Diabetes Matters Autumn 2017 by Diabetes WA

Autumn 2017 $6.95

Change the way

you think

about diabetes

Dealing with Feelings NEWS • RECIPES • RESEARCH • PEOPLE • EVENTS • FITNESS

Good Mood Food

From the Editor s and change. A fresh new year can bring with it new challenge

pect, while for others, For some this will be an exciting pros g. lmin change can be scary and overwhe previous editor, Stacey’s, For me, my 2017 challenge is to fill your editor of Diabetes Matters. very big and talented shoes, as the new ard to working hard to forw look I I’m Natasha – nice to meet you. ant and informative read. provide you with an interesting, relev our readers, to think In this issue, we are encouraging you, think about your you way the outside the box and change ical condition, med ical, phys a is etes diab gh diabetes. Thou th outcomes. heal your t affec can there are many factors that ical health are phys and tal men 14, page on ne As we outli more broadly about inter-related so perhaps it is time to think healthier) by trying how you can stay healthy (or become demonstrate some Yoga ara Tam something new. On page 30, s both young and old, basic yoga poses, achievable for beginner e. hom at to help you find your ‘zen’ s (page 8), talk about the We also bust some diabetes-related myth and introduce you to 10) e burgeoning issue of social stigma (pag a Reason (page 6). for Run HBF s ’ year our ambassadors for this phone to dial your local And finally, before you reach for your ge the way you think pizza shop, we encourage you to chan . We have included four away take t nigh ay about your cheeky Frid sy, high-fat food grea recipes that will help you to replace that es. nativ alter de ema hom with fresh, delicious Enjoy,

Natasha

AUTUMN 2017 Editor Natasha Simmons

Contents

Leeuwin Challenge

From the President.........................................................3 Current Matters...............................................................4

Diabetes News

Calling all Kellions..........................................................5 ISO Accreditation............................................................5 HBF Run 2017..................................................................6

Change the way you think Myth-Busting...................................................................8 Shame & Blame Game................................................10 The Miles-2 Report.......................................................12 Mind Over Matter.........................................................14 Dealing with Feelings...................................................16 Leaving a Legacy .........................................................18

Education Planner

Editorial & Advertising Enquiries Diabetes WA, PO Box 1699, Subiaco, WA, 6904

Plan Your Sessions........................................................20

Phone (08) 9325 7699

Research News

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 Tamara Yoga, Australian Healthy Food Guide, Ben Massey, Sherl Westlund Photography DWA staff, ambassadors and contributors, Tamara Graham, Shutterstock, Mark O’Meara Design key2creative

Research Round-up......................................................22 Diabetes Research WA Update...................................23

In the Community

Leeuwin Challenge.......................................................24 Partnering with PMH....................................................26 Q&A................................................................................26 Inspirational Ironman...................................................27

Moving Well

Exercise Your Way to Happiness.................................28 Changing Trends in Exercise ......................................29

Living Well

Yoga as Therapy ...........................................................30

Eating Well

Eat Better, Feel Better...................................................32 Homemade Takeaway Recipes....................................34

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

Leaving a L egacy

Members’ Area

Member Partners .........................................................37 Members’ Competition and Puzzle............................38

What’s on

Dates For Your Diary.....................................................39

From the President

ike autumn leaves changing with the season, organisations must also, over time, change to suit the environment in which they operate. For the falling leaves, this seasonal change brings with it new growth, development and natural evolution. This can also be said about the changes that will be taking place for Diabetes WA.

Our members are our most important asset and when making strategic decisions, we will always keep this at the forefront of our discussions. That is why I encourage you, as members, to have your say and be included in this dialogue when the opportunity is presented to you. Diabetes WA is now 52 years old. During this time, much has changed in our knowledge of diabetes, the range of programs and services, our financial scale, the distribution of service delivery and the overall structure of the WA health system. Looking ahead to the next 52 years, the Board of Diabetes WA continues to explore new opportunities for enhanced corporate and financial governance arrangements to ensure a strong and capable future for the organisation, and to make sure we remain accountable to our members, continuing to be open and transparent with our operations. Following the introduction in WA of the new Associations Act in July 2016, it is a requirement that all Western Australian incorporated associations review and update their constitutions. It is therefore an appropriate time for Diabetes WA to undertake an overall strategic review of its underlying governance principles, structure and operations. On review and having taken legal advice, the Board have formed the view that moving to a company limited by guarantee will enable the organisation to embrace future opportunities for the betterment of people living with diabetes such as potential new technologies, new program and service activities, new partnerships, as well as having access to alternative funding mechanisms.

Dr Moira Watson Diabetes WA President and Board Chair

Collaboration with other relevant community service providers within WA is also important to us and many years of sharing resources and expertise with Princess Margaret Hospital has been invaluable. This partnership between our two organisations has produced some outstanding programs, policies and events. You can find out more about our most recent projects on page 26. The significance of mental health in the management of diabetes is also a focus of this autumn edition of Diabetes Matters. On Page 14 we discuss the relationship between diabetes and mental health and how one can considerably affect the other. We provide you with some advice if you feel you are experiencing depression in relation to your diabetes, but it is always a good idea to visit your GP if you are struggling with any mental health issue. Finally, don’t forget to register for the HBF Run for a Reason, being held on Sunday, 28 May. As one of the official charity partners for this event, it is our biggest fundraising activity for the year. If you feel like you can’t participate, then perhaps sponsor someone who is running, walking or strolling in the event. See page 6 for all the event details and to read the stories of two of our amazing ambassadors. Until next time…

Dr Moira Watson President and Board Chair

•

Importantly, Diabetes WA’s incorporation as a company limited by guarantee, if approved by the membership, will not affect the legal identity of Diabetes WA. The new corporate governance structure will continue to value and retain all that the organisation has stood for throughout its lifespan. We hope that you can join us and embrace the new opportunities that this change provides.

Change the way you think about diabetes

Andrew Wagstaff, Diabetes WA CEO

he theme for this edition is “change the way you think about diabetes”. Never has there been a more appropriate time to have this as our focus topic. As I write this piece, your Diabetes WA is in the throes of considering this issue at the most fundamental of levels. Last year the State Parliament passed into legislation the new Associations Incorporation Act 2015 commencing 1 July 2016. This legislation replaced the old Associations Incorporation Act of 1987 which was repealed. Under the new Act, Diabetes WA is obliged to review and update its rules consistent with new model rules. Importantly the new Act also affords an Association the option of transferring its registration to another governance framework that may be more appropriate. Diabetes WA has been working through this process with the support of legal advice generously provided to us by K&L Gates. From this review it is apparent that having regard for the changes in our range, scope and scale of operations, since our formation in 1965, the Associations Incorporation Act is not the most appropriate governance framework for our business. This was particularly the case when the Board considered the rapidly changing operating context and potential future opportunities for our organisation. With that in mind the Board of Diabetes WA, having taken legal advice on both the processes to be followed and the merits of making the change, resolved to propose to the members of Diabetes WA that we contemporise our governance framework by moving to a public company limited by guarantee under the Federal Corporations Act of 2001. The Corporations Act will provide Diabetes WA with

a more robust and transparent governance framework on which to continue to grow our services to members and the population of people living with, or affected by, diabetes. Importantly, Diabetes WA’s incorporation as a company limited by guarantee, if approved by the membership, will not affect the legal identity of the organisation. The new corporate governance structure will continue to value and retain all that the organisation has stood for over the last 52 years. All existing members of Diabetes WA may be members under the new company structure and Diabetes WA members will continue to receive all current benefits. These are significant matters for Diabetes WA and its membership to consider. Indeed we are being asked to consider changing the way we think about Diabetes WA. Over coming weeks you will receive further information about the proposal including how you can share your thoughts with us. I would encourage all our members to embrace the process and have your say.

Andrew Wagstaff Diabetes WA CEO

•

Calling all Kellions

ere you diagnosed with type 1 diabetes in or before 1967? Have you lived with the condition for 50 years or more? Do you know someone who has? Every year Diabetes WA hosts the Kellion Victory Awards; a special event to recognise people who have lived with insulin dependent diabetes for 50 years or more. The Kellion Victory Medal recognises the achievement of living a fulfilling life with diabetes and aims to inspire younger people to reach their potential. Medals are awarded for 50, 60, 70 and 75 years of living with the condition. The Kellion Carers Award is also bestowed to recognise the many years of love, dedication and support a spouse, family member or close friend has given to the Victory Medal winner. The presentation function will take place during National Diabetes Week in July. If you or someone you know meets the criteria for a Kellion Victory Award, you will find an application form on the back of our cover letter, or you can obtain one by emailing us at community@diabeteswa.com.au

Thank you Thank you to all those who contributed to the annual Diabetes WA Christmas Appeal. We raised an impressive $1,446.20, which will assist in continuing to provide essential support and services for people living with, and affected by, diabetes in Western Australia.

Why ‘Kellion’? Established by Diabetes Australia in 1984, the Kellion Victory Medals have been presented to countless deserving recipients. The awards namesake, the late Mr Claude Kellion AM, made an outstanding contribution towards diabetes in Australia following the death of his son John in 1972. At just 38 years of age, John died as a result of complications of his diabetes. His father was dismayed by the lack of research into diabetes and decided to set up the Kellion Diabetes Foundation. For many years this foundation was the only private source of funding for diabetes research in Australia and, over the years, has donated well in excess of $1 million towards diabetes research. The Kellion Victory Medal honours both father Claude and son John, and is a lasting tribute to their name.

ISO Accreditation D

iabetes WA is currently in the process of working towards obtaining accreditation by the International Organisation for Standardisation (ISO) by 30 June 2017. To ensure we are focused on continuous improvement and quality standards, ISO accreditation certifies that our service and documentation procedure has all the requirements for standardisation and quality assurance. The accreditation process involves the entire team reviewing their procedures and documenting them to ensure consistency across the organisation and compliance to the ISO standards.

Quiz Night Success

n Friday 2 December, police officer Ian Anderson hosted his 11th annual quiz night to raise money for Diabetes WA. The night was a great success and Ian raised a total of $2,796 through door entry, raffles and auctions. Ian has now raised more than $39,000 since the event began and we are thankful for his years of dedication helping those living with diabetes.

HBF Run for a Reason I

t’s that time again – the HBF Run for a Reason is approaching quickly and we encourage you to get involved in the fun! Diabetes WA is one of the feature charity partners and the #BeTheReason movement has begun! Whatever your reason, whether it’s simple or ambitious, heartfelt or just because, be a part of something bigger on Sunday 28 May.

Meet our Ambassadors

Fwy Farmer Graham

Perth Busport

Plain St

Murray St Mall

CBD

Hay St

Mall

Stre et

Victoria Ave

Fraser Ave

HBF EVENT CENTRE

Th om as

CROWN PERTH

WACA

Adelaide Tce

Terrace Rd

Riverside Drive

Rivers ide

Mount Eliza Reservoir

Gloucester Park

FI NI S H

St Geor ges Tce CONVENTION CENTRE

Bennett St

STA R T

St Geo rges Tce

Plain St

m co Mal

et Stre

Hill St

Road

William St

Wellingto n St

Murray St Hay St

Kings Park

Barrack St

Milligan St

MITCHE LL FWY

Murray St Hay St

East Perth

Lord St

PERTH ARENA

Beauf ort

Northbridge

Wellingto n St

Victoria

PERTH STADIUM

Pa r k

Sunday 28 May

Dri ve

BELMONT PARK

NORTHBRIDGE TUNNEL

Kings Park

Victoria Park

Caus ew ay

THE BELL TOWER

Swan River

Forrest Dr

Lo ve kin

Ave

May Dr

Saw

ad y Ro s Ba nt Mou

SWAN BREWERY

Synergy Parkland

Commonwealth Bank Half Marathon

Ave Winthrop

e Av

Ave Park

rk s Pa King

Po ole Av e

START TIME: 6.45AM

Road closed into the city

Toilets First Aid Drink Station

Ramsay Health Care 12km

Entertainment

START TIME: 8AM

Cheer Zone

Ramsay Health Care 4km

Train Station

START TIME: 8.45AM

Shuttle Drop/Pickup

ess y acc Cit

You can challenge yourself to beat your record, or get a group of friends together for a fun activity. Join thousands of other families who enjoy the chance to walk, jog, run or push a pram together. Perhaps you’re inspired by someone else – whether they’re striving to reach new speeds, or are just starting out with new fitness goals. You might be moved to support someone who’s living their best life even while struggling against illness. Together, our reasons create something bigger. Be a part of it on 28 May at HBF Run for a Reason and #BeTheReason.

Join Team HypnoHale

In 2017 we are privileged to have comedic hypnotist and international speaker, Matt Hale, as our Diabetes WA media ambassador. Proudly Perth-based, Matt has hypnotised people all over the world in his hilarious stage shows and was an award finalist at the recent Fringe Festival. “I’m very honoured to be the ambassador for Diabetes WA, and I am inspired by the work and vital services they provide to the WA community living with diabetes. My grandad lived with type 1 diabetes, so I know how important education and support can be for people living with the condition,” said Matt. “I hope my involvement will help raise awareness of diabetes and encourage people to get involved, either by getting physically active and taking part themselves, or by supporting participants fundraising for Diabetes WA. Remember, no matter what level of fitness, you can take the chance to feel great about yourself and the positive impact it will have on those around you. So walk, jog, or run…and enjoy!” Although work commitments prevent Matt from taking part on the day, the keen surfer has started up Team HypnoHale and will be leading the team in spirit from the eastern states. To join Matt’s team, register online at www.hbfrun.com.au and pick Team HypoHale.

I choose to… elf, Be the best version of mys kids, Be the role model for my Be the bringer of hope, Be the source of joy, rs, Be the inspiration for othe #BeTheReason Matt Hale is leading Team HypnoHale

World Masters Champion Barrie Kernaghan

Age no barrier for Barrie Barrie Kernaghan first found a love of beach sprinting as an 18-year-old, and his keen interest, mixed in with a strong drive to win and dedication to the sport, has kept Barrie lacing up his racing shoes for close to 60 years! The 77-year-old recently won gold medals at the World Masters Athletics Championships held in Perth, and his long history with athletics has seen him win countless medals at competitions held throughout the world. Barrie competes in sprint events and relays every Tuesday and Friday night, and can be regularly seen running around the nearby sports oval with his dog Max by his side.

Sprinter of the Year Award in 2015 and, according to Barrie, he still has many years of competition left in him! A diagnosis of type 2 diabetes in 2011 came as a big shock, but apart from adding daily medication to his healthy eating and regular exercise routine, the grandfather of four has taken it all in his stride. “I haven’t let diabetes affect me one bit as I’ve made sure to keep a sensible diet and do plenty of exercise, and I would encourage others to do the same,” said Barrie. Barrie will be taking part in the 4km run in support of Diabetes WA and will no doubt lead the pack to the finish line in the 75 – 80 year old age category.

Barrie was chosen as a torch bearer for the Sydney Olympic Games in 2000, and was awarded the Australian Sports Medal by Queen Elizabeth in that same year. He also received the Male

Get Involved in 2017 Make diabetes your reason to get involved in the 2017 HBF Run for a Reason. Taking part in a team is a lot of fun, so organise your sporting team, school group, workmates, family or friends and join together to help raise money to support the 123,000 Western Australians living with diabetes. If you would like to sign up for the HBF Run for a Reason, visit www.hbfrun.com.au, choose Diabetes WA as your chosen charity and start an Everyday Hero fundraising page to share amongst your networks!

Myth-Busting

any people incorrectly associate diabetes with excessive sugar intake or an unhealthy lifestyle and think treatment means constantly injecting insulin. Though both of these viewpoints innocently come from a lack of knowledge about diabetes within the community, they can often create frustration amongst those living with the condition. While some of the preconceptions surrounding diabetes contain a little truth, there are more facts dispelling these presumptions than supporting them. With so many people now affected by the condition, it’s important to know how to separate fact from fiction. Here are five myths about diabetes – busted and explained by exercise physiologist and diabetes educator Marian Brennan:

Eating too much sugar causes diabetes.

Consuming high volumes of added sugar can result in weight gain due to high calorie intake. Being outside of the healthy weight range is a risk factor for type 2 diabetes, but the causes of the condition are multi-faceted and it’s difficult to attribute diabetes to any one cause. So does sugar alone cause type 2 diabetes? No. Lifestyle factors are not considered risk factors for type 1 diabetes. There is no truth to the notion that eating too much sugar is in any way related to the onset of this type of diabetes. Although not a risk factor, limiting discretionary foods high in added sugar is recommended for ALL Australians by the Australian Guide to Health Eating, produced by the Department of Health and Ageing.

I have a family history of type 2 diabetes so I will get it too.

Although family history is one risk factor for type 2 diabetes that we do not have any control over, there are many other risk factors that we can minimise to prevent the development of the condition. For some people, despite their increased risk due to their family history, improving modifiable risk factors such as diet and activity level can still have a significant and positive affect on their health outcomes. Being aware of your genetic disposition equips you with the knowledge to make informed lifestyle choices. A number of international landmark studies have found that after adopting simple lifestyle changes, such as increased exercise and healthier eating, people with pre-diabetes (a condition characterised

by slightly elevated blood glucose levels, regarded as indicative that a person is at risk of progressing to type 2 diabetes) reduced their risk of developing type 2 diabetes by 58 per cent.

Exercise physiologist and diabetes educator Marian Brennan

People with diabetes cannot eat sugar.

Sugar can, in fact, be consumed in moderation. As mentioned before, people often think diabetes is a sugar intake problem. So, they reason, if you don’t eat sugar, you won’t get diabetes or you will not have problems with your diabetes. Unfortunately, that is a significant oversimplification. If we talk about sugar, we need to talk about carbohydrate. Sugar is a carbohydrate along with breads, cereals, grains, legumes, starchy vegetables, fruit and some dairy. All forms of carbohydrate break down into the same thing – glucose. Therefore, all forms of carbohydrate will have an impact on your blood glucose levels. The amount

You can ‘reverse’ type 2 diabetes.

It can be exciting to hear that you can reverse type 2 diabetes, but is it really true? Well it really depends on what you mean by ‘reversing’. Your doctor will diagnose diabetes if your blood glucose levels reach a certain level. When someone says ‘reversing’ diabetes what they usually mean is that your levels have returned to within an optimal range. Even if you return your levels to normal, the risk factors that you can’t change such as age and genes are still present and may catch up with you eventually. That is why it may be better to think of your diabetes being stalled, halted, or in remission. This is because if you start to think ‘I am cured, my diabetes is gone,’ then you are much more likely to stop visiting your GP for regular health checks. You may not even notice if your blood glucose levels begin to rise again and sustained high blood glucose levels can increase your risk of serious complications

and type of carbs will determine how much and how quickly your blood glucose levels will rise. Carbohydrate and subsequent glucose are vital for optimal brain function and daily energy requirements. They also provide us with other important nutrients. As recommended for all Australians, good quality carbohydrates with a low Glycaemic Index (GI) are important in the management of diabetes. So can someone with diabetes have the odd ‘sugary’ cake or lollies? YES – as with most things in life, it is about moderation and a balanced lifestyle.

Quick fixes are the answer.

Despite continued research into the area, there is currently no cure for type 1 or type 2 diabetes, so the focus must be on healthy and effective management of the condition. There are many claims throughout the media of how to ‘fix’ diabetes – it is hard to know what is true and what is not. Below we outline some quick fix theories and why they don’t always work: • Rapid weight loss through interventions such as bariatric surgery or very low calorie diets These interventions may be appropriate for some and may result in sustained improvements in blood glucose levels; however, they should only be decided upon in consultation with a treating health care professional. For many people with diabetes, these options may be dangerous without appropriate medication adjustments and thorough medical review. Smaller, more sustainable changes can be far more successful for long-term diabetes management. • No or low carbohydrate diets Carbohydrates are vital for our day-to-day function and are the primary fuel source for the brain. We rely on them for a large component of energy, and they provide glucose which is essential for cell growth, structure and function.

Weight loss is often seen when people reduce their intake of carbohydrates, given they are eating less TOTAL kilojoules, but low or no carbohydrate diets can be very tricky to stick to and outcomes may not be sustainable. Carbs also provide us with calcium, folate, fibre, and vitamins A and B – all essential nutrients for health. For optimal function and to reduce the risk of developing other health-related issues, we require carbohydrates in our daily diet. • Certain foods and natural remedies There is very little evidence to suggest that certain foods or spices, such as cinnamon and turmeric, could cure diabetes. Some foods may be helpful alternatives to kilojoule-dense, nutrient-poor options, such as using cinnamon to sweeten a dish instead of adding sugar. But there is no single specific food or natural remedy that will make your diabetes disappear, it is all about a healthy balance.

The Shame and Blame Game P

eople living with diabetes often experience stigma in association with their condition. Often, stigma arises due to the belief that diabetes has been caused by the person’s behaviour. It also stems from negative stereotyping, status loss and discrimination by others. As with some other health conditions, such as mental illness, lack of information causes people to misunderstand and judge people living with diabetes. People often do not differentiate between the different types of diabetes, or believe that diabetes results from an unhealthy lifestyle. According to recent market research involving 5,000 people living with diabetes in the United States, some common stigmas related to type 1 diabetes include the belief that you can “outgrow” diabetes, it is considered the “bad kind of diabetes” or that you can manage the condition by making lifestyle changes. Other stigmas include frowning upon injections or blood testing with your glucose meter in public, believing that medical issues may interfere with the ability to work, or even ridiculous assumptions that insulin can give you an advantage at sporting events. The research also found that people with type 2 diabetes may feel that people believe they developed diabetes by living an unhealthy lifestyle and that it is entirely their fault, which is far from the truth as genetics, ethnicity and age play a much greater role. Others feel they are “undisciplined” if they eat sugar-containing foods and that type 2 diabetes is “no big deal”.

While we have a lot to do in terms of educating society in the hopes of shifting misconceptions and reducing stigma, it is good to remember that, in many cases, type 2 diabetes is as much a genetic condition as type 1 diabetes and can have very serious consequences. Over 40 genes have been identified so far in relation to type 2 diabetes, and over 60 genes have been identified in relation to type 1 diabetes. We know that for people at risk of developing type 2 diabetes, lifestyle factors like physical activity, healthy eating and weight management can prevent or delay developing the condition in approximately 60 per cent of cases. That means in around 40 per cent of type 2 diabetes cases, a diabetes diagnosis cannot be prevented as there are strong, non-modifiable risk factors at play. An often-cited narrative review by Schabert, Browne, Mosely, and Speight (2013) outlines the “potentially significant, yet under-researched” issue of the social stigma surrounding diabetes. The review draws on literature about health-related stigma in diabetes and other chronic conditions and found that people who do not have diabetes assume that diabetes is not a stigmatised condition. In contrast, people with diabetes report that stigma is a significant concern to them, experienced across many life domains.

Experiences of stigma

Consequences of stigma

People with diabetes sometimes experience stigma in a range of different ways, many of which are culturally dependent. The specific experiences cited in the review are:

As well as its psychological impact, stigma can be a substantial barrier to self-care. People experiencing health-related stigma report:

• embarrassment or fear in association with injecting insulin • self-stigma, such as feelings of failure, self-blame or guilt in people with type 2 diabetes on insulin, often reinforced by the media and perceived public opinion • stigma around meals due to dietary needs • fear of discrimination at work • fear of hypoglycaemia.

• anxiety and/or depression • attempts to conceal the condition, and subsequent compromise of self-care • isolation from family and social groups • a ‘culture of surveillance’ in which your behaviour is constantly being judged.

The experience of diabetes-related stigma has a significant negative impact on many aspects of psychological well-being and may also result in poor clinical outcomes for people with diabetes.

Within the review, the research team did not find any evidence on ways of reducing stigma. However, they identify the following possible avenues for evaluation;

What can be done

• Earlier detection and better treatment of diabetes • Education aimed at external sources of stigma • Counselling and support activities to reduce self-stigma

Acceptance can be challenging ony was diagnosed with type 2 diabetes more than 10 years ago. After being in a self-confessed state of denial for many years following his diagnosis, his 55th birthday marked a turning point for him.

“I was shocked when the doctor gave me the news as I was only in my early 40’s at the time,” says Tony. “The doctor told me that it was lifestyle induced – too much good food and wine and not enough exercise. He said that I should be able to control the condition by adjusting my lifestyle, which I did to a certain degree for a number of years.” After turning 55 last year, and becoming semi-retired, Tony says he has started taking his condition more seriously. His wife has been extremely supportive and he feels that his diabetes would be far harder to manage if he didn’t have her by his side. “As much as I want to ignore it, there are changes that having diabetes makes to your health which are frustrating and a little worrying,” he says. “I am particularly conscious of my eyesight and have my eyes checked on a regular basis. I am also now engaged in a diabetes management plan which includes seeing a physiologist and podiatrist. “My wife and I are conscious of eating healthily and eat lots of salads and grilled fish, chicken, etc but if I am being honest, I still often struggle with portion control.”

“I have never hidden the fact that I have diabetes and I have to say most people are really surprised when I tell them. I am extremely active playing tennis twice a week, as well as doing a lot of walking and running, so I guess people don’t look at me as if I have a condition.” Tony admits accepting the impact that his diabetes has on his lifestyle is something that he battles with daily. “Even after all this time, I still struggle with accepting the condition and there are symptoms that I try to ignore,” he says. “Whilst I know this is completely illogical and irrational, some of the changes that I should make are just too hard to accept. “I understand the science. I have been a white-collar worker most of my career and am well-educated, however, there just seems to be a mental block.” If you are struggling to manage your diabetes or need some advice, our free telephone help service, DIAL, can help. Manned by credentialed diabetes educators, DIAL is available 8.30am to 4.30pm weekdays. Call 1300 136 588 or email info@diabeteswa.com.au if you would prefer a written response.

No longer sitting at a computer as a busy professional has also enabled Tony to be more active.

Revealing the psychosocial impact of living with diabetes

ased on a survey conducted in 2015, a report by the Australian Centre for Behavioural Research in Diabetes (ACBRD) exploring what it is like to live with and manage diabetes, has shown that people living with diabetes experience significant levels of diabetes distress and often feel stigmatised. The Diabetes MILES-2 Report provides the second snapshot in five years highlighting unmet psychosocial needs of Australian adults living with type 1 or type 2 diabetes. The national survey included 2,342 adults with type 1 or type  2 diabetes and focused on three aspects of living with the condition: psychological, social and behavioural. This second survey by the ACBRD focused on some new issues, such as diabetes stigma, and enabled comparison with the 2011 findings from 3,338 Australian adults living with diabetes surveyed in the first Diabetes MILES Study.

Dr Adriana Ventura, Research Fellow at the ACBRD and lead author of the Diabetes MILES-2 Report said: “We found only one in ten people were participating in peer support programs or initiatives – this was the same rate we observed in 2011. More effort is needed to connect people with peer support groups, particularly online communities, as many people with diabetes appear to prefer this mode of delivery.” The report also noted the self-management behaviours (particularly healthy eating and physical activity) of the respondents were comparable to the 2011 survey.

Professor Jane Speight, Foundation Director of the ACBRD, said the MILES-2 findings were strikingly consistent with the results of the first Diabetes MILES – Australia survey. “The prevalence of depressive symptoms and diabetes-specific distress are largely comparable with the rates we observed in 2011.”

“The healthy eating and physical activity findings are very similar to those for the general Australian adult population, but people living with diabetes have an even greater imperative to engage in healthy behaviours as they are a critical part of an optimal self-management regimen for the prevention or delay of diabetes-related complications,” added Dr Ventura.

“In addition to the unmet psychological needs of people living with diabetes, this new survey reveals that Australian adults with diabetes face social challenges, including diabetes-related stigma, and a lack of social support for their diabetes self-management and coping.”

Source: Diabetes Victoria

A summary of the findings outlined the key highlights of the report:

Psychological and Emotional Aspects of Diabetes Moderate-to-severe depressive symptoms affected: • 36% of adults with insulin-treated type 2 diabetes; • 24% of adults with type 1 diabetes; and • 21% of adults with non-insulin-treated type 2 diabetes.

Severe diabetes distress was experienced by: • 24% of adults with type 1 diabetes; • 20% of adults with insulin-treated type 2 diabetes; and • 11% of adults with non-insulin-treated type 2 diabetes.

Social Aspects of Diabetes • Diabetes-related stigma was common among all respondents. This involved the perception and/or experience of being blamed, negatively judged or being treated unfairly due to having/managing diabetes. • 89% of respondents are not currently part of a peer support group or community and have never been in the past. 38% of these indicated they would like to be in the future.

Behavioural Aspects of Diabetes • Only 25% of adults had followed a healthful eating plan on all of the past seven days, and only 17% had participated in at least 30 minutes of physical activity on all seven days. • 37% of respondents had attended a group education program for their diabetes at some point.

The findings showed: • 2 in 3 adults with type 1 diabetes feel judged by others if they eat sugary foods or drinks • 2 in 3 adults with type 1 diabetes feel others make unfair assumptions about what they can and cannot do because of their diabetes • 1 in 2 adults with type 1 diabetes indicated that others assume it is their own fault for having type 1 diabetes • 1 in 2 adults with type 2 diabetes indicate that others assume they are overweight or have been in the past because of their type 2 diabetes • almost 1 in 2 adults with type 2 diabetes feel there is a negative stigma about type 2 diabetes being a 'lifestyle disease' • 1 in 3 adults with type 2 diabetes believe that some people judge them for their food choices

Diabetes MILES-2

Within the report, a man with type 2 diabetes is quoted: "As if the disease weren't bad enough, the stigma of type 2 diabetes is worse."

2016

Diabetes

SURVEY 2016 REPORT

MIL ES- 2

SURVEY REPORT

The report included novel findings focused around the social stigma of diabetes. It showed that this social ‘side-effect’ of diabetes needs to be further investigated, as it appears to be an issue that impacts strongly on those living with the condition.

‘Mind over Matter’ – Mental health and diabetes A

mong the wide-ranging co-morbidities associated with diabetes, mental health issues are probably among the most overlooked, despite their potential to compromise self-management and increase the risk for serious complications.

Checking blood glucose, taking medications, hitting the gym, counting carbs, and cooking up healthy meals; at times, the list of responsibilities may feel overwhelming. The understandable sense of burden or defeat that may occasionally punctuate your life with diabetes can be known as diabetes distress. Doctors are just beginning to understand this condition and how it affects your health and well-being. What is clear, though, is that diabetes distress can be difficult, and that's why researchers across the globe are seeking ways of overcoming these negative emotions.

Depression and mental health • Depression is a very real condition and is becoming increasingly common in the general population; approximately one in four people will experience depression some time in their adult life. For people who live with diabetes, this figure is even higher. • Up to 50 per cent of people with diabetes are thought to also have a mental illness such as depression or anxiety. • People with depression and diabetes may find it hard to maintain daily diabetes care. • Diabetes Australia and SANE have developed a booklet ‘The SANE Guide to Good Mental Health for people affected by diabetes’ which explains the relationship between diabetes and mental health and what you can do to look after yourself. For a copy of the booklet, contact Diabetes WA.

What is depression? Depression is not just low mood but a serious illness. People with depression find it hard to do normal activities and function from day to day. Depression has serious effects on physical as well as mental health.

Link between diabetes and depression Research shows that having diabetes more than doubles the risk of developing depression. Living with a chronic condition like diabetes, coping with biological and hormonal factors, plus needing to manage the condition on a daily basis, may increase the risk of depression. Conversely, people with a mental health condition are more likely to develop diabetes. Depression can increase the likelihood of developing diabetes complications. People with depression may find it harder to deal with everyday tasks. Over time, managing diabetes – regular blood glucose testing, taking medication, following a healthy eating plan and regular physical activity – can take its toll. This may increase a person’s risk of depression, which may in turn lead to their diabetes self-care being neglected.

Treatment

Stress and diabetes

Looking after your diabetes will help decrease the risk of getting depression. If you already have depression, good diabetes management will help lessen the negative impacts it can have.

A recent article in The West Australian newspaper, in which Diabetes WA Educator Sophie McGough featured, discussed the impact that stress can have on the development of a range of health problems, diabetes being one of them.

Fortunately the Australian Government’s Department of Health and Ageing has recognised that living with diabetes is difficult and has subsidised access to several allied health groups, including psychologists and social workers for people with diabetes. Medicare may provide a rebate on psychologist fees if you have chronic condition and are referred by your doctor. Discuss this with your doctor if you would like to seek counselling.

Helping yourself If you suspect you might have depression, take control of your health by: • • • • • • • • •

going to a doctor or other health professional getting involved in social activities engaging in regular moderate physical activity becoming informed about depression and diabetes eating healthily and including a wide variety of nutritious foods achieving and maintaining a healthy weight limiting your alcohol intake getting help, support and encouragement from family and friends asking your doctor to check your blood pressure, cholesterol, iron and blood glucose levels.

Stress can influence blood sugar levels in people with diabetes making its management an important element of diabetes control. In situations where your body’s fight or flight response is triggered, the liver immediately releases its stored glucose back into the bloodstream as a source of energy. However, people with type 1 diabetes, who do not produce their own insulin, are unable to get the glucose out of the blood stream and into their cells and people with type 2 diabetes who are insulin resistant cannot process the glucose quickly enough. “In both cases you will get a raised glucose level because the body’s natural response is to dump the glucose back into the blood, but in both kinds of diabetes you are slower to process that glucose so the glucose level remains higher for a longer period,” Sophie said. It is important that people living with diabetes find ways to manage their stress, either through relaxation, meditation and deep breathing techniques, or exercise including tai chi and yoga. (See our article on yoga on page 30 for tips). “This helps to slow down the breathing and calm the system to therefore have less of an impact on glucose levels,” Sophie said.

Source: Diabetes Australia

Dealing with feelings

hen a child is first diagnosed with diabetes, parents might spend a lot of time thinking about the condition’s physical effects. But emotional issues also come with a diabetes diagnosis, and these can affect how kids cope with the physical aspects. Type 1 diabetes is one of the most common chronic illnesses of childhood and requires a complex and demanding treatment regimen. In addition to the more obvious stresses of managing insulin levels, medication and diet, there are also more subtle difficulties that can include family stress. Often in young children, it is the parents who are managing the child’s diabetes and, therefore, parental roles often include reminders about, and supervision of, all diabetes related tasks. Children can report feeling that parents ‘nag them’ or chastise them more than siblings. This can lead to increased arguments and tension between parents and youth. There can also be tensions with siblings, and the feeling that parental concerns are all centred on the child with diabetes. According to Kidshealth.org, it's important for parents to recognise the feelings that kids with diabetes might experience and learn strategies to help them.

Your Child's Feelings Kids often experience these emotions when confronted with diabetes: • Isolation. Diabetes can make kids feel different from peers, friends, and family members. Kids who don't know other people with diabetes or are the only student who needs to visit the nurse for injections or blood tests during school might feel isolated or alone. • Denial. Kids want to blend in or be like other kids, so they may sometimes pretend that they don't have diabetes, which can be dangerous if they avoid testing and medication. • Depression. Feelings of depression, sadness, and hopelessness are common among kids with diabetes. A child may cry a lot, feel exhausted, have changes in eating or sleeping habits, or have a hard time sticking to the diabetes management plan because he or she is depressed.

• Guilt. Some kids may feel like diabetes is their fault or like they're causing problems for parents, siblings, and teachers because of their condition. • Anger, frustration, and resentment. Your child might be angry at you because you oversee testing and treatment, in addition to being frustrated by the diagnosis. Many kids resent the restrictions that diabetes can place on their everyday activities. • Fear and anxiety. Blood glucose control problems, needles, and the potential for long-term health problems can be scary for kids.

And in some cases, fearfulness can be the result of incorrect information they receive about diabetes. • Embarrassment. Kids with diabetes might be embarrassed about the extra attention they get, like when they're testing their glucose level and injecting insulin at school, at friends' homes, and in front of other kids. • Dependence. When kids find out they have diabetes, they might begin acting younger than their age and depending on parents more than their peers. The progress that they'd typically be making toward self-reliance can stop or reverse course.

Helping Your Child Once you learn to recognise your child's feelings, here are some tips for coping with those emotions: Acknowledge your child's feelings. Check in with your child regularly. Try to listen to everything your child has to say before bringing up your own feelings. Drawing, writing, or playing music can help kids with diabetes express their emotions, it doesn’t always have to be verbal communication. Encourage active health care management. It's important to reinforce the idea that when kids take good care of themselves and manage their diabetes, they can avoid undesirable things like extra injections or missing out on activities that their friends enjoy. Connect with others dealing with diabetes. Finding a support group for kids and families with diabetes can help kids to feel less different. These groups can also boost your confidence as you deal with diabetes and offer advice and tips on managing it. Tell friends, teachers, and others about your child’s diabetes. Ask if your child would like others to know about the diabetes. Kids sometimes find it less embarrassing if they tell friends and classmates that they have diabetes, so they don’t have to explain when they are administering medication or testing their levels. Teachers and care providers also should know about your child’s condition and its management.

Get help when you need it. Be sure to keep your child’s diabetes health care team in the loop about any emotional issues – they deal with this all the time and can provide help for your child and advice for you. Emphasise independence. It is important to resist the urge to overprotect a child with diabetes. With the encouragement and support of their parents, kids with diabetes can take on some responsibilities for managing it – a change that often has a positive, confidence-building effect. Help kids find their strengths. Is your child a reader, a hockey player, a student, a future astronomer, an art lover? He or she is a person in control of diabetes, but this does not define someone's life – it's only a very small part of who your child is. Focus on friendships. Having fun with friends builds confidence and a sense of belonging. Encourage your child to discuss diabetes with friends. This can help friends feel more comfortable interacting with your child in the same ways they did before your child developed the condition. Correct misconceptions. Talk to your child about the fact that people do nothing to deserve diabetes – it just happens. Also, if your child feels like the diabetes is causing problems for you or your family, offer reassurance that there's no reason to feel guilty.

Keep in mind that for most kids, negative feelings about diabetes pass or change with time as they adjust to living with it. Studies have found that after an initial spike in psychological problems following diagnosis, by 12 months post diagnosis, many of the symptoms have alleviated.

Your Feelings Parents often go through a grieving process when they find out that their child has a condition like diabetes. It can be difficult to come to terms with the idea that a child has a chronic health condition that will need to be managed for the rest of his or her life. It's normal to feel grief and sadness. Many parents also feel guilty about their child's diabetes and wonder if they could have prevented it somehow. Some parents might feel unsure about taking on the tasks of caring for a child with diabetes, such as administering medications and helping their child follow a meal plan. It's also common to worry about recognising symptoms of a diabetes problem and getting the right medical help. It's important to attend to your own needs as well as your child's. When you can, let others – like relatives and friends – share the responsibilities of caring for your family. Remember that you can't do it all.

Nancy Warner with son, Ross in 1983

A dear friend to many leaves a special legacy

generous act by Nancy Warner on her passing, has left a legacy that will significantly contribute to improving the lives of those living with a condition that was close to her heart.

Nancy Irene Warner, who passed in September 2014 at the age of 97, left a bequest to Diabetes WA from her estate – a portion of the sale of her home. The bequest – the act of giving or leaving personal property or money by a will – was arranged in the final years of Nancy’s life to ensure the assets that she left behind helped those in need.

Lynne said Nancy believed that the stress and demands of maintaining their insulin levels was tough on her husband and son and that they were both tired of managing their condition and disabilities, so they chose to stop using insulin in the weeks before they passed.

Her son, Ross, and husband, Joshua (known to many as Joe), both passed from complications of type 1 diabetes so the cause was always close to her heart and personally affected her life in a big way. Executor of Nancy’s will, Lynne Milne, spoke of her close friend’s passion for helping people with diabetes. “She was really just the loveliest lady and felt strongly that people with diabetes needed more mental health support. I think this was her way of trying to make a difference,” she said.

Nancy often wrote her thoughts and poetry in notebooks she kept on hand. The following is an extract from her diary entries; part of a reading included in her funeral service:

“Joe and Ross had been massively impacted by their diabetes. Joe had a leg amputated and Ross had lost his sight by the time he passed away at 63,” Lynne said.

“Remember” Do not weep at my grave, for I am not there I am the wind that blows Sunshine and rain softly falling I am the breeze so light Raindrops on my garden Stars in the night sky A thought, a smile, a word For those that I love most dear I will always be near. Each time a breeze blows – Remember.

Marketing and Communications Manager Deanne Dymock, who runs the bequest program at Diabetes WA, said the generosity of people such as Nancy will contribute essential funds to enable the organisation to reach out to those who are diagnosed with the condition. “So many lives are touched by diabetes, and the impact on the mental health of those managing this, or any, chronic condition, is a side effect that many people don’t consider,” Deanne said.

About our bequest program Leaving a bequest to a charity or cause close to your heart is one of the most generous and lasting ways in which you can show your support. A gift in your will is a valuable way of supporting Diabetes WA. We receive large and small bequests and each is welcome and greatly appreciated. If you are writing your first will, or updating your current one, please remember Diabetes WA and the difference you can make to the lives of countless Western Australians

How we can help you We understand that you may wish to know more about our vital work and the impact it has on people with diabetes when you are thinking about leaving a bequest to Diabetes WA.

Joe Warner 1987

If you would like to discuss any aspect of making such a gift to Diabetes WA, members of our small but dedicated fundraising team are here to help. We can provide information and assistance to ensure that making your bequest is a simple and rewarding experience.

Writing your will Before you write or update an existing will, we recommend that you seek advice from your solicitor or lawyer. In addition, we ask that you reflect on our Bequest Charter below before considering leaving a gift to Diabetes WA.

There are three types of bequests • Residuary bequest a gift of whatever is left of your estate (or a percentage thereof) after all your other gifts, taxes and debts have been fulfilled. • Pecuniary bequest a gift of a set dollar amount determined by you at the time of drawing up or altering your will. • Specific bequest a gift of an item of specific value such as property, to be passed to Diabetes WA to generate funds.

Further Information If you would like to know more about bequests, please call 1300 136 588 or email our fundraising team at fundraising@diabeteswa.com.au

Diabetes WA Bequest Charter Our bequest charter is our commitment to you: 1. We will at all times respect your privacy. 2. We understand that you must take care of your family and loved ones before considering leaving a bequest to any charity. 3. Because we are committed to reducing the impact of diabetes on the community we will always encourage people to leave a bequest to Diabetes WA. We recognise and respect that it is your decision that you need to make in your own time.

6. Where possible we will give you, and your family, options and information about how and where your gift will be used. 7. We recognise that anytime in the future you have the right to change your mind and we will respect such a decision. 8. We will endeavour to use your gift in a cost-efficient way which will have the greatest impact. 9. All gifts will be treated with integrity, sensitivity and respect.

4. We would be delighted for you to inform us that you have left a bequest but it is not compulsory for you to do so. 5. If you do decide to inform us, you’ll have the opportunity to choose how we talk to you in the future about our work.

Education Planner The Smart Series

Diabetes WA runs a number of education programs, held as two- to three-hour workshops, to help you manage your diabetes and improve your health.

DESMOND One day workshop

MealSmart – learn what a serve of everyday 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.

DESMOND – Diabetes Education and Self-Management for Ongoing and Newly Diagnosed – is a program designed to equip those living with type 2 diabetes with the knowledge and skills to better manage their condition. DESMOND can help you achieve lower HbA1C, weight reduction, greater physical activity, reduced diabetes distress and better overall health outcomes.

MeterSmart – master the art of blood glucose monitoring.

CarbSmart – unravel the mystery of carbohydrates with this carb counting masterclass.

Type 1 TACTICS

MedSmart – everything you need to know about your medications.

m 28 March 5.30–8.30p pm 1 April 9am–12 6 April 2–5pm

people hop designed to give A new free group works need y the tools and tactics with type 1 diabetes the levels se co ly manage blood glu to safely and effective surrounding exercise.

14 March 7–8.30pm Diabetes research and information update The focus of this presentation will be type 1 diabetes, technology and physical activity.

18 March DiAthlete Sports Clinic

MARCH 2017

Designed for young people with type 1 diabetes aged 10-17 years, this sports day aims to engage and encourage participation in sport activities for health and fitness.

29 March 4–6pm

Suitable for teachers, education assistants, school nurses and outdoor education staff, this session outlines the new checklist and management plans for families and school staff to use in preparation for school camps.

Rivervale

Joondalup

Subiaco

Forrestfield

Midland

Training for teachers – type 1 diabetes at school camps

Belmont

Joondalup Melville

Classroom (Subiaco)

Riverton

Subiaco

Mirrabooka

Cockburn

Melville

Mirrabooka

Caversham

Sun

Sat

Fri

Thu

Wed

Tue

Mon

APRIL 2017 Mon

Tue

Wed

3 High Wycombe

Thu

Melville

Sun 1

Subiaco Subiaco

Melville

Subiaco

26 May 9am–5pm

Joondalup

Sat

Subiaco

4 Forrestfield

Fri

Diabetes WA now offer a 15 per cent discount on health professional traini ng and updates to members.

20 Classroom (Forrestfield)

Ellenbrook

Diabetes update for health professionals Designed to provide GPs, enrolled and registered nurses, pharmacists and allied health professionals with an enhanced understanding of diabetes and the services that are available to their clients.

Rivervale

Subiaco

Joondalup

MAY 2017

23 June 1–5pm

Classroom (Belmont)

Melville

Belmont

Caversham

Joondalup

Medications and insulin update for nurses Specifically for nurses, this workshop aims to increase knowledge about diabetes and the services available to patients, with a particular focus on medications, insulin and the NDSS.

Key

Belmont

Fremantle

Canning Vale

22 Mount Lawley

Belmont

Subiaco

Dianella

Mirrabooka

Sun

Sat

Fri

Thu

Wed

Tue

Mon

MealSmart

Morley

Forrestfield

ShopSmart

JUNE 2017 Mon

Tue

MeterSmart Wed

Thu

Fri

Sat

7 Subiaco

Melville

27 Mirrabooka

9 Mirrabooka

Subiaco

22 Classroom (Joondalup)

28 Mirrabooka

29 Belmont

CarbSmart

DESMOND TACTICS Refer to events in blue boxes

Rivervale

Forrestfield

MedSmart

Rockingham

13 Joondalup

Sun

Forrestfield

FootSmart

23 Belmont

24 Belmont

For more information or to book into any of these workshops, visit www.diabeteswa.com.au, call 1300 136 588 or email bookings@diabeteswa.com.au

Research Round Up The latest in diabetes research

It’s great news for

Children with type 1 diabetes living in developing countries The expansion, and four-year extension, of a global aid program means a total of 20,000 youngsters with the condition will have benefited from the Changing Diabetes in Children initiative by 2020. Five new countries have joined the program that provides free diabetes care and insulin.

It’s good news for People with diabetic macular oedema UK researchers have discovered that the tablet form of the drug Darapladib, originally developed to treat cardiovascular disease, has the potential to reduce the need for monthly injections to treat the condition, while providing protection against the development of diabetes-related blindness.

It’s bad news for People who consume Splenda Researchers from Washington have found that sucralose, most popularly known by the brand name Splenda, has effects on the body’s responses to glucose, which could thereby increase diabetes risk.

Insulin discovery could aid type 2 diabetes understanding A

team from New Zealand has shown that a protein called beta catenin is essential for controlling insulin release into the blood.

The findings, which were published in the Biological Chemistry journal, might hold the key to understanding more about why type 2 diabetes develops. Lead researcher Professor Peter Shepherd, from the University of Auckland, said: “We wanted to understand what happens in the body’s cells that are associated with the gene TCF7L2 and how the processes that go on affect the regulation of glucose metabolism in the body. “TCF7L2 binds directly to beta catenin. By observing this interaction, we found that beta catenin levels not only change in response to rising and falling nutrient levels, but that they also regulate how

much insulin we have in our body and ensure that we have the right amount of insulin at the right time.” “One possible reason for this delay is that beta catenin has in the past been closely associated with cancer, not diabetes. Underneath the cell membrane there are layers of fibres called actin. These fibres form networks that somehow bind to insulin,” Professor Shepherd added. “This discovery potentially opens up a whole new drug discovery field to understand how we could manipulate beta catenin levels to control the release of insulin.”

NSW toddler reinfused with umbilical blood

Sydney toddler whose umbilical cord blood was stored to help treat her sister’s type 1 diabetes has had it reinfused after showing signs of the condition herself. In January this year, Lucy Hinchion, Kids Research Institute and funded by aged 20 months, became the youngest cord blood bank Cell Care Australia. child in the world to receive her own Lucy’s blood has been stored since birth cord blood to help prevent or delay (it can be stored for 18 – 24 years) the chronic condition’s onset as part in the hope it would eventually help of a five-year study at The Children’s her seven-year-old sister, Ava, who Hospital in Westmead. developed type 1 diabetes just before she The cells found in umbilical cord blood turned four. – unique immune cells called regulatory After testing positive for two antibodies T-cells, and stem cells – are considered herself, Lucy was at high risk of promising in improving the treatment developing the condition, so the blood of many conditions including type was infused back into Lucy’s system 1 diabetes, heart disease, stroke and using a simple 20-minute procedure. neurological disorders. Professor Maria Craig, who leads the More than 100 Australian children study, said ongoing follow-up will occur with a family history of type 1 diabetes with Lucy every three to six months are currently being screened in the for the next three years to monitor her Cord Reinfusion in Diabetes (CORD) response to the reinfusion. study, conducted through the hospital’s

Please note: The information on this page is a snapshot of the latest advances in diabetes research. Please keep in mind that research findings will not necessarily apply to your individual situation and this information should not be used to make decisions about treatment and management without the input of a health professional.

Two New Research Projects Underway by Diabetes Research WA Executive Director, Sherl Westlund

hanks to our incredibly generous supporters, two $80,000 grants have allowed Diabetes Research WA to undertake two new research projects in Western Australia.

Type 1 Diabetes and Exercise

Tapping into Type 2 Diabetes

Gaining a deeper understanding of the impact of blood glucose levels on exercise performance in people with type 1 diabetes is the focus of one of our newly-funded grants.

Our second grant is helping WA researchers see if they can tap into the body’s sympathetic nervous system to help reduce rates of diet-induced obesity and type 2 diabetes.

Project supervisor Dr Karen Rothacker, an endocrinology and diabetes fellow at Princess Margaret Hospital, said the research aimed to encourage people with type 1 diabetes to enjoy the benefits of exercise.

This research is being carried out by University of WA School of Medicine and Pharmacology Assistant Professor Vance Matthews and UWA Winthrop Professor Markus Schlaich, Head of the Dobney Hypertension Centre at the Royal Perth Hospital Campus and the Neurovascular Hypertension & Kidney Disease Lab at Melbourne’s Baker IDI Heart & Diabetes Institute.

“While type 1 diabetes is an autoimmune disease and not caused by an unhealthy lifestyle, regular physical activity reduces the risk of cardiovascular disease, assists in weight control and improves quality of life, while reducing stress in people with the condition,” she said. “However, given exercise can cause blood sugar levels to go too high or too low, it can create issues in managing type 1 diabetes which may deter those with the condition from engaging in physical activity. “We suspect that exercising with high blood glucose levels negatively impacts exercise performance. We also want to look at the differences when exercising with standard or low insulin rates. “The hope is to generate a picture of how blood glucose levels and insulin affect exercise performance and use that knowledge to help people with type 1 diabetes to perform at their best, thereby encouraging greater involvement in physical activity.”

Assistant Professor Matthews said the research had the potential to provide a fresh approach to treating obesity and type 2 diabetes through improving blood sugar levels. “We’ve recently generated exciting data which highlights, for the first time, that the sympathetic nervous system plays a role in regulating the major glucose reabsorption protein, sodium glucose co-transporter 2 (or SGLT2) which is believed to be expressed exclusively in the kidney,” he said. “The focus of this grant is to find out if we can develop ways to tap into the sympathetic nervous system and alter the expression of this protein. If we can do that, it opens up new avenues for treating obesity and type 2 diabetes.”

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.

Noah Fleming Project supervisor Dr Karen Rothacker with

Challenging young people

ach year Diabetes WA sponsors two young people, aged between 14 and 20 years, with type 1 diabetes to take part in The Leeuwin Ocean Adventure Ultimate Challenge.

The challenge is specifically designed for young people with limitations, and gives participants the opportunity to experience the thrill of tall ship sailing in a safe, fun and supportive environment. Individuals meet new friends, learn new skills and increase self-confidence on an exciting, inspiring and rewarding five-day adventure.

Ciara Crockett, 14, and Tayla Jones, 16, were the lucky two selected to undertake the adventure of a lifetime. The girls, who were diagnosed with type 1 diabetes in 2013 and 2014 respectively, were selected after submitting an application to Diabetes WA outlining why they would like to participate in the Challenge.

“I think one of my driving forces has been to prove to everyone that having diabetes doesn’t mean I can’t do everything I have always done and more,” said Tayla, of Albany. “In my school, sporting clubs and at cadets, I have never hidden my condition because I think it is really important that people see that diabetes isn’t

holding me back or going to stop me doing anything I want to do.” Ciara, who lives in Marmion, wrote in her application, “This trip will be a great opportunity for me to prove to myself and my parents that I can take care of my diabetes while putting myself under physical and emotional pressure.” Something common to both girls’ applications, and in their feedback on their experience, is their frustration at being seen to be incapable because of their condition and wanting to prove doubters wrong.

“The misconception that people with type 1 diabetes are unhealthy and have this condition because we didn’t look after ourselves is very frustrating and upsets me often,” Tayla said. “I have always been very fit and the people around me have seen that type 1 diabetes is not changing that about me. “I think the Leeuwin trip is obviously an incredible opportunity for someone with diabetes to get out there and do this. But it is also important to me that people on the trip that are not living with diabetes see how we can live a

happy, healthy life full of adventures, just like they can.” Australia’s largest ocean-going sail training tall ship, the STS Leeuwin II, is a working ship so, during the voyage, participants were part of all ship operations; from steering the ship, setting and furling the sails, navigating and cleaning the ship to climbing the masts, working aloft and standing watch while sailing through the night.

“This trip taught me to attempt any challenge that I am faced with and to always give everything my best shot”.

Ciara Crockett

rience that “This was an amazing expe that will taught me valuable skills d life. You assist me in both sailing an like sailing can’t do challenging things yla Jones a ship without a team.” Ta

Gavin Griffiths

Rockstar Kids' Camp

Partnering with PMH

e work closely with the wonderful team at Princess Margaret Hospital (PMH) on a number of projects; sharing knowledge, expertise and resources. Over the next few months we have some exciting events coming up that have been developed as a result of this great partnership. In March, we will be holding two events featuring Gavin Griffiths from the United Kingdom. An ultra-marathon runner and Olympic torchbearer for England at the 2012 London Olympics, Gavin has been living with type 1 diabetes since the age of eight. He is a passionate advocate for sport and exercise and has, to-date, accomplished over 70 ultra-endurance feats across five continents, including once running 30 marathons in 30 days across the length of the UK. He will be one of the guest speakers on 14 March at a Diabetes Research and Information Update held in Nedlands. The focus for the evening will be type 1 diabetes, technology and physical activity and will include presentations from the Diabetes Research Team at PMH as well as visiting guests and researchers.

Q&A is back!

April will see a group of 11–12 year olds with type 1 diabetes heading to Point Walter to have lots of fun and to learn about diabetes management at the Rockstar Kids Camp. To find out more or to register for any of these events email Jarnia at community@diabeteswa.com.au

ur invitation for you to ASK AN EXPERT.

A few years ago, we introduced a Q&A section in Diabetes Matters, where our experts answered questions that you, our members, sent in to us. In 2017 we have decided to bring it back. We are once again inviting you to Ask an Expert. If you have a diabetesrelated question that you would like answered, email it to community@diabeteswa.com.au

On 18 March, Gavin will be running a sports clinic, in conjunction with DWA and PMH, for kids aged 10–17 years living with type 1 diabetes. The aim of his workshop, DiAthlete is to educate, encourage and empower the next generation living with diabetes.

Remember – if you can’t wait until the next quarterly issue of Diabetes Matters to have your question answered, you can also speak to a member of the Diabetes WA education team. Call the Diabetes Information and Advice Line (DIAL) between 8.30am and 4.30pm weekdays on 1300 136 588.

elton 70.3 Ironman. Ben Massey crosses the finish line at the Buss

Inspirational Ironman

en Massey was diagnosed with type 1 diabetes 14 years ago, at the age of six. He recently competed in the Busselton 70.3 Ironman, completing it in just under five hours.

Ben worked carefully with a trainer and dietitian to prepare for the race, and says he pushes himself because it makes him feel good. “I am constantly looking for improvements,” he says, “and that keeps me motivated.” “I have been doing races for two years, after being talked into it by my trainer,” says Ben. “My first race was a sprint distance and I found that it only slightly affected my blood glucose levels (BGL). Now, having completed a few more races and undertaking a bit of trial and error, I have found what works best for me.”

his insulin pump and also administering small bolus doses, he managed to get it down to 6.5mmol/L by the end. “Managing my diabetes during training and racing is a constant battle and is always a bit of trial and error. Each race I learn something different about how to approach it, while also learning every day what not to do.” Ben feels that his focus on training has helped him to learn more about his body and his diabetes. “I’m feeling great mentally, and I put that down to my lifestyle of training.”

During the Busselton race, Ben’s BGLs fluctuated dramatically but, by using different temporary basal rates on

Exercise your way to happiness

veryone knows that regular exercise is good for the body and the management of diabetes. Exercise is also one of the most effective ways to improve your mental health. Regular exercise can have a profoundly positive impact on depression, anxiety, ADHD, and more and you don’t have to be a fitness fanatic to reap the benefits. Research indicates that modest amounts of exercise can make a difference. No matter your age or fitness level, you can learn to use exercise as a powerful tool to feel better.

What are the mental health benefits of exercise? Exercise is not just about aerobic capacity and muscle size. People who exercise regularly tend to do so because it gives them an enormous sense of well-being. They feel more energetic throughout the day, sleep better at night, have sharper memories, and feel more relaxed and positive about themselves and their lives. And it’s also powerful medicine for many common mental health challenges. Exercise and depression – Studies have shown that exercise can assist in treating mild to moderate depression, negating the need for antidepressant medication in some cases. In addition to relieving depression symptoms, research also shows that maintaining an exercise schedule can prevent you from relapsing. Exercise and anxiety – Exercise is a natural and effective anti-anxiety treatment. It relieves tension and stress, boosts physical and mental energy, and enhances well-being through the release of endorphins. Anything that gets you moving can help, but you’ll get a bigger benefit if you pay attention instead of zoning out. Exercise and stress – Ever noticed how your body feels when you’re under stress? Your muscles may be tense, you may feel a tightness in your chest, a pounding pulse, or muscle cramps. You may also experience problems such as insomnia, heartburn, stomach ache, diarrhoea, or frequent urination. The worry and

discomfort of all these physical symptoms can lead to even more stress, creating a vicious cycle between your mind and body. Exercising is an effective way to break this cycle. As well as releasing endorphins in the brain, physical activity helps to relax the muscles and relieve tension in the body. Since the body and mind are so closely linked, when your body feels better so, too, will your mind.

Other mental and emotional benefits of exercise • Sharper memory and thinking. The same endorphins that make you feel better also help you concentrate and feel mentally sharp for tasks at hand. Exercise also stimulates the growth of new brain cells and helps prevent age-related decline. • Higher self-esteem. When regular activity becomes habit, it can foster your sense of self-worth and make you feel strong and powerful. You’ll feel better about your appearance and, by meeting even small exercise goals, you’ll feel a sense of achievement. • Better sleep. Even short bursts of exercise in the morning or afternoon can help regulate your sleep patterns. If you prefer to exercise at night, relaxing exercises such as yoga or gentle stretching can help promote sleep. • More energy. Increasing your heart rate several times a week will give you more get-up-and-go. Start off with just a few minutes of exercise a day, and increase your workout as you feel more energized.

Changing Trends in Exercise

Overcoming mental health obstacles to exercise So now you know that exercise will help you feel better and that it doesn’t take as much effort as you might have thought. But taking that first step is still easier said than done. Here are some common barriers and what you can do to get past them. Feeling exhausted. When you’re tired or stressed, it feels like exercising will just make it worse. But the truth is that physical activity is a powerful energizer. Studies show that regular exercise can dramatically reduce fatigue and increase your energy levels. If you are really feeling tired, promise yourself a 5-minute walk. Chances are you’ll be able to go five more minutes. Feeling overwhelmed. When you’re stressed or depressed, the thought of adding another obligation can seem overwhelming. Exercising just doesn’t seem doable. Just remember that physical activity helps us do everything else better. If you begin thinking of physical activity as a priority, you will soon find ways to fit small amounts in a busy schedule. Feeling hopeless. Even if you’re starting at “ground zero,” you can still workout. Exercise helps you get in shape. If you have no experience exercising, start slow with low-impact movement a few minutes each day. Feeling pain. If you have a disability, severe weight problem, arthritis, or diabetes-related complication that limits your mobility, talk to your healthcare provider about ways to safely exercise. You shouldn’t ignore pain, but rather do what you can, when you can. Divide your exercise into shorter, more frequent chunks of time if that helps, or try exercising in water to reduce joint or muscle discomfort. Feeling bad about yourself. Are you your own worst critic? It’s time to try a new way of thinking about your body. No matter what your weight, age or fitness level, there are others like you with the goals of getting fit. Try surrounding yourself with people in your shoes. Accomplishing even the smallest fitness goals will help you gain body confidence.

Source: helpguide.org

The Sydney Morning Herald recently published an article discussing the top fitness trends of 2017. For the second year in a row, the American College of Sports Medicine has named wearable technology as the top fitness trend for the coming year. But, not much further down the list, changing views on why we exercise is highlighted. As we are all becoming more educated about the benefits of exercise, the more ‘exercise as medicine’ has become a trend, making its first entry on the list at number seven.

2017 Fitness Trends American College of Sports Medicine’s 11th annual survey 2017 1

Wearable technology

Body weight training

High-intensity interval training

Educated and certified, fitness professionals

Strength training

Group training

Exercise is Medicine®

Yoga

Personal training

Exercise and weight loss

Fitness programs for older adults

Functional fitness

Outdoor activities

Group personal training

Wellness coaching

Worksite health promotion

Smartphone exercise apps

Outcome measurements

Circuit training

Flexibility and mobility rollers

Yoga as Therapy

any people believe that yoga is not only calming and energising but also helps you to sleep better, makes you stronger and healthier and increases brain function, concentration and memory.

According to a study published in the Journal of Diabetes Research, yoga can be used as an effective therapy in reducing oxidative stress in type 2 diabetes, enhancing pulmonary and autonomic function, mood, sleep, quality of life and, in addition to standard care, helping to reduce body mass index and improving glycaemic control. The findings also suggest that yogic practices may promote significant improvements in the management of type 2 diabetes as regular practice of yoga poses, like the forward bends and twists, can stimulate the internal organs affecting proper functioning of the pancreas. Tamara Graham, founder of Tamara Yoga in Perth, says “Yoga is an ideal health system for everyone, but especially as we age, as the ageing process usually sees people stiffening, becoming rigid and closing down and forward. “Yoga reverses this by moving each joint through its full range of motion, stretching, strengthening and balancing each part.

While other weight bearing exercises contract muscles and tighten the musculoskeletal system adding to stiffness, yoga opens and expands the body.” A meta-analysis – a statistical analysis to combine the results of multiple relevant studies – (www.elsevierhealth.com) also found that yoga can be considered an effective complementary treatment for patients with type 2 diabetes. Some studies included in the meta-analysis indicate yoga can improve blood glucose levels as well as other health factors associated with diabetes. Although these findings are promising, larger and more robust research is needed to fully understand how yoga can be used in diabetes management. “Yoga is more than exercise – yoga is complete mind-bodyspirit rejuvenation that can lead to higher levels of happiness,” says Tamara.

Yoga Poses Try these postures, selected and demonstrated by Tamara Graham. They provide a good ‘beginner’s sequence’, yet pose the least risk of injury for people who don’t have a lot of experience with practicing yoga. “I’ve chosen these particular postures as they form a balanced sequence,” says Tamara. “Balancing, chest opening, twisting and forward bending postures cover a good range of motion.”

Vrikshasana (Tree pose) From standing, place the sole of your right foot on your left inner thigh, ankle, or calf. Raise your arms. Imagine you’re like a tree, with deep roots into the ground stabilizing you, a firm strong trunk and your arms like light branches. Looking at a point on the ground or in front of you helps to increase your balance. Repeat on other side.

Ardha Matsyendrasana From seated, cross your right leg over the left, placing your right foot down to the outside of your left thigh with your toes facing forward. Bend your left knee, drawing the foot back in line with the outside right hip. If this is not comfortable, you can extend your left leg out straight and sit on a blanket or bolster. Lengthen through your spine and turn your whole torso toward your right, keeping the centre of your head, sternum and abdomen aligned above the centre of your pelvis. Bring your right hand behind you and hug your left forearm into the outer right thigh. Look gently to the right. Inhale and lengthen your torso, exhale and twist. Repeat on your left side.

Bhujangasana (Cobra pose) Lay on your abdomen with your fingers in line with your chest; begin with your forehead on the ground to lengthen the back of your neck. Keeping the back of your neck and your lower back long, inhale to lift your chest up. Draw your elbows back and towards each other. Breathe here, engaging the muscles in the whole back of your body to stretch through your front.

Janu Sirsasana Bend your left leg and place the sole of your foot to the inside of your right thigh. Keep the centre of your body strong and your spine long as you rotate to the right using your abdominal muscles to hug your abdomen over towards the right. Move yourself forwards over your right leg only as far as you can while maintaining the natural curve in your spine, even width across the chest and upper back, and an engaged foundation in the legs. You may need to place a strap around your foot. Make sure you don’t strain to bend forwards. Most important is to lengthen through the whole back of your body, especially your spine, as you breathe yourself forwards. If you find you’re holding your breath you’ve come too far. If your torso comfortably rests to the right thigh in good alignment, allow the mid and upper spine to round forward over your extended leg. Breathe deeply here, relaxing through the whole back of your body. Repeat on left side.

Dhanurasana (Bow pose) Take hold of your ankles and kick your feet up and back as you lift your chest forward and up. Stretch your arms back as you reach your shins up and back. Press your pelvis downwards keeping space in the lumbar region, drawing your tailbone back and down as you draw your chest forward. (If you have a knee injury, extend your arms back without holding ankles)

Eat better, feel better

t is common knowledge that the quality of our diet has a huge effect on our physical health. But Australia’s obesity epidemic and physical health crisis is only part of the concern. We also need to consider how what we are putting into our bodies is affecting our mental health. Research has shown that increased depression and anxiety can be linked to high calorie foods that are usually processed, high in fat and offer low or no nutritional value. Those leading busy lifestyles tend to reach for the quick and easy alternatives that are often not the healthiest choice. Over the last half century, the food industry has profoundly changed the way we eat. Highly-processed snack and takeaway food products, rich in fat and sugar, have now displaced many of the fruit, vegetables and other nutritious, unprocessed foods in our diets. While we understand how these dietary changes have impacted physical health, their effect on mental well-being is only now being realised. According to recent studies by the Mental Health Foundation in the UK, nearly two thirds of those who do not report daily mental health problems eat fresh fruit or fruit juice every day, compared with less than half of those who do report daily mental health problems. This pattern is similar for fresh vegetables and salad. Those who report some level of mental

health problem also eat fewer healthy foods (fresh fruit and vegetables, organic foods and meals made from scratch) and more unhealthy foods (chips and crisps, chocolate, ready-made meals and takeaways). So what can we do about it? Is it simply a matter of eating better? Well, the simple answer is – yes...kind of. Ensuring we are making healthy food choices will not cure all mental health issues, but it is certainly a step in the right direction. Filling your body with fresh, healthy fuel can assist your brain to function at its best.

Three ways diet impacts your mental health So how does good nutrition impact brain health? 1. It’s crucial for brain development. Experts believe that we are, quite literally, what we eat. When we eat real food that nourishes us, it becomes the proteinbuilding blocks, enzymes, brain tissue, and neurotransmitters that transfer information and signals between various parts of the brain and body.

2. It puts the brain into grow mode. Certain nutrients and dietary patterns are linked to changes in a brain protein that helps increase connections between brain cells. A diet rich in nutrients like omega-3s and zinc boosts levels of this substance. On the other hand, a diet high in saturated fats and refined sugars has a very potent negative impact on brain proteins. 3. It fills the gut with healthy bacteria. Trillions of good bacteria live in the gut. They fend off bad germs and keep your immune system in check, which means they help tame inflammation in the body. Some gut germs even help make brain-powering B vitamins. Foods with beneficial bacteria (probiotics) help maintain a healthy gut environment, or “microbiome.” A healthier microbiome is going to decrease inflammation, which affects mood and cognition. A high-fat or high-sugar diet is bad for gut health and, therefore, your brain.

Food and Mood C

ertain nutrients may help prevent and treat minor depression by influencing the chemical balance of neurotransmitters in the brain. The Healthy Food Guide has some tips on eating to improve your mood.

Consume carbohydrates (in moderation) for a better mood The contentedness you feel after a carbohydrate-rich meal, such as pasta, is due to the boost in serotonin levels. But remember, carbs will affect blood glucose levels, so you need to monitor your carbohydrate intake. Keep up your serotonin supply by eating regular meals incorporating some carbohydrates like bread, cereal, rice, pasta, legumes, fruit and dairy foods.

Keep up your tryptophan

The good oils

An amino acid that also boosts serotonin, tryptophan is found in turkey, chicken, beef, brown rice, nuts, milk, cheese and eggs. To ensure a ready supply, include protein-rich food at every meal. For  example, milk or yoghurt at breakfast, a turkey sandwich at lunch, and lean meat, brown rice and vegetables at dinner.

A study published in the Australian and New Zealand Journal of Psychiatry showed supplementing with fish oil was almost as effective as one of the prescription drugs for major depression, with best results from a mix of both. Long chain omega-3 fatty acids, found in fish oil, are responsible for this result. You find them in oily fish like tuna, salmon, mackerel, perch, herrings and sardines. Two to three meals a week of oily fish will provide enough omega-3. You can also try white fish – such as cod, bass, haddock and snapper.

Boost your B-vitamins Folate, vitamin B6 and vitamin B12 help maintain production of neurotransmitters and low levels may contribute to depression. Find folate in green leafy vegetables, oranges, wholegrains, chickpeas, yeast extract and nuts. Rich sources of B12 are found in animal foods such as meat and fish, eggs and dairy foods. It may also be added to vegetarian meat substitutes and some soy milks. Keep up B6 levels by eating potatoes, salmon, chicken, spinach, bananas and certain breakfast cereals.

Experts caution that while diet can be part of a treatment plan for mental health issues, it shouldn’t be considered a substitute for medication and other treatments when they are required.

Change the way you think… about take away food A

s the weather gets cooler it is easy to fall into the trap of snuggling on the couch and ordering in our dinner. Greasy take-away food can be a comfort when we realise the sun is beginning to hide more often and the sunny carefree days of summer are no longer. But in the end, the grease loses its appeal when your stomach is bloated and you’re having to check your glucose levels more often to keep on track. Before reaching for the phone – CHANGE THE WAY YOU THINK about take-away junk food – and try one of these delicious homemade alternatives to your fast food binge. Your body will thank you from your tastebuds to your gut. Recipes courtesy of Healthy Food Guide magazine. For more tasty, dietitian-approved recipes every month, subscribe at mymagazines.com.au Photography: Mark O’Meara

Nutritional Information per serve

Energy: 1,584kJ Protein: 20.7g Total fat: 11.6g Saturated fat: 4g

Carbohydrate: 43.7g Sugar: 12g Dietary fibre: 11.2g Sodium: 479mg

Vegetable korma curry Before calling your favourite Asian take away, try this:

Serves 4

Ingredients

Method

• Cooking oil spray

1. Spray a large saucepan with cooking oil and set over medium heat. Add shallot and capsicum; cook for 5 minutes, or until vegies are soft. Add korma curry paste and cook, stirring, for 1 minute.

• 4 shallots, chopped • 1 red capsicum, thinly sliced • ¼ cup korma curry paste • 4 cups diced pumpkin • 1 cup dried red lentils, rinsed, drained • 250g green beans • 2 tablespoons coconut-milk powder • 2 tablespoons low-fat tzatziki, to serve • 2 naan breads, halved, warmed, to serve • ¼ cup coriander sprigs, to garnish

2. Add pumpkin and lentils to pan with 3 cups water. Bring mixture to the boil; reduce heat to low. Cover and simmer for 40 minutes, or until pumpkin is tender and lentils are cooked, adding beans for last 2 minutes of cooking. 3. Combine coconut-milk powder with 1 tablespoon warm water; stir mixture through vegetables. 4. Season curry with cracked black pepper; place in a serving bowl. Garnish with coriander sprigs and serve with tzatziki and warm naan bread.

Mexican beef & bean pizza with avocado salsa Forget Domino’s, make this:

Serves 4

Nutritional Information per serve

Energy: 2,310kJ Protein: 28.7g Total fat: 16.9g Saturated fat: 4.2g Carbohydrate: 64g Sugar: 9.8g Dietary fibre: 14g Sodium: 447mg

Ingredients

Method

• 2 x 22cm wholemeal pizza bases

1. Preheat oven to 200°C. Place a large non-stick frying pan over medium– high heat and spray with olive oil. Add red onion and cook, stirring, for 4 minutes, or until soft.

• Olive-oil spray • 1 small red onion, finely chopped • ½ teaspoon Mexican chilli powder • 200g Heart Smart beef mince • ½ x 400g can no-added-salt kidney beans, rinsed, drained • ¼ cup no-added-salt tomato paste • 1 small zucchini, thinly sliced • 1 small red capsicum, diced • Cup grated reduced-fat mozzarella • ½ ripe avocado, peeled, diced • ½ x 250g punnet cherry tomatoes, quartered

2. Add chilli powder to frying pan and cook, stirring, for 30 seconds, or until fragrant. Add beef mince and cook, breaking up mince with a wooden spoon, for 3–4 minutes, or until browned. Stir kidney beans through beef-mince mixture and remove pan from heat. 3. Spread pizza bases with an even layer of tomato paste. Top bases with mince mixture, zucchini and capsicum, then scatter with mozzarella. 4. Place pizzas in oven and cook for 10 minutes, or until cheese is bubbling and golden. 5. Meanwhile, combine avocado, cherry tomatoes and coriander in a small bowl to make salsa. 6. Cut pizzas into slices and serve with a side of avocado salsa.

• 2 tablespoons chopped coriander

Baked fish and chips with lemon yoghurt

Nutritional Information per serve

Fish and chips on a breezy beach? Sure! Make this and wrap it in some paper to take with you:

Serves 4

Energy: 1,533kJ Protein: 40.4g Total fat: 4.1g Saturated fat: 1.2g Carbohydrate: 37.1g Sugar: 13g Dietary fibre: 8g Sodium: 326mg

Ingredients

Method

• 700g orange sweet potato, unpeeled, cut into 2cm-thick chips

1. Preheat oven to 180°C. Line 2 large baking trays with baking paper. Arrange sweet potato chips on one prepared tray and spray with oil. Bake for 15 minutes, or until cooked.

• 2 egg whites, lightly beaten • 2 cups fresh wholemeal breadcrumbs • 600g firm white fish fillets, cut into 2cmthick strips • 2 teaspoons finely grated lemon rind • 1 tablespoon lemon juice •

⁄3 cup low-fat Greek-style yoghurt

2. Meanwhile, lightly beat egg whites in a shallow bowl with 1 tablespoon water. Place breadcrumbs onto a plate. Dip each piece of fish into egg mixture, then into breadcrumbs. Place onto remaining tray. Spray with oil and bake for 10 minutes, or until fish is golden and cooked through. 3. Meanwhile, combine lemon rind, juice and yoghurt in a small bowl. Serve fish with potatoes, lemon yoghurt, lemon wedges and salad.

• Lemon wedges, to serve • 8 cups salad

Raspberry, banana & chia smoothie

Nutritional Information per serve

Energy: 1,345kJ Protein: 21.4g Total fat: 5.4g Saturated fat: 1.6g Carbohydrate: 46.4g Sugar: 40.4g Dietary fibre: 6.5g Sodium: 236mg

Bypass Boost and try this:

Serves 2

Ingredients • 1 medium banana, sliced

1. Blend all ingredients in a food processor until thick and creamy.

• ½ cup frozen raspberries

2. Pour smoothie into tall glasses and serve immediately.

• 1½ cups skim milk •

⁄3 cup low-fat Greek-style yoghurt

• 2 teaspoons chia seeds • 2 teaspoons honey

Method

NB: The number of carbs in this smoothie means it would make a great breakfast rather than just a snack

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Get in early and pre-order your copy of the 2017/18 Entertainment Book from Diabetes WA to receive $200 of bonus offers!

The Entertainment Book offers hundreds of discounts and 2-for-1 deals at Perth's best restaurants, cafes, hotels and more. Bali once again is included and the number of discounts have even increased on last yearâ&#x20AC;&#x2122;s offerings. Available as a traditional hard-copy book or as a digital app for your Apple or Android device, your membership gives

you over $20,000 worth of valuable offers valid through to 1â&#x20AC;ŻJune 2018. For each book sold, Diabetes WA will receive 20 per cent of the proceeds which will go towards supporting those living with, affected by and at risk of diabetes. Entertainment Books cost $70.00 and will be available from early May.

To pre-order a copy today email fundraising@diabeteswa.com.au or call (08) 9436 6242. 37

Diabetes WA Rebus Puzzle

Just about everyone would like to keep their brain sharp no matter what their age, so take the advice of many researchers who say that some puzzles work to stave off dementia, strengthen critical thinking skills, and promote brain health. Can you solve these visual word puzzles? (Answers are at the bottom of the page)

Competition

Autumn

WIN an incredible yoga prize pack valued at over $500 from Tamara Yoga! With studios in Claremont, Bibra Lake and Fremantle, Tamara Yoga believes that yoga can change the world for the better, one person at a time. They offer a wide range of yoga classes to cater for all levels and capabilities. From children’s and beginner’s to restorative and advanced sessions, including a Vinyasa class for over 50’s, you’re sure to find the right class no matter where you are in your yoga journey. The Yoga Prize Pack includes: Value: $550 • 20 Tamara Yoga classes of your choice • Tamara Yoga Beginners DVD • Tamara Yoga Intermediate DVD

• Tamara Yoga tshirt • Eye pillow • Nag Champa incense

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

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membership@diabeteswa.com.au

Good Luck! Name: Diabetes WA membership number: Address: Contact number: Email address: Entries close 1 May 2017. ANSWERS: 1. Red in the face, 2. Green Eggs and Ham, 3. Backrub, 4. All thumbs, 5. Two left feet, 6. Black sheep of the family, 7. Big fish in a little pond, 8. Tennis shoes, 9. Long time, no see.

March

March 18 DiAthlete Sports Clinic

In conjunction with Princess Margaret Hospital and Novo Nordisk, Diabetes WA will be holding a free sports clinic for kids with type 1 diabetes aged 10-17 years. DiAthlete workshops are designed to educate, encourage and empower children, adolescents and families living with type 1 diabetes and are run by Gavin Griffiths, an ultra-marathon runner and Olympic torchbearer for England at the 2012 London Olympics. Gavin has lived with type 1 diabetes since being diagnosed at eight years old and uses his experience to inspire others. For more information or to register email Jarnia at community@diabeteswa.com.au

March 29

Diabetes WA Raffle 22 Be in it to win it – last minute raffle tickets are still on sale for your chance to win $10,000 and support Diabetes WA. To purchase call 1300 792 998 or email fundraising@diabeteswa.com.a u Winners drawn 30 March 2017.

April 18-21 Kids Camps Diabetes WA &

Training for teachers – type 1 mp diabetes at schoolion forca teachers, education

Our kids’ camps are legendary! This year’ and 12 years and PMH camp will be for ‘Rockstars’ aged 11 p in Bicton. Cam n eatio Recr will be held at Point Walter For more information contact Jarnia at community@diabeteswa.com.au.

ing sess Diabetes WA is running a school camp train ation staff. The session outlines educ oor outd and s, nurse ol scho , tants assis lies and school staff to use in fami for plan a new checklist and management preparation for school camps.

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June 16-18

May 28 HBF Run for a Reason 2017

Diabetes WA is once again one of the featu re charity partners for the HBF Run for a Reas on. It’s our biggest fundraising event of the year, so sign up to run and help us to raise mon ey, while getting fit and having fun. Register at hbfrun.com.au

September 8

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is SAVE THE DATE – Our annual corporate lunch make so nt, aura Rest place on 8 September at Frasers r, ande Alex Ron  . diary your in sure you mark the date and s Eagle t Coas t Wes the of h coac inaugural ralian current Director General of the Western Aust as our re featu will n, Department of Sport and Recreatio aker. t spe gues ities For information, sponsorship opportun act cont 10, of table a or to book deanne.dymock@diabeteswa.com.au

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

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Help us continue to meet the growing need for services and support for people affected by diabetes in Western Australia. A gift in your will is a valuable way of supporting Diabetes WA. We receive large and small bequests and each is welcome and greatly appreciated. If you are writing your first will, or updating your current one, please remember Diabetes WA and the difference you can make to the lives of countless Western Australians, perhaps even someone you know. If you would like to know more please call 1300 136 588 or visit www.diabeteswa.com.au.

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