Diabetes Matter Summer 2016/2017 by Diabetes WA

Summer 2016/2017 $6.95

Diabetes at a Distance

Sofia

Finland

Liu Yang China

Barbara USA

Ray

Ghana

Emanuel Argentina

Christmas

Feasting

NEWS • RECIPES • RESEARCH • PEOPLE • EVENTS • FITNESS

John

Australia

Diabetes around the world

From the Editor s. of Diabetes Matter Summer edition Welcome to the d the World portunity to atten most op e th d ha I o ag A few years and one of the how ss in Melbourne, Diabetes Congre personal stories of rts to g in ten lis s wa pa cts nt pe re as memorable ay life in diffe s affects day-to-d abetes World Diabe living with diabete how people living with type 1 di tes Day d eir ar th he of I r . fea in et cr se of the world a on iti nd co e th a ep in India had to ke ing cancelled, or people spending en be d th sulin in Africa an arranged marriage to collect their in e they can’t afford to s bu e th on y da full caus e to once a day be ese stories put a whole rationing their us . Th nt ou Diabetes around the World am ed ib cr alia es purchase their pr what living with diabetes in Austr y ne on join us for a jour new perspective self a cuppa and ur yo e ak m so e, is lik on page 9. From the President.........................................................3 around the world of the theme, a review e nc sta Di a at s Current Matters...............................................................4 abete WA Continuing our Di Diabetes Telehealth for Country ge 26 pa our of on s re ar tu ye o fea tw ell st fir gW 15, and our Eatin Diabetes News ation service is on page r eating in moder fo s tip l fu lp he e m so u yo e ! on giv World Diabetes Day........................................................5 as ll wi e se er indulgent festiv ahead of the rath – es ili Jamie’s Ministry of Food ...............................................6 k with your fam vely holiday brea I wish you all a lo Fabulous Fundraisers.....................................................8 see you in 2017! Best wishes,

Contents

Stacey

SUMMER 2016/2017 Editor Stacey Boyne Editorial & Advertising Enquiries Diabetes WA, PO Box 1699, Subiaco, WA, 6904 Phone (08) 9325 7699 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 International Diabetes Federation, Murdoch Books, Department of Health, St Hilda’s Anglican School for Girls, Dr Joe Kosterich, Alan Drew, Norma Dook Photography DWA staff, ambassadors and fundraisers, St Hilda’s Anglican School for Girls, IDF’s Life for a Child Program, Steve Campbell, Shutterstock, Department of Health

Diabetes around the World............................................9 Telehealth Success.......................................................15 Removing the Distance Barrier...................................16

Research News Research Round-up......................................................18 Diabetes Research WA Update...................................19

In the Community Managing Diabetes in Schools...................................20

Living Well Keep Oral Disease at Bay.............................................22

Moving Well Get on Track Challenge.................................................24

Eating Well Christmas Eating...........................................................26 Doctor’s Orders.............................................................27 Diabetes WA Christmas Favourites............................28 More Please Manu!......................................................30

Members’ Area Member Partners..........................................................32 Members’ Competition and Puzzle............................33

Design key2creative Print Quality Press Diabetes WA www.diabeteswa.com.au

Diabetes WA – Subiaco Office Level 3, 322 Hay Street, Subiaco WA 6008

Diabetes Information and Advice Line: 1300 136 588

Postal Address: PO Box 1699, Subiaco WA 6904

Phone: (08) 9325 7699 Email: info@diabeteswa.com.au

Diabetes WA – Belmont Office 172 Campbell Street, Belmont WA 6104 Postal Address: PO Box 726, Belmont WA 6984

Diabetes at a Distance

What’s on..................................................... 34

From the President

ith another year drawing to a close, December is a time of reflection as we look back at another successful year for our organisation. While 2016 brought many changes, including the Commonwealth government’s modifications to the National Diabetes Services Scheme (NDSS), it was inspiring to see the executive team and entire staffing group at Diabetes WA tackle these challenges Dr Moira Watson head on. It is clear that the needs of the diabetes community in WA Diabetes WA President and were kept at the forefront throughout the NDSS transition process Board Chair and this will continue with our efforts to ensure people living with diabetes throughout the State can access diabetes products without difficulty or delay.

Significant achievements in 2016 included the launch of SHED-IT, a popular, low-cost weight loss program designed for men, the introduction of MedSmart into our Smart range of information sessions, and the expansion of our DESMOND program regionally in WA, throughout the Eastern States and as far away as New Zealand. Further work is also being done to take the evidence-based program further afield and tailor it for our Aboriginal communities. Our adaptation of the School Management and Action Plans were rolled out to schools in WA and information about this and our new Camp Guidelines can be found on page 20. Our new and improved website, launched in June, makes it easier for people to find out about the services and programs we provide and our annual Corporate Lunch was once again a great success and showcased the work we are doing in the community. As we move into 2017, it is time to look at what the future holds for our organisation. Diabetes WA is now 51 years old, having been formed in 1965. During this time, much has changed in terms of our knowledge of diabetes. Medical advances, alternate treatment strategies and new management technologies have all influenced the nature and range of services we provide to West Australians at risk of diabetes and those living with the condition. Much has also changed for our organisation, including our financial scale, staff numbers, the regions we service, the overall structure of the WA health system and the regulatory environment in which we operate. With all these changes, it is appropriate that Diabetes WA undertakes a review of its structure and operations to ensure we maintain our relevance to the community moving forward. To that end, the Board of Diabetes WA is looking at the benefits of transferring its incorporation from an Incorporated Association to a Company Limited by Guarantee. This form of registration is already widely preferred by our larger peer organisations in other states and territories. Any transfer will require the approval of members of Diabetes WA, as well as the WA Commissioner for Consumer Protection. Importantly, any transfer of incorporation will not affect what we do or our engagement with the WA community. Over the coming months, all members of Diabetes WA will be contacted with further details including a full range of information on how they can be involved in this process. Our Annual General Meeting (AGM) was held on Thursday 20 October, and I am pleased to say our current board will continue into 2017. Our 2015 – 2016 Annual Review was released at the AGM, and you can view our latest statistics and information on our website, under ‘About Us’.

Finally, we marked our annual World Diabetes Day celebrations on Monday 14 November by donning comic blue glasses and encouraging the diabetes community to do the same. The idea gained plenty of momentum across our social media channels and it was fantastic to see Perth celebrities, politicians and the general public getting involved and posting their photos online using the hashtag #WDD. This year’s theme set by the International Diabetes Federation was ‘Eyes on Diabetes’, so our idea certainly filled the brief and proved to be an easy way for people to do their part in sharing the global diabetes message. As another year draws to a close, I wish you and your families a wonderful Christmas and New Year. I will certainly be toasting the many achievements of Diabetes WA over the festive period and I look forward to another productive year in 2017. Until next time…

Dr Moira Watson President and Board Chair

•

Stock up ahead of the Christmas Break With the Christmas and New Year holidays almost upon us, we recommend that you place your order for diabetes supplies with your preferred Access Point as soon as possible. This will help ensure you have plenty of stock to last throughout the period when community pharmacies may be closed. Diabetes WA will be closed from 4.30pm on Friday 23 December, and will re-open on Tuesday 3 January, 2017. If you require urgent medical advice throughout the Christmas break please contact Health Direct on 1800 022 222 or visit your nearest hospital with an emergency department.

Andrew Wagstaff, Diabetes WA CEO

A New Perspective on Distance

he theme for this edition of Diabetes Matters is Diabetes at a Distance, and we have taken a global look at the condition and how people around the world are affected differently along their journey with diabetes. Reading about the difficulties people face in terms of access to supplies, health facilities and costs of treatment, as well as the fact that some children do not survive a diagnosis of type 1 diabetes because of these factors, certainly puts things into perspective.

In 2011, Bell Potter Securities valued the global insulin market at $34 billion per annum and placed a value of $20 billion on other diabetes medications. In that same year, the global population of people with diabetes was estimated at 366 million. According to the International Diabetes Federation, the number increased to 415 million people over the past five years and, when considered globally, the scale of impact of diabetes is huge.

language of regional and remote as a means to differentiate populations of people who may be disadvantaged by distance. I am sure if I were to throw into the conversation traffic congestion in the metro area and access issues such as parking and availability of public transport, I would very quickly find a large number of people amongst Perth’s two million residents who would also cite at least some level of disadvantage.

In WA – a state of some 2.6 million square kilometres – conversations about dealing with the distance and solving issues around access to health services and medical supplies are a regular occurrence. The team at Diabetes WA are regularly challenged with providing workable solutions for supply into WA’s regional and remote areas, ensuring consumers can access products and services regardless of their location. To that end, Diabetes WA now operates a Diabetes Telehealth for Country WA service. The service provides connectivity between consumers with diabetes and our own diabetes educators via a number of digital means including video conferencing. Since commencing in early 2015, data indicates the service has saved some 57,000 kilometres in motor vehicle travel. Even at the Australian Taxation Office’s current rate of 66 cents per kilometre, that’s a whopping saving of around $38,000. The Telehealth service is available free of charge to people living in regional areas, so visit www.diabeteswa.com.au for more information or call 1300 136 588 to schedule a video-conferencing session.

Despite the changes to the National Diabetes Services Scheme on 30 June this year, Diabetes WA has been retained by the Commonwealth of Australia to provide a product and resource distribution service to people living in rural and remote areas of WA. This ensures access to the NDSS to all WA registrants, including those living regionally who are experiencing difficulty accessing the scheme through the new community pharmacy distribution model. For this purpose, Diabetes WA’s new website continues to provide a fully-stocked shop selling all NDSS products including insulin pump consumables. Anyone who is having trouble accessing their products via pharmacies is welcome to use the online shop; however, postage costs will apply. The NDSS product team is also happy to assist with any product supply queries and are available on 1300 136 588.

With the continuing growth of the Perth metropolitan area now nudging 6,400 square kilometres, we sometimes struggle when policy makers and program funders use the

Andrew Wagstaff, Diabetes WA CEO

Enjoy the Festive Season.

•

World Diabetes Day

his year’s World Diabetes Day celebrations focused on the theme of ‘Eyes on Diabetes’ and raised awareness of the importance of early screening and diagnosis of type 2 diabetes. Held annually on 14 November, World Diabetes Day is organised by the International Diabetes Federation and recognised by the blue circle representing the global symbol for diabetes awareness. Diabetes WA staff members donned round-frame blue glasses to mark the occasion and encouraged organisations throughout WA to do the same. Perth celebrities, politicians, health facilities and school groups all got involved, wearing the comic eyewear and posting photos online using the hashtag #WDD.

Thank you to everyone who took part in the celebrations. It was fantastic to see so many people joining in and sharing the global messages around diabetes prevention and awareness.

Residents Reconnect R

esidents in diabetes hotspots throughout Perth have refreshed their knowledge about type 2 diabetes thanks to a series of Reconnect with your Diabetes seminars. A recent session was held in Cannington, with attendees having the opportunity to learn more about healthy eating, understanding nutrition panels, medication and gaining general diabetes information. For more information about upcoming Reconnect sessions in 2017, visit our website or call 1300 136 588.

Cooking Skills Provide a Healthy Start

iabetes WA is helping young people get a healthy start in the kitchen by sponsoring teenagers living with diabetes to take part in Jamie Oliver’s Ministry of Food. The program focuses on nutrition and fresh produce, and teaches hands-on cooking skills so that participants are equipped with the knowledge and confidence to prepare healthy meals for themselves and their future families. The participants involved in the seven-week course were young people living with type 1 diabetes and their parents. They enjoyed learning how to make delicious, nutritious, simple and affordable meals from scratch at the mobile kitchen at Edith Cowan University in Joondalup. The program received rave reviews, with several parents commenting on how the sessions encouraged the teenagers to try new foods and share cooking tips about preparing easy meals with fresh ingredients. Diabetes WA General Manager of Health Services, Helen Mitchell, said the program is a fantastic way to get a head start in the kitchen from a young age. “Learning the importance of eating nutritious meals and having the skills to make healthy choices in the kitchen not only

cooking up delicious wagyu meatballs

helps the current program participants, but also passes on good habits to the whole family and gives a great foundation for future generations.” “Being able to learn lots of Jamie Oliver’s hints, tips and shortcuts, as well as being able to try his incredible recipes, is a huge bonus as well,” concludes Helen.

Teens Set Sail

Big Win for DESMOND Team

hanks to a generous donation from a kind supporter, over the past few years Diabetes WA has been able to participate in the Leeuwin Challenge, giving young people the opportunity to experience the thrill of tall-ship sailing. This year Tayla Jones and Ciara Crockett were the successful applicants to secure a spot on the unique five-day voyage that departed Fremantle on 14 November. The girls enjoyed experiences such as learning to sail the ship, climbing the rigging, taking part in fun evening activities and meeting new friends.

Mother/daughter duo Brenda and Lauren

he 2016 Australian Diabetes Society & Australian Diabetes Educators Association (ADS-ADEA) Conference was held in the Gold Coast in August and was attended by Diabetes WA team members Sophie McGough and Kylie Mahony. The exciting and innovative conference program brought together national and international experts to promote the exchange of the latest clinical practices and cutting edge research in diabetes. Kylie, a DESMOND Australia Diabetes Educator, had abstracts selected for both the oral presentations and poster presentations about the group education program teaching participants to self-manage their type 2 diabetes.

Kylie Mahony with her DESMOND poster presentation

Kylie was awarded Best Novice Oral Presentation for her abstract, DESMOND: Is it only for the newly diagnosed? A big congratulations goes out to Kylie and it’s fantastic to see DESMOND recognised at a national level.

Western Pacific Congress

iabetes WA’s DESMOND team travelled to Taipei, Taiwan in October for the International Diabetes Federation (IDF) 11th Western Pacific Congress and 8th Scientific Meeting of the Asian Association for the Study of Diabetes.

The congress centred on ‘creating a new dimension in diabetes: prevention, protection and care’, and Deb Schofield, General Manager of Health Services at Diabetes WA presented two abstracts to the congress. The first abstract, DESMOND: Does it deliver for Aboriginal and Torres Strait Islander People?, was presented as a poster and the second abstract, Fidelity: The missing dimension in structured diabetes education around the globe, was presented as an oral presentation. Tammy Moran, the IDF WA Young Leader in Diabetes, also attended the Western Pacific Regional Young Leaders training in Taiwan. 15 Young Leaders from 10 different countries came together to learn, grow and develop into the new voices for type 1 diabetes. While attending training they were educated on disaster mitigation, diabetes in medical missions, fundraising, public speaking and health diplomacy. They also had the opportunity to take part in a public awareness campaign run throughout Taipei, that included a fun-run, city tour and events involving the IDF’s blue circle symbol for diabetes awareness. Attending the Western Pacific Congress to view new technology, liaise with companies and meet prominent health corporation leaders was also a highlight.

Helen Mitchell and Deb Schofield representi ng Diabetes WA at the Western Pacific Congress

c Diabetes Young Leaders from throughout the Western Pacifi

Ian Anderson Quiz Night P

erth policeman Ian Anderson hosted his 11th annual quiz night on Friday 2 December at the Victoria Park-Carlisle Bowling Club. The Kensington resident has been coordinating the Ian Anderson Quiz Night since 2005 and has raised over $35,000 since the event began. As per usual tickets were in hot demand and it was fantastic to see such a big crowd in attendance to test their knowledge and support Ian’s efforts to raise money for Diabetes WA.

Ian out-did himself with his tricky questions and a great time was had by all. Thank you Ian!

Sophie and Jasmine McGough

Save the Date

he 2017 HBF Run for a Reason is locked in for Sunday 28 May. Mark your diary and start spreading the word to your family and friends – this fantastic community event keeps getting bigger and better every year.

Fremantle Running Festival

lose to 800 runners roughed the windy weather on Sunday 9 October to take part in the Fremantle Running Festival. The event has been generously raising funds to support the diabetes community since 2010. WA Marathon Club Sponsorship Coordinator, Bruce Hogg, says the Fremantle Running Festival provides a great opportunity for participants of all ages to support a vital cause and get a healthy dose of exercise while enjoying picturesque ocean views along South Beach.

Participants braving a chilly start for the Fremantle Running Festival

Congratulations and thank you to everyone who took part!

High Tea Fundraiser T la Clerk with St Hilda’s Diabetes WA staff Deanne Dymock and Nico and Vivienne Hammat students Caitlyn Watkins, Alia Corcoran

St Hilda’s Lapathon

he Santa Maria College community held a beautiful high tea on Sunday 30 October to raise funds for Diabetes WA. The event was organised by Anita Gray, whose daughter Laura attended the school as a boarding student and sadly passed away in 2011. Diabetes WA team members Deanne Dymock and Sophie McGough attended the fundraiser and commented on how lovely it was to see the school community still rallying around Anita and raising money in Laura’s memory five years on.

ver the last few months Diabetes WA has been visiting St Hilda’s Anglican School for Girls in Mosman Park and educating students about type 1 diabetes. The program culminated in a fundraising lap-a-thon in the junior school and we were thrilled to receive a very generous donation of over $20,000! A big thank you goes out to the entire St Hilda’s school community – your support is very much appreciated.

Sophie McGough, Anita Gray and Deanne Dymock St Hilda’s Junior School Lapathon

Diabetes around the World Estimated number of people with diabetes worldwide and per region in 2015 and 2040 (20-79 years) North America and Caribbean 2015 44.3 million 2040 60.5 million

Europe million 2040 71.1 million

2015 59.8

Middle East and North Africa 2015 35.4 million 2040 72.1 million

South and Central America 2015 29.6 million 2040 48.8 million

Africa 2015 14.2 million 2040 34.2 million

Western Pacific million 2040 214.8 million 2015 153.2

South East Asia 2015 78.3 million 2040 140.2 million 13

he growth of diabetes worldwide has been given a number of dramatic names, including the ‘diabetes epidemic’ and the ‘rising tsunami of diabetes’. Sadly, statistics released in the International Diabetes Federation (IDF) Diabetes Atlas (7 ed. Brussels, Belgium) confirm that the global reach of the condition deserves all the hype and, for many countries around the world, the consequences are devastating.

a blood glucose meter and relevant supplies, and can only According to the IDF Diabetes Atlas, diabetes is one of the largest check their blood glucose levels once a month during clinic global health emergencies of the 21st century. Studies show that Adults died and malaria visits. Some people face social issues, such as being rejected there arewho currently 415from milliondiabetes, people living HIV/AIDS, with diabetes intuberculosis, as a potential ‘suitor’ for arranged marriages, while others face the world and this number is set to rise to 642 million people negative stigma and have difficulty being able to follow strict by 2040. While people living with diabetes in Australia have religious rituals. access to government subsidies for medication and diabetes supplies, as well high-quality health facilities and support from In this article, we will visit the seven different regions featured organisations such as Diabetes WA, many people aren’t so lucky. in the IDF Diabetes Atlas, exploring various issues faced by For some, the cost of insulin is so prohibitive that they have to residents in these areas and how living with diabetes can affect limit doses to just once a day – far less than what they require people in different ways throughout the globe. for optimal health outcomes. Others can’t afford the cost of

5.0 million

1.5 million

0.6 million

2015

2013

from diabetes

from HIV/AIDS

from tuberculosis

from malaria

Africa “In Africa, more than two-thirds of people with diabetes are undiagnosed” An estimated 14.2 million adults aged 20–79 are living with diabetes in Africa. The region has the highest proportion of undiagnosed diabetes, with over two-thirds of people unaware that they have the condition. The Africa region has the lowest global health expenditure on diabetes and many people living with the condition struggle with the high cost of treatment, accessing essential supplies and travelling long distances to attend appropriate health facilities, especially for those living in regional areas.

Dr Emmanuel Ameeyaw and support from LFAC has allowed Ray to flourish into the healthy young man he is today. “I took my insulin to school in a flask with ice and kept it with my teachers until I needed it. When I started high school, I got access to the internet and began to read more about type 1 diabetes. I read about older people who had been living with the condition since before I was born and were still alive; this gave me hope and made me determined to live a healthy and long life,” said Ray.

Insulin out of reach for many There are over 46,000 African children under the age of 15 living with type 1 diabetes and many lack access to insulin, glucose test trips and trained health professionals. This low level of care inevitably leads to poor control of blood glucose levels and endangers the lives of many children living with the condition. According to Dr Thomas Ngwiri, from the Gertrudes Children’s Hospital in Nairobi, there are more than 5,000 children with type 1 diabetes in Kenya alone, but many are not diagnosed until it’s too late and succumb to complications such as diabetic ketoacidosis and kidney failure. Of those children receiving treatment at two major hospitals in Kenya, only 28 per cent were able to adequately control their blood glucose levels. This is due to a limited supply of insulin in hospitals and a total lack of self-monitoring given the high cost of blood glucose monitors and supplies.

Ray with Dr Emmanuel Ameeyaw in Ghana

“Although the Kenyan government subsidises insulin in public hospitals to the tune of 15 per cent of the price in private pharmacy outlets, it is still beyond the reach of many,” said Dr Ngwiri. “Some families try to keep the cost down by giving lower doses of insulin to ‘stretch’ the treatment out, but this has dire consequences and unfortunately lack of insulin has become a matter of life or death for these children.”

IDF Life for a Child Program Thankfully, the International Diabetes Federation’s Life for a Child (LFAC) Program has made it possible for thousands of African children to receive insulin, blood glucose monitoring equipment, diabetes education and basic medical care. The program works toward the vision that no child should die of diabetes, and supports over 18,000 children and young adults (up to the age of 26) in 43 countries around the world. LFAC has been supporting young people with diabetes in Ghana since 2011, and one person very grateful for their support is 19-year-old Ray. The high school graduate has been living with type 1 diabetes for nine years and, although the first two years were very difficult, treatment by his specialist

Congo camp participant Rose

Middle East & North Africa This region incorporates Iran in the North, Pakistan in the East, Sudan in the South and Morocco in the West, and this region is home to 35.4 million people aged 20–79 living with diabetes. The vast majority of those affected live in low-or middle-income countries.

tic Republic of Congo Touring Black Lake in Buhimba, Democra In the Democratic Republic of Congo, a lack of infrastructure, political challenges and civil war makes accessing essential care for diabetes very difficult, and ‘extras’ such as kids’ camps are beyond the wildest dreams of young people living with the condition. LFAC recently worked with Alfred Kakisingo from the Associacion des Diabétiqes du Congo to make this dream a reality, and the first camp was held in early August this year. Around 30 participants toured three lakes in the area and took part in information sessions in a safe and inclusive environment. “The camp was a great way for campers to meet others living with diabetes, feel less isolated, and learn about living with diabetes,” said Alfred. “It has been a wonderful experience for both the young people and the trainers.” LFAC is an International Diabetes Federation program, managed in Sydney by Diabetes NSW & ACT with support from Diabetes Australia. For more information or to make a donation please visit www.idf.org/lifeforachild

Jonathan’s Story My name is Jonathon, I am 52 years old and I live in Rwanda with my five children. I was diagnosed with type 2 diabetes in 2010 and, although I was initially prescribed tablets, it did not improve my blood glucose levels and I was put on insulin therapy. The past six years have been a long, hard and emotionally difficult journey as the cost to take care of my health has taken a huge toll on my family’s financial situation.

Many people living with diabetes in this region face difficulty when observing Ramadan, the ritual fasting observed by Muslims worldwide. Ramadan is the ninth month of the Islamic calendar and requires those of the Islamic faith to fast from dawn until sunset. Throughout the fast, participants must refrain from consuming food, drinking any liquids or using any oral medications. While fasting is obligatory for all adult Muslims, exclusions apply for those taking medication for conditions such as diabetes. However, many people living with diabetes still wish to take part in Ramadan, and are at high risk of developing complications from significant changes in food, fluid and medication intake. Diabetes WA Dietitian Sheryl Moore advises that those wishing to take part should put their health first and seek advice from a health professional prior to the commencement of Ramadan. “Going long periods between meals and consuming greater amounts of food before dawn and after sunset, particularly a higher intake of carbohydrate, may cause people with diabetes to experience large swings in blood glucose levels,” said Sheryl. “It’s important to check your blood glucose more frequently than usual and adjust your medication accordingly on advice from your health professional. Insulin injections hold no nutritional value and are allowed throughout the fast.” The IDF, in collaboration with the Diabetes and Ramadan (DAR) International Alliance, released new Ramadan guidelines in April 2016. Visit www.idf.org/news/idf-dardiabetes-in-ramadan-guidelines to download a copy.

Before my diagnosis, our source of income was farming and breeding, but I have had to sell farm animals to pay for diabetes consultations and medications. After a while, I ran out of animals to sell. I receive some help from the provided health insurance in Rwanda, but it has become nearly impossible to cover the costs of my children’s needs such as school fees. My daughter recently told me she is going to study to become a doctor so she can cure my diabetes one day.

capita with one out of eight adults with the disease. Europe has the highest number of children with type 1 diabetes; approximately 140,000, and faces an increase of around 21,600 new cases per year. In the South-East Asia Region, 24.2% of all live births are affected by high blood glucose during pregnancy. In the Middle East and North Africa Western Pacific Region, two out of five adults with diabetes are The Western Pacific accounts 39Central countriesAmerica and undiagnosed. In the Southfor and territories, including theof world’ s most populous country, Region, the number people with diabetes will China, as well Australia and New Zealand. increase by as 65% by 2040. It is particularly challenging to estimate total China has the largest number ofthe adults number of people with diabetes in the Africa living with diabetes – a staggering Region, as more than three quarters of countries

109.6 million people!

to use for extrapo on similarities in this seventh editi were chosen on t language, geogra levels. In 2015, it million and 29.3 m in the Africa Regi estimated to be u IDF region.

For the first time to quantify the un prevalence estim around the globa diabetes was est 11.4% [339-536 m

By 2040, it is estimated that this region will be home to over 1.8 billion adults aged 20–79.

Europe Europe has the highest number of children with type 1 diabetes, with approximately 140,000 children currently living with the condition and an estimated increase of around 21,600 new cases per year.

This region is home to the country with the world’s highest incidence of type 1 diabetes in children – Finland. Researchers are investigating why Finland, known to be one of the cleanest and wealthiest countries in the world, has the greatest number of new cases of type 1 diabetes in children under 15 years of age. There are 62.3 cases per 100,000 children each year, in comparison to 22.5 cases per 100,000 children in Australia. The study, undertaken by the University of Helsinki, looks into the connection between Finland’s cleanliness and incidence of diabetes. Researchers are investigating whether the lack of exposure to a specific group of bacteria found in the intestine may be causing weaker immune systems in Finnish children, making them more susceptible to type 1 diabetes. Led by Professor of Paediatrics Mikael Knip, the study involved analysing blood and tissue samples from nearly 3,500 children from Finland, Estonia and Karelia – a part of Russia that once belonged to Finland. Despite the three areas sharing similar language and genes, the level of hygiene is lower in the poorer countries of Estonia and Karelia and the rates of type 1 diabetes are significantly lower. “Karelia, just north of St Petersburg, is poorer and dirtier than the other two study areas, and Russian children grow up playing outside and around animals, exposing them to a greater amount of bacteria. The rate of diabetes in that area is less than 10 cases per 100,000 per year – more than six times lower than the rate in Finland,” said Professor Knip. Studies looking at the connection between cleanliness and type 1 diabetes have also taken place in the USA, and Professor Knip hopes that one day researchers might be able to develop a drug or probiotic that can stimulate the developing child’s immune system and help protect against autoimmune conditions like diabetes.

Top ten countries/territories for number of adults with diabetes 1

China

India United States of America

Brazil

Russian Federation

Mexico

Indonesia

Egypt

Japan

10 Bangladesh 0

109.6 million

United States

69.2 million

China

DIABETES IN SOCIETY

Executive summary

Top ten countr related health e

B endocrinology outpatient department every WORRY IS A DIABETES 3 wasGermany for my examination the cost million month although29.3 covered by Medicare. I have relied on support Over the 30 years family for a significantly and million from my parents the fear of not ha 4 Japan 14.3 large proportion of my medication costs. and not being glucose monitor 5 its government began 12.1 million Brazil After the Chinese also worry about current medical insurance policy, the level of to cover diabetes ca for outpatient reimbursement 11.5 6 France millioncosts rose coverage. The fac 20,000 RMB (3,075 US dollars) per year. In my money therapy has creat case, I have to spend all the insurance 7 10.0 million Canada in my case it is u on my medicines, including insulin. I visit the third world coun outpatient department once per month but I worry a judge myFede million Russian RMB by October,8which 20,000 usually finish the 7.8 means I have to spend my own money for the I remember whe 9 United 7.2 million Kingd rest of year. per vi US dollars without a prescr Mrs Zhu, 79 years, diagnosed with type 2 diabetes have always be 10 Italy 7.1 million in 1987, Beijing, China gone up more t liv years I’ve100 3050 80 100 120 0 that m 2015fortunate USD I feel concerned access to insulin dying because t that has been ar

Mrs Zhu’s Story My name is Mrs Zhu. I live in Beijing and I was diagnosed with type 2 diabetes in 1987. I was 50 years old and working as a middle school teacher, earning a salary of around US$100 per month. In the beginning I took oral 38 medication, but it wasn’t long before I was moved onto insulin injections and I have been on them for the past 18 years. I had to spend US$77 per month on blood glucose strips to help manage my unstable blood glucose levels, and was forced to retire from my job five years early due to my type 2 diabetes and related complications. Over the years I have had to rely on support from my parents and family for a significantly large proportion of my medication costs. The Chinese government’s medical insurance policy currently covers outpatient costs up to US$3,075 per year, so this helps with medicines and clinic visits but I usually use up my allocation by October and have to cover the costs myself for the rest of the year.

I was recently arthritis (RA) medication. Lik arthritis is an a have one auto more susceptib given me anoth and care. Costs many medicatio employed peop under Obamaca negative effect network covera their own insu costly to see m years who do n

ealth Service in Sri Lanka is free. However, the hospital was not able to issue me a glucometer (for blood glucose testing) and strips. So instead of chec king my blood glucose on a daily basis, I was only able to do so once a month during my trip to the hospital clinic. In early 2016, my paediatrician referred me to the Diabetes Association of Sri Lanka (DAS L) in South-East Asia Colombo for further follow up and man agement The South-East region India, of my Asia diab etes.comprises At the of association, I am given Bangladesh, Nepal, Sri Lanka, Mauritius, and the syringes, glucometer, stripBhutan s and lancets free of Maldives. According to the IDF’ s Diabetes Atlas, there charge. Also, my medical reviews areare close tofree 80 million people living with diabetes and halfcove of red for at DAS L. these cases are undiagnosed. My father is unemployed and has been disabled India is home to the second largest number of adults for 30 years following an accidental fall from a living with diabetes worldwide, after China, and this is coco tree. I have fourpeople sistelooking rs, buttoour mother causing majornut social issues for young left us partner. for anot her manand whe n I was seven years. find a life-long Matrimony arranged marriages Two of in my r siste rs are married are big business theolde Indian culture; however, people and they live in sepa rate es from living with diabetes arehom considered to beme. a poor choice by sister is My third ntlypotential in a prob ation parentscurre choosing suitors forhom their children. e for young mothers. My younger sister (6 years old) and I live at home Dr A.K. Jhingan, Chairperson of the Delhi Diabetes with my father. Our total family income is 6,000 Research Centre (DDRC), says there are a number of Sri Lankan Rupees [USD 40] a month which myths and concerns about marrying someone with diabetes, such as the fear that they cannot produce a s Voice Volume 61 - Issue 2 June 2016 healthyDiabete child.

“More often than not, men living with diabetes chose to remain silent about their condition before entering matrimony out of concern that the match will be rejected. There are misconceptions that they will not live long, can’t have a normal life and that future children will inherit the same condition,” said Dr Jhingan. A survey conducted by the DDRC revealed that of the married women living with type 1 diabetes, nearly 50 per cent were sent back to their parents’ homes within a year of marriage. “In one case, a young bride was sent back to her parents less than a week after her wedding because her new parents-in-law saw her taking insulin injections. Despite generating an income for the family as a teacher, they thought she would be an economic burden.” Dr Jhingan is working hard to reduce the negative stigma and misconceptions surrounding diabetes throughout South-East Asia, and has even founded www.diabeticmatrimony.com – an online dating website pairing hundreds of people living with diabetes with each other.

She was initially on rapid acting insulin however; we have now changed her insulin thera py to a pre mixed preparation. Her latest blood result is an HbA1c of 8%.

Miss Thilini is an 11 year old school girl who was diagnosed with type 1 diabetes in 2007 at age of 1 1/2 years.

Thilini’s Story

My name is Thilini, I am 11 years old and live in Sri Lanka. I was diagnosed with type 1 diabetes when I was 18 months old and I visit the hospital 45 minutes’ drive away to see my specialist once a month. I live with my father, who is unemployed and disabled after falling from a coconut tree 30 years ago, and my younger sister. Our family income is just US$40 a month. Our home was destroyed in the December 2004 Indian Ocean tsunami and we live in a home funded by foreign aid. Over the last 10 years I have only been able to test my blood glucose levels at my specialist appointments once a month. I was able to receive basic medical supplies and insulin free of charge through the National Health Service in Sri Lanka, but unfortunately I was not able to receive a glucometer and strips. Thankfully, I was referred to the Diabetes Association of Sri Lanka for further treatment in early 2016 and the association was able to provide me with syringes, a glucometer, strips and lancets so that I can self-manage my diabetes.

Region which has the highest prevalence per capita with one out of eight adults with the disease.

In the sixth edition, the choice of which country to use for extrapolation was primarily based on similarities in World Bank income levels. In this seventh edition, countries for extrapolation Europe has the highest number of children with were chosen on the basis of similar ethnicity, type 1 diabetes; approximately 140,000, and faces language, geography and World Bank income an increase of around 21,600 new cases per year. levels. In 2015, it is estimated that between 9.5 million and 29.3 million people live with diabetes In the South-East Asia Region, 24.2% of all live in the Africa Region. Of these, three quarters are births are affected by high blood glucose during North America & Caribbean estimated to be undiagnosed, the highest of any pregnancy. In the Middle East and North Africa two out ofinfive with diabetes are “InIDF myregion. mind, the increase in cost makes absolutely no sense. “One Region, adult in eight theadults North America undiagnosed. In the South and Central America We lived in a third world country, able to obtain the same For the first time, intervals have been produced andRegion, Caribbean region has diabetes” the number of people with diabetes will exact product, at a fraction of the cost – without insurance! to quantify the uncertainty around diabetes For the average Ghanaian family, diabetes supplies, increase by 65% byCanada, 2040. this region consists As well as the USA, Mexico and prevalence estimates. The uncertainty interval albeit life-saving, are financially out of reach. For the average of over 25 Caribbean countries and territories. An estimated around the global estimate of adults with It is particularly challenging to estimate the total American family, in the absence of medical insurance, the 44.3 million people are said to be living with diabetes, with diabetes was estimated to range from 7.2% to number of people with diabetes in the Africa same thing applies,” said Mrs Zigah. the vast majority residing in urban areas. Region, as more than three quarters of countries 11.4% [339-536 million]. “I am thankful my daughter has insurance. But if we did not, The United States of America has the highest diabetes-related we’d move back to Ghana in order to keep my daughter alive. health expenditure – US$320 billion for their 29.3 million Given the rising costs of insulin we’d have no other choice.” adults living with the condition. China comes next at US$51 billion, though their total of 109.6 million people is over three times greater than the number of people living with Top ten countries/territories for number of Top ten countries/territories for diabetesdiabetes in the USA. adults with diabetes related health expenditure (R=2*) Despite being a well-developed country with world-class 320 billion health facilities, government provided health cover is109.6 limited 1 China 1 United States of America million 320 billion and private health insurance in the USA comes at a very high 51 billion 2 India 2 China 69.2 million 90 billion cost. For those who can’t afford insurance, an unexpected trip 35 billion 3 United 3 Germany to the emergency roomStates can easily cost thousands of dollars of America 29.3 million 33 billion and the cost4of diabetes treatment is no different. 29 billion 4 Japan Brazil 14.3 million 28 billion

The Zigah family from the USA were living in Ghana, West 5 Russian Federation 12.1 million Africa when their seven-year-old daughter was diagnosed 6 Mexico 11.5 million with type 1 diabetes. As expatriates working abroad, they 7 Indonesia million were “rich enough” to afford insulin, syringes, lancets, 10.0 a blood glucose meter and glucose strips outright. The initial outlay 8 Egypt 7.8 million cost US$133.50, and when their daughter switched to a more 9 Japan 7.2 million expensive analogue insulin, insulin pens were US$100 each. 10 Bangladesh

7.1 million

When the family returned to the USA, the costs for the exact 0 20 40in comparison 60 100 same insulin were astronomical –80up to five times as much as they paid in Ghana.

120

Brazil

22 billion 29 billion

France

19 billion 17 billion

Canada

17 billion 14 billion

Russian Federation

14 billion 23 billion

United Kingdom

13 billion 12 billion

Italy

12 billion 12 billion

50 2015 USD

100

150

200

250

300

350

2015 International Dollars

Executive summary

South & Central America This region includes 20 countries and territories in South & Central America, and is home to approximately 29.6 million people living with diabetes. Emanuel Vaccari, Argentina’s IDF Young Leader in Diabetes, has been living with type 1 diabetes for 10 years. While his diagnosis came as a shock, Emanuel was able to learn more by participating in diabetes camps and committees, and is now returning the favour by helping young people being diagnosed with the condition.

“Argentina has a law that says people living with diabetes have the right to receive appropriate treatment and are able to live with a great quality of life. Unfortunately, people living in remote cities do not have this benefit or are unable to access it,” said Emanuel.

According to Emanuel, it is estimated that there are nearly three million people with diabetes in South & Central America, and of this, only 65 per cent know they are living with the condition.

Statistics and graphics in this article were reproduced from the IDF Diabetes Atlas with copyright permission. If you would like to view the full copy of the Atlas, visit http://www.idf.org/idf-diabetes-atlas-seventh-edition. IDF also assisted with personal stories and images via their Life for a Child Program and Diabetes Voice magazine.

referrals 491total occasions 805 of service referrals for 54 the Aboriginal community

Telehealth Success

he Diabetes Telehealth Service for Country WA commenced in January 2015 and was designed to fill the gap in regional and remote Western Australia where the opportunity to have a consultation with a diabetes educator was limited or did not exist. Out of the 120,000 West Australians currently living with diabetes, over 28 per cent reside outside major cities and had been experiencing difficulty accessing specialised diabetes information and support.

Funded by the Western Australian Country Health Service (WACHS) Southern Inland Health Initiative and subsidised by the state governments Royalties for Regions program, the free service delivered by Diabetes WA has proven to be a great success. At the time of publication, our qualified and credentialed diabetes educators have held 805 sessions throughout Western Australia, assisting participants from the south-west coast, remote inland areas and all the way up to towns and communities in the north-west of the state. The core element of the Diabetes Telehealth Service for Country WA is the use of video conferencing technology. Video conferencing is like having a face-to-face appointment with a diabetes educator but you need not be in the same physical room, town or region. Communication can occur through a computer, television, tablet or phone screen and consultations take place at local hospitals, health centres, doctors’ offices or at community resource centres.

This allows diabetes educators working in the Diabetes WA Subiaco Office to provide one-on-one or small group consultations for people requiring support in managing their diabetes no matter where they live. Participant feedback from the first two years has been outstanding, and it is clear the service is making a huge difference in reducing the distance barrier for people living with diabetes in regional WA. In addition to providing diabetes education services to residents throughout WA, the Diabetes WA team conducts regular information sessions for health professionals working in regional areas. From March 2015 to September 2016 the team provided 33.5 hours of upskilling and professional development to 649 attendees. These sessions cover a range of topics including diabetes medications, hypoglycaemia management and type 1 diabetes and mental health.

In the future, the Telehealth team at Diabetes WA will continue to establish the service as a core option for country residents while working closely with existing health partners in the regions. This will ensure every person living with diabetes in Western Australia will receive high quality care and assistance to successfully manage their condition. If you would like to book an appointment using the Diabetes Telehealth Service for Country WA, speak to your doctor for a referral or contact Diabetes WA on 1300 136 588. Further information about the service can be found online at www.diabeteswa.com.au “The support I received prompted me to be more careful about managing my condition. I became more interested in my own health and the service cost me nothing except a better insight into taking my own health care seriously.”

Removing the Distance Barrier

ew technology such as video-conferencing has made access to diabetes education easier than ever before; however, face-to-face contact and involvement in group programs play an important role in improving diabetes self-management.

Throughout 2015/16, the Health Services team at Diabetes WA has worked with local health professionals to identify barriers that have prevented people in rural areas from participating in DESMOND programs. DESMOND – Diabetes Education and Self-Management for the Ongoing and Newly Diagnosed – is a group education program for people with type 2 diabetes discussing topics such as healthy food choices, physical activity and medication management. DESMOND is now being delivered from the Kimberley to the Great Southern, as well as in Aboriginal communities throughout WA. Barriers to access included administration issues when promoting upcoming sessions in rural areas and booking in participants, as well as a lack of availability of DESMOND facilitators with current knowledge to run the programs. In order to remedy the first issue, Diabetes WA has begun offering greater administration and promotional support to those running DESMOND in the regions. Some regional DESMOND facilitators identified that, as they did not have many opportunities to deliver the program, they were no longer confident in their ability to do so. To remedy this we hosted two free DESMOND study days in target regions, enabling facilitators to refresh their knowledge of the curriculum. We also began making our own DESMOND facilitators available to co-deliver the program in some areas. The feedback generated by our increased support has been overwhelmingly positive. Regional DESMOND sessions are now filling up and, in the Wheatbelt, the program is so popular that the majority of sessions currently have waiting lists. If you would like to find out more about DESMOND sessions taking place in your area, email info@diabeteswa.com.au or call 1300 136 588.

Support across the State A diagnosis of diabetes can come as a big shock, and many people often feel isolated and alone in those first few weeks. Speaking to a friendly face who understands what it feels like can make all the difference, and support groups play a big part in connecting people with others also living with the condition. According to a new study titled Diabetes peer support in Australia: A National Survey, almost 70 per cent of people with diabetes find peer support helps their diabetes self-management, improves their wellbeing and helps them connect to health services. “Peer support provides people with the opportunity to share knowledge, experience, emotions, ideas and concerns with other people with diabetes,” said Dr Jessica Browne from the Australian Centre for Behavioural Research in Diabetes. “Peer support helps people to share the emotional burden of living with the condition and it can effectively supplement and reinforce the knowledge and expertise offered by health professionals. People can also learn how to better access the services they need.” The report also showed that while face-to-face group sessions are still the most popular, 25 per cent of respondents are now participating in online forums or Facebook groups for support. Here in WA, support groups stretch from Bridgetown in the south-west to Broome in the far-north, and there are also a number of online groups you can join. Groups are coordinated by volunteers living with diabetes and held on a regular basis at community halls, sports clubs and cafés.

Type 1 Diabetes Location

Group

Contact

Online

YWAIT (Young Western Australian Insulin Takers) 18–30 year olds but all are welcome – online support on Facebook and occasional events.

Rachel Lamb E: ywait@live.com.au

Online

myD Group Young adults with type 1 diabetes Facebook page

http://myd.ndss.com.au

Online

WAIT (Western Australian Insulin Takers) 30+ year olds but all are welcome – online support on Facebook and occasional events.

Julie-Anne Watson M: 0432 955 616 E: westernaustralianinsulintakers@yahoo.com.au

Northern Metro

Parents of children with type 1 diabetes Meet on a regular basis at different locations. Children welcome to attend.

Olivia Marcinkowski P: 0410 556 935 E: bartjmar@bigpond.com

Type 1 and Type 2 Diabetes Location

Frequency

Contact

Bridgetown

Meetings 10.00am on 1st Tuesday of the month at the Old Convent.

Joyce Ingram P: 9761 4208

Broome

Monthly meetings

Terri or Bernadette at BOAB Health Service P: 9192 7888 E: terri.oliver@boabhealth.com.au

Osborne Park and Innaloo

Meetings 9.30am on 4th Thursday of the month at Innaloo Sportsman’s Club

Gwen Stonehouse P: 9204 1510

Rockingham

Monthly meetings at Palm Beach Café, Rockingham

June Streeter P: 9527 3850 E: junehs@bigpond.com

Yanchep Two Rocks Area

Meetings 10.00am on 3rd Wednesday of the month

June Sims P: 9561 1174 E: ljsims@bigpond.com

Peripheral Neuropathy Location

Frequency

Contact

Nedlands

2nd Monday of the month

June Gascoigne P: 9296 7190 E: junegascoigne@westnet.com.au

Rockingham Support Group needs new members! There are almost 2,000 people living with diabetes in Rockingham, yet the local support group has just three loyal members! June Streeter heads up the group and encourages new members to join them for morning tea at the local café once a month. The group offers a wealth of knowledge and understanding on what living with diabetes is like, as well as great conversation and the opportunity to grow new friendships. Contact June on junehs@bigpond.com for upcoming meeting dates.

Start a support group We need more support groups! If you would like to connect with people living with diabetes in your area, why not start

your own support group and register it with Diabetes WA. We can provide you with resources to help you start a group and promote your contact details to other interested parties. To register your interest in starting a support group, please call 1300 136 588 or email community@diabeteswa.com.au

Research Round Up The latest in diabetes research

It’s great news for active people living with type 1 diabetes According to two recent studies published in diabetes and scientific reports, improving muscle health could enhance response to insulin in people living with type 1 diabetes.

It’s good news for CGM users The Endocrine Society has issued a Clinical Practice Guideline recommending continuous glucose monitors (CGMs) as the gold standard of care for adults with type 1 diabetes. Information about funding from the Australian government for CGM use is set to be released in early 2017.

It’s bad news for babies with a low birth weight A new study published in Nature journal revealed that the genetic regions linked to low birth weight overlapped with those connected to an individual’s chance of developing type 2 diabetes and heart disease.

Play a role in the ViKCoVac study A

re you aged between 50 and 80 and interested in playing a role in the prevention of heart disease?

Led by Winthrop Professor and Cardiologist Carl Schultz, Royal Perth Hospital’s cardiology team are seeking diabetes patients to be involved in the ViKCoVac study looking at calcium buildup or “hardening of arteries” in the heart. Study participants will take part in a three month trial, attending monthly clinic

appointments at Royal Perth Hospital and taking daily medication for the duration of the trial. For more information or to register your interest, contact Study Coordinator Dr Jamie Bellinge on (08) 9224 3181 or email Jamie.Bellinge@health.wa.gov.au

Half of all type 1 diabetes cases diagnosed after 30 years of age

t the European Association for the Study of Diabetes 2016 Annual Meeting, Dr Nicholas Thomas from the University of Exeter Medical School revealed that the onset of type 1 diabetes is just as likely to occur in people older than 30 years of age as in those younger. This result refutes the long-held belief aged 40 to 70 from the UK Biobank, that type 1 diabetes is primarily a juvenile a network designed to study many condition. It has only been in the last 20 diseases that includes people with and years that the terms ‘juvenile’ and ‘adultwithout diabetes. onset’ diabetes were officially changed As expected, nearly all the diabetes below to ‘type 1’ and ‘type 2,’ so the perception age 30 was type 1 and, as age increased, of it being a childhood condition still the prevalence of type 2 diabetes rose persists. Furthermore, most studies on dramatically. However, they also found type 1 diabetes have been on children that roughly half of type 1 diabetes cases and adolescents, with only a few studies were occurring after 30, but weren’t as available on adults. easy to recognise because of the vast Identifying type 1 diabetes in adulthood number of type 2 cases. is challenging because the vast majority Dr Thomas has advised clinicians of adults with new-onset diabetes have to be aware that adults can develop type 2 diabetes. Antibody tests to identify auto-immune diabetes. immune-mediated diabetes are also too expensive for routine use. “It’s knowing this does happen, and therefore just keeping an open mind when To get around this problem, Dr Thomas you spot someone who’s not behaving like used a risk score comprising 30 single type 1 or not responding as you would nucleotide polymorphisms associated anticipate when you go through the usual with type 1 diabetes (T1D-GRS). His team treatment guidelines for type 2,” said applied the type 1 genetic risk score Dr Thomas. to a cohort of 120,000 British adults

Get Involved

he Australian Centre for Behavioural Research in Diabetes (ACBRD) is looking for Australian adults living with type 1 diabetes to evaluate a new smartphone app designed to help improve hypoawareness. Participants will use the app daily for three weeks, provide information about episodes of hypoglycaemia and complete an online questionnaire. Taking part will put you in the draw to win an Apple iPad. Email strawley@acbrd.org.au for more information.

Art Therapy & Latest Research

e were thrilled to celebrate World Diabetes Day on Monday 14 November with a seminar giving an overview of some of WA’s most exciting diabetes-focused research. We were also glad to be able to award two new grants of $80,000 each to two West Australian researchers, and we look forward to continuing to support research in WA for many more years to come.

Diabetes & Art Therapy

Latest Research in Gestational Diabetes

With stress hormones often wreaking havoc on blood glucose levels, keeping stress at bay (or reducing it) is critical and we’re helping raise awareness of the benefits of art therapy to manage stress. We have released two colouring pages as a simple way for people living with diabetes (and without!) to take time out and boost relaxation and mindfulness.

With gestational diabetes becoming more common, we’re passionate about ensuring women know about new research underscoring how they can reduce their risk of diabetes during and after pregnancy, regardless of their weight.

Emotional distress is believed to impact as many as four in every 10 people with type 1 and type 2 diabetes. It can sometimes spark behaviours that can affect blood glucose levels, such as drinking more alcohol, not eating as well and exercising less. Mindful art therapy has been shown to be able to help people with diabetes manage stress, anxiety and depression. If you’re not keen on artistic time out, any activity that helps you relax, such as walking in nature, swimming, meditating or playing with pets is worth dedicating time to because high blood glucose levels can lead to many health complications. The colouring pages are available for download at www.diabetesresearchwa.com.au and community groups are welcome to contact us for multiple copies.

A study out of China and a meta-analysis from Norway recently revealed that overweight and obese women who did supervised exercise for one hour a day, three times a week during pregnancy were less likely to develop gestational diabetes than those who continued their usual activities, even if they did not lose weight. Exercise during pregnancy has also been associated with a lower risk of hypertension. These findings suggest it’s never too late to reduce your risk of being diagnosed with pregnancy-related diabetes and boost your health with exercise. Recent research has also discovered that for women who had gestational diabetes, breastfeeding for more than three months protected them against type 2 diabetes for up to 15 years after they gave birth as it led to long-term metabolic changes. Queensland researchers have also revealed that following a Mediterranean diet high in vegetables, legumes, fruit, nuts, fish and wholegrain cereal and pasta could help women reach a healthy body mass index (BMI) and therefore reduce their risk of hypertension in pregnancy.

www.diabetesresearchwa.com.au

To learn more about these topics, our work or to help us fund cutting-edge WA diabetes research, head to www.diabetesresearchwa.com.au or call us on (08) 9224 1006.

Managing Diabetes in the School Environment As part of Diabetes WA’s Mission to improve the lives of those at risk of, living with or affected by diabetes, we help thousands of Western Australians and their families by providing all the information and support they need to enjoy a full life.

wasn’t user-friendly and needed to be reviewed. Diabetes WA instigated the process to develop a nationally consistent, high-quality management and access plan, which was adapted from guidelines currently in use in Victoria and Queensland.

One area we are heavily involved in is managing diabetes in the school environment. This includes giving parents the confidence that their child is in safe hands throughout the day, preparing schools with all of the necessary information required and providing training for teachers and school nurses.

The Diabetes WA Health Services team worked tirelessly to prepare the new plans and consulted with the Princess Margaret Hospital (PMH) Diabetes Service to adapt them for use in WA. We are pleased to announce that Dr Liz Davies, Head of the PMH Diabetes Service, endorsed the implementation of the updated plans and advised that they are based on current, evidence-based best practice.

There have been a number of new developments in this area over recent months to ensure young people with type 1 diabetes can enjoy every aspect of their years spent at school.

Big Win for Management & Action Plans Every child with type 1 diabetes must have a health care plan in place before attending school. In Western Australia, the existing Diabetes Management and Emergency Response Plan (Form 6)

This is a big win for the Diabetes WA team, with the Department of Education rolling out the use of the amended plans to government schools throughout the State. Private schools have been made aware of their use, and PMH will include them in all new client packs. They can also be accessed and printed online via the ‘Professionals’ tab at www.diabeteswa.com.au

New Guidelines for School Camps For a number of years, parents, teachers and school nurses have contacted Diabetes WA for checklists and guidelines that allow young people with diabetes to attend overnight camps. Understandably, most students will want, and should be given, every opportunity to attend school camps or overnight excursions as a part of a school’s learning program, but the longer-term, round-the-clock care can make this difficult. A general lack of resources meant that teaching staff did not feel confident enough to take on the risk, and parents weren’t comfortable that their child would be safe camping in remote locations for extended periods. This inevitably meant that many young people with diabetes missed out. Throughout 2016, Diabetes WA have been working with St Hilda’s Anglican School for Girls on new camp guidelines to enable students with type 1 diabetes to go on school camps.

“While all our staff are trained with an Advanced Wilderness First Aid certificate – which includes diabetes management in a remote area; we were faced with a unique challenge with our current Year 10 group as there are four students living with type 1 diabetes,” said Matt Berry, Head of Outdoor Education. The Year 10 camp at St Hilda’s, called the Odyssey Expedition, is a particularly unique and challenging outdoor education camp. It is a mobile journey over seven days through the rugged landscape of the half a million acre Wooleen Cattle Station in the Murchison region of Western Australia, approximately 650 km north north-east of Perth. The expedition is student led in small groups and allows each group to set the tone of their trip based on knowledge and experiences gained on previous outdoor programs. “The unusually high number of students with type 1 diabetes led us to confer with Diabetes WA to ensure we had everything in place to support our students attending the camp,” said Mr Berry. “We are delighted that the result of these discussions has been new guidelines that will benefit schools, parents and students around Australia.” “Although we had processes in place to support students with type 1 diabetes, the new guidelines are more comprehensive and clearly articulate the responsibilities for the school, medical practitioners and parents,” added Mr Berry.

St Hilda’s also arranged for an outdoor education trained paramedic to attend the expedition and ensure the safety of the students throughout the journey. “All four of our Year 10 girls with type 1 diabetes successfully attended the camp – though it was challenging for them to maintain their levels given the change to their diet and exercise while away, it was an integral experience as part of the girls’ personal growth while at our school.” The checklist and management plan for families and school staff has been developed to guide them in preparation for any school camps that involve an overnight stay. The guidelines are available to download from the Diabetes WA website or you can email info@diabeteswa.com.au to obtain a copy.

Training for Teachers Diabetes WA recognises the important role that educators can play in assisting young people to manage their diabetes. As such, we have developed a range of resources and training programs for early years, primary school and secondary school settings. ‘Diabetes Awareness in Schools’ is a training program designed to increase levels of understanding and knowledge of diabetes management among school employees. This training program has been developed with input from Princess Margaret Hospital and outlines signs, symptoms and management of diabetes and hypo-and hyperglycaemic episodes.

It also discusses food choices and physical activity, with reference to insulin pens and pumps. The training session for teachers can be held on-site or via videoconference for schools in regional and remote areas. In June, Diabetes WA provided training to teachers and education assistants at Joondalup Primary School after being contacted by parent Bec Goldring. Bec’s son Alex was diagnosed with type 1 diabetes in March this year and sending him to school while adjusting to four insulin injections each day and multiple blood glucose tests was very nerve-wracking. “I’m so grateful for the training Diabetes WA have provided to Alex’s school,” said Bec. “This has helped a great deal; providing comfort as a parent of a child with diabetes and the feedback I have received from the school has been very positive.” “It’s hard enough for a six-year-old, or any school-aged child, to come to terms with the new life changes of their diagnosis. If all schools were able to provide training for their staff by the team at Diabetes WA, it would ensure an easier transition for these kids back into ‘school life’.” If you are interested in finding out more about diabetes education through schools, or would like to arrange a training session at your child’s school, visit our website. You’ll find information under Training via the Professionals tab, or call 1300 136 588 to speak to a member of the Diabetes WA Education team.

Keep Oral Disease at Bay

t’s common knowledge that living with diabetes can affect eyes, nerves, kidneys, the heart and other important body systems, but did you know that the condition can also cause complications in the mouth?

Oral disease in people with diabetes may occur due to one or more factors including poor blood glucose control, poor circulation, medications and hypoglycaemia treatments such as sweetened drinks or lollies. Smoking further increases the likelihood and severity of oral disease. People with diabetes, regardless of age, are prone to a number of oral diseases including the following:

Tooth decay People living with diabetes who have trouble regulating their blood glucose levels can experience reduced saliva flow, resulting in a dry mouth. A dry mouth encourages dental plaque to form on the teeth which may lead to tooth decay. Untreated tooth decay can lead to toothache, tooth nerve infections, abscesses and possible tooth removal.

Fungal infections Diabetes lowers the body’s resistance to infection. People living with the condition are more likely to experience fungal infections such as thrush. The fungus Candida Albicans, which causes oral thrush, grows on the soft tissues within the mouth and may present as white bumps on the tongue, inner cheeks, tonsils and/or gums. Some people also notice redness and cracks at the corners of the mouth. People experiencing oral thrush may find it difficult to swallow and consequently choose foods that are easier to eat, which may not support their diabetes management plan or promote good oral health.

Gum disease Gum disease is caused by bacteria which produce toxins and create gum inflammation. Mild gum disease (gingivitis) may result in inflamed and/or bleeding gums and bad breath, while moderate to advanced gum disease (periodontitis) may result in the presence of pus within the gums or loose teeth from loss of bone structure around the teeth. Patients may also feel a change in their bite or notice spaces developing between their teeth. Increased amounts of food packing between the teeth can also be an indication of gum disease. Slow healing after extractions or oral surgery can also be a consequence of diabetes. This is due to the thickening of blood vessels, delaying the delivery of nutrients to tissues.

People with diabetes are three to four times more likely to develop periodontal disease. Over the past 10 years, research has been undertaken on the link between diabetes and periodontal disease. Periodontal disease is the sixth leading complication of diabetes. For people with diabetes, the management of periodontal disease is extremely important as emerging research suggests that the relationship between periodontal disease and diabetes is two-way. Not only are people with diabetes more susceptible to periodontal disease, but periodontal disease has the potential to affect blood glucose control and contribute to the progression of diabetes.

How can you improve your oral health and help prevent oral diseases? Adoption of several healthy habits are required to improve your oral health, including: • Brushing your teeth twice a day with fluoride toothpaste and a soft brush. Take care to remove all plaque on and between your teeth and next to the gum line. It is also a good idea to gently brush your tongue each day to remove bacteria and keep your mouth fresh and healthy. • Using dental floss or interdental cleaners every day to clean plaque build-up from between your teeth. • If you have dentures (full or partial), remove them overnight and clean them daily. • Avoiding a dry mouth by drinking plenty of fluoridated tap water and chewing sugar-free gum to stimulate saliva production. • Following treatment for hypoglycaemia, it is important to brush your teeth half an hour later to remove sugar from your teeth to prevent decay and cavities; or if you can’t brush at that time, chewing sugar-free gum may help stimulate saliva. • Visiting your dentist or other oral health professionals regularly (even if you wear dentures, you are still at risk of gum disease) and booking your appointments for the morning when your insulin level is more stable. • Looking for early signs of gum disease (inflamed and/or bleeding gums). • Keeping blood glucose levels within target ranges to ensure efficient blood circulation in the mouth, and taking medications as prescribed by your health professional.

• Quitting smoking. In addition to the well-known effects of smoking, smokers have higher levels of gum disease caused by poor blood circulation in the tissues around their teeth. People with diabetes who smoke have a much greater chance of developing severe gum problems. Speak to your dentist or oral health care professional for more information on keeping oral disease at bay. If you need assistance locating a private dentist, visit www.ada.org.au/Find-a-Dentist. Dental Health Services is also available on (08) 9313 0555 for health care or pensioner concession card holders.

Photo courtesy of WA Department of Hea lth

Gary Goanna and the ‘Fairy Croc Father’

iabetes WA is currently supporting the University of Western Australia Dental School’s efforts to spread dental messages to kids in Aboriginal communities by sharing the use of our popular ‘Gary the Goanna’ character for the promotional campaign. Gary Goanna has become a firm favourite with children throughout Aboriginal communities thanks to the release of the Gary Goanna Goes Healthy book teaching children to choose healthy food and drinks to prevent type 2 diabetes. Promotional posters produced for the oral health campaign contain Gary Goanna and his new friend, the ‘Fairy Croc Father’, and aim to encourage kids to brush their teeth twice-a-day and choose water and healthy treats over sweet drinks and lollies. Additional posters also teach parents the importance of only putting water or unflavoured milk in bub’s bottle, and that the first dental visit should coincide with the child’s first birthday.

Get Moving with Get on Track D

iabetes WA’s Get on Track Challenge is a free, online, team-based challenge designed to help you increase your daily physical activity and fruit and vegetable intake. Funded by the WA Department of Health, Get on Track Challenge has been encouraging Western Australians to move more and eat better since 2008. The program is based on the latest behaviour change research, which supports consistent, small changes for long-term health outcomes. Official Challenges are coordinated bi-monthly, with each one lasting around six weeks. Workplaces are encouraged to team up in groups of four, tracking fruit and vegetable intake and physical activity in order to move around a virtual track. Teams compete against other workplaces throughout the State, with great prizes up for grabs for the winning teams. The most recent Diabetes WA Official Challenge began on 29 August and involved 111 teams ‘virtually’ touring the Kimberley region. Teams started in Broome before visiting the rugged gorges and epic waterways along Gibb River Road and trampling the Bungle Bungles before finishing up in WA’s far north-east at Kununurra. The race finished on 10 October and the hotly contested win was taken out by the DICWAMERS1 who covered 3,104.86 virtual kilometres, followed by the Jolly

Walkers with 3,064.65 km and the Traveling Turtles with 3,039.73 km. First place winners, the DICWAMERS1 (Does It Come With a Medal), said they joined the Challenge due to their competitive nature and the ability to take part online. Team members boosted their exercise levels by cycling, walking, running and swimming before and after work, and reminded each other to eat the required amount of fruit and vegetables each day. “The best thing about participating in the challenge was the competitive banter with other teams at our work place, and it was great to see the progress we made each day along the track,” said Amanda Murphy, team captain of the DICWAMERS1 team. Runners up by just 40kms, the Jolly Walkers consisted of four work friends from the Department of Regional

Development. This was their fourth time taking part in Get on Track Challenge, and feel that it is a great way to motivate each other to exercise more frequently and be aware of eating healthy snacks. “We sit in front of a computer all day, so instead of carrying unhealthy snacks we tried to substitute them for fruits and vegetables and encouraged each other to eat healthy foods,” said Shirley Driver from team Jolly Walkers. “The healthier lifestyle made me feel much more energised and we enjoyed the camaraderie that we formed as part of the team.” “I would absolutely recommend the challenge to others; we are promoting Get on Track at our workplace and will be broadcasting our recent success to our fellow employees,” concluded Shirley.

Upcoming Official Challenge dates and tracks can be found online at www.getontrackchallenge.com.au, or, alternatively, you can create your own challenge to suit the specific needs of your workplace or group. If you would like to know more about getting involved in the Get on Track Challenge, email gotc@diabeteswa.com.au

Jolly Walkers team members Angela, Tani ele, Shirley and Cecilia

Live Stronger Together at Curves D

esigned specifically for women, Curves offers a program that combines strength training, cardio and stretching for every fitness level. The scientifically proven 30 minute work-out, in conjunction with personalised meal plans and weekly group coaching sessions, has helped many women achieve their personal health goals and live stronger together. Women’s fitness group Curves WA is a member partner of Diabetes WA and maintains a strong connection with the diabetes community. Many Curves members are living with diabetes and use the program to start on their journey in search of a healthier lifestyle. Mandy, a working mother with type 1 diabetes, was drawn to Curves because she felt the 30 minute work-out would be achievable despite her busy lifestyle. She attends four sessions per week and was amazed to lose over 11 kilograms and lower her blood glucose levels from an average of 11 to her target level of 6.

“I would definitely recommend Curves to others living with diabetes, as not only do you feel much healthier,

you have more energy and the results show in more controlled, lower blood sugar levels which I believe will make a difference as we get older,” said Mandy. Managing diabetes can be overwhelming especially with busy lifestyles. Curves WA empowers women with knowledge and education to make better informed choices day-to-day and move them towards a healthier lifestyle. Whether it’s advice on eating the right food or personal guidance using equipment, Curves have the expertise to help women realise their full potential in a non-judgemental and safe environment. Curves isn’t just a gym, it’s a healthy, sustainable future. For your nearest Curves Club go to www.curves.com.au

Christmas Eating On-the-Plate T

he festive season is a time for celebrating with friends and family and, more often than not, these gatherings revolve around food. Whether it be the traditional Christmas roast dinner, an Aussie seafood feast, tasty canapés at the work Christmas party or Nan’s famous trifle made just once a year – the silly season is full of opportunities to ‘eat, drink and be merry’ and indulge in our favourite treats. Unfortunately, reality sets in after all the chocolate gifts have been consumed on Boxing Day. As per usual, you start the New Year with a few extra kilograms on board and lots of resolutions to break the same bad habits. So keep reading and arm yourself with some tips about Christmas eating so you can enjoy your pudding guilt-free! The release of the 2013 Australian Dietary Guidelines saw the guidelines and health professionals using a new term: ‘discretionary foods’. Confusing for some, this was meant for those foods that are high in saturated fat, sugar and salt. Think takeaways, chips, soft drink and chocolate or, at Christmas time, the fruit mince pies, shortbread and rocky road. Another way to view these foods is to think of them in terms of what we should have on our plates, the ‘on-the-plate’ foods, versus what belongs ‘off-the-plate’. On-the-plate foods are those that we know are full of nutrients, vitamins and minerals. We classify them under five groups known as the core food groups. They include breads and cereals; meat; dairy; vegetables and fruit. The amounts of each of these foods that we should eat each day depends on our age, gender and physical activity levels. These foods are vital for good health and wellbeing.

The main problem is our tendency to over indulge in off-the-plate foods – the ones that we don’t need every day. Up to 35 per cent of the food that Australians consume each day can come from these foods, and they are usually kilojoule dense, meaning it is easy for us to eat more than we require daily. When we do this on a regular basis, we tend to slowly, progressively put on weight until suddenly we are 10 or 15 kilograms heavier than our goal weight. This excess weight gain is what can cause chronic conditions such as type 2 diabetes and heart disease. Some big contributors to off-the-plate foods include alcohol, cakes, biscuits, soft drinks and confectionery foods, as well as convenience foods high in fat, sugar and salt. Throughout the Christmas period, it’s important to focus on eating a wide range of on-the-plate foods at the various festive gatherings, and enjoying the off-the-plate foods as a special treat rather than an everyday occurrence. This doesn’t mean you have to forgo your favourite desserts at the Christmas buffet, but choose to fill the majority of your plate with delicious roast meat and vegetables, and stick with a small serving of yummy pavlova – with plenty of fruit salad on the side! Starting a new way of thinking about the types of food you are eating, as well as how often you are eating them, will help you develop a healthy eating mindset to take into the New Year and beyond.

Can Food Be Healthy? Dr Joe Kosterich www.drjoe.net.au

nce in a while one reads something that causes a double take. An article in The Washington Post entitled “No food is healthy. Not even kale” essentially made the point that no food is healthy. Sounds totally against all current thinking. We hear so much about whether one food or another is ‘healthy’. This seems to change weekly and is often contradictory. But if you think about it for a moment, the notion that no food is healthy actually makes tremendous sense. Food can provide nutrition but is not of itself healthy. As human beings, we can be healthy or not and this is not solely a function of what we eat. Roxanne Sukol of Cleveland Clinic told the Post “Our food isn’t healthy. We are healthy. Our food is nutritious. Words are the key to giving people the tools they need to figure out what to eat. Everyone is so confused”.

At the neighbourhood street party ….. Swap potato crisps for pretzels – calories are reduced by 30 per cent and the saturated fat reduces significantly.

At the end-of-year office celebrations…. Swap meatlovers pizza for vegetarian – this provides a 40 per cent reduction in calories, increased fibre and a wider range of vitamins and minerals from the various coloured vegetables.

At Christmas Eve drinks …. Swap full-strength beer for mid-strength – this not only gives your liver a break from the alcohol but the calories have been reduced by a third.

At the Christmas BBQ ….. Swap the fatty lamb chop for a lean lamb chop with the fat cut off – immediately you’ve cut off 100 calories and reduced the saturated fat by a third.

This nails it. So many people are confused about a myriad of claims made about foods. This is particularly the case with processed foods with ‘added’ this or that. Why has it been added and what process was involved? Some are labelled ‘natural’ or ‘all natural’ but what does that mean? Let’s keep it simple. An apple or carrot is natural. It has not been processed and nothing has been added. Butter is churned milk. Eggs are unprocessed. Fresh meat, fish, poultry and legumes are not processed. You can see the pattern here. If we eat nutritious foods then we are more likely to be healthy. If we change our thinking about foods, then the question shouldn’t be ‘is this food healthy?’ It should be ‘is this food giving me nutrition that my body needs?’

Diabetes WA Christmas Favourites W

e love the festive season here at DWA. And even though Christmas treats are often well-earned after spending a long lunch with Great Uncle Harold, as he falls asleep at the dining table, it is important to remember… everything in moderation.

Here are some of the DWA Team’s favourite recipes that they share with their family and friends at Christmas.

Grumps’ Christmas Turkey What’s a traditional Christmas meal without a turkey? – though some Aussie seafood lovers might disagree! After years of enjoying her Dad’s juicy turkey, Tash, from the Communications Team says, don’t be afraid to get your hands dirty while preparing this dish. TIP from Grumps: “As a general rule a 6kg bird will feed 10 adults (and a few days of leftovers).”

Serves 10

• Energy 1471.8kJ • Protein 32.2g •Total Fat 17.7g • Saturated Fat 5.5g • Carbohydrate 14.2g • Sugar 6.9g • Dietary fibre 1.3g • Sodium 570.1mg

Ingredients

Method

Stuffing: (Quantities dependant on the size of your turkey)

Stuffing: Chop and mix everything together, whisk the egg and mix through, add a little water to hold it loosely together. Set aside.

• Breadcrumbs

Turkey: 1. Dry off the bird and leave out long enough to reach room temperature. 2. Mix ingredients together to form a thin paste. 3. Carefully lift the skin from the body of the turkey by poking your finger under the skin, starting at the ‘neck hole’, and moving as far as possible down the breast without breaking skin. Stuff the mix under the skin as far down the breast as possible. Massaging on the surface will move it further down. 4. Rub any mix left over on the outside of the bird. 5. Stuff the inside of the turkey with the stuffing mixture.

• Raisins or sultanas • Brown onions • Lemon pieces • Celery • Bacon • Mixed fresh or dried herbs (parsley, rosemary, oregano and thyme) • 1 Egg. Turkey: • Lots of minced garlic • A little melted butter • Olive oil • Lemon juice • Herbs (as above) finely chopped.

Nutritional Information per serve

Cooking: 1. Preheat the oven to 200°C, reduce to 180°C after 30 mins of cooking. 2. Put some water at the bottom of the roasting pan to keep the environment moist. 3. Rub some olive oil and a little salt over bird, place it breast up and cover the whole thing with a foil ‘tent’. 4. Cook for 30 mins per kilo or until the turkey juices run clear when skin is pricked and lightly pressed with a knife. 5. Baste every 25 mins. Cover any parts that are darkening too much with foil to stop them burning or drying out (often the breast and tops of thighs).

Great Auntie Norma’s Stuffed Baked Pumpkin Magazine Editor, Stacey, loves her Great Auntie Norma’s pumpkin recipe because it brings back childhood memories of the chaos of her family’s Christmas.

Serves 10-15 as a side dish

Ingredients • 1 large kent pumpkin • ½ tsp each of salt, pepper, & ground nutmeg • 5 tbls butter • 1 finely chopped sautéd brown onion • 1½ cups fresh breadcrumbs • 1 cup chopped ham or cooked bacon bits • 1 bay leaf • 1 carton reduced-fat cream • ½ tsp dried sage

Nutritional Information per serve (14 serves)

• Energy 1035.7kJ • Protein 7.5g •Total Fat 17.8g • Saturated Fat 10g • Carbohydrate 12g • Sugar 7.5g • Dietary fibre 2.6g • Sodium 330.3mg

Method • 1 clove crushed garlic • 1 carton light sour cream (how much cream depends on size of pumpkin) • ½ cup grated Swiss cheese or any tasty cheese • ½ cup unsalted nuts you prefer. I use cashews. • Aluminium foil – to wrap pumpkin in • Baking dish that the pumpkin fits snuggly into.

1. Cut circular lid out of the pumpkin, about 12cm in diameter. Angle the knife towards centre so side of lid is a wedge shape. 2. Scoop out seeds and stringy bits (this is the hardest part). 3. Mix salt, pepper and nutmeg with 2 tablespoons of the butter and smear inside pumpkin and lid. 4. Sauté onion in remaining butter, remove from heat and stir in breadcrumbs, sage, ham or bacon, nuts and cheese. Put into pumpkin, then pour in both creams. Give it a bit of a stir then place bay leaf on top. 5. Put pumpkin lid on and place into baking container and cook in a hot oven – 225°C – for 1.5 hours. Then a further 30 mins at moderate heat – 180°C – or until soft when pierced with a skewer. TIP from Norma: “I sometimes start cooking the prepared empty pumpkin in the microwave to hasten cooking. Good luck and happy eating.”

Nicola’s Summer Berry Pudding This light summery pudding, full of sweet berries, is a refreshing end to Health Services Program Coordinator Nicola’s family Christmas meal. As Nicola is gluten-intolerant, she uses gluten-free bread for this recipe.

Nutritional Information per serve

• Energy 830.4kJ • Protein 4.8g •Total Fat 1g • Saturated Fat 0g • Carbohydrate 45.6g • Sugar 20g • Dietary fibre 7.2g • Sodium 348mg

Serves 10

Ingredients

Method

• 1kg mixed berries, fresh or frozen

1. Place 800 grams berries, sugar and water in a medium saucepan and cook until juices run (about 3-4 minutes for fresh and 8-10 minutes if frozen). 2. Meanwhile, line pudding basin with bread ensuring that there are no gaps (cut to fit). 3. Remove approximately 1/3 cup juice from saucepan and then spoon remaining berries and juice into bread-lined pudding basin. 4. Cover berries with remaining bread and then gently spoon over a few tablespoons of the reserved juice so that the bread is all red in colour. Cover the remaining juice and store in the fridge. 5. Cover pudding with a clean saucer that fits just inside the pudding basin and then put a heavy weight on top (e.g. a heavy plate). 6. Refrigerate the pudding for at least four hours. 7. To serve, remove pudding from fridge and discard saucer. 8. Place a serving plate over the pudding base and carefully invert the pudding onto the plate. If there are any white spots on the bread, cover these up with the reserved juice. 9. Decorate with reserved fresh berries and serve with cream or custard.

• ¼ cup sugar • 45mls water (3 tablespoons) • Fresh bread (crusts removed) to cover the inside of a 1 kilogram pudding basin, about 8 regular slices or 500 grams gluten free bread.

More Please Manu! M

anu Feildel, co-host of one of the country’s best-loved TV programs, My Kitchen Rules (MKR), shares with us two of his family recipes, which he says you’ll love to cook and share.

Images and recipes from More Please! By Manu Feildel with Clarissa Weerasena (Murdoch Books) RRP: $39.99

Oven-baked ratatouille Manu says: If you’re not a big fan of vegetables, I have a feeling this recipe from the south of France will change your mind. Ripe vegetables are baked together with garlic and fresh herbs, and the result smells like summer.

Nutritional Information per serve

• Energy 351kJ • Protein 2.8g •Total Fat 4.1g • Saturated Fat 0.6g • Carbohydrate 6.6g • Sugar 6.1g • Dietary fibre 4.9g • Sodium 23mg

Serves 4 as a main or 6 as a side

Ingredients

Method

• 60ml olive oil

1. Preheat the oven to 200°C. 2. Place a frying pan over medium heat, add 1 tablespoon of the olive oil and sauté the onion for about 15 minutes, or until lightly golden, reducing the heat a little if the onion begins to catch. Add the garlic and 1 tablespoon of thyme and cook for 2 minutes. Spread the onion mixture over the base of a large roasting tin. 3. Wash the veggies and cut them widthways into 1cm thick slices. 4. Tightly arrange the vegetables in rows over the onion base, starting with the zucchini, followed by the eggplant, then the tomato. Gently push the slices out so they sit in a diagonal pattern, exposing some of the flesh. 5. Drizzle with the remaining olive oil and sprinkle over the rosemary and remaining thyme. Season with salt and pepper and bake for 45 minutes, or until the vegetables are tender.

• 4 brown onions, thinly sliced • 4 garlic cloves, thinly sliced • 2 tablespoons thyme leaves • 3 large zucchini • 3 Japanese eggplants • 6 truss tomatoes • 2 tablespoons coarsely chopped rosemary • Sea salt and freshly ground black pepper

Nutritional Information per serve

Hokkien noodles with pork and prawns Manu says: What’s not to like in this crowd-pleasing recipe? Easy to cook and even easier to eat, it’s everything you want in a noodle dish. As with all stir-fries, make sure you have all the ingredients and sauces prepared and close to your wok before you start cooking.

• Energy 2087kJ • Protein 29.7g •Total Fat 18.4g • Saturated Fat 3.9g • Carbohydrate 51.2g • Sugar 3.1g • Dietary fibre 4.9g • Sodium 1086mg NB: The sodium content in this recipe is quite high. To reduce your salt intake, consider using salt-reduced soy sauce and chicken stock.

Serves 6

Ingredients

Method

• 250g pork scotch fillet, thinly sliced

1. To make the marinade, combine all the ingredients in a bowl. Add the pork and stir to coat thoroughly, then cover and set aside for 30 minutes. 2. Wash the choy sum well, then separate the leaves from the stalks and cut into 5cm pieces. 3. Bring a kettle of water to the boil. Put the noodles in a colander set over a large heatproof bowl and pour over the boiling water to rinse. Drain thoroughly and set aside. 4. Heat a large wok over high heat and add 2 tablespoons of the oil. When the oil is starting to smoke, add the pork and marinade and stir-fry for 2 minutes. Add the garlic and prawns and stir-fry for another minute. Add the choy sum stalks and toss to combine, then pour in the chicken stock and half the soy sauce and cook for 2 minutes. Add the choy sum leaves and stir until wilted. Transfer to a bowl or plate and set aside. 5. Heat the remaining oil in the wok over high heat. When the oil is smoking, add the onion and stir-fry for 3–4 minutes, or until it is lightly golden. Add the noodles, spreading them evenly across the wok, and leave to crisp slightly at the bottom. Drizzle over the remaining soy sauce and stir-fry for a few seconds. 6. Add the pork and prawn mixture and toss to combine. Season with extra soy sauce to taste, and serve garnished with fresh chilli, if desired.

• 1 bunch choy sum • 1kg hokkien noodles • 100ml peanut or vegetable oil • 3 small garlic cloves, finely chopped • 12 raw prawns, peeled and deveined, tails intact • 250ml chicken stock • 1 tablespoon soy sauce, plus extra to taste • 1 large brown onion, diced • 2 fresh long red chillies, thinly sliced (optional) Marinade: • 1 tablespoon Chinese rice wine • 1 teaspoon freshly ground white pepper • ½ teaspoon sea salt • ¼ teaspoon sugar • 2 tablespoons oyster sauce • 2 tablespoons cornflour

New to type 2 diabetes? You need to meet DESMOND! NO OBLIGATION

O TAKE THIS INT

B A CURVES CLU

7 DAY

TATION & TION CONSUL NO OBLIGA

Membership benefits include: Total body workout Equipment designed for women Strength & cardio workouts

itions Terms and cond

apply.

Curves Complete weight loss programme* CurvesSmart™ personal training technology*

All in one place!

Meet people who are just like you and learn everything you need to know about type 2 diabetes, including information on food choices and physical activity. Call 1300 136 588 to book or visit www.diabeteswa.com.au

In-Club coaching

Free access to Curves Clubs globally*

DESMOND is a free program that puts you in the driver’s seat for self-managing your diabetes.

Strengthening women inside and out.

1300 287 837 curves.com.au

^Valid for 7 consecutive days, at the same club. Must be used by 31.12.16. First time users only. Age 18+. No cash value. *7 day FREE trial excludes Curves Complete, Curves Smart and Curves Travel Pass. Club Terms and Conditions apply. ©2016 Curves All rights reserved.

Everyone can be a lifesaver! LEARN HOW TO SAVE A LIFE

YOUR MEMBERSHIP

DISCOUNT BUYING SERVICE

OUR SERVICES ELECTRICAL DISCOUNTS Need a new electrical or gas appliance? Have you shopped around? Your next step? Simply call us directly or complete an online enquiry quote request. Then let us find you a better deal! It’s that easy! TRADES & SERVICES Receive special deals from over 60 ShopRite retail partners! Offering real discounts to ShopRite members, you are sure to find a bargain! MOTOR VEHICLE SALES ShopRite Relationship Managers will find you your next car, for the best price. We buy more, so you pay less. Also ask us about finance & salary packaging options!

EXAMPLES OF SAVINGS

10% discount for

Diabetes WA members

Diabetes WA members receive a 10% discount on First Aid training and products at Royal Life Saving Society WA this year*!

BOOK ONLINE at lifesavingwa.com.au and enter the code DIABETESWA or for corporate or group booking enquiries call our bookings team on (08) 9383 8200 *10% discount applies to all available First Aid and Resuscitation courses run by RLSSWA, as well as products purchased through RLSSWA’s online shop using the discount code. Offer valid through 30/06/2017.

Royal Life Saving Society WA is a Registered Training Organisation (code #0854)

PRODUCT

MEMBER’S PRICE

(Dishwasher, Fridge, Oven)

$5760

$4955

$805

Electrolux Oven

$1950

$1496

$454

Smeg Dishwasher

$1399

$1171

$228

08 9300 1221

www.shoprite.com.au

OUR PRICE

SAVINGS

Diabetes WA

Word Search

Summer

Competition

WIN one of two copies of Manu Feildel and his partner, Clarissa Weerasena’s, latest cookbook More Please! Manu Feildel has become one of the most popular personalities on Australian television as co-host of the highest-rating prime-time TV show My Kitchen Rules. He has also starred in My France with Manu and Around the World with Manu. In his latest offering, More Please!, Manu and his partner, Clarissa, draw on their diverse cultural roots – French, of course, but also Chinese, Malay and Sri Lankan – to present a collection of recipes that they like to cook at home. The result is a collection of simply delicious recipes that tick all the boxes: quick, easy and enticing for all the family on those busy weeknights, plus plenty of special-occasion dishes you can whip up to impress a crowd. Publisher: Murdoch Books RRP: $39.99 To enter, complete the competition slip and mail to:

Diabetes Matters – Members’ Competition PO Box 1699, Subiaco, WA, 6904 or email the below details to

membership@diabeteswa.com.au

Good Luck! Name: Diabetes WA membership number: Address: Contact number: Email address: Entries close 1 February 2017.

DESMOND(Diabetes Education

Dec till Mar

Have you met DESMOND yet? DESMOND ly Diagnosed) is a and Self-Management for Ongoing and New type 2 diabetes program designed to equip those living with their condition. age man r with the knowledge and skills to bette ht reduction, weig 1C, HbA r lowe ve DESMOND can help you achie distress and better greater physical activity, reduced diabetes overall health outcomes. at various locations DESMOND is run on various dates and 1300 136 588 or throughout Western Australia. Contact further details. for m.au email bookings@diabeteswa.co

Dec 26

Get Smart

Diabetes WA runs a number of education programs to help you manage your diabetes and improve your health.

MealSmart – learn what a serve of every day food is and how much you need for your body.

ShopSmart – this supermarket tour helps you decode food labels (‘Classroom’ format also available). FootSmart – everything you need to know about caring for your feet. MeterSmart – master the art of blood glucose monitoring.

CarbSmart – unravel the mystery of carbohydrates with this carb counting masterclass. MedSmart – everything you need to know about your medications. Various dates and locations are available. All sessions are free for NDSS registrants and Diabetes WA members. Bookings are essential. For more information, visit www.diabeteswa.com.au, call 1300 136 588 or email bookings@diabeteswa.com.au

Dec

National Leftovers Day

billion worth Did you know Australians throw away $8 encourages Day vers Lefto nal Natio year? of food every unt of food amo us to love our leftovers and reduce the round. year all and on wasted during the festive seas vers, For tips and recipes on using up lefto for ch sear and u om.a visit www.foodwise.c ‘Leftovers Day.’

Christmas Appeal

Christmas is a special time of the year – a time when most of us wish for nothing more than the health and happiness of our loved ones. But with 120,000 Western Australians now living with diabetes, and one person being diagnosed every 50 minutes, good health cannot be taken for granted. We need your help to support individuals and families who are at risk of, or affected by, diabetes. Every dollar received goes towards vital servi ces and community projects, for example: • $20 – helps us provide services to peop le with or at risk of diabetes. • $50 – helps to pay for a person with new ly diagnosed diabetes to attend one of our programs. • $100 – helps parents under financial press ure to send their child to our Kids’ Camp. • $1000 – Allows us to visit primary scho ols and train staff on how to manage child ren living with type 1 diabetes. So please consider giving an extra spec ial gift this Christmas by donating to our Christmas appeal. Donations can be mad e by visiting www.diabeteswa.com.au , calling 1300 136 588 or posting cheques to Diabetes WA, PO Box 1699, Subiaco WA 6904.

13-19 February

25 February

Healthy Weight Week

Australia’s Healthy Weight Week raises awareness of the importance of achieving and maintaining a healthy weight and lifestyle. Health services around the country will be getting involved by hosting talks, events and activities Find out more at www.healthyweightweek.com.au

9 March

Rottnest Channel Swim

One of Western Australia’s most iconic events – The Rottnest Channel Swim – is back for 2017. The swim is 19.7km of open water, which can be completed by individuals or teams. Why not put a team together and fundraise for Diabetes WA? Find out more at www.rottnestchannelswim.com.au

World Kidney Day

World Kidney Day aims to raise awareness of the importance of our kidneys to our overall health and to reduce the frequency and impact of kidney disease and its associated health problems. Find out more at www.worldkidneyday.org

11-12 March Coles Gluten-Free Food and Healthy Living Expo This expo aims

to educate people about coeliac disease, as well as the importance of eating a healt hy diet. The expo will feature more than 50 exhibitors plus seminars and cooking demonstrations. Visit www.glutenfreeinwa.com.au for more details.

13-20 March areness Walsoeehavek Coeliac Aw of people with type 1 diabetes Did you know that 10%

coeliac disease?

get involved visit To learn more or find out how you can . aw/ au/c .org. eliac www.co

12-18 March World Glaucoma Week This week is all about raising awareness of glaucoma, what it can do to your vision and how it might affect you or someone you love. Visit www.glaucoma.org.au to find out more.

17 March National Close the Gap Day Aboriginal and Torres Strait Islander people can expect to live 10–17 years less than non-indigenous Australians. National Close the Gap Day aims to change this terrible reality by raising awareness and encouraging community leaders to take action. For more information visit www.oxfam.org.au and search for ‘Close the Gap.’

Real Solutions Real Support Obesity Surgery WA offers a multidisciplinary team approach to people with obesity. It is well known that obesity is a high risk factor for developing type 2 diabetes. The good news is that losing weight can improve your type 2 diabetes, help stabilise blood sugar and decrease medication requirements to make your life healthier. Don’t leave it until it’s too late, while your diabetes is poorly controlled it is doing slow and irreversible damage to your organs. The less time you have elevated blood glucose levels, the better. Harsha Chandraratna Surgeon

Janet Barry Obesity Assessment Clinician

Angela Houston Dietitian

Jo Climo Nurse

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

Practical Surgery Options Sleeve Gastrectomy

Call 9332 0066 to make a healthier life.

Gastric Banding

Subiaco • Murdoch • Mandurah

Roux-en-Y Gastric Bypass

www.obesitysurgerywa.com.au

Omega Loop Gastric Bypass

Join Diabetes WA

Connect to the latest information and services to help you live well with diabetes or reduce your risk of developing type 2 diabetes.

Access discounts and special offers

To become a member, simply complete this form and return to us with your membership fee. ENTER YOUR PERSONAL DETAILS - please print

PLEASE FIND ENCLOSED Cheque/money order (made payable to Diabetes WA) or

First Name

Charge my

Surname Date of Birth

Mastercard

Visa

Card No

Card Expiry Date

Postal Address

Signature

Postcode Telephone Email Do you have diabetes? (please tick type) Type 1

Type 2

Gestational

Other

Make a donation I wish to make a tax deductible donation to help people with diabetes

Membership Fees (please tick the appropriate box) Full fee for 1 yr=$50

Concession fee for 1 yr=$26.00

Donation:

Full fee for 2 yrs=$90 (save $10)

Concession fee for 2 yrs=$46.00 (save $6)

(donations of $2 or more are tax deductible)

Pension

Senior

Health Care

DVA

Student

Under 18 yrs of age

Concession Card No

Mail to Diabetes WA, PO Box 1699, Subiaco WA 6904 or join online at www.diabeteswa.com.au and view the complete list of benefits.