educators or dietitians suggest people choose lower GI foods in their diet because these foods cause blood glucose to rise more slowly. Instead of asking for a list of foods TO HAVE and TO AVOID, it is better to focus on F.A.T.:

F How often we are having the food? (frequency) A How much of it do we have? (amount) T What type of foods do we have in our diet? (type)

The best way to find out how foods impact on blood glucose levels is to keep a food record for 3-5 days and start self-blood glucose monitoring (doing finger prick checks) at certain times, for example fasting or before meals and two hours after the start of a meal. Working with a diabetes educator or dietitian to develop a personalised plan is important as individuals can have different reactions to the amount and type of food and different target ranges of blood glucose levels. We all have different energy and nutrient requirements based on factors such as age, sex, medical conditions and activity levels. With a personalised plan, people can learn and adapt it to their lifestyle for successful diabetes management.

ON THE

line

CATE MITCHELL

Cate is a registered nurse, midwife and diabetes educator, with experience in paediatrics, adolescents, remote community nursing and Aboriginal and school health including health care planning, diabetes education and selfmanagement group education. She is passionate about making a difference and supporting people to manage their diabetes in a way that recognises their uniqueness and diversity. Her favourite things in life are family, her dog (probably the dog first), glamping – because who goes camping without a coffee machine? – and long walks (with the dog, of course!) One of the most common queries I deal with comes from clients living with gestational diabetes. “I have cut out carbs in my diet and my blood glucose levels (BGLs) in the morning are higher than my target of <5.1mmol/L. what can I do?” Fasting BGLs are not usually related to carbohydrate intake but instead come from glucose being released into the bloodstream from stores in the liver. The liver releases glucose into the blood to be used by the body as fuel, during any fasting state (like sleep), so cutting out carbohydrates the day before will not have any impact on BGLs taken in the morning. A fasting blood glucose reading is taken to see what impact the hormones from the placenta are having on blood glucose levels during the fasting state. The reading is to check if the body’s cells are resistant to insulin or a result of blood glucose levels dropping in the night, which causes your liver to release glucose into the bloodstream. It’s important to take this reading to keep the blood glucose levels within the optimum range for you. Your health care professional or diabetes educator will suggest checking your blood glucose levels at 2 or 3am to see if the high blood glucose levels (>5.1mmol/L) are a result of going low (<4mmol/L) overnight and may suggest a supper before bed with a low GI carbohydrate, making sure you are only fasting for around 8-10 hours.

The Diabetes WA Helpline is available Mon-Fri 8.30am-4.30pm for all people in WA. The Diabetes Telehealth Service is for country WA only.

Call 1300 001 880

Diabetes WA Webinars If you’re still isolating from home, Diabetes WA’s series of online educational webinars offers a convenient way to hear about a variety of hot topics on diabetes from our Credentialled Diabetes Educators from the comfort of your living room. Free for Western Australians who are registered on the NDSS, the webinars are held via Zoom, with new sessions added regularly. To book into a webinar, head to diabeteswa.com.au/ eventscalendar.

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 – understand how to read food labels and learn how to make the best food choices for your health. FootSmart – this session will teach you all you need to know about checking and caring for your feet. MonitorSmart – learn how to effectively monitor you blood glucose levels. CarbSmart – learn how you can choose the type and amount of carbs that are healthier for you. MedSmart – understand how your medications can help you manage your diabetes. Living with Insulin – learn all about insulin and the importance of looking after your blood glucose levels. Ready Set Go, Let’s Move – this session gives you the facts on diabetes and exercise and provides tips on how to start exercising and stay motivated. Insulin Pump Workshop – this practical session will show you how to get the most benefit out of your insulin pump and its features. Type 1 Tactics For Exercise – Learn how the body responds to different types of activity and how to effectively adjust insulin, carbohydrates, and exercise to manage blood glucose levels.

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

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. 22

Workshop Perth Metro Armadale Armadale Bayswater Bentley Cannington Cannington Cannington Cockburn Cockburn Cockburn Cockburn Floreat Floreat Floreat Floreat Fremantle Fremantle Fremantle Heathridge Heathridge Mandurah Mandurah Mandurah Mandurah Mandurah Melville Melville Midland Midland Midland Midland Midland Mindarie Mirrabooka North Beach North Beach North Beach North Beach North Beach Riverton Rivervale Rockingham Rockingham Scarborough Secret Harbour Subiaco Subiaco Subiaco Subiaco Subiaco Subiaco

FootSmart DESMOND DESMOND DESMOND CarbSmart MedSmart DESMOND CarbSmart MonitorSmart DESMOND DESMOND DESMOND DESMOND CarbSmart FootSmart ShopSmart Ready-Set-Go Let's Move DESMOND FootSmart CarbSmart DESMOND Connect with Diabetes MonitorSmart ShopSmart DESMOND DESMOND DESMOND DESMOND FootSmart MonitorSmart ShopSmart DESMOND DESMOND DESMOND MedSmart ShopSmart FootSmart CarbSmart Living With Insulin Connect with Diabetes DESMOND CarbSmart MonitorSmart DESMOND DESMOND Type 1 Tactics – Exercise Insulin Pump Workshop CarbSmart FootSmart Ready-Set-Go Let's Move ShopSmart

8 October 16 November 18 November 16 October 5 October 5 October 1 December 15 October 15 October 25 October 8 December 28 October 2 December 9 December 9 December 22 October 22 October 12 November 10 November 10 November 23 October 23 November 30 November 30 November 4 December 1 October 20 November 4 October 27 October 8 November 8 November 22 November 6 October 25 November 9 October 9 October 19 October 19 October 24 November 28 October 29 November 26 October 26 October 5 November 9 November 11 October 1 November 13 November 13 November 15 November 6 December

Calendar WA Regional Albany Albany Albany Albany Albany Albany Bunbury Bunbury Bunbury Bunbury Bunbury Bunbury Busselton Collie Geraldton Geraldton Geraldton Geraldton Geraldton Geraldton Kalgoorlie Karratha Katanning Katanning Northam South Hedland South Hedland

CarbSmart MonitorSmart ShopSmart FootSmart DESMOND DESMOND DESMOND DESMOND CarbSmart FootSmart MonitorSmart ShopSmart DESMOND DESMOND DESMOND CarbSmart MonitorSmart DESMOND ShopSmart CarbSmart DESMOND DESMOND CarbSmart MonitorSmart DESMOND DESMOND DESMOND

3 November 3 November 10 December 10 December 25 October 22 November 26 October 17 November 6 October 6 October 2 November 2 November 1 October 3 November 15 October 29 October 29 October 15 November 3 December 3 December 10 November 24 November 12 October 12 October 4 November 20 October 1 December

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.

Keeping you safe Diabetes WA has a comprehensive COVID-19 plan in place, strictly following the WA Roadmap and including elements such as – venues with plenty of space; screening before people attend a program (there’ll be extra questions we need to ask); hygiene safety advice for the session itself; and adjustments made to the delivery of interactive parts of the workshops so everyone can stay at a safe distance from each other. We know that people are better able to manage their diabetes after attending our workshops, so we want to offer support as soon as possible. Keep an eye out for updates on our website and in our e-newsletters for the sessions starting up in your area, or call 1300 001 880 for more information.

For more information or to book into any of these workshops, visit diabeteswa.com.au, call 1300 001 880 or email bookings@diabeteswa.com.au 23

LIVING

well

LIVING WITH Over the next few issues, TEENA TOWNSEND will be looking at how we can live better by cutting down on the clutter – starting with our pantries!

We’re all familiar with the overused modern jargon for learning to live with less – minimalising, decluttering and downsizing, to name just a few. But cutting back can seriously improve our own health and wellbeing, not to mention the health of our planet! Living with less stuff doesn’t necessarily mean purging your home. Instead, it's about adopting a different approach to the way you live your life on a day-to-day basis. Small actions such as recycling, reducing what you bring into your home, and finding better ways to do things – such as food shopping, cooking, cleaning, commuting – can all make a big difference. An easy place to start is rethinking our habits around food.

Grow your own

vegetables, herbs and even eggs • Fruit, are within reach. You don't need bags of room – a balcony tub, a wall garden or raised vegetable beds will do the trick!

pick what you want when you need it, • You reducing waste and ensuring what you eat is as fresh as possible.

you’re harvesting your own food you • When know what you are getting – no unhealthy pesticides, herbicides etc.

are no carbon miles for getting it from • There your garden to your kitchen. too much harvest, make it into products • Iftothere’s keep for a later date – see next tip.

LIVING

well

LESS: FOOD Make your own

about making your own hummus, jams, pickles, • Think nut butters, pesto, tomato sauce, preserved fruit, dried herbs, stock – the options are endless.

your own food not only reduces packaging • Making but also reduces or eliminates the hidden additives, preservatives and chemicals found in processed foods.

the most of all-natural, seasonal produce by • Make preserving, freezing, cooking, dehydrating for use out of season.

Don’t default to unhealthy “convenience” foods

Nose-to-tail cooking and eating

isn't as awful as it sounds. It reduces waste and • Offal is better for the environment and your hip pocket. offal into the kitchen by making stock and • Incorporate bone broth with carcasses. hesitant about the offal experience can try making • Those pate with liver, putting a few kidneys in a beef stew, or mincing and “hiding” offal in stews, bolognese, curries and dishes where it will not be discovered.

jump right in and give lamb brains, liver • Alternatively, and bacon, tripe, sweetbreads, chicken feet or pig trotters a go!

the remainder of the animal that you can’t, won’t, or • For your own soups in winter – clean, pure, simple food don’t eat, make it into super healthy, nutritional pet food • Make loaded with nutrition without any of the other stuff. and treats for your furry friends. Buy block cheese and grate it yourself. It has none of the • anticaking additives and preservatives. A 1kg block too Food storage much? Then freeze it. Learn to store different food items appropriately, in the • correct place and at the correct temperature. your own biscuits and cakes –you can’t deny that a • Bake homemade ANZAC biscuit tastes much better. To avoid possible toxins and petrochemicals, avoid • storing food in plastic where possible and opt for glass, your own crackers and snacks. Why pay $6 for • Make stainless steel, ceramic or silicon. Recycle previously 100gm of artisan crackers plus packaging when you can make your own for a fraction of the cost.

Bulk buy

food and produce in bulk when in season or when • Buy it can be frozen, stored or made into jams, preserves or sauces.

large sides of meat such as lamb or beef to split and • Buy share with friends and family.

used bottles and jars.

the health of the planet avoid single use containers, • For cutlery or straws, plastic wrap, Ziplock bags, excess packaging, plastic produce bags and bottled water.

the health of the planet opt for compostable • For materials, beeswax wraps, reusable produce and

shopping bags, reusable water bottles and keep cups for coffee and tea.

Bulk cook

one freeze one. So many family favourites are • Eat super easy to cook in bulk, much cheaper and with much less packaging.

cooking is not just for a rainy day, it’s for a busy • Bulk day, a sick day or any day you don’t want to cook. Not needing to cook every night of the week is a real bonus for physical and mental health.

By no means are these ideas and tips all encompassing – they are merely the tip of the iceberg and intended to provide a starting point to think about how making lifestyle improvements for your physical and mental health can be intertwined with improving the health of our planet. 25

MOVING

well

GOING THE Endurance sports can be particularly challenging for people with diabetes, but a group of swimmers managed to make the long swim to Rottnest this year – with a bit of help, writes MYKE BARTLETT With summer around the corner, it’s natural that West Australians turn their thoughts to the beach. Swimming might be great, low impact exercise, but most of us won’t swim further than a dozen or so laps – or out to the Cottesloe shark net and back, if we’re feeling adventurous. Some swimmers have bigger fish to fry, however, and have their eye on the horizon. Every year, a hardy breed makes the 20km crossing from Cottesloe Beach to the shores of Rottnest Island, either as part of a small team or a solo effort. While making the channel crossing is an extraordinary achievement for any swimmer, it’s a particular challenge for people with diabetes. That didn’t stop a team of four swimmers with type 1 diabetes from taking to the water earlier this year.

“Without the pumps, I don’t know whether it would be possible,” Jake says. “None of the glucose meters are waterproof. And trying to tread water and finger prick? It would be next to impossible. I managed to do all of my training swims – as well as the actual swim itself – with my pump on. Which was fantastic. That real time feedback of your glucose and the trends means you know if your glucose is steady, or if it’s trending upwards. It’s very reassuring and means you can just focus on the actual swimming.”

Jake O’Brien was one quarter of that team – the T1D Collective – and says he was inspired to take part after watching the swimmers arrive at Rotto the previous year.

Despite a lot of training and planning, the big day itself didn’t quite go to plan. Jake had volunteered to swim the first length of the journey, which meant having to swim a kilometre out to the boat, where his glucose and meter would be waiting.

“I’d gone alone to watch the event, because I had some friends doing it and just got really hooked in from that. I loved the energy from the day and I was like, ‘I have to do this.’”

“I wanted to not have to take any insulin just to get that first kilometre out of the way and not have to worry,” Jake says. “But I think I really stuffed up my insulin dose for my dinner the night before, which I carb loaded for the event.”

Although he was a keen runner, Jake hadn’t swum seriously since high school. Having assembled his team, he soon found swimming laps required a very different kind of fitness to running them.

The adrenalin from the excitement of the impending event saw his blood glucose sit at around 13 or 14% for most of the night, despite three attempts to correct it.

"Your lungs are what gives out when you're swimming. You just can't get enough air.” It also became clear that managing his diabetes for an endurance event would be far more challenging in the water than on land. “I think probably the most challenging thing is the recognition of symptoms, particularly of hypos, as it’s such a different sensation being in the water than being on land. A typical sign like sweating is very different, because you can’t be in the water. Your body’s already wet. You don't know if you're sweating because the water temperature is cold.” 26

It was a case of technology to the rescue. To ensure they could train and compete safely, all four swimmers were armed with insulin pumps and continuous glucose monitoring (CGM).

“And then it came crashing down when I got up in the morning when I was meant to be fasted on no insulin. So the plans that I had and the ones that I’d be using for all the training were thrown out the window. But we adapted and it all worked out well in the end.” One of the more surprising aspects of planning for an endurance event with diabetes was the food of choice. Forget high-tech energy bars or garish drinks loaded with electrolytes. The T1D Collective went back to basics. “Most of the food we had was actually baby food,” Jake says. “Because it's so mashed up, it's really easy to digest. When you’re exercising, the blood flow goes to the muscles and

MOVING

well

DISTANCE the gut gets deprived a little bit. So trying to break down anything complex is pretty hard for the gut and takes such a long time. But it was weird, standing in the baby food aisle at Coles, wondering which one I’d like.” Even without the complexities of diabetes management, the crossing proved a challenging swim. Jake and the rest of the T1D Collective had spent most of their training in the Victoria Park swimming pool, but open water conditions made for a very different experience. “For the first half it was an absolute breeze and we were actually going really well. We surprised ourselves. But once we got to that 15km mark, when the swell changed and came from a different angle, it was just incredibly choppy. We felt like we were constantly changing swimmers, because we got so tired and felt like we were just going nowhere.” Jake says he doesn’t think any of his team really considered surrender, but there were a few long kilometres when making it through to the other side seemed impossible. All that changed once the Rottnest beach came into view. “Rotto was so close that we were like, this is ridiculous. We can't give it up.” While it’s traditional to celebrate the marathon swim with a beer or three at the pub, Jake’s team satisfied themselves with a handful of biscuits and a catch up with friends. He says the experience has made a serious swimmer out of him, although he’s not sure if he can find the time to train up for a solo swim. “I’ve always enjoyed endurance sport and that challenge of ‘let me prove that I can do this with diabetes’. I think the long duration stuff really feels like proof in the fact that you've got to be able to sustain that – the monitoring and management – for such a long period of time.” He would encourage anyone else with diabetes who has ever thought about taking swimming more seriously to get along to this summer’s channel crossing and see if inspiration strikes. “If you need any motivation, go along to the event. And then just start swimming. Take it slowly. The more that you do that, the more you get used to it. You find out how your body reacts and adapt from there.” 27

EATING

well

GO WITH YOUR GUT A new book from the CSIRO outlines a diet that may dramatically improve our digestive health – and our general wellbeing. MYKE BARTLETT writes. As the saying goes, we are what we eat. But new research is showing that what we eat, and the impact it has on the ecology of our gut, has a profound impact on our immune system, our overall sense of wellbeing and even our brain. Eating the right types of high fibre foods means we’re feeding the gut microbiome – all those microbes in our digestive system, good and bad – with the fuel it needs to grow the good bacteria, which can have particular benefits for people living with diabetes. Research scientist and dietitian Pennie Taylor is one of the authors of The CSIRO Gut Care Guide, designed as an easy introduction to the world of soluble fibre, insoluble fibre and resistant starch – three ingredients that are, in careful measures, the secret to good gut health. Taylor says she became interested in the gut health diet after an increasing number of patients at her clinic were suffering from mysterious gut disturbances. “Patients were getting quite a lot of complaints called dysbiosis. We worked through several scenarios of FODmaps or other diets to reduce either carbohydrate burden or additives and preservatives. It didn't matter what we took out, we still saw a growth in my clients having gut concerns.” A CSIRO survey mapped out a constellation of common symptoms including bloatedness, reflux, general discomfort and fatigue. Many of Taylor's patients hadn’t made the connection between gut health and a lack of wellbeing. “A lot of people will say, well, that is because I'm busy or getting older. People become quite dismissive of those types of symptoms.” This dysbiosis – brought on by an overgrowth of bad bacteria in the gut or “microbiome” – is a symptom of modern living, where our diets are increasingly dominated by extensively processed foods, added salts and sugars, and a lack of diverse and proper fibre. “There’s a number of reasons why we have an imbalance in our gut microbiome, but more predominantly, it can be 28

brought on by poor diet and lifestyle choices over the longer term. We also know that inflammation caused by a longer term poor diet and lifestyle choices are what contributes to the development of disease, including type 2 diabetes.” The new book aims to make what can seem a complex diet – with its talk of multiple kinds of fibre, starches and the gut microbiome – simple to implement, even for those of us with busy lifestyles. Within the pages are a variety of daily food plans, adapted to shift workers and the time poor. The diet also fits in with reducing carbs and might help people manage or even prevent diabetes. Poor gut health – or an unbalanced gut microbiome – is associated with a condition called leaky gut, which is thought to play a causative role in developing type 2 diabetes. “We know type 2 diabetes is associated with increased intestinal permeability and what people would call leaky gut,” Taylor says. “There is accumulating evidence that looks at the differences in the gut microbiome link for people with type 2 diabetes compared to individuals without type 2 diabetes. Eating more resistant starch has also been shown to prevent some cancers, slow the progression of type 2 diabetes, and assist in immune defence.” One solution to our lifestyle issues will be foods that are fortified with or enhanced by cutting edge food tech, such as the growing trend for producers to include prebiotic fibre (one of the magic ingredients for gut health) in their products. This is more than empty marketing spin. CSIRO’s patented BARLEYmax™️, a resistant starch grain the organisation developed, has been put into a wide range of cereals, bars and breads that can now legitimately make claims about improving digestive wellness. Taylor says she’s also aware that, in our digital age of mass misinformation, consumers often have difficulty telling apart the claims backed by scientific organisations such as CSIRO from those made by the so-called wellness industry. “Personally, I think our scientists and our clinicians need to be a bit more vocal about what the science is saying. The

EATING

well

The three crucial ingredients for gut health online presence of health and wellbeing gurus out there means strong personalities can dominate over someone who has all the science and knowledge and ability behind them. I do think that it still is quite confusing out there in the market. What's adequate? What's a suitable diet? I think that also is compounded by the fact that not one diet fits all.” Indeed, Taylor is keen to stress that the gut health diet as laid out in the book might not work for everyone, although it can be easily adapted to a range of cultural backgrounds. She encourages people to give it a go, either on its own or in combination with other, scientifically rigorous diets. “We know one size doesn't fit all, but this might just add to the information that's out there. That's beneficial. In my practice, I have so many people who just don't trust their knowledge about themselves. When you actually sit down with them, and you go through their breakfast, lunch and dinners? 90% of their diet is right. It's just maybe a few tweaks that we're making.”

The CSIRO Gut Care Guide by Michael Conlon, Pennie Taylor, Dr Cuong D Tran and Megan Rebuli, Published by Macmillan Australia, RRP $39.99, Photography by Rob Palmer

Soluble fibres Nuts and legumes, fruit, oats and barley, most vegetables These slow digestion (and blood glucose uptake), help control hunger, increase the body’s ability to absorb nutrients and support the growth of good bacteria.

Insoluble fibres Legumes, nuts and seeds, most wholegrain goods, most fruit, most vegetables These propel food along the gastrointestinal tract, create a sense of fullness to control appetite.

Resistant starch Legumes, grains, under-ripe bananas, cooked and cooled potatoes, novel cereals such as BARLEYmax™️ Resists digestion in small intestine and is extensively fermented by the gut microbiome. Helps to lower cholesterol and assists with blood glucose levels. 29

EATING

well

Serves: 4 | Prep: 15 mins | Cook: 30 mins

BROCCOLI PESTO PASTA 150 g low-GI wholemeal pasta 3 teaspoons extra virgin olive oil 1 large onion, finely chopped 1 large zucchini, finely diced 1 cup (155 g) frozen peas 4 cups (60 g) chopped cavolo nero or kale juice of ½ lemon 200 g drained tinned tuna in spring water 40 g parmesan, shaved

Broccoli pesto

1 head broccoli, florets and stem chopped into 1–2 cm pieces 2½ tablespoons extra virgin olive oil 2 garlic cloves, unpeeled 2 tablespoons walnuts 1 bunch basil, leaves picked 1 bunch coriander, stems and leaves roughly chopped 60 g parmesan, grated

1. Preheat the oven to 180°C (160°C fan-forced). 2. To start the pesto, scatter the broccoli over a large baking tray and drizzle with 1 teaspoon olive oil. Add the garlic cloves, then place in the oven and roast for 20 minutes. Scatter over the walnuts and roast for a further 5 minutes, or until the broccoli is tender and lightly charred and the walnuts are golden brown. 3. Meanwhile, cook the pasta according to the packet instructions, then drain and set aside. 4. Heat the olive oil in a large frying pan over medium heat. Add the onion and zucchini and cook for 8–10 minutes until tender. Add the peas and cavolo nero or kale and cook for 2 minutes, until the peas have thawed and the cavolo nero or kale has wilted. Remove from the heat while you finish the pesto. 5. Tip the roasted broccoli and walnuts into a food processor and squeeze in the flesh from the garlic cloves. Add the remaining olive oil, basil, coriander and parmesan and blitz to form a chunky paste. 6. Add the pesto, drained pasta and lemon juice to the frying pan and toss through the vegetable mixture to coat. Season with black pepper and add the tuna, then gently toss again. 7. Divide evenly among four bowls, sprinkle over the parmesan and serve.

TIP

To make this vegetarian, omit the tuna and mash 1 boiled egg through each bowl of pasta instead. 30

EATING

well

Serves: 4 | Prep: 15 mins | Cook: 5 mins

½ small head cauliflower

CAULIFLOWER WALDORF

1 baby fennel bulb, trimmed 1 medium green apple 4 celery sticks 2 heads witlof (endive) 400 g shop-bought roasted chicken, shredded, skin and bones discarded 3 tablespoons walnuts 4 thin slices rye bread, toasted and cut into triangles

Dressing

3 tablespoons whole-egg mayonnaise 3 tablespoons reduced-fat Greek-style yoghurt 1 tablespoon extra virgin olive oil juice of ½ lemon

1. Push the cauliflower through a thin slicing attachment on your food processor, use a mandoline or simply finely shred it with a sharp knife. Shred the fennel, green apple, celery and witlof in the same way. Place in a large bowl, add the shredded chicken and toss to combine. 2. To make the dressing, mix together all the ingredients in a small bowl. Add 1–2 tablespoons water to thin it out, then pour the dressing over the salad and toss to coat well. 3. Heat a large frying pan over medium heat. Crush the walnuts in your hand and add to the pan, then cook, tossing, for 2–3 minutes until golden brown. 4. Divide the salad among four bowls. Top with the walnuts and freshly ground black pepper, and serve with toasted rye bread triangles.

NOTE

» Using shop bought roast rotisserie chicken is always convenient. However, if you have time, consider substituting shop bought roasted chicken with 400g of cooked skinless chicken breast to lower your total dietary fat. » Watercress can also be substituted for Witlof or any other vegetables listed in your food group list (as defined in the book). 31

Stroganoff steak and sweet potato wedges Serves 2 (as a main) 400g orange sweet potatoes, unpeeled, cut into long wedges 1 Tbsp olive oil + 1 tsp olive oil 1/2Tbsp + 1 tsp Freshly ground black pepper 2 x 125g beef sirloin steaks, trimmed of fat 150g Swiss brown mushrooms, sliced 1/2 clove garlic, crushed 1 tsp smoked paprika 1 Tbsp sherry vinegar 100ml salt-reduced beef stock or gluten-free stock 6 Tbsp Carnation Lite Cooking Cream 1 Tbsp chopped flat-leaf parsley Picked watercress, to serve 1. Preheat oven to 180°C (fan-forced). Line a baking tray with baking paper. Toss the wedges with 1 tablespoon olive oil and season with pepper. Spread out on a non-stick baking tray and cook for 25-30 minutes or until tender. 2. Meanwhile, heat a large non-stick frying pan over high heat. Rub the remaining oil over the steaks and season with pepper. Add to the pan and cook for 11/2 minutes on each side, for medium or until cooked to your liking. Transfer to a warm plate, cover with foil and set aside to rest. 3. Add the mushrooms to the same pan and cook, stirring, over high heat for 5 minutes until deep golden, softened and all their liquid has evaporated (add a tiny drizzle more oil if the mushrooms are sticking). Add the garlic and paprika to the pan. Cook, stirring, for 2 minutes. 4. Pour in the sherry vinegar and simmer for 1 minute until it disappears. Add the beef stock and simmer for 3 minutes. Reduce the heat to medium and stir in the sour cream and any resting juices from the steak. Simmer for 2 minutes. Season with pepper. Stir the parsley into the pan. Spoon over the steak and serve with the wedges and watercress.

Nutrition Info

PER SERVE 2030kJ, protein 37g, total fat 20g (sat. fat 9g), carbs 34g, fibre 7g, sodium 258mg • Carb exchanges 21/2 • GI estimate low • Gluten-free option

LOWER-CARB OPTION:

Replace sweet potato fries with steamed vegetables. Steam 1 bunch broccolini and 1 large carrot, sliced.

Nutrition Info

PER SERVE 1530kJ, protein 38g, total fat 16g (sat. fat 8g), carbs 12g, fibre 7g, sodium 310mg • Carb exchanges 1 • GI estimate low • Gluten-free option • Lower carb

Diabetes WA Dietitian’s Note:

The saturated fat is higher than recommended for people with diabetes in this recipe. To reduce the saturated fat we recommend replacing the lite cream with evaporated milk.

Photography Ben Dearnley and Immediate Media, Styling Vanessa Austin, Food Preparation Tina McLeish, Recipes Immediate Media, Alison Roberts and Shannon Laverty (dietitian)

Prep: 10 mins Cook: 30 mins

For more great recipes and articles check out the latest issue of Diabetic Living. 32

Chicken, kale & mushroom pie

1. Heat 1/4 teaspoon of the oil in a small non-stick frying pan over medium heat. Add the chicken and cook for 3 minutes each side or until almost cooked. Transfer to a plate, cover loosely with foil and set aside. 2. Heat the remaining oil in a large non-stick frying pan over medium heat. Add the leek and celery. Cook, stirring occasionally, for 5-6 minutes or until the leek starts to soften. 3. Meanwhile, put the sweet potato and 60ml (¼ cup) water in a microwave-safe dish. Cover and cook on High/100% for 4-5 minutes or until tender. Drain and set aside. 4. Stir the mushrooms, garlic and thyme into leek mixture. Increase heat to high and cook, stirring often, for 2-3 minutes or until the mushrooms soften. Add the flour to pan and cook, stirring, for 1 minute. Gradually stir in the milk. Bring to a simmer. Add the kale and cook, stirring, for 2-3 minutes or until soften. Remove the pan from the heat. Stir in the sweet potato, mustard, paprika and cheese. 5. Chop the chicken into pieces and stir into the vegie mixture. Spoon into a 2L (8-cup) rectangular ovenproof dish. Set aside for 1 hour to cool. 6. Preheat oven to 190°C (fan-forced). Roll out the pastry on a lightly floured sheet of baking paper large enough to cover filling. Place on top of filling, pinching on edge of dish to seal. Trim excess. Make a few small slits in the top to help steam escape while cooking. Brush pastry with a little egg. Bake for 25-30 minutes or until golden brown. Serve.

Prep: 20 mins (+ 1 hour cooling) Cook: 45 mins

Serves: 6 (as a main) 2 tsp extra virgin olive oil 500g skinless chicken breast fillet, trimmed of excess fat 1 leek, trimmed, halved lengthways, thickly sliced 2 stalks celery, sliced 700g orange sweet potato, chopped 300g button mushrooms, larger ones halved 2 cloves garlic, crushed 1/2 bunch thyme, leaves picked 2 Tbsp wholemeal plain flour 435ml (13/4 cups) skim milk 1/2 bunch kale, inner core removed, shredded 1 Tbsp wholegrain mustard 1/4 tsp smoked paprika 55g (1/2 cup) grated mozzarella 1 sheet Pampas Light Shortcrust Pastry 25% Reduced Fat, thawed 60g egg, lightly whisked

Nutrition Info

PER SERVE 1570kJ, protein 33g, total fat 8g (sat. fat 3g), carbs 37g, fibre 8g, sodium 315mg • Carb exchanges 21/2 • GI estimate low Remember to take care with portion sizes • Even healthy cake is not an everyday food.

WINTER OFFER FROM DIABETIC LIVING

GET A YEAR’S SUBSCRIPTION (6 ISSUES) TO DIABETIC LIVING FOR ONLY $28! Eat better, feel better, live better with Diabetic Living, Australia’s only lifestyle magazine for people with diabetes and their carers. HEALTH & FITNESS

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hether it’s taking the dog for a walk or lifting weights in the ad break of your favourite TV show, every little bit of physical activity counts towards getting the scales and your BGLs moving in the right direction. In every issue we give you lots of recipes and information about meals that will give your diabetes management a healthy lift, the next step is to make regular exercise part of your natural routine. Why? Because exercising improves the sensitivity of your cells to insulin and increases the uptake of glucose from your bloodstream. ‘That means you will feel less tired and you will have lower circulating glucose levels,’ says accredited exercise physiologist Christine Armarego. ‘High BGLs are the cause of diabetes complications, so regular exercise prevents complications. ‘Every bout of exercise you do improves your insulin sensitivity for up to 48 hours, peaking at 24 hours. Exercising daily will have the optimal effect, but if you can’t manage that, aim to exercise every second day.’ Feeling daunted by the idea of starting an exercise program – and sticking to it? Just follow our simple, step-by-step guide…

STEPS TO A FITTER YOU Moving more is essential for keeping your type 2 on track. You’ll love the side effects of losing weight and feeling great!

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magshop.com.au/p/M20BDWA Diabetic Living is published bi-monthly. Please see magshop.com.au/p/M20BDWA for full terms and conditions of this offer. Offer valid for Australian residents only and ends 31/12/2021. Subscriptions may not include promotional items packed with the magazine. Our Privacy Policy can be found at aremedia.com.au/privacy and includes important information about our collection, use and disclosure of your personal information (including the provision of targeted advertising based on your online activities).

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DELICIOUS RECIPES MONDAY

ONE

CHICKEN, COUSCOUS AND HARISSA BROTH

Give your GP the heads up

Before you start any new exercise program, it’s important to check in with your GP or endocrinologist to confirm you’re physically and medically able to exercise. Your care team can also help you understand how exercise will affect your BGLs and whether your medication, food intake or insulin will need to be adjusted when you begin. Once you’ve got the all clear, seek advice and a program to suit you from an exercise physiologist or a trainer recommended by your GP or diabetes educator.

PREP 10 MINS COOK 35 MINS SERVES 2 (AS A MAIN)

1 tsp olive oil 2 (125g each) skinless chicken thigh fillets, trimmed Freshly ground black pepper 1 small brown onion, thinly sliced 1 head baby fennel, thinly sliced 1 clove garlic, sliced 1 Tbsp harissa paste 100g Blu Gourmet Pearl Cous Cous 250ml (1 cup) salt-reduced chicken stock 250ml (1 cup) water 150g silverbeet, inner core removed, shredded 1 Heat the oil in a deep, non-stick frying pan over medium-high heat. Add the chicken and cook for 5-6 minutes on each side until really caramelised and cooked through. Transfer to a plate, cover loosely with foil and set aside to rest until cool enough to handle. Shred.

How our food works for you see page 75

TWO

Start gently and build on your success

Armarego stresses that everyone is different in their relationship to exercise – we all have exercise baggage of good or bad experiences that we carry around with us. Starting small is a proven way of overcoming this baggage and of developing a new and positive relationship with training. For example, Armarego says she might start a client who is fearful of or resistant to exercise with simple activities such as sit-to-stand (sitting in a chair and standing up), walking up and down the hallway, and using light hand weights to build arm strength.

5 DAYS 5 DINNERS

2 Add onion, fennel and garlic to pan. Season with pepper. Cook, stirring occasionally, for 10 minutes or until vegetables are soft. Stir in the harissa and couscous and cook, stirring, until all grains are coated. 3 Add the stock and water to pan and simmer for 10 minutes. Stir in silverbeet and shredded chicken. Cook for a further 5 minutes. Serve.

Enjoy these delicious new recipes, featuring sesame-crusted tuna with miso dressing, a lemon, spinach pilaf and more. Midweek just got tasty!

Nutrition info PER SERVE 1770kJ, protein 32g, total fat 10g (sat. fat 2g), carbs 47g, fibre 8g, sodium 823mg • Carb exchanges 3 • GI estimate low

LOWER-CARB OPTION Reduce the couscous to 40g and add 1 cup of small cauliflower florets with the stock in Step 3.

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LCO PER SERVE (lower-carb option) 1370kJ, protein 30g, total fat 10g (sat. fat 2g), carbs 26g, fibre 7g, sodium 845mg • Carb exchanges 11/2 • GI estimate low

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25/03/2021 10:03:35 AM

and quote M20BDWA

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amplifon.com.au Available for everyone aged 18 and above.

TAKE

a hike

TAKE A HIKE

After weeks of constant rain, DENISE BROWNSDON seized the chance to try out a new track. It’s nearing the end of winter here in Perth after an unusually wet July. When it’s raining non-stop, I do sometimes struggle to get motivated to head out for a hike when it’s so much warmer and drier inside. So when the sun decided to come out the other day, I took the opportunity to explore a new trail in Rockingham with my friends – Lake Cooloongup Fire Trail. We mapped it out and it appeared to be a 4km track. We all started off together and then we spread out, going at our own pace. Some ran it all, others like me walked and jogged it. This trail had a good variety of terrain to get through, giving us a few welcome challenges! The rain had left us patches of slippery mud and there were the usual sandy patches but there was also plenty of even, dry surfaces so I was able to confidently jog a fair way. What I love most about heading out to a new area is being able to enjoy some unfamiliar scenery. I’ve lived in Australia for nearly 20 years now and I am still awed by the amazing landscape and animals that can be found here. I do encourage anyone wanting to try their hand at hiking to make sure they pack their GPS! We would have been lost without ours. The track took us a bit longer to complete as we weren’t fully sure where our turns would be. It also turned out to be nearly 6.5km instead of 4km but we couldn’t complain. After weeks of rain, it was such a great feeling to be out in the fresh air and sunshine! With the weather starting to warm up and the days growing longer I look forward to doing some more exploring! I’m going to be heading out again with The Hike Collective soon so I look forward to reporting back next time after another awesome hike. 35

ABORIGINAL

voice

WHY WE NEED MORE ABORIGINAL HEALTH Trained Aboriginal health workers are in the best position to connect with Aboriginal communities and help them manage their health, writes NATALIE JETTA. The report into the Aboriginal and Torres Strait Islander health workforce is a big deal for us (see page 3). It’s shown what those of us working in the space already know, which is that care from Aboriginal health workers has a huge impact on patient satisfaction and outcomes in remote communities. Here at Diabetes WA, we’re working hard to recruit and train more Aboriginal health workers to tackle a rising epidemic of type 2 diabetes in Aboriginal communities. I’ve recently taken on a new role as the leader of our Aboriginal Health Workforce Development Project, the sole purpose

of which is to get more Aboriginal health workers into those communities to deliver our Diabetes Education SelfManagement Yarning (DESY) programs, which are based around person-centred care. We’re doing this for a number of reasons. One is, we can’t be there all the time. We fly in and we fly out. But if we train up Aboriginal health workers who have the respect and knowledge and connection with their own community, they’re in a much better position to follow up and nurture and look after their clients. That sense of cultural connection with Community is essential. If I go to a remote area which I've never been to before, and I don’t know the history or a single person there, and I just walk in and “Hey, come to this workshop”, the odds are, nobody will turn up. If they know you and they respect you, they'll feel more comfortable attending. Added to that, in some communities, there are strict protocols in place, where visitors will need to seek permission from an elder or council to enter. Part of our recruitment drive has involved working with every Aboriginal Medical Service (AMS) across WA to identify which of their Aboriginal health staff has potential to be able to help deliver DESY. It’s also crucial that we help workers make space in their current workloads so that they have the capacity. We know a lot of Aboriginal health workers get super busy in their current roles and we don’t want to overload them! After training workers, we make sure we don’t just abandon them, but keep in touch throughout a two year mentorship and make sure they're still following our philosophy and way of facilitating that philosophy, which empowers people with diabetes to improve their self-management, is particularly important in remote areas, where medical services often aren’t easily accessible. When we talk about person centred care, what we mean is helping people to look after their diabetes their own way and

ABORIGINAL

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WORKERS IN REMOTE COMMUNITIES giving them the confidence to ask their doctor more questions. Often, they will leave the doctor’s surgery without having an understanding of what they’ve just been told. If we can teach people what an HbA1c test is and tell them what to ask every three months when they get the test done, then they can keep track of how they're going with their diabetes care. This philosophy is also one that I believe really resonates with Aboriginal health workers. Person centred care is in their nature. It’s really important that we start to turn things around in Aboriginal communities. Traditional ways of living and eating have been severely disrupted. In remote areas, it’s harder to go out hunting when you’ve got to have permission before you go on farms. And it doesn’t help when fried foods are cheaper and more accessible than fruit and veggies in remote communities. For these communities, diabetes has just become a sad fact of life. Recently, I went to went to a couple of regional schools and the Aboriginal

kids said “Oh yeah, when I get older I'm going to have diabetes.” Their mum and dad have it, their grandparents have it, their uncles have it. It’s really tragic that Aboriginal kids are growing up in these communities, just assuming that’s normal. Even more sad is the fact that, in the past 12 months, we've been hearing about some kids who are still in schools are being diagnosed with type 2 diabetes. We’re doing what we can to raise awareness of diabetes prevention and management. I’ve just come back from running two DESY sessions in the Pilbara and another in Collie. COVID continues to make our job harder, but we’re having some success running digital webinars. We do know that accessing digital sessions continues to be an issue for some people in remote communities, so there’s still no real substitute for having a worker on the ground. And, I guess, in our days of COVID, it’s even more important that those workers aren’t having to fly in and out but instead belong to the communities they’re helping.

When we talk about person centred care, what we mean is helping people to look after their diabetes and giving them the confidence to ask their doctor more questions.

The Aboriginal Health Workforce Development project is funded by a grant provided by the Commonwealth Department of Health as part of the Indigenous Australians Health Program. 37

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Non-fiction Four Thousand Weeks Oliver Burkeman (Bodley Head) Reviewed by Myke Bartlett British writer Oliver Burkeman has built his career around being sceptical about the self-help industry. His previous book The Antidote had the subtitle “happiness for people who can’t stand positive thinking” and for years he had a regular column in the Guardian with the semi-ironic title ‘This Column Will Change Your Life’. In both, Burkeman revealed an interest in the messiness of life and an increasingly stoic approach to coming to terms with failure and disaster. His new book

Fiction The Kingdoms Natasha Pulley (Bloomsbury) Reviewed by Myke Bartlett This genre-bending thriller is the sort of clever escapism we could all do with at this rather dark moment of history. Indeed, it’s core time-travelling notion of rewriting history to a preferred version seems quite appealing. But rather than erasing pandemics, The Kingdoms is concerned with correcting a war – the Napoleonic War, to be exact. Our hero Joe wakes up in 19th century Britain and, remembering nothing of his

Fiction [Audiobook] Nine Perfect Strangers Liane Moriarty (Pan Macmillan) Reviewed by Teena Townsend I didn’t read Nine Perfect Strangers, but instead listened to the audio version on Audible, which was narrated by Caroline Lee.  l must admit her narration jarred for me, making the 19 hours of listening sometimes feel too much like hard work! I loved Big Little Lies – both the book and the TV series. Knowing that this more recent novel by Moriarty was also being made into a TV series inspired me to give it a go. Nine Perfect Strangers is a well-written story about nine

is, in part, a call to arms. We’re only on this planet for 4000 weeks – how do we want to spent that short span? The book outlines Burkeman’s own journey away from looking for the key to becoming happier, fitter, and more productive. He identifies the notion of productivity as being a modern invention, one that has arrived alongside the Industrial Revolution’s insistence on strict time management and a loss of faith in an eternal afterlife. The answer isn’t to get better at time management (as all those self-help books insist) but rather to come to terms with our limitations. We won’t – and can’t – do everything. Missing out is an inevitable consequence of any decisions we make. If that sounds grim, it’s worth stressing that the experience of the book is an uplifting and empowering one. There is a strange freedom in recognising your own restrictions. Highly recommended.

own past, finds that the French won the battle of Waterloo and have conquered his homeland. And yet there are glimpses and hints of another world, another history, where things were very different. Can Joe put things right? And at what great personal cost? I really enjoyed Pulley’s first two off-kilter historicals, which flirted with fantasy around vivid and realistic characters and settings. Her latest is no less enjoyable, although it leans more heavily into the weird and mystifying (not necessarily a complaint). Perhaps fittingly, there’s a sense that the present – our present – is increasingly bleeding into her work, resulting in very 21st century dialogue and attitudes that can jar with the historical setting. A minor quibble. This is great, strange fun.

people from different walks of life – all interesting, likeable and relatable characters - who turn up to a luxury spa and health resort in the countryside. They are all there to find their inner peace, detox, lose weight and transform their lives in some way while purging their inner demons or getting over personal dramas and problems.  Of course, not all is as it seems. The plot lurches towards the ridiculous as the story develops, things start to go bonkers and chaos ensues. I am still keenly looking forward to the TV adaptation with its star power and huge promotional budget. As an end note, I will confess that the book has made me reconsider my desires and fantasies of one day booking into idyllic countryside retreats and health spas to find my inner self! 39

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Train Your

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Brain

Give your brain a good workout with this number-crunching Sudoku puzzle.

The aim of the game is to fill the entire 9 by 9 grid - which is made up of nine 3 by 3 boxes - with the numbers 1-9. Note that each of the 3 by 3 boxes must also contain the numbers 1-9. (Answers below)

Good luck!

Competition

Spring

In this follow-up to the bestselling Healthy Gut Diet, leading CSIRO research scientists and dietitians share the latest findings on gut health, including the essential role of fibre and the potential benefits of probiotics, prebiotics and fermented foods. Also included are sample meal plans and 60 delicious recipes to boost your gut health. Thanks to Pan Macmillan Australia, we have five copies of The CSIRO Gut Care Guide (valued at $39.99) to give away!

To enter, complete your details below and send it to: Membership – The Gut Care Guide comp 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 November 1, 2021.

The winner of our member giveaway in our Winter 2021 edition is Jadwiga (Judy) Hooper who won The 12 Step Mind-Body-Food Reset from Pan Macmillan Australia. Congratulations! 41

Diabetes Matters Spring 2021

Articles inside

Aboriginal Health

Take a Hike with Denise

Recipes

Gut Recipes

Go With Your Gut

On the Line

Join us at our AGM

Going the Distance

Sleeping Well

Kellion Victory Awards

Workshops Update

Sleeping On It

Living With Less: Food